Exploring Asian Indian and Pakistani views about cancer and participation in cancer genetics research: toward the development of a community genetics intervention

Variations in racial and ethnic groups' trust in researchers associated with willingness to participate in research

Low enrollment in U.S. biomedical research by non-White adults has historically been attributed to mistrust, but few studies have simultaneously examined dimensions of trust in three or more racial/ethnic groups. Leveraging the racial/ethnic diversity of New Jersey, we prospectively recruited 293 adults (72% women, 38% older than 54 years of age) between October 2020 and February 2022 to complete two anonymous surveys in English or one of the common languages (e.g., Spanish, Mandarin Chinese). The first consisted of 12 Likert Scale questions related to trust in biomedical researchers (according to safety, equity, transparency), and the second assessed willingness to consider participation in eight common research activities (health-related survey, blood collection, genetic analysis, medication study, etc). Participants self-reported as Hispanic (n=102), Black (n=49), Chinese (n=48), other Asian (n=53), or White (n=41) race/ethnicity. Factor analysis showed three aspects related to trust in researchers: researchers as fiduciaries for research participants, racial/ethnic equity in research, and transparency. Importantly, we observed differences in the relationship between mistrust and willingness to participate. Whereas Chinese respondents' low trust in researchers mediated their low interest in research involving more than health-related surveys, Hispanic respondents' low trust in research equity did not deter high willingness to participate in research involving blood and genetic analysis. We caution that a generic association between trust and research participation should not be broadly assumed, and biomedical researchers should prospectively assess this relationship within each minoritized group to avoid hasty generalization.

Beliefs and willingness towards participating in genetic testing for depression in low-income and racial/ethnic minority mothers at-risk

PURPOSE

To identify mothers' salient normative, behavioral and control beliefs and willingness towards participating in genetic salivary testing for depression.

DESIGN

A qualitative, descriptive design was employed. 41 multi-ethnic mothers completed surveys that underwent directed content analysis according to The Theory of Planned Behavior. Percentages and frequency counts were used to categorize responses and calculate willingness.

FINDINGS

Salient beliefs included: Behavioral: Finding a cure/treatment for depression (29.3 %), Normative: Family would approve (46.3 %), and Church associates would disapprove (19.5 %).

CONTROL

Lacking information/explanations (34.1 %) as barriers, convenient locations (24.4 %) as facilitators. Most mothers indicated a willingness to participate (90.2 %).

CONCLUSIONS

Interventions should target families, emphasize benefits, explain purposes and procedures, and use community based participatory methods.

Genetic counseling and testing for Asian Americans: a systematic review

PURPOSE

Asian Americans have been understudied in the literature on genetic and genomic services. The current study systematically identified, evaluated, and summarized findings from relevant qualitative and quantitative studies on genetic health care for Asian Americans.

METHODS

A search of five databases (1990 to 2018) returned 8,522 unique records. After removing duplicates, abstract/title screening, and full text review, 47 studies met inclusion criteria. Data from quantitative studies were converted into "qualitized data" and pooled together with thematic data from qualitative studies to produce a set of integrated findings.

RESULTS

Synthesis of results revealed that (1) Asian Americans are under-referred but have high uptake for genetic services, (2) linguistic/communication challenges were common and Asian Americans expected more directive genetic counseling, and (3) Asian Americans' family members were involved in testing decisions, but communication of results and risk information to family members was lower than other racial groups.

CONCLUSION

This study identified multiple barriers to genetic counseling, testing, and care for Asian Americans, as well as gaps in the research literature. By focusing on these barriers and filling these gaps, clinical genetic approaches can be tailored to meet the needs of diverse patient groups, particularly those of Asian descent.

Pakistan Oral Cancer Collaborative: analyzing barriers and obstacles to oral cancer diagnosis, treatment, and prevention in Pakistan

Oral cancer is a global health problem with increasing case numbers worldwide and no significant improvement in prognosis over the last few decades. It is one of the most common cancers and a leading cause of death in Pakistan, although the number reported is significantly underreported owing to the lack of a national cancer repository, and the true magnitude of this challenge is not known. Bilateral discussions and workshops funded by the Global Challenges Research Fund brought together a number of like-minded researchers and clinicians from the United Kingdom and Pakistan to analyze the status quo and plan the future course. This article reviews some of these discussions as well as barriers to oral cancer diagnosis in Pakistan and makes recommendations to investigate the magnitude and develop measures that may help tackle this devastating disease.

Public attitudes towards the genetic testing in Georgia

The aim of this study is to assess attitudes towards genetic testing in Georgian public. We used a Likert-scale written questionnaire. The survey was completed by 480 respondents. A majority of respondents (75.3%) curious about predictive genetic testing and 40.6% of participants preferred to be tested only for disorders that are treatable or preventable. Approximately 65% of the participants would like to test their newborn children for late-onset disorders and undergo preconception carrier screening (73%). In addition, the majority (59%) of our respondents were not worried that genetic testing would further stigmatize people with disabilities. These results indicate that the respondents surveyed in our study may have placed particularly high importance on the availability of genetic testing and greatly valued access to genomic information.

Exploring Asian Indian views about cancer and participation in cancer research: an evaluation of a culturally tailored educational intervention

Asian Indians (AIs) are a growing population in the United States (US) with increased cancer incidence and mortality. However, screening rates among this population are low, and the population has been underrepresented in clinical research. This pilot study aims to address gaps in the literature in order to understand if a culturally tailored educational intervention will improve knowledge, risk perceptions, and awareness of cancer risk assessments among AIs. We delivered an educational intervention comprised of culturally tailored case studies describing risk factors for developing cancer in both males and females. We assessed knowledge gaps about cancer risk and genetic testing, cancer risk perceptions, and willingness to participate in medical research studies, pre- and post-intervention. Among 23 participants, knowledge of genetic testing use and screening recommendations significantly improved post-intervention, with increased willingness to discuss cancer with family members, participate in medical research, and undergo genetic testing for cancer risk assessment. However, findings at the 1-month follow-up time did not show significant changes, except for one knowledge item. Culturally tailored educational interventions, delivered in a community setting, can influence knowledge and risk perceptions about cancer risk and genetics among AIs. Our findings lay the groundwork to continue educational efforts in the area of cancer risk and genetic testing in the AI population, a growing population that has been understudied in the US.

Asian Americans are less willing than other racial groups to participate in health research

Background

Asian Americans constitute 5% of the U.S. population. Their willingness to participate in research is important to examine because it influences participation rates and the representativeness of study results.

Methods

A total of 17,339 community members participated from six diverse Clinical and Translational Award (CTSA) sites. Community members were asked about their willingness to volunteer for eight different types of health research, their expectation of monetary compensation for research participation, their trust in research and researchers, their preferred language to receive health information, and their socio-demographic background. We examined Asian Americans' willingness to participate in various types of health research studies and compared their perceptions with other racial/ethnic groups (i.e., Asian n = 485; African-American n = 9516; Hispanic/Latino n = 1889; Caucasian n = 4760; and other minority n = 689).

Results

Compared to all other racial/ethnic groups, Asian Americans were less willing to participate in all eight types of health research. However, Asian Americans reported a lower amount of fair compensation for research participation than African-Americans and Hispanics/Latinos but were as likely to trust researchers as all other racial/ethnic groups.

Conclusion

Asian Americans are less willing to participate in health research than other racial/ethnic groups, and this difference is not due to dissatisfaction with research compensation or lower trust in researchers. Lack of trust in research and language barriers should be addressed to improve representativeness and generalizability of all populations in research.

Differences in attitudes toward genetic testing among the public, patients, and health-care professionals in Korea

With further advances in medical genetics, genetic tests to determine predisposition to disease are becoming viable for a growing number of diseases. Accordingly, it has also become important to identify various viewpoints on genetic testing. The aims of this study were to examine awareness of and attitudes toward genetic testing among the general public (public), cancer patients (patients), and health-care professionals (clinicians and researchers) in Korea. The present survey was conducted from November 2016 to February 2017. The public and patients were surveyed via face-to-face interviews conducted by trained interviewers. Health-care professionals were surveyed via self-administered questionnaires. In total, 1500 individuals from the general public, 1500 cancer patients, 113 clinicians, and 413 researchers were surveyed. Most respondents from the public and patients had previously heard about genetic testing (public, 89.4%; patients, 92.7%, p < 0.01). Differences in attitudes toward genetic testing among the public, patients, and professionals were noted, although most respondents in the present study were aware of genetic testing. Most of the cancer patients tended to overestimate the potential benefit of genetic testing, whereas clinicians expressed concerns for genetic testing. Providing correct information to people who are scheduled to undergo or order genetic testing could help in making an informed decision thereon.

Human papillomavirus vaccine initiation in Asian Indians and Asian subpopulations: a case for examining disaggregated data in public health research

OBJECTIVES

Vaccine disparities research often focuses on differences between the five main racial and ethnic classifications, ignoring heterogeneity of subpopulations. Considering this knowledge gap, we examined human papillomavirus (HPV) vaccine initiation in Asian Indians and Asian subpopulations.

STUDY DESIGN

National Health Interview Survey data (2008-2013), collected by the National Center for Health Statistics, were analyzed.

METHODS

Multiple logistic regression analysis was conducted on adults aged 18-26 years (n = 20,040).

RESULTS

Asian Indians had high income, education, and health insurance coverage, all positive predictors of preventative health engagement and vaccine uptake. However, we find that Asian Indians had comparatively lower rates of HPV vaccine initiation (odds ratio = 0.41; 95% confidence interval = 0.207-0.832), and foreign-born Asian Indians had the lowest rate HPV vaccination of all subpopulations (2.3%).

CONCLUSIONS

Findings substantiate the need for research on disaggregated data rather than evaluating vaccination behaviors solely across standard racial and ethnic categories. We identified two populations that were initiating HPV vaccine at abysmal levels: foreign-born persons and Asian Indians. Development of culturally appropriate messaging has the potential to improve these initiation rates and improve population health.