Minority Health and Health Equity Archive
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Item Cancer and men from minority ethnic groups: an exploration of the literature(2000) Lees, S.; Papadopoulos, I.Abstract available at publisher's web site.Item Social and Cultural Factors Influence African American Men's Medical Help Seeking(2011) Griffith, D. M.; Ober Allen, J.; Gunter, K.Objective: To examine the factors that influenced African American men’s medical help seeking. Method: Thematic analysis of 14 focus groups with 105 older, urban African American men. Results: African American men described normative expectations that they did not go to the doctor and that they were afraid to go, with little explanation. When they did go, men reported that they were particularly uncomfortable with the tone physicians used when talking to them. Providers often made recommendations but offered the men little useful information on how to make lifestyle and behavior changes. Following receipt of care, spouses, medical test results, and men’s desire to fulfill social roles were key motivating and instrumental factors in following medical advice. Conclusions: African American men’s medical help seeking seemed to be negatively influenced by social norms and patient-provider interactions but positively influenced by spouses and the desire to fulfill social roles.Item Participation in Cancer Clinical Trials: Race-, Sex-, and Age-Based Disparities(2004) Murthy, Vivek H.; Krumholz, Harlan M.; Gross, Cary P.Context Despite the importance of diversity of cancer trial participants with regard to race, ethnicity, age, and sex, there is little recent information about the representation of these groups in clinical trials. Objective To characterize the representation of racial and ethnic minorities, the elderly, and women in cancer trials sponsored by the National Cancer Institute. Design, Setting, and Patients Cross-sectional population-based analysis of all participants in therapeutic nonsurgical National Cancer Institute Clinical Trial Cooperative Group breast, colorectal, lung, and prostate cancer clinical trials in 2000 through 2002. In a separate analysis, the ethnic distribution of patients enrolled in 2000 through 2002 was compared with those enrolled in 1996 through 1998, using logistic regression models to estimate the relative risk ratio of enrollment for racial and ethnic minorities to that of white patients during these time periods. Main Outcome Measure Enrollment fraction, defined as the number of trial enrollees divided by the estimated US cancer cases in each race and age subgroup. Results Cancer research participation varied significantly across racial/ethnic and age groups. Compared with a 1.8% enrollment fraction among white patients, lower enrollment fractions were noted in Hispanic (1.3%; odds ratio [OR] vs whites, 0.72; 95% confidence interval [CI], 0.68-0.77; P<.001) and black (1.3%; OR, 0.71; 95% CI, 0.68-0.74; P<.001) patients. There was a strong relationship between age and enrollment fraction, with trial participants 30 to 64 years of age representing 3.0% of incident cancer patients in that age group, in comparison to 1.3% of 65- to 74-year-old patients and 0.5% of patients 75 years of age and older. This inverse relationship between age and trial enrollment fraction was consistent across racial and ethnic groups. Although the total number of trial participants increased during our study period, the representation of racial and ethnic minorities decreased. In comparison to whites, after adjusting for age, cancer type, and sex, patients enrolled in 2000 through 2002 were 24% less likely to be black (adjusted relative risk ratio, 0.76; 95% CI, 0.65-0.89; P<.001). Men were more likely than women to enroll in colorectal cancer trials (enrollment fractions: 2.1% vs 1.6%, respectively; OR, 1.30; 95% CI, 1.24-1.35; P<.001) and lung cancer trials (enrollment fractions: 0.9% vs 0.7%, respectively; OR, 1.23; 95% CI, 1.16-1.31; P<.001). Conclusions Enrollment in cancer trials is low for all patient groups. Racial and ethnic minorities, women, and the elderly were less likely to enroll in cooperative group cancer trials than were whites, men, and younger patients, respectively. The proportion of trial participants who are black has declined in recent years.Item How Scholarly Nursing Literature Addresses Health Disparities for Racial/Ethnic Minority Men(2004) Dallas, ConstanceThe purpose of this article is to review conceptual/theoretical and review/agenda setting nursing literature on the health care of racial/ethnic minority men [specifically African American/Black, Hispanic/Latino, American Indian/Alaskan Native and Asian/Pacific Islander men] in one of the four targeted areas of health disparities. CINAHL and MEDLINE computer databases were searched from 1983 to the present using a combination of manual and computer-based methods to identifying the nursing literature that included any racial/ethnic men in the sample and addresses at least on the four areas of health disparities targeted by Department of Health and Human Services (DHHS) that affect adults: heart disease, malignant neoplasms (cancer), diabetes mellitus and Human Immunodeficiency Virus (HIV)/AIDS. This review provides an overview of health disparities experienced by racial/ethnic minority men in the targeted areas and of the types of conceptual and agenda-setting articles published in scholarly nursing literature in those targeted areas.Item Black Men who Have Sex with Men and the HIV Epidemic: Next Steps for Public Health (Editorial)(2003) Malebranche, David JBlack men who have sex with men (BMSM) are disproportionately affected by HIV/AIDS in the United States. The Young Men's Survey estimates an HIV incidence rate of 14.7% among BMSM in 6 US cities, compared with 2.5% and 3.5% among White and Hispanic men who have sex with men (MSM), respectively.[1] Yet the disparity is not explained by higher rates of unprotected anal and oral sex. There are 4 possible explanations, which are not mutually exclusive: (1) bias in assessment of risk behaviors, (2) increased prevalence of HIV among sexual contacts, (3) increased infectiousness among sexual partners, and (4) increased physiological susceptibility to HIV. By exploring these possibilities more deeply, we can increase our understanding of the apparent disparity between behavioral risks and outcomes while at the same time improving the design and implementation of prevention programs that address the specific needs of BMSM.Item Association of Co-Occurring Psychosocial Health Problems and Increased Vulnerability to HIV/AIDS Among Urban Men Who Have Sex With Men(2003) Stall, Ron; Mills, Thomas C; Williamson, John; Hart, Trevor; Greenwood, Greg; Paul, Jay; Pollack, Lance; Binson, Diane; Osmond, Dennis; Catania, Joseph AObjectives. We measured the extent to which a set of psychosocial health problems have an additive effect on increasing HIV risk among men who have sex with men (MSM). Methods. We conducted a cross-sectional household probability telephone sample of MSM in Chicago, Los Angeles, New York, and San Francisco. Results. Psychosocial health problems are highly intercorrelated among urban MSM. Greater numbers of health problems are significantly and positively associated with high-risk sexual behavior and HIV infection. Conclusions. AIDS prevention among MSM has overwhelmingly focused on sexual risk alone. Other health problems among MSM not only are important in their own right, but also may interact to increase HIV risk. HIV prevention might become more effective by addressing the broader health concerns of MSM while also focusing on sexual risks.Item A Decade of Research on Disparities in Medicare Utilization: Lessons for the Health and Health Care of Vulnerable Men(2003) Gornick, Marian EMedicare research has shown that there are substantial disparities by race and socioeconomic status in use of services. In this article, I review past research and discuss how findings apply specifically to vulnerable men aged 65 years or older. Six lessons from this review are identified and illustrated here. Disparities in certain measures of health are growing; to reverse this trend, substantial efforts are needed, including dissemination of information about disparities as well as testing of hypotheses regarding underlying causes.Item 20-Year Outcomes Following Conservative Management of Clinically Localized Prostate Cancer(2005) Albertson, Peter C; Hanley, James A; Fine, JudithContext: The appropriate therapy for men with clinically localized prostate cancer is uncertain. A recent study suggested an increasing prostate cancer mortality rate for men who are alive more than 15 years following diagnosis. Objective: To estimate 20-year survival based on a competing risk analysis of men who were diagnosed with clinically localized prostate cancer and treated with observation or androgen withdrawal therapy alone, stratified by age at diagnosis and histological findings. Design, Setting, and Patients: A retrospective population-based cohort study using Connecticut Tumor Registry data supplemented by hospital record and histology review of 767 men aged 55 to 74 years with clinically localized prostate cancer diagnosed between January 1, 1971, and December 31, 1984. Patients were treated with either observation or immediate or delayed androgen withdrawal therapy, with a median observation of 24 years. Main Outcome Measures: Probability of mortality from prostate cancer or other competing medical conditions, given a patient’s age at diagnosis and tumor grade. Results: The prostate cancer mortality rate was 33 per 1000 person-years during the first 15 years of follow-up (95% confidence interval [CI], 28-38) and 18 per 1000 personyears after 15 years of follow-up (95% CI, 10-29). The mortality rates for these 2 follow-up periods were not statistically different, after adjusting for differences in tumor histology (rate ratio, 1.1; 95% CI, 0.6-1.9). Men with low-grade prostate cancers have a minimal risk of dying from prostate cancer during 20 years of follow-up (Gleason score of 2-4, 6 deaths per 1000 person-years; 95% CI, 2-11). Men with high-grade prostate cancers have a high probability of dying from prostate cancer within 10 years of diagnosis (Gleason score of 8-10, 121 deaths per 1000 person-years; 95% CI, 90-156). Men with Gleason score of 5 or 6 tumors have an intermediate risk of prostate cancer death. Conclusion: The annual mortality rate from prostate cancer appears to remain stable after 15 years from diagnosis, which does not support aggressive treatment for localized low-grade prostate cancer.Item Minority Health to be Discussed(2004) Putnam, YolandaHealth officials and legislators will gather at the Chattanooga Convention Center this week to discuss how to address health disparities in the minority community. "So many of our diseases are preventable, so we have an obligation to cut these disparities down and do a better job with our exercise and diet," said George Curry, editor of the National Newspaper Publishers Association News Service.