Patricia Chalela

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.

Salud America! Developing a National Latino Childhood Obesity Research Agenda

U.S. childhood obesity has reached epidemic proportions, with one third of children overweight or obese. Latino children have some of the highest obesity rates, a concern because they are part of the youngest and fastest-growing U.S. minority group. Unfortunately, scarce research data on Latinos hinders the development and implementation of evidence-based, culturally appropriate childhood obesity interventions. In response, the Salud America! network conducted a national Delphi survey among researchers and stakeholders to identify research priorities to address Latino childhood obesity and compare differences by occupation and race or ethnicity. The resulting first-ever National Latino Childhood Obesity Research Agenda provides a framework to stimulate research and collaboration among investigators, providers, and communities, and inform policy makers about the epidemic’s seriousness and specific needs for priority funding. The agenda ranks family as the main ecological level to prevent Latino childhood obesity—followed by community, school, society, and individual—and ranks top research priorities in each level.

Developing a Media- and School-Based Program for Substance Abuse Prevention among Hispanic Youth: A Case Study of Mirame!/Look at Me!

Mirame!/Look at Me! is a substance abuse prevention program for low-income Mexican American youth 9 to 13 years of age. The theory-driven curriculum, developed for mass distribution via a satellite television network, features social models who demonstrate cognitive-behavioral skills and display conservative norms regarding substance abuse. An 18-session curriculum contains 5-minute videos that are assigned to be followed by discussion and social reinforcement from a teacher or volunteer. This case study reports the program development process and experiences in the initial dissemination of the program through national networks for schools and cable television subscribers.

Testing Three Different Cancer Genetics Registry Recruitment Methods with Hispanic Cancer Patients and Their Family Members Previously Registered in Local Cancer Registries in Texas

Objective: To increase accrual among Hispanics to the Cancer Genetics Network national cancer genetics registry. Methods: Drawing from South Texas cancer registries, 444 Hispanic men and women were randomly assigned to one of three experimental conditions: standard direct-mailed procedures (X1), X1 plus culturally tailored materials (X2), and X2 plus interpersonal phone contact (X3). Participants were also surveyed about the effectiveness of the education materials and the phone contact. A refusal survey was provided for those who declined to join the study. Results: A total of 154 individuals joined the Cancer Genetics Network. The X3 condition yielded the greatest accrual (43.2%) compared to X1 (30.9%) and X2 (29.9%; p < 0.05). Tailored materials appeared to have no effect but were highly regarded. The main reasons for not participating were a lack of interest and time requirements. Conclusion: Interpersonal communication can have a powerful effect on recruitment. However, more research is needed to determine the cost-efficacy of more labor-intensive approaches to registry accrual.

Promoting Factors and Barriers to Participation in Early Phase Clinical Trials: Patients Perspectives

BACKGROUNDnInclusion of minorities in clinical research is an essential step to develop novel cancer treatments, improve health care overall, understand potential differences in pharmacogenomics and address minorities disproportionate cancer burden. However, Latinos and other minority groups continue to be critically underrepresented, particularly in early-phase clinical trials (EPCTs). The objective of the present study was to explore barriers and promoting factors influencing patients decisions to enroll or not in early phase clinical trials (EPCTs) and identify areas for intervention to increase minority enrollment into clinical research.nnnMETHODSnAn interviewer-administered survey was conducted with 100 cancer patients in the predominantly Latino region of South Texas. Exploratory factor analysis was conducted to identify underlying dimensions, and multiple logistic regression assessed significant factors that promote or deter patients enrollment to EPCTs. In addition, a separate subgroup mean analysis assessed differences by enrollment status and race/ethnicity.nnnRESULTSnFor one standard deviation increase in the importance given to the possibility of symptoms improvement, the predicted odds of refusing enrollment were 3.20 times greater (OR=3.20, 95% CI=1.06-9.71, p 0.040). Regarding barriers, among patients who considered fear/uncertainty of the new treatment a deterrent to enrollment, one standard deviation increase in agreement with these barriers was associated with a 3.60 increase (OR=3.60, 95% CI=1.30-9.97h, p 0.014) in the odds of not being enrolled in an EPCT. In contrast, non-enrolled patients were less likely (OR=0.14, 95% CI=0.05-0.44, p 0.001) to consider fatalistic beliefs as an important barrier.nnnCONCLUSIONnThis study, one of the first to identify South Texas patients barriers to enroll in EPCTs, highlights potential focal areas to increase participation of both minority and non-minority patients in clinical research. Culturally tailored interventions promoting patient-centered care and bilingual, culturally competent study teams could solve common barriers and enhance Latinos likelihood of joining clinical trials. These interventions may simultaneously increase opportunities to involve patients and physicians in clinical trials, while ensuring the benefits of participation are equitably distributed to all patients.

Tobacco Control Policy Advocacy Attitudes and Self-Efficacy Among Ethnically Diverse High School Students

This study applied self-efficacy theory to assess empowerment to advocate on behalf of tobacco control policies. The Youth Tobacco Survey with added policy advocacy self-efficacy, attitudes, and outcome expectations scales was given to 9,177 high school students in Texas. Asians showed the lowest prevalence of experimentation and current smoking, followed by African Americans. Anglo-Europeans had higher rates of current smoking. Latino male students had the highest experimentation and current smoking rates. Policy advocacy self-efficacy was higher among African Americans. Latinos scored lowest. Asians had the highest level of approval for tobacco control policies. African Americans had the highest scores in policy advocacy outcome expectations, followed by Asians and Latinos. Anglo-Europeans scored lowest. Students who had never tried smoking had the highest scores in all three scales, with a decreasing trend as the frequency of smoking increased. Associations with smoking status remained significant when controlling by gender and ethnicity

Developing a theory-based anti-drug communication campaign for Hispanic children and parents.

Recent research suggests some alarming substance abuse trends among Hispanic/Latino adolescents. Children in this age group are at a particularly vulnerable juncture in their lives, and early prevention efforts are warranted. For a national anti-drug campaign targeting this young Hispanic/Latino audience and their parents, the White House Office of National Drug Control Policy and the Partnership for a Drug-Free America are incorporating culturally appropriate messages based on behavioral science research and theories. The purpose of this article is to provide information and recommendations on relevant factors and influences in the Hispanic/Latino culture that should be addressed in designing and implementing this campaign.

Early Phase Clinical Trials: Referral Barriers and Promoters among Physicians

BACKGROUNDnPhysician referral is among the most effective means of recruiting patients into cancer clinical trials. Therefore, to increase minority representation in early-phase clinical trials (EPCTs), specifically accrual of Latinos, it is first necessary to examine physicians attitudes and practices regarding these studies and factors that influence physicians referral decisions.nnnMETHODSnThis study surveyed oncologists (N=111) from a Texas Medical Association mailing list to examine barriers and promoting factors associated with physician referral of patients to EPCTs and identify areas for intervention to increase accrual of Latinos and other minorities into clinical research. Exploratory factor analysis was conducted to identify underlying dimensions, and significant factors that promote or deter physicians from referring patients to EPCTs were assessed through multiple logistic regression.nnnRESULTSnBurden of the clinical trial process was the only significant dimension associated with referring patients to EPCTs. Physicians who agreed with this set of logistical barriers-such as diverting time and resources away from their practice-were less likely to refer patients than physicians with opposing opinions (OR= 0.28, 95% CI= 0.08-0.94).nnnCONCLUSIONnThis study, one of the first to identify physician barriers for referring patients to EPCTs in Texas, highlights potential focal areas for physician and community-based education and communication to promote clinical trial opportunities among both minority and non-minority patients. Given that Texas physicians deal with a large proportion of Latino patients, such efforts could also address ethnic disparities in clinical trial participation, which will become increasingly important as the Latino population continues to grow.

Developing a media- and school-based program for substance abuse prevention among Hispanic youth: A case study of Mirame!/Look at Me!

Mirame!/Look at Me! is a substance abuse prevention program for low-income Mexican American youth 9 to 13 years of age. The theory-driven curriculum, developed for mass distribution via a satellite television network, features social models who demonstrate cognitive-behavioral skills and display conservative norms regarding substance abuse. An 18-session curriculum contains 5-minute videos that are assigned to be followed by discussion and social reinforcement from a teacher or volunteer. This case study reports the program development process and experiences in the initial dissemination of the program through national networks for schools and cable television subscribers.

Breast cancer genetic testing awareness, attitudes and intentions of Latinas living along the US-Mexico border: a qualitative study.

BACKGROUNDnGenetic testing for breast cancer may facilitate better-informed decisions regarding cancer prevention, risk reduction, more effective early detection, and better determination of risk for family members. Despite these potential benefits, significant portions of the US population-particularly Latinas-lack awareness of genetic testing for breast cancer susceptibility. Among women who are tested, less than 4% are Latina. To uncover reasons for Latinas low participation, this study explores awareness, attitudes and behavioral intentions to undergo genetic testing among average-risk Latinas along the Texas-Mexico border.nnnMETHODSnEight focus groups were conducted with 58 Latinas aged 19-69 living in Hidalgo County, a largely Latino region of South Texas. Focus group discussions were digitally recorded, transcribed and analyzed using qualitative content analysis to assess, categorize and interpret them. Two experienced study team members analyzed transcripts to identify major concepts grouped into theme categories.nnnRESULTSnParticipants mostly had less than a high-school education (43%), spoke primarily Spanish (52%), were of Mexican-American origin (90%) and had a family income of