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African American women are substantially underrepresented in breast cancer genetic research studies and clinical trials, yet they are more likely to die from breast cancer. Lack of trust in the medical community is a major barrier preventing the successful recruitment of African Americans into research studies. When considering the city of Memphis, TN, where the percentage of African Americans is significantly higher than the national average and it has a high rate of breast cancer mortality inequities among African American women, we evaluated the feasibility of utilizing a community-based participatory (CBPR) approach for recruiting African American women into a breast cancer genetic study, called the Sistas Taking A Stand for Breast Cancer Research (STAR) study. From June 2016 and December 2017, African American women age 18 and above were recruited to provide a 2 mL saliva specimen and complete a health questionnaire. A total of 364 African American women provided a saliva sample and completed the health questionnaire. Greater than 85% agreed to be contacted for future studies. Educational workshops on the importance of participating in cancer genetic research studies, followed by question and answer sessions, were most successful in recruitment. Overall, the participants expressed a strong interest and a willingness to participate in the STAR study. Our findings highlight the importance of implementing a CBPR approach that provides an educational component detailing the importance of participating in cancer genetic research studies and that includes prominent community advocates to build trust within the community.

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Despite efforts to promote healthy weight, obesity is at epidemic levels among adults in the US. We examined the prevalence of weight loss attempts among a racially diverse sample of overweight and obese primary care patients (n = 274) based on sociodemographic, clinical and psychological factors, and shared decision-making (SDM) about weight loss/management. This observational study was conducted from December 2015 through January 2017. Data were obtained by self-report via survey. Overall, 64% of participants were attempting to lose weight at the time of survey. No significant differences in current weight loss attempts were found based on racial background, sociodemographic characteristics, or clinical factors. Participants who believed they were obese/overweight (OR = 6.70, 95% CI = 2.86, 15.72, p < 0.0001) or who were ready to lose/manage their weight (OR = 4.50, 95% CI = 1.82, 11.09, p = 0.001) had an increased likelihood of attempting to lose weight. The likelihood of attempting to lose weight increased with greater SDM with providers (OR = 1.54, 95% CI = 1.06, 2.22, p = 0.02). Patient perceptions about their weight, their readiness for weight loss/management, and SDM were associated significantly with weight loss attempts.

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OBJECTIVE: Primary care providers play an important role in obesity prevention and reduction by advising patients about weight loss strategies. This study examined receipt of provider advice to lose weight among primary care patients who were overweight and obese. METHODS: Observational study conducted among primary care patients (n = 282) who completed a survey that measured receipt of provider advice about weight loss/management, chronic health conditions, perceived weight status, and perceptions about shared decision making about weight loss/management. RESULTS: Fifty-nine percent of participants had been advised by their physician to lose weight. Participants who were obese were more likely than those who were overweight to report provider advice (odds ratio [OR] = 1.31, 95% CI = 1.25-4.34, P = .001). Similarly, participants who believed they were obese/overweight had a greater likelihood of reporting provider advice compared with those who did not believe they were obese/overweight (OR = 1.40, 95% CI = 2.43-6.37, P = .0001). Shared decision making about weight loss/management was associated with an increased likelihood of reporting provider advice (OR = 3.30, 95% CI = 2.62-4.12, P = .0001). CONCLUSIONS: Patient beliefs about their weight status and perceptions about shared decision-making are important to receiving provider advice about weight loss/management among primary care patients. PRACTICE IMPLICATIONS: Continued efforts are needed to enhance provider advice about weight loss/management among obese/overweight patients.

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Implementing behavioral interventions for cardiovascular risk reduction and weight management is challenging in primary care. Primary care patients and providers were recruited for qualitative interviews to identify priorities and preferences for addressing weight management. Thematic analysis was used to identify relevant resources, barriers to lifestyle modification, health behavior change, and implementation of weight management strategies into care. Patients and providers prioritized increasing physical activity and healthy diets when managing chronic disease; and reported decreased patient motivation, knowledge, and limited organizational capacity and time among providers to deliver intensive interventions. Providers and patients disagreed regarding who owns accountability for weight management.

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As guidelines for prostate cancer screening have changed from an annual screening recommendation starting at age 50 to discussing the benefits and harms of screening with health care providers, it is necessary to examine other types of factors that are important to prostate cancer screening decisions among African American men. Perceived risk of developing cancer has been shown to predict cancer control behaviors and is lower among African Americans. We characterized perceived risk of developing prostate cancer among African American men from November 2009 to 2011 and evaluated the relationship between prostate cancer risk perceptions and sociodemographic characteristics, health care experiences, and knowledge and exposure to health information about cancer. Chi square tests and logistic regression were employed to determine independent associations. Overall, men did not believe they were at increased risk of developing prostate cancer; they believed their risk was equivalent to or lower than men the same age. Perceived risk of prostate cancer was associated with income (OR = 0.59, 95% CI = 0.26, 1.34, p = 0.03), hypertension (OR = 2.68, 95% CI = 1.17, 6.16, p = 0.02), and beliefs about the association between race and cancer risk (OR = 2.54, 95% CI = 1.24, 5.20, p = 0.01). Clinic and community-based approaches to improve prostate cancer risk comprehension among African American men are needed to reduce the discordance between perceived risk and epidemiological data on prostate cancer risk factors. Risk education interventions that are developed for African American men may need to integrate information about susceptibility for multiple diseases as well as address strategies for risk reduction and prevention, and chronic disease management.

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Prior research and systematic reviews have examined strategies related to weight management, less is known about lifestyle and behavioral counseling interventions optimally suited for implementation in primary care practices generally, and among racial and ethnic patient populations. Primary care practitioners may find it difficult to access and use available research findings on effective behavioral and lifestyle counseling strategies and to assess their effects on health behaviors among their patients. This systematic review compiled existing evidence from randomized trials to inform primary care providers about which lifestyle and behavioral change interventions are shown to be effective for changing patients' diet, physical activity and weight outcomes. Searches identified 444 abstracts from all sources (01/01/2004-05/15/2014). Duplicate abstracts were removed, selection criteria applied and dual abstractions conducted for 106 full text articles. As of June 12, 2015, 29 articles were retained for inclusion in the body of evidence. Randomized trials tested heterogeneous multi-component behavioral interventions for an equally wide array of outcomes in three population groups: diverse patient populations (23 studies), African American patients only (4 studies), and Hispanic/Mexican American/Latino patients only (2 studies). Significant and consistent findings among diverse populations showed that weight and physical activity related outcomes were more amenable to change via lifestyle and behavioral counseling interventions than those associated with diet modification. Evidence to support specific interventions for racial and ethnic minorities was promising, but insufficient based on the small number of studies.

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Photovoice was used as a participatory research method to document perceived local environmental hazards, pollution sources, and potential impact on health among community members to address environmental health disparities. A convenience sample of 16 adults in Orangeburg, South Carolina participated in Photovoice. Photos depicted positive and negative implications of the environment across seven themes: recreation and leisure; food access; hazards and pollution; health, human, and social services; economic issues; beautification; and accommodation and accessibility. Positive and negative photos demonstrated a high level of interest among community members in considering how the environment influences health and health disparities.

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Since prostate cancer continues to disproportionately affect African American men in terms of incidence, morbidity, and mortality, prostate-specific antigen (PSA) screening plays an important role in early detection, especially when men engage in informed decision making to accept or decline this test. The authors evaluated utilization of PSA testing among African American men based on factors that are important components of making informed decisions. Utilization of PSA testing was evaluated based on whether men had ever had PSA testing and PSA testing during the past year in a community-based sample of African American men ages 50 to 75 ( n = 132). Overall, 64% of men ( n = 85) reported that they had ever had a PSA test; the mean ( SD) age for first use of PSA testing was 47.7 ( SD = 7.4). The likelihood of ever having a PSA test increased significantly with physician communication (odds ratio [OR] = 14.2; 95% confidence interval [CI] = 4.20, 48.10; p = .0001) and with having an annual household income that was greater than $20,000 (OR = 9.80; 95% CI = 3.15, 30.51; p = .0001). The odds of ever having a PSA test were also decreased with each unit increase in future temporal orientation (OR = 0.66; 95% CI = 0.47, 0.93; p = .02). Of the men who had ever had PSA testing, 57% were screened during the past year. Only health insurance status had a significant independent association with having annual PSA testing (OR = 5.10; 95% CI = 1.67, 15.60; p = .004). Different factors were associated significantly with ever having PSA testing and annual testing among African American men. African American men may not be making an informed decision about prostate cancer screening.

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INTRODUCTION: Many factors influence women's decisions to participate in guideline-recommended screening mammography. We evaluated the influence of women's socioeconomic characteristics, health-care access, and cultural and psychological health-care preferences on timely mammography screening participation. MATERIALS AND METHODS: A random digit dial survey of United States non-Hispanic Black, non-Hispanic White, and Hispanic women aged 40-75, from January to August 2009, determined self-reported time of most recent mammogram. Screening rates were assessed based on receipt of a screening mammogram within the prior 12 months, the interval recommended at the time by the American Cancer Society. RESULTS: Thirty-nine percent of women reported not having a mammogram within the last 12 months. The odds of not having had a screening mammography were higher for non-Hispanic White women than for non-Hispanic Black (OR = 2.16, 95% CI = 0.26, 0.82, p = 0.009) or Hispanic (OR = 4.17, 95% CI = 0.12, 0.48, p = 0.01) women. Lack of health insurance (OR = 3.22, 95% CI = 1.54, 6.73, p = 0.002) and lack of usual source of medical care (OR = 3.37, 95% CI = 1.43, 7.94, p = 0.01) were associated with not being screened as were lower self-efficacy to obtain screening (OR = 2.43, 95% CI = 1.26, 4.73, p = 0.01) and greater levels of religiosity and spirituality (OR = 1.42, 95% CI = 1.00, 2.00, p = 0.05). Neither perceived risk nor present temporal orientation was significant. DISCUSSION: Odds of not having a mammogram increased if women were uninsured, without medical care, non-Hispanic White, older in age, not confident in their ability to obtain screening, or held passive or external religious/spiritual values. Results are encouraging given racial disparities in health-care participation and suggest that efforts to increase screening among minority women may be working.

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RATIONALE: The U.S. Preventive Services Task Force recommends annual low-dose computed tomography (LDCT) for lung cancer screening in high-risk individuals. Preventive healthcare is provided predominantly by primary care providers (PCPs). Successful implementation of a screening program requires acceptance and participation by both providers and patients, with available collaboration with pulmonologists. OBJECTIVES: To identify perceptions of and perspectives on lung cancer screening and implementation among PCPs and eligible veteran patients at high risk for lung cancer. METHODS: We conducted a qualitative study using grounded theory in which 28 veterans and 13 PCPs completed a questionnaire and participated in focus groups. Sessions were recorded, transcribed verbatim, and analyzed with NVivo 10 software. Counts and percentages were used to report questionnaire results. MEASUREMENTS AND MAIN RESULTS: While 58% percent of providers were aware of lung cancer screening guidelines, many could not recall the exact patient eligibility criteria. Most patients were willing to undergo LDCT screening and identified smoking as a risk factor for lung cancer, but they did not recall their PCP explaining the reason for the testing. All providers assessed smoking behavior, but only 23% referred active smokers for formal cessation services. Patients volunteered information regarding their hurdles with smoking cessation while discussing risk factors for cancer. PCPs cited time constraints as a reason for lack of appropriate counseling and shared decision making. Both parties were willing to explore modalities and decision aid tools to improve shared decision making; however, while patients were interested in individual risk prediction, few PCPs believed statistical approaches to counseling would confuse patients. CONCLUSIONS: While patients and providers are receptive to LDCT screening, efforts are needed to improve guideline knowledge and adherence among providers. System-level interventions are necessary to facilitate time and resources for shared decision making and smoking cessation counseling and treatment. Further research is needed to identify optimal strategies for effective lung cancer screening in the community.

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IMPORTANCE: Precision medicine is an approach to detecting, treating, and managing disease that is based on individual variation in genetic, environmental, and lifestyle factors. Precision medicine is expected to reduce health disparities, but this will be possible only if studies have adequate representation of racial minorities. OBJECTIVE: It is critical to anticipate the rates at which individuals from diverse populations are likely to participate in precision medicine studies as research initiatives are being developed. We evaluated the likelihood of participating in a clinical study for precision medicine. DESIGN, SETTING, PARTICIPANTS: Observational study conducted between October 2010 and February 2011 in a national sample of African Americans. MAIN OUTCOME MEASURE: Intentions to participate in a government sponsored study that involves providing a biospecimen and generates data that could be shared with other researchers to conduct future studies. RESULTS: One third of respondents would participate in a clinical study for precision medicine. Only gender had a significant independent association with participation intentions. Men had a 1.86 (95% CI = 1.11, 3.12, p = 0.02) increased likelihood of participating in a precision medicine study compared to women in the model that included overall barriers and facilitators. In the model with specific participation barriers, distrust was associated with a reduced likelihood of participating in the research described in the vignette (OR = 0.57, 95% CI = 0.34, 0.96, p = 0.04). CONCLUSION AND RELEVANCE: African Americans may have low enrollment in PMI research. As PMI research is implemented, extensive efforts will be needed to ensure adequate representation. Additional research is needed to identify optimal ways of ethically describing precision medicine studies to ensure sufficient recruitment of racial minorities.

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BACKGROUND: The premise of community advocacy is to empower residents by increasing their capacity to address and change neighborhood and structural factors that contribute to adverse health outcomes. An underlying assumption is that community residents will advocate for public policy and other changes. However, limited empirical evidence exists on community residents' perceived ability to advocate for neighborhood change. In this study, we characterized perceived neighborhood control and efficacy for neighborhood change and evaluated independent associations between efficacy and control beliefs and sociodemographic factors, community involvement, and perceptions of social environment. METHODS: Cross-sectional data from 488 African American adults were analyzed to describe efficacy and control beliefs and to characterize bivariate associations between these beliefs and sociodemographic factors, social environment, and community involvement variables. Variables with significant relationships (p < 0.10) were included in a multivariate logistic regression model to identify factors having significant independent associations with efficacy and control beliefs. RESULTS: Overall, beliefs about neighborhood control and confidence were varied, yet approximately half of residents (49 and 55 %, respectively) reported having a little control over things that happen in their neighborhood and a little confidence in their ability to change things where they live. The likelihood of reporting confidence to make neighborhood improvements increased with greater collective efficacy (OR = 1.78, 95 % CI = 1.19-1.31, p = 0.002). In addition, participants who were involved in a community organization were more likely to report confidence to improve their neighborhood (OR = 2.03, 95 % CI = 1.21-3.42, p = 0.01). CONCLUSION: Efforts are needed to improve residents' ability to become positive agents of change in their community. Creating a research infrastructure within academic community partnerships that focus on strengthening advocacy and public policy may improve resident's efficacy and ability to seek and encourage neighborhood change.

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Family health history (FHH) is the most basic form of genomic information. Although public health efforts have been made to promote FHH collection, empirical data on the extent to which community residents in rural areas actively collect FHH is limited. Therefore, we examined rates of FHH collection in a community-based sample of South Carolina residents. We conducted a structured telephone survey in a random sample of black and white South Carolina residents. Respondents were asked if they had ever actively collected FHH from relatives using an item developed by the Centers for Disease Control and Prevention. Overall, 42 % of respondents reported that they had actively collected their FHH. Blacks were significantly more likely than whites to have collected their FHH in bivariate analysis, but race did not have a significant association with FHH collection in the multivariate model (OR = 1.36, 95 % CI = 0.79, 2.35, p = 0.26). The likelihood of collecting FHH was increased among respondents whose last medical visit occurred in the past year compared to those whose last medical visit was more than 1 year ago (OR = 2.00, 95 % CI = 1.12, 3.56, p = 0.02). In addition, older respondents had a reduced likelihood of collecting their FHH (OR = 0.69, 95 % CI = 0.53, 0.90, p = .01). Lastly, women were about twice as likely as men to have collected their FHH (OR = 1.83, 95 % CI = 1.12, 2.99, p = 0.02). Greater efforts are needed to increase the collection of FHH information; these efforts may need to target men, the elderly, and individuals who have not had a recent medical visit.

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Social determinants are important to cancer screening among African Americans. To evaluate the association between social determinants (e.g., psychological characteristics, perceived social environment, cultural beliefs such as present temporal orientation) and colorectal cancer (CRC) screening among African Americans. African American adults (n = 262) ages 50-75 completed a telephone interview. Multivariate logistic regression analysis was used to identify factors having significant independent associations with CRC screening. Only 57% of respondents reported having CRC screening. The likelihood of screening increased with greater neighborhood satisfaction (OR = 1.38, 95% CI = 1.01, 1.90, p = 0.04), older age (OR = 1.75, 95% CI = 1.24, 2.48, p = 0.002), greater self-efficacy (OR = 2.73, 95% CI = 1.40, 5.35, p = 0.003), and health care provider communication (OR = 10.78, 95% CI = 4.85, 29.94, p = 0.0001). Community resources are important precursors to CRC screening and outcomes among African Americans. In addition to addressing psychological factors and patient-provider communication, efforts to ensure the availability of quality health care facilities that provide CRC screening in the neighborhoods where African Americans live are needed.

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Populations of color and low-income communities are often disproportionately burdened by exposures to various environmental contaminants, including air pollution. Some air pollutants have carcinogenic properties that are particularly problematic in South Carolina (SC), a state that consistently has high rates of cancer mortality for all sites. The purpose of this study was to assess cancer risk disparities in SC by linking risk estimates from the U.S. Environmental Protection Agency's 2005 National Air Toxics Assessment (NATA) with sociodemographic data from the 2000 US Census Bureau. Specifically, NATA risk data for varying risk categories were linked by tract ID and analyzed with sociodemographic variables from the 2000 census using R. The average change in cancer risk from all sources by sociodemographic variable was quantified using multiple linear regression models. Spatial methods were further employed using ArcGIS 10 to assess the distribution of all source risk and percent non-white at each census tract level. The relative risk (RR) estimates of the proportion of high cancer risk tracts (defined as the top 10% of cancer risk in SC) and their respective 95% confidence intervals (CIs) were calculated between the first and latter three quartiles defined by sociodemographic factors, while the variance in the percentage of high cancer risk between quartile groups was tested using Pearson's chi-square. The average total cancer risk for SC was 26.8 people/million (ppl/million). The risk from on-road sources was approximately 5.8 ppl/million, higher than the risk from major, area, and non-road sources (1.8, 2.6, and 1.3 ppl/million), respectively. Based on our findings, addressing on-road sources may decrease the disproportionate cancer risk burden among low-income populations and communities of color in SC.

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Cancer risk perceptions and cancer worry are shaped by race/ethnicity, and social, economic, and environmental factors, which in turn shape health decision-making. A paucity of studies has explored risk perceptions and worry in metropolitan areas with disparate environmental conditions and cancer outcomes. This study examined perceptions of cancer risk, neighborhood environmental health risks, and risk-reducing health behaviors among Blacks. A 59-item survey was administered to respondents in Metropolitan Charleston, South Carolina from March to September 2013. A convenience sample of males and females was recruited at local venues and community events. Descriptive statistics, bivariate analyses (Chi square tests), and logistic regression models were estimated using SAS 9.3 software. Respondents (N = 405) were 100% Black, 81% female (n = 323), and ranged from 18 to 87 years of age (M = 49.55, SD = 15.27). Most respondents reported lower perceptions of cancer risk (37%) and equated their cancer beliefs to direct or indirect (i.e. personal or family) experiences. Low perceived cancer risk (absolute risk) was significantly associated (p < .05) with non-alcohol consumption, having a colon cancer screening test, being female, and being age 25-44 or 45-64. Cancer worry was significantly associated (p < .05) with being a current smoker, having a "fair" diet, non-alcohol consumption, and having any colon cancer screening test. Perceived cancer risk is an important indicator of health behaviors among Blacks. Direct or indirect experiences with cancer and/or the environment and awareness of family history of cancer may explain cancer risk perceptions.

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BACKGROUND: Studies have demonstrated a relationship between segregation and level of education, occupational opportunities, and risk behaviors, yet a paucity of research has elucidated the association between racial residential segregation, socioeconomic deprivation, and lifetime cancer risk. OBJECTIVES: We examined estimated lifetime cancer risk from air toxics by racial composition, segregation, and deprivation in census tracts in Metropolitan Charleston. METHODS: Segregation indices were used to measure the distribution of groups of people from different races within neighborhoods. The Townsend Index was used to measure economic deprivation in the study area. Poisson multivariate regressions were applied to assess the association of lifetime cancer risk with segregation indices and Townsend Index along with several sociodemographic measures. RESULTS: Lifetime cancer risk from all pollution sources was 28 persons/million for half of the census tracts in Metropolitan Charleston. Isolation Index and Townsend Index both showed significant correlation with lifetime cancer risk from different sources. This significance still holds after adjusting for other sociodemographic measures in a Poisson regression, and these two indices have stronger effect on lifetime cancer risk compared to the effects of sociodemographic measures. CONCLUSIONS: We found that material deprivation, measured by the Townsend Index and segregation measured by the Isolation index, introduced high impact on lifetime cancer risk by air toxics at the census tract level.

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BACKGROUND: According to the US Environmental Protection Agency (EPA), Superfund is a federal government program implemented to clean up uncontrolled hazardous waste sites. Twenty-six sites in South Carolina (SC) have been included on the National Priorities List (NPL), which has serious human health and environmental implications. The purpose of this study was to assess spatial disparities in the distribution of Superfund sites in SC. METHODS: The 2000 US census tract and block level data were used to generate population characteristics, which included race/ethnicity, socioeconomic status (SES), education, home ownership, and home built before 1950. Geographic Information Systems (GIS) were used to map Superfund facilities and develop choropleth maps based on the aforementioned sociodemographic variables. Spatial methods, including mean and median distance analysis, buffer analysis, and spatial approximation were employed to characterize burden disparities. Regression analysis was performed to assess the relationship between the number of Superfund facilities and population characteristics. RESULTS: Spatial coincidence results showed that of the 29.5% of Blacks living in SC, 55.9% live in Superfund host census tracts. Among all populations in SC living below poverty (14.2%), 57.2% were located in Superfund host census tracts. Buffer analyses results (0.5mi, 1.0mi, 5.0mi, 0.5km, 1.0km, and 5.0km) showed a higher percentage of Whites compared to Blacks hosting a Superfund facility. Conversely, a slightly higher percentage of Blacks hosted (30.2%) a Superfund facility than those not hosting (28.8%) while their White counterparts had more equivalent values (66.7% and 67.8%, respectively). Regression analyses in the reduced model (Adj. R2 = 0.038) only explained a small percentage of the variance. In addition, the mean distance for percent of Blacks in the 90th percentile for Superfund facilities was 0.48mi. CONCLUSION: Burden disparities exist in the distribution of Superfund facilities in SC at the block and census tract levels across varying levels of demographic composition for race/ethnicity and SES.

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There are approximately 590,000 underground storage tanks (USTs) nationwide that store petroleum or hazardous substances. Many of these tanks are leaking, which may increase the risk of exposure to contaminants that promote health problems in host neighborhoods. Within this study, we assessed disparities in the spatial distribution of leaking underground storage tanks (LUSTs) based on socioeconomic status (SES) and race/ethnicity in South Carolina (SC). Chi-square tests were used to evaluate the difference in the proportion of populations who host a LUST compared to those not hosting a LUST for all sociodemographic factors. Linear regression models were applied to examine the association of distance to the nearest LUST with relevant sociodemographic measures. As percent black increased, the distance (both in kilometers and miles) to the nearest LUST decreased. Similar results were observed for percent poverty, unemployment, persons with less than a high school education, blacks in poverty, and whites in poverty. Furthermore, chi-square tests indicated that blacks or non-whites or people with low SES were more likely to live in LUST host areas than in non-host areas. As buffer distance increased, percent black and non-white decreased. SES variables demonstrated a similar inverse relationship. Overall, burden disparities exist in the distribution of LUSTs based on race/ethnicity and SES in SC.

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OBJECTIVES: We assessed spatial disparities in the distribution of Toxic Release Inventory (TRI) facilities in Charleston, SC. METHODS: We used spatial methods and regression to assess burden disparities in the study area at the block and census-tract levels by race/ethnicity and socioeconomic status (SES). RESULTS: Results revealed an inverse relationship between distance to TRI facilities and race/ethnicity and SES at the block and census-tract levels. Results of regression analyses showed a positive association between presence of TRI facilities and high percentage non-White and a negative association between number of TRI facilities and high SES. CONCLUSIONS: There are burden disparities in the distribution of TRI facilities in Charleston at the block and census-tract level by race/ethnicity and SES. Additional research is needed to understand cumulative risk in the region.

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