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1.  Breast cancer epidemiology in blacks and whites: disparities in incidence, mortality, survival rates and histology 
Background
This study presents black-white breast cancer statistics, tumor histology and receptor status, and treatment patterns for all ages and by age groups (under 40, between ages 40 and 49, and age 50 and over).
Methods
The study used data from the National Cancer Institute (NCI) Surveillance, Epidemiology and End Results (SEER) program for the time period 1995–2004. Age-adjusted incidence, mortality, relative survival rates, tumor grade, histology and receptor status, and treatment patterns for invasive breast cancer were calculated for nine SEER cancer registries for 1995–2004.
Results
Invasive breast cancer age-adjusted incidence for black women age <40 was significantly higher than those for white women (rate ratio=1.16, 95% confidence interval=1.10–1.23). Age-adjusted mortality rate for black women age <40 was twice that for white women. Compared to white women, black women were significantly more likely to be diagnosed with regional or distant disease, have lower relative five-year survival rate, and have higher likelihood of being diagnosed with tumors with poorer prognosis. Black women were less likely to receive breast cancer surgery as part of the treatment plan.
Conclusions
Race/ethnic disparities in invasive breast cancer epidemiology, prognostic indicators, and treatment patterns exist between black and white women. The study findings support the need for innovative research, especially on the multifaceted determinants of the differential epidemiology of breast cancer. Equally importantly, there is a need for evidence-guided equal delivery of quality care to eliminate breast cancer disparities among black women.
PMCID: PMC3603001  PMID: 18507200
breast cancer; minority health; mortality; survival; receptor; tumor
2.  Analysis of Maryland Cancer Patient Participation in NCI Supported Cancer Treatment Clinical Trials 
Purpose
We examined the relationship of sociodemographic factors, urban/rural residence, and countylevel socioeconomic factors on accrual of Maryland patients with cancer to National Cancer Institute (NCI)-sponsored cancer treatment clinical trials.
Patients and Methods
Data were analyzed for the period 1999 to 2002 for 2,240 Maryland patients with cancer accrued onto NCI-sponsored treatment trials. The extent to which Maryland patients with cancer and patients residing in lower socioeconomic and/or rural areas were accrued to cancer trials and were representative of all patients with cancer in Maryland was determined. Data were obtained from several sources, including NCI’s Cancer Therapy Evaluation Program for Maryland patients with cancer in Cooperative Group therapeutic trials, Maryland Cancer Registry data on cancer incidence, and United States Census and the Department of Agriculture.
Results
For Maryland patients with cancer accrued onto NCI-sponsored treatment trials between 1999 and 2002, subgroups accrued at a higher rate included pediatric and adolescent age groups, white patients, female patients (for sex-specific tumors), patients with private health insurance, and patients residing in the Maryland National Capitol region. Moreover, between 1999 and 2002, there was an estimated annual decline (8.9% per year; P < .05) in the percentage of black patients accrued onto cancer treatment trials. Logistic regression models uncovered different patterns of accrual for female patients and male patients on county-level socioeconomic factors.
Conclusion
Results highlight disparities in the accrual of Maryland patients with cancer onto NCI-sponsored treatment trials based on patient age, race/ethnicity, geography of residence, and county-level socioeconomic factors. Findings provide the basis for development of innovative tailored and targeted educational efforts to improve trial accrual, particularly for the underserved.
PMCID: PMC3782110  PMID: 19711497
cancer; clinical trials; participation; accrual; socio-demographic; minorities; urban/rural; disparities; women’s health; men’s health
3.  A Descriptive Analysis of State Legislation and Policy Addressing Clinical Trials Participation 
Objectives
This report describes state policy and legislation related to clinical trials participation and Maryland's model to enhance clinical trial availability and participation.
Methods
Descriptive review of state policy and legislation related to coverage for clinical trials costs based on data from the National Cancer Institute (NCI) State Cancer Legislative Database, the American Cancer Society, and NCI; additionally, discussion of Maryland's comprehensive multilevel clinical trial model comprising policy initiatives, community engagement, research, education, and infrastructure support.
Results
Twenty-four states have mandated clinical trial coverage through specific legislation or agreements since 1994. Covered benefits varied among the states.
Conclusions
Besides cost and insurance barriers, there is a need to address important patient, physician and researcher, and structural barriers to clinical trial participation. Maryland provides a comprehensive model to address the multi-faceted clinical trial participation determinants as it tracks state and federal policy, documents trial barriers, and conducts community education.
PMCID: PMC3626735  PMID: 19711491
Clinical trials participation; policy; legislation; insurance coverage; Maryland clinical trials; diversity
4.  Increasing Pap Smear Utilization Among Samoan Women: Results from a Community Based Participatory Randomized Trial 
Background
We tested the effectiveness of a theory-guided, culturally tailored cervical cancer education program designed to increase Pap smear use among Samoan women residing in the U.S. Territory of American Samoa.
Methods
We used a two-group, pretest-posttest design. The sample comprised 398 Samoan women age 20 and older who we recruited from Samoan churches. Women in the intervention group received a culturally tailored cervical cancer education program in three weekly sessions. The primary outcome was self-reported receipt of a Pap smear.
Results
Overall, there was a significant intervention effect, with intervention compared with control group women twice (adjusted odds ratio = 2.0, 95% confidence interval = 1.3–3.2, p<.01) as likely to self-report Pap smear use at the posttest.
Conclusions
The findings support the efficacy of the multifaceted, theory-guided, culturally tailored community-based participatory cervical cancer education program for Samoan women in effecting positive changes in Pap smear use and cervical cancer related knowledge and attitudes.
PMCID: PMC3604739  PMID: 19711495
Pacific Islander; Samoan; minority; women's health; cancer; cervix or cervical; Papanicolaou; Pap smear; education program; intervention; randomized trial; disparities; knowledge; attitude; practice; screening; prevention and control; early detection; health behavior framework; empowerment pedagogy; Freirian pedagogy; community based participatory research
5.  Analysis of Maryland Cancer Patient Participation in NCI Supported Cancer Treatment Clinical Trials 
Purpose
We examined the relationship of sociodemographic factors, urban/rural residence, and countylevel socioeconomic factors on accrual of Maryland patients with cancer to National Cancer Institute (NCI)-sponsored cancer treatment clinical trials.
Patients and Methods
Data were analyzed for the period 1999 to 2002 for 2,240 Maryland patients with cancer accrued onto NCI-sponsored treatment trials. The extent to which Maryland patients with cancer and patients residing in lower socioeconomic and/or rural areas were accrued to cancer trials and were representative of all patients with cancer in Maryland was determined. Data were obtained from several sources, including NCI’s Cancer Therapy Evaluation Program for Maryland patients with cancer in Cooperative Group therapeutic trials, Maryland Cancer Registry data on cancer incidence, and United States Census and the Department of Agriculture.
Results
For Maryland patients with cancer accrued onto NCI-sponsored treatment trials between 1999 and 2002, subgroups accrued at a higher rate included pediatric and adolescent age groups, white patients, female patients (for sex-specific tumors), patients with private health insurance, and patients residing in the Maryland National Capitol region. Moreover, between 1999 and 2002, there was an estimated annual decline (8.9% per year; P < .05) in the percentage of black patients accrued onto cancer treatment trials. Logistic regression models uncovered different patterns of accrual for female patients and male patients on county-level socioeconomic factors.
Conclusion
Results highlight disparities in the accrual of Maryland patients with cancer onto NCI-sponsored treatment trials based on patient age, race/ethnicity, geography of residence, and county-level socioeconomic factors. Findings provide the basis for development of innovative tailored and targeted educational efforts to improve trial accrual, particularly for the underserved.
doi:10.1200/JCO.2007.14.6027
PMCID: PMC3602973  PMID: 18612153
cancer; clinical trials; participation; accrual; socio-demographic; minorities; urban/rural; disparities; women’s health; men’s health
6.  Recruitment and Participation In Clinical Trials: Socio-Demographic, Rural/Urban, and Health Care Access Predictors 
Background
Recruitment and participation in clinical trials by minorities, particularly African Americans and rural underserved populations, are low. This report examines predictors of clinical trial recruitment and participation for adult Marylanders.
Methods
A cross-sectional design was used to survey 5,154 adults (18 years and older) residing in 13 of the 24 jurisdictions in Maryland, including urban Baltimore City, and the rural regions of Western Maryland and the Eastern Shore. The survey, conducted between December 2001 and March 2003, used Computer-Assisted Telephone Interviewing and random-digit dialing procedures. Primary dependent variables included “ever asked to participate” (i.e., recruited) and “participated” in clinical trials.
Results
11.1% of the respondents had been recruited to clinical trials. In addition, 59.4% of the respondents recruited to clinical trials actually participated in a clinical trial. Among respondents recruited to clinical trials, black and middle income respondents were significantly less likely to actually participate in clinical trials; whereas, respondents who received information about clinical trials from their health care provider, who were knowledgeable about clinical trials, and those who had the time commitment were significantly more likely to participate in clinical trials.
Conclusions
These results suggest serious gaps in efforts to recruit racial/ethnic minorities and residents of rural regions into clinical trials. The findings provide the basis for the development and implementation of community-based educational programs for both the general public and health care professionals, and to enhance availability of community-based clinical trials, especially in the rural areas of the state.
doi:10.1016/j.cdp.2005.12.001
PMCID: PMC3276312  PMID: 16495020
clinical trial; cancer disparities; patient selection; research participant recruitment; patient participation; rural or urban population; minority groups; neoplasm; knowledge; attitudes; source of information
7.  Clinical Trials – The Art of Enrollment 
Seminars in Oncology Nursing  2008;24(4):262-269.
Objectives
Enrollment barriers and multidisciplinary approaches to increase cancer trials participation are presented. Recruitment barriers, research in Maryland, and a Best Practice for cancer trials are discussed.
Data Sources
Journal and research articles, web sites.
Conclusion
Clinical trials have produced prevention and care advances for cancer and other diseases. Trial enrollment is lower for minorities and underserved communities. A comprehensive program for addressing enrollment barriers should incorporate research on barriers, multidisciplinary teams, and education and trial infrastructure in community settings.
Implications for Nursing Practice
Health disparities training, including culturally appropriate enrollment approaches for education and retention of underserved communities, should incorporate community stakeholders and nurse/physician researchers.
doi:10.1016/j.soncn.2008.08.006
PMCID: PMC3262589  PMID: 19000600
clinical trials enrollment; barriers; accrual; minority and underserved
9.  A Randomized Trial Comparing Web-Based Decision Aids on Prostate Cancer Knowledge for African-American Men 
Objectives
Few decision aids are tailored for African-American men. We sought to determine if web-based decision aids increased knowledge of prostate cancer screening among African men.
Methods
This postintervention, quasiexperimental research measured knowledge of prostate cancer screening among African-American men following receipt of 1 of 2 web-based decision aids: enhanced or usual care. Men ages 40–65 were recruited at the annual convention of the Prince Hall Masons in the summer of 2007, which was attended by 1,170 masons. The primary outcome was knowledge of prostate cancer screening.
Results
There were 87 participants in the sample with a mean age of 52 years (standard deviation=6.9). Forty-six masons were randomized to the enhanced decision aid, and 41 masons were randomized to the usual care decision aid. Knowledge scores were statistically significantly higher among the men receiving the enhanced decision aid compared to the usual care decision aid after simultaneously adjusting for age, educational level, marital status, family history, previous prostate specific antigen test and digital rectal exam (p=0.01).
Conclusion
We found evidence that the enhanced web decision aid was significantly more effective than the usual care decision aid in promoting knowledge of the benefits, limitations and risks of prostate cancer screening. Web-based sites may be effective in facilitating discussions about screening between patients and health care providers.
PMCID: PMC3883720  PMID: 18942274
African Americans; prostate cancer; screening
10.  Esophageal cancer epidemiology in blacks and whites: racial and gender disparities in incidence, mortality, survival rates and histology. 
BACKGROUND: Esophageal cancer rate disparities are pronounced for blacks and whites. This study presents black-white esophageal cancer incidence, mortality, relative survival rates, histology and trends for two five-year time periods--1991-1995 and 1996-2000--and for the time period 1991-2000. METHODS: The study used data from the National Cancer Institute's population-based Surveillance Epidemiology End Results (SEER) program with submission dates 1991-2000. Age-adjusted incidence, mortality, relative survival rates and histology for esophageal carcinoma were calculated for nine SEER cancer registries for 1991-2000. Rates were analyzed by race and gender for changes over specified time periods. RESULTS: Esophageal cancer age-adjusted incidence of blacks was about twice that of whites (8.63 vs. 4.39/100,000, p < 0.05). Age-adjusted mortality for blacks, although showing a declining trend, was nearly twice that of whites (7.79 vs. 3.96, p < 0.05). Although survival was poor for all groups, it was significantly poorer in blacks than in whites. Squamous cell carcinoma was more commonly diagnosed in blacks and white females, whereas adenocarcinoma was more common among white males (p < 0.001). CONCLUSIONS: Racial disparities in esophageal cancer incidence, mortality, survival and histology exist. Survival rates from this disease have not significantly improved over the decade. These data support the need for advances in prevention, early detection biomarker research and research on new, more effective treatment modalities for this disease.
Images
PMCID: PMC2594901  PMID: 16334494
11.  Needs and Preferences for Receiving Mental Health Information in an African American Focus Group Sample 
Community mental health journal  2008;45(2):117-126.
The purpose of this study is to better understand the mental health/illness information and service delivery preferences among African American residents of Baltimore. We conducted four focus groups (n=42) among African American adults currently unconnected with the mental health system. Participants expressed fear of stigma and perceptions of racism as major barriers to seeking information and/or services and discussed some normalizing strategies to address these barriers. African Americans harbor cultural and traditional beliefs regarding mental illness which could also act as barriers. Findings have implications for imparting acceptable and culturally-sensitive mental health education and service delivery programs in community settings.
doi:10.1007/s10597-008-9157-4
PMCID: PMC3618894  PMID: 18633704
mental health; minority health; help-seeking; stigma; health information; qualitative research
12.  Results of a randomized trial to increase mammogram usage among Samoan women 
Background
There are no effective breast cancer education programs targeting Samoan women. We tested the effectiveness of a theory-guided, culturally appropriate breast cancer education program (the intervention) designed to increase mammography use among Samoan women.
Methods
This community-based participatory cluster-randomized controlled intervention trial used a parallel two-group design. The sample consisted of 776 women aged 42 and older who had not had a mammogram in the preceding two years. The primary outcome was self-reported mammogram use between pretest and posttest.
Results
Overall, there was no statistically significant intervention effect, although the odds of self-reported mammogram use were higher in the intervention than the control group (odds ratio [OR] 1.26, 95% CI [0.74, 2.14], p = 0.39). Exploratory subgroup analyses found that the intervention was effective only among women who were aware of mammograms but had never previously obtained one (OR 1.99, 95% CI [1.03, 3.85], p = 0.04). Low need for social support and lack of endorsement of culture-specific beliefs about breast cancer were associated with mammogram use in this group. In women unaware of mammography at pretest, high perceived susceptibility to breast cancer and endorsement of culture-specific beliefs were associated with mammogram use. For women who had previously obtained a mammogram, lower self-efficacy was associated with mammogram use. Intervention compared with control group women had significantly higher levels of knowledge of risk factors and lower endorsement of culture-specific beliefs at posttest.
Conclusions
Results suggest that a multifaceted education intervention may improve mammogram usage for certain subgroups of Samoan women.
doi:10.1158/1055-9965.EPI-07-0148
PMCID: PMC3612893  PMID: 18086763
breast cancer screening; Samoan; Pacific Islander; minority; women’s health; community-based participatory research; mammography; education program; field trial; culture; behavior theory; education theory; education intervention

Results 1-12 (12)