Specific Aims: I wish to establish a research academic career in prevention and population-based cancer research, with special emphasis on palliative and end-of-life care for underserved populations. The overall goal of this K01 research career development award is to develop strong, rigorous skills in quantitative analytic methods. In Phase 1, I will pursue formal graduate level coursework in quantitative methods leading to an MPH or master's degree in Health Services Research. During Phase 2, I intend to conduct secondary analyses of large national datasets to determine the relationship between trust and breast cancer prevention practices and behaviors for diverse populations of black women with non-Hispanic and Hispanic ethnicity. I am specifically interested in how race, in relation to ethnicity and other sociodemographic factors, influences that relationship. Research Hypotheses: The research hypotheses presume that differences in ethnic and sociodemographic characteristics will modify the effect of trust in the continuum of breast cancer care in the following ways: (1) Cancer prevention behaviors (use of mammograms and/or clinical breast exams) and perceptions of various dimensions of trust (e.g. entrusting or fidelity; confidence in provider competence; and interpersonal trustworthiness) will differ among black women across levels of education, age, income and Hispanic ethnicity. (2) Correlation of trust in doctor-patient relationships and race/ethnicity will vary according to the specific dimensions of trust measured. Methods: I will conduct secondary analyses of datasets from the Community Tracking Study (CTS) Household Survey and the Behavioral Risk Factor Surveillance System (BRFSS) to identify relationships among independent variables (race, Hispanic vs. non-Hispanic ethnicity and sociodemographic factors) and dependent variables (women's cancer prevention practices and specific dimensions of trust in physicians). Bivariate analyses will examine the relationship between ethnicity and mammogram/clinical breast exam practices and between ethnicity and different dimensions of trust. Multivariate analysis will examine relationships among race/ethnicity and multiple outcome variables. These relationships will be controlled for potential confounding variables. Significance: As minority trust in physicians has been correlated with increased prevention health behaviors, it is important to identify specific physician and institutional behaviors or practices that may impede or foster trust among ethnically diverse populations of black women. By building on the strengths of national datasets, this study addresses several of the limitations of our current understanding of cancer prevention behaviors among black ethnic subgroups.
| Crawley, LaVera M; Ahn, David K; Winkleby, Marilyn A (2008) Perceived medical discrimination and cancer screening behaviors of racial and ethnic minority adults. Cancer Epidemiol Biomarkers Prev 17:1937-44 |
