RESUMO
Purpose: Adolescents and young adults (AYAs) employ self-disclosure in normative social interactions and in promoting identity development. Disclosure is associated with numerous psychological and physical benefits. Little research has examined how AYA cancer survivors diagnosed during adolescence disclose their cancer history. Methods: Using a qualitative design, this study explored cancer-related disclosures among survivors (N=26) 16-24 years old at study (M=19.6 years), 14-18 years old at diagnosis (M=15.6 years), and currently at least 6 months post-treatment (M=3.2 years). Semi-structured interview guides were developed and used. Disclosure-related topics included survivorship communications and others' responses to AYAs' disclosure of their cancer experiences. Results: Grounded theory and thematic content analysis guided analyses, with an inductive data-driven approach. Three themes and eight subthemes emerged: "it depends" decision-making processes (don't ask/don't tell, shared experience, relationship potential), perceptions of others' responses (perceived apprehension, positive responses), and methods of disclosure (verbal, written, behavioral). No thematic differences were found by gender or age, although females reported greater frequency of disclosures. Conclusion: Disclosure emerged as a nuanced and complex process. "It depends" decision-making processes were most frequently endorsed, consistent with developmental complexities of this age group. This reflects social and psychological changes and highlights unique challenges for AYA survivors. This also reflects the importance of peers and social interactions as variables that influence disclosure. In the context of AYA cancer survivorship, understanding ways in which disclosure may bolster or hinder social support can assist survivors, clinicians, and families navigate survivorship. Implications for future research are discussed.
RESUMO
Black women are at increased risk for breast cancer mortality. The black category is assumed to be homogeneous, an assumption that may be misleading. This study aims to examine the relationship between nativity and breast cancer risk factors among women identified as black. A sample of 236 black women over 18 years of age in Brooklyn, New York, was recruited. Data were collected on race/ethnicity, breast cancer risk factors, and other sociodemographic, behavioral, and early life experience factors. Logistic regression analyses were used to estimate prevalence ratios for association between nativity and breast cancer risk factors. US-born blacks were more likely to be unemployed, smoke, not breastfeed, and breastfeed for a shorter duration than foreign-born blacks (all p< or =0.01). Foreign-born blacks were more likely to have parents who achieved at least a high school education (p<0.05). After adjustment for smoking, employment, and parental education, US-born blacks were twice as likely to never breastfeed (PR 2.2, 95% CI: 1.1, 4.46) compared to foreign-born blacks. Among women who breastfed, US-born blacks were also less likely to breastfeed for 6-11 months or more than 12 months, but these associations were not statistically significant. Because lactation reduces breast cancer risk and is a leading modifiable risk factor, understanding its variation within black women will help physicians and public health practitioners to target patient counseling and education of breast cancer risk.