Health behaviors and breast cancer: experiences of urban African American women.

Breast-cancer survival rates are lower among African American women compared to White women. Obesity may contribute to this disparity. More than 77% of African American women are overweight or obese. Adopting health behaviors that promote a healthy weight status may be beneficial because obesity increases risk for recurrence. Studies among White breast-cancer survivors indicate that many make health behavior changes after diagnosis. This cross-sectional pilot study collected quantitative and qualitative data on the attitudes, beliefs, barriers, and facilitators related to health behavior changes in 27 overweight/obese African American breast-cancer survivors. Results indicated that most participants reported making dietary changes since their diagnosis, and some had increased their physical activity. Focus groups provided rich details on the barriers and facilitators for behavior change. These results begin to address the significant gap in our knowledge of African American breast-cancer survivors' health behaviors and underscore the need for culturally competent health behavior interventions.

Workplace Discrimination Is Associated With Alcohol Abuse Among Ethnically Diverse Hospital Staff.

Research suggests that workplace discrimination plays a role in absenteeism, productivity, and turnover. A link among workplace discrimination, mental health, and health disparities may also exist. The purpose of this study was to determine whether self-reported workplace discrimination is associated with alcohol abuse among hospital workers. Cross-sectional analysis of baseline data collected from a prospective cohort study of workers in two healthcare institutions (n = 664) was conducted. Workplace discrimination in the previous 12 months was reported by 14% (n = 91) of participants who were four times more likely to score higher on likely alcohol abuse than their peers. White participants who reported any discrimination were more likely to score higher on likely alcohol abuse than racial/ethnic minority participants who reported any discrimination. Given a diversifying workforce, further research is needed on how workplace discrimination contributes to stress and maladaptive coping, and ultimately health disparities.

Cognitive-behavioral group therapy for insomnia in individuals with serious mental illnesses: a preliminary evaluation.

Chronic insomnia is a problem among individuals with serious mental illnesses. In an effort to expand treatment options, we examined whether well-established cognitive-behavioral treatments for insomnia developed for individuals in the general population generalize to those for people with serious mental illnesses. Individuals participated in comprehensive sleep evaluations and cognitive-behavioral therapy. Results suggest that sleep problems often began during periods of distress and/or exacerbation of illness but were maintained by environmental, behavioral, and cognitive factors. With the treatment, participants reported improvement in many sleep parameters. Initial indication is that cognitive-behavioral therapy does generalize. More rigorous research seems warranted.

How old are African American women when they receive their first mammogram? Results from a church-based study.

African American women in the U.S. have the highest breast cancer mortality though not the highest breast cancer incidence. This high mortality rate has been attributed in part to discrepancies in screening between African American and White women. Although this gap in mammography utilization is closing, little is known about what has been and is driving the screening practices of African American women, in particular age at first mammogram. This study examined the rates of breast cancer screening in an African American community sample from eight churches in greater Baltimore, Maryland and investigated the association between various factors and age at first mammogram. Participants were 213 women ages 22-89 years. About 77% of women had ever had a mammogram. Over 40% had their first mammogram before age 40. Women who first screened before age 40 had greater odds than women who had never screened of being knowledgeable about screening guidelines, of having received a physician recommendation to screen, and of having three or more female relatives who had been screened. Women who first screened at or after age 40 were more likely to have stronger religious beliefs of health than women who never had screened. These findings suggest the importance of reinforcing factors in screening behavior for African American women and have implications for physician training and public health education about breast cancer screening. A better understanding of African American women's mammography practice including early screening is needed to reduce this population's disproportionate breast cancer mortality risk.

A combined breast health/weight loss intervention for Black women.

BACKGROUND: Overall incidence of breast cancer is slightly lower, but mortality rates are higher, for Black women compared to White women. Higher body mass index (BMI), sedentary lifestyles, and lower compliance with recommended breast health behaviors may contribute to higher risk and mortality. METHODS: A randomized pilot intervention trial was conducted to assess feasibility and efficacy of a combined breast health/weight loss intervention for 64 overweight or obese Black women, ages 35-65. The primary objectives were to determine whether a 20-week (twice weekly) intervention could decrease weight and dietary fat intake and increase physical activity and breast self-exam (BSE) proficiency. RESULTS: The project was implemented in two cohorts and retention was high for both (96% and 89%, respectively). Both cohorts showed increased proficiency in BSE in the intervention versus the control group (2.4 vs. -0.4, P<0.05; 3.3 vs. -0.2, P<0.001, respectively), but only cohort 2 showed decreased percent body weight (4.0% decrease vs. 0.9% increase, P<0.01), increased physical activity frequency (2.4 vs. 0.1 times/week, P<0.05), and a trend for decreased dietary fat (-2.6% kcal vs. 0.0% kcal, P=0.07) in the intervention compared to the control group. CONCLUSION: Few studies have documented weight loss among Black women, and no combined breast health/weight loss intervention has been conducted. This study documents the feasibility of recruiting, randomizing, and retaining women in a combined intervention and demonstrated weight loss and associated lifestyle changes.