Behavioral & Community Health
Permanent URI for this communityhttp://hdl.handle.net/1903/2271
Prior to January 24, 2011, this unit was named the Department of Public & Community Health.
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Item Role of life events in the presence of colon polyps among African Americans(Springer Nature, 2013-06-12) Ashktorab, Hassan; Namin, Hassan Hassanzadeh; Taylor, Teletia; Williams, Carla; Brim, Hassan; Mellman, Thomas; Shokrani, Babak; Holt, Cheryl L; Laiyemo, Adeyinka O; Nouraie, MehdiAfrican Americans have disproportionately higher incidence and death rates of colorectal cancer among all ethnic groups in the United States. Several lifestyle factors (e.g. diet, physical activity and alcohol intake) have been suggested as risk factors for colorectal cancer. Stressful life events have also been identified as risk factors for colorectal cancer. The association between stressful life events and colon polyps, which are precursors of colorectal cancer, has yet to be determined. We aimed to evaluate the relationship between stressful life events and the presence of colon polyps and adenomas in African American men and women. In this cross-sectional study, 110 participants were recruited from a colon cancer screening program at Howard University Hospital. Participants completed an 82-item Life Events Questionnaire (Norbeck 1984), assessing major events that have occurred in the participants’ life within the past 12 months. Participants also reported whether the event had a positive or negative impact. Three scores were derived (total, positive, and negative). Total life events scores were higher (Median [M] = 29 and Interquartile range [IQR] = 18-43) in patients with one or more polyps compared to patients without polyps (M, IQR = 21,13-38; P = 0.029). Total, positive or negative Life Events scores did not differ significantly between normal and adenoma patients. Total, negative and positive Life Events scores did not differ between patients who underwent diagnostic colonoscopy (symptomatic) and patients who underwent colonoscopy for colon cancer screening (asymptomatic) and patients for surveillance colonoscopies due to a personal history of colon polyps. Linear regression analysis indicated that male gender is associated with 9.0 unit lower total Life Events score (P = 0.025). This study suggests that patients who experienced total life events may be at higher risk of having colon polyps and adenomas which indicates an association between stress and the development of colorectal polyps.Item The relationship between health literacy and indicators of informed decision making for colorectal cancer screening among African Americans(2016) Tagai, Erin Kelly; Holt, Cheryl L; Garza, Mary A; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)African Americans are disproportionately affected by colorectal cancer (CRC) incidence and mortality. CRC early detection leads to better treatment outcomes and, depending on the screening test, can prevent the development of CRC. African Americans, however, are screened less often than Whites. Aspects of decision making (e.g., decisional conflict, decision self-efficacy) can impact decision making outcomes and may be influenced by social determinants of health, including health literacy. However the relationship between social determinants of health and indicators of decision making in this population is not fully understood. Additionally, individuals have a choice between different CRC screening tests and an individual’s desire to use a particular screening test may be associated with social determinants of health such as health literacy. This study aimed to examine the relationship between social determinants of health and indicators of decision making for CRC screening among African Americans. A total of 111 participants completed a baseline and 14-month follow-up survey assessing decisional conflict, decision self-efficacy, decisional preference (shared versus informed decision making), and CRC test preference. Health literacy was negatively associated with decisional conflict and positively associated with decision self-efficacy (ps < .05). Individuals who were unemployed or working part-time had significantly greater decisional conflict than individuals working full-time (ps < .05). Individuals with a first-degree family history of CRC had significantly lower decision self-efficacy than individuals without a family history (p < .05). Women were significantly more likely to prefer making a shared decision rather than an informed decision compared to men (p < .05). Lastly, previous CRC screening behavior was significantly associated with CRC test preference (e.g., individuals previously screened using colonoscopy were significantly more likely to prefer colonoscopy for their next screening test; ps < .05). These findings begin to identify social determinants of health (e.g., health literacy, employment) that are related to indicators of decision making for CRC among African Americans. Furthermore, these findings suggest further research is needed to better understand these relationships to help with the future development and improvement of interventions targeting decision making outcomes for CRC screening in this population.Item THE ROLE OF DENIAL AND PERCEIVED HIV STIGMA AS BARRIERS TO ENGAGING IN HIV MEDICAL CARE AMONG HIV POSITIVE AFRICAN AMERICANS IN THE WASHINGTON, DC AREA(2015) Geiger, Tanya; Boekeloo, Bradley O; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)HIV is a potentially fatal and highly stigmatized disease such that diagnosis with the disease is often met with high anxiety. Many people who test positive for HIV may not receive sufficient linkage to HIV care or do not remain engaged in continuous HIV medical care once they have entered care. While a considerable amount of research exists on referral, access, personal characteristics, and mental illness barriers associated with engagement in HIV medical care, far less attention has been given to psychosocial factors, specifically denial and perceived HIV stigma as important barriers to engaging in HIV medical care. The purpose of this study was to determine whether denial and/or perceived HIV stigma are associated with engagement in HIV medical care for African-American people living with HIV/AIDS (PLWHA). Data were collected as part of a peer-based community health worker program (CHW), based in Washington DC, designed to link PLWHA to HIV medical care and services. Logistic regression analyses were performed to determine whether the psychosocial variables were predictors of engagement in HIV medical care.Results indicated that disclosure is a major issue for this population, as 46% of the participants had not disclosed their HIV status to others. Separate analyses were conducted for the total sample (n=262) and with the disclosed sample (n=120). Results in the total sample revealed that disclosure of HIV status was associated with engagement in HIV status. PLWHA who disclosed HIV status to others were 2.2 times more likely to engage in HIV medical care than persons who had not disclosed HIV status. In the disclosed sample, gender, educational level and employment status were also associated with engagement in HIV medical care. Women and persons with low educational level and unemployed were less likely to engage in HIV medical care. Denial and perceived HIV stigma were not found to be independent predictors of engagement in HIV medical care when other covariates were included in the model. Disclosure of HIV status, gender and educational level were predictors of engagement in HIV medical care for this population. These obstacles to care may be amenable to disclosure and gender-specific interventions; and, therefore, warrant better understanding to improve outreach interventions to PLWHA who are not engaged in HIV medical care.Item Associations and Pathways between Substance Involvement and Risky Sexual Behavior over the Life Course of Urban African Americans(2015) Zebrak, Katarzyna A.; Green, Kerry M.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)African Americans are disproportionately affected by HIV/AIDS and other sexually transmitted infections (STIs) relative to other racial/ethnic groups. Substance involvement has been linked to risky sexual behavior, an important risk factor for HIV/STI transmission, relatively early in the life course; yet such associations have not been found consistently among African Americans. Understanding of how substance involvement relates to risky sexual behavior among men and women over time and into midlife remains limited. The goal of this study was to examine the associations and pathways between substance involvement and risky sexual behavior over the life course in a community-based urban African American cohort (n=1242) followed prospectively from age 6 to 42 years. Using a combination of structural equation modeling and mediation testing, the study examined (1) prospective associations (from adolescence through adulthood) and within-life stage associations (in adolescence, young adulthood, and midlife) between substance involvement and risky sexual behavior, (2) the role of young adult social bonds as potential pathways linking substance use and risky sexual behavior over time, and (3) gender differences in the associations and pathways. The results revealed statistically significant positive associations between earlier substance involvement and subsequent risky sexual behavior over the life course among men and women. Greater adolescent substance use predicted greater midlife risky sexual behavior, partly through greater young adult substance problems and risky sexual behavior for both genders. Substance involvement was also positively correlated with sexual/risky sexual behavior in adolescence, young adulthood, and midlife among men and women. Although greater adolescent substance use predicted fewer young adult social bonds for both men and women, the latter was associated with decreased involvement in midlife risky sexual behavior among women only. Considered individually, young adult social bonds were not significant mediators of the adolescent substance use–midlife risky sexual behavior association for either gender. Given the complex pattern of associations and pathways between substance involvement and risky sexual behavior over time, public health interventions to address substance involvement among urban African Americans at any life stage, starting with adolescence, may have immediate and long-term effects, and direct and indirect effects on decreasing sex-related HIV/STI risk.Item CONDOM USE IN OLDER AFRICAN AMERICANS: AN EXPLORATORY STUDY(2012) Ramos, Ina Ananda; Desmond, Sharon M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The purpose of this mixed methods exploratory study was to examine perceptions regarding condom use and sexual intercourse among African Americans 50 to 65 years of age, specifically attitudes, norms, self-efficacy and barriers regarding condom use behavior. There were three study phases: 1) a pilot study of the survey instrument (N=31), 2) an on-line survey (N=175), and 3) post survey explanatory interviews (N=10). The online survey contained items from the Sexual Risk Behavior Beliefs and Self-Efficacy Scales (SRBBS) (Basen-Enquist et al., 1999). Pilot study data indicated the online survey was understandable, acceptable, readable and appropriate for use by this sample of African Americans. Factor analyses of the survey items yielded similar constructs to the original SRBBS with seven of eight scales demonstrating internal consistency; Cronbach's alpha reliabilities ranged from .49 to 1.0. Logistic regression models found two independent variables increased the likelihood of condom use (condoms should be used even if people know each other well and friends feel condoms should be used even if pregnancy isn't possible) and two decreased the likelihood of condom use (friends feel you should use condoms even if people know each other well, and using condoms would be a hassle). A logistic regression model of significant independent variables found that provider speaking to patients about safer sex and male gender increased condom use, while being married and lower educational level decreased condom use behavior. Post-survey interviews, where participants (N = 10) were asked to elaborate on study findings, yielded six themes (the importance of trust and relationships, lack of knowledge, attitudes about condom use, sexual activity, health care providers, and friends opinions) that further explained statistical findings. Findings from this study have the potential to reduce the spread of HIV/STDs in this population through the use of educational programs that include empowerment and risk reduction components. Additionally, health care providers can potentially play a key role in these efforts and should be trained on how to communicate effectively with older adults around sexual health.Item The Role of Racial Identity and Religious Beliefs in the Attitudes of African American Cancer Patients Toward and Intention To Enroll in Therapeutic Cancer Trials(2011) Banda, Deliya Rose; Green, Kerry M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)There is increasing evidence that societal inequities and cultural differences in attitudes toward cancer and its treatment drive health outcomes. Therapeutic clinical trials represent a promising treatment option for cancer patients, yet the percentage of African American patients who enroll in clinical trials is lower than the national average. This creates a racial imbalance that limits the extent to which research results from clinical trials can be generalized. Studies of African Americans report some attitudes toward trial participation are based on trust and fear. Enrollment of minority patients is necessary to collect group specific data, and adapt treatments as may be necessary. To that end, interventions aimed at shifting attitudes hol promise, but hinge upon a better understanding of the interplay between attitudes toward trial participation, cultural constructs, and enrollment. The purpose of this dissertation was to examine interrelationships between two socio-cultural constructs, and four attitudinal barriers to clinical trial participation among African American cancer patients. Specifically, the study sought to (1) understand the relationship between attitudinal barriers to clinical trial participation and the subsequent intention to enroll; (2) understand the contribution of racial identity (racial centrality) and religious belief (specifically a belief in `God as healer') to intention to enroll. The study was guided by elements of the Theory of Planned Behavior and theories of racial identity and religiosity. Interviews were conducted with 111 African American cancer patients in a purposive sample from an urban, community-based teaching hospital in Washington, D.C. Logistic regression analyses explored the predictive value of four attitudinal constructs in patients' intention to enroll. Three of the four attitudinal barriers were significant predictors of intention for this sample. The concern about ethical conduct of investigators was the only attitudinal barrier that remained statistically significant in the unadjusted model (OR =0.85, p=0.04). Racial identity and a belief in God as healer were not significant predictors of intention to enroll. Finally, a moderation analysis explored the effect of levels of racial centrality and religious belief on attitudes and on intention. A belief in God as healer significantly moderated the association between the concern about ethical conduct of investigators and intention to enroll in a therapeutic clinical trial. Among participants with a low belief in God as a healer, a lower level of concern about the ethical conduct of investigators predicted a greater intention to enroll than those with a higher level of concern about ethics. Racial centrality did not significantly moderate any of the attitudinal barriers. The extant literature is scant in terms of addressing the role that socio-cultural constructs play in clinical trial decision-making for African American patients. In particular, implications of this study suggest that the historical legacy of research abuse and unethical treatment of African Americans in research continues to color attitudes towards clinical trials. This study provides a basis for further exploration of socio-cultural moderators among African Americans, an understanding of which may enable tailoring of interventions on these factors, which may improve intervention effects.Item The "Get More" Message: Promoting Fast Food to Blacks(2005-04-20) Smith, Nancy Gray; Sawyer, Robin G.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Blacks in the United States suffer disproportionately from overweight and associated health problems, relative to whites. Reasons are complex but environmental factors including fast food promotions may be contributing. This project compares promotional messages in fast food television advertisements targeted to blacks with those targeted to the larger general television audience. The primary promotional message of interest is that suggesting a better value exists through the purchase of larger or additional food items, referred to as the "get more" message. Also examined is the fast food promotional message for low or reduced calorie fare, referred to as the "get less" message. The main study hypotheses test for whether a greater proportion of "get more" food for the money messages, and a lesser proportion of "get less" calorie messages, respectively, are associated with fast food television advertisements featuring blacks, than with fast food television advertisements that do not feature blacks. The portrayal of identifiably black characters in advertisements, especially blacks in dominant roles, is defined in this study as a fundamental black targeting cue. The research method was a content analysis of 311 (138 unduplicated) fast food television advertisements videotaped on the six major U.S. broadcast networks (ABC, CBS, NBC, FOX, UPN, and WB) during one composite week of primetime television. The sample week was constructed over an 8 month period during 2003-2004. Ads were content coded by two teams, respectively, each consisting of one black and one white coder. Hypotheses were analyzed primarily through chi-square tests of association. Key findings are that significantly more "get more" messages were associated with advertisements featuring blacks than advertisements that did not feature blacks, and this association remained strong after controlling for type of restaurant, network, and date aired. Also, significantly fewer "get less" messages were associated with advertisements featuring blacks than advertisements that did not feature blacks. In short, fast food television advertisements featuring blacks were more likely to promote the purchase of larger amounts of food and higher calorie food than advertisements that did not feature blacks. Implications are discussed with respect to community education, policy, and the need for further research.