Racial differences in beliefs about genetic screening among patients at inner-city neighborhood health centers.

BACKGROUND: Genetic testing has the potential to identify persons at high risk for disease. Given the history of racial disparities in screening, early detection and accessing treatment, understanding racial differences in beliefs about genetics is essential to preventing disparities in some conditions. METHODS: In 2004, a sample of older adult patients from four inner-city health centers was surveyed to assess beliefs about genetic determinants of disease, genetic testing and religion. Logistic regression determined which beliefs were associated with race. RESULTS: Of the 314 respondents, 50% were African Americans. Most respondents thought that sickle cell disease, cystic fibrosis and diabetes are primarily genetic. African Americans were more likely than Caucasians to believe that genetic testing will lead to racial discrimination (Odds ratio (OR): 3.02, 95% confidence interval (CI): 1.5-6.0) and to think that all pregnant women should have genetic tests (OR=3.8, 95% CI: 1.7-8.6). African Americans were more likely to believe that God's Word is the most important source for moral decisions (OR: 3.6, 95% CI :1.5-8.7). CONCLUSION: African Americans and Caucasians differ in beliefs about genetic testing and the basis for moral decision-making. Acknowledging and understanding these differences may lead to better medical care.

Determinants of adult vaccination at inner-city health centers: a descriptive study.

BACKGROUND: Pneumococcal polysaccharide vaccination rates among adults 65 years and older or less than 65 years with high risk medical conditions are still below Healthy People 2010 recommended levels of 90%. This study was designed to: 1) assess self-reported pneumococcal vaccination rates following health center level interventions to increase adult vaccination rates; and 2) determine factors associated with vaccination. METHODS: Tailored interventions to increase immunizations were implemented at two inner-city health centers. We surveyed 375 patients 50 years of age and older. Multivariate logistic regression examines the predictors of 1) self-reported pneumococcal vaccination and 2) combined self-reported influenza and pneumococcal vaccination. Both of these models were stratified by age group (50-64 years and 65 years and older). RESULTS: Pneumococcal vaccination rates were 45% by self-report, 55% by medical record review, 69% for patients 65 years old and older, 32% for patients 50-64 years; they did not differ by race. Receipt of the previous season's influenza vaccine was significantly related to pneumococcal vaccination among both younger and older patients. Receiving both the pneumococcal vaccine and the most recent influenza vaccine compared with receiving neither, among younger patients was related to unemployment, more frequent physician visits, and belief that those who do not receive the flu shot are more susceptible to the flu. For older patients, receipt of both vaccines was related to nonsmoking status, believing that friends/family think the patient should be vaccinated, seeing posters advertising flu shot clinics, and belief that those who do not receive the flu shot are more susceptible to the flu. CONCLUSION: Our findings suggest that improving overall pneumococcal vaccination rates among eligible adults, has the potential to eliminate racial disparities. Interventions delivering vaccination messages specific to older and younger adult groups may be the best strategy for improving adult vaccination rates.

Impact of vaccine economic programs on physician referral of children to public vaccine clinics: a pre-post comparison.

BACKGROUND: The Vaccines for Children (VFC) Program is a major vaccine entitlement program with limited long-term evaluation. The objectives of this study are to evaluate the effect of VFC on physician reported referral of children to public health clinics and on doses administered in the public sector. METHODS: Minnesota and Pennsylvania primary care physicians (n = 164), completed surveys before (e.g., 1993) and after (2003) VFC, rating their likelihood on a scale of 0 (very unlikely) to 10 (very likely) of referring a child to the health department for immunization. RESULTS: The percentage of respondents likely to refer was 60% for an uninsured child, 14% for a child with Medicaid, and 3% for a child with insurance that pays for immunization. Half (55%) of the physicians who did not participate in VFC were likely to refer a Medicaid-insured child, as compared with 6% of those who participated (P < 0.001). Physician likelihood to refer an uninsured child for vaccination, measured on a scale of 0 to 10 where 10 is very likely, decreased by a mean difference of 1.9 (P < 0.001) from pre- to post-VFC. The likelihood to refer a Medicaid-insured child decreased by a mean of 1.2 (P = 0.001). CONCLUSION: Reported out-referral to public clinics decreased over time. In light of increasing immunizations rates, this suggests that more vaccines were being administered in private provider offices.

Predictors of pneumococcal polysaccharide vaccination among patients at three inner-city neighborhood health centers.

BACKGROUND: Despite the availability of pneumococcal polysaccharide vaccine (PPV), vaccination rates are modest, and racial disparity in these rates is known to occur. OBJECTIVE: The purpose of this study was to identify determinants of patient-reported receipt of PPV among patients from 3 inner-city health centers that serve large numbers of minority and disadvantaged patients. METHODS: In 2003, a random sample of patients from 3 inner-city health centers was surveyed by computer-assisted telephone interview concerning their vaccination status and their attitudes and beliefs about PPV. The questionnaire was based on the theory of reasoned action, which emphasizes the contributions to behavioral intention of cognitive beliefs (including the likelihood of consequences), the value of those consequences, and normative beliefs. Factor analysis was conducted to examine whether survey items specific to attitudes about PPV would group together; the variance of the components resulting from the factor analysis was expressed in eigenvalues. Logistic regression analyses were conducted to determine which factors, demographic characteristics, and health habits were independently associated with PPV status. RESULTS: Of 674 patients sent introductory letters (13 of whom were ineligible), 325 (49%) completed the interview with usable data. These patients were primarily aged > or = 65 years (52% [168/325]), female (69% [223/325]), and white (57% [174/306]), and had an annual household income < 20,000 dollars (61% [174/287]). Vaccination status or intention to be vaccinated was unknown for 25 persons, reducing the sample to 300. Of these respondents, 59% (178) reported vaccination, 9% (26) intended to be vaccinated within 6 months, and 32% (96) had no intention of being vaccinated. Vaccination rates were 76% (119/157) for responders aged > or = 65 years and 41% (59/143) for responders aged 50 to 64 years (P < 0.001). Logistic regression analyses found 3 variables that were significantly associated with the likelihood of vaccination: age > or = 65 years; frequency of physician visits; and timing of the last complete physical examination. The factor analysis with varimax rotation identified 2 factors that increased the likelihood of reporting ever receiving PPV: attitudes about PPV and social influences (eigenvalue = 2.69), and beliefs about pneumonia risk and vaccine efficacy (eigenvalue = 1.24). When these factors were added to the model, the effects of age and frequency of seeing a physician became nonsignificant. Compared with those having a complete physical examination < 1 year ago, those having an examination 1 to 2 years ago (odds ratio [OR] = 0.16; 95% CI = 0.04-0.69) or > 2 years ago (OR = 0.10; 95% CI = 0.01-0.78) were less likely to be vaccinated. Those agreeing with the attitudes and social influence factor were more likely to be vaccinated (OR = 8.24; 95% CI = 3.97-17.12), as were those agreeing with the pneumonia risk and vaccine efficacy factor (OR = 2.63; 95% CI = 1.20-5.80). CONCLUSIONS: Attitudes about vaccination and a clinician's recommendation are the most powerful predictors of PPV status. Efforts to raise rates of vaccination and reduce racial disparities should emphasize communication of clinicians' recommendations to patients.

Barriers and facilitators of colon cancer screening among patients at faith-based neighborhood health centers.

We determined the barriers to and facilitators of colorectal cancer (CRC) screening among two faith-based, inner city neighborhood health centers in Southwestern Pennsylvania. Data from a random sample of patients 50 years and older (n = 375) were used to estimate logistic regression equations to compare and contrast the predictors of four different CRC screening protocols: (1) fecal occult blood test (FOBT) < or = 2 years ago, (2) colonoscopy < or = 10 years ago, (3) lower endoscopy (colonoscopy or sigmoidoscopy) < or = 10 years ago, and (4) any of these screening measures. Racial differences (between African Americans or Caucasians) in type of colon cancer screening were not found. Controlling for covariates, logistic regression equations showed that a physician's support of colon cancer screening was positively associated with the receipt of colonoscopy (OR: 19.47, 95% CI: 5.45-69.54), lower endoscopy (OR: 10.96, 95% CI: 3.77-31.88) and any colon cancer screening (OR: 10.12, 95% CI: 3.36-30.46). Patients who see their physicians more frequently were also more likely to be screened for CRC. Unlike other studies, the faith-based environment in which these patients are treated may explain the lack of racial disparity specific to our measures of CRC screening.

Barriers to pneumococcal and influenza vaccination in older community-dwelling adults (2000-2001).

OBJECTIVES: To identify facilitators of and barriers to vaccination in patients from a range of socioeconomic levels. DESIGN: A survey was conducted in 2001 using computer-assisted telephone interviewing. SETTING: Patients from inner-city health centers and suburban practices were interviewed. PARTICIPANTS: Inclusion criteria were aged 66 and older and an office visit after September 30, 1998. MEASUREMENTS: Self-reported influenza and pneumococcal vaccination status and facilitating conditions, attitudes, social influences, and perceived consequences from the Triandis model were assessed. RESULTS: Overall, 557 interviews were completed with 775 eligible patients (72%). Patients who reported having received pneumococcal vaccine more frequently believed that their physicians recommended the vaccine than did the unvaccinated (97% vs 49%; P=.001). This was also true for influenza vaccine (99% vs 80%; P<.001). More unvaccinated patients than vaccinated patients felt that obtaining either vaccine was more trouble than it is worth (pneumococcal 19% vs 1%; P=.04, influenza 20% vs 1%; P=.004). The vaccinated were more likely to be willing to obtain the influenza and pneumococcal vaccines at the same time (pneumococcal 91% vs 59%; P=.002, influenza 91% vs 55%; P=.014). CONCLUSION: Physicians should take every opportunity to recommend vaccination to their eligible adult patients. Offering influenza and pneumococcal vaccines at the same visit is an acceptable means to ensure that adults are fully vaccinated.

Shortage of influenza vaccine in 2000-2001: did it change patient beliefs?

OBJECTIVE: To determine which patient beliefs associated with influenza vaccination changed during a vaccine shortage year (2000-2001) from a nonshortage year (1999-2000). METHODS: Elderly patients (n=319), who had been previously interviewed about the 1999-2000 influenza season, were interviewed regarding the 2000-2001 season. Participants were from inner-city and suburban medical practices receiving influenza vaccine supply on time or late in the season. RESULTS: Although vaccination rates did not diminish due to the influenza vaccine shortage (73% in 1999-2000 vs 74% in 2000-2001), some patient attitudes changed. More respondents expressed concerns about the influenza vaccine (3% in 1999-2000 vs 12% in 2000-2001, p<0.0001), and fewer responded that friends thought that they should get the vaccine (75% 1999-2000 vs 66% 2000-2001, p=0.005); that if one person in the household "got the flu" others would also (71% 1999-2000 vs 67% 2000-2001, p<0.0001), and that "a person who does not get the flu shot will get influenza" (36% 1999-2000 vs 30% 2000-2001, p=0.02). CONCLUSIONS: The influenza vaccine shortage resulted in a small increase in concerns about influenza vaccine, even in a population with good access to vaccine and high vaccination rates. Vaccine availability updates should include reassurances of vaccine safety and efficacy.