A Note from the Editor
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The final issue of our 17th volume, this issue has two major themes, adolescent health and health policy and finance, and two articles that are the outgrowth of the Tuskegee Legacy Project, described briefly below.
Tuskegee Legacy Project
The Tuskegee Legacy Project, underway for over ten years, was designed to address, and understand, a range of issues related to the recruitment and retention of Blacks and other minorities in biomedical research studies. (The name of the project is an acknowledgment of the importance of the unethical treatment of Black men in the United States Public Health Service (USPHS) Syphilis Study at Tuskegee (1932–72).) Ralph Katz, a distinguished member of JHCPU's Editorial Board, and colleagues from a number of institutions, in their paper compare self-reported willingness of Blacks, Hispanics, and Whites to participate as research subjects in biomedical studies. The Tuskegee Legacy Project's questionnaire was administered to 1,133 adults. Two significant findings stand out for their contrast: (1) Blacks have higher fear of participation than Whites, but (2) no differences were found by race/ethnicity in willingness to participate in biomedical research. Thus, the authors conclude, the recruitment of Black and Hispanic minorities for biomedical studies appears to be a fully attainable goal for most types of biomedical studies, in addition to being highly desirable for ensuring diversity within study populations in biomedical research.
The second Tuskegee Legacy Project paper, by McCallum, Katz and others, is a review of existing literature assessing African Americans' 1) general awareness and/or specific knowledge of the U.S. Public Health Service (USPHS) Syphilis Study at Tuskegee, and 2) attitudes towards and/or willingness to participate in biomedical research. The literature appears to be in unanimous agreement that familiarity with the USPHS Syphilis Study at Tuskegee did not necessarily ensure accurate knowledge of it. In keeping with the findings in the Katz study, McCallum et al. report that four studies in the literature found that awareness of the USPHS Syphilis Study at Tuskegee did not relate to willingness to participate in biomedical research. Overall, the literature reviewed suggests that a broad array of structural and sociocultural factors influence minorities' willingness to participate in biomedical studies, rather than its being influenced predominantly by distrust persisting from the syphilis study. [End Page v]
Adolescents
Of the five papers concerning adolescents in this issue, two concern adolescent girls, two American Indians, and one the prior health care experiences of adolescents who are just now enrolling in SCHIP programs. All five emphasize the importance of better meeting the pronounced health needs of adolescents in historically underserved communities.
Sylvia Tejeda and a team from the Fred Hutchinson Cancer Research Center and the School of Public Health and Community Medicine at the University of Washington report on the effectiveness of a one-hour cervical cancer screening curriculum for Hispanic adolescents. The team presented the curriculum to 142 girls in grades 9–12 in a rural part of Washington State. In the pre-test, 32% of the participants had heard of a Pap smear and less than 5% had ever received one (considerably less knowledge than found with other groups of adolescents); the number of correct answers increased significantly on the post-test, where correct responses ranged from 94–95%. The proportion answered correctly by a control group did not alter significantly between the pre- and post-tests. The research demonstrates both the need for this sort of instruction and the ease and effectiveness of its administration.
Diane McKee and colleagues, from the Albert Einstein School of Medicine at Yeshiva University in the Bronx, studied primary care received by 819 girls attending public high schools in the Bronx, a sample that was predominantly from low-income and racial or ethnic minority households. Two important points coming out of this study are (1) that immigrant girls were less likely than U.S.-born girls to have a regular source of care and (2) that teens whose usual setting of care was a community, school, or teen-based clinic were more likely to report confidential care than those who see a private doctor. The former finding complements Tejeda...
