Talking about cancer: Explaining differences in social support among Chinese American and European American breast cancer survivors.

Cultural models of emotional disclosure and its impact on seeking support are understudied in the context of cancer diagnosis. We argue that two different cultural norms must be considered: (1) the importance of emotional disclosure and (2) attitudes toward seeking support from loved ones. Our interviews with 37 foreign-born Chinese American and 23 European American breast cancer survivors revealed differences in disclosure of cancer diagnosis and perception of social support. Both Chinese American and European American survivors receive and provide emotional and social support with loved ones, but their manifestations of disclosure and help-seeking behaviors are culturally specific.

Delivering on the Promise of Smoke-Free Public Housing.

On November 30, 2016, the US Department of Housing and Urban Development (HUD) published a final rule mandating that public housing authorities it supports prohibit all smoking on their residential premises, including within residents' apartments. The primary rationale for this action was to protect nonsmoking residents from the harms of tobacco smoke exposure. Although the harms of secondhand smoke are clear and the potential for reducing nonsmoking residents' exposure is real, it will be no simple matter to successfully implement the policy requirements set down by HUD. Some challenges to policy implementation will apply to all public housing authorities, and others will be unique to specific settings. By being aware of the benefits of smoke-free public housing as well as the challenges inherent in complying with HUD's rule, public housing authorities stand the best chance of fulfilling the potential of this major policy initiative to significantly improve public health in a vulnerable population.

Perceptions, expectations, and attitudes about communication with physicians among Chinese American and non-Hispanic white women with early stage breast cancer.

PURPOSE: Asian Americans have consistently reported poorer communication with physicians compared with non-Hispanic Whites (NHW). This qualitative study sought to elucidate the similarities and differences in communication with physicians between Chinese and NHW breast cancer survivors. METHODS: Forty-four Chinese and 28 NHW women with early stage breast cancer (stage 0-IIa) from the Greater Bay Area Cancer Registry participated in focus group discussions or individual interviews. We oversampled Chinese women because little is known about their cancer care experiences. In both interview formats, questions explored patients' experiences and feelings when communicating with physicians about their diagnosis, treatment, and follow-up care. RESULTS: Physician empathy at the time of diagnosis was important to both ethnic groups; however, during treatment and follow-up care, physicians' ability to treat cancer and alleviate physical symptoms was a higher priority. NHW and US-born Chinese survivors were more likely to assert their needs, whereas Chinese immigrants accepted physician advice even when it did not alleviate physical problems (e.g., pain). Patients viewed all physicians as the primary source for information about cancer care. Many Chinese immigrants sought additional information from primary care physicians and stressed optimal communication over language concordance. CONCLUSIONS: Physician empathy and precise information were important for cancer patients. Cultural differences such as the Western emphasis on individual autonomy vs. Chinese emphasis on respect and hierarchy can be the basis for the varied approaches to physician communication we observed. Interventions based on cultural understanding can foster more effective communication between immigrant patients and physicians ultimately improving patient outcomes.

A mixed method exploration of survivorship among Chinese American and non-Hispanic White breast cancer survivors: the role of socioeconomic well-being.

PURPOSE: Cancer-related stress is heavily influenced by culture. This study explored similarities and differences in survivorship care concerns among Chinese American and non-Hispanic White (NHW) breast cancer survivors. METHODS: A sequential, mixed-method design (inductive/qualitative research-phase I and deductive/quantitative research-phase II) was employed. Eligible women identified from the Greater Bay Area Cancer Registry were age ≥21, diagnosed with stage 0-IIa breast cancer between 2006 and 2011, and had no recurrence or other cancers. In phase I, we conducted 4 Chinese (n = 19) and 4 NHW (n = 22) focus groups, and 31 individual telephone interviews (18 Chinese immigrants, 7 Chinese US-born, and 6 NHW). Content analysis was conducted to examine qualitative data. In phase II, another 296 survivors (148 NHW age-matched to 148 Chinese cases) completed a cross-sectional survey. Descriptive statistics and linear regression analysis were conducted to examine quantitative data. RESULTS: Qualitative data revealed "socioeconomic well-being" (SWB) as a dominant survivorship concern, which was operationalized as a cancer survivor's perceived economic and social resources available to access care. Quantitative data showed that low-acculturated Chinese immigrants reported the poorest SWB, controlling for covariates. Highly acculturated Chinese immigrants and the US-born Chinese/NHW group reported similar SWB. Women who had low-income levels or chemotherapy had poorer SWB. CONCLUSIONS: SWB emerged as an important aspect of breast cancer survivorship. Immigration stress, cancer care costs, and cultural values all contributed to immigrants' socioeconomic distress. Immigrant and US-born breast cancer survivors experienced different socioeconomic circumstances and well-being following treatment. Our findings warrant further investigation of socioeconomic distress and survivorship outcomes.

Results of a randomized controlled trial testing the efficacy of a culturally targeted and a generic video on mammography screening among chinese-american immigrants.

BACKGROUND: Research comparing the effects of culturally targeted and generic but linguistically appropriate intervention programs is limited. We conducted a randomized controlled trial comparing the efficacy of a culturally targeted video, a generic video, and a fact sheet (control) in promoting mammography screening among Chinese-American immigrants. METHODS: We randomized 664 Chinese-American women from the Washington, DC, and New York City areas who were older than 40 years and nonadherent to annual mammography screening guidelines to three study arms (each with ∼221 women). The outcome was self-reported mammography screening 6 months post intervention. Measures of knowledge, Eastern cultural views, and health beliefs were administered before and after the intervention. RESULTS: The culturally targeted video, the generic video, and the fact sheet increased mammography use by 40.3%, 38.5%, and 31.1% from baseline, respectively. A significant intervention effect was observed only in one subgroup: The culturally targeted video significantly increased mammography screening among low-acculturated women over the fact sheet [OR, 1.70; 95% confidence interval (CI), 1.04-2.78]. Overall, women who obtained a mammogram during the follow-up period reported significantly fewer barriers to screening after intervention than those who had not obtained screening. Both of the video groups reported fewer barriers after intervention than the control group. CONCLUSIONS: Both theoretically guided videos increased the likelihood of mammography use to a similar extent. Cultural targeting was only effective for low-acculturated women. Both videos reduced perceived barriers to screening and consequently increased screening behavior. IMPACT: The results of this study provide empirical evidence on the efficacy of cultural targeting for minority immigrants.

The role of patient-provider communication for black women making decisions about breast cancer treatment.

OBJECTIVE: Recent reports suggest that Black breast cancer patients receive adjuvant therapies less often than their White counterparts; however, few studies have examined the self-reported experiences of Black breast cancer patients making treatment decisions. This study examined cultural beliefs and healthcare factors that impacted Black women's treatment decisions. METHODS: In-depth interviews were conducted with 49 Black women with early stage breast cancer (stages 0-III). Participants resided in Washington, DC (n = 13), and Philadelphia, Pennsylvania (n = 36). Women's ages ranged from 26 to 85 (m = 53.9). All interviews were transcribed verbatim and then entered into a qualitative software program. Three coders independently read and coded transcripts using this software. RESULTS: The data did not reveal common cultural themes that influenced women's treatment decisions. Spiritual beliefs were important to all participants and did seem to help them cope with and reframe their illness experiences. The patient-provider relationship was the most notable factor that influenced treatment decisions. While most women reported that they were satisfied with their provider relationships, their narratives revealed that many lacked knowledge about their diagnoses and treatment regimens. Those patients who demonstrated a better understanding of their disease and treatments also seemed to adhere to recommendations for adjuvant therapy. CONCLUSIONS: Poor communication may impact treatment decision-making and, ultimately, outcomes. Important next steps will include quantifying Black women's patient-provider interactions and examining how these factors influence adherence behaviors. Ensuring that patients understand their diagnosis and treatment options will also be important for clinical practice.

Adolescents' knowledge, beliefs, and behaviors regarding hepatitis B: Insights and implications for programs targeting vaccine-preventable diseases.

PURPOSE: To gain a better understanding of adolescents' knowledge, beliefs, and behaviors regarding hepatitis B. METHOD: Three types of data were collected as part of this investigation: (a) 45 in-depth individual interviews with staff from 20 adolescent health, sexually transmitted disease (STD), and family planning clinics; (b) 96 individual interviews with adolescents and young adults; and (c) questionnaires completed by 17,063 adolescents and young adults. All instruments focused on one or more of the following five topics: (a) knowledge about vaccines; (b) knowledge about hepatitis B; (c) barriers to vaccine acceptance, and ways to overcome these barriers; (d) benefits of the vaccine acceptance, and ways to enhance these benefits; and (e) eight hepatitis B risk factors. Interview data was analyzed using qualitative thematic note-based analyses. Survey data was analyzed using descriptive statistics and Chi-square tests. RESULTS: Adolescents and young adults seen in these clinics know very little about vaccinations in general, or hepatitis B, in particular. Adolescents exhibit low levels of perceived susceptibility, severity, response efficacy, and self-efficacy toward hepatitis B and the hepatitis B vaccine. On average, these adolescents engage in 2.36 high-risk behaviors (the most frequent of which include sexual activity, body piercing, and tattooing). Those who were sexually active, had a tattoo, had a STD, or worked with blood were significantly more likely to begin the vaccination series. CONCLUSIONS: There is a clear need for additional educational efforts regarding both vaccinations in general, and hepatitis B in particular. Though adolescents are engaging in a variety of high-risk behaviors, most perceive their risk to be low, and therefore many are not taking the necessary precautions to protect themselves.