Ohio physician attitudes toward medical Cannabis and Ohio's medical marijuana program.

BACKGROUND: Ohio's medical cannabis program is one of three states that require physicians to become certified to recommend medical cannabis to their patients. The current study examines the attitudes of Ohio physicians toward medical cannabis and Ohio's program to ascertain how likely physicians are to participate in Ohio's program. METHODS: Physicians were invited to complete an internet survey that asked them about their concerns regarding medical marijuana, Ohio's program, their likelihood of recommending medical cannabis, and becoming certified within the state. Ordinal and logistic regressions were used to understand the physicians' likelihood of recommending cannabis, of becoming certified to recommend cannabis, and their attitude toward Ohio's program. RESULTS: In total, 11,665 physicians licensed to practice in Ohio were contacted by email, and 344 responses were received for a response rate of 2.9%. Only 42 physicians reported being certified or had plans to become certified to recommend marijuana, and 62% were unlikely to recommend marijuana to their patients. Overall, the belief that medical cannabis should be legal had the greatest association with the likelihood of recommending cannabis (OR = .37, 95% CI = .24-.54), of becoming certified (OR = .21, 95% CI = .10-.38), and believing that Ohio's program is too strict (OR = .39, 95% CI = .30-.51). However, the study sample precludes generalizing the results beyond this study. The 2.9% response rate could indicate a bias toward physicians who have strong opinions about the legality of medical cannabis. CONCLUSION: The results show that many physicians have concerns about medical cannabis and Ohio's program, and many physicians may not participate in the program. This could be a problem for patients who would like to use cannabis for medical reasons; therefore, these patients, may need to utilize one physician for cannabis and another for regular care. Physicians will likely be caring for patients who are using cannabis regardless of their own beliefs about it. The lack of training regarding cannabis in healthcare, along with requiring "certified recommenders" to have training could result in a fractured healthcare system.

Black Women's Confidence in the Genetic Information Nondiscrimination Act.

Black women at-risk for hereditary breast and ovarian cancer (HBOC) continue to underutilize genetic counseling and testing (GCT). One reason for this disparity is a fear of discrimination from insurance companies if identified as high-risk. The Genetic Information Nondiscrimination Act (GINA) was enacted to protect against this type of discrimination; however, Black women's levels of confidence in this law are unknown. In this descriptive study, we sought to (1) assess Black women's confidence in the GINA law and (2) identify multilevel factors related to their confidence in GINA. Ninety-four Black women at-risk of HBOC completed surveys that assessed intrapersonal, interpersonal, and structural factors. Multiple regression analysis determined factors associated with confidence in GINA. Most women were ≤50 years of age (66.0%) and about half never had a cancer diagnosis (51.1%). Confidence in GINA was moderate (mean = 10.67; standard deviation = 2.54; range = 5-15). Women who valued GCT reported more confidence in GINA (ß = 0.345; CI 0.017 to 0.673; p = 0.040). Lack of confidence in GINA may serve as a barrier to seeking GCT. Efforts to increase the perceived value of GCT among Black women could be benefited by increasing awareness of national efforts towards privacy protections of genetic information.

Understanding Medical Mistrust in Black Women at Risk of BRCA 1/2 Mutations.

The benefits of genetic counseling and testing for hereditary breast and/or ovarian cancer (HBOC) are well documented; however, Black women are less likely to use these services compared to White women. Mistrust of the medical system has been associated with Black women's use of genetic counseling and testing (GCT). However, relatively little is known about the correlates of medical mistrust in Black women at increased risk of HBOC. In this study, we examined the prevalence and predictors of medical mistrust in 94 Black women at-risk of HBOC. Most women were married (48.7%) and had at least some collegiate education (57.1%). While no predisposing characteristics were significantly related to medical mistrust, bivariate analysis indicated significant relationships between mistrust and fatalism (p=0.04), perceptions of discrimination in the healthcare setting (p=0.01), and self-efficacy in obtaining GCT (p=0.01). Multivariable analysis revealed that women who reported more discriminatory experiences and women with less confidence in obtaining GCT expressed greater medical mistrust. Multilevel approaches are needed to address psychosocial factors associated with feelings of mistrust. Future efforts must not solely focus on educating women on the importance of and need for GCT; addressing structural barriers, such as patient-provider interactions, that contribute to mistrust must become a priority.