Rationale: Minority patients with lung cancer are less likely to receive stage-appropriate treatment. Along with access to care and provider-related factors, cultural factors such as patients’ lung cancer beliefs, fatalism, and medical mistrust may help explain this disparity. Objectives: To determine cultural factors associated with disparities in lung cancer treatment. Methods: Patients with newly diagnosed lung cancer were recruited from four medical centers in New York City from 2008 to 2011. Using validated tools, we surveyed participants about their beliefs regarding lung cancer, fatalism, and medical mistrust. We compared rates of stage-appropriate treatment among blacks, Hispanics, and nonminority patients. Multiple regression analyses and structural equation modeling were used to assess whether cultural factors are associated with and/or mediate disparities in care. Measurements and Main Results: Of the 352 patients with lung cancer in the study, 21% were black and 20% were Hispanic. Blacks were less likely to receive stage-appropriate treatment (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.27–0.93) compared with whites, even after adjusting for age, sex, marital status, insurance, income, comorbidities, and performance status. No differences in treatment rates were observed among Hispanics (OR, 1.05; 95% CI, 0.53–2.07). Structural equation modeling showed that cultural factors (negative surgical beliefs, fatalism, and medical mistrust) partially mediated the relationship between black race and lower rates of stage-appropriate treatment (total effect: −0.43, indirect effect: −0.13; 30% of total effect explained by cultural factors). Conclusions: Negative surgical beliefs, fatalism, and mistrust are more prevalent among minorities and appear to explain almost one-third of the observed disparities in lung cancer treatment among black patients. Interventions targeting cultural factors may help reduce undertreatment of minorities.

Knowledge of pre-exposure prophylaxis (prep) continues to remain scarce among Black women who are disproportionally affected by hiv in the United States. A thematic analysis of open-ended questions from a sample of Black women (n=119) who completed a mix-methods, online, e-health study was conducted to examine the perceived advantages and disadvantages of using prep. Being a female controlled method, empowerment, option for women with risky sex partners, and serodiscordant couples were advantages described. Disadvantages of prep were identified as the complexity of the choice, encouragement of sex with risky partners, increased burden, promotion of unprotected sex, and newness of the drug.

Background. Due to their intersecting racial identity and gender identity, Black women are characterized by stigmatizing race-based sexual stereotypes (RBSS) that may contribute to persistent, disproportionately high rates of adverse sexual and reproductive health outcomes. RBSS are sociocognitive structures that shape Black women’s social behavior including their sexual scripts. Objective. The purpose of this study was to explore the influence of RBSS on the sexual decision making of young Black women (YBW). Methods. We conducted four focus groups with 26 YBW between the ages of 18 and 25, living in a New York City neighborhood with a high HIV prevalence. Qualitative analysis was used to identify emergent themes within the domains of sexual decision making as it relates to safer sex practices and partner selection. Results. Thematic analyses revealed that RBSS may cause women to adopt more traditional gender stereotypes and less likely to feel empowered in the sexual decision making. Participants reported that RBSS may lead Black women to being resistant to learning new information about safer sex practices, feeling less empowered within intimate relationships, and jeopardizing their sexual well-being to affirm themselves in other social areas encouraging unprotected sex and relationships with men who have multiple sex partners. Discussion and Conclusion. Future research should focus on understanding the social and cultural factors that influence Black women’s power in maintaining and improving their sexual health, including the aforementioned stereotypes that have influenced how others may view them as well as how they view themselves.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: EHealth technology has significantly impacted HIV prevention strategies, but reach and utilization among African American women has been scarce. Objective: To explore the feasibility, acceptability, and preference of an avatar, eHealth video to increase awareness and knowledge of HIV post and pre-exposure prophylaxis (PEP and PrEP) among a sample of African American women. Methods: A cross-sectional, descriptive, online study was conducted with 116 African American women ages 18 to 61. We explored: 1) consumer-awareness, 2) intention to use, and 3) preference for post and pre-exposure prophylaxis after watching the eHealth video. Results: Eighty-nine percent rated the video as good or higher. A higher rating of the educational video was significantly predicted by: no current use of drugs/alcohol (β = -.814, p = .004); not having unprotected sex in the last 3 months (β =-.488, p = .025); higher income (β =.149, p = .026); lower level of education (β =-.267, p = .005); and, a lower exposure to sexual assault since age 18 (β =-.313, p = .004). After watching the eHealth video, interest in both, PEP and PrEP was high, with intentions to use PEP and PrEP being 96.7% and 75.6% respectively. Ninety-three percent reported recommending PEP and 90.1% PrEP to other women. Conclusions: Utilization of an avatar-led, eHealth, online video fostered education about PEP and PrEP. We can leverage this approach to increase awareness and usage among African American women.