Cultural Barriers to Breast Cancer Screening and Medical Mistrust Among Arab American Women.

Breast cancer is a common cancer among women in the US and cultural barriers and medical mistrust have been associated with breast cancer screening (BCS) rates among minority populations. A heterogeneous sample of Arab women (N = 196) were recruited from across the Detroit metropolitan area and administered a questionnaire. Multiple regression analyses revealed an association between Arab Cultural Specific Barriers (ACSB) to BCS and Group-Based Medical Mistrust Scale. The environmental ACSB to BCS was associated with the medical mistrust-suspicion of HC providers (ß = 0.363, p = 0.01), lack of HC provider support (ß = 0.396, p = 0.001), and Arab inequities (ß = 0.250, p = 0.05). Findings suggest that ACSB to BCS are predictive of medical mistrust for Arab American women. This study illuminates the need to emphasize strategies that will target the medical care system and the cultural barriers to BCS that Arab American women face in the health care system.

Health Effects Reported by Adolescent Water Pipe and/or Cigarette Smokers Compared to Nonsmokers.

PURPOSE: The purpose of this study was to determine the prevalence of respiratory and/or physical fitness health problems in adolescent (ages 18-21) water pipe (WP) smokers (with or without cigarette smoking), cigarette-only smokers, and nonsmokers. METHODS: A comparative four-group study design was used to recruit a non-probability sample of 153 WP smokers only, 103 cigarette smokers only, and 102 cigarette+WP smokers along with 296 nonsmokers. Our hypothesis was that youth who smoked WPs and/or cigarettes would report more respiratory problems and/or poorer physical fitness than those who did not smoke. RESULTS: The results showed that coughs were significantly associated with smoking in all three of the smoking groups (p < .05). Cigarette-only smokers reported the most adverse outcomes with more wheezing, difficulty breathing, and less ability to exercise without shortness of breath. A dose-response analysis showed similar patterns of adverse health effects for both WP and cigarette smokers. The combined use of both products was not appreciably worse than smoking one product alone. This could be due to cigarette+WP smokers' reporting using less of the respective products when only one product was smoked. CONCLUSIONS: Even during the adolescent years, WP and/or cigarette smoking youth experienced reportable negative health effects.

Members of Minority and Underserved Communities Set Priorities for Health Research.

Policy Points Engaging and involving underrepresented communities when setting research priorities could make the scientific research agenda more equitable, more just, and more responsive to their needs and values. Groups and individuals from minority and underserved communities strongly prioritized child health and mental health research, often choosing to invest at the highest possible level. Groups consisting of predominantly Native American or Arab American participants invested in culture and beliefs research at the highest level, while many groups did not select it at all. The priority given to culture and beliefs research by these groups illustrates the importance of paying special attention to unique preferences, and not just commonly held views, when getting public input on spending priorities for research. CONTEXT: A major contributor to health disparities is the relative lack of resources-including resources for science-allocated to address the health problems of those with disproportionately greater needs. Engaging and involving underrepresented communities in setting research priorities could make the scientific research agenda more equitable, more just, and more responsive to their needs and values. We engaged minority and underserved communities in informed deliberations and report here their priorities for health research. METHODS: Academic-community partnerships adapted the simulation exercise CHAT for setting health research priorities. We had participants from minority and medically underserved communities (47 groups, n = 519) throughout Michigan deliberate about health research priorities, and we used surveys and CHAT software to collect the demographic characteristics and priorities selected by individuals and groups. FINDINGS: The participants ranged in age (18 to 88), included more women than men, and were overrepresented by minority groups. Nearly all the deliberating groups selected child health and mental health research (93.6% and 95.7%), and most invested at the highest level. Aging, access, promote health, healthy environment, and what causes disease were also prioritized by groups. Research on mental health and child health were high priorities for individuals both before and after group deliberations. Access was the only category more likely to be selected by individuals after group deliberation (77.0 vs 84.0%, OR = 1.63, p = .005), while improve research, health policy, and culture and beliefs were less likely to be selected after group deliberations (all, p < .001). However, the level of investment in many categories changed after the group deliberations. Participants identifying as Black/African American were less likely to prioritize mental health research, and those of Other race were more likely to prioritize culture and beliefs research. CONCLUSIONS: Minority and medically underserved communities overwhelmingly prioritized mental health and child health research in informed deliberations about spending priorities.

Communication from Learned to Innate Olfactory Processing Centers Is Required for Memory Retrieval in Drosophila.

The behavioral response to a sensory stimulus may depend on both learned and innate neuronal representations. How these circuits interact to produce appropriate behavior is unknown. In Drosophila, the lateral horn (LH) and mushroom body (MB) are thought to mediate innate and learned olfactory behavior, respectively, although LH function has not been tested directly. Here we identify two LH cell types (PD2a1 and PD2b1) that receive input from an MB output neuron required for recall of aversive olfactory memories. These neurons are required for aversive memory retrieval and modulated by training. Connectomics data demonstrate that PD2a1 and PD2b1 neurons also receive direct input from food odor-encoding neurons. Consistent with this, PD2a1 and PD2b1 are also necessary for unlearned attraction to some odors, indicating that these neurons have a dual behavioral role. This provides a circuit mechanism by which learned and innate olfactory information can interact in identified neurons to produce appropriate behavior. VIDEO ABSTRACT.

Correction to: the role of the complement system in traumatic brain injury: a review.

After publication of the article [1], it was brought to our attention that Tables 1 and 2 were missing from the final manuscript, These tables can be seen below and have now been added to the revised version of the article.

The role of the complement system in traumatic brain injury: a review.

Traumatic brain injury (TBI) is an important cause of disability and mortality in the western world. While the initial injury sustained results in damage, it is the subsequent secondary cascade that is thought to be the significant determinant of subsequent outcomes. The changes associated with the secondary injury do not become irreversible until some time after the start of the cascade. This may present a window of opportunity for therapeutic interventions aiming to improve outcomes subsequent to TBI. A prominent contributor to the secondary injury is a multifaceted inflammatory reaction. The complement system plays a notable role in this inflammatory reaction; however, it has often been overlooked in the context of TBI secondary injury. The complement system has homeostatic functions in the uninjured central nervous system (CNS), playing a part in neurodevelopment as well as having protective functions in the fully developed CNS, including protection from infection and inflammation. In the context of CNS injury, it can have a number of deleterious effects, evidence for which primarily comes not only from animal models but also, to a lesser extent, from human post-mortem studies. In stark contrast to this, complement may also promote neurogenesis and plasticity subsequent to CNS injury. This review aims to explore the role of the complement system in TBI secondary injury, by examining evidence from both clinical and animal studies. We examine whether specific complement activation pathways play more prominent roles in TBI than others. We also explore the potential role of complement in post-TBI neuroprotection and CNS repair/regeneration. Finally, we highlight the therapeutic potential of targeting the complement system in the context of TBI and point out certain areas on which future research is needed.

The State as Community in Community-Based Participatory Research.

BACKGROUND: Community-based participatory research (CBPR) typically defines communities by geography, ethnicity, shared health needs, or some combination. OBJECTIVES: We describe a CBPR project aiming to engage diverse minority and underserved communities throughout Michigan in deliberations about health research priorities. METHODS: A steering committee (SC) with 15 members from minority and underserved communities and 4 members from research organizations led the project, with the help of regional advisory groups (RAGs) formed at the SC's request. Evaluation of the SC used questionnaires, focused group discussion, and review of SC meetings to describe engagement, partnership, and communication. LESSONS LEARNED: An academic-community partnership with a diverse, dispersed, and broadly defined community found value in RAGs, dedicated academic staff, face-to-face meetings, varied communication modalities, capacity building tailored to varying levels of CBPR experience, and ongoing evaluation. CONCLUSIONS: A geographically and culturally diverse partnership presents challenges and opportunities in representativeness, relationship building, capacity building, and communication.

Association between Family Communication and Health Literacy among Underserved Racial/Ethnic Women.

Health literacy and the family can be used to promote cancer screenings. We examined the associations of socio-demographic factors, family communication, and cancer literacy in a diverse population. Baseline data from the Kin Keeper(SM) Cancer Prevention randomized controlled trial were analyzed for Black (n=216), Latino (n=65), and Arab (n=235) women. Key variables were based on the Family Adaptability and Cohesion Scale IV, and the Cancer Literacy Assessment Tool. Among Blacks, cervical cancer literacy was positively associated with family communication. Cancer literacy was associated with higher educational level, employment, and family self-rated health status among Black and Arab women. Among Latinas, who were the least educated and had the lowest literacy scores, family communication was inversely related to breast cancer literacy. Family-centered networks may be a viable resource for the transmission of health cancer literacy information, inform health care decision-making, and contribute to decreasing breast and cervical cancer mortality.

Intimate partner violence, depression, and barriers to service utilization in Arab American women.

How intimate partner violence (IPV), depression, and barriers to services affect Arab American women in the United States is not very well documented. This cross-sectional exploratory descriptive study examines (a) the relationship between depression and IPV and (b) whether living in the United States 10 or more years decreases barriers to reporting intimate partner violence and depression in a sample (N = 312) of Arab American women 19 years and older. Findings demonstrate significant relationships between women who were at risk for IPV and depression scores (r = .44, p < .001), and number of years living in the United States and barriers to service (r = .25, p < .001). There was a significant negative relationship between barriers to service and depression (r = -.30, p < .001), and barriers to service and IPV (r = -.23, p < .001), and number of years living in the United States and depression (r = .25, p < .001). Findings underscore the importance of screening referral and follow-up for Arab American women experiencing IPV and depression.

Kin KeeperSM: design and baseline characteristics of a community-based randomized controlled trial promoting cancer screening in Black, Latina, and Arab women.

BACKGROUND: Although breast and cervical cancer deaths have declined due to early screening, detection, and more effective treatment, racial and ethnic disparities persist. This paper describes the study design and baseline characteristics of a randomized controlled trial (RCT) evaluating the effectiveness of the Kin Keeper(SM) Cancer Prevention Intervention, a family-focused educational intervention for underserved women applied in a community-based setting to promote health literacy and screening adherence to address cancer disparities. METHODS: Female public health community health workers (CHWs) were trained to administer the intervention. They recruited female clients from their public health program caseload and asked each to assemble two to four adult female family members for the breast and cervical cancer home-based education sessions the CHWs would deliver in English, Spanish or Arabic. We randomized the clients into the kin keeper group (treatment) or the participant client group (control). RESULTS: Complete data were obtained on 514 Black, Latina, and Arab women. Close to half were unemployed and had yearly family income below $20,000. Thirty-four percent had no medical insurance, and 21% had diabetes. Almost 40% had no mammography in the last year. Treatment and control groups were similar on most sociodemographics but showed differences in breast and cervical screening history. CONCLUSIONS: This innovative study demonstrates the implementation of an RCT using community-based participatory research, while delivering cancer prevention education across woman's life span with women not connected to the health care system.

Knowledge, attitudes, and beliefs of Arab-American women regarding inherited cancer risk.

The increasing incidence of breast cancer in the Arab world, coupled with a relatively early age of onset, raises concern for the presence of hereditary risk factors in this population. However, due to potential structural and cultural barriers, Arab Americans make up the smallest percentage of individuals tested for Hereditary Breast and Ovarian Cancer Syndrome in the United States. The objectives of this qualitative pilot focus group of 13 Arab-American women were to explore attitudes, knowledge and beliefs regarding hereditary breast cancer in the Arab-American community in metropolitan Detroit, identify barriers that would prevent women from seeking hereditary cancer screening/testing and determine who women would talk to about inherited cancer. Results indicated that cultural beliefs and personal experiences with cancer influenced the women's perspectives on hereditary cancer risk. A high level of secrecy about cancer within Arab-American families was present, which may prevent accurate risk assessment and referral for genetic services. Other identified barriers that may influence hereditary risk assessment included stigma, fears and misconceptions of cancer. While these barriers were present, participants also expressed a strong need for education and tailored cancer risk information for their community.

Protective practices and respiratory illness among US travelers to the 2009 Hajj.

BACKGROUND: All mass gatherings can place travelers at risk for infectious diseases, but the size and density of the annual Hajj pilgrimage to the Kingdom of Saudi Arabia (KSA) present important public health and infection control challenges. This survey of protective practices and respiratory illness among US travelers to the 2009 Hajj was designed to evaluate whether recommended behavioral interventions (hand hygiene, wearing a face mask, cough etiquette, social distancing, and contact avoidance) were effective at mitigating illness among travelers during the 2009 Hajj. METHODS: US residents from Minnesota and Michigan completed anonymous surveys prior to and following travel to the 2009 Hajj. Surveys assessed demographics, knowledge, attitudes, and practices (KAP) related to influenza A(H1N1), vaccination, health-seeking behaviors, sources of health information, protective behaviors during the Hajj, and respiratory illness during and immediately after the Hajj. RESULTS: Pre- and post-travel surveys were completed by 186 participants. Respiratory illness was reported by 76 (41.3%) respondents; 144 (77.4%) reported engaging in recommended protective behaviors during the Hajj. Reduced risk of respiratory illness was associated with practicing social distancing, hand hygiene, and contact avoidance. Pilgrims who reported practicing more recommended protective measures during the Hajj reported either less occurrence or shorter duration of respiratory illness. Noticing influenza A(H1N1) health messages during the Hajj was associated with more protective measures and with shorter duration of respiratory illness. CONCLUSIONS: Recommended protective behaviors were associated with less respiratory illness among US travelers to the 2009 Hajj. Influenza A(H1N1) communication and education in KSA during the Hajj may also have been an effective component of efforts to mitigate illness. Evaluations of communication efforts and preventive measures are important in developing evidence-based public health plans to prevent and mitigate disease outbreaks at the Hajj and other mass gatherings.

Traditional healing practices among American Muslims: perceptions of community leaders in southeast Michigan.

Despite growing numbers of American Muslims, little empirical work exists on their use of traditional healing practices. We explored the types of traditional healing practices used by American Muslims in southeast Michigan. Twelve semi-structured interviews with American Muslim community leaders identified through a community-academic steering committee were conducted. Using a framework coding structure, a multidisciplinary investigative team identified themes describing traditional healing practices. Traditional healing practices can be categorized into three domains: Islamic religious text based practices, Islamic worship practices, and folk healing practices. Each domain may further contain therapies such as spiritual healing, medicinal herbs, mind body therapy, and dietary prescriptions. Traditional healing practices are utilized in three capacities of care: primary, secondary, and integrative. Our findings demonstrate that American Muslims actively utilize traditional healing practices. Healthcare practitioners caring for this population should be aware of the potential influence of these practices on health behaviors.

Differences in knowledge of breast cancer screening among African American, Arab American, and Latina women.

INTRODUCTION: We examined differences in knowledge and socioeconomic factors associated with 3 types of breast cancer screening (breast self-examination, clinical breast examination, and mammogram) among African American, Arab, and Latina women. METHODS: Community health workers used a community-based intervention to recruit 341 women (112 Arab, 113 Latina, and 116 African American) in southeastern Michigan to participate in a breast cancer prevention intervention from August through October 2006. Before and after the intervention, women responded to a previously validated 5-item multiple-choice test on breast cancer screening (possible score range: 0 to 5) in their language of preference (English, Spanish, or Arabic). We used generalized estimating equations to analyze data and to account for family-level and individual correlations. RESULTS: Although African American women knew more about breast cancer screening at the baseline (pretest median scores were 4 for African American, 3 for Arab and 3 for Latina women), all groups significantly increased their knowledge after participating in the breast cancer prevention intervention (posttest median scores were 5 for African American and 4 for Arab and Latina women). Generalized estimating equations models show that Arab and Latina women made the most significant gains in posttest scores (P < .001). CONCLUSION: Racial/ethnic differences in knowledge of breast cancer screening highlight the need for tailored information on breast cancer screening for African American, Arab, and Latina women to promote adherence to breast cancer screening guidelines.

Feasibility of group lifestyle intervention for diabetes prevention in Arab Americans.

AIMS: To assess the feasibility and acceptability of a community-based, culturally-specific, Diabetes Prevention Program (DPP)-adapted, group lifestyle intervention in Arab-Americans. METHODS: Overweight (BMI ≥ 27 kg/m(2)) Arab-Americans aged ≥ 30 years and without a history of diabetes were recruited to participate in a 24-week group lifestyle intervention. The DPP core-curriculum was culturally rewritten, translated into Arabic, and delivered in weekly sessions over a 12-week period. Follow-up was performed at week-24. The primary goals were to achieve ≥ 7% weight loss and ≥ 150 min/week of physical activity. An intent-to-treat analysis was performed. RESULTS: Of the 71 participants (mean age ± SD 47 ± 10 years, 38% males), 44% achieved ≥ 7% weight loss, 59% achieved ≥ 5% reduction in weight, and 78% reached the physical activity goal of ≥ 150-min/week. The mean ± SD weight loss was 5.2 ± 4.4 kg at week-24 (p<0.0001), Marked reduction in body measurements, daily energy and fat intake were noted. Retention was high with 86% completing the intervention. CONCLUSIONS: This trial demonstrates that a culturally-specific, DPP-adapted, group lifestyle intervention implemented in a community setting is feasible and effective in Arab-Americans.

Intervention effects on tobacco use in Arab and non-Arab American adolescents.

A quasi-experimental design was used to test a modified Project Towards No Tobacco (TNT) use program on cigarette smoking in 380 Arab American and 236 non-Arab American 9th graders in the Midwest. Tenth grade Non-Arab American students given the intervention as 9th graders were 23% less likely to experiment (Odds Ratio=1.31, 95% CI: 1.05, 1.64) or to have smoked cigarettes in the past 30 days (Odd Ratio=1.43 times, 95% CI: 1.03, 2.01) compared to Arab American youth. Arab American students reported greater experimentation with water pipe smoking than cigarettes (38% vs. 22%), and more current (16% vs. 6%) and regular (7% vs. 3%) use of water pipes than cigarettes, respectively. The intervention designed to focus on cigarette smoking had non-significant effects on water pipe smoking. These findings provide support for a school-based intervention revised to focus on prevention as well as cessation and to be culturally consistent. They also call for further research and intervention tailoring to address the problem of water pipe smoking in a growing Arab American adolescent population.

Asthma, environmental risk factors, and hypertension among Arab Americans in metro Detroit.

Asthma and obesity-related health problems disproportionately impact low-income ethnic minority communities residing in urban areas. Environmental risk factors, particularly those related to housing and indoor air, may impact the development or exacerbation of asthma. There is increasing evidence to suggest a link between obesity-related health problems and asthma. Previous studies have also reported that immigrant status may influence myriad risk factors and health outcomes among immigrant populations. The Arab American Environmental Health Project (AAEHP) was the first study to explore environmental health problems among Arab Americans. This paper examined whether hypertensive status modified the relationship between environmental risk factors and asthma among Arab Americans in metro Detroit. An environmental risk index (ERI) was used to quantify household environmental risk factors associated with asthma. Physician diagnosed hypertension was self-reported, and asthma status was determined using responses to a validated symptoms checklist and self-reported diagnosis by a physician. Hypertension significantly modified the relationship between ERI and asthma in this study population. The positive association between household environmental risk factors and asthma was stronger among participants diagnosed with hypertension. Effect modification of the relationship between environmental risk factors and asthma could have serious implications among high-risk communities. However, further research is needed to elucidate the relationships between hypertension, environmental risk factors, and asthma.

A community-based approach to translating and testing cancer literacy assessment tools.

BACKGROUND: To address the issue of cancer disparities among women whose first language is not English, researchers and public health educators are challenged to develop culturally and linguistically appropriate material and instruments. METHODS: This study documents the process used to linguistically and culturally translate breast and cervical cancer literacy assessment tools from English to Spanish and from English to Arabic by using a community-based method. RESULTS: Results from field testing the assessments demonstrated good reliability for overall cancer literacy in English (Cronbach's alpha .99), Spanish (Cronbach's alpha .99), and Arabic (Cronbach's alpha .81). CONCLUSION: Using a community-based approach to translate the cancer assessments helped to insure they were culturally appropriate.

Comparison of point of care and laboratory HbA1c analysis: a MetroNet study.

BACKGROUND: Evaluating new technology in clinical practice is an important component of translating research into practice. We considered the feasibility of using a Clinical Laboratory Improvement Amendments (CLIA)-waived point of care (POC) glycohemoglobin (HbA1c) methodology in busy family medicine centers by comparing the results of POC HbA1c and laboratory analysis results. METHODS: Recruited from 5 MetroNet practices, the participants were adult diabetic patients having blood samples drawn for laboratory analysis of HbA1c. Each agreed to provide a capillary blood sample for POC testing. RESULTS: With data on 99 paired samples, the POC method yielded a mean HbA1c of 7.38%, which was equivalent to the mean of 7.53% produced with all combined standard laboratory analyses. The Pearson correlation between POC and the laboratory analysis test results was 0.884 (P < .001). POC test sensitivity was 81.8% and specificity was 93.2%. Eighteen percent of patients with an HbA1c > = 7% by laboratory analysis were not identified as such by the POC test. CONCLUSIONS: Before adopting a POC methodology, practices are encouraged to review its feasibility in the context of the office routine, and also to conduct periodic comparisons of the accuracy of POC test results compared with those from laboratory analysis.

Comparison of cigarette and water-pipe smoking by Arab and non-Arab-American youth.

BACKGROUND: Water-pipe smoking is a rapidly growing form of tobacco use worldwide. Building on an earlier report of experimentation with cigarette and water-pipe smoking in a U.S. community sample of Arab-American youth aged 14-18 years, this article examines water-pipe smoking in more detail (e.g., smoking history, belief in harmfulness compared to cigarettes, family members in home who smoke water pipes) and compares the water-pipe-smoking behaviors of Arab-American youth with non-Arab-American youth in the same community. METHODS: A convenience sample of 1872 Arab-American and non-Arab-American high school students from the Midwest completed a 24-item tobacco survey. Data were collected in 2004-2005 and analyzed in 2007-2008. RESULTS: Arab-American youth reported lower percentages of ever cigarette smoking (20% vs 39%); current cigarette smoking (7% vs 22%); and regular cigarette smoking (3% vs 15%) than non-Arab-American youth. In contrast, Arab-American youth reported significantly higher percentages of ever water-pipe smoking (38% vs 21%) and current water-pipe smoking (17% vs 11%) than non-Arab-American youth. Seventy-seven percent perceived water-pipe smoking to be as harmful as or more harmful than cigarette smoking. Logistic regression showed that youth were 11.0 times more likely to be currently smoking cigarettes if they currently smoked water pipes. Youth were also 11.0 times more likely to be current water-pipe smokers if they currently smoked cigarettes. If one or more family members smoked water pipes in the home, youth were 6.3 times more likely to be current water-pipe smokers. The effects of ethnicity were reduced as a result of the explanatory value of family smoking. CONCLUSIONS: Further research is needed to determine the percentages, patterns, and health risks of water-pipe smoking and its relationship to cigarette smoking among all youth. Additionally, youth tobacco prevention/cessation programs need to focus attention on water-pipe smoking in order to further dispel the myth that water-pipe smoking is a safe alternative to cigarette smoking.