Sheryl Thorburn

Are HIV/AIDS Conspiracy Beliefs a Barrier to HIV Prevention Among African Americans?

Objectives:This study examined endorsement of HIV/AIDS conspiracy beliefs and their relations to consistent condom use and condom attitudes among African Americans. Methods:We conducted a telephone survey with a random sample of 500 African Americans aged 15 to 44 years and living in the contiguous United States. Results:A significant proportion of respondents endorsed HIV/AIDS conspiracy beliefs. Among men, stronger conspiracy beliefs were significantly associated with more negative condom attitudes and inconsistent condom use independent of selected sociode-mographic characteristics, partner variables, sexually transmitted disease history, perceived risk, and psychosocial factors. In secondary follow-up analyses, mens attitudes about condom use partially mediated the effects of HIV/AIDS conspiracy beliefs on condom use behavior. Conclusions:HIV/AIDS conspiracy beliefs are a barrier to HIV prevention among African Americans and may represent a facet of negative attitudes about condoms among black men. To counter such beliefs, government and public health entities need to work toward obtaining the trust of black communities by addressing current discrimination within the health care system as well as by acknowledging the origin of conspiracy beliefs in the context of historical discrimination.

Conspiracy Beliefs About Birth Control: Barriers to Pregnancy Prevention Among African Americans of Reproductive Age

This article examines the endorsement of conspiracy beliefs about birth control (e.g., the belief that birth control is a form of Black genocide) and their association with contraceptive attitudes and behavior among African Americans. The authors conducted a telephone survey with a random sample of 500 African Americans (aged 15-44). Many respondents endorsed birth control conspiracy beliefs, including conspiracy beliefs about Black genocide and the safety of contraceptive methods. Stronger conspiracy beliefs predicted more negative attitudes toward contraceptives. In addition, men with stronger contraceptive safety conspiracy beliefs were less likely to be currently using any birth control. Among current birth control users, women with stronger contraceptive safety conspiracy beliefs were less likely to be using contraceptive methods that must be obtained from a health care provider. Results suggest that conspiracy beliefs are a barrier to pregnancy prevention. Findings point to the need for addressing conspiracy beliefs in public health practice.

African American women and family planning services: perceptions of discrimination.

ABSTRACT Objectives: The purpose of this study was to examine perceived race-based discrimination in obtaining family planning or contraceptive services among African American women in the U.S. Methods: We conducted a 30-minute telephone survey with a random sample of 500 African Americans (aged 15–44), which included questions about race-based discrimination when obtaining family planning services. The present analyses were limited to the 326 women who completed interviews. Results: The majority (79%) of women reported having seen a health care provider for family planning or birth control services. Of those, 67% reported race-based discrimination when obtaining such services. Half of the women reported more general experiences of discrimination when obtaining family planning services (e.g., poorer service), and 52% reported experiences that reflect stereotypes of African American women (e.g., doctor or nurse assumed they had multiple sexual partners). Most indicated that experiences of discrimination occurred infrequently. Generally, background characteristics were not significantly associated with perceived discrimination. However, in multivariate models, stronger Black identity, younger age, and lower income were associated with reports of discrimination. Conclusion: African American women may be vulnerable to prejudice within reproductive health care contexts, including family planning.

HIV prevention heuristics and condom use among African-Americans at risk for HIV.

The goal of this study was to improve understanding of whether incorrect HIV/AIDS heuristics and characteristics-based risk theories are barriers to HIV prevention among young African-Americans at increased risk for HIV. We explored: (1) the beliefs of men and women regarding disease prevention strategies, and (2) the relationship of such beliefs to safer sexual behaviours. In Phase I, semi-structured individual interviews were conducted with both members of 22 heterosexual couples at increased risk for HIV/STIs. Subsequently, in Phase II, structured individual interviews were conducted with another 40 women and 40 men (not couples). Participants in Phase I reported use of condoms and monogamy as major strategies for disease prevention. The beliefs that were endorsed by the largest percentage of Phase II participants were related to the ‘known partners are safe partners’ and ‘trusted partners are safe partners’ heuristics. Moreover, stronger endorsement of the ‘known partners’ heuristic was negatively associated with measures of condom use and pregnancy prevention behaviour. Our findings highlight the need for interventions and programmes to encourage intimate partners to consistently use condoms until both members of the dyad are tested and agree to mutual monogamy.

Medical Mistrust and Discrimination in Health Care: A Qualitative Study of Hmong Women and Men

Low rates of breast and cervical cancer screening among Hmong women have been documented. Mistrust of Western medicine and the health care system, as well as experiences of discrimination in health care, may be barriers to seeking health care for this population. In this study, we explored medical mistrust among Hmong women and men, their experiences with discrimination in health care, and how these factors may influence Hmong women’s breast and cervical cancer screening behavior. We conducted semi-structured, in-depth interviews with women and men who were members of the Hmong community in Oregon. Transcripts of 83 interviews were analyzed using content analysis. Despite personally trusting Western medicine and the health care system, participants shared reasons that some Hmong people feel mistrust including lack of understanding or familiarity, culture, and tradition. Although mistrust was thought to result in delaying or avoiding breast or cervical cancer screening, more frequently trust was described as positively influencing screening. In addition, few participants reported being treated differently during breast or cervical cancer screening because they were Hmong. When discussing health care more broadly, however, some participants described differential (e.g., disrespectful or rude) treatment. Such experiences led to feelings such as anger and sadness and affected behavior, including willingness to seek care and choice of provider. Medical mistrust and perceived discrimination were not major barriers to breast and cervical cancer screening in this study. Additional studies are needed to assess whether our findings reflect the experiences of other Hmong.

“In a Country as Affluent as America, People Should be Eating”: Experiences With and Perceptions of Food Insecurity Among Rural and Urban Oregonians

Many factors are associated with food insecurity in the United States. We conducted interviews with 25 low-income and/or food-insecure Oregonians to explore their experiences with food insecurity, the role of social support, and whether these experiences differed based on rural/urban residence. Ill health and unemployment emerged as food-insecurity contributors. Coping strategies cited included use of nutrition assistance programs, alternate food sources, and drawing on social support. The findings suggest that policy and practice efforts should be directed at increasing the human capital of low-income Oregonians and the benefit levels of essential nutrition assistance programs.

Perceived discrimination during prenatal care, labor, and delivery: an examination of data from the Oregon Pregnancy Risk Assessment Monitoring System, 1998-1999, 2000, and 2001.

Although recent research has examined discrimination in health care, no studies have investigated womens experiences during prenatal or obstetrical care. Analyses of data from the Oregon Pregnancy Risk Assessment Monitoring System showed that 18.53% of mothers reported discrimination by providers during prenatal care, labor, or delivery, most commonly because of age or insurance status. Perceived discrimination was associated with maternal characteristics such as age, marital status, and type of insurance, but not with number of subsequent well-baby visits.

The relationship between income and food insecurity among Oregon residents: does social support matter?

OBJECTIVE Millions of US households experienced food insecurity in 2005. Research indicates that low wages and little social support contribute to food insecurity. The present study aimed to examine whether social support moderates the relationship between income and food insecurity. DESIGN Using a mail survey, we collected data on social support sources (social network, intimate partner and community) and social support functions from a social network (instrumental, informational and emotional). We used hierarchical logistic regression to examine the potential moderation of various measures of social support on the relationship between income and food insecurity, adjusting for potential confounding variables. SETTING Oregon, USA. SUBJECTS A stratified random sample of Oregonians aged 18-64 years (n 343). RESULTS We found no evidence of an association between social support and food insecurity, nor any evidence that social support acts as a moderator between income and food insecurity, regardless of the measure of social support used. CONCLUSIONS Although previous research suggested that social support could offset the negative impact of low income on food security, our study did not find support for such an effect.

Examining CAM use disclosure using the Behavioral Model of Health Services Use.

OBJECTIVES To improve understanding of factors that may influence disclosure of complementary and alternative medicine (CAM) use in the U.S. DESIGN Cross-sectional survey. METHODS Data are from the 2001 Health Care Quality Survey (HCQS), a nationally representative study of adults aged 18 and older living in the continental United States. Using the Behavioral Model of Health Services Use, we conducted multivariate logistic regressions to identify factors associated with disclosing CAM use among the sub-sample of recent CAM users (n=1995). MAIN OUTCOME MEASURE Disclosure of CAM use. RESULTS Most CAM users (71.0%) disclosed their use of CAM to their doctors. Contextual, individual, and health behavior factors were associated with CAM use disclosure. Of particular interest, disclosure was significantly more likely among those who perceived high quality relationships with their providers (AOR=1.59, CI: 1.01, 2.49) and among those who had a regular source of medical care (AOR=1.54, CI: 1.03, 2.29). The odds of disclosure were also higher among those who used practitioner-provided CAM, with (AOR=2.02, CI: 1.34, 3.06) or without (AOR=1.52, CI: 1.05, 2.20) concurrent herbal medicine use, compared to those who used herbal medicines only. CONCLUSIONS The Behavioral Model of Health Services Use is a useful framework for examining factors that may influence disclosure of CAM use. Further research should examine these relationships using more comprehensive measures.

Breast and cervical cancer screening: exploring perceptions and barriers with Hmong women and men in Oregon.

Background. Hmong women are reported to have very low rates of breast and cervical cancer screening compared to other Asian and White women in the USA. Reasons for low cancer screening rates among this population are not well understood. Methods. This qualitative study (n=83) explored Hmong women and mens perceptions of breast and cervical cancer and cancer screening, womens experiences with breast and cervical cancer screening, and health care system barriers to screening. Results. Hmong women and men perceived breast cancer to be more severe than other types of cancers. Participants believed that breast cancer is curable if detected early. Cervical cancer was not well understood and was of greater concern than breast cancer because of its location within the body and its consequences for reproduction. In general, few participants had personal experiences with breast and/or cervical cancer. Overall, women and men had positive things to say about screenings for breast and cervical cancer, expressing that screenings offered a ‘proof of illness.’ The majority of women did not report any concerns with the exams themselves, although some discussed embarrassment, pain, and discomfort. Barriers to screening included lack of health insurance, making co-payments, language, and issues related to scheduling appointments. Barriers differed for younger and older women. Conclusion. Results of this study provide new insight into perceptions, experiences, and barriers to breast and cervical cancer screening among Hmong women and men. These findings have implications for developing culturally appropriate interventions to increase breast and cervical cancer screening in this population.