Richard B. Warnecke

Understanding African Americans' Views of the Trustworthiness of Physicians

AbstractBACKGROUND: Many scholars have written about the historical underpinnings and likely consequences of African Americans distrust in health care, yet little research has been done to understand if and how this distrust affects African Americans’ current views of the trustworthiness of physicians. OBJECTIVE: To better understand what trust and distrust in physicians means to African Americans. DESIGN: Focus-group study, using an open-ended discussion guide. SETTING: Large public hospital and community organization in Chicago, IL. PATIENTS: Convenience sample of African-American adult men and women. MEASUREMENTS: Each focus group was systematically coded using grounded theory analysis. The research team then identified themes that commonly arose across the 9 focus groups. RESULTS: Participants indicated that trust is determined by the interpersonal and technical competence of physicians. Contributing factors to distrust in physicians include a lack of interpersonal and technical competence, perceived quest for profit and expectations of racism and experimentation during routine provision of health care. Trust appears to facilitate care-seeking behavior and promotes patient honesty and adherence. Distrust inhibits care-seeking, can result in a change in physician and may lead to nonadherence. CONCLUSIONS: Unique factors contribute to trust and distrust in physicians among African-American patients. These factors should be considered in clinical practice to facilitate trust building and improve health care provided to African Americans.

Smoking cessation interventions in U.S. racial/ethnic minority populations: an assessment of the literature.

BACKGROUND Smoking prevalence rates in some ethnic minority groups are elevated relative to the majority population. Thus, identifying cessation interventions that are effective for these groups is important. This article reviews published studies that examine effects of smoking cessation interventions relevant to racial ethnic minority populations. METHODS A literature search of tobacco interventions, reporting smoking cessation outcomes (including quit rates) in U.S. minority populations, was conducted for the period 1985 to 2001. RESULTS Thirty-six studies met preset criteria for inclusion. Twenty-three reported quit rates for African Americans, 4 for Asian/Pacific Islanders, 3 for Native Americans, and 10 for Hispanics. CONCLUSIONS The disproportionate number of studies that focused on African American smokers compared with the other major racial/ethnic groups suggests the need for continued efforts to develop and evaluate the effectiveness of smoking cessation interventions for all ethnic minority populations. Abstinence rates varied considerably depending on study design and intervention strategy. Moreover, a relatively small percentage of studies that were randomized trials reported statistically significant findings, and most used intervention strategies that do not reflect the current state-of-the-art. These results strongly suggest that more research is needed to identify successful smoking cessation interventions in these populations.

Smoking-related behavior, beliefs, and social environment of young black women in subsidized public housing in Chicago.

Survey data indicate that young Black female smokers living in public housing are heavier smokers and have weaker motivation to quit, health beliefs and social environment less conducive to cessation, and less knowledge of where to get help to quit than other young Black female smokers in metropolitan Chicago. Compared with White women, the latter, other Black women smoke fewer cigarettes daily and have a stronger desire to quit and more concern about health reasons for quitting, but have a weaker belief in the risk of lung cancer from smoking, greater concern about quitting difficulties, and less knowledge of where to get help to quit. Low education, not race, is associated with higher smoking prevalence and less social pressure to quit or support for quitting.

Some methodologic lessons learned from cancer screening research

Credible and useful methodologic evaluations are essential for increasing the uptake of effective cancer screening tests. In the current article, the authors discuss selected issues that are related to conducting behavior change interventions in cancer screening research and that may assist researchers in better designing future evaluations to increase the credibility and usefulness of such interventions. Selection and measurement of the primary outcome variable (i.e., cancer screening behavior) are discussed in detail. The report also addresses other aspects of study design and execution, including alternatives to the randomized controlled trial, indicators of study quality, and external validity. The authors conclude that the uptake of screening should be the main outcome when evaluating cancer screening strategies; that researchers should agree on definitions and measures of cancer screening behaviors and assess the reliability and validity of these definitions and measures in different populations and settings; and that the development of methods for increasing the external validity of randomized designs and reducing bias in nonrandomized studies is needed. Cancer 2004.

Misconceptions about breast lumps and delayed medical presentation in urban breast cancer patients

Background: Despite current recommendations for women to be screened for breast cancer with mammography every 1 to 2 years, less than half of all newly diagnosed breast cancers are initially detected through screening mammography. Prompt medical attention to a new breast symptom can result in earlier stage at diagnosis, yet many patients delay seeking medical care after becoming aware of a breast symptom. Methods: In a population-based study of breast cancer, we examined factors potentially associated with patient delay in seeking health care for a breast symptom among 436 symptomatic urban breast cancer patients (146 white, 197 black, and 95 Hispanic). Race/ethnicity, socioeconomic status, health care access and utilization, and misconceptions about the meaning of breast lumps were the key independent variables. Results: Sixteen percent of patients reported delaying more than 3 months before seeking medical advice about breast symptoms. Misconceptions about breast lumps and lacking a regular provider, health insurance, and recent preventive care were all associated with prolonged patient delay (P < 0.005 for all). Misconceptions were much more common among ethnic minorities and women of lower socioeconomic status. Conclusion: Reducing patient delay and disparities in delay will require educating women about the importance of getting breast lumps evaluated in a timely manner and providing greater access to regular health care. Cancer Epidemiol Biomarkers Prev; 19(3); 640–7

Effects of Social Support and Relapse Prevention Training as Adjuncts to a Televised Smoking-Cessation Intervention.

Smokers registering for a televised cessation program who also expressed interest in joining a support group and who had a nonsmoking buddy were randomly assigned to 3 conditions: no-contact control, discussion, and social support. All Ss received a self-help manual and were encouraged to watch the daily TV program. Ss in the discussion and social support conditions were scheduled to attend 3 group meetings (one with a buddy). Social support Ss and buddies received training in support and relapse prevention. A 4th analysis group was composed of Ss who failed to attend any of the scheduled meetings (no shows). There were strong group effects at the end of treatment. Abstinence rates were highest in the social support group, followed, in order, by the discussion group, no shows, and no-contact controls. The social support group improved outcome by increasing both the level of support and program material use (reading the manual and watching TV).

An investigation of the effects of social desirability on the validity of self-reports of cancer screening behaviors.

We evaluated 4 approaches to improving the reporting of disease prevention and screening behaviors. The conditions evaluated include (1) the mode in which data are collected, (2) asking the interview subject about her intention to obtain the procedure before asking whether the behavior occurred, (3) asking the interview subject about barriers that might keep respondents from getting the procedure before asking about whether she has received it, and (4) asking the interview subject about exceptions to the regularity with which she might report getting the examination. Data were collected in 2001 from a sample of women aged 50 and older in Champaign-Urbana, Illinois. After completing a telephone or audio computer-assisted self-interview (ACASI), respondents gave permission to abstract their medical records to validate self-reports of Papanicolaou tests, mammograms, and clinical–gynecologic examinations received during the past 3 years. Interviews and matching medical records were available for 588 respondents. Results indicated that first asking about future intentions may be an important design feature that warrants additional consideration. In addition, the use of ACASI may lead to lower quality reporting among women with little computer experience. This study represents the only research to date that reports experimental attempts to address the social desirability biases commonly found in the reporting of cancer screening behaviors.

Use of lay health educators for smoking cessation in a hard-to-reach urban community

A description of the use of indigenous lay health educators as they participated in the implementation of a community-based smoking cessation program is provided. The target population was young black women who resided in several urban public housing developments. The intervention, which was conducted in tandem with a larger televised smoking cessation program, consisted of either class sessions conducted by or reminder visits from community lay health educators. The lay health educators were successful in organizing this population, often viewed as difficult to reach, to become more aware of the dangers of smoking and to become more interested in participating in a structured smoking cessation program. They motivated 235 individuals to sign up for the program; of these, 141 attended at least one class session or accepted at least an initial reminder visit. The results suggest that lay health educators may be able to mobilize this population to participate in health promotion programs. However, due to differences in this population related to smoking, the findings indicate that new methods must be developed for sustaining their involvement after they have been reached.

Results of an intervention to improve compliance with referrals for evaluation of suspected malignancies at neighborhood public health centers.

A study was conducted at Neighborhood Health Centers to evaluate procedures to improve compliance with referrals of patient at risk for cancer. Intervention consisted of a standardized communication from the exit nurse, a patient form to be returned after compliance, and one written and one telephone reminder as needed. Compliance was 68.2 percent in a control group and 89.0 percent among patients who received the experimental intervention, a significant increase of 20.8 percent (95% CI: 12.5, 29.1).

Factors Associated With Response Rates in a National Survey of Primary Care Physicians

This article addresses the results and implications of offering a national sample of primary care physicians an option to complete a questionnaire by mail or phone. An overall cooperation rate of 62.7% was achieved; 55% of the interviews were completed via telephone. Noticeable differences in rate of cooperation and mode preference were observed across the four physician specialties surveyed. The importance of a lengthy field period, due to differences between early and late responders on variables important to the study, is also demonstrated.