The role of health literacy on African American and Hispanic/Latino perspectives on cancer clinical trials.

Although cancer clinical trials are important for discovering lifesaving therapies, participation remains low among racial/ethnic minorities, and little research explores the role of health literacy in racial/ethnic minority perceptions of cancer clinical trials (CCTs). Five focus groups (n = 50) with African American and Hispanic participants explored CCT perceptions using a multidimensional health literacy framework. We found poor scientific literacy including misconceptions of scientific information, perceptions of clinical trials as uncertain and fear; limited civic literacy around topics of trust, perceptions of participants as guinea pigs, and concerns about of IRB protections; and cultural literacy challenges regarding the importance of home remedies for health, use of native language, and the importance of race/ethnicity matching to health care professionals. Results highlight the importance of attending to scientific literacy, cultural literacy, and civic literacy. Future educational interventions regarding cancer clinical trials should address the importance of health literacy in understanding cancer clinical trial decision making.

Self-reported pain and utilization of pain treatment between minorities and nonminorities in the United States.

OBJECTIVES: To investigate differences in reported pain and pain treatment utilization (use of over-the-counter and prescription pain medications, seeing a pain specialist, and use of complementary and alternative medicine) among minorities and nonminorities in the general population. DESIGN: Secondary analysis of a national probability survey conducted by the CBS News/New York Times in January 2003. SAMPLE: Adult population in the United States, 18 years or older, having a telephone line at home. MEASUREMENTS: The survey asked respondents a series of questions about demographics, pain characteristics, and utilization of pain treatment; logistic regression was used to identify variables predicting reported utilization of pain treatment. RESULTS: Of the 902 respondents completing the survey, 676 (75%) reported experiencing "any type of pain." Of these, 17% reported being diagnosed with chronic pain. Minorities reported a higher average daily pain than Whites (4.75 vs. 3.72; p<.001). However, race/ethnicity did not explain utilization of pain treatment; income, education, age, gender, and pain levels explained more variability in different pain treatment utilization variables than race/ethnicity. CONCLUSIONS: Although minorities report higher pain levels than Whites, race/ethnicity does not explain utilization of treatment for pain. Future studies should consider more nuanced examination of interactions among race/ethnicity, pain, and socioeconomic variables.

Exploring older women's approaches to cervical cancer screening.

The purpose of this qualitative study (N = 98, 11 focus groups) is to investigate how low-income, African American and Hispanic older women make decisions about cervical cancer screening. Using the health belief model to guide content analysis of transcripts, we found that primary barriers to screening were; embarrassment with, fear of, and pain from the test, difficulty in accessing screening, stigma associated with Medicaid coverage, and prior negative experiences with cancer detection. Women experienced cues to screening from their own bodies, in symptoms, and relied on spiritual beliefs to support them in coping with their health problems. Enhanced understanding of these factors could increase uptake of cervical cancer screening among the unscreened and underscreened.

Hispanic adults' beliefs about type 2 diabetes: clinical implications.

PURPOSE: This integrative literature review focused on Hispanic adults' beliefs about type 2 diabetes. Type 2 diabetes is a progressive, chronic illness with the potential for debilitating complications that disproportionately affect Hispanic adults. By understanding Hispanic adults' beliefs about type 2 diabetes, health professionals will be able to offer more culturally competent health care. DATA SOURCES: Published research reports on Hispanic adults' beliefs about type 2 diabetes were obtained using multiple computerized databases and by searching reference lists of published reports. A total of 15 research reports comprised this review. CONCLUSION: While there was some variance among Hispanic subgroups, in general, Hispanic adults' understanding of the etiology of diabetes was an integration of biomedical causes such as heredity and traditional or folk beliefs such as susto, which is the concept of strong emotions. Hispanic adults believed that diabetes is a serious illness and that they could identify many of the symptoms of diabetes. They identified both biomedical and herbal treatments for diabetes. Negative attitudes toward insulin were common. Religious beliefs also factored into Hispanic adult's explanatory models of type 2 diabetes. IMPLICATIONS FOR PRACTICE: Hispanic adults have a fairly cohesive explanatory model of diabetes. Healthcare professionals can use this information as a starting point to discuss each individual patient's explanatory model of illness, clarify misconceptions, and develop an individualized plan of care.

Effects of a school-based, early childhood intervention on adult health and well-being: a 19-year follow-up of low-income families.

OBJECTIVE: To determine the effects of an established preventive intervention on the health and well-being of an urban cohort in young adulthood. DESIGN: Follow-up of a nonrandomized alternative-intervention matched-group cohort at age 24 years. SETTING: Chicago, Illinois. PARTICIPANTS: A total of 1539 low-income participants who enrolled in the Child-Parent Center program in 20 sites or in an alternative kindergarten intervention. INTERVENTIONS: The Child-Parent Center program provides school-based educational enrichment and comprehensive family services from preschool to third grade. MAIN OUTCOME MEASURES: Educational attainment, adult arrest and incarceration, health status and behavior, and economic well-being. RESULTS: Relative to the comparison group and adjusted for many covariates, Child-Parent Center preschool participants had higher rates of school completion (63.7% vs 71.4%, respectively; P = .01) and attendance in 4-year colleges as well as more years of education. They were more likely to have health insurance coverage (61.5% vs 70.2%, respectively; P = .005). Preschool graduates relative to the comparison group also had lower rates of felony arrests (16.5% vs 21.1%, respectively; P = .02), convictions, incarceration (20.6% vs 25.6%, respectively; P = .03), depressive symptoms (12.8% vs 17.4%, respectively; P=.06), and out-of-home placement. Participation in both preschool and school-age intervention relative to the comparison group was associated with higher rates of full-time employment (42.7% vs 36.4%, respectively; P = .04), higher levels of educational attainment, lower rates of arrests for violent offenses, and lower rates of disability. CONCLUSIONS: Participation in a school-based intervention beginning in preschool was associated with a wide range of positive outcomes. Findings provide evidence that established early education programs can have enduring effects on general well-being into adulthood.

Broadcasting behavior change: a comparison of the effectiveness of paid and unpaid media to increase folic acid awareness, knowledge, and consumption among Hispanic women of childbearing age.

Awareness about folic acid's effectiveness in reducing the risk of certain birth defects has increased among women in the United States; however, few Hispanic women are consuming enough folic acid daily. A 1998 survey conducted by the Gallup Organization for the National March of Dimes Birth Defects Foundation found that English-speaking Hispanic women had lower folic acid awareness (53% vs. 72%) and lower daily consumption (29% vs. 33%) than non-Hispanic White women. In 1999, the Centers for Disease Control and Prevention (CDC) conducted baseline surveys with Spanish-speaking Hispanic women in selected U.S. markets to measure folic acid awareness, knowledge, and consumption. A Spanish-language public service announcement (PSA) volunteer campaign and a paid Spanish-language media and community education campaign were conducted in 2000 and 2002, respectively. Comparisons of postcampaign surveys indicate that the paid media campaign was significantly more effective than the PSA campaign in increasing folic acid awareness, knowledge, and consumption among Spanish-speaking Hispanic women.

An examination of sociocultural factors associated with health and health care seeking among Latina immigrants.

The purpose of this study was to examine the sociocultural factors associated with health maintenance and health care seeking among Latina immigrants. Data were collected from eight focus groups with 54 Latina immigrants between the ages of 19 and 62 (M=29.3+/-9.34). The PEN-3 model provided the framework for the study. Most of the participants came from Mexico; 46% had not completed high school; 85.2% had been in the United States for less than 7 years, and 73.6% reported not having health insurance coverage. Participants identified both positive and negative perceptions, enablers, and nurturers associated with health maintenance and health care seeking. Participants acknowledged the importance of physical, mental, and spiritual health and what they should do to be healthy. Despite such knowledge, they tended to engage in unhealthy behaviors due to a variety of nonstructural barriers such as lack of time, "tradition," and procrastination. They tended to use alternative/complementary medicine first, and then seek medical help if these practices are not effective. Many women believe that they do not have control over their own health attributing this lack of control to the "system." Participants also mentioned structural barriers to seeking health care such as lack of transportation, lack of proper documentation, lack of health insurance, language barriers, long waiting time at the clinics, and lack of knowledge on where to go for affordable care. Our study suggests that there are important structural and nonstructural barriers that hinder health maintenance and care seeking. The findings also lend support to the PEN-3 model, and suggest that positive perceptions, enablers, and nurturers associated with health maintenance and health care seeking, if properly reinforced, can counterbalance negative perceptions, enablers and nurturers in this population.

Cardiovascular risk among older Hispanic women: a pilot study.

This study used a descriptive correlational design to describe the relationship between cardiovascular risk and anxiety, spirituality, acculturation, and the objective indices of cardiac risk among a sample of 21 adult Hispanic women. Objective indices of risk included weight, blood pressure, blood lipids, and glucose. Four survey instruments were used to assess anxiety, spirituality, acculturation, and perceived risk. Findings revealed that all study participants had 3 or more risk factors, placing them in the moderate risk category for developing heart disease or having a heart attack within 10 years. State and trait anxiety scores were lower than the normative samples for adult women. Spirituality scores were higher than average; individuals with higher anxiety scores had lower spirituality scores. More research is needed to determine the health needs of unskilled workers with limited education in employment settings.

Identifying culturally appropriate strategies for educating a Mexican immigrant community about lead poisoning prevention.

Lead paint is one source of exposure for lead poisoning; however, recent Latino and other immigrant populations are also at risk of exposure through ceramic cooking pots with lead glaze, some imported candies, and certain stomach ailment home remedies. Public health agencies and practitioners acknowledge that Latino families should be educated about lead poisoning prevention but report barriers to conducting outreach and education in Latino communities. This study reports findings from focus groups and interviews with the local Latino immigrant community and professionals on (1) current knowledge and beliefs about lead poisoning and (2) recommendations of culturally appropriate educational strategies.

Early infant feeding decisions in low-income Latinas.

Breastfeeding rates remain low, especially among low-income minority women. The objective of this qualitative study was to assess barriers to breastfeeding and reasons for combination feeding among low-income Latina women and their families. Meetings were held with key informants to inform the sampling plan and develop questions for focus groups. Data were collected from eight qualitative focus groups with primiparous mothers postpartum, mothers breastfeeding at 4 to 6 months, mothers formula feeding at 4 to 6 months, grandmothers and fathers, and 29 individual interviews with formula- and combination-feeding mothers. Transcripts of focus groups and interviews were content coded and analyzed for thematic domains and then compared for concurrence and differences. Four main domains with 15 categories were identified: (a) Best of both: Mothers desire to ensure their babies get both the healthy aspects of breast milk and "vitamins" in formula. (b) Breastfeeding can be a struggle: Breastfeeding is natural but can be painful, embarrassing, and associated with breast changes and diet restrictions. (c) Not in Mother's Control: Mothers want to breastfeed, but things happen that cause them to discontinue breastfeeding. (d) Family and cultural beliefs: Relatives give messages about supplementation for babies who are crying or not chubby. Negative emotions are to be avoided so as to not affect mother's milk. Those counseling Latina mothers about infant feeding should discourage and/or limit early supplementation with formula, discuss the myth of "best of both," understand the fatalism involved in problem-solving breastfeeding issues, and enlist the altruism embedded in the family unit for support of the mother-infant pair.

Interpersonal and print nutrition communication for a Spanish-dominant Latino population: Secretos de la Buena Vida.

Participants (N=357) were randomly assigned to 1 of 3 conditions: lay health advisor (promotora) plus tailored print materials, tailored print materials only (tailored), or off-the-shelf print materials (control). The primary outcomes were calories from fat and daily grams of fiber. Secondary outcomes included total energy intake, total and saturated fat intake, and total carbohydrates. Adjusted for baseline values, calories from fat were 29%, 30%, and 30% for the promotora, tailored, and control conditions, respectively, and grams of fiber consumed were 16 g, 17 g, and 16 g. Significant Condition X Time interactions were not observed between baseline and 12-weeks postintervention. The LHA condition achieved significantly lower levels of energy intake, total fat and saturated fat, and total carbohydrates. The relative superiority of the promotora condition may derive from the personal touch achieved in the face-to-face interactions or from the women's use of print materials under the promotora's guidance.

A pilot study: the effects of music therapy interventions on middle school students' ESL skills.

The purpose of this study was to investigate the effects of music therapy techniques on the story retelling and speaking skills of English as a Second Language (ESL) middle school students. Thirty-four middle school students of Hispanic heritage, ages 10-12, in high and low-functioning groups participated in the study for 12 weeks. Pretest to posttest data yielded significant differences on the story retelling skills between the experimental and control groups. Chi Square comparisons on English speaking skills also yielded significant results over 3 months of music therapy intervention. A variety of music therapy techniques were used including music and movement, active music listening, group chanting and singing, musical games, rhythmic training, music and sign language, and lyric analysis and rewrite activities as supplemental activities to the ESL goals and objectives. Comparisons of individual subjects' scores indicated that all of the students in the experimental groups scored higher than the control groups on story retelling skills (with the exception of 1 pair of identical scores), regardless of high and low functioning placement. Monthly comparisons of the high and low functioning experimental groups indicated significant improvements in English speaking skills as well.

Complementary and alternative therapy use by older adults in three ethnically diverse populations: a pilot study.

Americans have overwhelmingly embraced complementary and alternative therapies. Although the primary purpose of this study was to refine a questionnaire on complementary and alternative therapy use by older adults, the findings of this pilot study identified knowledge and use of complementary and alternative therapies in a convenience sample of 60 older adults, 54 to 92 years of age from three ethnically diverse senior centers. Eighty percent of the participants used two or more therapies. There were no significant differences in therapy use by ethnicity. The most commonly used therapies were prayer, vitamins, diet, massage, and meditation. The participants rated the effectiveness of therapies higher than their knowledge of the therapies. Older adults need accurate information from health care providers to make safe decisions regarding the combination of complementary therapies and prescribed treatments to reduce the risk of interaction.

Helping Hispanic/Latino home health patients manage their pain.

The research focusing on pain in Hispanic/Latino populations suggests that their cultural values and beliefs of stoicism, fatalism, the importance of family, spirituality, and folk healing have an impact on their pain experience. Based on research findings this article suggests strategies nurses can use to assess and suggest pain management interventions for patients of Hispanic/Latino culture.

Cultural perspectives on contraception: a literature review.

The incorporation of transcultural nursing concepts has become an integral component of holistic nursing practice. However, to deliver culturally appropriate nursing care, knowledge of cross-cultural health beliefs and practices is necessary. This article reviews cultural perspectives on contraception based on a literature review of qualitative and quantitative health care research studies related to the topics of culture and contraception. The purpose of this literature review is to provide a knowledge foundation for health care providers who provide contraceptive counseling. Implications for practice, as well as recommendations for future research, are developed.

Listening to Hispanic mothers: guidelines for teaching.

Teaching Hispanic mothers in a culturally sensitive way to care for their children is a challenge to pediatric nurses. Pediatric nurses must be familiar with customs and the folk medicine practiced by Hispanic mothers. It is very important that the pediatric nurse listens to the voices of Hispanic mothers to determine their health practices, and those that may have been used in their children. Familiarity with folk medicine and health practices will facilitate an appropriate treatment plan and will help to determine whether the mothers' practices are dangerous or beneficial for the child. Pediatric nurses should assess for concurrent use of home remedies and conventional medications to determine if there are any known interactive effects. Finally, increasing the number of pediatric nurses who are fluent in Spanish will enable the voices of Hispanic mothers to be better heard, which in turn, will improve the health status of Hispanic children.

Effective promotion of breastfeeding among Latin American women newly immigrated to the United States.

Across the United States, advance practice nurses (APNs) are increasingly encountering recently immigrated Latin American populations. This article provides an overview of the situation of Latin Americans in the United States and discusses aspects of Latin American culture such as, respeto (respect), confianza (confidence), the importance of family, and the value of a personal connection. Strategies that will assist practitioners to incorporate culturally holistic principles in the promotion of breastfeeding among Latin American women who are new arrivals in the United States are described. If practitioners are to respond to the increasing numbers of Latin American women who need health care services, and also provide thorough, holistic health care then health care activities must be integrated with cultural competence.

Seeking a healthy baby: Hispanic women's views of pregnancy and prenatal care.

The goal of this study was to develop a grounded theory of pregnancy and prenatal care for a cohort of Hispanic women residing in an industrial city in the Northeast. Twenty-one women, of predominantly Puerto Rican and Dominican heritage, participated in in-depth interviews lasting 30-50 minutes in which they shared their views of pregnancies and prenatal care including cultural influences on pregnancy, social support, initiation of prenatal care, and interest and participation in perinatal education. The core category, seeking a healthy baby, emerged from the data using a constant comparison analysis method. The women enhanced their chances of achieving the goal of having a healthy baby three ways: (1) caring for self by having a positive attitude, viewing pregnancy as normal, seeking education, eating healthily, balancing activity and rest, having good habits, and initiating and continuing prenatal care; (2) receiving support from their network in the form of receiving advice, listening to problems and concerns, and providing housing, babysitting, financial aid, and transportation; and (3) accepting care from providers in Western and folk medicine.

Evaluating AIDS-related social skills in Anglo and Latino adolescents. Focus on assessment.

The purpose of this study was to examine the assessment of AIDS-related social skills (measured by role play) in Anglo and Latino adolescents (N = 383) and to explore ethnic and gender differences on these skills. Eight skills were assessed on five measures evaluating molar, molecular, verbal, and nonverbal dimensions of behavior. Interrelationships between skills and measurement dimensions were examined using factor analysis. Results revealed that Anxiety and Nonverbal Behavior each loaded across different skills on individual respective factors, whereas verbal content and assertiveness measures loaded by skill on separate factors. Differences in skill emerged between female and male, and Latino and Anglo youth. Preliminary social validity data were collected for the skills assessed. Social validity results were skill specific, with judges validating certain skills and certain measurement dimensions more than others. Implications for future assessment and intervention research of AIDS-related social skills are discussed.