The Impact of a Family History of Breast Cancer on Screening Practices and Attitudes in Low-Income, Rural, African American Women

In Maryland, outreach initiatives have been unsuccessful in engaging low-income African American women in mammography screening. This study aimed to identify factors influencing screening rates for low-income African American women. Based on the Health Belief Model, a modified time series design was used to implement a culturally targeted intervention to promote a no-cost mammography-screening program. Data were collected from women 40 years of age and older on their history of mammography use and their knowledge and beliefs about breast cancer. A 50% screening rate was achieved among 119 eligible participants. Significant predictors of screening behaviors were perceived barriers, lack of insurance, and limited knowledge. This culturally targeted intervention resulted in an unprecedented screening rate among low-income African American women in Baltimore, Maryland.

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Overcoming Obesity: A Mixed Methods Study of the Impact of Primary Care Physician Counseling on Low-Income African American Women Who Successfully Lost Weight

American Journal of Health Promotion ◽

10.1177/0890117117690853 ◽

2017 ◽

Vol 32 (2) ◽

pp. 374-380 ◽

Cited By ~ 3

Author(s):

Elaine Seaton Banerjee ◽

Sharon J. Herring ◽

Katelyn E. Hurley ◽

Katherine Puskarz ◽

Kyle Yebernetsky ◽

...

Keyword(s):

Primary Care ◽

Weight Loss ◽

African American ◽

Mixed Methods ◽

African American Women ◽

Low Income ◽

Positive Deviance ◽

American Women ◽

Patient Reported ◽

The Impact

Purpose: Low-income, African American women are disproportionately impacted by obesity. Little is known about the interactions between low-income, African American women who successfully lost weight and their primary care physicians (PCPs). Design: Mixed methods, positive deviance study. Setting: Urban university-based family medicine practice. Participants: The positive deviance group comprised low-income, African American women who were obese, lost 10% body weight, and maintained this loss for 6 months. Measures: The PCP- and patient-reported weight-related variables collected through the electronic medical record (EMR), surveys, and interviews. Analysis: Logistic regression of quantitative variables. Qualitative analysis using modified grounded theory. Results: The EMR documentation by PCPs of dietary counseling and a weight-related medical problem were significant predictors of positive deviant group membership. Qualitative analyses of interviews revealed 5 major themes: framing obesity in the context of other health problems provided motivation; having a full discussion around weight management was important; an ongoing relationship with the physician was valuable; celebrating small successes was beneficial; and advice was helpful but self-motivation was necessary. Conclusion: The PCP counseling may be an important factor in promoting weight loss in low-income, African American women. Patients may benefit from their PCPs drawing connections between obesity and weight-related medical conditions and enhancing intrinsic motivation for weight loss.

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Gestational Weight Gain: Results from the Delta Healthy Sprouts Comparative Impact Trial

Journal of Pregnancy ◽

10.1155/2016/5703607 ◽

2016 ◽

Vol 2016 ◽

pp. 1-12 ◽

Cited By ~ 5

Author(s):

Jessica L. Thomson ◽

Lisa M. Tussing-Humphreys ◽

Melissa H. Goodman ◽

Sarah E. Olender

Keyword(s):

African American ◽

Weight Gain ◽

African American Women ◽

Gestational Weight Gain ◽

Low Income ◽

Home Visiting ◽

High Risk Population ◽

American Women ◽

Gestational Weight ◽

The Impact

Introduction. Delta Healthy Sprouts trial was designed to test the comparative impact of two home visiting programs on weight status, dietary intake, and health behaviors of Southern African American women and their infants. Results pertaining to the primary outcome, gestational weight gain, are reported.Methods. Participants (n=82), enrolled early in their second trimester of pregnancy, were randomly assigned to one of two treatment arms. Gestational weight gain, measured at six monthly home visits, was calculated by subtracting measured weight at each visit from self-reported prepregnancy weight. Weight gain was classified as under, within, or exceeding the Institute of Medicine recommendations based on prepregnancy body mass index. Chi-square tests and generalized linear mixed models were used to test for significant differences in percentages of participants within recommended weight gain ranges.Results. Differences in percentages of participants within the gestational weight gain guidelines were not significant between treatment arms across all visits.Conclusions. Enhancing the gestational nutrition and physical activity components of an existing home visiting program is feasible in a high risk population of primarily low income African American women. The impact of these enhancements on appropriate gestational weight gain is questionable given the more basic living needs of such women. This trial is registered with ClinicalTrials.govNCT01746394, registered 4 December 2012.

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Next Generation Sequencing Reveals High Prevalence of BRCA1 and BRCA2 Variants of Unknown Significance in Early-Onset Breast Cancer in African American Women

Ethnicity & Disease ◽

10.18865/ed.27.2.169 ◽

2017 ◽

Vol 27 (2) ◽

pp. 169 ◽

Cited By ~ 11

Author(s):

Luisel Ricks-Santi ◽

J. Tyson McDonald ◽

Bert Gold ◽

Michael Dean ◽

Nicole Thompson ◽

...

Keyword(s):

Breast Cancer ◽

African American ◽

Next Generation Sequencing ◽

Family History ◽

African American Women ◽

Additive Model ◽

Age At Diagnosis ◽

History Of ◽

Generation Sequencing

Background: Variants of unknown significance (VUSs) have been identified in BRCA1 and BRCA2 and account for the majority of all identified sequence alterations. Notably, VUSs occur disproportionately in people of African descent hampering breast cancer (BCa) management and prevention efforts in the population. Our study sought to identify and characterize mutations associated with increased risk of BCa at young age.Methods: In our study, the spectrum of mutations in BRCA1 and BRCA2 was enumerated in a cohort of 31 African American women of early age at onset breast cancer, with a family history of breast or cancer in general and/or with triple negative breast cancer. To improve the characterization of the BRCA1 and BRCA2 variants, bioinformatics tools were utilized to predict the potential function of each of the variants.Results: Using next generation sequencing methods and in silico analysis of variants, a total of 197 BRCA1 and 266 BRCA2 variants comprising 77 unique variants were identified in 31 patients. Of the 77 unique variants, one (1.3%) was a pathogenic frameshift mutation (rs80359304; BRCA2 Met591Ile), 13 (16.9%) were possibly pathogenic, 34 (44.2%) were benign, and 29 (37.7%) were VUSs. Genetic epidemiological approaches were used to determine the association with variant, haplotype, and phenotypes, such as age at diagnosis, family history of cancer and family history of breast cancer. There were 5 BRCA1 SNPs associated with age at diagnosis; rs1799966 (P=.045; Log Additive model), rs16942 (P=.033; Log Additive model), rs1799949 (P=.058; Log Additive model), rs373413425 (P=.040 and .023; Dominant and Log Additive models, respectively) and rs3765640 (P=.033 Log Additive model). Additionally, a haplotype composed of all 5 SNPs was found to be significantly associated with younger age at diagnosis using linear regression modeling (P=.023). Specifically, the haplotype containing all the variant alleles was associated with older age at diagnosis (OR= 5.03 95% CI=.91-9.14).Conclusions: Knowing a patient’s BRCA mutation status is important for prevention and treatment decision-making. Improving the characterization of mutations will lead to better management, treatment, and BCa prevention efforts in African Americans who are disproportionately affected with aggressive BCa and may inform future precision medicine genomic-based clinical studies. Ethn Dis. 2017;27(1):169-178; doi:10.18865/ed.27.2.169

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