ABSTRACT
BACKGROUND: Medicare implemented reimbursement for screening mammography in 1991. MAIN FINDINGS: Post-implementation, breast cancer mortality declined faster (p< .0001) among White than among Black elderly women (65+ years). No excess breast cancer deaths occurred among Black elderly compared with White elderly through 1990; over 2,459 have occurred since. Contextual socioeconomic status does not explain differences between counties with lowest Black breast cancer mortality/post-implementation declines in disparity and counties with highest Black breast cancer mortality/widened disparity post-implementation. CONCLUSIONS: The results lead to these hypotheses: (a) Medicare mammography reimbursement was causally associated with declines in elderly mortality and widened elderly Black:White disparity from breast cancer; (b) the latter reflects inherent Black-White differences in risk of breast cancer death; place-specific, unaddressed inequalities in capacity to use Medicare benefits; and/or other factors; (c) previous observations linking poverty with disparities in breast cancer mortality are partly confounded by factors explained by theories of human capability and diffusion of innovation.
Subject(s)
Breast Neoplasms/ethnology , Breast Neoplasms/mortality , Healthcare Disparities/ethnology , Mammography/statistics & numerical data , Medicare/statistics & numerical data , Black or African American , Aged , Aged, 80 and over , Breast Neoplasms/diagnosis , Female , Humans , Risk Factors , Socioeconomic Factors , United States , White PeopleABSTRACT
This study explored the knowledge of breast cancer and the use of breast cancer screening services by homeless African-American women in an attempt to understand their use of cancer screening services and whether they understood the information about breast cancer and breast cancer screening. A qualitative study using a focus group format was employed to obtain a deeper understanding of the participants' experiences as they related to knowledge of breast cancer and their use of breast cancer screening services. The sample consisted of 25 (N = 25) African-American women who were currently living in a transient shelter for homeless women and children. Three, one-hour focus group sessions were conducted over a three-week period. Sessions were audio taped and transcribed for analysis. Content analysis was used to analyze the data. Findings from the study revealed categories that were associated with the women's personal experiences with cancer, their knowledge of breast cancer and experiences with the use of screening services, and their motivations as they related to breast cancer screenings. These categories can be useful in providing access to care and in addressing cancer education, screening behaviors, and program planning in homeless African-American women.
Subject(s)
Attitude to Health/ethnology , Black or African American , Breast Neoplasms/diagnosis , Ill-Housed Persons , Mass Screening/statistics & numerical data , Women , Adaptation, Psychological , Adult , Black or African American/education , Black or African American/ethnology , Breast Neoplasms/ethnology , Educational Status , Family Characteristics , Female , Focus Groups , Health Behavior/ethnology , Health Knowledge, Attitudes, Practice , Health Planning , Health Services Accessibility , Ill-Housed Persons/education , Ill-Housed Persons/psychology , Humans , Marital Status , Middle Aged , Needs Assessment , Nursing Methodology Research , Qualitative Research , Self Care/psychology , Southeastern United States , Urban Population , Women/education , Women/psychologyABSTRACT
OBJECTIVES: To describe the epidemiology of cancer in the United States-risk factors, trends, and recent patterns of disparities in cancer incidence, mortality, and survival. DATA SOURCES: Published articles, research reports and monographs, book chapters, government publications, and machine-readable public-use data files. CONCLUSION: The discipline of cancer epidemiology has greatly increased our understanding of cancer risk, morbidity and mortality, survival, trends over time, and disparities in cancer treatment and outcomes. IMPLICATIONS FOR NURSING PRACTICE: Nursing can use epidemiologic tools to reduce the suffering and death caused by cancer and improve the quality of life for cancer survivors.
Subject(s)
Cause of Death , Ethnicity/statistics & numerical data , Mortality/trends , Neoplasms/epidemiology , Neoplasms/nursing , Breast Neoplasms/epidemiology , Breast Neoplasms/nursing , Breast Neoplasms/pathology , Clinical Nursing Research , Female , Humans , Incidence , Male , Neoplasms/pathology , Oncology Nursing , Risk Assessment , Sex Distribution , United States/epidemiologyABSTRACT
OBJECTIVES: To provide an overview of the cancer disparities among racial and ethnically diverse populations and to describe primary and secondary prevention among them. DATA SOURCES: Published articles, reports, book chapters, and government documents. CONCLUSION: Despite the advances in cancer diagnosis, treatment, and survival, racial and ethnic minorities suffer disproportionately from cancer. Poverty has emerged as a significant factor influencing poor cancer outcomes for all races, but especially among racial and ethnic minorities. IMPLICATIONS FOR NURSING PRACTICE: Continued and sustained efforts are needed on all fronts (education, practice, and research, policy) to improve the poor cancer-related outcomes for minorities.
Subject(s)
Attitude to Health/ethnology , Ethnicity/statistics & numerical data , Needs Assessment , Neoplasms/ethnology , Neoplasms/prevention & control , Clinical Nursing Research , Female , Humans , Incidence , Male , Minority Groups/statistics & numerical data , Mortality/trends , Oncology Nursing , Primary Prevention/methods , Prognosis , Risk Assessment , Socioeconomic Factors , United States/epidemiologyABSTRACT
The voices of rural women are frequently absent in discussions of quality healthcare. This study utilized a phenomenological research design to examine rural African American women's descriptions of mammogram quality. Twenty-three women in rural Georgia communities were interviewed. Participants desired quality mammogram experiences in which they were treated with kindness and respect, were given explanations of the mammogram procedure and outcome, and were cared for by health professionals who were competent in their roles.
Subject(s)
Attitude to Health/ethnology , Black or African American/ethnology , Mammography/standards , Quality of Health Care/standards , Rural Population , Women/psychology , Adult , Black or African American/education , Attitude of Health Personnel , Clinical Competence/standards , Communication , Educational Status , Female , Georgia , Health Care Surveys , Health Knowledge, Attitudes, Practice , Humans , Income , Mammography/psychology , Mass Screening/standards , Middle Aged , Nursing Methodology Research , Patient Education as Topic/standards , Professional Role , Professional-Patient Relations , Qualitative Research , Quality Indicators, Health Care/standards , Surveys and Questionnaires , Women/educationABSTRACT
BACKGROUND: The purpose of this study was to explore the use of storytelling as a method to teach breast health information to older African American women. METHODS: A qualitative design utilizing the focus-group method. RESULTS: Six story types (categories) emerged from the focus-group data and were integrated into the breast health education class. Categories were: 1) loss, 2) pain, 3) suffering, 4) fear and worry/stress, 5) death, and 6) faith in God and prayer. Three major outcomes resulted from the storytelling format: 1) peer teaching enhanced learning, 2) incorrect information was identified and clarified, and 3) personal experiences were validated. CONCLUSIONS: Integration of African American women's self-identified issues and concerns with breast health messages through storytelling resulted in a meaningful teaching-learning experience.
