Racial/ethnic disparities in patient-reported nonsteroidal antiinflammatory drug (NSAID) risk awareness, patient-doctor NSAID risk communication, and NSAID risk behavior.

OBJECTIVE: Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly used and frequently lead to serious adverse events. Little is known about NSAID-related ethnic/racial disparities. We focused on differences in patient NSAID risk awareness, patient-doctor NSAID risk communication, and NSAID risk-avoidance behavior. METHODS: We performed a cross-sectional analysis of survey data from the Alabama NSAID Patient Safety Study. Eligible patients were > or = 65 years old and currently taking prescription NSAIDs (Rx NSAIDS). Generalized linear latent and mixed models accounted for nesting of patients within physicians. RESULTS: Of all 404 participants, 32% were African American and 73% were female. The mean +/- SD age was 72.8 +/- 7.5 years, and 64% reported an annual household income <$20,000. African American patients were less likely than white patients to recognize any risk associated with over-the-counter (OTC) NSAIDs (13.3% versus 29.3%; P = 0.001) and Rx NSAIDs (31.3% versus 49.6%; P = 0.001), report that their doctor discussed possible NSAID-related gastrointestinal problems (38.0% versus 52.4%; P = 0.007), and take medications to reduce ulcer risk (30.5% versus 50.2%; P = 0.001). Patients with lower income and education reported significantly less risk awareness for OTC and Rx NSAIDs. Racial/ethnic differences persisted after adjusting for multiple confounders. CONCLUSION: In this community-based study of low income elderly individuals receiving NSAIDs, we identified important racial/ethnic differences in risk awareness, communication, and behavior. Additional efforts are needed to promote safe NSAID use and reduce ethnic/racial disparities.

Effects of a psychosocial intervention on breast self-examination attitudes and behaviors.

An educational intervention to promote breast self-examinations (BSEs) among young women was tested. In a group (intervention versus control) x time (Session 1 versus Session 2) mixed design, 172 college females were randomly assigned to either an intervention or control condition. Both groups attended two sessions; the second session was 48 hours after the first. The intervention consisted of an essay, lecture, video portraying young survivors of breast cancer, group discussions, self-test and instructions on performing BSEs. The control group had the same format; however, the information was focused on nutrition and exercise. Participants in the intervention group scored higher on rational problem solving and behavioral intentions, suggesting that the intervention increased adaptive responses to breast cancer threat. Conversely, control participants scored significantly higher on maladaptive reactions (e.g. hopelessness, avoidance and fatalistic religiosity) to breast cancer threat. For intervention participants, the initial decline in maladaptive reactions remained stable at 3-month follow-up, but adaptive reactions decreased. Intervention participants had greater confidence in performing BSEs compared with controls but performed them on an irregular basis. Results were interpreted in terms of protection motivation theory, a model that applies the social psychology of persuasion to preventive health.

Effects of coping information and value affirmation on responses to a perceived health threat.

In this study, we examined the effects of coping information and self-affirmation on an individual's response to threatening health information. A total of 202 women college students read an essay containing threatening information about breast cancer. The essay described their population as being at risk for breast cancer and included both pictures of cancerous breasts and vivid descriptions of chemotherapy treatments. Participants were randomized into either the low-affirmation condition or the high-affirmation condition when they first arrived. In addition, half of the participants were randomly assigned to receive coping information that described breast self-examinations as an effective method of detecting breast cancer and focused on the importance of early detection. Participants who received coping information scored lower on maladaptive behaviors (avoidance, hopelessness, religiosity), suggesting that coping information plays a role in decreasing maladaptive behaviors. No significant differences were found between the low-affirmation and high-affirmation conditions. Supplemental analyses indicated that vicarious exposure to breast cancer (having a friend, relative, or mother diagnosed with breast cancer) affected how individuals interpret threatening health information. Participants with previous exposure scored higher on the adaptive coping modes (behavioral intentions, rational problem solving) and 1 maladaptive coping mode (religiosity) when compared to individuals without previous exposure. In addition, participants in the high-affirmation condition with previous exposure scored higher on avoidance and hopelessness than those without previous exposure. The results suggest that coping information and previous exposure are factors that need to be considered when presenting threatening health information.