Objective: The impact of breast cancer is immense for all women, but the literature reveals an even greater impact on women of color and among socially and economically disadvantaged populations. Persistent differences in incidence and outcome are undoubtedly due to multiple factors, but one element in poor outcome may be treatment choice. Those treatments shown to be related to best outcomes are less likely to be chosen by certain groups of women. The effects of economic and cultural factors on breast cancer treatment choice have not been thoroughly explored; these factors must be understood if health care professionals are to intervene effectively to address disparities and improve breast cancer outcomes for all women. Methods: A review of the breast cancer literature was conducted in order to: (1) describe breast cancer disparities in the United States; (2) delineate factors that might contribute to those disparities; (3) assess possible mitigating factors for predominant causes; (4) begin to decide how health care interventions might allay the factors that contribute to disparities in breast cancer incidence and mortality. Results: Breast cancer incidence and outcome disparities in the United States are due to multiple interacting factors. These include information about treatment, different types of treatment, the emotional context of decision-making, and patient preference for level of involvement. Treatment decision-making is complex. Conclusion: Health literacy and level of decision-making involvement, both embedded in social and economic reality, are key components in breast cancer treatment decision-making and may contribute to breast cancer disparities in the United States. Current models of shared decision-making may not be generalizable to all breast cancer patients. Practice implications: Optimal breast cancer outcomes for all women depend on culturally and ethnically appropriate professional support. #

Cultural competence in health care has come to the forefront with the changing demographics in the United States. Standards have been created by the Office of Minority Health for culturally appropriate health care. This article presents the findings of one hospital system's cultural competency assessment. Employee surveys and patient and physician focus groups were conducted to gain insight into cultural differences and challenges encountered in this system. Statistically significant effects of ethnicity and gender on language skills and awareness, as well as differences in awareness and knowledge by the respondent's employment position, were found. Patient concerns included access to care and respect from staff. The need for cross-cultural education and training for all health care delivery personnel was reinforced. Cultural competency will not be achieved if education, attention to diversity, trained interpreters, and the understanding that social factors have a profound influence on health and health outcomes are not considered.

One of the fastest growing segments of the population infected with HIV is the nation's youths. Thus, prevention in this high-risk population is vital. The authors detail the process of adapting an evidence-based HIV/AIDS educational program (HIVEd) to the unique needs of high-risk youths in adjudicated and detained facilities and alternative high schools. The HIVEd program derives from St. Lawrence's Becoming A Responsible Teen (BART) curriculum. This article describes the modification of BART into HIVEd, identifies the challenges encountered and lessons learned, and suggests future directions for HIVEd as a useful tool for prevention of HIV/AIDS and sexually transmitted infection in high-risk youths.

Alcohol use among college students continues to be a major public health threat to our nation. The purpose of this study was to explore faculty perceptions of their roles and responsibilities in alcohol education and prevention. The researchers adapted the Core Faculty and Staff Environmental Alcohol and Other Drug Survey to include only questions regarding alcohol and created additional questions concerning Friday classes. The survey was sent to all faculty members (N = 1,712). Completed surveys were collected from 122 faculty members (7.1%). The majority (95%) agreed that institutions of higher education should be involved in alcohol awareness efforts. Fewer (76%) agreed that they could positively affect students' alcohol consumption. Responses from open-ended questions revealed areas where faculty perceived they could have the most impact. Recommendations include implementing the Institute of Medicine strategies on campuses and incorporating faculty in these alcohol education and prevention strategies.