Ethnic Identity predicts loss-to-follow-up in a health promotion trial

Increasing Representation of Historically Marginalized Populations in Allergy, Asthma, and Immunologic Research Studies: Challenges and Opportunities

A growing body of epidemiological data indicates that the prevalence and public health burden of asthma and other common allergic conditions (eg, atopic dermatitis, food allergy, allergic rhinitis, and drug allergy) is greatest among certain historically marginalized populations. However, these historically marginalized populations are often under-represented in research aiming to better understand, treat, and prevent these chronic conditions, raising concerns about the generalizability of the resulting study findings to those who are most affected. In a country as heterogeneous as the United States, with respect to race and ethnicity, socioeconomic status, culture, geography, and behavior, researchers aiming to characterize the burden of allergic disease, evaluate treatments, and/or better understand its mechanisms must pay particular attention to whether their samples are sufficiently diverse and representative in order to maximize the validity-and scientific utility-of the resulting data. Therefore, the goal of this clinical commentary is to highlight the need for improved, more thoughtful representation of the full diversity of affected populations in allergy/immunology research and share best practices for study design, recruitment, retention, and data analysis, so that both the research process and products can have maximal public health impact.

Changing Health Beliefs about Breast Cancer Screening among Women in Multi-Ethnic Malaysia

This study evaluated the impact of the 'Be Cancer Alert' mass media campaign for breast cancer (BCAC-BC) in terms of changes to women's health beliefs regarding BC susceptibility and the benefits and barriers of breast cancer screening in Malaysia. Pre- and post-campaign surveys evaluated changes in health beliefs among women aged 40 years and above (n = 676). The perceived susceptibility to breast cancer was significantly higher at follow-up (mean ± SD: 7.30 ± 2.77 vs. 7.63 ± 2.58, p = 0.008) whereas the mean score for the perceived benefits of undertaking screening was high at baseline and follow-up (16.34 ± 2.36 vs. 15.95 ± 2.07, p = 0.001). The perceptions or beliefs about barriers to screening did not change significantly (31.70 ± 8.26 vs. 31.77 ± 7.63, p = 0.841). Regression analyses indicated that mean scores for the barriers subscale were significantly lower among Chinese women (-2.61, 95% CI -4.67, -0.55, p = 0.013) compared to Malay, and among single compared to married women (-2.40, 95% CI -4.60, -0.21, p = 0.032) after adjustment for other demographic variables and past screening history. Malaysian women appeared to already have positive perceptions before the BCAC-BC mass media campaign about the benefits of BC screening. However, the campaign appeared to be linked to both an increased awareness of the susceptibility to breast cancer and to positive beliefs that countered emotional barriers to screening, particularly among single women and Chinese-Malay women.

African American Manhood and self-rated health: What demographic characteristics, health conditions, and aspects of manhood matter?

Few studies have tested what aspects of manhood are associated with health. In this study, we examine how aspects of African American Manhood are related to health. Using cross-sectional data from a criterion sample of 300 African American men 35-73 years old (M = 46.53), we examined how aspects of African American Manhood, demographic characteristics, and health conditions were related to self-rated health. When we controlled for demographics, SES and health conditions, different aspects of manhood were associated with good/excellent health. Across four linear regression models, we found that the Religion and Spirituality factor was the component of African American Manhood most strongly associated with good/excellent self-rated health. The Religion and Spirituality factor was the only aspect of African American Manhood that remained significant when we controlled for SES and health conditions. Neither Reputation, Respectability, nor aspects of role strain remained significantly associated with good/excellent self-rated health when we controlled for SES and health conditions. In analyses examining the relationship between lower odds of good/excellent self-rated health and aspects of ethnic identity, only Afrocentric subscales that highlight behaviors that demonstrate a connection to Africa (e.g., celebrating Kwanzaa) and greater importance of learning about African culture or spiritual beliefs in Africa remained significant. Finally, we found that African American men who reported a body mass index in the normal range, an income level above $50,000, being employed, and having no chronic conditions were more likely to report good/excellent self-rated health than African American men who reported poor/fair health.

Computer-delivered indirect screening and brief intervention for drug use in the perinatal period: A randomized trial

BACKGROUND

Under-reporting of drug use in the perinatal period is well-documented, and significantly limits the reach of proactive intervention approaches. The Wayne Indirect Drug Use Screener (WIDUS) focuses on correlates of drug use rather than use itself. This trial tested a computer-delivered, brief intervention designed for use with indirect screen-positive cases, seeking to motivate reductions in drug use without presuming its presence.

METHODS

Randomized clinical trial with 500 WIDUS-positive postpartum women recruited between August 14, 2012 and November 19, 2014. Participants were randomly assigned to either a time control condition or a single-session, tailored, indirect brief intervention. The primary outcome was days of drug use over the 6-month follow-up period; secondary outcomes included urine and hair analyses results at 3- and 6-month follow-up. All outcomes were measured by blinded evaluators.

RESULTS

Of the 500 participants (252 intervention and 248 control), 36.1% of participants acknowledged drug use in the 3 months prior to pregnancy, but 89% tested positive at the 6-month follow-up. Participants rated the intervention as easy to use (4.9/5) and helpful (4.4/5). Analyses revealed no between-group differences in drug use (52% in the intervention group, vs. 53% among controls; OR 1.03). Exploratory analyses also showed that intervention effects were not moderated by baseline severity, WIDUS score, or readiness to change.

CONCLUSIONS

The present trial showed no evidence of efficacy for an indirect, single-session, computer-delivered, brief intervention designed as a complement to indirect screening. More direct approaches that still do not presume active drug use may be possible and appropriate.

Anxiety Contributes to Poorer Asthma Outcomes in Inner-City Black Adolescents

BACKGROUND

The factors associated with poor asthma control, exacerbations, and health care utilization in black adolescents are complex and not well understood. Although psychological comorbidities such as anxiety are common in patients with asthma, these have not been studied in this population.

OBJECTIVE

This study characterized anxiety and associated asthma features in a cohort of black inner-city adolescents with persistent asthma and determined the association between anxiety symptoms, persistent uncontrolled asthma, and prospective health care utilization over 1 year.

METHODS

Eighty-six black adolescents were enrolled, phenotyped, and screened for anxiety symptoms with the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A). Participants were telephoned every 2 months and a second study visit was completed at 1 year. Primary outcomes included persistent uncontrolled asthma, asthma exacerbations requiring systemic corticosteroids, and unscheduled health care utilization during the 1-year study period.

RESULTS

A total of 31% (n = 27) of adolescents had probable anxiety (ie, HADS-A score >7) and 27% (n = 23) had possible anxiety (ie, HADS-A score 5-7) at the baseline visit. Anxiety symptoms were associated with poorer asthma control, more impaired quality of life, and more insomnia symptoms. Adolescents with probable anxiety disorders also had increased odds of persistent uncontrolled asthma and emergency department utilization, with no differences in physician visits or systemic corticosteroid receipt.

CONCLUSIONS

Inner-city black adolescents with persistent asthma have a high prevalence of anxiety symptoms associated with poorer asthma control, impaired quality of life, insomnia, and increased prospective emergency department utilization for asthma. Routine screening for anxiety disorders may be useful in the clinical management of adolescents with asthma.

Current State and Future Trends to Optimize the Care of Chronic Kidney Disease in African Americans

BACKGROUND

African Americans (AAs) suffer the widest gaps in chronic kidney disease (CKD) outcomes compared to Caucasian Americans (CAs) and this is because of the disparities that exist in both health and healthcare. In fact, the prevalence of CKD is 3.5 times higher in AAs compared to CAs. The disparities exist at all stages of CKD. Importantly, AAs are 10 times more likely to develop hypertension-related kidney failure and 3 times more likely to progress to kidney failure compared to CAs.

SUMMARY

Several factors contribute to these disparities including genetic and social determinants, late referrals, poor care coordination, medication adherence, and low recruitment in clinical trials. Key Messages: The development and implementation of CKD-related evidence-based approaches, such as clinical and social determinant assessment tools for medical interventions, more widespread outreach programs, strategies to improve medication adherence, safe and effective pharmacological treatments to control or eliminate CKD, as well as the use of health information technology, and patient-engagement programs for improved CKD outcomes may help to positively impact these disparities among AAs.

Factors associated with age at pyeloplasty in children with ureteropelvic junction obstruction

OBJECTIVES

Our objectives were to: (1) delineate factors associated with surgery at <1 year and (2) determine if early intervention was associated with increased risk of readmission.

METHODS

We conducted a retrospective review of children age 0-18 years with a diagnosis of UPJ obstruction who underwent pyeloplasty from 1/1/1999 to 9/1/2009 using the PHIS database. Data collected included patient factors (race, gender, insurance type, APR-DRG severity of illness) and hospital factors (annual case volume, census region, academic status). Outcomes assessed were: age at surgery and hospital readmission within 1 year of surgery. Data were analyzed using logistic regression and Cox PH for multivariate analyses.

RESULTS

4499 children met study criteria. Minority race (OR 1.55), male gender (OR 1.49), public insurance (OR 1.37), high severity of illness (OR 3.60), Southern region (OR 1.44), and low hospital volume (OR 1.37) were significant predictors of early surgery (p < 0.05). Only early surgery (HR 2.42; 95% CI 1.67-3.49 2.42) was associated with increased risk of readmission.

CONCLUSIONS

In children with UPJ obstruction, age at surgery is associated with patient demographic and hospital factors. Early surgery is associated with higher rates of readmission, suggesting that variations in age at surgery may be associated with significant differences in outcomes.

The association between ethnic identity and condom use among young men in the Eastern Cape Province, South Africa

This article reports on the association between ethnic identity and condom use among Black African men in the rural areas of the Eastern Cape Province, South Africa. Individual face-to-face structured interviews were conducted by trained community research assistants among 1,656 men who had undergone traditional initiation and male circumcision. Logistic regression analyses were used to explore the association between two components of ethnic identity (cultural affiliation and cultural alienation) and condom use. Overall, 49.2 % of the participants reported using condoms consistently and, of these users, 66.4 % used them correctly. Logistic regression adjusting for age, employment status, education level, and nation of origin showed that participants who expressed high as opposed to low cultural affiliation were significantly more likely to use condoms consistently and correctly when having sex, especially if they reported to have more than one sexual partner. Cultural alienation was negatively related with consistent condom use, whereas its association with correct use was unclear. The findings of this study suggest that positively emphasizing the ethnic identity of African black men may promote condom use.

Correlates of consistent condom use among recently initiated and traditionally circumcised men in the rural areas of the Eastern Cape Province, South Africa

Background

Consistent use of condoms is the most effective method of preventing STIs including HIV. However, recent evidence suggests that limited knowledge about HIV prevention benefits from male circumcision leads to inconsistent condom use among traditionally circumcised men. The aim of this paper is to report on the prevalence of consistent condom use and identify its psychosocial correlates to inform future HIV prevention strategies among traditionally circumcised men in rural areas of the Eastern Cape Province of South Africa.

Methods

A cross-sectional study using interviewer administered fully structured questionnaires was conducted among 1656 men who had undergone initiation and traditional male circumcision in rural areas of the Eastern Cape Province of South Africa. Logistic regression was used to evaluate univariate and multivariate relationships of psychosocial correlates with consistent condom use.

Results

The mean age of the participants was 21.4 years. About 45% belonged to the amaXhosa ethnic group, followed by 15.1% of the amaMpondo, 11.6% of the amaHlubi, and 27.9% from other ethnic groups. A total of 72.3% reported having a main sexual partner and of those 44.8% indicated having other sexual partners as well. About 49% reported consistent condom use and 80% used free government issued condoms, varies among ethnic groups. A total of 35.1% indicated having tested for HIV. Of those who tested for HIV, 46% reported inconsistent condom use when having sex with their sexual partners. Univariate and multivariate analyses showed a positive association between consistent condom use and the general knowledge of condom use, attitude towards condom use with main and casual sexual partners, subjective norm towards condom use with the main sexual partner, perceived self-efficacy towards condom use, positive self-esteem, beliefs about traditional male circumcision and STI protection, attitude towards gender based violence, and cultural alienation.

Conclusions

The study findings reveal important target points for future cultural sensitive health education aimed at increasing consistent condom use among initiated and traditionally circumcised men in the Eastern Cape Province.

Characterizing researchers by strategies used for retaining minority participants: results of a national survey

Limited attention has been given to the optimal strategies for retaining racial and ethnic minorities within studies and during the follow-up period. High attrition limits the interpretation of results and reduces the ability to translate findings into successful interventions. This study examined the retention strategies used by researchers when retaining minorities in research studies. From May to August 2010, we conducted an online survey with researchers (principal investigators, research staff, and IRB members) and examined their use of seven commonly used retention strategies. The number and type of retention strategies used, how these strategies differ by researcher type, and other characteristics (e.g., funding) were explored. We identified three clusters of researchers: comprehensive retention strategy researchers - utilized the greatest number of retention strategies; moderate retention strategy researchers - utilized an average number of retention strategies; and limited retention strategy researchers - utilized the least number of retention strategies. The comprehensive and moderate retention strategy researchers were more likely than the limited retention strategy researchers to conduct health outcomes research, work with a community advisory board, hire minority staff, use steps at a higher rate to overcome retention barriers, develop new partnerships with the minority community, modify study materials for the minority population, and allow staff to work flexible schedules. This study is a novel effort to characterize researchers, without implying a value judgment, according to their use of specific retention strategies. It provides critical information for conducting future research to determine the effectiveness of using a combination of retention strategies.

Assessing the remedy: the case for contracts in clinical trials

Current orthodoxy in research ethics assumes that subjects of clinical trials reserve rights to withdraw at any time and without giving any reason. This view sees the right to withdraw as a simple extension of the right to refuse to participate all together. In this paper, however, I suggest that subjects should assume some responsibilities for the internal validity of the trial at consent and that these responsibilities should be captured by contract. This would allow the researcher to impose a penalty on the subject if he were to withdraw without good reason and on a whim. This proposal still leaves open the possibility of withdrawing without penalty when it is in the subject's best interests to do so. Giving researchers recourse to legal remedy may now be necessary to protect the science, as existing methods used to increase retention are inadequate for one reason or another.