Nell Forge

Lay patient navigator program implementation for equal access to cancer care and clinical trials: essential steps and initial challenges.

Disparities in cancer detection, treatment, and outcomes among racial/ethnic minorities and low‐income patients are well documented. One way to reduce these disparities is to use patient navigators to address barriers to care. However, little information about optimal characteristics of navigator programs or considerations for those interested in setting up such programs is available.

CORRELATES OF FIRST INTERCOURSE AMONG WOMEN IN JAMAICA

This study examines retrospective reports offactors anticipated to impact first intercourse in arandom sample of 897 Jamaican women, and contributes toour understanding of the relationship between sexual risk, knowledge, and economic and demographiccorrelates of first intercourse. A relationship betweeninitiation of intercourse prior to the age of consent(16 Years) and factors occurring at or around the time of first intercourse was found. Earlyinitiators were more likely to have had less earlyfamily stability and to have experienced menarche at ayounger age than late initiators. Although early initiators of intercourse were more likely toreport lower socioeconomic status, less STD knowledge,and greater numbers of pregnancies, they were no morelikely to report more sexual partners than women who engaged in first intercourse after the ageof consent, and had a greater number of long-termrelationships. Regardless of age of first intercourse,women need to be made aware of the risks of sexual contact so that they can make informeddecisions about the consequences of sexual activity.Overall, results are consistent with work conducted inother parts of the Caribbean and America regarding the age at which young women engage in firstintercourse. Findings suggest the need for further workexploring expectations at first intercourse such asmarriage, economic support, or relationship stability. Implications of these findings are discussedwithin the context of economic and structural factorsthat both increase and decrease risks.

Strategies to Build Trust and Recruit African American and Latino Community Residents for Health Research: A Cohort Study

This study used Community Partnered Participatory Research (CPPR) to address low participation of racial and ethnic minorities in medical research and the lack of trust between underrepresented communities and researchers.

The Vulnerability of Middle‐Aged and Older Adults in a Multiethnic, Low‐Income Area: Contributions of Age, Ethnicity, and Health Insurance

This community‐partnered study was developed and fielded in partnership with key community stakeholders and describes age‐ and race‐related variation in delays in care and preventive service utilization between middle‐aged and older adults living in South Los Angeles. The survey sample included adults aged 50 and older who self‐identified as African American or Latino and lived in ZIP codes of South Los Angeles (N=708). Dependent variables were self‐reported delays in care and use of preventive services. Insured participants aged 50 to 64 were more likely to report any delay in care (adjusted predicted percentage (APP)=18%, 95% confidence interval (CI)=14–23) and problems obtaining needed medical care (APP=15%, 95% CI=12–20) than those aged 65 and older. Uninsured participants aged 50 to 64 reported even greater delays in care (APP=45%, 95% CI=33–56) and problems obtaining needed medical (APP=33%, 95% CI=22–45) and specialty care (APP=26%, 95% CI=16–39) than those aged 65 and older. Participants aged 50 to 64 were generally less likely to receive preventive services, including influenza and pneumococcal vaccines and colonoscopy than older participants, but women were more likely to receive mammograms. Participants aged 50 to 64 had more problems obtaining recommended preventive care and faced more delays in care than those aged 65 and older, particularly if they were uninsured. Providing insurance coverage for this group may improve access to preventive care and promote wellness.

Personal and psychosocial characteristics associated with psychiatric conditions among women with human immunodeficiency virus

This study presents information on correlates of mental health and substance abuse problems among women with human immunodeficiency virus (HIV), a particularly vulnerable, poor and minority population. Data are from 847 women in the HIV Cost and Services Utilization Study, a national probability sample of adults with known human immunodeficiency virus infection. Fifty-five percent of women manifested a probable psychiatric condition. Results indicated that increased risk for psychiatric conditions among these women was associated with younger age, having acquired immunodeficiency virus (rather than asymptomatic), using avoidant coping strategies, reporting increased conflict with others, and prior physical abuse, needing income assistance, and putting off going to the doctor because of caring for someone else. Findings suggest we need to address womens need for safety from assaultive partners and that we may need special programs for women burdened with having to care for others.

Community-Partnered Approaches to Enhance Chronic Kidney Disease Awareness, Prevention, and Early Intervention

There is a need to increase community involvement in addressing the growing burden of chronic kidney disease (CKD). Community-partnered participatory research (CPPR) is a collaborative approach that equitably involves academic, community, and professional partners in research, and the development of shared goals and of interventional programs to attain these goals. We present a case study of the processes, strategies, and activities concerning the interface of World Kidney Day goals and community-academic partnerships using a CPPR model focused on CKD. We show that CPPR methods can be used to (1) bring together community and academic leaders around goal sharing and research agenda development, (2) convene a community/professional conference aimed at knowledge transfer and data collection among partners, and (3) develop workgroups from a diverse group of participants to collaborate in community partnered strategies to reduce the burden of CKD. Participants included health care professionals, patients, faith-based professionals, government employees and officials, academics, caregivers, and community members. Follow-up workgroups developed action plans to address shared concerns. Using CPPR practices and principles, we were able to incorporate World Kidney Day objectives with community-derived goals to develop a community-partnered infrastructure, shared objectives, and workgroups to reduce the burden of chronic kidney disease.

Partnering to harmonize IRBs for community-engaged research to reduce health disparities.

Emerging advances in health disparities research include controlled trials and comparative effectiveness studies that are frequently conducted at multiple community and academic sites. Review by different institutional review boards (IRBs) presents a major impediment to the timely and effective conduct of such research. When research involves minority and underserved communities as well as multiple geographic regions, institutional requirements and interpretation of ethical standards may vary substantially. Such variations can complicate the informed consent process and research protocol, and may undermine participant respect and trial quality. In addition, multiple IRB review can lead to unnecessary delays, jeopardizing funding and capacity to perform collaborative projects. In response to these issues, the Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN) is developing a community-partnered approach to streamlining IRB review across its consortium of 18 RCMI grantee institutions that will ensure compliance while enhancing the quality of health disparities research.

Integrating community expertise into the academy: South Los Angeles’ community-academic model for partnered research

Abstract:The Problem: Charles R. Drew University (CDU) and community partners wanted to create a structure to transcend traditional community–academic partnerships. They wanted community leaders integrated into CDU’s research goals and education of medical professionals.Purpose of Article: To explain the establishment of the Community Faculty Program, a new model of community–academic partnership that integrates community and academic knowledge.Key Points: Using CBPR principles, CDU and community partners re-conceptualized the faculty appointment process and established the Division of Community Engagement (DCE). CDU initially offered academic appointments to nine community leaders. Community Faculty contributes to CDU’s governance, education, research, and publication goals. This model engaged communities in translational research and transformed the education of future healthcare professionals.Conclusion: The Community Faculty Program is a new vision of partnership. Using a CBPR approach with committed partners, a Community Faculty Program can be created that embodies the values of both the community and the academy.

A Community Partnered-Participatory Research Approach to Reduce Cancer Disparities in South Los Angeles

Background: Community–academic partnerships may offer opportunities to improve population health in communities that suffer from cancer-related health disparities.Objectives: This project describes a community partnered effort to promote cancer research and reduce local cancer-related disparities.Methods: We used a community-partnered participatory research (CPPR) model and modified Delphi method approach to bring together community and academic stakeholders from South Los Angeles around reducing cancer disparities.Results: The 36-member Community–Academic Council consisted of cancer survivors, academics, and representatives of local community-based organizations and churches. Forty-nine unique cancer-related community priorities were collaboratively used to develop shared products. Early CPPR products included convening of a community conference, a collaboratively developed survey instrument, and new partnerships resulting in externally funded projects.Conclusions: Our approach demonstrates the feasibility of the use of a replicable model of community and academic engagement that has resulted in products developed through collaborative efforts.

The vulnerability of middle-aged and older adults in a multiethnic, low-income area

This community‐partnered study was developed and fielded in partnership with key community stakeholders and describes age‐ and race‐related variation in delays in care and preventive service utilization between middle‐aged and older adults living in South Los Angeles. The survey sample included adults aged 50 and older who self‐identified as African American or Latino and lived in ZIP codes of South Los Angeles (N=708). Dependent variables were self‐reported delays in care and use of preventive services. Insured participants aged 50 to 64 were more likely to report any delay in care (adjusted predicted percentage (APP)=18%, 95% confidence interval (CI)=14–23) and problems obtaining needed medical care (APP=15%, 95% CI=12–20) than those aged 65 and older. Uninsured participants aged 50 to 64 reported even greater delays in care (APP=45%, 95% CI=33–56) and problems obtaining needed medical (APP=33%, 95% CI=22–45) and specialty care (APP=26%, 95% CI=16–39) than those aged 65 and older. Participants aged 50 to 64 were generally less likely to receive preventive services, including influenza and pneumococcal vaccines and colonoscopy than older participants, but women were more likely to receive mammograms. Participants aged 50 to 64 had more problems obtaining recommended preventive care and faced more delays in care than those aged 65 and older, particularly if they were uninsured. Providing insurance coverage for this group may improve access to preventive care and promote wellness.