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Objectives. A community trial was undertaken to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program, a lay health advisor network intervention intended to increase screening among rural African American women 50 years and older. Methods. A stratified random sample of 801 African American women completed baseline (1993-1994) and follow-up (1996-1997) surveys. The primary outcome was self-reported mammography use in the previous 2 years. Results. The intervention was associated with an overall 6 percentage point increase (95% confidence interval [CI] =-1, 14) in communitywide mammography use. Low-income women in intervention counties showed an 11 percentage point increase (95% CI = 2, 21) in use above that exhibited by low-income women in comparison counties. Adjustment for potentially confounding characteristics did not change the results. Conclusions. A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income, rural populations.

Socioeconomic factors and cultural beliefs may cause some women to wait until their breast cancer is far advanced before seeking medical screening or treatment. Researchers questioned 540 women with newly diagnosed breast cancer, 94 of whom had advanced disease. African-American race, low income and lack of insurance or transportation were linked to more advanced breast cancer. Certain beliefs were also linked to advanced disease, such as the fear that women who have breast surgery are no longer attractive. Many of these factors explain why black women have higher mortality rates from breast cancer than white women.

Responses from personal interviews with a random sample of 2,178 adults aged 60 years and older living in their homes in eastern North Carolina were used to examine the effects of predisposing, enabling, and need indicators on differences in the use of health and community-based services separately for African American and White elders. Health services include primary care visits and visits to specialists. Community-based services were categorized into personal care services and financial assistance. Logistic regression analyses were done in an attempt to explain why African American elders are more likely than are Whites to use both kinds of community-based services, are less likely than are Whites to use specialty care, and whether there are differences by race in the use of primary care physicians. Results indicate that the odds of using financial assistance and medical care vary by race according to selected predisposing, enabling, and need characteristics. There is little difference by race, however, in the use of financial assistance services. The implications of the findings are discussed., Perhaps because of persistently higher mortality (Cooper et al. 1986; Dressler 1993; Freeman and Wasfie 1989; Otten et al. 1990) and morbidity rates (Dressler 1993; Wallace 1990) among African Americans [...]

This paper analyzes in-depth interviews with 26 black women who entered the medical system in rural North Carolina with advanced breast disease. In these narratives, women draw on multiple sources of knowledge in order to come to terms with the diagnosis of breast cancer - a biomedically-defined disease that they often refuse to acknowledge or accept. The analysis demonstrates how women relate the meaning of their individual episodes of illness to one or more of the following sources of knowledge: an indigenous model of health emphasizing balance in the blood, popular American notions about cancer, and particular biomedical conceptions about breast disease and its treatment. These narratives provide an important window into the processes involved when individuals attempt to adapt personal experience to pre-existing cultural models, modify such models in the light of new information, and confront conflicts in their own interpretations of the meaning of a single episode of illness.

Identified two subdimensions of an index designed to measure children's perceptions of older adults in responses from 120 Afro-Caribbean children living in a rural Costa Rican community. Findings showed older females were perceived as more authoritative and older males as more affective. Used ethnographic techniques with survey results to elaborate upon findings and discuss implications. (Author/ABL)

Purpose: This study assessed the extent to which community-dwelling rural older adults mismanage their prescription medication regimens and predicted mismanagement of medications from selected socioeconomic, health status, and medication profile characteristics. Design and Methods: Personal interviews with 499 community-dwelling adults aged 66 and over taking at least one prescription medication and living in a rural region of the Southeast. With approximately equal numbers of African American and white men and women, the SUDAAN multiple logistic regression procedure was used to predict the mismanagement of prescription medications. Results: The mismanagement of prescribed medication regimens is relatively common among older adults. Those more likely than others to mismanage their regimens are African American, younger, in poorer mental health, with more acute care physician visits, and those who find payment for their medications to be problematic. Implications: The implications of the findings for what is known about the self-modification of drug regimens, targeting prescription drug cost benefits or interventions, and the limitations of the study are discussed. Key Words: Aging, Prescription drug mismanagement, Noncompliance

The highly variable selves that ethnographers have documented cross-culturally all build upon the universal human self described by neurobiologists. The link between cultural selfhood and this neurally-based self is emotional arousal. Arousal heightens the effect of synaptic plasticity, insuring that clusters of strong associations, or cognitive schemas, result from many fewer repetitions of the arousing experience. There are identifiable types of such predictably arousing experiences cross-culturally, many occurring early in life. While susceptible to individual variation, these are typically based in kinds of experience widespread in groups. Culturally elaborated, these shared experiences result in distinctive cultural selves. The argument is illustrated at length with one of these types, disciplinary childrearing practices. Early attachment, cultural psychodynamic defenses, and several other shared, culturally variable experiences that are predictably emotionally arousing are also considered: unintended consequences of childrearing; separation from primary caretaker(s); trauma of all kinds; rituals such as initiation rites or religious conversion; and cultural idealizations of occasions, institutions, or roles. [ABSTRACT FROM AUTHOR]

Conclusions. Socioeconomic stares. age, and other characteristics--but not race/ethnicity--were related to reports of a physician recommendation, a precursor strongly associated with mammography use. Efforts to increase physician recommendation should include complementary efforts to help women address socioeconomic and other barriers to mammography use. (Am J Public Health. 2001 ;91:49-54) [ABSTRACT FROM AUTHOR]