African American Women's Participation Research Articles

Perspectives of African American women about barriers to breast cancer prevention and screening practices: A qualitative study.

Breast cancer is a severe illness that often has fatal consequences. Adherence to the recommendations for breast cancer surveillance is poorly practiced among African American women. The study aimed to identify barriers to preventative screening for breast cancer among African American women (AAW) using a qualitative research design. We explored the influence of personal barriers, stereotypes, socioeconomic status, culture, attitudes, and beliefs on African American women's behavior regarding breast cancer screening. Fourteen African American women were interviewed. Data analysis was completed with Interpretative Phenomenology Approach (IPA). This study's findings demonstrated that African American women perceived the barriers to breast cancer screening include lack of information about available resources, belief that screening cannot change genetic predisposition, embarrassment from exposing the breast for a mammogram, fear of mammograms, and fear of a positive result. These findings may be used to develop interventions to increase AAW's participation in breast cancer screening.

The association of mindfulness and depression stigma among African American women participants in a mindfulness-based intervention: A pilot study.

Depression stigma is a potential barrier to engagement in and efficacy of depression treatment. This pilot study examined the association of mindfulness with depression stigma among participants in an eight-week mindfulness-based intervention for depressive symptoms. Thirty-one African American women with depressive symptoms were recruited from an urban Federally Qualified Health Center (FQHC) to participate in a mindfulness intervention (M-Body). Mindfulness, depressive symptoms, and depression stigma were assessed at baseline, eight weeks, and 16 weeks. Focus groups were conducted to examine participants' subjective experiences with the mindfulness intervention. Mindfulness significantly increased from baseline to eight weeks. There was a non-significant decrease in depression from baseline to eight weeks and a significant decrease in depression from baseline to 16 weeks. Depression stigma significantly increased from baseline to eight weeks and significantly decreased from eight to 16 weeks; however, depression stigma did not return to the baseline. An exploratory qualitative analysis of focus group data revealed themes related to direct and indirect factors that may perpetuate and maintain depression stigma. This is one of the first studies to explicitly explore the relationship between mindfulness, depression symptoms, and depression stigma among African American women.

Uncovering stories of resilience among successful African American women in STEM

The need to increase the number of African American women who obtain STEM degrees has been well documented in the literature by researchers, scientists, and policymakers. Increasing the participation of this group of women and other underrepresented groups in STEM is both an issue of social justice and economic advancement on a national scale. Despite decades of efforts to address this need through research and funding, the participation of African American women in STEM is still low. In part, this may be due to the limited number of studies that include the voices of African American women. Drawing upon the theories of cultural border crossing and resiliency, this paper highlights the stories of eight successful African American women who earned a terminal degree in a STEM field. The purpose of the study was to identify and describe the key factors that these women said aided in their persistence and resilience during two key periods: before postsecondary education and during postsecondary education. We use a case study approach to interpret their stories about the obstacles they faced and the strategies they employed to overcome them. Our findings suggest that experiences outside of school are more important than experiences inside school. The paper concludes with a discussion of the finding’s implications and recommendations for African American women’s recruitment and retention in STEM.

Building Partnerships and Stakeholder Relationships for HIV Prevention: Longitudinal Cohort Study Focuses on Community Engagement.

African American women bear disproportionate human immunodeficiency virus (HIV) burden in the United States, yet are often underrepresented in clinical research. Community engagement may decrease research mistrust and increase participation. We describe strategies used to engage community partners and female participants in a multisite HIV incidence study, HIV Prevention Trials Network (HPTN) 064. HPTN 064 assessed HIV incidence among women in 10 geographic areas chosen for both high prevalence of HIV and poverty. Women were recruited using venue-based sampling and followed for six to 12 months. Recruitment and engagement approaches aligned with the National Institutes of Health (NIH) Director's Council of Public Representatives (COPR) Community Engagement Framework's. Results showed engagement activities increased rapport and established new partnerships with community stakeholders. Study sites engaged 56 community organizations with 2,099 women enrolled in 14 months. Final retention was 94%. The COPR model maximized inclusiveness and participation of African American women impacted by HIV, supported recruitment and retention, and was the cornerstone of community engagement.

Building Partnerships and Stakeholder Relationships for HIV Prevention: Longitudinal Cohort Study Focuses on Community Engagement

Building Partnerships and Stakeholder Relationships for HIV Prevention:Longitudinal Cohort Study Focuses on Community Engagement Rondalya D. DeShields, MSN, RN, Jonathan Paul Lucas, MPH, Melissa Turner, MSW, LICSW, Kemi Amola, PhD, Valarie Hunter, Stephanie Lykes, MPH, Anne M. Rompalo, MD, ScM, Sten H. Vermund, MD, Suzanne Fischer, MA, and Danielle F. Haley, MPH, PhD What Is the Purpose of This Study? • HIV Prevention Trials Network 064 assessed HIV incidence among 2,099 women living in 10 communities with high prevalence of HIV and poverty. • Women were recruited from community locations using venue-based sampling and followed in the study for 6 to 12 months. • Community engagement activities were designed to build rapport and establish mutual respect between researchers and community stakeholders. • The recruitment and engagement approach aligned with the National Institutes of Health (NIH) Director's Council of Public Representatives Community Engagement Framework's five core principles: meaningful community involvement, mutual respect, authentic community-academic partnerships, community stakeholder capacity building, and effective results dissemination. • The purpose of the manuscript is to describe the strategies used to engage community partners by the HPTN 064, a large NIH-funded, multisite trial, to successfully recruit and retain women at increased risk of HIV acquisition in the United States. • We describe the methods used throughout all phases of the research process to engage and sustain community partnerships and stakeholder relationships. What Is the Problem? • African American women bear a disproportionate burden of HIV in the United States, yet are under-represented in clinical research. • For African American women, the HIV incidence rate is 20 times higher than that of White women, and nearly five times higher than that of Hispanic/Latina women, yet African American women are under-represented in clinical research. • African American communities in the United States may mistrust research. • One effective strategy to decrease public mistrust and increase participation of African American communities in HIV prevention clinical research is community engagement. • Although there is a growing body of literature which supports the role of community engagement in HIV prevention research and potential frameworks for doing so, few studies describe detailed methods applied by research teams in field settings. [End Page 3] What Are the Findings? • We enrolled 2,099 women (88% African American) in only 14 months; final retention was 94%. • Community engagement activities spanned all phases of the research process and were designed to build community rapport and establish mutual respect between researchers and community stakeholders. • Study success, as evidenced by rapid recruitment and high retention, was grounded in the strong emphasis on meaningful community engagement throughout the research process. • HPTN 064 found that our pre-implementation work was pivotal to the success and laid the foundation for community engagement. • Applying the core principles of the Council of Public Representatives' model ensured inclusiveness and participation of African American women impacted by HIV from study inception to results dissemination, and supported recruitment and retention efforts. [End Page 4] Rondalya D. DeShields Department of Medicine, Rutgers University New Jersey Medical School Jonathan Paul Lucas Science Facilitation Department, FHI 360 Melissa Turner Infectious Disease Practice, Veteran's Administration Kemi Amola School of Medicine, University of North Carolina at Chapel Hill Valarie Hunter Hubert Department of Global Health, Emory University Stephanie Lykes Harlem Prevention Center, Columbia University Anne M. Rompalo Department of Medicine, Johns Hopkins University School of Medicine Sten H. Vermund Vanderbilt Institute for Global Health, Vanderbilt University Medical Center Suzanne Fischer Research Utilization, FHI 360 Danielle F. Haley Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill Copyright © 2020 Johns Hopkins University Press

Association of APOL1 With Heart Failure With Preserved Ejection Fraction in Postmenopausal African American Women

APOL1 genotypes are associated with kidney diseases in African American individuals and may influence cardiovascular disease and mortality risk, but findings have been inconsistent. To discern whether high-risk APOL1 genotypes are associated with cardiovascular disease and stroke in postmenopausal African American women, who are at high risk for these outcomes. The Women's Health Initiative is a prospective cohort that enrolled 161 838 postmenopausal women into clinical trials and an observational study between 1993 and 1998. This study includes 11 137 African American women participants who had a clinical event from enrollment to June 2014. Data analyses were completed from January 2017 to August 2017. The variants of APOL1 were genotyped or imputed from whole-exome sequencing. Incident coronary heart disease, stroke and heart failure subtypes, and overall and cause-specific mortality were adjudicated from hospital records and death certificates. Estimated incidence rates were determined for each outcome and hazard ratios (HR) and 95% CIs for the associations of APOL1 groups with outcomes. The mean (SD) age of participants was 61.7 (7.1) years. Carriers of high-risk APOL1 variants (n = 1370; 12.3%) had higher prevalence of hypertension, use of cholesterol-lowering medications, and reduced estimated glomerular filtration rate (eGFR). After a mean (SD) of 11.0 (3.6) years, carriers of high-risk APOL1 variants had a higher incidence rate of hospitalized heart failure with preserved ejection fraction (HFpEF) than low-risk carriers did but showed no differences for other outcomes. In adjusted models, there was a significant 58% increased hazard of hospitalized HFpEF (HR, 1.58 [95% CI, 1.03-2.41]) among carriers of high-risk APOL1 variants compared with carriers of low-risk APOL1 variants. The association with HFpEF was attenuated (HR = 1.50 [95% CI, 0.98-2.30]) and no longer significant when adjusting for baseline eGFR. Status as a carrier of a high-risk APOL1 genotype was associated with HFpEF hospitalization among postmenopausal women, which is partly accounted for by baseline kidney function. These findings do not support an association of high-risk APOL1 genotypes with coronary heart disease, stroke, or mortality in postmenopausal African American women.

Processes in Increasing Participation of African American Women in Cancer Prevention Trials: Development and Pretesting of an Audio-Card

The enrollment of African American women into cancer prevention trials (CPTs) continues to be low despite their higher cancer mortality rates. Clinical trials are vital to the discovery of new prevention, diagnostic, and treatment methods that improve cancer outcomes. This study addressed attitudes and beliefs associated with the sub optimal participation of African American women in CPTs through the development and pretesting of an educational tool. The use of community-engaged research (CER) in the formative phase of this study was the basis for developing an audio-card. Cultural and linguistic elements were incorporated into the tool’s audio and written messages, and visual images highlighted the importance of CPT participation among African American women. The CPT beliefs and behavioral intent of 30 African American women who received information from the audio-card were compared with 30 controls. Findings indicated statistically significant differences at posttest between the control and treatment groups in personal value (p = .03), social influence (p = .03), and personal barriers (p = .0001); personal barriers in the pretest group also demonstrated significant differences (p = .009). Consideration of cultural context and language needs of populations are vital to the development and design of effective health promoting tools.

Abstract C81: A systematic review of breast cancer screening strategies for African American women

Abstract BACKGROUND: Breast cancer mortality is higher among African American women (AAW) in comparison to any other racial/ethnic group. This disparity is reflective of multiple factors including health care access, biological factors and participation in screening mammography. Currently there is a scarcity of literature on evidence-based interventional strategies to increase AAW's participation in screening mammography. Our study aims to: 1) Identify the literature from 2009-2015 on interventional strategies to increase the participation of AAW ≥40 years old in screening mammography and 2) Summarize the evidence from this literature including any impact of these interventions on breast cancer outcomes. METHODS: We conducted a systematic review of published and grey literature on breast cancer screening interventions from 2009-2015. The literature search was conducted in PubMed, Embase (Elsevier), CINAHL (Ebsco), PsycINFO (Ebsco) and the Cochrane Central Register of Controlled Trials (Wiley). Grey literature was searched for using ClinicalTrials.gov, National Cancer Institute's clinical trials database and ProQuest Dissertations and Theses database. Queries utilized a combination of keywords and database-specific terminology derived from pre-determined eligibility criteria. The four reviewers were divided into two teams to balance expertise in public health, primary care, cancer disparities, breast oncology and breast cancer basic science research. The review protocol was developed with guidance from PRISMA standards. Methodological quality of the studies will be determined by examination of study design, theoretical framework and quality of data reporting. RESULTS: Our literature search yielded a total of 1,83O studies. After removal of duplicates, 1,274 studies were screened for inclusion. Twenty studies met all criteria and were designated for abstraction and data analysis. Nineteen studies presented original data from a US based intervention and had a population which included AAW ≥ 40 years old. Study designs included: randomized control trials, quasi-experimental, pre/post study, non-randomized with controls, cohort and case-control studies. The common interventional strategies employed were reminder systems; trained volunteers; media campaigns; telephone and DVD coaching; and patient navigation/case management. Reported outcome measures included: demographics, pre- and post-intervention mammography participation, and intervention retention rates. Study limitations stemmed from limited sample size, lack of generalizability, absence of theoretical framework, attrition rate and utilization of self-reported data. CONCLUSION: Despite knowledge of disparities in breast cancer mortality for AAW and the impact of screening mammography on breast cancer mortality, there is a paucity of evidence on interventional strategies to increase the participation of AAW in screening mammography. The limited evidence available suggests that interventional strategies that incorporate mass media communication, family and social support networks, and nurse navigation increased the number of AAW who participate in screening mammography. Citation Format: Shana O. Ntiri, Laundette P. Jones, Gonca Kocoglu, Emilie Ludeman, Paula Y. Rosenblatt. A systematic review of breast cancer screening strategies for African American women. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C81.

Focus on You: Cancer clinical trials perspectives.

BackgroundClinical trials test new ways to prevent, detect, diagnose, or treat diseases. Researchers have found that minority patients are willing to participate in clinical trials, yet these patients have barriers which hinder their access to trials.MethodsTo explore African American women's participation in breast cancer clinical trials, eight focus groups were conducted with breast cancer patients, family members/care givers, religious leaders, and healthcare providers to gather information on the perspectives and opinions on the topic. The focus group conversations were transcribed, and transcripts were imported into QSR International's NVivo 10 software. The transcripts were organized into folders based on four categories. The content analysis performed was based on recordings and notes.ResultsThe following themes were generated as a result of conducting these focus groups and gathering information on the perspectives and opinions about participating in clinical trials, based on the groups who participated: Promoting participation in research; Personal experience with cancer; Support and support services; Awareness, knowledge, and experience with clinical trials; Providers' roles in clinical trials.ConclusionThe data collected in this study present several actionable themes that, if addressed by individual researchers and the medical community at large, could increase participation in clinical trials by African American patients. They also provide a deeper and more nuanced understanding of the factors influencing African American patients' decisions around participating in clinical trials.

Admixture mapping of genetic variants for uterine fibroids.

Uterine leiomyoma (UL) are benign neoplasms arising from the smooth muscle cells of the uterus. One of the established risk factors for UL is African American ethnicity. Studies have consistently shown that African Americans have 2-3 times higher risk compared with that of non-Hispanic Whites. However, there is still no adequate explanation for the higher risk among African Americans. To investigate the genetic contribution to the observed difference between the African American and European American populations, we conducted an admixture scan in 525 eligible African American women participants to the NIEHS uterine fibroid study (NIEHS-UFS). In models with no stratification, we found multiple genomic regions showing significant and suggestive evidence of association, with chromosomal band 2q32.2 at rs256552 showing the highest score (Z-score = 7.86, Bonferroni adjusted p-value = 5.5×10-12) consistent with the suggestive evidence reported for this genomic region in the Black Women's Health Study. However, in models stratified by the body mass index (BMI) covariate, chromosomal 1q42.2 was the sole genomic region that consistently showed suggestive associations across the BMI categories tested (Z-scores ≤ -3.96, Bonferroni adjusted p-values ≤ 0.107). In age-stratified models, a significant association was observed in the older category (age > 40) reaching a Z-score of 6.44 (Bonferroni-adjusted p-value = 1.64 × 10-7) at rs256552. The mean percentage of European ancestry among cases was lower than that among controls in the NIEHS-UFS study. However, our study did not show a significant association between mean percentage of European ancestry and UL.

Stressful Life Events and Behavior Change: A Qualitative Examination of African American Women's Participation in a Weight Loss Program

We qualitatively assessed how life stressors affected African American women's participation in a weight reduction program. A sample of 9 women, who completed a behavioral lifestyle intervention, participated in individual, structured, in-depth interviews. Life stressors, ranging from personal illness to changes in employment status, had varied effects on participation. Some women coped with life stressors by using them as a motivational tool to improve their own health, while others reported limited ability to devote time to attend meetings or engage in the prescribed lifestyle changes due to life stressors. A critical key to improving weight loss outcomes for African American women may be using intervention strategies that teach positive coping skills to alter maladaptive responses to life stressors.

The Recruitment and Retention of African American Women as Public School Superintendents

This qualitative study was based on a phenomenological narrative design that specifically addresses the issues of recruitment and retention of African American women in the public school superintendency. The narratives of eight African American women participants identified common similarities and differences about race, gender, and social politics as applied to recruitment and retention of public school superintendents. When African American women are hired for and able to maintain the public school superintendency, they in fact are learning, teaching, and modeling how to overcome racism, sexism, and oppressive sociopolitics. This is not to say that every African American woman hired as a public school superintendent has the capacity to become a transformative leader within a school district, but rather their mere presence in the position demonstrates their individual ability to transcend the challenges presented throughout this study.

Preconception Biomarkers of Allostatic Load and Racial Disparities in Adverse Birth Outcomes: the Bogalusa Heart Study

Large disparities in adverse birth outcomes persist between African American and white women in the US despite decades of research, policy, and public health intervention. Allostatic load is an index of dysregulation across multiple physiologic systems that results from chronic exposure to stress in the physical and socio-cultural environment which may lead to earlier health deterioration among racially or socio-economically disadvantaged groups. The purpose of this investigation was to examine relationships between maternal biomarkers of allostatic load prior to conception and the occurrence of preterm birth and small for gestational age infants among a cohort of white and African American women participants in the Bogalusa Heart Study. Data from women participants were linked to the birth record of their first-born infant. Principal components analysis was used to construct an index of allostatic load as a summary of the weighted contribution of nine biomarkers representing three physiologic domains: cardiovascular, metabolic, and immune systems. A series of Poisson regression models based on samples ranging from 1467 to 375 women were used to examine race, individual biomarkers of allostatic load, and quartiles of the allostatic load index as predictors of preterm birth (n = 150, 10.2%) and small for gestational age (n = 135, 9.2%). There was no evidence of a relationship between maternal preconception allostatic load and either adverse birth outcome in this sample. Further, there was no evidence of effect modification of by race or education. More work is needed in understanding the biological mechanisms linking social inequities to racial disparities in adverse birth outcomes.

The Other Southern Belles: Civil War Reenactment, African American Women, and the Performance of Idealized Femininity

This essay examines African American women's participation in Civil War reenactment as performances of idealized femininity. African American Civil War reenactments enable black men and women to construct narratives of historical subjectivity through performances of masculine and feminine agency. In enacting the role of the “demure southern belle” supporting black Union soldiers, black women reenactors occupy an image associated with idealized femininity. This appropriation of southern belle iconicity destabilizes past and contemporary representations, rooted in southern mythology, relegating black women to the categories of the mammy and Jezebel, the black whore. In this endeavor, they use these performances as resistance, thereby suggesting the presence of power and subversion within traditionalism. Moreover, as the black male reenactor's occupation of the conservative image of the idealized citizen-soldier is perceived as anathema to contemporary black masculinist discourse, the ironies inherent in black women's performance of traditional femininity as feminist discourse underscore the problematics embedded within mainstream feminism, revealing the situated nature of its core assumptions.

Establishing a community partnership to optimize recruitment of African American pedigrees for a genetic epidemiology study

We developed a breast cancer genetic epidemiology study in collaboration with a community partnership to optimize recruitment and participation of African American women. We recognized that recruitment of relatives for a family-based study was a unique challenge in this minority group in the USA. Through an established partnership with The National Witness Project, we convened focus groups to identify potential recruitment challenges and issues related to decisions about study participation that may be unique to African Americans and family-based recruitment. Using the PEN-3 model, we analyzed qualitative data and applied the thematic findings to our recruitment protocol in order to mitigate potential recruitment challenges. The most relevant positive themes included a need for research and education and potential benefit to future generations. Negative themes included communication barriers in sharing disease status within a family and historical issues such as fatalistic attitudes and shamefulness of cancer. Collaboration with community partners allowed for development of culturally appropriate recruitment strategies for African American breast cancer survivors and their family members for a genetic epidemiology study. Understanding factors unique to family-based recruitment in the USA is a significant factor in enhancing participation of under-represented minorities in future genetic studies.

Physical Activity Among African American Women: A Response to Karla A. Henderson

I am very appreciative of Karla Henderson’s remarks. Obviously well versed on the topic, she has published on her own and in collaboration with my high school classmate—Academy Fellow #376, Barbara Ainsworth—a number of peer-reviewed scholarly articles dealing with women of color and physical activity. This is most impressive in that it is extremely rare that an individual most closely associated with the discipline of recreation would collaborate on a series of essays with a dedicated epidemiologist. In this plenary address Henderson provides very clear, suggestive, and thoughtful interpretations and analysis that should receive our full attention and ultimately our serious consideration. Henderson points out that an increasing amount of research has recently been completed to help explain the relatively low level of physical activity, obesity problems, and overall lack of good health among African American women. The results of this research indicate that the disparities in levels of physical activity and leisure activities between African American women and many other groups are highly complex. Investigators have uncovered a host of personal constraints and perceived barriers for African American women that have limited their involvement in physical activity and leisure activities, including economic conditions, child rearing duties, safety concerns, lack of facilities, physical illnesses, access to resources, lack of social support, concerns about physical appearance during exercise, major life changes or trauma, and lack of environmental opportunities such as parks and playgrounds. Adding to this long list is the matter of race, which Henderson understands must be considered along-side historical inequalities and cultural stereotypes in any discussion regarding the level of participation of African American women in physical activity and leisure pursuits. Henderson complements her synopsis of the basic research literature with an overview of the various intervention strategies implemented to raise the level of participation of African American women in physical activity and leisure pursuits and concludes with suggestions for future studies in the context of different ways of knowing. Here Henderson cites studies which argue that successful interventions must be based on shared beliefs and values, be cognizant of the need to gain credibility and respect within the African American community, and be focused on

Healthy Start Program Participation: The Consumers' Perspective

In 1991, the federal Maternal and Child Health Bureau developed the Healthy Start Initiative as a comprehensive community-based program to eliminate the high rates of poor pregnancy outcomes among women of color. To date, few studies of the programmatic outcomes of this Initiative have examined the views of Healthy Start consumers. To understand the benefits of Healthy Start from their consumers' perspective, the Pittsburgh Allegheny County Healthy Start project conducted a survey of 202 of their Healthy Start participants in 2003. The participants completing the survey reported benefits of participating in the program including stress reduction, receiving resources and referrals, and consistent social support of program staff. According to the project's annual statistics, Healthy Start has improved pregnancy outcomes among African American women participants in the Pittsburgh community. However, and according to these participants, the quality of staff and consumer connectedness, availability and consistency of material resources, and social support are as critical as more traditional health interventions to their satisfaction, motivation to participate, and willingness to refer others to the program. Women of color will often forego health services perceived as intimidating and/or culturally insensitive, but programs such as the Healthy Start Initiative offer a critical link that encourages participation and, as a result, improves maternal and child health status.

Barriers to recruiting urban African American women into research studies in community settings

This qualitative study identified barriers to African American women's participation in a community-based behavioral intervention trial to increase mammography screening. Four themes emerged from focus group discussions with community agency providers and research team members. These themes were (1) going to the gatekeepers; (2) knowing the culture; (3) location is everything; and (4) protocols, policies, and possibilities. A checklist of actions that nurse researchers could consider to increase African American women's participation in community trials is provided.

Ethnography's role in assisting mental health research and clinical practice

In this article, the author discusses the utility of qualitative approaches in mental health research and clinical practice. He highlights the value of conceptualizing research designs and procedures that include relevant cultural information about study participants. Emphasis is placed on African American women participants, consumers, and others who are understudied, underrepresented, and underserved in large-scale studies and treatment. Limitations and strengths are noted. Contributions of qualitative methodology are described, particularly the functions of ethnography and grounded theory in conceptualization, hypotheses building, and hypotheses testing of outcome data on African American women and culturally diverse groups. Clinical researchers are encouraged to utilize qualitative and mixed methods approaches to bolster outcomes and better inform their clinical practice.

Barriers to breast cancer control for African-American women: the interdependence of culture and psychosocial issues.

This study evaluates the cultural context of the behaviors and beliefs of African-American women to determine the success or failure of breast cancer prevention and control interventions. Cultural and psychologic reactions, such as fear, distrust, fatalism, and other "historic rooted" factors, are major determinants to participation in these interventions by African-American women. Psychosocial and cultural issues were delineated through a literature review in the areas of cancer prevention, breast cancer control, and African-American women. Assessments were conducted to document key successful models and activities that increased the participation of African-American women in breast cancer prevention and control interventions. Current community-based intervention strategies and activities were assessed. Effective breast cancer prevention and control programs must address and develop cultural competent models that promote behavioral change in this population of women. Studying the relationship between culture and psychosocial issues is integral to our understanding of how African-American women participate and respond to cancer prevention and control interventions. Cultural competent models that reduce and eliminate cancer disparities in this population must be developed.