Rena Pasick - Academia.edu (original) (raw)
Papers by Rena Pasick
Cancer Epidemiology, Biomarkers & Prevention, 2020
Purpose: The excess breast cancer mortality among African Americans is well documented, and insuf... more Purpose: The excess breast cancer mortality among African Americans is well documented, and insufficient treatment quality in low-resource settings is a key cause. The second opinion could connect patients with the best available medical knowledge. We explored the extent to which treatment plans can be improved through consultations at NCI-designated Comprehensive Cancer Centers (CCC) that deliver the latest treatments, and to describe the experience of patients and consulting clinicians. Methods: Eligible patients, those who self-identify as African American and have concerns about breast cancer, were recruited from communities and clinics. The research grant covered the cost of consultations. Ethnographic methods (audio-recorded observations and in-depth interviews) were used to ascertain consultation impacts. Data sources were transcripts from consultations; post-consult patient interviews, once following the consultation and again after treatment decisions were made; and one cli...
Quality of Life Research, 2013
Purpose-Cancer-related stress is heavily influenced by culture. This study explored similarities ... more Purpose-Cancer-related stress is heavily influenced by culture. This study explored similarities and differences in survivorship care concerns among Chinese American and Non-Hispanic White (NHW) breast cancer survivors. Methods-A sequential, mixed-method design (inductive/qualitative research-phase I and deductive/quantitative research-phase II) was employed. Eligible women identified from the Greater Bay Area Cancer Registry were age ≥21, diagnosed with stage 0-IIa breast cancer between 2006-2011, and had no recurrence or other cancers. In phase I, we conducted 4 Chinese (n=19) and 4 NHW (n=22) focus groups, and 31 individual telephone interviews (18 Chinese immigrants, 7 Chinese US-born, and 6 NHW). Content analysis was conducted to examine qualitative data. In phase II, another 296 survivors (148 NHW age-matched to 148 Chinese cases) completed a crosssectional survey. Descriptive statistics and linear regression analysis were conducted to examine quantitative data. Results-Qualitative data revealed "socioeconomic wellbeing" (SWB) as a dominant survivorship concern, which was operationalized as a cancer survivor's perceived economic and
Journal of Women's Health, 2013
Background: Abnormal mammograms are common, and the risk of false positives is high. We surveyed ... more Background: Abnormal mammograms are common, and the risk of false positives is high. We surveyed women in order to understand the factors influencing the efficiency of the evaluation of an abnormal mammogram. Methods: Women aged 40-80 years, identified from lists with Breast Imaging Reporting and Data System (BIRADS) classifications of 0, 3, 4, or 5, were surveyed. Telephone surveys asked about the process of evaluation, and medical records were reviewed for tests and timing of evaluation. Results: In this study, 970 women were surveyed, and 951 had chart reviews. Overall, 36% were college graduates, 68% were members of a group model health plan, 18% were Latinas, 25% were African Americans, 15% were Asian, and 43% were white. Of the 352 women who underwent biopsies, 151 were diagnosed with cancer (93 invasive). Median time to diagnosis was 183 days for BIRADS 3 compared to 29 days for BIRADS 4/5 and 27 days for BIRADS 0. At 60 days, 84% of BIRADS 4/5 women had a diagnosis. Being African American (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.49-0.97, p = 0.03), income < $10,000 (HR 0.55, 95% CI 0.31-0.98, p < 0.04), perceived discrimination (HR 0.22, 95% CI 0.09-0.52, p < 0.001), not fully understanding the results of the index mammogram (HR 0.49, 95% CI 0.32-0.75, p = 0.001), and being notified by letter (HR 0.66, 95% CI 0.48-0.90, p = 0.01) or telephone (HR 0.62, 95% CI 0.42-0.92, p = 0.02) rather than in person were all associated with significant delays in diagnosis. Conclusions: Evaluation of BIRADS 0, 4, or 5 abnormal mammograms was completed in most women within the recommended 60 days. Even within effective systems, correctible communication factors may adversely affect time to diagnosis.
Cancer Epidemiology, Biomarkers & Prevention, 2020
Introductory sentence with purpose of study: The Éxito! Latino Cancer Research Leadership Trainin... more Introductory sentence with purpose of study: The Éxito! Latino Cancer Research Leadership Training (Éxito!) program was developed to encourage Latino master’s level students and graduates to pursue a doctoral degree and career in Latino cancer health disparities (CHD) research. Cancer is the leading cause of death among Latinos who represent 18% of the population. However, similar to under-represented groups there is a disproportionate representation at the terminal degree level. Thus, it t is imperative that the next generation of health practitioners and researchers is representative of the diverse U.S. population and that culturally competent solutions are implemented to eliminate cancer related CHD among all ethno-cultural groups especially Latinos. Brief description of pertinent experimental procedures: Twenty-five selected participants are invited to complete an intense five-day Summer Institute (SI). The SI is led by successful Latinx researchers and Latinx role models. For t...
Preventive Medicine, 2019
Social media has become a valuable tool for disseminating cancer prevention information. However,... more Social media has become a valuable tool for disseminating cancer prevention information. However, the design of messages for achieving wide dissemination remains poorly understood. We conducted a multi-method study to identify the effects of sender type (individuals or organizations) and content type (personal experiences or factual information) on promoting the spread of cervical cancer prevention messages over social media. First, we used observational Twitter data to examine correlations between sender type and content type with retweet activity. Then, to confirm the causal impact of message properties, we constructed 900 experimental tweets according to a 2 (sender type) by 2 (content type) factorial design and tested their probabilities of being shared in an online platform. A total of 782 female participants were randomly assigned to 87 independent 9-person online groups and each received a unique message feed of 100 tweets drawn from the 4 experimental cells over 5 days. We conducted both tweet-level and group-level analyses to examine the causal effects of tweet properties on influencing sharing behaviors. Personal experience tweets and organizational senders were associated with more retweets. However, the experimental study revealed that informational tweets were shared significantly more (19%, 95% CI: 11 to 27) than personal experience tweets; and organizational senders were shared significantly more (10%, 95% CI: 3 to 18) than individual senders. While rare personal experience messages can achieve large success, they are generally unsuccessful; however, there is a reproducible causal effect of messages that use organizational senders and factual information for achieving greater peer-to-peer dissemination.
Journal of cancer education : the official journal of the American Association for Cancer Education, Jan 16, 2018
Latinos lag behind other racial/ethnic groups in pursuit of master's and doctoral degrees in ... more Latinos lag behind other racial/ethnic groups in pursuit of master's and doctoral degrees in public health and the health sciences. Éxito! is modeled after the Minority Training Program in Cancer Control Research (MTPCCR), which found that Latino participants went on to doctoral programs at a lower rate (12%) than African American (36%) and Asian participants (33%). Éxito! Latino Cancer Research Leadership Training is designed to increase the number of Latinos who pursue doctoral degrees and careers in cancer health disparity (CHD) research. The program has three components: recruitment with partnering universities and associations, an ethnically tailored intensive 5-day summer institute (SI), and 6-month paid internships offered on a competitive basis. Up to 20 master's level students/master's level health professionals are selected annually to participate in the SI; faculty are leaders in Latino CHD research. Funded by the National Cancer Institute (NCI) from 2011 to 2...
Journal of cancer education : the official journal of the American Association for Cancer Education, Jan 11, 2018
Online social media platforms represent a promising opportunity for public health promotion. Rese... more Online social media platforms represent a promising opportunity for public health promotion. Research is limited, however, on the effectiveness of social media at improving knowledge and awareness of health topics and motivating healthy behavior change. Therefore, we investigated whether participation in an online social media platform and receipt of brief, tailored messages is effective at increasing knowledge, awareness, and prevention behaviors related to human papillomavirus (HPV) and cervical cancer. We conducted an online study in which 782 recruited participants were consecutively assigned to nine-person groups on a social media platform. Participants were shown a unique random set of 20 tailored messages per day over five days. Participants completed a baseline and post survey to assess their knowledge, awareness, and prevention behaviors related to HPV and cervical cancer. There were no statistically significant changes in knowledge and prevention behaviors from the baselin...
Journal of community genetics, 2017
As genetics and genomics become part of mainstream medicine, these advances have the potential to... more As genetics and genomics become part of mainstream medicine, these advances have the potential to either reduce or exacerbate health disparities. Relatively, little research has explored the quality of genetic counseling communication experienced by limited English proficiency patients, especially Chinese Americans. We observed and audio recorded genetic counseling appointments (n = 40) of low-income, limited English-proficient Chinese patients (n = 25) and conducted post-visit interviews (n = 17) using stimulated recall to examine patient understanding of the communication. Standard techniques based in grounded theory, including iterative data review and multiple coders, were used to analyze observation fieldnotes and interview transcripts and to identify these themes: (1) strong beliefs in environmental causes of cancer and skepticism about genetic causes, (2) willingness to undergo genetic testing despite skepticism of hereditary cause of cancer, (3) misunderstanding of key infor...
Health affairs (Project Hope), 2018
The great potential for reducing the cancer burden and cancer disparities through prevention and ... more The great potential for reducing the cancer burden and cancer disparities through prevention and early detection is unrealized at the population level. A new community-based coalition, the San Francisco Cancer Initiative (SF CAN), focuses on the city and county of San Francisco, where cancer is the leading cause of death. SF CAN is an integrated, cross-sector collaboration launched in November 2016. It brings together the San Francisco Department of Public Health; the University of California, San Francisco; major health systems; and community coalitions to exert collective impact. Its goals are to reduce the burden of five common cancers-breast, lung and other tobacco-related, prostate, colorectal, and liver-for which there are proven methods of prevention and detection, while reducing known disparities. We describe the infrastructure, coalition building, and early progress of this initiative, which may serve as a model for other municipalities.
Journal of immigrant and minority health, Jan 22, 2017
Chinese Americans have low colorectal cancer (CRC) screening rates. It is unclear whether physici... more Chinese Americans have low colorectal cancer (CRC) screening rates. It is unclear whether physicians should offer all CRC screening modalities (fecal occult blood test [FOBT], sigmoidoscopy, colonoscopy) to Chinese Americans to increase screening. Seven hundred and twenty-five Chinese Americans were asked in a survey if their physician had ever recommended CRC screening and to self-report receipt and type of CRC screening. Participants whose physician had recommended all CRC screening modalities were significantly more likely to report ever having screening (adjusted odds ratio 4.29, 95% CI 1.26-14.68) and being up-to-date (4.06, 95% CI 2.13-7.74) than those who reported that their physician only recommended FOBT. Participants who received a recommendation of only one type of screening did not report a significant difference in ever having or being up-to-date for screening. A potential strategy to increase CRC screening among Chinese Americans is for clinicians to recommend all avai...
Journal of Genetic Counseling, 2017
Journal of Genetic Counseling, 2017
As genetics and genomics become part of mainstream Medicine, these advances have the potential to... more As genetics and genomics become part of mainstream Medicine, these advances have the potential to reduce or exacerbate health disparities. Gaps in effective communication (where all parties share the same meaning) are widely recognized as a major contributor to health disparities. The purpose of this study was to examine GC-patient communication in real time, to assess its effectiveness from the patient perspective, and then to pilot intervention strategies to improve the communication. We observed 64 English-, 35 Spanish-and 25 Chinese-speaking (n = 124) public hospital patients and 10 GCs in 170 GC appointments, and interviewed 49 patients who were offered testing using the audio recordings to stimulate recall and probe specific aspects of the communication. Data analyses were conducted using grounded theory methods and revealed a fundamental mismatch between the information provided by GCs and the information desired and meaningful to patients. Several components of the communication that contributed to this mismatch and often resulted in ineffective communication included: (1) too much information; (2) complex terminology and conceptually difficult presentation of information; (3) information perceived as not relevant by the patient; (4) unintentional inhibition of patient engagement and questionasking; (5) vague discussions of screening and prevention recommendations. Our findings indicate a need to transform the standard model of genetic counseling communication using evidence-based principles and strategies from other fields of Medicine. The high rates of limited health literacy in the US, increasing access of diverse populations to genetic services, and growing complexity of genetic information have created a perfect storm. If not directly addressed, this convergence is likely to exacerbate health disparities in the genomic age.
Cancer, Jan 12, 2017
Delays in abnormal mammogram follow-up contribute to poor outcomes. In the current study, the aut... more Delays in abnormal mammogram follow-up contribute to poor outcomes. In the current study, the authors examined differences in abnormal screening mammogram follow-up between non-Hispanic white (NHW) and Asian women. The authors used a prospective cohort of NHW and Asian women with a Breast Imaging, Reporting and Data System (BI-RADS) abnormal result of category 0 or 3-plus in the San Francisco Mammography Registry between 2000 and 2010. Kaplan-Meier estimation for the median number of days to follow-up with a diagnostic radiologic test was performed, and the authors compared the percentage of women with follow-up at 30 days, 60 days, and 90 days and no follow-up at 1 year for Asian women overall (and Asian ethnic groups) and NHW women. In addition, the authors assessed the relationship between race/ethnicity and time to follow-up with adjusted Cox proportional hazards models. Among Asian women, Vietnamese and Filipina women had the longest, and Japanese women the shortest, median fol...
Health Education Quarterly, 1996
The increasing diversity of American communities raises an important question about the efficienc... more The increasing diversity of American communities raises an important question about the efficiency, appropriateness, and feasibility of tailoring messages and intervention strategies to target groups identified by race and ethnicity. To explore this issue, This article distinguishes race and ethnicity from culture and then discusses four questions: (1) What is the meaning of culture in health promotion? (2) What is the role of culture in understanding health behavior? (3) What is the role of culture in the design of interventions? and (4) What do the relationships of culture to behavior and to intervention mean for cultural tailoring? Based on this analysis, the authors suggest that effective health promotion will tailor interventions by culture as necessary but reach across cultures when possible and appropriate. A framework is presented to assess the need for cultural tailoring, and a new generation of health promotion research is proposed to facilitate cross-cultural comparisons.
American journal of preventive medicine, 2016
Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions ... more Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions to increase CRC screening in this population are lacking. This study aims to compare the efficacy of two interventions in increasing CRC screening among Chinese Americans. Cluster randomized comparative trial. From 2010 to 2014, a community-academic team conducted this study in San Francisco, CA with Chinese Americans aged 50-75 years who spoke English, Cantonese, or Mandarin. Lay health worker (LHW) intervention plus in-language brochure (LHW+Print) versus brochure (Print). LHWs in the LHW+Print arm were trained to teach participants about CRC in two small group sessions and two telephone calls. Change in self-reports of ever having had CRC screening and being up to date for CRC screening from baseline to 6 months post-intervention. Statistical analysis was performed from 2014 to 2015. This study recruited 58 LHWs, who in turn recruited 725 participants. The average age of the participa...
Journal of health disparities research and practice, 2016
Semi-structured interviews were conducted with 16 Latino cancer patients diagnosed in California;... more Semi-structured interviews were conducted with 16 Latino cancer patients diagnosed in California; 10 health professionals from the San Francisco Bay Area and Fresno, California; and 10 Cancer Information Services (CIS) information specialists from the regional offices handling calls from Spanish-speakers. Interview guides were designed by the investigators to answer three main research questions: 1) How do Latinos obtain information about cancer and what types of information do they access?; 2) What sources of cancer information do they seek out and find credible?; and 3) What are the barriers and facilitators to Latinos obtaining cancer information? Stakeholders generally viewed health professionals as the most credible source of cancer information. All groups regarded family and friends as important sources of information. Patients and health professionals tended to differ on the value of print materials. Although patients found them generally useful, health professionals tended t...
American journal of public health, Jan 23, 2016
To determine the effectiveness of a statewide telephone service in identifying low-income women a... more To determine the effectiveness of a statewide telephone service in identifying low-income women at risk for hereditary breast and ovarian cancer and referring them to free genetic counseling. From June 2010 through August 2011, eligible callers to California's toll-free breast and cervical cancer telephone service were screened for their family histories of breast and ovarian cancer. High-risk women were identified and called for a baseline survey and randomization to an immediate offer of genetic counseling or a mailed brochure on how to obtain counseling. Clinic records were used to assess receipt of genetic counseling after 2 months. Among 1212 eligible callers, 709 (58.5%) agreed to answer family history questions; 102 (14%) were at high risk (25% Hispanic, 46% White, 10% Black, 16% Asian, 3% of other racial/ethnic backgrounds). Of the high-risk women offered an immediate appointment, 39% received counseling during the intervention period, as compared with 4.5% of those rece...
Health Education Quarterly, 1996
Health education materials designed for the general population may be perceived as unattractive, ... more Health education materials designed for the general population may be perceived as unattractive, irrelevant, or unclear by members of certain cultural groups. Given the increasingly multicultural demographics of the United States, planners need to be aware of the specific characteristics of a target audience to address cultural differences and similarities in health messages. The authors describe the use of the subjective culture methodology and social marketing to develop health education materials targeted to multicultural populations, illustrate cultural factors that should be considered when designing printed materials, and outline steps in the design of attractive, stimulating, and culturally appropriate materials. The authors describe the challenges and problems in designing printed materials for multiethnic communities, give suggestions for written educational messages, present a summary of the lessons learned in the development of materials for ethnically diverse populations...
Journal of Medical Internet Research, 2015
Supportive Care in Cancer, 2014
Breast cancer is the most commonly diagnosed form of cancer for women regardless of race/ ethnici... more Breast cancer is the most commonly diagnosed form of cancer for women regardless of race/ ethnicity. Women of color are diagnosed at later stages and experience greater mortality than their White counterparts. However, there has been comparatively little research on coping with breast among racial/ethnic minorities at time of diagnosis, during treatment, or in the course of survivorship. This is despite the fact that research has repeatedly shown that distress can impact disease progression and survival. The questions asked of this systematic literature review include: (1) What is known about coping with breast cancer among major racial/ethnic groups? (2) What are the strengths and gaps in research to date? Over 120 peer-reviewed published studies (1980-2012) were reviewed. A total of 33 met criteria for inclusion including 15 quantitative, 17 qualitative, and 1 mixed methods study. The majority of studies were small sample cross-sectional studies. Only five studies were longitudinal, and two randomized-controlled intervention trials sought to improve coping among survivors. The most common topic in both quantitative and qualitative studies was spirituality and coping among African American breast cancer patients. Thirteen studies included Latinas only or in combination with other groups. Only one quantitative and one qualitative study solely addressed the Asian American population exploring coping and adjustment. In the course of this systematic literature review, we elucidate what is known about coping with breast cancer among racial/ethnic minority women and identify priorities for future research.
Cancer Epidemiology, Biomarkers & Prevention, 2020
Purpose: The excess breast cancer mortality among African Americans is well documented, and insuf... more Purpose: The excess breast cancer mortality among African Americans is well documented, and insufficient treatment quality in low-resource settings is a key cause. The second opinion could connect patients with the best available medical knowledge. We explored the extent to which treatment plans can be improved through consultations at NCI-designated Comprehensive Cancer Centers (CCC) that deliver the latest treatments, and to describe the experience of patients and consulting clinicians. Methods: Eligible patients, those who self-identify as African American and have concerns about breast cancer, were recruited from communities and clinics. The research grant covered the cost of consultations. Ethnographic methods (audio-recorded observations and in-depth interviews) were used to ascertain consultation impacts. Data sources were transcripts from consultations; post-consult patient interviews, once following the consultation and again after treatment decisions were made; and one cli...
Quality of Life Research, 2013
Purpose-Cancer-related stress is heavily influenced by culture. This study explored similarities ... more Purpose-Cancer-related stress is heavily influenced by culture. This study explored similarities and differences in survivorship care concerns among Chinese American and Non-Hispanic White (NHW) breast cancer survivors. Methods-A sequential, mixed-method design (inductive/qualitative research-phase I and deductive/quantitative research-phase II) was employed. Eligible women identified from the Greater Bay Area Cancer Registry were age ≥21, diagnosed with stage 0-IIa breast cancer between 2006-2011, and had no recurrence or other cancers. In phase I, we conducted 4 Chinese (n=19) and 4 NHW (n=22) focus groups, and 31 individual telephone interviews (18 Chinese immigrants, 7 Chinese US-born, and 6 NHW). Content analysis was conducted to examine qualitative data. In phase II, another 296 survivors (148 NHW age-matched to 148 Chinese cases) completed a crosssectional survey. Descriptive statistics and linear regression analysis were conducted to examine quantitative data. Results-Qualitative data revealed "socioeconomic wellbeing" (SWB) as a dominant survivorship concern, which was operationalized as a cancer survivor's perceived economic and
Journal of Women's Health, 2013
Background: Abnormal mammograms are common, and the risk of false positives is high. We surveyed ... more Background: Abnormal mammograms are common, and the risk of false positives is high. We surveyed women in order to understand the factors influencing the efficiency of the evaluation of an abnormal mammogram. Methods: Women aged 40-80 years, identified from lists with Breast Imaging Reporting and Data System (BIRADS) classifications of 0, 3, 4, or 5, were surveyed. Telephone surveys asked about the process of evaluation, and medical records were reviewed for tests and timing of evaluation. Results: In this study, 970 women were surveyed, and 951 had chart reviews. Overall, 36% were college graduates, 68% were members of a group model health plan, 18% were Latinas, 25% were African Americans, 15% were Asian, and 43% were white. Of the 352 women who underwent biopsies, 151 were diagnosed with cancer (93 invasive). Median time to diagnosis was 183 days for BIRADS 3 compared to 29 days for BIRADS 4/5 and 27 days for BIRADS 0. At 60 days, 84% of BIRADS 4/5 women had a diagnosis. Being African American (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.49-0.97, p = 0.03), income < $10,000 (HR 0.55, 95% CI 0.31-0.98, p < 0.04), perceived discrimination (HR 0.22, 95% CI 0.09-0.52, p < 0.001), not fully understanding the results of the index mammogram (HR 0.49, 95% CI 0.32-0.75, p = 0.001), and being notified by letter (HR 0.66, 95% CI 0.48-0.90, p = 0.01) or telephone (HR 0.62, 95% CI 0.42-0.92, p = 0.02) rather than in person were all associated with significant delays in diagnosis. Conclusions: Evaluation of BIRADS 0, 4, or 5 abnormal mammograms was completed in most women within the recommended 60 days. Even within effective systems, correctible communication factors may adversely affect time to diagnosis.
Cancer Epidemiology, Biomarkers & Prevention, 2020
Introductory sentence with purpose of study: The Éxito! Latino Cancer Research Leadership Trainin... more Introductory sentence with purpose of study: The Éxito! Latino Cancer Research Leadership Training (Éxito!) program was developed to encourage Latino master’s level students and graduates to pursue a doctoral degree and career in Latino cancer health disparities (CHD) research. Cancer is the leading cause of death among Latinos who represent 18% of the population. However, similar to under-represented groups there is a disproportionate representation at the terminal degree level. Thus, it t is imperative that the next generation of health practitioners and researchers is representative of the diverse U.S. population and that culturally competent solutions are implemented to eliminate cancer related CHD among all ethno-cultural groups especially Latinos. Brief description of pertinent experimental procedures: Twenty-five selected participants are invited to complete an intense five-day Summer Institute (SI). The SI is led by successful Latinx researchers and Latinx role models. For t...
Preventive Medicine, 2019
Social media has become a valuable tool for disseminating cancer prevention information. However,... more Social media has become a valuable tool for disseminating cancer prevention information. However, the design of messages for achieving wide dissemination remains poorly understood. We conducted a multi-method study to identify the effects of sender type (individuals or organizations) and content type (personal experiences or factual information) on promoting the spread of cervical cancer prevention messages over social media. First, we used observational Twitter data to examine correlations between sender type and content type with retweet activity. Then, to confirm the causal impact of message properties, we constructed 900 experimental tweets according to a 2 (sender type) by 2 (content type) factorial design and tested their probabilities of being shared in an online platform. A total of 782 female participants were randomly assigned to 87 independent 9-person online groups and each received a unique message feed of 100 tweets drawn from the 4 experimental cells over 5 days. We conducted both tweet-level and group-level analyses to examine the causal effects of tweet properties on influencing sharing behaviors. Personal experience tweets and organizational senders were associated with more retweets. However, the experimental study revealed that informational tweets were shared significantly more (19%, 95% CI: 11 to 27) than personal experience tweets; and organizational senders were shared significantly more (10%, 95% CI: 3 to 18) than individual senders. While rare personal experience messages can achieve large success, they are generally unsuccessful; however, there is a reproducible causal effect of messages that use organizational senders and factual information for achieving greater peer-to-peer dissemination.
Journal of cancer education : the official journal of the American Association for Cancer Education, Jan 16, 2018
Latinos lag behind other racial/ethnic groups in pursuit of master's and doctoral degrees in ... more Latinos lag behind other racial/ethnic groups in pursuit of master's and doctoral degrees in public health and the health sciences. Éxito! is modeled after the Minority Training Program in Cancer Control Research (MTPCCR), which found that Latino participants went on to doctoral programs at a lower rate (12%) than African American (36%) and Asian participants (33%). Éxito! Latino Cancer Research Leadership Training is designed to increase the number of Latinos who pursue doctoral degrees and careers in cancer health disparity (CHD) research. The program has three components: recruitment with partnering universities and associations, an ethnically tailored intensive 5-day summer institute (SI), and 6-month paid internships offered on a competitive basis. Up to 20 master's level students/master's level health professionals are selected annually to participate in the SI; faculty are leaders in Latino CHD research. Funded by the National Cancer Institute (NCI) from 2011 to 2...
Journal of cancer education : the official journal of the American Association for Cancer Education, Jan 11, 2018
Online social media platforms represent a promising opportunity for public health promotion. Rese... more Online social media platforms represent a promising opportunity for public health promotion. Research is limited, however, on the effectiveness of social media at improving knowledge and awareness of health topics and motivating healthy behavior change. Therefore, we investigated whether participation in an online social media platform and receipt of brief, tailored messages is effective at increasing knowledge, awareness, and prevention behaviors related to human papillomavirus (HPV) and cervical cancer. We conducted an online study in which 782 recruited participants were consecutively assigned to nine-person groups on a social media platform. Participants were shown a unique random set of 20 tailored messages per day over five days. Participants completed a baseline and post survey to assess their knowledge, awareness, and prevention behaviors related to HPV and cervical cancer. There were no statistically significant changes in knowledge and prevention behaviors from the baselin...
Journal of community genetics, 2017
As genetics and genomics become part of mainstream medicine, these advances have the potential to... more As genetics and genomics become part of mainstream medicine, these advances have the potential to either reduce or exacerbate health disparities. Relatively, little research has explored the quality of genetic counseling communication experienced by limited English proficiency patients, especially Chinese Americans. We observed and audio recorded genetic counseling appointments (n = 40) of low-income, limited English-proficient Chinese patients (n = 25) and conducted post-visit interviews (n = 17) using stimulated recall to examine patient understanding of the communication. Standard techniques based in grounded theory, including iterative data review and multiple coders, were used to analyze observation fieldnotes and interview transcripts and to identify these themes: (1) strong beliefs in environmental causes of cancer and skepticism about genetic causes, (2) willingness to undergo genetic testing despite skepticism of hereditary cause of cancer, (3) misunderstanding of key infor...
Health affairs (Project Hope), 2018
The great potential for reducing the cancer burden and cancer disparities through prevention and ... more The great potential for reducing the cancer burden and cancer disparities through prevention and early detection is unrealized at the population level. A new community-based coalition, the San Francisco Cancer Initiative (SF CAN), focuses on the city and county of San Francisco, where cancer is the leading cause of death. SF CAN is an integrated, cross-sector collaboration launched in November 2016. It brings together the San Francisco Department of Public Health; the University of California, San Francisco; major health systems; and community coalitions to exert collective impact. Its goals are to reduce the burden of five common cancers-breast, lung and other tobacco-related, prostate, colorectal, and liver-for which there are proven methods of prevention and detection, while reducing known disparities. We describe the infrastructure, coalition building, and early progress of this initiative, which may serve as a model for other municipalities.
Journal of immigrant and minority health, Jan 22, 2017
Chinese Americans have low colorectal cancer (CRC) screening rates. It is unclear whether physici... more Chinese Americans have low colorectal cancer (CRC) screening rates. It is unclear whether physicians should offer all CRC screening modalities (fecal occult blood test [FOBT], sigmoidoscopy, colonoscopy) to Chinese Americans to increase screening. Seven hundred and twenty-five Chinese Americans were asked in a survey if their physician had ever recommended CRC screening and to self-report receipt and type of CRC screening. Participants whose physician had recommended all CRC screening modalities were significantly more likely to report ever having screening (adjusted odds ratio 4.29, 95% CI 1.26-14.68) and being up-to-date (4.06, 95% CI 2.13-7.74) than those who reported that their physician only recommended FOBT. Participants who received a recommendation of only one type of screening did not report a significant difference in ever having or being up-to-date for screening. A potential strategy to increase CRC screening among Chinese Americans is for clinicians to recommend all avai...
Journal of Genetic Counseling, 2017
Journal of Genetic Counseling, 2017
As genetics and genomics become part of mainstream Medicine, these advances have the potential to... more As genetics and genomics become part of mainstream Medicine, these advances have the potential to reduce or exacerbate health disparities. Gaps in effective communication (where all parties share the same meaning) are widely recognized as a major contributor to health disparities. The purpose of this study was to examine GC-patient communication in real time, to assess its effectiveness from the patient perspective, and then to pilot intervention strategies to improve the communication. We observed 64 English-, 35 Spanish-and 25 Chinese-speaking (n = 124) public hospital patients and 10 GCs in 170 GC appointments, and interviewed 49 patients who were offered testing using the audio recordings to stimulate recall and probe specific aspects of the communication. Data analyses were conducted using grounded theory methods and revealed a fundamental mismatch between the information provided by GCs and the information desired and meaningful to patients. Several components of the communication that contributed to this mismatch and often resulted in ineffective communication included: (1) too much information; (2) complex terminology and conceptually difficult presentation of information; (3) information perceived as not relevant by the patient; (4) unintentional inhibition of patient engagement and questionasking; (5) vague discussions of screening and prevention recommendations. Our findings indicate a need to transform the standard model of genetic counseling communication using evidence-based principles and strategies from other fields of Medicine. The high rates of limited health literacy in the US, increasing access of diverse populations to genetic services, and growing complexity of genetic information have created a perfect storm. If not directly addressed, this convergence is likely to exacerbate health disparities in the genomic age.
Cancer, Jan 12, 2017
Delays in abnormal mammogram follow-up contribute to poor outcomes. In the current study, the aut... more Delays in abnormal mammogram follow-up contribute to poor outcomes. In the current study, the authors examined differences in abnormal screening mammogram follow-up between non-Hispanic white (NHW) and Asian women. The authors used a prospective cohort of NHW and Asian women with a Breast Imaging, Reporting and Data System (BI-RADS) abnormal result of category 0 or 3-plus in the San Francisco Mammography Registry between 2000 and 2010. Kaplan-Meier estimation for the median number of days to follow-up with a diagnostic radiologic test was performed, and the authors compared the percentage of women with follow-up at 30 days, 60 days, and 90 days and no follow-up at 1 year for Asian women overall (and Asian ethnic groups) and NHW women. In addition, the authors assessed the relationship between race/ethnicity and time to follow-up with adjusted Cox proportional hazards models. Among Asian women, Vietnamese and Filipina women had the longest, and Japanese women the shortest, median fol...
Health Education Quarterly, 1996
The increasing diversity of American communities raises an important question about the efficienc... more The increasing diversity of American communities raises an important question about the efficiency, appropriateness, and feasibility of tailoring messages and intervention strategies to target groups identified by race and ethnicity. To explore this issue, This article distinguishes race and ethnicity from culture and then discusses four questions: (1) What is the meaning of culture in health promotion? (2) What is the role of culture in understanding health behavior? (3) What is the role of culture in the design of interventions? and (4) What do the relationships of culture to behavior and to intervention mean for cultural tailoring? Based on this analysis, the authors suggest that effective health promotion will tailor interventions by culture as necessary but reach across cultures when possible and appropriate. A framework is presented to assess the need for cultural tailoring, and a new generation of health promotion research is proposed to facilitate cross-cultural comparisons.
American journal of preventive medicine, 2016
Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions ... more Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions to increase CRC screening in this population are lacking. This study aims to compare the efficacy of two interventions in increasing CRC screening among Chinese Americans. Cluster randomized comparative trial. From 2010 to 2014, a community-academic team conducted this study in San Francisco, CA with Chinese Americans aged 50-75 years who spoke English, Cantonese, or Mandarin. Lay health worker (LHW) intervention plus in-language brochure (LHW+Print) versus brochure (Print). LHWs in the LHW+Print arm were trained to teach participants about CRC in two small group sessions and two telephone calls. Change in self-reports of ever having had CRC screening and being up to date for CRC screening from baseline to 6 months post-intervention. Statistical analysis was performed from 2014 to 2015. This study recruited 58 LHWs, who in turn recruited 725 participants. The average age of the participa...
Journal of health disparities research and practice, 2016
Semi-structured interviews were conducted with 16 Latino cancer patients diagnosed in California;... more Semi-structured interviews were conducted with 16 Latino cancer patients diagnosed in California; 10 health professionals from the San Francisco Bay Area and Fresno, California; and 10 Cancer Information Services (CIS) information specialists from the regional offices handling calls from Spanish-speakers. Interview guides were designed by the investigators to answer three main research questions: 1) How do Latinos obtain information about cancer and what types of information do they access?; 2) What sources of cancer information do they seek out and find credible?; and 3) What are the barriers and facilitators to Latinos obtaining cancer information? Stakeholders generally viewed health professionals as the most credible source of cancer information. All groups regarded family and friends as important sources of information. Patients and health professionals tended to differ on the value of print materials. Although patients found them generally useful, health professionals tended t...
American journal of public health, Jan 23, 2016
To determine the effectiveness of a statewide telephone service in identifying low-income women a... more To determine the effectiveness of a statewide telephone service in identifying low-income women at risk for hereditary breast and ovarian cancer and referring them to free genetic counseling. From June 2010 through August 2011, eligible callers to California's toll-free breast and cervical cancer telephone service were screened for their family histories of breast and ovarian cancer. High-risk women were identified and called for a baseline survey and randomization to an immediate offer of genetic counseling or a mailed brochure on how to obtain counseling. Clinic records were used to assess receipt of genetic counseling after 2 months. Among 1212 eligible callers, 709 (58.5%) agreed to answer family history questions; 102 (14%) were at high risk (25% Hispanic, 46% White, 10% Black, 16% Asian, 3% of other racial/ethnic backgrounds). Of the high-risk women offered an immediate appointment, 39% received counseling during the intervention period, as compared with 4.5% of those rece...
Health Education Quarterly, 1996
Health education materials designed for the general population may be perceived as unattractive, ... more Health education materials designed for the general population may be perceived as unattractive, irrelevant, or unclear by members of certain cultural groups. Given the increasingly multicultural demographics of the United States, planners need to be aware of the specific characteristics of a target audience to address cultural differences and similarities in health messages. The authors describe the use of the subjective culture methodology and social marketing to develop health education materials targeted to multicultural populations, illustrate cultural factors that should be considered when designing printed materials, and outline steps in the design of attractive, stimulating, and culturally appropriate materials. The authors describe the challenges and problems in designing printed materials for multiethnic communities, give suggestions for written educational messages, present a summary of the lessons learned in the development of materials for ethnically diverse populations...
Journal of Medical Internet Research, 2015
Supportive Care in Cancer, 2014
Breast cancer is the most commonly diagnosed form of cancer for women regardless of race/ ethnici... more Breast cancer is the most commonly diagnosed form of cancer for women regardless of race/ ethnicity. Women of color are diagnosed at later stages and experience greater mortality than their White counterparts. However, there has been comparatively little research on coping with breast among racial/ethnic minorities at time of diagnosis, during treatment, or in the course of survivorship. This is despite the fact that research has repeatedly shown that distress can impact disease progression and survival. The questions asked of this systematic literature review include: (1) What is known about coping with breast cancer among major racial/ethnic groups? (2) What are the strengths and gaps in research to date? Over 120 peer-reviewed published studies (1980-2012) were reviewed. A total of 33 met criteria for inclusion including 15 quantitative, 17 qualitative, and 1 mixed methods study. The majority of studies were small sample cross-sectional studies. Only five studies were longitudinal, and two randomized-controlled intervention trials sought to improve coping among survivors. The most common topic in both quantitative and qualitative studies was spirituality and coping among African American breast cancer patients. Thirteen studies included Latinas only or in combination with other groups. Only one quantitative and one qualitative study solely addressed the Asian American population exploring coping and adjustment. In the course of this systematic literature review, we elucidate what is known about coping with breast cancer among racial/ethnic minority women and identify priorities for future research.