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Richmond A, Aguilar-Gaxiola S, Perez-Stable EJ, Menon U, Hughes-Halbert C, Watson KS, Greer-Smith R, Clyatt C, Tobin JN, Wilkins CH. Proceedings of the 2017 Advancing the Science of Community Engaged Research (CEnR) Conference. BMC Proc 2019; 13:3. [PMID: 31019549 PMCID: PMC6474049 DOI: 10.1186/s12919-019-0164-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To address an urgent need to advance the field of community engaged research, faculty at Vanderbilt University Medical Center and Meharry Medical College organized the national meeting "Advancing the Science of Community Engaged Research (CEnR): Innovative & Effective Methods of Stakeholder Engagement in Translational Research, Washington, DC September 14-15, 2017 (See Additional file 1). These meetings brought together a diverse group of stakeholders to share community engaged research evidence and practical knowledge for implementing new and enhancing existing research programs. The conference series' goals were: 1) to expand the scientific basis for the community engaged research field by convening researchers, community partners, patient advocacy organizations, and others to share innovative methods and strategies; 2) to engage community representatives and patient advocates in the development of new approaches in community engaged research by meaningfully involving them in the planning, as speakers and presenters, and as conference participants; and 3) to catalyze innovative community engaged research using interactive meeting methods that promote learning, support collective problem solving, and encourage new conceptual frameworks. These conferences have advanced community engagement across the translational research spectrum in biomedical research. For the 2017 meeting, described here, the overarching theme was Innovative and Effective Methods of Stakeholder Engagement in Translational Research. METHODS The forum was attended by over 210 participants. This conference used novel approaches to fulfill its objectives of participant diversity, meaningful stakeholder engagement, and eliciting varied distinct perspectives to advance the science of community engaged research. Innovative strategies for the conference included: Think Tanks focused on emerging community engaged research topics or topics in need of urgent attention. These dynamic group sessions provided for freely sharing ideas with the purpose of creating change and facilitating new research collaborations. Learning Labs offered unique opportunities to gain practical knowledge regarding innovative methods in community engaged research. Learning Labs also facilitated the wide broadcast of locally successful engagement methods with the goal of speeding the uptake and implementation of community engaged methods. Travel Scholarships were provided for twenty community and patient representatives to participate in the conference. The lack of travel funds was a significant barrier to stakeholder participation in prior community engaged research meetings. The scholarships expanded the role of community and patient representatives in setting research priorities and promoting methods development. Meaningful Engagement meant that community members and patients participated in decision making on all aspects of the conference planning, including the selection of themes, topics, and speakers, and were fully integrated into the conference as speakers, panelists, and moderators. CONCLUSIONS Community and stakeholder engagement can directly impact research by enhancing clinical trial design, increasing relevance, and increasing recruitment, accrual and retention (Staley K.: Exploring Impact: Public 53 Involvement in NHS, Public Health and Social Care Research - INVOLVE.; 2009, Johnson et al Clin Transl Sci 8:388-54 390, 2015, Joosten et al Acad Med 90:1646-1650, 2015). The 2017 Advancing the Science of Community Engaged Research meeting, Innovative and Effective Methods of Stakeholder Engagement in Translational Research facilitated meaningful engagement of diverse stakeholder groups including racial and ethnic minorities, community and patient representatives, and junior investigators. Of 210 attendees, 72 completed the evaluation, and, of those, 36% self-affiliated as community members, and 21% as patient/caregiver advocacy, faith-based, or tribal organization members. This conference 1) represented a step toward expanding the scientific basis for the community engaged research (CEnR) field; 2) catalyzed innovative community engaged research; and 3) enhanced the reach and impact of the scientific developments emerging from pioneering work in community engagement.
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Affiliation(s)
- Al Richmond
- Community Campus Partnerships for Health, Raleigh, NC 27605 USA
| | - Sergio Aguilar-Gaxiola
- Clinical Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA 95817 USA
| | - Eliséo J. Perez-Stable
- National Institute on Minority Health and Health Disparities, Bethesda, MD 20892-5465 USA
| | - Usha Menon
- University of South Florida, Tampa, FL 33612 USA
| | | | - Karriem S. Watson
- University of Illinois at Chicago Cancer Center, Chicago, IL 60612 USA
| | | | - Courtney Clyatt
- Patient-Centered Outcomes Research Institute, Washington, DC 20036 USA
| | | | - Consuelo H. Wilkins
- Vice President for Health Equity, Vanderbilt University Medical Center, Executive Director, Meharry-Vanderbilt Alliance, 1005 Dr. D.B. Todd Jr. Boulevard, Nashville, TN 37208 USA
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Ramirez AG, Holden AE, Gallion K, SanMiguel SA, Munoz E, Penedo FJ, Perez-Stable EJ, Talavera GG, Carrillo JE, Fernandez ME. Abstract PD08-05: Spanning the Continuum to assess, serve and navigate Latinas with breast cancer: A Tale of Six Projects. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-pd08-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Breast cancer is the most commonly diagnosed cancer among Latinas: 14,200 diagnosed in 2009. Groundbreaking work has shown that patient navigation may assist minority patients to negotiate the Cancer Care Continuum. Here we report the efforts of Redes En Acción: The National Latino Cancer Research Network at the Institute for Health Promotion Research in San Antonio, Texas in applying these findings to Latinas.
Methods We conducted six studies to assess and address the needs and self-reported barriers to care of Latina breast cancer patients, leading to the development and controlled trial of a theory-driven, culturally appropriate patient navigation model and program. We currently are evaluating health-related quality of life and barriers to genetic testing in Latina breast cancer survivors.
Results Latinas with breast cancer face significant obstacles across the cancer care continuum, originating from multiple domains, including traditional values, timely access to care and cultural orientation. These have a direct influence on interaction with the system or indirectly via influences on existing barriers including socioeconomic marginalization and affective response to the stress of any of these.
Conclusion Although not considered as such, the Cancer Care Continuum implicitly demands consideration of the cultural underpinnings of behavior that govern interaction with it. Further research is required to understand these underpinnings. Simultaneously, culturally-sensitive services must be incorporated into the medical care system in order to ensure its successful function.
Acknowledgement This research was enabled by grants from the San Antonio Cancer Institute/Cancer Therapy and Research Center, San Antonio, Texas (P30-CA054174), Susan G. Komen for the Cure (POP 2000 704), and the National Cancer Institute via Redes En Acción (U01-CA86117 and U54 CA153511-01).
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD08-05.
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Affiliation(s)
- AG Ramirez
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - AE Holden
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - K Gallion
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - SA SanMiguel
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - E Munoz
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - FJ Penedo
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - EJ Perez-Stable
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - GG Talavera
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - JE Carrillo
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - ME Fernandez
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
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Horn-Ross PL, John EM, Lee M, Stewart SL, Koo J, Sakoda LC, Shiau AC, Goldstein J, Davis P, Perez-Stable EJ. Phytoestrogen consumption and breast cancer risk in a multiethnic population: the Bay Area Breast Cancer Study. Am J Epidemiol 2001; 154:434-41. [PMID: 11532785 DOI: 10.1093/aje/154.5.434] [Citation(s) in RCA: 173] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Research on the relation between phytoestrogens and breast cancer risk has been limited in scope. Most epidemiologic studies have involved Asian women and have examined the effects of traditional soy foods (e.g., tofu), soy protein, or urinary excretion of phytoestrogens. The present study extends this research by examining the effects of a spectrum of phytoestrogenic compounds on breast cancer risk in non-Asian US women. African-American, Latina, and White women aged 35-79 years, who were diagnosed with breast cancer between 1995 and 1998, were compared with women selected from the general population via random digit dialing. Interviews were conducted with 1,326 cases and 1,657 controls. Usual intake of specific phytoestrogenic compounds was assessed via a food frequency questionnaire and a newly developed nutrient database. Phytoestrogen intake was not associated with breast cancer risk (odds ratio = 1.0, 95% confidence interval: 0.80, 1.3 for the highest vs. lowest quartile). Results were similar for pre- and postmenopausal women, for women in each ethnic group, and for all seven phytoestrogenic compounds studied. Phytoestrogens appear to have little effect on breast cancer risk at the levels commonly consumed by non-Asian US women: an average intake equivalent to less than one serving of tofu per week.
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Affiliation(s)
- P L Horn-Ross
- Northern California Cancer Center, Union City, CA 94587, USA.
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Abstract
BACKGROUND Evidence shows that social relationships play an important role in health and health behavior. We examined the relationship between social networks and cancer screening among four U.S. Hispanic groups. METHODS We used telephone surveys to collect data in eight U.S. regions that have concentrations of diverse Hispanic-origin populations. We interviewed 8903 Hispanic adults, for a response rate of 83%; analysis was restricted to the 2383 women aged > or =40. As a measure of social integration, we formed a social network index from items on the number of close relatives and friends, frequency of contact, and church membership. We used logistic regression to estimate the effects of social integration on screening, adjusting for sociodemographic factors. RESULTS Among Mexican, Cuban, and Central-American women, the effect of social integration on mammography screening was slight. The odds ratios (OR) per unit change in social integration category ranged from 1.16 to 1.22 with confidence intervals (CI) that overlapped with the null. For Pap smear screening, the effect was strongest among Mexican-American women (OR=1.44, 95% CI=1.21 to 1.72), but also evident among Central-American women (OR=1.22, 95% CI=0.72 to 2.06) and Cuban women (OR = 1.25, 95% CI = 0.81 to 1.93). Among Puerto Rican women, social integration had no effect on either mammography (OR=1.03) or Pap smear screening (OR=1.08). CONCLUSIONS Independent of socioeconomic factors, social integration appears to influence cancer screening participation of Hispanic women. The modest effect is not universal across Hispanic groups and was stronger for Pap smear than for mammography screening behavior. Researchers should recognize Hispanic group differences in social network characteristics and the potential of social networks to change screening behavior.
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Affiliation(s)
- L Suarez
- Department of Disease Control and Prevention, Texas Department of Health, Austin, Texas, USA
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Benowitz NL, Perez-Stable EJ, Fong I, Modin G, Herrera B, Jacob P. Ethnic differences in N-glucuronidation of nicotine and cotinine. J Pharmacol Exp Ther 1999; 291:1196-203. [PMID: 10565842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
We previously reported that the metabolism of cotinine, the proximate metabolite of nicotine, is significantly slower in black than in white cigarette smokers. To understand why the metabolism of nicotine and cotinine might differ between blacks and whites, we studied the pattern of nicotine metabolism in blacks and whites. One hundred eight healthy smokers (51 blacks and 57 whites), of similar age, gender distribution, and smoking history, received an i.v. infusion of deuterium-labeled nicotine and cotinine. The clearance of cotinine, the fractional conversion of nicotine to cotinine, and the metabolic clearance of nicotine to cotinine were significantly lower in blacks than in whites. Blacks excreted significantly less nicotine as nicotine-N-glucuronide and less cotinine as cotinine-N-glucuronide than whites, but there was no difference in the excretion of 3'-hydroxycotinine-O-glucuronide. Nicotine and cotinine glucuronidation appeared to be polymorphic, with evidence of slow and fast N-glucuronide formers among blacks but was unimodal with fast conjugators only among whites. Other findings of note included the demonstration of a significant correlation between the distribution volumes of nicotine and cotinine with lean body mass: there was a smaller distribution volume and a shorter half-life for cotinine in women than in men and a smaller volume of distribution of cotinine in blacks than in whites. We conclude that the metabolism of cotinine is slower in blacks than in whites because of both slower oxidative metabolism of nicotine to cotinine (presumably via cytochrome P-450 2A6) and slower N-glucuronidation. Ethnic differences in the metabolism of other drugs undergoing N-glucuronidation should be studied.
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Affiliation(s)
- N L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center, University of California, San Francisco, 94143-1220, USA.
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Abstract
OBJECTIVES This paper provides misclassification rates for current cigarette smokers who report themselves as nonsmokers. Such rates are important in determining smoker misclassification bias in the estimation of relative risks in passive smoking studies. METHODS True smoking status, either occasional or regular, was determined for individual current smokers in 3 existing studies of nonsmokers by inspecting the cotinine levels of body fluids. The new data, combined with an approximately equal amount in the 1992 Environmental Protection Agency (EPA) report on passive smoking and lung cancer, yielded misclassification rates that not only had lower standard errors but also were stratified by sex and US minority majority status. RESULTS The misclassification rates for the important category of female smokers misclassified as never smokers were, respectively, 0.8%, 6.0%, 2.8%, and 15.3% for majority regular, majority occasional, US minority regular, and US minority occasional smokers. Misclassification rates for males were mostly somewhat higher. CONCLUSIONS The new information supports EPA's conclusion that smoker misclassification bias is small. Also, investigators are advised to pay attention to minority/majority status of cohorts when correcting for smoker misclassification bias.
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Affiliation(s)
- A J Wells
- Impact Assessment, Inc, California Department of Health Services, Environmental Health Investigations Branch, Emeryville, USA
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Kerlikowske KM, Katz MH, Chan AK, Perez-Stable EJ. Antimycobacterial therapy for disseminated Mycobacterium avium complex infection in patients with acquired immunodeficiency syndrome. Arch Intern Med 1992; 152:813-7. [PMID: 1558440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND--Antimycobacterial therapy for disseminated Mycobacterium avium complex (DMAC) in patients with acquired immunodeficiency syndrome (AIDS) may ameliorate symptoms and decrease bacteremia. However, no studies have demonstrated improved survival in patients with AIDS treated for DMAC. We assessed the effects of treatment of DMAC on the survival of patients with AIDS. METHODS--We retrospectively reviewed records of patients with AIDS and DMAC seen at two San Francisco, Calif, hospitals between January 1, 1988, and January 1, 1990. The treatment group (N = 76) consisted of patients who received 2 weeks or more of antimycobacterial therapy with at least three agents. The untreated group (N = 74) received either no therapy or isoniazid alone. Patients in both groups lived a minimum of 2 weeks after the diagnosis of DMAC. RESULTS--The median survival in the treatment group was 191 days, compared with 80 days in the untreated group. In a multivariate proportional hazards model (N = 145), both treatment of DMAC (relative hazard = 0.34; 95% confidence interval, 0.23 to 0.51) and treatment with zidovudine (relative hazard = 0.54; 95% confidence interval, 0.36 to 0.82) were associated with improved survival. CONCLUSION--Patients with AIDS and DMAC who are treated with antimycobacterial drugs may survive longer than untreated patients. We recommend that a randomized trial be conducted to evaluate the optimal treatment of DMAC.
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Affiliation(s)
- K M Kerlikowske
- Department of General Internal Medicine, Veterans Affairs Hospital, University of California, San Francisco 94143-0320
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Affiliation(s)
- E Callaway
- Department of Psychiatry, University of California, San Francisco
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Gordin FM, Perez-Stable EJ, Reid M, Schecter G, Cosgriff L, Flaherty D, Hopewell PC. Stability of positive tuberculin tests: are boosted reactions valid? Am Rev Respir Dis 1991; 144:560-3. [PMID: 1892295 DOI: 10.1164/ajrccm/144.3_pt_1.560] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To determine the stability and presumed significance of tuberculin skin tests, we followed a cohort of 380 tuberculin-positive patients living in chronic care facilities. Each patient had a positive reaction (greater than or equal to 10 mm induration to 5 tuberculin units of purified protein derivative) to one of three sequential baseline tuberculin tests. One year after the initial series, each patient had a single repeat skin test. Reversion to a negative test occurred in 98 (26%) of the 380 patients. Decreases in induration of 6 mm or more occurred in 88 (90%) of the reverters. Initially positive tests were more likely (p less than 0.001) to remain stable than tests that were "boosted" to positive reactions on the second or third initial administration. Stable responses were found in 96% of those whose tests had greater than or equal to 15 mm induration compared with 61% of those with reactions of 10 to 14 mm induration. Increasing age also was associated with a high rate of reversion. The instability of boosted tuberculin reactions brings into question the clinical significance of these tests. We propose limiting tuberculin testing to two sequential tests.
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Affiliation(s)
- F M Gordin
- Department of Medicine, Veterans Affairs Medical Center, Washington, DC 20422
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Flegal KM, Ezzati TM, Harris MI, Haynes SG, Juarez RZ, Knowler WC, Perez-Stable EJ, Stern MP. Prevalence of diabetes in Mexican Americans, Cubans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982-1984. Diabetes Care 1991; 14:628-38. [PMID: 1914812 DOI: 10.2337/diacare.14.7.628] [Citation(s) in RCA: 210] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to estimate the prevalence of diagnosed and undiagnosed diabetes among Mexican Americans, Cubans, and Puerto Ricans in the United States and compare these estimates to data from prior surveys for U.S. non-Hispanic whites and blacks. Data for this study are from the Hispanic Health and Nutrition Examination Survey, a multipurpose cross-sectional survey of three U.S. Hispanic populations conducted in 1982-1984. The interviewed sample of people aged 20-74 yr included 3935 Mexican Americans in the southwest, 1134 Cubans in Florida, and 1519 Puerto Ricans in the New York City area. The diabetes component consisted of interview questions on diabetes diagnosis and treatment and an oral glucose tolerance test administered to a subsample. The prevalence of diabetes was two to three times greater for Mexican Americans and Puerto Ricans than for non-Hispanic whites surveyed in 1976-1980. In Cubans, the prevalence was similar to that for non-Hispanic whites. In men and women 45-74 yr of age, the prevalence of diabetes was extremely high for both Mexican Americans (23.9%) and Puerto Ricans (26.1%) compared with Cubans (15.8%) or non-Hispanic whites (12%). The total prevalence of diabetes was not significantly different for Mexican Americans and Puerto Ricans but was significantly lower for Cubans. The relatively lower prevalence of diabetes among Cubans and the high prevalence in both Mexican Americans and Puerto Ricans may be related to socioeconomic, genetic, behavioral, or environmental factors.
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Affiliation(s)
- K M Flegal
- National Center for Health Statistics, Hyattsville, Maryland 20782
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Marin BV, Perez-Stable EJ, Marin G, Sabogal F, Otero-Sabogal R. Attitudes and behaviors of Hispanic smokers: implications for cessation interventions. Health Educ Q 1990; 17:287-97. [PMID: 2228631 DOI: 10.1177/109019819001700305] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The smoking behavior of Hispanics, especially Mexican Americans, has been reported to differ from that of non-Hispanic whites, in both large gender differences in prevalence as well as a lower self-reported number of cigarettes smoked per day. This study compared the responses of a convenience sample of 263 Hispanic (44% Mexican American and 38% Central American) and 150 non-Hispanic white smokers, in order to identify other ethnic; gender, and acculturation differences in smoking behaviors. Hispanic women smoked fewer cigarettes and initiated smoking at a comparatively later age than Hispanic men; they were also less likely to smoke during pregnancy than non-Hispanic white women. Hispanics smoked more cigarettes on Saturday than other days, but this was not true for non-Hispanic whites. Will power (voluntad propia) and knowing the negative effects of smoking were considered the most helpful techniques for quitting by Hispanics. Considering that light smokers are able to quit with less intensive cessation techniques, these data suggest that a properly developed health education community intervention may have an impact on smoking rates among Hispanics.
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Affiliation(s)
- B V Marin
- Division of General Internal Medicine, University of California, San Francisco 94143-0320
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Schaaf VM, Perez-Stable EJ, Borchardt K. The limited value of symptoms and signs in the diagnosis of vaginal infections. Arch Intern Med 1990; 150:1929-33. [PMID: 2393324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The etiology of vaginitis can be difficult to prove. To determine the relationship between clinical criteria (symptoms and signs) and three causes of vaginitis, we prospectively evaluated 22 criteria in 123 unselected symptomatic patients. Diagnoses of Candida albicans and Trichomonas vaginalis infection were based on culture. Bacterial vaginosis was defined by the presence of 3 of 4 clinical criteria. Only 49% of our patients received diagnoses, and itching was the only symptom more frequently noted among those with diagnoses. Symptoms did not differ among the three infections, and lack of vaginal odor in yeast infection was the only significantly different physical sign. Yeast and trichomonads were seen on microscopy in 63% and 75% of culture-positive specimens. Bacterial vaginosis had no significant clinical criteria beyond those that defined the diagnosis. We conclude that presenting symptoms and signs in vaginitis evaluation have limited value, and that half of the women with vaginitis may lack a microbiologic diagnosis.
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Affiliation(s)
- V M Schaaf
- Department of Health Policy and Administration, School of Public Health, University of California, Berkeley
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Marin G, Vanoss Marin B, Perez-Stable EJ, Vanoss B. Feasibility of a telephone survey to study a minority community: Hispanics in San Francisco. Am J Public Health 1990; 80:323-6. [PMID: 2305916 PMCID: PMC1404672 DOI: 10.2105/ajph.80.3.323] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In two random digit dialing surveys conducted among Hispanics using a modified Mitofsky-Waksberg procedure, we found low refusal rates (4.7% and 3.1%), low assumed noncontact rate (14.0% and 18.3%), and high response rates (88.6% and 88.4%) with limited investment in time (1.58 hours and 1.66 hours per completed interview). These results suggest that Hispanics are willing to participate in telephone surveys and that this method may be feasible and useful for research and evaluation purposes.
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Affiliation(s)
- G Marin
- Department of Psychology, University of San Francisco, CA 94117-1080
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Perez-Stable EJ, McMillen MM, Harris MI, Juarez RZ, Knowler WC, Stern MP, Haynes SG. Self-reported diabetes in Mexican Americans: HHANES 1982-84. Am J Public Health 1989; 79:770-2. [PMID: 2786349 PMCID: PMC1349640 DOI: 10.2105/ajph.79.6.770] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In the Hispanic Health and Nutrition Examination Survey (HHANES) of 3,928 Mexican Americans ages 20-74 years, the age-adjusted prevalence of self-reported diabetes was 6.8 percent among men and 7.6 percent among women. Comparable age-adjusted rates for the US population in a national survey were 2.9 percent in men and 3.8 percent in women. The prevalence of diabetes in Mexican Americans is greater in older age groups, was similar in men and women, and among women only was inversely associated with education.
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Affiliation(s)
- E J Perez-Stable
- Department of Medicine, University of California, San Francisco 94143-0320
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Marín G, Perez-Stable EJ, Otero-Sabogal R, Sabogal F, VanOss Marín B. Stereotypes of smokers held by Hispanic and white non-Hispanic smokers. Int J Addict 1989; 24:203-13. [PMID: 2793279 DOI: 10.3109/10826088909047284] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A group of Hispanic and White non-Hispanic smokers were asked to report the stereotypes they hold of smokers in general. All respondents tended to think that smokers were Nervous, Friendly, and Sociable; although White non-Hispanics felt more certain than Hispanics that smokers were Friendly, Aggressive, Sociable, Attractive, and Feminine. Factor analyses of the responses showed three common (across ethnicity) factors: Sociability, Self-Presentation, and Nervousness. Only the Self-Presentation factor showed statistically significant differences between the two ethnic groups. The amount of cigarettes smoked had no effect on the stereotypes but the more highly acculturated Hispanics showed stereotypes that resembled those of the White non-Hispanics.
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Affiliation(s)
- G Marín
- Department of Psychology, University of San Francisco, California 94117-1080
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Abstract
We conducted a phone survey of 1,669 San Francisco Hispanics ages 15 to 64 years. The age-adjusted overall smoking prevalence was 25.4 per cent (95% CI = 23.3, 27.5) with more men (32.4 per cent) smoking than women (16.8 per cent). Age-adjusted smoking rates were higher among the less acculturated males (37.5 vs 26.7 per cent) and among the more acculturated females (22.6 vs 13.6 per cent). The more acculturated, however, smoked a greater number of cigarettes per day independent of gender. Community-based smoking cessation interventions, adapted to local conditions, may have a greater potential for success among Hispanics.
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Affiliation(s)
- G Marin
- Department of Medicine, University of California, San Francisco 94143-0320
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Perez-Stable EJ, Flaherty D, Schecter G, Slutkin G, Hopewell PC. Conversion and reversion of tuberculin reactions in nursing home residents. Am Rev Respir Dis 1988; 137:801-4. [PMID: 3354984 DOI: 10.1164/ajrccm/137.4.801] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
To assess the consistency of tuberculin reactions over time, we performed tuberculin tests in a cohort of 495 nursing home residents in both 1982 and 1985. Significant reactions (greater than or equal to 10 mm of induration to 5 TU PPD) were found in 258 (52.1%) and 209 (42.2%) residents in 1982 and 1985, respectively. Males, nonwhites, and persons younger than 80 yr of age had a greater proportion of significant reactions (all, p less than 0.01). Of the 237 persons with nonsignificant reactions in 1982, 15 (6.3%) had a significant reaction in 1985. None of the 15 converters was found to have current tuberculosis. Tuberculin reversions occurred in 64 (24.8%) of 258 persons who had significant reactions in 1982. Of the patients who had a significant reaction only after boosting in 1982, 16 of 21 (76.2%) had nonsignificant reactions with up to 3 tests in 1985. Tuberculin reactions in nursing home residents may vary over time and may not be recalled by boosting, boosted reactions may be transient, and apparent conversions may be due to an extension of the booster phenomenon.
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Gordin FM, Perez-Stable EJ, Flaherty D, Reid ME, Schecter G, Joe L, Slutkin G, Hopewell PC. Evaluation of a third sequential tuberculin skin test in a chronic care population. Am Rev Respir Dis 1988; 137:153-7. [PMID: 3122610 DOI: 10.1164/ajrccm/137.1.153] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To evaluate factors that might influence the accuracy of tuberculin tests in identifying elderly persons recently infected with Mycobacterium tuberculosis, we performed as many as 3 sequential administrations of 5 tuberculin units of purified protein derivative in 1,726 persons residing in chronic care facilities. Significant reactions (greater than or equal to 10 mm of induration) to 1 of 3 tests were found in 702 (40.7%) persons. Of these, 68% were found with Test 1, 22.5% with Test 2, and 9.5% with Test 3. Of 1,146 persons with nonsignificant reactions to Test 1, 13.8% had significant reactions on Test 2, and of 769 persons with nonsignificant reactions to Tests 1 and 2, 8.7% had significant reactions on Test 3. Males, nonwhites, and persons between 50 and 79 yr of age had a greater proportion of significant reactions for each of the first 2 tests but not for the third test. These data indicate that continued boosting of the tuberculin reaction occurs in a substantial number of persons who receive a third sequential test. Marked increases in the size of reactions caused by boosting may explain high apparent conversion rates found in facilities where the third test is delayed for one year.
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Affiliation(s)
- F M Gordin
- Department of Medicine, Veterans Administration Medical Center, Washington, D.C. 20422
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McPhee SJ, Mitchell TF, Schroeder SA, Perez-Stable EJ, Bindman AB. Training in a primary care internal medicine residency program. The first ten years. JAMA 1987; 258:1491-5. [PMID: 3625948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We surveyed all 49 graduates of the University of California, San Francisco, residency program in primary care internal medicine to determine whether they chose careers as general internists and whether training in ambulatory care at the expense of hospital-based medicine is adequate preparation for general internal medicine practice. Graduates rated adequacy of training and relevance to their current clinical practice of 87 content and skill areas on five-point Likert scales. Of the 44 respondents, 39 (89%) chose careers as general internists and five (11%) as subspecialty internists. Training in nine of 11 internal medicine disciplines (eg, cardiology) was rated as highly adequate, and the areas as highly relevant. For ten of 15 non-internal medicine areas (eg, ear, nose, and throat), mean relevance scores significantly exceeded adequacy scores, suggesting training underemphasis. Mean relevance scores also significantly exceeded adequacy scores for seven of 11 basic knowledge/skill areas (eg, patient interviewing) and 13 of 14 areas related to clinical practice (eg, quality assurance). We conclude that the vast majority of graduates of the University of California, San Francisco, primary care residency program became general internists and that, rather than feeling deficient in training in hospital-based medicine, graduates reported unmet needs for ambulatory-care experiences and skills related to general internal medicine practice.
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Abstract
To determine the optimal strategy for tuberculin testing in elderly persons, we examined two aspects of the test: (1) the concordance between tuberculin skin test readings 2 and 7 days after application, and (2) the frequency of boosting of nonsignificant reactions. Four hundred eleven nursing home residents (mean age 74.5 yr) were tested. Significant reactions (greater than or equal to 10 mm of induration to 5TU PPD) were found in 133 (32%) subjects on day 2. Men, nonwhites, and persons younger than 75 yr of age had an increased proportion of significant reactions (p less than 0.01). Tuberculin reactivity steadily declined in persons between 75 and 90 yr of age but was increased among persons age 90 to 101 yr of age. Of 380 subjects with readings on both day 2 and day 7, 96 (25%) had significant reactions on both, 23 (6%) had indurations greater than or equal to 10 mm on day 2 only, and 20 (5%) had indurations greater than or equal to 10 mm on day 7 only. Repeat testing found an additional 14 subjects whose reactions increased from less than 10 mm to greater than or equal to 10 mm (booster effect). This evaluation indicates that the most sensitive and efficient strategy for tuberculin testing consists of a single reading at day 7 followed by a second test with a reading in 48 h for persons with reactions less than 10 mm.
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Perez-Stable EJ, Slutkin G, Paz EA, Hopewell PC. Tuberculin reactivity in United States and foreign-born Latinos: results of a community-based screening program. Am J Public Health 1986; 76:643-6. [PMID: 3706591 PMCID: PMC1646768 DOI: 10.2105/ajph.76.6.643] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Because of the concern that we were underestimating the prevalence of tuberculosis within the Latino community in San Francisco, we undertook a community-based screening program directed largely towards recent immigrants. Of 1,871 intermediate-strength (5 TU) tuberculin tests applied and read, 37 per cent of the reactions were greater than or equal to 10 mm. Significant reactions were found in 53 per cent of foreign-born persons compared to 7 per cent of those born in the United States. Persons older than 20 years of age were more likely to have significant reactions compared to younger Latinos. Among the foreign-born, the frequency of significant reactions was not influenced by the length of stay in the US or a history of BCG (bacille Calmette-Guérain) vaccination. Two foreign-born children were found to have current tuberculosis. The prevalence of tuberculin reactors among US-born Latino children was 3 per cent, which suggests that undetected transmission of tuberculosis may be occurring. We conclude that Latino immigrants should be systematically screened for tuberculosis.
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Perez-Stable EJ. Immunizations for adults. West J Med 1986; 144:616-9. [PMID: 3716426 PMCID: PMC1306734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
The variability of tuberculin skin test readings among six trained and experienced readers was evaluated using a modified sliding caliper method. Each of 537 tests were read independently by two readers. There were 23 disagreements between paired readers resulting in an overall interobserver reliability of 95.7 per cent. In 82 per cent of the paired readings the results were different by 2 mm or less. The observer lack of variability was likely due to the training and experience of the readers.
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Perez-Stable EJ, Levin R, Pineda A, Slutkin G. Tuberculin skin test reactivity and conversions in United States- and foreign-born Latino children. Pediatr Infect Dis 1985; 4:476-9. [PMID: 4047959 DOI: 10.1097/00006454-198509000-00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The rate of positive tuberculin skin tests for Latino children was examined to help define high risk groups. We reviewed 330 charts of subjects, 18 years of age or younger, with one or more tuberculin (5 tuberculin units, purified protein derivative) skin test readings in a 5-year period. Overall 9% of United States-born and 53% of foreign-born Latinos had positive tuberculin tests (P less than 0.01). Repeat applications identified 35 converters and a greater proportion of United States-born Latinos were in this group (P less than 0.05). Radiographic changes on chest films consistent with active tuberculous disease were found in four of the foreign-born converters. The calculated tuberculin conversion rate of these Latinos is 15 to 30 times that of the United States general population. Unsuspected transmission of tuberculosis may be one possible explanation. We recommend that: clinicians should perform routine tuberculin skin tests in healthy Latino children whether born in the United States or in a foreign country; and active screening for tuberculosis of Latino immigrants by local health departments be conducted with appropriate funding support.
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Perez-Stable EJ. Urethritis in men. West J Med 1983; 138:426-9. [PMID: 6687967 PMCID: PMC1021507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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