Multilevel contributors to racial and ethnic inequities in the resolution of abnormal mammography results

PURPOSE

Multiple ecological levels influence racial inequities in the completion of diagnostic testing after receiving abnormal mammography results (diagnostic resolution). Yet, few studies examine more than two ecological levels. We investigated the contributions of county, imaging facility, and patient characteristics on our primary and secondary outcomes, the achievement of diagnostic resolution by (1)Black women and Latinas, and (2) the entire sample. We hypothesized that women of color would be less likely to achieve resolution than their White counterparts, and this relationship would be mediated by imaging facility features and moderated by county characteristics.

METHODS

Records for 25,144 women with abnormal mammograms between 2011 and 2019 from the Carolina Mammography Registry were merged with publicly available county data. Diagnostic resolution was operationalized as the percentage of women achieving resolution within 60 days of receiving abnormal results and overall time to resolution and examined using mixed effects logistic regression and Cox proportional hazard models, respectively.

RESULTS

Women of color with abnormal screening mammograms were less likely to achieve resolution within 60 days compared with White women (OR 0.83, CI 0.78-0.89; OR 0.74, CI.60-0.91, respectively) and displayed longer resolution times (HR 0.87, CI 0.84-0.91; HR 0.78, CI 0.68-0.89). Residential segregation had a moderating effect, with Black women in more segregated counties being less likely to achieve resolution by 60 days but lost statistical significance after adjustment. No mediators were discovered.

CONCLUSION

More work is needed to understand how imaging center and community characteristics impact racial inequities in resolution and resolution in general.

Reach and effectiveness of a centralized navigation program for patients with positive fecal immunochemical tests requiring follow-up colonoscopy

Completion rates for follow-up colonoscopies after an abnormal fecal immunochemical test (FIT) are suboptimal in federally qualified health center (FQHC) settings. We implemented a screening intervention that included mailed FIT outreach to North Carolina FQHC patients from June 2020 to September 2021 and centralized patient navigation to support patients with abnormal FITs in completing follow-up colonoscopy. We evaluated the reach and effectiveness of navigation using electronic medical record data and navigator call logs detailing interactions with patients. Reach assessments included the proportion of patients successfully contacted by phone and who agreed to participate in navigation, intensity of navigation provided (including types of barriers to colonoscopy identified and total navigation time), and differences in these measures by socio-demographic characteristics. Effectiveness outcomes included colonoscopy completion, timeliness of follow-up colonoscopy (i.e., within 9 months), and bowel prep adequacy. Among 514 patients who completed a mailed FIT, 38 patients had an abnormal result and were eligible for navigation. Of these, 26 (68%) accepted navigation, 7 (18%) declined, and 5 (13%) could not be contacted. Among navigated patients, 81% had informational needs, 38% had emotional barriers, 35% had financial barriers, 12% had transportation barriers, and 42% had multiple barriers to colonoscopy. Median navigation time was 48.5 min (range: 24-277 min). Colonoscopy completion differed across groups - 92% of those accepting navigation completed colonoscopy within 9 months, versus 43% for those declining navigation. We found that centralized navigation was widely accepted in FQHC patients with abnormal FIT, and was an effective strategy, resulting in high colonoscopy completion rates.

Economic Pressure and Intention to Complete Colorectal Cancer Screening: A Cross-Sectional Analysis Among U.S. Men

Although men's lives can be saved by colorectal cancer (CRC) screening, its utilization remains below national averages among men from low-income households. However, income has not been consistently linked to men's CRC screening intent. This study tested the hypothesis that men who perceive more economic pressure would have lower CRC screening intent. Cross-sectional data were collected via an online survey in February 2022. Men (aged 45-75 years) living in the U.S. (N = 499) reported their CRC screening intent (outcome) and their perception of their economic circumstances (predictors). Adjusted binary and ordinal logistic analyses were conducted. All analyses were conducted in March 2022. Men who perceived greater difficulty paying bills or affording the type of clothing or medical care they needed (i.e., economic strain) were less likely to have CRC screening intent (OR = 0.67, 95% CI: 0.49, 0.93). This association was no longer significant when prior screening behavior was accounted for (OR = 0.75, 95% CI: 0.52, 1.10). Contrary to our hypothesis, men who reported more financial cutbacks were more likely to report wanting to be screened for CRC within the next year (OR = 1.06, 95% CI: 1.01, 1.11). This is one of the first studies to demonstrate that men's perceptions of their economic circumstances play a role in their intent to complete early-detection screening for CRC. Future research should consider men's perceptions of their economic situation in addition to their annual income when aiming to close the gap between intent and CRC screening uptake.

Sociodemographic correlates of colorectal cancer screening completion among women adherent to mammography screening guidelines by place of birth

Introduction

Colorectal cancer screening rates in the U.S. still fall short of national goals, while screening rates for other cancer sites, such as breast, remain high. Understanding characteristics associated with colorectal cancer screening among different groups of women adherent to breast cancer screening guidelines can shed light on the facilitators of colorectal cancer screening among those already engaged in cancer prevention behaviors. The purpose of this study was to explore which demographic characteristics, healthcare access factors, and cancer-related beliefs were associated with colorectal cancer screening completion among U.S. and foreign-born women adherent to mammography screening recommendations.

Methods

Analyses of the 2015 National Health Interview Survey were conducted in 2019. A sample of 1206 women aged 50–74 who had a mammogram in the past 2 years and were of average risk for colorectal cancer was examined. Logistic regression was used to determine demographic, health service, and health belief characteristics associated with colorectal cancer screening completion.

Results

Fifty-five percent of the sample were adherent to colorectal cancer screening recommendations. Women over the age of 65 (AOR = 1.76, 95% CI 1.06–2.91), with any type of health insurance, and who were bilingual (AOR = 3.84, 95% CI 1.83–8.09) were more likely to complete screening, while foreign-born women (AOR = 0.53, 95% CI 0.34–0.83) were less likely. Cancer-related beliefs did not influence adherence. Stratified analyses by nativity revealed additional associations.

Conclusions

Demographic and health service factors interact to influence colorectal cancer screening among women completing breast cancer screening. Colorectal cancer screening interventions targeting specific underserved groups and financing reforms may enhance women’s colorectal cancer screening rates.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01694-1.

Using Facebook Advertisements for Women's Health Research: Methodology and Outcomes of an Observational Study

BACKGROUND

Recruitment of diverse populations for health research studies remains a challenge. The COVID-19 pandemic has exacerbated these challenges by limiting in-person recruitment efforts and placing additional demands on potential participants. Social media, through the use of Facebook advertisements, has the potential to address recruitment challenges. However, existing reports are inconsistent with regard to the success of this strategy. Additionally, limited information is available about processes that can be used to increase the diversity of study participants.

OBJECTIVE

A Qualtrics survey was fielded to ascertain women's knowledge of and health care experiences related to breast density. This paper describes the process of using Facebook advertisements for recruitment and the effectiveness of various advertisement strategies.

METHODS

Facebook advertisements were placed in 2 rounds between June and July 2020. During round 1, multiple combinations of headlines and interest terms were tested to determine the most cost-effective advertisement. The best performing advertisement was used in round 2 in combination with various strategies to enhance the diversity of the survey sample. Advertisement performance, cost, and survey respondent data were collected and examined.

RESULTS

In round 1, a total of 45 advertisements with 5 different headlines were placed, and the average cost per link click for each headline ranged from US $0.12 to US $0.79. Of the 164 women recruited in round 1, in total 91.62% were eligible to complete the survey. Advertisements used during recruitment in round 2 resulted in an average cost per link click of US $0.11. During the second round, 478 women attempted the survey, and 87.44% were eligible to participate. The majority of survey respondents were White (80.41%), over the age of 55 years (63.94%), and highly educated (63.71%).

CONCLUSIONS

Facebook advertisements can be used to recruit respondents for health research quickly, but this strategy may yield participants who are less racially diverse, more educated, and older than the general population. Researchers should consider recruiting participants through other methods in addition to creating Facebook advertisements targeting underrepresented populations.

Stakeholder Perspectives on Colonoscopy Navigation and Colorectal Cancer Screening Inequities

Black adults complete colonoscopies at lower rates than other groups despite increased colorectal cancer risk. Patient navigation represents a strategy to address the varied factors that influence colonoscopy completion, but few reports describe how navigation reduces racial disparities in colorectal cancer screening rates. The purpose of this study was to understand how a statewide colonoscopy navigation program addressed the challenges faced by low-income Black adults attempting to complete screening colonoscopy. A qualitative case study analysis was conducted at a participating clinical site of a statewide colonoscopy navigation program. Clinical observations, document reviews, and semi-structured interviews were conducted with patients, patient navigators, and clinical staff. Patient participants were recruited to ensure maximum variation related to gender and colonoscopy completion. Thematic coding allowed researchers to examine experiences, perceptions, and emotions related to patient navigation. In total, 31 interviews were completed between October 2014 and February 2015. Patients and patient navigators reported logistical, psychosocial, and knowledge-related barriers to colonoscopy completion. Clinical staff reports focused mostly on logistical barriers. Benefits of patient navigation also varied by participant type with clinical staff revealing positive effects on the clinic's relationships with referring specialty practices. Patient navigators address barriers that are important to patients, but often unseen by clinical staff/providers. New information about the benefits different stakeholders derive from this strategy was revealed. Together these findings provide insight into the processes associated with this strategy and novel information about the appeal of patient navigation to various stakeholders.

False-positive mammography and mammography screening intentions among black women: the influence of emotions and coping strategies

Introduction: Abnormal mammograms confirmed as benign are known as false-positive mammography (FPM) results. Research indicates that a history of FPM results may be linked to diagnostic delays in Black women, yet much of the research on FPM has focused on White women.Objectives: The purpose of this study was to examine: 1) The influence of FPM on breast cancer (BrCa) screening beliefs and intentions among Black women and 2) Whether emotional states, personality traits or coping behaviors altered the previously described relationships.Design: BrCa-free, Black women, aged 40 and older who completed screening mammograms in 2016 were recruited for a case-control study from 2016 to 2017. Women with FPM results were cases, and women with normal results served as matched controls. Print surveys assessing demographics, personality traits, emotions, BrCa screening history, BrCa beliefs, and africentric coping behaviors were mailed to participants. The final sample consisted of 118 respondents (55 cases, 63 controls). Ordinary least squares (OLS) models were constructed. Personality traits and emotions were tested as mediators and coping behaviors as moderators of the relationship between FPM results and BrCa beliefs.Results: FPM status was associated with a higher perception of barriers to mammography, and an elevated perception of barriers was associated with lower intentions to complete mammography. Collective coping behaviors functioned as a moderator and were associated with a decreased perception of mammography barriers in women with FPM results.Conclusions: FPM status had a detrimental impact on mammography intention indirectly through the perception of mammography barriers, but the use of africentric coping behaviors moderated the relationship between FPM status and perceived barriers to mammography. Culturally specific research focused on Black women is needed to explore influences on BrCa screening beliefs and mammography completion in this population.

Examining Breast Cancer Screening Behavior Among Southern Black Women After the 2009 US Preventive Services Task Force Mammography Guideline Revisions

Updated United States Preventive Services Task Force (USPSTF) and American Cancer Society mammography screening recommendations push for increased age of initiation and lengthened breast cancer screening intervals. These changes have implications for the reduction of breast cancer mortality in Black women. The purpose of this study was to examine breast cancer screening behavior in a cohort of Southern Black women after the release of the 2009 USPSTF recommendations. Surveys assessing cancer screening information were collected from members of Black churches between 2006 and 2013. The sample was restricted to women aged 40 to 74 years, who did not report a breast cancer diagnosis, or a recent diagnostic mammogram (n = 789). Percentages of women ever completing a mammogram (age 40-49) and annual mammography (age 50-74) in 2006-2009 and 2010-2013 were compared using chi-square statistics. Logistic regression models were fit to determine the predictors of adherence to pre-2010 screening guidelines. No significant changes in mammography rates were found for women in the 40-49 age group (X² = 0.42, p = 0.52) nor for those in the 50-74 age group (X² = 0.67, p = 0.41). Completing an annual clinical breast exam was a significant predictor of adherence to pre-2010 screening guidelines for both age groups (OR 19.86 and OR 33.27 respectively) and participation in education sessions (OR 4.26). Stability in mammography behavior may be a result of PCP's advice, or community activities grounded pre-2010 screening recommendations. More research is needed to understand how clinical interactions and community-based efforts shape Black women's screening knowledge and practices.

Abstract C69: Patient satisfaction and mammography intention among Black women: Contributions of patient-provider interactions

Background: Given rising breast cancer incidence rates and documented delays in completing follow-up testing among Black women, understanding factors that contribute to intention to complete the mammography screening process will be important for reducing the disproportionate burden of breast cancer in this population. Satisfaction with the mammography encounter has been routinely linked with mammography completion, but research describing the influence of patient-provider interactions on this relationship has been mixed.

Purpose: (1) To examine the connection between satisfaction with specific aspects of mammography experiences and Black women's intention to complete the mammography screening process, and (2) to determine whether discrimination or disrespect during the mammography encounter function as mediators or moderators of this relationship. We hypothesize that all aspects of patient satisfaction will positively influence mammography intention and that experiencing discrimination or disrespect will moderate this relationship.

Methods: Black women aged 40+, breast cancer free, who completed screening mammograms from January to August 2016 at participating mammography facilities in South Carolina were eligible for study inclusion. Demographic information, assessments of the women's recent screening mammography experience, and mammography intentions were collected via a paper survey tool. The Cockburn Mammography Satisfaction Scale was used to assess six aspects of satisfaction: general satisfaction, convenience and accessibility, provider interpersonal skills, patient-provider communication, physical surroundings, and perceived provider competence. Patient-provider interactions were measured using the discrimination and disrespectful office staff subscales of the Interpersonal Processes of Care Survey. Intention to complete future screening mammograms and follow-up tests were each assessed with a single item: 1) How likely are you get your next screening mammogram as scheduled? and 2) If you are asked to return for follow-up testing after your next screening mammogram, how likely are you to complete those additional tests? Multiple regression models linking each type of satisfaction to both types of mammography intention were created in STATA 13. All models controlled for survey respondents' age, education, income, health insurance status, marital status, geographic location, and history of abnormal mammograms. Moderation was tested using interaction terms created from satisfaction and patient-provider interactions variables.

Results: Analyses were limited to 129 eligible surveys with complete responses on variables of interest. None of the models describing the relationships between satisfaction and mammography screening was statistically significant. Intention to complete mammography follow-up was positively influenced by satisfaction with convenience and accessibility (R2=0.22, p=0.00), provider interpersonal skills (R2=0.21, p=0.00), and perceived provider competence (R2=0.17, p=0.02). Disrespect served as neither a mediator nor a moderator in any of the models. Discrimination did not function as a mediator, but it moderated intention to complete mammography follow-up in the three significant models. Among women experiencing discrimination, follow-up intentions increased as satisfaction increased. For women who did not encounter discrimination, follow-up intention remained constant regardless of satisfaction levels.

Discussion: Black women's experiences during and perceptions of their mammography encounters have consequences with respect to their desire to complete follow-up testing. More research is needed to understand influences on mammography follow-up in Black women.

Citation Format: Deeonna E. Farr, Heather M. Brandt, Daniela B. Friedman, Cheryl A. Armstead, Swann A. Adams, Jeanette Fulton, Douglas Bull,. Patient satisfaction and mammography intention among Black women: Contributions of patient-provider interactions [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C69.

Abstract A79: Influence of culture and religion on fatalistic cancer beliefs

Background Cancer-related beliefs, including cancer fatalism, have been shown to influence Blacks' adherence to cancer screening behaviors. Healthcare discrimination, religious beliefs, income, and education are known determinants of cancer fatalism, however, it is unclear whether other cultural and cancer-related beliefs and/or experiences play a role in fatalistic beliefs. Purpose To determine how sociodemographic characteristics, cancer-related and cultural beliefs contribute to cancer fatalism in a sample of Black adults. Methods A statewide survey was completed by 194 Black adults ≥18 years without a history of cancer from November 2014-July 2015. Sociodemographic characteristics, cancer worry, perceived cancer risk, knowing someone with cancer, mistrust in the medical system, present orientation, religious identity, and religious behaviors were assessed through the survey. Cancer fatalism was measured using a revised version of the Powe Fatalism Inventory. Multiple regression was used to analyze survey data. Results Regression analyses on 131 surveys with complete responses showed that age, income, possessing health insurance, having a present orientation, and engaging in prayer were significant predictors of fatalistic cancer beliefs (R2= 0.26, p<0.05). Discussion The results support some previously established influences on cancer fatalism; however, other influences, specifically medical mistrust, religious identification, and church attendance did not predict cancer fatalism. Cancer fatalism is not directly related to religion but may be indirectly associated with religious practices that indicate a high external locus of control. Examining the contributors of cancer-related beliefs may yield valuable information that can enhance culturally appropriate cancer communication and programming.

Citation Format: Deeonna E. Farr, Heather M. Brandt, Daniela B. Friedman, Cheryl A. Armstead, Sue P. Heiney, Swann A. Adams, Wanda Green, James R. Hébert. Influence of culture and religion on fatalistic cancer beliefs. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A79.

Abstract C03: Untangling the influence of healthcare distrust on black Americans' intention to participate in cancer prevention research

Background: Eliminating racially driven cancer inequities requires conducting research with underrepresented groups, such as Black Americans, yet research participation is not comparable with the burden of cancer in this population. Distrust of the healthcare system is often cited as a central reason for Blacks' lower cancer research participation rates. Few studies have explored whether distrust operates alone or in combination with other attitudes toward research to influence Blacks' intention to participate in cancer research. The study purpose was to explain the relationship between healthcare distrust and the intention to participate in cancer prevention research among a group of Southern Blacks. We hypothesized that healthcare distrust would be inversely related to and a significant predictor of intention to participate in cancer prevention research.

Methods: A survey tool was developed based on previous qualitative research and administered between November 2014 and July 2015. Eligible respondents identified as Black American, were 18 or older, residents of South Carolina, and had never been diagnosed with cancer. Of the 208 surveys collected, 194 met eligibility criteria. Analyses were restricted to 130 participants with complete responses. Survey items assessed participant demographics, healthcare distrust, and previous research participation. Research related attitudes/beliefs collected included positive and negative beliefs about research participation, social norms around participation, and beliefs about individual and community level outcomes of research participation. Multiple regression models were created to describe the relationship between negative beliefs about cancer prevention research and intention to participate in cancer prevention research. Analyses were conducted in STATA 13.

Results: The analytic sample was predominately female (88.5%), employed (73.9%), lived in urban areas (83.9%), and had a high school education or less (55.4%). A large proportion reported being likely or very likely to participate in cancer prevention research (83.4%) but only 34.6% reported previous participation in health research. Intention to participate in cancer prevention research had a slightly negative association with healthcare mistrust (r= -0.19). Healthcare mistrust was predictive of intention to participate in the base model (R2=0.04), but after the addition of control variables healthcare mistrust became an insignificant predictor. The model was strengthened with the addition of scales reflecting positive and negative attitudes, social norms, and outcomes related to cancer prevention research participation (R2=0.40). Except for participation outcomes, all research related beliefs were significant predictors of intention. Additional models were constructed to determine the demographic covariates of research related beliefs. Only the model describing social norms around cancer prevention research was significant (R2=0.17), with gender serving as a significant predictor of the model.

Conclusion: Although commonly referenced as a barrier to research participation among Black Americans, healthcare distrust failed to predict intention to participate in cancer prevention research. Social norms regarding participation and positive and negative attitudes toward participation in cancer prevention research were strong predictors of intention, yet beliefs about the outcomes of research had no impact on willingness to participate. This study highlights the need to explore a wider set of attitudes and beliefs in order to determine what drives intention to participate in cancer research in this population. Equally important is the need to explore influences on research participation outside of intention given the disparity between intention and participation in the study sample.

Citation Format: Deeonna E. Farr, Heather M. Brandt, Daniela B. Friedman, Cheryl A. Armstead, Sue P. Heiney, Swann A. Adams, Wanda Green, Samira Khan, James R. Hebert. Untangling the influence of healthcare distrust on black Americans' intention to participate in cancer prevention research. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C03.

Cancer Research Participation Beliefs and Behaviors of a Southern Black Population: A Quantitative Analysis of the Role of Structural Factors in Cancer Research Participation

Increasing the participation of Blacks in cancer research is a vital component of a strategy to reduce racial inequities in cancer burden. Community-based participatory research (CBPR) is especially well-suited to advancing our knowledge of factors that influence research participation to ultimately address cancer-related health inequities. A paucity of literature focuses on the role of structural factors limiting participation in cancer research. As part of a larger CBPR project, we used survey data from a statewide cancer needs assessment of a Black faith community to examine the influence of structural factors on attitudes toward research and the contributions of both structural and attitudinal factors on whether individuals participate in research. Regression analyses and non-parametric statistics were conducted on data from 727 adult survey respondents. Structural factors, such as having health insurance coverage, experiencing discrimination during health care encounters, and locale, predicted belief in the benefits, but not the risks, of research participation. Positive attitudes toward research predicted intention to participate in cancer research. Significant differences in structural and attitudinal factors were found between cancer research participants and non-participants; however, directionality is confounded by the cross-sectional survey design and causality cannot be determined. This study points to complex interplay of structural and attitudinal factors on research participation as well as need for additional quantitative examinations of the various types of factors that influence research participation in Black communities.

A comparison of a centralized versus de-centralized recruitment schema in two community-based participatory research studies for cancer prevention

Use of community-based participatory research (CBPR) approaches is increasing with the goal of making more meaningful and impactful advances in eliminating cancer-related health disparities. While many reports have espoused its advantages, few investigations have focused on comparing CBPR-oriented recruitment and retention. Consequently, the purpose of this analysis was to report and compare two different CBPR approaches in two cancer prevention studies. We utilized frequencies and Chi-squared tests to compare and contrast subject recruitment and retention for two studies that incorporated a randomized, controlled intervention design of a dietary and physical activity intervention among African Americans (AA). One study utilized a de-centralized approach to recruitment in which primary responsibility for recruitment was assigned to the general AA community of various church partners whereas the other incorporated a centralized approach to recruitment in which a single lay community individual was hired as research personnel to lead recruitment and intervention delivery. Both studies performed equally well for both recruitment and retention (75 and 88 % recruitment rates and 71 and 66 % retention rates) far exceeding those rates traditionally cited for cancer clinical trials (~5 %). The de-centralized approach to retention appeared to result in statistically greater retention for the control participants compared to the centralized approach (77 vs. 51 %, p < 0.01). Consequently, both CBPR approaches appeared to greatly enhance recruitment and retention rates of AA populations. We further note lessons learned and challenges to consider for future research opportunities.

Preventing recurrence of thromboembolic events through coordinated treatment in the District of Columbia

RATIONALE

PROTECT DC examines whether stroke navigators can improve cardiovascular risk factors in urban underserved individuals newly hospitalized for stroke or ischemic attack. Within one-year of hospital discharge, up to one-third of patients no longer adhere to secondary prevention behaviors. Adherence rates are lower in minority-underserved groups, contributing to health disparities. In-hospital programs increase use of stroke prevention therapies but may not be as successful in underserved individuals. In these groups, low literacy, limited healthcare access, and sparse community resources may reduce adherence. Lay community health workers (navigators) improve adherence in other illnesses through education and assisting in overcoming barriers to achieving desired health behaviors and obtaining needed healthcare services.

AIMS AND DESIGN

PROTECT DC is a Phase II, single-blind, randomized, controlled trial comparing in-hospital education plus stroke navigators to usual care. Atherogenic ischemic stroke and transient ischemic attack survivors are recruited from Washington, DC hospitals. Navigators meet with participants during the index hospitalization, perform home visits, and meet by phone. They focus on stroke education, medication compliance, and overcoming practical barriers to adherence. The interventions are driven by the theories of reasoned action and planned behavior.

STUDY OUTCOMES

The primary dependent measure is a summary score of four objective measures of stroke risk factor control: systolic blood pressure, low-density lipoprotein, hemoglobin Hb A1C, and antiplatelet agent pill counts. Secondary outcomes include stroke knowledge, exercise, dietary modification, and smoking cessation.

CONCLUSION

PROTECT DC will determine whether a Phase III trial of stroke navigation for urban underserved individuals to improve adherence to secondary stroke prevention behaviors is warranted.

Abstract P29: Positive Attitudes Towards Risk Factor Reduction in an Urban Underserved Population Newly Diagnosed With Stroke or TIA

Introduction: The transtheoretical model describes how people modify a problem behavior or acquire positive behaviors. The central construct is the stages of change, where behavior change is a continuum describing readiness to change: precontemplation, contemplation, preparation, action, and maintenance. People progress through these stages at varying rates, often moving back and forth along the continuum before attaining maintenance. We investigated whether urban underserved persons newly hospitalized for stroke or TIA intend to change their stroke prevention behaviors, and their belief about their premorbid behaviors.

Methods: Participants in the PROTECT DC Phase II trial of health navigation to improve adherence with secondary stroke prevention behaviors were evaluated. They met the following criteria: atherogenic ischemic stroke or TIA diagnosed within 30 days, resident of the District of Columbia, community dwelling, and able to provide informed consent. Participants were recruited at 4 hospitals, and were interviewed regarding their risk factor management intentions.

Results: In 87 participants aged 60.7 ± 12 yrs, the median NIH Stroke Scale score was 2(0-16), 45% were male, 90% were African-American. Long-term (>6 mos) medication adherence was reported by 52%, 7% reported adherence <6mos, and 32% intended to adhere during the next 6 mos. Dietary adherence >6 mos was reported by 26%, and 62% intended to start adherence. Eighty percent intended to learn more about stroke, and 94% of active smokers (30 individuals) intended to quit smoking within 6 months.

Discussion: In a sample of urban underserved hospitalized for acute stroke, a large proportion reported the intent to adhere to risk management behaviors or already believed themselves adherent. Our data suggest that this population is quite motivated to engage in the recommended behaviors. Many report adherence to medication, diet and exercise recommendations prior to stroke onset; it is unclear how these perceptions relate to current stroke prevention guidelines. Urban underserved populations are receptive to behavioral changes associated with risk reduction, acute hospitalization may provide an important opportunity to initiate and refine effective stroke prevention behaviors.

Milne, a new low-frequency antigen

A new low-incidence red cell antigen (Milne) has been detected. The antigen is inherited as an autosomal dominant and is not controlled by MNSs, Kell, Duffy, or Se. Anti-Milne is not uncommon and is often found in sera containing antibodies to other low-frequency antigens.

The utilization of human factors information by designers

Ten packaging designers were tested on three specially developed tests which required them to analyze various design situations and to construct a conceptual drawing of the equipment configuration according to design specifications. Five human factors specialists were also tested on several sub-test items. Designers appear to have little or no interest in human factors criteria or information and usually fail to consider human factors in their designs. Their analysis of design requirements is minimal and shallow. Human factors personnel reacted in a manner similar to designers in terms of overall design criteria.