Background: There is a substantial racial/ethnic disparity in female breast cancer mortality in Chicago between Non-Hispanic Black (NHBlack) and Hispanic patients compared to their Non-Hispanic White (NHWhite) counterparts. This observation prompted a multilevel examination of factors that might account for the disparity, with the goal of identifying potential policy interventions that might meaningfully address it Methods: In the Breast Cancer Care in Chicago study, 411 NHBlack, 397 NHWhite and 181 Hispanic patients diagnosed between the ages of 30–79 were interviewed, and medical records were abstracted information on screening and diagnostic follow-up. We conducted a multilevel analysis to assess the role of neighborhood context, patient resources, facility characteristics and mode of detection in determining the disparity in later stage at diagnosis. Results: After adjustment for neighborhood context, mode of detection and facility accreditation/resources, there was no significant disparity in later stage breast cancer diagnosis between NHBlack or Hispanic patients compared to NHWhite patients. Conclusion: The results suggest that racial/ethnic differences in mode of detection and facility accreditation/resources account for most of the disparity in stage at diagnosis. Understanding the causes of differential screen-detection and access to highly accredited facilities could inform interventions to meaningfully address this disparity. Impact: Multilevel approaches to studying health disparities are becoming the research standard for understanding and addressing health disparities. Optimal design of multilevel interventions addressing disparities in later stage diagnosis would benefit from enhanced understanding of pathways to detection and diagnosis available to patients in medically underserved communities.
Background The United States Preventive Services Task Force (USPSTF) endorses routine screening for genetic risk for breast/ovarian cancer as a component of primary healthcare. Implementation of this recommendation may prove challenging, especially in clinics serving disadvantaged communities. Methods We tested the feasibility of implementing the USPSTF mandate at a Federally Qualified Health Center (FQHC) in order to identify women eligible for genetic counseling (GC). A 12-month usual care phase was followed by a 12-month enrollment phase, during which cancer genetic risk assessment (CGRA) was systematically performed for all women age 25–69 years presenting for an annual exam. Women eligible for GC were recruited to participate in the study. Results After initiating CGRA, 112 women eligible for GC consented to study participation, and 56% of them received a referral for counseling from their PCP. A subgroup of 50 participants were seen by the same PCP during both the usual care and the enrollment phases. None of them were referred for counseling during usual care, compared to 64% after initiation of CGRA (p< 0.001). Only 16% of referred participants attended a GC session. Conclusion Implementing USPSTF recommendations for CGRA as a standard component of primary healthcare is feasible in FQHCs and improves referral of minority women for genetic counseling, but more work is needed to understand the beliefs and barriers that prevent many underserved women from accessing cancer genetic services.
Few victims of sexual harassment at work file complaints. The current study looks at ways in which the organizational climate, including trust in the system and fear of reprisal, impacts victim decisions to file complaints. A military sample offers the advantage of a work context with formalized reporting processes and a highly segregated and gendered work environment. The findings indicate that fear of coworker backlash keeps victims from seeking organizational relief. Such non-formal consequences of reporting should be addressed in future workplace sexual harassment policies. The findings also suggest that widespread mishandling of complaints erodes trust in the grievance process, which may in turn influence future responses to sexual harassment. The discussion highlights the limitations of current cross-sectional research designs for identifying the causal order of this trust-filing relationship and suggests ways in which future quantitative studies may be designed to gain a broader understanding of the dynamic relationship between organizational context and victim response.
While most research has examined the long-term effects of alcohol consumption on health, the current study examines how health status impacts on drinking behavior. Using data from a national study conducted between 2010 and 2011 to assess the impact of the recession on drinking behavior, this study examines how economic hardships linked to the recent economic recession affect physical health, and how physical health may in turn affect alcohol use. Structural equation models were used to test the predicted associations. The data demonstrate that many of the economic stressors linked to the recession are associated with increased somatic symptoms. Somatic symptoms are also associated with increased drinking for men, but not for women. These findings suggest that men may use alcohol to self medicate somatic symptomatology. The current findings are consistent with gender role-based explanations that account for gender disparities in the utilization of medical care.
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