Understanding the influence of urban- or rural-living on cardiac patients' decisions about diet and physical activity: descriptive decision modeling

Experiences With Suicide Loss: A Qualitative Study

To better understand suicide loss survivors' experiences and barriers to accessing support and mental health care, 28 (21 women and 7 men) suicide loss survivors were interviewed. Using qualitative analysis of 28 in-depth, semi-structured phone interviews data, three categories emerged: Life before Suicide, Life after Suicide, and Meaning of Life. This deeper understanding of suicide loss survivors along with inclusion of experiences of male and rural participants' suicide loss, fill previously identified research gaps. Our findings suggest importance in providing emotional support and mental health resources to those with suicide intent or experiences with suicide loss. Most importantly, the recognition of suicide loss survivors extends beyond the immediate family and includes cousins, friends, and work associates. Recognition of extended suicide loss survivors' bereavement will provide additional opportunities for healthcare providers to effectively intervene with this vulnerable population.

Understanding ethno-cultural differences in cardiac medication adherence behavior: a Canadian study

BACKGROUND

There are ethno-cultural differences in cardiac patients' adherence to medications. It is unclear why this occurs. We thus aimed to generate an in-depth understanding about the decision-making process and potential ethno-cultural differences, of white, Chinese, and south Asian cardiac patients when making the decision to adhere to a medication regimen.

METHODS

A hierarchical descriptive decision-model was generated based on previous qualitative work, pilot tested, and revised to be more parsimonious. The final model was examined using a novel group of 286 cardiac patients, using their self-reported adherence as the reference. Thereafter, each node was examined to identify decision-making constructs that might be more applicable to white, Chinese or south Asian groups.

RESULTS

Non-adherent south Asians were most likely to identify a lack of receipt of detailed medication information, and less confidence and trust in the health care system and health care professionals. Both Chinese and south Asian participants were less likely to be adherent when they had doubts about western medicine (eg, the effects and safety of the medication). Being able to afford the cost of medications was associated with increased adherence. Being away from home reduced the likelihood of adherence in each group. The overall model had 67.1% concordance with the participants' initial self-reported adherence, largely due to participants' overreporting adherence.

CONCLUSION

These identified elements of the decision-making process are generally not considered in traditionally used medication adherence questionnaires. Importantly these elements are modifiable and ought to be the focus of both interventions and measurement of medication adherence.

Built Environment Factors Influencing Walking to School Behaviors: A Comparison between a Small and Large US City

A growing body of evidence supports the association between the built environment and children walking to school (WTS), but few studies have compared WTS behaviors in cities of different sizes. This case-comparison study utilized WTS data from fourth graders in the small city of Manhattan, KS, USA (N = 171, from all eight schools) and data from fourth graders in the large city of Austin, TX, USA (N = 671 from 19 stratified-sampled schools). The same survey instrument was used in both locations. After controlling for socioeconomic and demographic variables, built environment, neighborhood, and attitudinal differences were demonstrated by the odds ratios for WTS in the small city vs. the large city. WTS in the small city was more likely to be associated with walking paths/trails and sidewalk landscape buffers en route to school despite lower perceived neighborhood social cohesion, school bus availability, and parental concerns about crime, compared to WTS in the large city. Also, the small city lacked key pedestrian infrastructure elements that were present in the large city. This study highlights important differences related to WTS behaviors and, thus, provides key insights for encouraging WTS in cities of different sizes.

The influence of neighborhood socioeconomic status and race on survival from ovarian cancer: a population-based analysis of Cook County, Illinois

PURPOSE

Despite significant improvements in treatment for ovarian cancer, survival is poorer for non-Hispanic black (NHB) women compared to non-Hispanic white (NHW) women. Neighborhood socioeconomic status (SES) has been implicated in racial disparities across a variety of health outcomes and may similarly contribute to racial disparities in ovarian cancer survival. The purpose of this analysis is to assess the influence of neighborhood SES on NHB-NHW survival differences after accounting for differences in tumor characteristics and in treatment.

METHODS

Data were obtained from 2432 women (443 NHB and 1989 NHW) diagnosed with epithelial ovarian cancer in Cook County, Illinois between 1998 and 2007. Neighborhood (i.e., census tract) SES at the time of diagnosis was calculated for each woman using two well-established composite measures of affluence and disadvantage. Cox proportional hazard models measured the association between NHB race and survival after adjusting for age, tumor characteristics, treatment, year of diagnosis, and neighborhood SES.

RESULTS

There was a strong association between ovarian cancer survival and both measures of neighborhood SES (P < .0001 for both affluence and disadvantage). After adjusting for age, tumor characteristics, treatment, and year of diagnosis, NHB were more likely than NHW to die of ovarian cancer (hazard ratio [HR] = 1.47, 95% confidence interval [CI]: 1.28-1.68). The inclusion of neighborhood affluence and disadvantage into models separately and together attenuated this risk (HRaffluence = 1.37, 95% CI: 1.18-1.58; HRdisadvantage = 1.28, 95% CI: 1.08-1.52; and HRaffluence + disadvantage = 1.28, 95% CI: 1.08-1.52.

CONCLUSIONS

Neighborhood SES, as measured by composite measures of affluence and disadvantage, is a predictor of survival in women diagnosed with ovarian cancer in Cook County, Illinois and may contribute to the racial disparity in survival.

The effect of neighborhood disadvantage on the racial disparity in ovarian cancer-specific survival in a large hospital-based study in cook county, illinois

This paper examines the effect of neighborhood disadvantage on racial disparities in ovarian cancer-specific survival. Despite treatment advances for ovarian cancer, survival remains shorter for African-American compared to White women. Neighborhood disadvantage is implicated in racial disparities across a variety of health outcomes and may contribute to racial disparities in ovarian cancer-specific survival. Data were obtained from 581 women (100 African-American and 481 White) diagnosed with epithelial ovarian cancer between June 1, 1994, and December 31, 1998 in Cook County, IL, USA, which includes the city of Chicago. Neighborhood disadvantage score at the time of diagnosis was calculated for each woman based on Browning and Cagney’s index of concentrated disadvantage. Cox proportional hazard models measured the association of self-identified African-American race with ovarian cancer-specific survival after adjusting for age, tumor characteristics, surgical debulking, and neighborhood disadvantage. There was a statistically significant negative association (−0.645) between ovarian cancer-specific survival and neighborhood disadvantage (p = 0.008). After adjusting for age and tumor characteristics, African-American women were more likely than Whites to die of ovarian cancer (HR = 1.59, p = 0.003). After accounting for neighborhood disadvantage, this risk was attenuated (HR = 1.32, p = 0.10). These findings demonstrate that neighborhood disadvantage is associated with ovarian cancer-specific survival and may contribute to the racial disparity in survival.