Industry has played a complex role in the rise of tobacco-related diseases in the United States. The tobacco industry's activities, including targeted marketing, are arguably among the most powerful corporate influences on health and health policy. We analyzed over 400 internal tobacco industry documents to explore how, during the past several decades, the industry targeted inner cities populated predominantly by low-income African American residents with highly concentrated menthol cigarette marketing. We study how major tobacco companies competed against one another in menthol wars fought within these urban cores. Little previous work has analyzed the way in which the inner city's complex geography of race, class, and place shaped the avenues used by tobacco corporations to increase tobacco use in low-income, predominantly African American urban cores in the 1970s–1990s. Our analysis shows how the industry's activities contributed to the racialized geography of today's tobacco-related health disparities.
Introduction. Effective smoking cessation treatment requires active patient engagement. This may be particularly important for rural smokers who have less access to smoking cessation resources than others. This study describes long-term engagement in counseling for smoking cessation and factors associated with engagement. Methods. As part of a randomized trial, 231 rural smokers received up to 6 telephone-based counseling sessions at 6-month intervals over 24 months. Engagement in treatment was categorized according to the number of counseling calls each interval. During the final 6-month interval, more than 60% of continuing smokers remained engaged in treatment. Call completion varied over time; while levels of engagement dropped after the first interval, many continuing smokers remained engaged throughout the study. Education, age, motivation, income, diabetes, and health insurance status were predictors of treatment engagement. Conclusion. This study demonstrates that smokers will remain engaged in long-term counseling designed to address the chronic nature of nicotine dependence.
Purpose. This study examines the associations among employment and socioeconomic factors and the outcomes, current smoking, cigarette abstinence and former smoking among adult U.S. workers ages 18–64 (n=288,813). Methods. Multivariate logistic regression was used to examine the associations among the variables using cross-sectional data from the 1998–1999 and 2001–2002 Tobacco Use Supplements to the Current Population Survey. Results. Lower odds of current smoking was observed among part-time workers compared to those working variable hours and multiple job holders compared to persons holding one job. The self-employed, part-time workers and multiple job holders had higher odds of former smoking than comparison groups. Employment factors were not associated with short-term abstinence or 12-month abstinence from smoking, but income, education, marital status, and duration of smoking were associated with 12-month abstinence. Conclusions. These data suggest that while employment factors are associated with current and former smoking, socioeconomic factors are associated with long-term quitting.
Physical, cultural, and social factors influence health risk and behavior, but few have explored how the environmental context affects African American men's prostate cancer screening and treatment. This paper describes a structural analysis of data from eight focus groups of rural, southern African American men (n=66). A structural approach highlights the interrelationships between individuals, the health service system, and community factors that directly and indirectly affect screening and treatment for prostate cancer. The availability of accurate and timely health information and health services, social norms regarding health and professional help-seeking, and the sociopolitical context shaped men's screening and treatment behaviors. These proximal and distal health factors affected men's prostate cancer knowledge, perceived risk, willingness to seek care and trust in the health service system. The findings suggest that prostate cancer screening and treatment occurs in a larger structural context that has important implications for help-seeking and health promotion.
Purpose: This paper examines the rates of recent mammography use among African American and White women, the influence of demographic characteristics, socioeconomic status, health insurance coverage, and breast cancer risk factors on recent mammography use and reasons for not having a mammogram. Methods: Cross-sectional data from the Southern Community Cohort Study were used to analyze mammography use among African American and White women. Results: Among 27,123 mostly low-income women age 42–79 in the Southern Community Cohort Study, the rate of recent (within the past 2 years) mammography use was 73% among African Americans and 68% among Whites. Health insurance coverage, age, household income, education, family history of breast cancer, hormone replacement therapy use, and post-menopausal status were positively associated with recent mammography, whereas consumption of 2 or more alcoholic drinks/day was negatively associated. These associations were observed in both African American and White women who never had received a mammogram (non-users) although some variation existed. Differential effects of these factors on recent mammography were also examined in non-users and past users. Doctor has not recommended this test and cost were the two most commonly self-reported reasons for non-use. Conclusions: Characteristics of non-users and past users identified may provide valuable information for maintaining the progress made and for further improving adherence to the screening guidelines.
This study explores beliefs about complementary and alternative medicine (CAM) use for pain management among 15 U.S.-born and 15 foreign-born Chinese women with breast cancer. For this investigation, trilingual interviewers conducted individual, face-to-face, qualitative interviews in Cantonese, Mandarin, or English. All study participants lived in San Francisco, and the foreign-born women had resided in the U.S. for 15 years or fewer. Findings indicate that many participants consider CAM a viable method of pain management. However, concerns about affordability and quality of treatment prevent some women from using CAM on a regular basis. Many participants indicated that Western health care providers are poorly equipped to provide CAM to manage the pain resulting from breast cancer treatment. Future research should explore how access to CAM can be improved for poor and uninsured patients with cancer and how alternative approaches to pain management can be integrated more broadly in the U.S. health care system.
Background. Breast cancer in Hispanic women is poorly understood and data on tumor hormone receptor status in this population are limited. Methods. Using data from the Arizona Cancer Registry, we assessed differences in tumor characteristics between Hispanic and non-Hispanic White (NHW) women using logistic regression modeling. 25,494 invasive breast cancer cases (23,657 NHWs and 1,837 Hispanics) reported to the cancer registry in 1995 to 2003 were included in the analysis. Results. In age-adjusted models, compared with NHW women, Hispanics were more likely to have high-grade cancers, larger tumors, a greater number of positive lymph nodes, and advanced stage at diagnosis. Hispanic women were less likely to have tumors that are both estrogen and progesterone receptor positive (ER###1###/PR###1###), particularly those under age 60. Conclusions. The profile of tumor presentation in Hispanic women in Arizona is consistent with a more aggressive disease pattern and less favorable prognosis than that of NHWs.
Purpose: We examined demographic, behavioral, psychosocial, and dietary correlates of prostate, breast, and colorectal cancer screening in a population-based sample of African Americans in North Carolina (n=405). Methods: Cross-sectional data of African Americans in North Carolina were analyzed using linear regression models. Results: Seventy-eight percent of men had obtained prostate screening (PSA test) and 81% of women had received breast cancer screening (mammogram) during the previous two years. Screening rates for CRC were lower (48% women, 31% men in the previous ten years). Older age, college education, and being married were associated with all screening modalities, as was belief in a diet-cancer relationship with PSA testing and mammography. There were correlations of former smoking, obesity, and healthy eating self-efficacy with PSA testing, and family/personal cancer history with CRC screening. Screening for all cancers was associated with lower fat consumption, and PSA testing with high fruit/vegetable intake (p<.05). Conclusions: Cancer screening was prevalent, but rates did not approach national targets. Knowledge of these correlates can be used to design effective cancer screening interventions for African Americans.
Despite a disproportionate burden of environmental hazards in lower socioeconomic positions (SEP) and racial/ethnic minority communities, research suggests that such communities may have concerns about environmental risks different from those of their higher SEP and White counterparts. These groups also face disproportionate barriers to accessing and utilizing public health information. Little work has focused on the environmental risk communication barriers that low-SEP minorities face. This paper reports on the results of seven focus groups conducted in three low-SEP Massachusetts communities, with an over-sample of racial/ethnic minorities. We explored (1) definitions of the environment, (2) perceptions of environmental health effects, (3) information-seeking behaviors around these issues, and (4) challenges to accessing and utilizing information. The local environment shapes these communities' perceptions of environmental risks; they face considerable barriers to accessing, understanding, and utilizing other sources of information about environmental health risks. We discuss the implications for future targeted campaigns to reduce negative impacts of environmental health risks.
Community-based participatory research (CPBR) represents a growing research approach for addressing health disparities disfavoring members of racial/ethnic minorities and other underserved populations in the U.S. While such endeavors are often guided by explicit principles regarding the relationships between communities and universities, few studies have reported on the development or strength of such relationships. This paper describes the methods and preliminary results of a cross-sectional analysis of the ties between community and university organizations in a CBPR network to address cancer disparities between Pacific Islanders in Southern California and the general population. These analyses afford a means of representing the collaborative relationships and may enhance tracking improvements in CBPR links for cancer education, research, and training. Such tracking will help concerned parties understand how academic and community groups collaborate and coordinate their efforts to reach shared and overlapping goals.
Abstract: A persistent challenge to self-report data across racial, ethnic, or cultural groups is the inherent difficulty of attaining cross-cultural comparability of key measures. The current research study investigated the cross-cultural functioning of health-survey questions presented to four groups: (1) Koreans who were monolingual in Korean; (2) non-Korean native speakers of English; (3) bilingual Koreans interviewed in English, and (4) bilingual Koreans interviewed in Korean. This design allowed us to include those likely to be medically underserved, and to assess both linguistic and cultural barriers to collecting health survey data. A total of 36 cognitive interviews were conducted to identify (a) translation problems; (b) problems of cultural adaptation that impede cross-cultural comparability; and (c) generic problems of questionnaire design that affect all groups. An important category of problems was identified that appeared to result from the interaction of respondent and question characteristics. Such problems can best be assessed through explicit consideration of the socio-cultural backgrounds of survey respondents, as opposed to the more usual focus on details of item translation and wording.