Impact of patient and navigator race and language concordance on care after cancer screening abnormalities.

BACKGROUND: Patient navigation improves the timely diagnosis of cancer among minorities, but little is known about the effects of patient and navigator race and language concordance on health outcomes. METHODS: The authors investigated the effects of patient and navigator race and language concordance on the time to diagnosis of cancer screening abnormalities among participants in the Boston Patient Navigation Research Program, a clinical effectiveness trial for women who had breast or cervical cancer screening abnormalities identified from January 1, 2007 to December 31, 2008. Hazard ratios and 95% confidence intervals were estimated using proportional hazards regression adjusting for clinical and demographic factors. RESULTS: In total, 1257 women had breast cancer screening abnormalities (n = 655) or cervical cancer screening abnormalities (n = 602) identified, and 56% were nonwhite. Language concordance was associated with timelier resolution for all patients in the cervical cancer screening abnormalities group during the first 90 days (adjusted hazard ratio, 1.46; 95% confidence interval, 1.18-1.80), and specifically for Spanish speakers during the first 90 days (adjusted hazard ratio, 1.43; 95% confidence interval, 1.10-1.84), but no difference was observed after 90 days for women who had cervical cancer screening abnormalities or at any time for those who had breast cancer screening abnormalities. Race concordance was associated with significant decreases in the time to diagnosis for minority women with breast and cervical cancer screening abnormalities in analyses stratified by race, but no differences were observed in analyses that included all women. CONCLUSIONS: Patient navigator race and language concordance improved the timeliness of care in a minority population. Patient navigators who are racially/ethnically diverse and multilingual may help address barriers to care and improve cancer outcomes for low-income minorities.

Predictors of timely follow-up after abnormal cancer screening among women seeking care at urban community health centers.

BACKGROUND: We sought to measure time and identify predictors of timely follow-up among a cohort of racially/ethnically diverse inner city women with breast and cervical cancer screening abnormalities. METHODS: Eligible women had an abnormality detected on a mammogram or Papanicolaou (Pap) test between January 2004 and December 2005 in 1 of 6 community health centers in Boston, Massachusetts. Retrospective chart review allowed us to measure time to diagnostic resolution. We used Cox proportional hazards models to develop predictive models for timely resolution (defined as definitive diagnostic services completed within 180 days from index abnormality). RESULTS: Among 523 women with mammography abnormalities and 474 women with Pap test abnormalities, >90% achieved diagnostic resolution within 12 months. Median time to resolution was longer for Pap test than for mammography abnormalities (85 vs 27 days). Site of care, rather than any sociodemographic characteristic of individuals, including race/ethnicity, was the only significant predictor of timely follow-up for both mammogram and Pap test abnormalities. CONCLUSIONS: Site-specific community-based interventions may be the most effective interventions to reduce cancer health disparities when addressing the needs of underserved populations.

The associations of binge alcohol use with HIV/STI risk and diagnosis among heterosexual African American men.

BACKGROUND: Studies on the mechanisms of the association between illicit drug use and HIV/STI provide important insight into why there are disproportionate rates of HIV/STI among heterosexual African American men; far less work has been conducted to examine the associations between binge alcohol use and HIV/STI risks in this population. OBJECTIVE: To assess whether binge alcohol use is associated with risky sexual behaviors and recent HIV/STI diagnosis among heterosexual African American men reporting multiple sex partners in the past year. METHODS: Participants (n=672) were heterosexually active African American men age 18-65 years recruited from urban health centers and clinics in Boston, MA, and who participated in a health survey. Logistic regression analyses were used to assess associations between past 30 day binge drinking and the following outcome variables: unprotected sex, six or more sex partners in the past year, sex trade involvement, and past 6 month HIV/STI diagnosis. Analyses were adjusted to control demographics, incarceration history, illicit drug use, and injection drug use. RESULTS: Significant associations were observed between binge alcohol use and unprotected vaginal sex with non-main female partners (AOR=1.7, 95% CI=1.2-2.3), unprotected anal sex with non-main female partners (AOR=2.3, 95% CI=1.4-4.0), sex trade involvement (AOR=2.1, 95% CI=1.3-3.5), and recent HIV/STI diagnosis (AOR=1.9; 95% CI=1.05-3.6). CONCLUSION: Heterosexual African American men engaging in binge alcohol use may be at increased risk for HIV/STI; findings support the need for integrating alcohol risk reduction into HIV prevention programs targeting this population.

Victims of intimate partner violence more likely to report abuse from in-laws.

The current study of South Asians in the United States was designed to assess quantitatively the association between intimate partner violence (IPV) and emotional abuse by in-laws (n=169) and to qualitatively identify via in-depth interviews with battered women (n=23) forms of abuse perpetrated by in-laws. Quantitative findings demonstrate a significant relationship between IPV and abuse from in-laws (odds ratio=5.7, 95% confidence interval=1.5-21.5). Qualitative data demonstrate that abuse by in-laws includes emotional abuse (e.g., isolation, social and economic control, and domestic servitude), awareness or support of IPV, and direct physical abuse. Domestic violence interventions with South Asian women must consider abuse from in-laws and IPV experiences.

Masculine gender roles associated with increased sexual risk and intimate partner violence perpetration among young adult men.

This study sought to assess the association between traditional masculine gender role ideologies and sexual risk and intimate partner violence (IPV) perpetration behaviors in young men's heterosexual relationships. Sexually active men age 18-35 years attending an urban community health center in Boston were invited to join a study on men's sexual risk; participants (N=307) completed a brief self-administered survey on sexual risk (unprotected sex, forced unprotected sex, multiple sex partners) and IPV perpetration (physical, sexual and injury from/need for medical services due to IPV) behaviors, as well as demographics. Current analyses included men reporting sex with a main female partner in the past 3 months (n=283). Logistic regression analyses adjusted for demographics were used to assess significant associations between male gender role ideologies and the sexual risk and IPV perpetration behaviors. Participants were predominantly Hispanic (74.9%) and Black (21.9%); 55.5% were not born in the continental U.S.; 65% had been in the relationship for more than 1 year. Men reporting more traditional ideologies were significantly more likely to report unprotected vaginal sex in the past 3 months (OR(adj) = 2.3, 95% CI = 1.2-4.6) and IPV perpetration in the past year (OR(adj) = 2.1, 95% CI = 1.2-3.6). Findings indicate that masculine gender role ideologies are linked with young men's unprotected vaginal sex and IPV perpetration in relationships, suggesting that such ideologies may be a useful point of sexual risk reduction and IPV prevention intervention with this population.

Perpetration of intimate partner violence associated with sexual risk behaviors among young adult men.

OBJECTIVE: We assessed the association between intimate partner violence (IPV) perpetration and sexual risk behaviors and fatherhood (having fathered children) among young men. METHODS: Sexually active men aged 18 to 35 years who visited an urban community health center and who reported having sexual intercourse with a steady female partner during the past 3 months (N = 283) completed a brief self-administered survey about sexual risk behaviors, IPV perpetration, and demographics. We conducted logistic regression analyses adjusted for demographics to assess associations between IPV and sexual risk behaviors and fatherhood. RESULTS: Participants were predominantly Hispanic (74.9%) and Black (21.9%). Participants who reported IPV perpetration during the past year (41.3%) were significantly more likely to report (1) inconsistent or no condom use during vaginal and anal sexual intercourse, (2) forcing sexual intercourse without a condom, (3) having sexual intercourse with other women, and (4) having fathered 3 or more children. CONCLUSION: IPV perpetration was common among our sample and was associated with increased sexual risk behaviors. Urban community health centers may offer an important venue for reaching this at-risk population.