Tuskegee Syphilis Study Research Articles

Quantifiable Cross-cultural Research on Medical Mistrust is Necessary for Effective and Equitable Vaccination in Low- and Middle-income Countries.

Perceptions of healthcare personnel and institutions substantially impact healthcare behaviors. In the US, minority experiences with racist events like the Tuskegee study, alongside everyday experiences of marginalization and discrimination, drive medical mistrust in populations that are already burdened with health inequalities. However, the concept of medical mistrust is rarely applied outside of industrialized contexts. Histories of colonialism, underfunded healthcare institutions, and the enormous cultural and ethnolinguistic diversity present in low- and middle-income countries (LMICs) make medical mistrust a likely contributor to health behavior in these contexts. In the era of COVID-19 and emergent malaria vaccines, there is an urgent need to mitigate factors leading to medical mistrust, which impedes interest in novel vaccines. Doing so requires substantial investment in research that examines the causes of medical mistrust across diverse communities, develops methodological tools that can effectively measure medical mistrust across diverse cultural and ethno-linguistic contexts, and applies this data to policy and public health messaging. This commentary highlights the role of medical mistrust in vaccination and argues for its utility in addressing vaccine decision-making in LMICs.

Ethical Considerations in Clinical Trials: Ethical Dilemmas in Patient Consent and Animal Testing

Clinical trials are indispensable to the advancement of medical science, providing a framework for evaluating the safety and efficacy of new treatments, interventions, and technologies. However, they present profound ethical challenges, particularly in relation to patient consent and the use of animals in preclinical testing. Informed consent is central to safeguarding patient autonomy, yet practical difficulties arise from issues such as patient comprehension, vulnerability, and cultural differences. Animal testing, while traditionally viewed as a necessary component of preclinical research, prompts serious ethical concerns regarding animal welfare and the broader moral implications of causing harm to animals for human benefit. This review examines these ethical dilemmas, tracing their historical evolution, analysing current regulatory frameworks, and evaluating potential alternatives to both patient consent challenges and animal testing. Through the examination of case studies like the Tuskegee Syphilis Study and the Henrietta Lacks case, as well as debates surrounding animal rights, this article emphasizes the need for continuous ethical vigilance and adaptive frameworks that can balance scientific progress with moral responsibility.

Respect for history: an important dimension of contemporary obstetrics & gynecology.

"Those who cannot remember the past are condemned to repeat it." This maxim underscores the importance of historical awareness in medicine, particularly for obstetricians and gynecologists (ObGyns). ObGyns significantly impact societal health through their care for pregnant women, fetuses, and newborns, uniquely positioning themto advocate for health initiatives with lasting societal benefits. Despite its importance, the history of medicine is underrepresented in medical curricula, missing opportunities to foster critical thinking and ethical decision-making. In today's climate of threatened reproductive rights, vaccine misinformation, and harmful ideologies, it is imperative for ObGyns to champion comprehensive historical education. The history of medicine, particularly in relation to societal issues- such as racism, discrimination, genocides, pandemics, and wars- provides valuable context for addressing challenges like maternal mortality, reproductive rights, vaccine hesitancy, and ethical issues. Understanding historical milestones and notable ethical breaches, such as the Tuskegee Study and the thalidomide tragedy, informs better practices and safeguards patient rights. Technological advancements in hygiene, antibiotics, vaccines, and prenatal care have revolutionized the field, yet contemporary ObGyns must remain vigilant about lessons learned from past challenges and successes. Integrating historical knowledge into medical training enhances clinical proficiency and ethical responsibility, fostering innovation and improving health outcomes. By reflecting on historical achievements and their impacts, current and future ObGyns can advance the field, ensuring comprehensive and ethically sound approaches to patient care. This paper highlights the crucial role of historical knowledge in shaping modern ObGyn practices, advocating for its integration into medical education to address contemporary health challenges and ethical considerations.

Peter Buxtun: US government employee who exposed racist and unethical Tuskegee syphilis study

Peter Buxtun: US government employee who exposed racist and unethical Tuskegee syphilis study

Deception and Racism in the Tuskegee Syphilis Study

During the twentieth century (1932-1972), white physicians representing the United States government conducted a human experiment known as the Tuskegee Syphilis Study on black syphilis patients in Macon County, Alabama. The creators of the study, who supported the idea of black inferiority and the concept that black people’s bodies functioned differently from white people’s, observed the effects of a disease called syphilis on untreated black patients in order to collect data for further research on syphilis. Black individuals involved with the study believed that they were receiving treatment, although in truth, treatments for syphilis were purposely held back from them. Not only this, but fluids from their bodies, such as blood and spinal fluid, were extracted to serve as research material without their awareness of the purpose of the collection. The physicians justified their approach by positioning it as mere observation, asserting that they were not actively intervening with the patients participating in the experiment. However, despite their claims of passivity, these white physicians engaged in various morally improper actions, including deceit, which ultimately resulted in the deaths of numerous black patients who might have had a chance at survival.

Bioethics-CSR Divide

Bioethics-CSR Divide

Historical Trauma, Health Care Distrust, and the Legacy of Tuskegee: Implications for Nurse Practitioner Practice and Research

Nurse practitioners (NPs) represent a strong cadre of healers and researchers active in a global quest to eliminate health disparities and create health equity. Barriers to health care result in a disproportionate burden of disease/disability on marginalized groups. Historical trauma results in or contributes to health care distrust manifested as a unique type of barrier with implications for nurse practitioners in research and practice. The legacy of Tuskegee is a reminder and a sentinel exemplar of how Black American male participants in “The Tuskegee Study of Untreated Syphilis in the Negro Male” (the United States Public Health Services Study at Tuskegee) experienced historical trauma and how intergenerational trauma is linked to negative health care outcomes.

Refurbishing a Rusty Cystoscope into the Retrospectroscope Award

Objectives The AUA Earl Nation Retrospectroscope Award is presented annually for the best presentation and paper at the annual History Forum. The award, bestowed by voting members of the AUA History Committee, includes a personalized and refurbished Brown-Buerger cystoscope and an AUA honorarium. The history of this prestigious award itself, however, is not widely known. Our objective was to identify the persons, vision, and processes required to establish the award and continue its tradition as a highlight of the annual meeting of the AUA. Methods We reviewed contemporaneous documents including AUA Board of Directors’ Meeting items, AUA archives, History Committee minutes, and notes by the AUA museum curators. Original newspaper archives were obtained as cited from digital resources. Secondary publications regarding the founding of the AUA History Club, the History of Urology Forum, its creators, and the award itself were obtained from the AUA Archives or from on-line resources as indicated. Results The annual History Forum at the American Urologic Association national meeting has been held annually since 1975, modelled after the smaller history meetings moderated by Earl Nation and Frank Bicknell since 1965. The development of an award for the top history paper was proposed at the 2005 meeting and formally approved by the AUA Board of Directors in 2006. During this time the AUA Museum had collected numerous ACMI Brown-Buerger cystoscopes from urologists who were switching to fiberoptic instruments. The Retrospectroscope Award, later named after 1977 AUA President Earl Nation, thus came into existence whereby the winning History Forum presenter would be given one of the donated cystoscopes and a small honorarium. The first Retrospectoscope winner was Shamim Baker for her 2005 paper on the Tuskegee experiment. The prize has been awarded annually for the past 19 years, eventually coming under AUA sponsorship in 2014. Conclusions The History of Urology Club at the AUA began in 1965 but an award for the best presentation has only been awarded since 2006. The AUA website lists prior award winners. The History of Urology Forum has significantly increased in popularity from the original 5 presentations in 1965 to 21 podium presentations in 2022 with 14 posters, a keynote “Bicknell Oration”, and a Medical Ethics Debate. As competition for the AUA Earl Nation Retrospectroscope Award has increased, contenders must submit a completed manuscript in addition to their presentation.

Trust in Medical Research: A Comparative Study among Patients at a Regional Referral Hospital and Community Members in Lira District, Northern Uganda.

Events such as the Tuskegee syphilis study shaped how the public perceives and trusts medical research globally. However, few studies have examined trust in medical research in developing countries. We tested the hypothesis that levels of trust may be lower among community members compared to hospitalized persons in Uganda. We enrolled 296 participants in rural northern Uganda, and 148(50%) were from the community, 192(65%) were female. Mean level of trust for medical research was higher among hospitalized persons compared to community members (p = 0.0001). Previous research participation (p = 0.03), and willingness to participate in future research (p = 0.001) were positively associated with trust. Medical personnel should engage more with the communities in which they practice fostering trust in medical research.

Engaging Underrepresented Patients in Hematology Clinical Trials through the LLS Impact (Influential Medicine Providing Access to Clinical Trials) Research Grant: A Multi-Institutional Effort

Introduction: Despite governmental and industry-sponsored efforts, clinical trial participation among rural residents and racial and ethnic minorities remains low. The NIH Revitalization Act of 1993 directed the NIH to establish guidelines for inclusion of women and minorities in clinical research. In 2015, the Food and Drug Administration launched an action plan to improve the quality of demographic subgroup data collection, identify barriers to enrollment, employ strategies to increase participation, and promote transparency of related data. However subsequent studies (Green et al. Health Aff. March 2022, Kanapuru et al. Blood Advances. March 2022.) showed no improvement in participation of racial minorities, including Blacks and Hispanics since this plan was enacted. Various complex system- and individual-based factors, including lack of clinical trial availability; lack of diversity in the investigator work force; scant patient and provider awareness of clinical trials; lack of trust in the health care system; and issues with access to care-often driven by financial, geographic, or social constraints (Allison et al. Cureus. Apr 2022.), and stringent eligibility criteria are deemed responsible. The Leukemia & Lymphoma Society (LLS) IMPACT (Influential Medicine Providing Access to Clinical Trials) research grant strives to bridge this unrelenting care gap. Methods: The LLS IMPACT program includes a 5-year research grant which was launched in 2021. The IMPACT grants support the establishment of clinical trial networks involving academic cancer centers (“Hubs”) linked to community clinics and oncology centers (“Spokes”). The program's overall goal is to provide patients access to trials through participation at the community sites. Initially, 3 institutional sites were selected to participate. These institutions had unique and tailored strategies to improve engagement of underrepresented patients, including black, indigenous, people of color, Hispanic, Latina/Latino, and people from rural communities in vastly different climates and local cultures. The IMPACT grant expanded to encompass 4 additional sites given the imminent needs and clamor of the hematology clinical trials community (Figure 1A). The catchment areas and strategies employed at each institution are summarized in the table (Figure 1B). Results: At the start of the grant period, focus was on building clinical research infrastructure and opening non-interventional clinical trials to teach personnel about clinical research and create relationships with patients. Other programs such as webinar series, tumor boards, technological advancements, and educational workshops were also established to enhance engagement among physicians, match patients to clinical trials, and to provide clinical trial education to potential patients. One trial that has seen early success is the CHIVE IMPACT trial, a non-interventional registry and biorepository which has enrolled 24 patients at a rural and underserved site as of July 2023. The purpose of CHIVE is to enroll patients who have clonal hematopoiesis (CH) or are at risk of CH and follow prospectively in efforts to understand risk of progression and potential for early intervention. The Universal Protocol is another biorepository trial which has more than tripled its enrollment number at a community site between 2021 and 2022. Of the 63 patients enrolled in 2022, 66% of them identified as a race other than White. As our core goal is to increase access to interventional trials, we hope to bring industry sponsored phase II and phase III studies to underrepresented areas that serve a broad patient population. Lack of financial resources, lack of transportation and distance to trial sites, and residual distrust of the medical community (e.g., legacy of Tuskegee experiments) are barriers the grantees are focused on overcoming to enroll the intended populations into clinical trials. Conclusion: The innovative strategies employed to expand access to clinical trials for underrepresented population at the various institutions through the LLS's IMPACT research grant can be utilized during clinical trials design and implementation phases to improve generalizability of clinical trials in hematologic malignancies. In the third year of this program, 7 participating sites are engaging impactful strategies (Figure 1B) which will be reported at the end of the grant period.

An Ill-bred Culture of Experimentation: Malaria Therapy and Race in the United States Public Health Service Laboratory at the South Carolina State Hospital, 1932-1952

Abstract While most are aware of the Tuskegee syphilis experiments in which African American syphilis patients went untreated, less is known about experiments with malaria fever therapy conducted upon syphilis patients during the same period by the Unites States Public Health Service at the Williams Laboratory on the grounds of the South Carolina State Hospital (SCSH) in Columbia, SC. Over a twenty-year period, physicians maintained patients as malaria reservoirs for patient-to-patient inoculation and subjected patients to extreme fevers and thousands upon thousands of insect bites as part of a program in which one disease was tested as therapy for another. Using extant administrative files, medical journals from the period, and a database created from SCSH annual reports, this paper considers the ethics of malaria fever therapy experiments while exposing the conditions under which patients suffered the intersecting oppressions of race, class, and mental illness. It illuminates the prevalent scientific racism of the period that enabled pseudo-medical assumptions about African Americans’ perceived penchant for poverty, deviant sex, and pain tolerance, which combined to enable a culture of experimentation that influenced events at Stateville Penitentiary and continued long after penicillin became widely available.

On the application of AI in ethical decision-making in research ethics and ethics education

Abstract Background ChatGPT is tested everyday by millions of users with different use cases. Exploring the gap between theoretical and practical ethical problems and how it is affected by the ongoing development of ChatGPT is one of these cases. The aim of this report is to present the results of testing ChatGPT in ethical decision-making in research ethics and its applicability in ethics education. Methodology The tests were conducted between February and April 2023 with 3 updates of ChatGPT in this period. GPTZero AI detector was used to test whether the AI generated text can be detected as not written by human. For ethical decision-making a 4-step model developed in Medical University - Pleven was applied to the Tuskegee experiment case. Results Two tests were conducted, in February and in April. In both cases ChatGPT was given a simple task to analyse the Tuskegee experiment by applying a methodology for case analysis. In February it used a 6-step method and in April it used a 4-step approach. In both cases ChatGPT managed to identify ethical problems regarding informed consent, human rights, harms. With more detailed instructions ChatGPT managed to follow them to some degree. It identified the issue of vulnerability and the relevance of Nuremberg code and Declaration of Helsinki but it couldn’t interpret them without additional plugin. Given a simple instruction ChatGPT produced a content that was detected by GPTZero as written by AI. By instructing ChatGPT for creating content with high degree of burstiness and perplexity and more detailed instructions about the methodology it produced a content of which two-thirds were detected as written by AI. Conclusions Given the task ChatGPT can identify ethical issues at basic level. Even with more detailed instructions it can’t go into detailed ethical reasoning. It wouldn’t be sufficient for professional ethical decision-making. It could help in ethics education but with certain limitations. Key messages • ChatGPT is still not able to go into detailed ethical reasoning and researchers should be careful if they plan to use it in their scientific work. • Educators should always check whether the content of their students’ work is developed by AI and have ethical guidelines for using AI in education.

Visualizing Racism within Medicine

The Tuskegee experiment became the public symbol and face of research medical malfeasance. Numerous scholars, literature, and science frame this study through the lens of distrust, lack of ethics and informed consent. However, Tuskegee foregrounded practices, behaviors, beliefs, and standards that already existed. History and science reveal disconnections from the historical implication of black individuals and disparate experiences within communities. Currently, medical doctors cite challenges to publishing research on race with scholarly medical journals. Biomedical research literature discusses racism within the confines of editorial and commentary features. In 2021, top editor of the Journal of American Medicine stepped down amid controversial comments about race.
 Medical doctors cite challenges to publishing research on race with scholarly medical journals. Racial disparities within medicine, scientific records, scholarly publishing, and medical literature are not silos and are interconnected. This poster is research in design illustrating their intersections and explores the following research questions:
 
 How do existing university course content describe race and ethics?
 Can racism be conceptualized as an ethical issue within medical education?
 

Experimenting with Humans and Animals: from Aristotle to Crispr, second edition

Experimenting with Humans and Animals: from Aristotle to Crispr, second edition

Current health care experiences, medical trust, and COVID-19 vaccination intention and uptake in Black and White Americans.

The COVID-19 pandemic spotlighted Black Americans' inequitable health care experiences. Across two studies, we tested the associations between health care experiences, historical knowledge of medical mistreatment, medical trust, and COVID-19 vaccination intention and uptake in Black and White Americans. We hypothesized that Black Americans' worse current health care experiences (rather than historical knowledge) and lower medical trust would be associated with lower COVID-19 vaccination intention (Study 1) and that feeling less cared for by their personal physician would be associated with Black Americans' lower medical trust (Study 2). In convenience (Study 1, December 2020) and nationally representative samples (Study 2, March-April 2021), participants completed online surveys. In Study 1 (N = 297), Black (relative to White) Americans reported lower vaccination intention (Cohen's d = -.55, p < .001) and lower medical trust (Cohen's d = -.72, p < .001). Additionally, less positive health care experiences among Black participants (Cohen's d = -.33, p = .022) were associated with less medical trust and in turn lower vaccination intention. Tuskegee Study knowledge was not associated with vaccination intention or medical trust. Study 2 (N = 12,757) data revealed no statistically significant racial differences in COVID-19 vaccination receipt or intention. Black (relative to White) Americans reported feeling less cared for by their personal physician (Cohen's d = -.44, p < .001), which was associated with lower medical trust (Cohen's d = -.51, p < .001). Findings highlight factors that may contribute to Black Americans' vaccination hesitancy and medical trust. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Eunice Rivers, RN: The Myth of “The Only Woman” in the Tuskegee Study

The Tuskegee Study of Untreated Syphilis (TSUS) was a 40-year study based in Macon County, Alabama. Miss Eunice Rivers, RN, a public health nurse and scientific assistant, was a critical, long-term worker in the TSUS. After scandal closed the TSUS in 1972, Rivers was the target of adverse attention, often portrayed as the only woman involved in the study in both fictional depictions and other nonfiction sources. No other women were identified as culpable. A review of the TSUS publications revealed the contributions of other women in the TSUS. Publications and other historical sources identified these women, their active roles, and even accolades bestowed. This article reviews the myth of Eunice Rivers as the lone woman involved in this study. The discussion offers analysis of the women in these roles and their subsequent publications. Eunice Rivers co-authored two TSUS publications. Six white women co-authored 11 publications. In conclusion, pre-1972, the public health research experiences of Rivers and the white women appeared equitable in their public exposure. Post 1972 TSUS disclosure in the media, equity vanished, and Rivers was the sole target of adverse attention. All women who had roles in the TSUS matter. This article addresses an unmet need for equitable full disclosure and reckoning.

Ethical, Cultural, and Historical Leadership Implications of Conducting Public Health Research on Minority Populations

The study focuses on ethical and cultural research into the public health sector. The content analysis of research identifies disproportionate knowledge of implications affecting the misappropriated, disenfranchised, and institutionalized minority segments of the general population affected by COVID-19 cases. Historic mistreatment of minority individuals, inmates, and the military has left a lasting negative impression of clinical research on minority groups. In 1932, the United States Public Health Service (USPHS) began a public health research study on the lethality of syphilis using African American men from Macon County, Alabama as research subjects. Referred to as the Tuskegee Syphilis Studies (or Tuskegee Experiments), researchers monitored 600 subjects, 399 of which were previously infected with the syphilis bacteria. This article looks at the historical contexts of the lack of bioethics during Tuskegee Experiments and how it currently influences African-Americans reluctance early on to get the COVID-19 vaccines and reluctance to participate in clinical trials research.

HF01-09 REFURBISHING A RUSTY CYSTOSCOPE INTO THE RETROSPECTROSCOPE AWARD

You have accessJournal of UrologyCME1 Apr 2023HF01-09 REFURBISHING A RUSTY CYSTOSCOPE INTO THE RETROSPECTROSCOPE AWARD Thomas Osinski and Ronald Rabinowitz Thomas OsinskiThomas Osinski More articles by this author and Ronald RabinowitzRonald Rabinowitz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003243.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The AUA Earl Nation Retrospectroscope Award is presented annually to the winner of the previous year’s History of Urology Forum’s best presentation and paper, decided by the voting members of the AUA History Committee. The history of this prestigious award is not widely known. METHODS: We reviewed contemporaneous documents and the book “Urology. A View Through the Retrospectroscope” by John R. Herman, regarding the creation of the AUA Earl Nation Retrospectroscope Award to document the background and history of this award. RESULTS: At the 1965 AUA annual meeting, Frank Bicknell organized and moderated with Elmer Belt 5 presentations at the initial meeting of the History of Urology Club, which became the Forum on the History of Urology in 1975. At the 2005 meeting, Shamim Baker gave a stunning presentation on the Tuskegee experiment to the History Forum, which renewed the desire by the AUA History Committee to give a prize to the best history presentation at the annual History of Urology Forum. At this same time, many urologists were donating their old Brown-Buerger cystoscopes (often referred to as the original ‘workhorse’ of urology) to the Didusch Museum, as they transitioned to fiberoptics. In 2006, the AUA Board of Directors approved the presenting of a History award and ACMI, the company that produced the Brown-Buerger Cystoscope, agreed to be the sponsor. A proposed name ‘The Rusty Cystoscope Award’ was deemed ‘too tarnished’, and the name came from John Herman’s 1973 history book ‘A View Through the Retrospectroscope’. Gyrus-ACMI reprinted the book and presented the book with a boxed and refurbished Brown-Buerger cystoscope to Baker at the 2006 meeting, as the winner of ‘The Retrospectroscope Award’. In 2008 the award was renamed ‘The AUA Earl Nation Retrospectroscope Award’ to honor former AUA President Earl Nation (1910-2008), a founder of the American Osler Society (an organization dedicated to medical history), and the 2002 Ramon Guiteras winner for his contributions to the art and science of urology. In 2014 the AUA assumed funding for all awards. CONCLUSIONS: While the History of Urology Club has been around since 1965, an award for the best presentation has only been awarded since 2006. The AUA website lists prior award winners. The History of Urology Forum has significantly increased in popularity from the original 5 presentations in 1965 to 21 podium presentations and 14 posters in 2022. As competition for the ‘AUA Earl Nation Retrospectroscope Award’ has increased, contenders must submit a completed manuscript in addition to their presentation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e258 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Osinski More articles by this author Ronald Rabinowitz More articles by this author Expand All Advertisement PDF downloadLoading ...

Forced Organ Harvesting

Forced Organ Harvesting

Effective Recruitment Strategies Utilized to Examine Dietary Practices of Blacks in New York City in the Midst of the COVID-19 Pandemic

BackgroundBlack Americans have long been considered a hard-to-reach population for research studies, whether quantitative surveys or for clinical research. Studies have explored multiple rationales for why Blacks are hard to reach, and the explanations have included historical mistrust, the need to assess the benefits from participating in research, and the expense of spending time participating in research, among others. What has not been explored is the continuous merging of all individuals who identify as Black, particularly when exploring reasonings for a lower interest in participating in research. This paper addresses this issue by investigating the participation rate of individuals identifying as Black in New York City in a study exploring dietary practices as a predictor of colorectal cancer screening behavior. Participants were asked to self-report screening behavior, intent to screen, and dietary and other lifestyle practices. In this analysis, we discuss the unique experience encountered in recruiting Black American participants to participate in this study, particularly amid a worldwide pandemic of COVID-19.MethodsThe methodology for this study included a systematic review of the literature, a two-part recruitment process, and data analysis. The first part of the recruitment process involved registering individuals who were interested in participating in the study and consented to be contacted and reminded to come to the location where they were recruited on a scheduled date to complete the actual survey. With this part of the recruitment process, we engaged with n = 488 Black men and women between November 2019 and February 2020. The second part of the recruitment process utilized availability sampling outside of NYC subway stations and other high traffic areas as well as large community events. We engaged with n = 319 individuals. Total engagement with n = 807 individuals yielded a sample size for the survey of 504 completed surveys.ResultsOf the total engaged (n = 807), 14% declined to participate due to a lack of time, 11% chose not to participate in the study because the incentive was not enough to compensate for their time 0.02% declined due to not trusting institutions conducting research, and 0.03% did not feel comfortable understanding the questions due to a language barrier. We had a sample size of (n = 504) of the total 807 individuals engaged.ConclusionsRecruiting Black Americans into our colorectal cancer study did not prove to be challenging with the two-tiered model of recruitment that involved consistent engagement and having the primary researcher lead this recruitment process. Extracting within race differences is critical in demystifying the conclusion of numerous studies that African Americans specifically are hesitant to participate due to historical mistrust related to tragedies such as the Tuskegee Experiment and numerous other occurrences of African Americans being treated as guinea pigs for the advancement of research. This data contributes knowledge to this field regarding understanding recruitment challenges in the Black population, but further work needs to be conducted. Mistrust in this study primarily came from the individuals engaged in Caribbean neighborhoods, where many expressed more comfort with home remedies and bush doctors when asked about colorectal cancer screening and declined to participate. Innovative communication, qualitative research, and recruitment strategies tailored to the Caribbean population are needed in future studies to address this recruitment challenge that we experienced.