Prostate cancer screening among ethnically diverse first-degree relatives of prostate cancer cases.

OBJECTIVE: This study examined potential ethnic differences in prostate cancer screening behavior and correlates of screening in an ethnically diverse sample of first-degree relatives of prostate cancer cases. METHODS: The California Cancer Registry was used to identify a sample of prostate cancer cases who were contacted and invited to refer male first-degree relatives to the study. Telephone surveys with 1,029 first-degree relatives (354 non-Latino Whites, 228 Latinos, 272 African Americans, 175 Asians) assessed prostate cancer screening behavior and correlates of screening. RESULTS: Less than half of the participants had received a prostate specific antigen (PSA) test in the past year, with lowest rates observed among Latinos. Factors independently associated with an increased likelihood of the PSA test receipt in the total sample included: prior PSA testing, having a physician recommendation to be screened, and reporting fewer barriers to screening. Being the brother versus the son of the case predicted a higher likelihood of screening for all ethnic groups except for African Americans. In addition, the negative influence of barriers on screening was significantly greater for Latinos compared with Asians. CONCLUSIONS: Although ethnicity was not an independent predictor of screening, ethnic variations were observed in the relationship between some predictors and screening and in the modifiable correlates of screening. Findings may inform future intervention research that aims to enhance informed decision-making regarding prostate cancer screening and ultimately reduce prostate cancer health disparities.

Effect of mental health care and shared decision making on patient satisfaction in a community sample of patients with depression.

This study sought to understand if shared decision making and/or receipt of mental health care was associated with patient satisfaction for patients with depression and to determine whether gender modified this relationship. The data are from the Quality Improvement for Depression study, a national collaborative study of 1,481 patients diagnosed with major depression in managed care settings. The cross-sectional analyses were performed using multiple logistic regression on a sample of 1,317 patients who answered both the baseline and month six questionnaires. Shared decision making and receipt of mental health care were both positively associated with patient satisfaction. Gender was not a moderator of this relationship. Health plans may be able to improve patient satisfaction levels by teaching physicians the importance of shared decision making. Contrary to expectations, patient gender made no difference in the effects of quality of care on patient satisfaction.

Policy implications of a national public opinion survey on abortion in Mexico.

In Mexico, recent political events have drawn increased public attention to the subject of abortion. In 2000, using a national probability sample, we surveyed 3000 Mexicans aged 15-65 about their knowledge and opinions on abortion. Forty-five per cent knew that abortion was sometimes legal in their state, and 79% felt that abortion should be legal in some circumstances. A majority of participants believed that abortion should be legal when a woman's life is at risk (82%), a woman's health is in danger (76%), pregnancy results from rape (64%) or there is a risk of fetal impairment (53%). Far fewer respondents supported legal abortion when a woman is a minor (21%), for economic reasons (17%), when a woman is single (11%) or because of contraceptive failure (11%). In spite of the influence of the Church, most Mexican Catholics believed the Church and legislators' personal religious beliefs should not factor into abortion legislation, and most supported provision of abortions in public health services in cases when abortion is legal. To improve safe, legal abortion access in Mexico, efforts should focus on increasing public knowledge of legal abortion, decreasing the Church's political influence on abortion legislation, reducing the social stigma associated with sexuality and abortion, and training health care providers to offer safe, legal abortions.

Patient satisfaction for homeless women.

BACKGROUND: Patient satisfaction is a key quality of care indicator for which little is known for the homeless women population. We hypothesized that homeless women who last visited homeless-focused healthcare sites (shelter/outreach clinics and mobile vans) will have higher satisfaction ratings than homeless women who last visited county/government clinics. This association was also tested using the Gelberg-Andersen Behavioral Model for Vulnerable Populations. METHODS: Data were gathered on 974 homeless women aged 15-44 in a probability cluster sample of 60 shelters and 18 meal programs in Los Angeles County. The homeless women participated in 45-minute interviews. RESULTS: Our hypothesis was partially supported, as shelter and outreach clinics were positively and significantly associated with greater quality satisfaction (beta = 10.2, p < 0.001). Healthcare at private doctors' offices was also associated with quality, access, and appointment satisfaction when compared with care received at county/government clinics (beta = 15.9, p < 0.001; beta = 8.6, p < 0.05; beta = 16.3, p < 0.01). CONCLUSIONS: Policymakers should encourage healthcare sites that serve homeless women to improve their care by learning from shelter/outreach clinics and private doctors.