A six-year follow-up study of social network changes among African-American, Caribbean, and U.S.-born Caucasian urban older adults.

This study explores dynamic changes in network size and composition by examining patterns of older adults' social network change over time, that is: types of movements; the reason for the loss of network members; and the relation of movement and composition in concert. This study is a 6-year follow up of changes in the social networks of U.S.-Born Caucasian, African-American, and Caribbean older adults. One hundred and twenty-four community-dwelling older adults were interviewed during 2 data collection points over a 6-year period. Differences between Wave 1 and Wave 2 data were examined using paired sample t-tests confirmed with post-hoc tests and multivariate analyses. Results regarding types of movement showed that network changes were attributed to attrition--the "loss" of network members and a novel movement--the "addition" of network members not heretofore discussed. The results show an interaction between kinship status, ethnicity, and time--the attrition of non-kin members was underscored by ethnic differences. The type of network change was specific for type of network affiliation, such that children were more likely to be added to the networks of the young-old and kin were more likely to be lost in networks of the old-old. Older adults engage in social network interactions marked by compensatory processes beyond loss of network members such as social promotion and demotion. These social network processes are of emotional and functional significance for the older adult.

Noninitiation of adjuvant chemotherapy in women with localized breast cancer: the breast cancer quality of care study.

PURPOSE: For some women, adjuvant chemotherapy for nonmetastatic breast cancer decreases recurrences and increases survival; however, patient-physician decisions regarding chemotherapy receipt can be influenced by medical and nonmedical factors. PATIENTS AND METHODS: We used a prospective cohort design and multivariate modeling to investigate factors related to noninitiation of chemotherapy among women with newly diagnosed breast cancer recruited from three US sites. We interviewed patients at baseline and during treatment on sociodemographic, tumor, and treatment decision-making factors. Patients were categorized according to National Comprehensive Cancer Network guidelines as those for whom chemotherapy was definitely indicated, clinically discretionary, or discretionary based on age greater than 70 years. RESULTS: Of 1,145 patients recruited, chemotherapy was clinically indicated for 392 patients, clinically discretionary for 459 patients, discretionary because of age for 169 patients, and not indicated for 93 patients; data were insufficient for 32 patients. Chemotherapy rates were 90% for those in whom chemotherapy was clinically indicated, 36% for those in whom it was discretionary because of clinical factors, and 19% for those in whom it was discretionary based on age greater than 70 years. Nonreceipt of chemotherapy was associated with older age, more negative beliefs about treatment efficacy, less positive beliefs about chemotherapy, and more concern about adverse effects. In the two discretionary groups, clinical predictors of worse outcome (greater tumor size, positive nodes, worse grade, and estrogen receptor- and progesterone receptor-negative status) were associated with increased chemotherapy initiation. CONCLUSION: Utilization of adjuvant chemotherapy was most common among patients who, based on clinical criteria, would most likely benefit from it, patients with more positive than negative beliefs regarding treatment efficacy, and patients with few concerns about adverse effects.

Regulating emotion expression and regulating emotion experience: divergent associations with dimensions of attachment among older women.

Adult attachment research does not systematically distinguish between experiential and expressive forms of regulation. Drawing insights from developmental-functionalism - a lifespan theory of emotion and emotion regulation - the current report examined the relations among attachment, trait emotion, and expressive emotion regulation in a large (N = 1204) sample of older women. Although both preoccupation and fearful-avoidance predicted more anxiety and anger, preoccupation predicted greater fear withdrawal and less fear expression, while fearful-avoidance predicted greater fear expression and greater anger withdrawal; attachment security predicted less fear withdrawal and less anger expression. Importantly, results regarding expressive regulation held even when controlling for trait levels of the underlying emotion. Results are interpreted within the context of models of attachment and lifespan socioemotional functioning. It is suggested that attachment research may benefit from considering the distinct functions of experienced versus expressed emotion in developmentally diverse contexts. Limitations are discussed and directions for future research are given.

Non-initiation of adjuvant hormonal therapy in women with hormone receptor-positive breast cancer: The Breast Cancer Quality of Care Study (BQUAL).

Adjuvant hormonal therapy for non-metastatic hormone receptor (HR)-positive breast cancer decreases risk of breast cancer recurrence and increases survival. However, some women do not initiate this life-saving treatment. We used a prospective cohort design to investigate factors related to non-initiation of hormonal therapy among women with newly diagnosed, non-metastatic HR-positive breast cancer recruited from three U.S. sites. Serial interviews were conducted at baseline and during treatment to examine sociodemographic factors, tumor characteristics, and treatment decision-making factors. Multivariate modeling assessed associations between variables of interest and hormonal therapy initiation. Of 1,050 breast cancer patients recruited, 725 (69%) had HR-positive breast cancer, of whom 87 (12.0%) based on self-report and 122 (16.8%) based on medical record/pharmacy fill rates did not initiate hormonal therapy. In a multivariable analysis, non-initiation of hormonal therapy, defined by medical record/pharmacy, was associated with having greater negative beliefs about efficacy of treatment (OR 1.42, 95% CI 1.18-1.70). Non-initiation was less likely in those who found the quality of patient/physician communication to be higher (OR 0.96, 95% CI 0.93-0.99), the hormonal therapy treatment decision an easy one to make (OR 0.45, 95% CI 0.23-0.90) or neither easy nor difficult (OR 0.34, 95% CI 0.20-0.58); and had more positive beliefs about hormonal therapy efficacy (OR 0.40, 95% CI 0.34-0.62). Factors influencing non-initiation of adjuvant hormonal therapy are complex and influenced by patient beliefs regarding treatment efficacy and side effects. Educational interventions to women about the benefits of hormonal therapy may decrease negative beliefs and increase hormone therapy initiation.

The Breast Cancer Quality of Care Study (BQUAL): a multi-center study to determine causes for noncompliance with breast cancer adjuvant therapy.

In oncology, quality of care is a major issue for patients and providers. Significant variations in care, including nonreceipt of adjuvant systemic therapy, nonadherence to therapy, and/or early discontinuation of therapy, occur frequently and may impact survival. Reasons for these variations are not well understood, but may play a role in the prominent disparity in breast cancer survival between blacks and whites. Since May 2006, the Breast Cancer Quality of Care Study (BQUAL) has recruited 1158 women with nonmetastatic breast cancer from several centers across the country, with completed data on 1057 participants to date. Detailed information on demographic, behavioral, biomedical, and emotional factors related to chemotherapy use was collected on each participant at baseline and at two follow-up interviews during the first 6 months. In addition, for women with ER+ tumors, further questionnaires were completed every 6 months regarding hormonal therapy use. Each participant was also asked to provide a DNA sample, and to allow medical record review. We surveyed physicians providing care to the study participants regarding attitudes toward adjuvant treatment. The mean age of participants was 58 years (SD 11.6), and 15% (n = 160) were black. The majority had an annual household income <$90,000 (n = 683), had college education or higher (n = 802), 55.9% were married, and 57.9% were not currently employed. Seventy-six percent had hormone-receptor-positive tumors, 49.9% initiated chemotherapy and 82.7% started hormonal therapy. Blacks were more likely to have lower annual household income (p < 0001), less education (p = 0.0005), ER negative tumor status (p = 0.02), and poorly differentiated cancer (p = 0.0002). The main endpoints of the study are noninitiation of chemotherapy or hormonal therapy, nonadherence to therapy and early discontinuation of therapy. Treatment and outcomes will be compared on the 15% of participants who are black versus other participants. The BQUAL Study will be a rich ongoing source of information regarding reasons for differences in receipt of both adjuvant chemotherapy and hormonal therapy. This information may be useful in planning interventions to improve quality of care.

"Let's get down to business: a validation study of the Psychopathic Personality Inventory among a sample of MBA students.".

While the Psychopathic Personality Inventory (PPI) has gained increasing attention as a measure of noncriminal psychopathy, absent has been research involving samples including business people. This study investigated the validity of the PPI with such a population by examining the association between psychopathic traits and moral decision-making among MBA students. Sixty-six MBA students were assessed using the PPI, the MACH-IV (a measure of Machiavellianism), the Ethical Position Questionnaire (EPQ), and the Defining Issues Test (DIT-2). Only PPI Machiavellian Egocentricity was associated with level of post-conventional moral reasoning. MACH-IV Machiavellianism was a stronger predictor of the Subjectivist ethical position than were PPI subscales. However, a combination of MACH-IV Machiavellianism and four PPI scales accounted for 46% of the variance in Subjectivism. Results suggested that Machiavellian Egocentricity and Machiavellianism are distinct constructs. Benning, Patrick, Hicks, Blonigen, & Krueger (2003)'s two factor model of the PPI was also supported. In general, the findings provided further validation for the PPI as a tool for assessing psychopathic traits among "mainstream" individuals, including business people.

Synergy between molecular and contextual views of coping among four ethnic groups of older adults.

The coping styles of four ethnic groups of older adults in response to negative life events were analyzed in a population-based study of 1118 residents of Brooklyn, New York. Using a molecular approach, data regarding the context of events and the corresponding coping responses was obtained. Open-ended semi-structured interviews allowed participants to describe recent negative life events and explain how they coped. An empirically derived coding system distinguished four major negative life events: Death, Illness/Injury, Empathic Response to Distress of Others, and Interpersonal Conflict. Nine major styles of coping emerged: Medicate, Active Coping, Passive Response, Prayer, Stoicism, Social Support, Positive Self-Talk, Acknowledgment of Emotions, and Distraction. Gender and ethnic differences in coping styles were found. Although ethnic specificity in coping emerged when context was considered, the few effects of ethnicity suggests that the major normative events of later life may pull for generic coping responses.

The obscuring object of race: clinical breast exams and coping styles in ethnic subpopulations of women.

OBJECTIVES: Differences in breast cancer screening rates have been linked to many factors including race, access to healthcare, and breast cancer knowledge and beliefs; less frequently studied has been the role of characteristic styles of coping. In this study, we examined ethnicity and the role of coping with a possible breast cancer diagnosis in the context of whether or not women obtained clinical breast examinations (CBE). DESIGN: To measure coping, a stressor, in the form of a vignette asking participants to imagine they had just received a breast diagnosis upon a doctor's visit, was used. METHOD: Three hundred and eight women from seven ethnic subpopulations (and from three racial groups) in the USA were interviewed regarding frequency of breast screening, as well as how they would likely cope with a diagnosis of breast cancer. RESULTS: CBE rates were similar across groups and were differentially predicted by the different coping styles. Analysing the results using typical racial categories (rather than distinct ethnic groupings) obscured these results. Furthermore, avoidance predicted CBE and mammogram rates differently, specifically, predicting mammogram rates differentially for each group, with no relation to CBE rates. CONCLUSION: Recognition of the roles of problem solving, social support, and avoidance in coping with a possible breast cancer diagnosis may guide the development and provision of interventions that are more sensitive to the characteristics of specific groups of women. Examinations of psychological variables in preventive health behaviours must begin to analyse diversity by paying attention to ethnic specificity, rather than race, as well as to the underlying nature of the screening task.

Cancer worry and insomnia complaints among American women.

One-third of women worrying about breast cancer report impaired ability to function daily. It is unclear whether women who worry about breast cancer would experience more sleep problems than those who do not. Data were obtained from a cross-sectional study of black and white women to investigate the association between breast cancer worry and insomnia complaints. Several questionnaires were administered during face-to-face interviews to elicit health and sociodemographic data. The present analyses focused on black and white women (n = 1,038; age range = 50-70 years) with no cancer antecedents or history. Overall, 62% of the women worried about breast cancer, and 49% reported insomnia complaints. Logistic regression analyses, adjusting for effects of age, ethnicity, family history, and perceived risk of developing breast cancer, yielded an odds ratio for insomnia complaints of 1.52 (95% CI: 1.15-2.02, p < .001) among women reporting breast cancer worry. More than one half of the women worrying about breast cancer were likely to report insomnia complaints, notwithstanding the fact that those women did not have a history of cancer. Although fewer black women reported breast cancer worry and insomnia complaints, they were as affected as white women by the impact of worry on mood and daily activities.

Sharing the good, sharing the bad: the benefits of emotional self-disclosure among middle-aged and older adults.

OBJECTIVE: The present study was designed to assess the impact of experimentally manipulating positive and negative self-disclosure on three domains of well-being among healthy middle-aged and older adults: emotional, psychological, and physical. METHOD: Using a modified self-disclosure paradigm for sad, mixed (sad and happy), and neutral content, the authors examine changes in depressive symptomatology, stress, sad and happy mood, and self-reported health across 4 weeks in a sample (N = 200) of African American and European American men and women (age M = 54 years). RESULTS: Consistent with research on younger groups, health symptomatology declined over time (irrespective of condition). However, although African Americans reported reductions in stress and depressive symptomatology in the sad condition, European Americans experienced similar reductions only in the neutral condition. DISCUSSION: Results are discussed in terms of applications of the self-disclosure paradigm to developmentally and ethnically diverse groups.

Late life attachment in context: patterns of relating among men and women from seven ethnic groups.

The purpose of the present study was to develop the later life attachment literature by providing data contrasting patterns of attachment among 616 older men and women (aged 50 to 70) from seven ethnic groups in the United States: African Americans, English-speaking Caribbeans, Haitians, Dominicans, Puerto Ricans, Eastern Europeans, and European Americans. A multivariate analysis of the variance with ethnicity, gender, and income as factors predicting four dimensional styles of attachment (secure, dismissive, preoccupied, and fearful avoidant) revealed numerous ethnic differences in attachment styles. Most notably, Haitians reported greater dismissiveness than all other groups, with Eastern Europeans reporting more than Dominicans, Puerto Ricans, European Americans and African Americans. Haitians also reported lower fearful avoidance than all other groups. Dominicans and Puerto Ricans reported greater preoccupation than Haitians, African Americans, and English-speaking Caribbeans. The most notable interactions with gender and income revealed that although preoccupation was lower among African American, English-speaking Caribbean, Haitian, and European American women versus men, it was greater among Dominican, Puerto Rican, and Eastern European women, and that whereas security was generally high among European Americans notwithstanding income, income strongly impacted attachment security in other groups. These differences are interpreted in light of ethnic differences in historical, familial, and religious contexts. This study provides a glimpse into the ethnic and cultural diversity in the ways in which older adults relate to significant others.

The adaptive and maladaptive faces of dependency in later life: links to physical and psychological health outcomes.

OBJECTIVES: Negotiating the balance between reliance on others and desires for autonomy is a fundamental task of successful aging. The purpose of the present study was to replicate and extend a three-factor model of interpersonal dependency in a sample of older adults, and to examine the physical and psychological health correlates of this multifaceted construct. METHODS: Data come from the third wave of a population-based study of older Americans (n = 166; mean age 80 years). We conducted an exploratory factor analysis of selected dependency items from two scales, and then conducted logistic and hierarchical linear regressions to analyze the association of dependency factors with self-reported health, use of hypertension medication, depressed affect and positive affect. RESULTS: We found three factors closely paralleling those of Bornstein and Languirand's (Psychological Bulletin, 112(1), 3-23, 2004) measure: destructive overdependence, healthy dependency and dysfunctional detachment, as well as a fourth factor we labeled 'healthy independence'. Healthy dependency was associated with better self-reported health. Dysfunctional detachment was related to a greater likelihood and healthy independence a lesser likelihood of taking hypertension medication. Whereas both healthy independence and healthy dependency were positively related to positive affect and negatively related to depressed affect, destructive overdependence was positively related to depressed affect. CONCLUSION: Understanding the complex nature of interpersonal dependency and autonomy in old age, as well as their implications for health and wellbeing, may enable practitioners to assist older adults in negotiating the task of balancing these needs.

The influence of coping styles on mammography screening in a multiethnic sample.

A total of 308 women from seven ethnic subpopulations (comprising major ethnic groups of Black, Hispanic, and non-Hispanic White) were interviewed to examine their coping styles in response to an imagined breast cancer diagnosis and to determine relationships among ethnicity, access to mammography, coping styles, and mammography screening. There were ethnic subpopulation differences in the five coping styles identified (problem solving, social support, positive reframing, wishful thinking, and avoidance), and in the relations between screening rates and coping styles. Specifically, ethnicity differentially moderated the relationship between screening rates and avoidance within and between major groups. Researchers studying behavior that is likely to be impacted by culture, such as health preventive behaviors, are well advised to take coping styles into account, as well as to examine potential ethnic subpopulation differences.

Insomnia symptoms in a multiethnic sample of American women.

BACKGROUND: Ethnic disparities in socioeconomic factors, risk markers, and coping styles affect health status. This study examined whether those factors influence insomnia symptoms in a multiethnic sample of urban American women. METHODS: Women (n = 1440, average age = 59.5 +/- 6.45 years) participating in the study were recruited using a stratified, cluster sampling technique. The sample comprises African Americans (22%), English-speaking Caribbeans (22%), Haitians (22%), Dominicans (12%), Eastern Europeans (11%), and European Americans (11%). Trained staff conducted face-to-face interviews lasting 1.5 hours acquiring demographic, health, and sleep data. RESULTS: Analysis indicated significant ethnic differences in socioeconomics, risk markers, and health characteristics. The prevalence of insomnia symptoms (defined as either difficulty initiating sleep, difficulty maintaining sleep, or early morning awakening) among African Americans was 71%, English-speaking Caribbeans 34%, Haitians 33%, Dominicans 73%, Eastern Europeans 77%, and European Americans 70%. Hierarchical regression results showed that ethnicity explained 20% of the variance in the insomnia variable. Sociodemographic factors explained 5% of the variance, risk markers explained 5%, medical factors 20%, and coping styles 1%. Goodness-of-fit test indicated the model was reliable [chi-square = 276, p < 0.001], explaining 51% of the variance. CONCLUSIONS: Findings show interethnic heterogeneity in insomnia symptoms, even among groups previously assumed to be homogeneous. Different factors seemingly influence rates of insomnia symptoms within each ethnic group examined. These findings have direct relevance in the management of sleep problems among women of different ethnic backgrounds. Understanding of ethnic/cultural factors affecting the sleep experience is important in interpreting subjective sleep data.

Psychosocial influences on suboptimal adjuvant breast cancer treatment adherence among African American women: implications for education and intervention.

Despite lower incidence, African American women are at increased risk of dying from breast cancer relative to their European American counterparts. Although there are key differences in both screening behavior and tumor characteristics, an additional part of this mortality difference may lie in the fact that African American women receive suboptimal adjuvant chemotherapy and may receive suboptimal hormonal therapy, therapies that are known to increase survival. The authors consider ethnic differences in the psychosocial factors that have been shown to relate to poor screening adherence and consider how they may influence adherence to breast cancer adjuvant treatment, thus the receipt of suboptimal adjuvant chemo or hormonal therapy. To this end, they review ethnic differences in cognitive, emotional, and social network variables. Psychosocial variables should be included in research designed to understand cancer disparities as well interventions that can be tailored to culturally diverse populations to improve treatment adherence.

Influence of coping with prostate cancer threat on frequency of digital rectal examinations.

OBJECTIVES: To determine the role of personality variables in coping with cancer threat in the receipt of digital rectal examinations among men from 7 ethnic subpopulations composing 3 major ethnic groups. METHODS: Three hundred eight men were assessed on how often they obtained digital rectal exams and their likelihood of coping with a hypothetical cancer diagnosis. RESULTS: There were ethnic disparities in screening frequency that were not accounted for by demographic/background variables. Coping styles that reflect problem solving, use of social support, and avoidance provided unique and additional variance in understanding these disparities. CONCLUSIONS: Cancer researchers and educators must account for heterogeneity within typical major ethnic groups, as well as consider the role of personality variables, as they differentially predict outcomes in ethnic subpopulations.

Cancer incidence and mortality in the Caribbean.

BACKGROUND: Nearly 10% of immigrants to the United States come from the Caribbean region. In this paper, we analyzed incidence and mortality rates of the major cancers in the Bahamas, Barbados, Cuba, the Dominican Republic, Haiti, Jamaica, Puerto Rico, and Trinidad and Tobago, and compared them with US patterns. METHODS: We obtained age-standardized, sex-specific cancer incidence and mortality rates for cancers of the bladder, breast, cervix, esophagus, large bowel, liver, lung, pancreas, prostate, and stomach for 8 Caribbean countries and the United States from the GLOBOCAN program of the International Agency for Research in Cancer (IARC) and for the U.S. population from the Surveillance, Epidemiology, and End Results (SEER) Program of the NCI. RESULTS: GLOBOCAN incidence and mortality rates for the overall United States were lower than but correlated with overall SEER rates. Based on GLOBOCAN data, the incidence and mortality rates of cancers of the breast, prostate, large bowel, and lung, and, among males, bladder cancer were lower in the Caribbean countries than the United States. Caribbean countries had higher rates of cancers of the cervix, esophagus, liver, and stomach. Haiti had the highest incidence and mortality rates of cervix and liver cancers. Jamaica and Haiti had the highest rates of stomach cancer. CONCLUSIONS: Cancer incidence and mortality in the Caribbean generally follow known patterns of association with economic development, infectious agents, and racial/ethnic origin. Studying these patterns and how immigration changes them may yield clues to cancer etiology. A better understanding of cancer incidence and mortality rates may help health policymakers to implement state-of-the-art treatment and preventive services for people of Caribbean descent both in their native countries and in immigrant communities in the United States.

African-Caribbean cancer consortium for the study of viral, genetic and environmental cancer risk factors.

This is a short summary of a meeting of the "African-Caribbean Cancer Consortium", jointly organized by the University of Pittsburgh, Department of Epidemiology and the University of Pittsburgh Cancer Institute, held in Montego Bay, Jamaica as a satellite meeting at the Caribbean Health Research Council, 52nd Annual Council and Scientific meeting on May 4, 2007.

Breast screening in response to gain, loss, and empowerment framed messages among diverse, low-income women.

Framed messaging has emerged as an important means of promoting a number of health behaviors, including breast cancer screening. However, studies of message framing have infrequently considered race and income as possible moderators of framing effects, despite their importance to screening behavior. The current study examined whether demographic characteristics moderated participant responses to message framing. In the study, 102 Black and 42 White low-income, low-screening women were randomized to a loss, gain, or empowerment frame telephone intervention and re-contacted at 6 and 12 months. Contrary to expectation, there was no main effect for framing condition, although both loss and empowerment conditions elicited superior screening than the gain condition at 12 months. Income proved an important moderator of framing effects, interacting with both condition and race to influence screening. Message frames may differ in the amount of time they require to manifest in behavioral outcomes and may lead to changes in different screening outcomes. Understanding how framing effects vary as a function of key demographic characteristics such as race and income is likely to prove important as such variables facilitate targeting of frames.