Interventions For African Americans Research Articles

End-of-Life Interventions for African Americans With Serious Illness: A Scoping Review.

Older African Americans (AAs) with serious illness experience disparities in advance care planning, access to palliative care and hospice, and decision-making at end of life. While culturally specific drivers of care outcomes have been identified, little has been done to standardize integration and application of targeted elements of end-of-life (EOL) interventions for AA populations. A scoping review was conducted to describe and evaluate the benefit of culturally targeted EOL interventions for AAs. A computerized search of empirical and gray literature was completed. Twelve full-text articles, 1 brief report, and 1 abstract describing a total of 14 EOL interventions for AAs with a range of serious illness were reviewed. Interventions were described relative to culturally targeted adaptations and resulting cognitive, emotional, and behavioral outcomes. Most interventions were theory-based and used psychoeducational approaches and interactive discussion and interviews. Significant improvements in psychological and behavioral outcomes were reported including knowledge and self-efficacy (n = 8); self-reported anxiety, depression, and/or well-being (n = 5); and advance care plan completion (n = 3). Few culturally tailored randomized controlled trials (n = 9) have been conducted. Preliminary results show promise for interventions using cultural adaptations. Culturally targeted intervention approaches are feasible to address EOL outcomes for AA patients and families experiencing serious illness.

Abstract A040: “Don’t tell anybody I have breast cancer, they gonna tell everybody! I don’t want my business in the street”: Patterns of secrecy regarding breast cancer among African American breast cancer survivors

Abstract Introduction: African American women suffer disproportionately from breast cancer relative to other women. One potential contributing historic and cultural factor regards a need for privacy and non-disclosure of disease experiences. This study was a first step to characterize the diffusion of personal breast cancer information throughout African American women’s social networks. Methods: This is a secondary analysis of the Offering African Survivors Increased Support (OASIS) study, which compares the survivorship experiences of women who were/were not navigated throughout diagnosis and treatment. To be eligible, participants had to be: 1) diagnosed within 2011-2014 at Advocate Health in Chicago, IL; 2) female; 3) 18 years or older; and, 4) African American. Trained interviewers conducted 60-90 minute interviews in participants’ homes, libraries, or office spaces, wherein they administered a modified version of Burt’s General Social Survey instrument regarding communication during breast cancer diagnosis and treatment. Results: Approximately 27% of our 33 participants were 50-74 years old, 39% had a bachelor’s degree or greater level of education, and 76% were retired. Overall, 157 family and friends identified as individuals with whom survivors were close during the period of diagnosis/treatment. Survivors disclosed their breast cancer diagnosis to 81% of these individuals, of which 81% were female, 31% were relatives, and 44% communicated with survivors on a daily basis. Qualitative analysis suggest: 1) disclosure was not aligned with fear of disease or a lack of self-assurance/ideology as a strong black woman; rather, disclosure was rooted in societal norms and acceptance of vulnerabilities of black women. Qualitative findings also suggested this disclosure led to a syndrome of silence and level of secrecy too difficult to unravel, fostering a lifetime of secrecy. Conclusion: Our preliminary data have important implications regarding how rising breast cancer incidence rates and breast cancer interventions for African Americans may not necessarily result in increased community knowledge and exchange of evidence-based, personally experienced information about breast cancer. Ongoing analyses will explicitly identify family and friends who were not engaged about breast cancer and reasons for non-disclosure. Citation Format: Desmona C Strahan, Nyahne Bergeron, Shaila Strayhorn, Aditya Khanna, Dana Villines, Karriem S WatsonY, Yamilé Molina. “Don’t tell anybody I have breast cancer, they gonna tell everybody! I don’t want my business in the street”: Patterns of secrecy regarding breast cancer among African American breast cancer survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A040.

Abstract B041: Community-health worker delivered weight loss and maintenance intervention for rural African American adults

Abstract Introduction: Excess body weight is a critical modifiable risk factor for numerous cancers and one of the top public health problems in the country. Unfortunately, underserved groups bear a disproportionate burden, with African Americans having the highest rates of obesity. Behavioral weight loss interventions have been recommended by several governmental agencies to treat obesity and improve cancer risk, control, and survivorship. However, health care provider shortages in underserved areas have resulted in access gaps. Community Health Workers (CHWs), trusted community members, have filled these gaps and been successful in changing health behaviors (e.g. dietary intake, screening), associated with weight loss or cancer, but have not been thoroughly engaged to deliver evidence-based behavioral weight loss interventions. To increase reach among the underserved, community-based weight loss and maintenance interventions are critical. Methods: Building on a 10+ year partnership between community and academic researchers, an evidence-based behavioral weight loss program was adapted for African Americans of faith to create a group-based, CHW-delivered weight loss and maintenance intervention. With the intention of recruiting two CHWs per church, a total of 61 CHWs were recruited and underwent 28 hours of training over 4-6 weeks to deliver the intervention. A total of 31 churches were randomized to a Weight Loss Only arm (16 core lessons) or a Weight Loss + Maintenance arm (16 core + 12 maintenance lessons) in this cluster randomized controlled trial (n=440). Actual weight and height (BMI—body mass index), dietary behaviors, and physical activity were assessed at 0, 6, 12, and 18 months. Linear mixed models and fit by restricted maximum likelihood were implemented using SAS 9.2. All analyses were conducted with the intention-to-treat principle. Results: The intervention produced significant weight loss from baseline to 6-months (-2.47 (-3.13, -1.80)), with 23.7% of all participants losing at least 5% of their body weight. Among those with clinically significant weight loss (≥5%) at 6 months, there was a statistical trend of lower weight regain in the Weight Loss + Maintenance at 12 months. Participants in the Weight Loss + Maintenance arm also reported higher levels of physical activity at 12 months. There were no significant differences between arms at 18 months. Discussion: The intervention produced significant weight loss from baseline to 6-months on par with other evidence-based weight loss interventions for African Americans, including adaptations that utilized health professionals. Compared to health-care professionals, CHWs may be a more cost-effective way to deliver evidence-based behavioral weight loss interventions. Engagement of institutional infrastructures already in place in communities, such as churches, may be a feasible way to sustainably implement and disseminate evidence-based weight loss interventions for those not reached by traditional healthcare institutions Citation Format: Karen Yeary, Carol Cornell, Page Moore, C. Heath Gauss, Elaine Prewitt, Jerome Turner. Community-health worker delivered weight loss and maintenance intervention for rural African American adults [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B041.

Health Literacy Intervention for African Americans With Diabetes

Health Literacy Intervention for African Americans With Diabetes

Motivational Interviewing and Motivational Enhancement Therapy: Cultural Implications in Addiction Intervention for African Americans

Motivational Interviewing and Motivational Enhancement Therapy: Cultural Implications in Addiction Intervention for African Americans

Abstract B15: Motivation for cancer control changes among African Americans

Abstract Background: Healthy dietary behaviors are critical strategies for cancer control. Despite this, many African Americans do not meet the recommended guidelines for fruit and vegetable intake. To develop effective cancer control interventions for African Americans, it is first necessary to understand within group variation in motivations for making dietary behavior changes and identify socioeconomic, social, and clinical factors that have significant independent associations with these motivations. Objectives: To characterize motivations for making dietary changes among African Americans and to identify socioeconomic, social, and clinical factors having significant independent associations with these intrinsic and extrinsic motivations among African American adults (n=530). Results: The mean (SD) level for intrinsic motivation was 26.5 (3.5) whereas the mean (SD) level for extrinsic motivation was 16.1 (4.8). Increasing age (Beta=0.03, p=0.03) and membership in at least one community organization (Beta=1.20, p=0.0003) had significant independent associations in the regression model for intrinsic motivation (n=479, F=5.97, p=0.0001). Lower incomes (Beta=-1.10, p=0.02) and age (Beta=0.06, p=0.006) had significant independent associations with extrinsic motivation. None of the clinical factors were associated significantly with intrinsic and extrinsic motivation. Conclusions: African Americans may be motivated to make dietary changes for cancer control because of intrinsic motivations. Different variables had significant independent associations with intrinsic and extrinsic motivations to make dietary changes among African Americans. It may be important to use alternative strategies to enhance these motivations as part of cancer control interventions that are developed for these individuals. Citation Format: Melanie S. Jefferson, Vanessa Briggs, Ernestine Delmoor, LaShanta Rice, Jerry Johnson, Chanita Hughes-Halbert. Motivation for cancer control changes among African Americans. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B15.

Systematic review: The nature and extent of social work research on substance use disorders treatment interventions among African Americans

Summary Little is known about the contribution made by social workers to empirical evidence on substance use disorders treatment, especially interventions for African Americans. This article presents a systematic review of 23 articles, presentations, and dissertations written by social workers that focus on substance use disorders treatment interventions with African Americans. The aim of this review is to estimate the extent of contribution made by social workers to the research knowledge base on substance use disorders treatment interventions that are effective among African Americans, and to assess the methodological quality of those studies. Findings The review shows social workers’ contributions to research examining substance use disorders treatment interventions with African Americans is inadequate and the methodological rigor of these studies is slightly below average. Of the 23 articles examined, few studies included only African American samples, and most investigated substance use disorders treatment interventions in samples with a small percentage of African American participants. Moreover, most of the reviewed studies were published between 1994 and 2010 in non-social work journals and were cited an average of 6.67 times. Applications The social work profession must increase its contribution to the empirical knowledge base on substance use disorders intervention research with African Americans because it is essential to the provision of culturally sensitive, evidence-based practice to African Americans. More quasi-experimental and experimental designs are needed to compare multiple evidence-based treatments across diverse populations, and to determine causality between treatment processes and outcomes.

Marital Status, Hypertension, Coronary Heart Disease, Diabetes, and Death Among African American Women and Men: Incidence and Prevalence in the Atherosclerosis Risk in Communities (ARIC) Study Participants.

Heart disease is the leading cause of death in the United States, and African Americans disproportionately experience more cardiovascular disease, including coronary heart disease (CHD), hypertension, and diabetes. The literature documents a complex relationship between marital status and health, which varies by gender. We prospectively examine the relationship between African American men’s and women’s marital status and their risk of developing cardiovascular diseases and dying using the Atherosclerosis Risk in Communities (ARIC) data. After multivariable adjustment for individual characteristics and health status, we found that marital status was not associated with hypertension or new cases of CHD, but remaining single throughout the study period was associated with an increased risk of developing diabetes for women and an increased likelihood of death for men. Culturally appropriate interventions for African Americans are needed to decrease racial disparities in cardiovascular diseases and mortality.