Search

The recent global focus on the promotion of faith-based health and social interventions requires two major empirical data sets: (a), an understanding of how the health needs of churches relate to the assets they hold and (b) the collective capacity of members to use needed resources to help address a wide range of health issues including HIV/AIDS that continue to challenge many African countries' already limited health-related resources. In this study, we hypothesized that if Nigerian churches have less stated perceived needs in relation to more perceived assets that could be used for HIV/AIDS prevention and control, they would have greater collective efficacy and engage in more HIV/AIDS prevention and control activities. Estimates of churches' perceived needs, assets, collective efficacy, and activities as reported by church members from 81 Nigerian churches were aggregated. The linear regression method was used to test if needs and assets predicted collective efficacy and HIV/AIDS activities. The sum of...

Background: Figs are a rich source of soluble fiber. We evaluated the effect of consuming dried California Mission figs on serum lipids in hyperlipidemic adults. Methods: In a crossover trial men and women aged 30–75 years with elevated low-density lipoprotein cholesterol (100–189 mg/dl) were randomized to add dried California Mission figs (120 g/day) to their usual diet for 5 weeks or eat their usual diet for 5 weeks, then crossed over to the other condition for another 5 weeks. Six 24-hour dietary recalls were obtained. Results: Low- and high-density lipoprotein cholesterol and triglyceride concentrations did not differ between usual and figs-added diets (Bonferroni-corrected p > 0.017), while total cholesterol tended to increase with fig consumption (p = 0.02). Total cholesterol increased in participants (n = 41) randomized to usual followed by figs-added diet (p = 0.01), but remained unchanged in subjects (n = 42) who started with figs-added followed by usual diet (p = 0.4). During the figs-added diet, soluble fiber intake was 12.6 ± 3.7 versus 8.2 ± 4.1 g/day in the usual diet (p < 0.0001). Sugar intake increased from 23.4 ± 6.5 to 32.2 ± 6.3% of kcal in the figs-added diet (p < 0.0001). Body weight did not change (p = 0.08). Conclusions: Daily consumption of figs did not reduce low-density lipoprotein cholesterol. Triglyceride concentrations were not significantly changed despite an increase in sugar intake.

Introduction/Purpose: Black women now have higher breast cancer (BC) incidence and mortality than White women. They also use more hair products containing hormonally-active chemicals. Studies are beginning to link chemical ingredients in these products to BC risk. Little is known about community knowledge of BC and the potential association with hair product-related risk. The purpose of this study was to evaluate the hazard level of hair products used by Black women, and assess their knowledge about BC and hair product-related risks. Methodology: We employed principles of community-based participatory research and conducted the study through partnership between community advocates and university scientists. We collected hair products from locations frequented by Black women and hair stylists and used the Environmental Working Group's Skindeep© database to evaluate ingredient toxicity. We then explored knowledge of BC and hair product-related risk using a 41-item survey. Survey data were analyzed using SPSS. Results: All 54 products evaluated contained hazardous ingredients. Fourteen of the ingredients had an overall high hazard rating between 7-10, with 10 indicating very high levels of toxicity. The potential harmful effects of these chemicals include cancer, endocrine disruption and reproductive system toxicant. Survey data showed most women (62%) in the sample had a college or graduate degree. Participants (n=211) were more knowledgeable about the diagnosis and treatment of BC (46.3%), lifestyle-related risk factors (59.6%), and genetic risk factors (54.9%) than about hair product risk (40.8%). Conclusion: Several hair products frequently used by black women contained ingredients that have potential links to BC. Though the women in this study were highly educated, they had limited knowledge about the association between BC and toxins found in hair products. Research should further clarify the link between hair products and BC risk. As knowledge is evolving, given our emerging risk understanding, health educators and community advocates can promote efforts for women to learn more about exposure reduction to help them make informed decisions about the risk beauty product chemicals may hold regarding cancer. There is also a need for policies on personal care products that aim to protect the health of our communities. Citation Format: Dede Teteh, Phyllis Clark, Lenna Dawkins-Moultin, Rick Kittles, Susanne Montgomery. My crown or my health: Black women's knowledge of breast cancer and hair product-related risk [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5290.

To validate a 204-item quantitative FFQ for measurement of nutrient intake in the Adventist Health Study-2 (AHS-2).Calibration study participants were randomly selected from the AHS-2 cohort by church, and then subject-within-church. Each participant provided two sets of three weighted 24 h dietary recalls and a 204-item FFQ. Race-specific correlation coefficients (r), corrected for attenuation from within-person variation in the recalls, were calculated for selected energy-adjusted macro- and micronutrients.Adult members of the AHS-2 cohort geographically spread throughout the USA and Canada.Calibration study participants included 461 blacks of American and Caribbean origin and 550 whites.Calibration study subjects represented the total cohort very well with respect to demographic variables. Approximately 33 % were males. Whites were older, had higher education and lower BMI compared with blacks. Across fifty-one variables, average deattenuated energy-adjusted validity correlations were 0.60 in whites and 0.52 in blacks. Individual components of protein had validity ranging from 0.40 to 0.68 in blacks and from 0.63 to 0.85 in whites; for total fat and fatty acids, validity ranged from 0.43 to 0.75 in blacks and from 0.46 to 0.77 in whites. Of the eighteen micronutrients assessed, sixteen in blacks and sixteen in whites had deattenuated energy-adjusted correlationsor=0.4, averaging 0.60 and 0.53 in whites and blacks, respectively.With few exceptions validity coefficients were moderate to high for macronutrients, fatty acids, vitamins, minerals and fibre. We expect to successfully use these data for measurement error correction in analyses of diet and disease risk.

Objective Examine acculturation and gender on intention to eat a healthful diet among Latino adolescents using the Theory of Planned Behavior. Design Secondary analysis of data set and condensed version of the Short Acculturation Scale for Hispanics (SASH). Setting Data collected from 34 randomly selected high schools in San Bernardino, CA. Participants 265 Latino high school adolescents. Main Outcome Measures Effects of acculturation and gender on variables of the Theory of Planned Behavior on intention to eat a healthful diet. Analysis Multiple regression analysis examined acculturation/gender differences, and modifications on the prediction of intention. General linear modeling determined differences across gender and acculturation groups. Results Females had stronger intention, more positive attitude, and greater subjective normative influence. Females indicated feeling healthy and looking good and males indicated good athletic performance as contributors to eating healthfully. Mother was influential for both genders, and stronger for females. Siblings were influential for less acculturated males, and friends were influential for highly acculturated females. Less acculturated adolescents had stronger intention to eat healthfully, more tolerance to give up liked food items, and more support and encouragement. Conclusions and Implications Professionals need to take into account gender and acculturation differences when making dietary recommendations for Latino adolescents.

The purpose of this study was to identify what factors impact low-income women's infant feeding decisions. A cross-sectional convenience sample of 109 black pregnant women, ages 18 to 45, regularly attending Women, Infant, and Children (WIC) clinics and associated programs in the Inland Empire Region of California were recruited to complete a structured questionnaire about their breastfeeding beliefs and intentions. Multivariable logistic regression was used to explore participant's intentions to breastfeed. After adjusting for confounding factors, results indicate that women who attended support groups were more than twice as likely to intend to breastfeed compared with women who did not. These results highlight the importance of social influences on the decision to breastfeed, and indicate the need for broadened community-based education for the promotion of breastfeeding. J Hum Lact. 25(2):157-162.

To explore factors related to youths’ delay in seeking care after an HIV diagnosis. Multivariate analyses were performed on 347 participants who were selected from a sample of 351 adolescents participating in a 1994-1996 survey among youth in four U.S. metropolitan cities. Key findings were that participants with prosocial peer behaviors took longer (34 days) to seek care than youth with poorer social engagement and excessive fibbing delayed seeking care (23 days). Potentially important findings suggest being female, older, having close peer networks, conduct problems, and certain housing settings may delay seeking care. Multivariate regression analyses indicate that later entry into medical care was observed among those with close social networks and behavioral characteristics related to delinquency.

The incidence rate of breast cancer for African American women has recently converged with that of non‐Hispanic White women in the United States, although African Americans have a higher mortality rate due to this disease. Although most research exploring health disparities associated with this phenomenon has focused on differences between women based on biology and behavior, both the academic and lay communities have begun to explore the potential role of environmental exposure to estrogen and endocrine disrupting chemicals (EDCs). This study reviews the current state of the science associating one such means of exposure, hair products containing EDCs, with breast cancer risk in African American women. We found a growing body of evidence linking: (1) environmental estrogen and EDC exposures to breast cancer risk, (2) the presence of such chemicals in personal care products, including hair products, and (3) the use of certain hair products with potential breast cancer risk in African Americans. At the same time, there is also increasing concern in the lay community about this risk. These results indicate the need for additional research, and the opportunity to benefit from strategic partnerships in community‐collaborative approaches in order to better understand the potential “cost of beauty.”

Objective: To explore how older adults from three prominent ethnoracial groups experience cognitive decline and aging. Method: Semistructured key informant interviews (KIIs) and focus groups (FGs) were conducted with caregivers, experts, and older adults. Results: ( N = 75). Fifteen KIIs regarding cognitive aging issues were conducted among health care professionals and community-based agencies serving older adults. Eight FGs included family caregivers and physicians, and six FGs with Latino, African American, and White older adult community members. Major themes included (a) personal expectations about aging, (b) societal value of older adults, (c) model of care preferred, and (d) community concerns. An overarching theme was a sense of loss associated with aging; however, how this loss was experienced and dealt with varied. Discussion: Distinct patterns of concerns and views are important to understand for the development of programs aimed at meeting the needs of diverse older adult community members to improve health outcomes.

The current review examines conceptual and methodological issues related to the use of dialectical behavior therapy for adolescents (DBT-A) in treating youth who engage in deliberate self-harm. A comprehensive review of the literature identified six studies appropriate for the review. Results indicated several inconsistencies and limitations across studies including the mixing of various forms of self-harm; variations in diagnostic inclusion/exclusion criteria, insufficient use of standardized self-harm outcome measures, variable lengths and intensity of provided treatment, and inadequate attention paid to DBT adherence. Each of these areas is reviewed along with a discussion of ways to improve the quality of future research.

Background:Since 2003, WHO has recommended exclusive breastfeeding (EBF) for the first 6 months of life. In the NW Region of Cameroon only 34% of women EBF for six months. Previous research indicates that family members positively influence women's breastfeeding practices, but are often excluded from breastfeeding promotion campaigns. Study Objective: To design an Entertainment Education (EE) audio program to test the hypothesis that EE improves EBF knowledge, benefits, and decreases misconceptions and barriers among family members of breastfeeding women. Methods: Formative research consisting of 12 semi-structured interviews and 6 focus group discussions informed the content of an EE audio program using grounded theory. Differences in EBF knowledge, benefits, barriers and misconceptions between and within the control group and the intervention group were evaluated using pre-and post-tests and analyzed with Wilcoxon Sign Test and Mann-Whitney statistical tests. Results: The audio program significantly imp...

The intentions of 614 adolescents to have sex were examined in conjunction with their participation in risky behaviors (hard drugs, violence and suicide, alcohol and marijuana use) and protective factors (community connected and against teen sex, educational aspirations, emotional support from family, friends and girlfriend/boyfriend or sexual partner). Key findings from bivariate and linear regression analyses revealed that alcohol and marijuana use were correlated with intention to have sex among adolescents, as was emotional support from a boyfriend/girlfriend or sexual partner. This study offers insights regarding intentions to have sex among adolescents, pointing particularly to the issue of emotional support in a dating relationship as a motivation for having sex. Findings from this study can be used to develop health education and promotion programs focusing on delaying sexual intercourse.

Injection drug use is a risk factor for HIV among adolescents and young adults, yet the interpersonal dynamics of needle-sharing among young injectors remain poorly understood. Research has focused on identifying the characteristics of individual IV drug users (IVDUs) that increase their risk of needle-sharing. Most studies have not taken into consideration IVDUs' decisions to share needles with certain partners but not with other partners. This study examined partner characteristics associated with needle-sharing among 96 male and 77 female young adult IV drug users who had shared needles previously. Men were most likely to share needles with partners who gave them emotional support, partners who they injected or who injected them, and partners with whom they had had sex. Women were most likely to share needles with partners who they injected or who injected them, partners with whom they had discussed HIV risk, and partners with whom they had had sex. Results indicate that needle-sharing occurs within the context of mutual injection rituals and close emotional and sexual relationships. Public health interventions are needed to help young IVDUs to avoid needle-sharing with intimate partners.

Background The worldwide incidence of prostate cancer is higher among American black men than any other male group. In the United States, lack of participation in screening for prostate cancer by black men is influenced by several cultural factors, including knowledge, health beliefs, barriers, and relationships with primary healthcare providers. Methods We used the qualitative and paralleling descriptive quantitative findings of a mixed-method longitudinal study exploring prostate cancer screening behaviors among 277 black men. Results Five themes were identified as critical elements affecting men's screening for prostate cancer: lack of knowledge, communication, social support, quality of care, and sexuality. These themes were associated with a sense of disconnectedness by black men from the healthcare system and contributed to nonparticipation in prostate cancer early detection activities. Conclusions Lack of discussion about the decision to screen for prostate cancer and general lack of culturally appropriate communication with healthcare providers has engendered distrust, created fear, fostered disconnect, and increased the likelihood of nonparticipation in prostate cancer screening among black men.

We explored the concept of using a Mindfulness-based intervention to reduce perinatal grief among Indian women. Data were collected using mixed methods to explore concept acceptability, receptivity, modality, and feasibility of the intervention. The intervention was piloted and evaluated with measures of perinatal grief, psychosocial wellbeing, religious coping, perceived social provision of support, and mindfulness. The intervention was well received and effective in teaching skills to help women deal with high levels of grief and subsequent mental health challenges. To overcome attendance barriers modification is necessary. Partnership with a local nursing school is critical to enhance sustainability of the intervention.

Relatively little empirical attention has been paid to understanding how refugees conceptualize depression and how this concept varies between genders. The purpose of this study was to explore beliefs about depression among Afghans residing in San Diego County, California, using cultural consensus analysis. Using the prescribed mixed-method approach, we employed results from in-depth interviews to develop a culturally meaningful questionnaire about depression. Consensus analysis of responses to questionnaire items from 93 Afghans (50 men, 43 women) indicates shared beliefs that associates depression causality with mild traumatic experiences and post-resettlement stressors, symptomatology to include culturally salient idioms of distress, and treatment selections ranging from lay techniques to professional care. Divergence between genders occurred most in the symptoms subdomain, with women associating depression with more somatic items. This study contributes to understanding the etiology of and cultural responses to depression among this population, which is critical to improving culturally sensitive intervention for Afghan refugees.

Assets church members believed they needed to engage in effective HIV/AIDS prevention and control activities. We used the three-step forum focus group discussion (FFGD) methodology to elicit responses from 32 church leaders and lay members, representing five denominations in Aba, Nigeria. Concrete resources, health expertise, finances, institutional support, capacity building, and spiritual support connected to the collective interest of members were indicated as useful for church members to engage in HIV/AIDS prevention and control activities. Adequate planning and delivery of cost-effective, appropriate and sustainable health promotion programs require an understanding of perceived church-based assets. Key Words: Community-Based Programs, Closing Forum, Health Education, Health Promotion, HIV/AIDS, Prevention, Focus Groups, Forum Focus Group Discussion, Open Forum, Nigeria, Qualitative Methods. More than 70% of people living with HIV/AIDS reside in Africa (Ahn, Grimwood, Schwarzwald, & Herman, 2003), and given limited resources for sustainable interventions many experts look for alternative self sustainable local efforts that can be managed so that affected individuals continue to have some resources as HIV/AIDS funding from foreign sources (i.e., UNAIDS, Global Fund) decreases. It has been argued that linking to the faith community is one such natural option but few neither understand how this can best be done nor is it clearly understood what the major barriers to the operation of such church based programs are and how to spark off such a movement. Anticipated complicating factors for the systematic use of faith based entities to provide HIV/AIDS services and programs are a lack of understanding of experiences churches have to operate such efforts, a lack of current collaboration between churches given denominational differences, and a general lack of readiness to “step up” in this way as many might feel that they have no assets to offer. In general terms, Christian churches have unique characteristics that hold access to “land, people, and history” (Simpson & King, 1999, p. 43), connections (Burkhardt, 1994), relationships (Dyson, Cobb, Forman, 1997), including social, spiritual and political awareness (Stillman, Bone, Rand, Levine, & Becker, 1993), and other resources that might be important to better serving the many needs of those affected by HIV/AIDS.

This historical cohort study investigated whether dimensions of the expanded Health Belief Model (HBM), the theoretical framework most applicable to the Women's Center Jamaica Foundation (WCJF) Program for Adolescent Mothers, can be applied to predict the occurrence of repeat pregnancies among teen mothers. A random sample ( n = 260) of primiparous Jamaican adolescent mothers 16 years and under who gave birth in 1994 in the parishes of Kingston & St. Andrew, St. Catherine, and Manchester was selected from vital records and interviewed in 1998 for this study. Multivariate analyses indicated that in addition to WCJF program participation, perceived severity, perceived susceptibility, and perceived benefits were significant ( p < .05) independent predictors of repeat pregnancy. We recommend the HBM as a useful tool to identify participants who are more likely to experience one or more repeat pregnancies.

Using epidemiological and social network research methods, this study examines gender differences in HIV risk and protective behaviors and social network characteristics among 193 young injection drug users (IDUs) and 127 referred members of their social networks. Respondents reported on their drug use, sexual behavior, and relationships within three types of social networks: hang out (i.e., friendship); drug use; and sexual networks. Most respondents were homeless and had experienced numerous life stressors. Females' social networks consisted more predominantly of drug injectors, and members more frequently appeared multiple networks. Females reported needle sharing more frequently than males, but also reported more protective behaviors such as needle exchange use and carrying clean syringes. Young female IDUs may compound their risk by having sex and injecting with higher risk partners. However, their propensity to practice protective behaviors may provide an opening for interventions to reduce their HIV risk and that of their social network members.

Prostate cancer (PCa) is the most commonly diagnosed cancer and second leading cause of cancer-related deaths in American men. African American (AA) men are more likely to be diagnosed with aggressive PCa at a younger age and twice as likely to die from the disease as European American (EA) men. In order to reduce PCa mortality and its associated racial disparities, there is a critical need to identify and target pathways responsible for PCa aggressiveness. An unexplored target is the plasminogen system, which is key to cancer cell migration and tissue invasion during metastasis. During inflammation, activation of the plasminogen pathway degrades extracellular fibrin networks; however, in the context of cancer, this activation promotes cancer tissue invasion and metastasis. Mounting evidence shows that the glycolytic enzyme alpha-enolase (ENO1) plays a vital role in both increased energy metabolism and plasminogen activation during cancer progression and metastasis. Using immunoseroproteomic profiling of anti-tumor autoantibody responses in AA and EA men with PCa, we identified several tumor-associated autoantigens with functions in glycolysis and plasminogen signaling, including ENO1, annexin A2, fructose bisphosphate aldolase, glucose-regulated protein 78, glyceraldehyde-3-phosphate dehydrogenase and phosphoglycerate kinase. In a cohort of PCa (N=157) and non-PCa sera (N=183), we found a significantly higher frequency of autoantibodies to ENO1 in patients with PCa (p Citation Format: Tino Wilson Sanchez, Guangyu Zhang, Jitian Li, Liping Dai, Saied Mirshahidi, Nathan R. Wall, Clayton Yates, Colwick Wilson, Susanne Montgomery, Jian-Ying Zhang, Carlos A. Casiano. Targeting the tumor-associated autoantigen alpha-enolase in prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1130. doi:10.1158/1538-7445.AM2017-1130

Prostate cancer (PCa) presents the greatest US cancer health disparity in terms of incidence and mortality, disproportionately affecting African American (AA) men. The biological characteristics of prostate tumors are exaggerated in AA men compared to European American (EA) men at time of diagnosis. The mechanisms underlying increased PCa aggressiveness in AA men are not fully understood; therefore, there is a critical need to identify biological determinants contributing to PCa mortality disparities. Glucocorticoids—a type of stress hormone—have been implicated as driving factors in PCa progression. The underlying mechanism involves endogenous glucocorticoid (cortisol) binding to its glucocorticoid receptor (GR) and activating genes that promote tumor aggressiveness and therapy resistance. A clinical dilemma exists as glucocorticoids, important in the palliative care of PCa patients, are now emerging as accelerators of disease progression and shortened survival. Chronically elevated levels of cortisol have been documented in AA men compared to EA men. This unhealthy cortisol production has been linked to stressful life events, which occur more frequently in the AA population. In addition, AA men are more sensitive to glucocorticoid exposure than EA men. These observations support the hypothesis that chronic stress leading to elevated cortisol in AA men may contribute to PCa health disparities. This study focused on examining the effects of glucocorticoid agonists and antagonists on the expression of stress oncoproteins, particularly LEDGF/p75 (Lens epithelial-derived growth factor of 75 kd) and CLU (clusterin), which are upregulated in PCa tumors and promote features of tumor aggressiveness, including resistance to clinically relevant taxanes used for advanced PCa treatment. We exposed a racially diverse panel of PCa cell lines, MDA-PCa-2b, 22Rv1, PC3, and DU145, to glucocorticoids (cortisol and dexamethasone), and observed by immunoblotting a time and dose-dependent upregulation of GR, LEDGF/p75 and CLU, particularly and more robustly in AA cells. Treatment of cells with mifepristone, a GR antagonist, attenuated this glucocorticoid-induced upregulation. In addition, siRNA- and shRNA-knockdown of LEDGF/p75 in PC3 cells resulted in decreased GR expression, suggesting a functional interplay between these two proteins in PCa cells. Interestingly, we also observed, using ELISA, increased circulation levels of LEDGF/p75 in AA PCa patients compared to EA patients and non-PCa controls, suggesting that this stress oncoprotein might play a more prominent role in AA PCa patients. These findings imply that activation of GR-signaling by glucocorticoids contributes to the activation of stress survival pathways associated with PCa aggressiveness and chemoresistance. These results add to the emerging contribution of GR signaling in PCa, particularly in the context of PCa health disparities. Citation Format: Leanne Woods-Burnham, Arthur Love, Christina K. Cajigas-Du Ross, Laura Stiel, Evelyn S. Sanchez, Kwame Amponsah, Susanne Montgomery, Colwick Wilson, Carlos A. Casiano. Glucocorticoid-mediated upregulation of stress oncoproteins: implications for prostate cancer health disparities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5285. doi:10.1158/1538-7445.AM2017-5285

Background: Since 2003, the World Health Organization has recommended exclusive breastfeeding (EBF) for the first 6 months of life. In the Northwest Region of Cameroon approximately 90% of women in...

Despite introduction of numerous smoking prevention programs in schools, tobacco use has not declined among adolescents. Schools face the dilemma of what to do with students who smoke and are not ready to quit. This study evaluated two programs based on the stages of change model. The educational program, the Tobacco Education Group (TEG), was designed for adolescents not yet thinking about quitting. The cessation program, the Tobacco Awareness Program (TAP), was intended for adolescents who want to quit. Evaluation was completed on 351 students at six public high schools. Compared to a control group of adolescent smokers not assigned to programs, both intervention groups significantly decreased tobacco use. Self-reported use was validated biochemically. Self-efficacy for quitting increased in both programs. Posttest use was predicted by posttest self-efficacy, peer support, and parental support, after controlling for initial use and initial self-efficacy.

This study provides a cross-sectional analysis of the relations between group self-identification and adolescent drug use in 3 samples of youth: comprehensive high-school, continuation high-school, and runaway/street youth. Youth identified with discrete groups in all 3 samples, and similar general groups were formed. In most comparisons, a high-risk group showed greater levels of drug use than did other groups. This is the first study to demonstrate that group self-identification (a) is a generalizable construct across different types of adolescent samples, (b) is related to use of drugs other than tobacco, and (c) remains a significant correlate of drug use controlling for its relations with demographic variables and several other psychosocial variables.

Purpose: To describe the service utilization patterns of homeless and runaway youth in a "service-rich" area (Los Angeles, California); identify demographic and other correlates of utilization; and contextualize the findings with qualitative data. Method: During Phase 1 of this study, survey data were collected from an ethnically diverse sample of 296 youth aged 13–23 years, recruited from both service and natural "hang-out" sites using systematic sampling methods. During Phase 2, qualitative data were collected from 46 youth of varying ethnicities and lengths of time homeless. Results: Drop-in centers and shelters were the most commonly used services (reported by 78% and 40%, respectively). Other services were used less frequently [e.g., medical services (28%) and substance abuse treatment (10%) and mental health services (9%)]. Utilization rates differed by ethnicity, length of time in Los Angeles, and city of first homeless episode (Los Angeles vs. all others). Shelter use was strongly associated with use of all other services. Despite youths' generally positive reactions to services, barriers were described including restrictive rules, confidentiality and reporting problems, and negative interactions with staff members. Youth suggested improvements including more targeted services, more long-term services, revised age restrictions, and more and/or better job training and transitional services to get them off the streets. Conclusions: Because shelters and drop-in centers act as gateways to other services and offer intervention potential for these hard-to-reach youth, it is vital that barriers to use of these services are eliminated.

Despite the increasing knowledge about homeless and street youth in the United States, little is known about the youngest segments of those populations, early adolescents (12 through 15 years of age). Investigated in this study were the demographic and lifestyle characteristics of 245 street youth in California. Measures included demographic characteristics (e.g., gender, ethnicity, sexual orientation), peer group identification, history of homelessness, sources of shelter and money, and perceived health status. Results revealed high rates of problem behaviors and health risks: 34% reported affiliation with gangs, and 40% reported involvement in illegal activities such as prostitution, drug dealing, mugging, or stealing. Early adolescent street youth differed from older street youth on several demographic and lifestyle measures. These data indicated that early adolescents are especially at risk for negative psychological and physical consequences of life on the streets. Further research is needed to understand the unique needs of this understudied population.

OBJECTIVES: This study investigated the secondary prevention effects of a substance abuse primary prevention program. METHODS: Logistic regression analyses were conducted on 4 waves of follow-up data from sixth- and seventh-grade baseline users of cigarettes, alcohol, and marijuana taking part in a school-based program in Indianapolis. RESULTS: The program demonstrated significant reductions in cigarette use at the initial follow-up (6 months) and alcohol use at the first 2 follow-ups (up to 1.5 years). Models considering repeated measures also showed effects on all 3 substances. CONCLUSIONS: Primary prevention programs are able to reach and influence high-risk adolescents in a nonstigmatizing manner.

Evaluated in this study was the extent to which stress, coping strategies, and social support were associated with depressive symptoms, poor physical health, and substance use in homeless youth. Data were obtained from a stratified random sample of 432 homeless youth recruited.from service sites and street sites in Los Angeles, California. Stres,sful life events were associated positively with symptoms of depression, poor physical health, and substance use. Use of emotion-focused coping strategies increased the risk of symptoms of depression, poor health, and substance-use disorders, whereas use of problem-focused coping strategies decreased the risk of alcohol use disorder and poorhealth. Social support decreased the risk of symptoms of depression and poor health but was not related to the risk of substance use. Results indicate that effective coping skills and social support may counteract the negative efficts of stressful life events on physical and psychological health in homeless youth.

Purpose: The purpose of this research were to explore homeless youths' histories of exposure to violence, perpetration of violence, and fear of violent victimization, and to examine the extent to which these constructs are associated with demographic variables. Methods: A sample of 432 youth (between 13 and 23 years old) who were homeless or at imminent risk for homelessness were sampled from both service and street sites. The percentage of youth who reported exposure to each type of violence was calculated. Multiple regression analyses were used to examine differences in the risk of exposure to violence across gender, ethnicity, age, and length of time homeless. Results: Respondents reported a high rate of exposure to violence. Female respondents reported levels of exposure to violence that were as high as those reported by males. Females were more likely to report having been sexually assaulted and fearing victimization, and tended to be less likely to report perpetrating violence. With a few exceptions, ethnic identity was not a significant predictor of exposure to violence or fear of victimization. Age tended to be inversely associated with risk of exposure to violence. Length of time homeless was not associated with fear of victimization. Conclusions: Homeless youth are at high risk for exposure to a variety of forms violence as both witnesses and victims. The overall rates of exposure to violence and patterns of association with demographic variables are significantly higher than those reported in national samples of adolescents.

This study used systematic sampling methods to recruit a sample of 432 homeless youth from both service and natural "hang-out" sampling sites. According to DSM-III criteria, the majority of respondents were classified as having an alcohol and/or illicit "drug abuse" disorder (71%). The results from multivariate logistic regression analyses indicate that cumulative length of time homeless is positively associated with risk for an "abuse" disorder. The implications of these findings and recommendations for service interventions are discussed.

Research was conducted to identify subcultural peer groups within a homeless youth population and determine whether these groups differ with respect to drug use patterns and HIV risk. Using systematic sampling methods, 309 homeless youth (ages 13–23 years) were recruited from street and service sites. Drug use patterns and HIV risk profiles were found to vary according to group affiliation. Respondents in the punks and gay/bisexual groups were more likely to have a substance abuse disorder. Respondents in the “punker” group also were at increased risk for having unprotected sex and sharing needles. Respondents in the “gay/bisexual” and “hustler” groups were at increased risk for having survival sex. Yet, unlike the “gay/bisexual group,” the “hustler” group was more likely to report being tested for HIV. These findings suggest that outreach and intervention strategies may need to be tailored to the specific norms, values, and behavioral risk profiles of each peer group.

Studies have shown a high prevalence (40–83%) of complementary and alternative medicine (CAM) use among cancer patients in the U.S.A cross-sectional, mixed-methods pilot study was completed. This paper focuses on the quantitative analysis conducted on demographic predictors of complementary medicine (CM) use, reasons to use CM, and disclosure to healthcare provider data. Surveys were interview-administered at the Loma Linda University Medical Center Cancer Center. Participants, 18 years or older, were selected from a convenient sample. Eighty-seven percent (87.9%) of participants reported to have used CM as a cancer treatment and most reported to have used it “to help fight the cancer.” Women were eight-times more likely to use prayer. All non-Caucasian and Hispanic participants reported to use CM as a cancer therapy and none reported to use a CM provider. More women (72%) disclosed their CM use than men (53.3%). Different prevalences and predictors exist when differentiating CM modalities, reasons to use CM vary by gender, and disclosure proportions vary by gender.

This cross-sectional study investigated whether the theory of planned behavior (TPB) constructs: attitudes, subjective norms, and perceived behavioral control were related to intention of dietary supplements use among African-American women living with Human Immunodeficiency Virus and/or Acquired Immune Deficiency Syndrome (HIV/AIDS).A closed-ended questionnaire based on the TPB was utilized to explore the use of dietary supplements among a cohort of 153 HIV-positive African-American women.Overall, 45% of the respondents used dietary supplements to manage/control their HIV. Combined, attitudes, subjective norms and perceived behavioral control were significant predictors of intention toward dietary supplement use (69% of the variance explained, p0.0001). Attitudes (β=0.23, p0.001) and perceived behavioral control (β=0.45, p0.0001) were found to be significant independent predictors of intention. Behavioral intention and proximal TPB constructs (attitudes, subjective norms, and perceived behavioral control), as well as their underlying beliefs about dietary supplements use, were all found to be significantly more positive in users of dietary supplements compared to non-users (p0.001).Results showed that attitudes, subjective norms and perceived behavioral control are important predictors in the intention to use dietary supplements for control of HIV among African-American women. Implications from this study suggest that the TPB can be used to better identify and understand salient beliefs that surround intentions to use alternative therapies for management of disease. These beliefs can be used to develop interventions surrounding HIV treatment and care.

This study uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to provide estimates of sexual risk behaviors for 877 youth, age 11-14 at baseline, in the child welfare system. It examines the association between baseline psychosocial risk and protective factors on engagement in sexual risk behaviors after 36 months. It further compares rates of sexual risk behaviors between youth placed in out-of-home care and those who remained with their biological family. Key findings include a high rate of pregnancy, a high percentage of youth who initiated sexual activity at or before age 13 as well as a limited role of protective factors in moderating sexual risk behaviors. A history of placement into out-of-home care is not significantly associated with greater engagement in sexual risk behaviors. Implications for intervention development and child welfare policy for this population are discussed.

Despite promising evidence of the effectiveness of psychosocial-based approaches to drug abuse prevention, these programs have not been widely adopted by schools. This article considers the feasibility of widespread diffusion of empirically based prevention programs in school settings. The literature on determinants of diffusion is reviewed, results of recent research on strategies to increase diffusion are discussed, and barriers to successful diffusion in school settings are identified. The article concludes by presenting implications of these research findings for policy, practice, and future research.

During the past decade, coalitions have been assumed to be central to the structure and functioning of community health promotion and disease prevention projects. However, there has been little empirical evaluation of community coalitions. The present paper presents case studies of two different coalition models, one a coalition developed to support a community-based drug abuse prevention trial, and the other, a CSAP Community Partnership Demonstration Program site. Comparison of the two coalitions on key characteristics indicated that they were similar except for their impetus for initiation (researcher versus community-initiated) and primary purpose (to support experimental program components versus to coordinate prevention programming and develop new prevention services). Members of the two coalitions (n = 51 in the researcher-initiated, and n = 49 in the community-initiated coalition) responded to a written survey that assessed immediate coalition process and activity outcomes, including perceptions of coalition efficiency, outcome efficacy, interagency coordination, and benefits of involvement. After controlling for demographic differences, the two groups of coalition members were similar, overall, on the measures of immediate outcomes. Univariate analyses indicated only one difference: members of the researcher-initiated coalition had higher ratings of perceived action committee effectiveness than did members of the community-initiated coalition. The results suggest that the impetus for initiation and primary purpose of a coalition may not be as important as other factors in influencing immediate process and activity outcomes. © 1996 John Wiley & Sons, Inc.

Prostate cancer (PCa) presents the greatest US cancer health disparity in terms of incidence and mortality, disproportionately affecting African American (AA) men. The biological characteristics of prostate tumors are exaggerated in AA men compared to European American (EA) men at time of diagnosis, including higher PSA levels, higher Gleason scores, and advanced tumor stage. These factors influence the relatively poorer prognosis and worse overall survival rate observed in AA men. There is, however, a gap in our understanding of the mechanisms underlying increased PCa aggressiveness in AA men; therefore, there is a critical need to identify biological determinants contributing to PCa mortality disparities. Glucocorticoids—a type of steroid hormone produced in the human biological response to stress—have been implicated as driving factors in PCa progression. The underlying mechanism involves endogenous glucocorticoid (cortisol) binding to its glucocorticoid receptor (GR) and activating genes that promote tumor aggressiveness and therapy resistance. Results from phase 3 of clinical trial AFFIRM revealed that men receiving glucocorticoids to reduce the negative side effects of advanced PCa and treatment showed a significantly worse survival rate than those not receiving glucocorticoids. A clinical dilemma exists as glucocorticoids, important in the palliative care of PCa patients are now emerging as accelerators of disease progression and shortened survival. Chronically elevated levels of cortisol, which promote metabolic disorders, have been documented in AA men compared to EA men. This unhealthy cortisol production has been linked to stressful life events, which occur more frequently in the AA population. In addition, AAs are more sensitive to glucocorticoid exposure than EAs. These observations support the hypothesis that chronic stress leading to elevated cortisol in AA men may contribute to PCa health disparities. This study focused on examining the effects of glucocorticoid agonists and antagonists on the expression of stress oncoproteins, particularly LEDGF/p75 and clusterin, which are upregulated in PCa tumors and promote features of tumor aggressiveness, including resistance to clinically relevant taxanes used for advanced PCa treatment. We exposed a racially diverse panel of PCa cell lines, MDA-PCa-2b, 22Rv1, PC3, and DU145, to glucocorticoids (cortisol and dexamethasone), and observed by immunoblotting a time and dose-dependent upregulation of LEDGF/p75 and clusterin, particularly and more robustly in AA cells. Treatment of cells with mifepristone, a GR antagonist, attenuated this glucocorticoid-induced upregulation. In addition, shRNA-mediated depletion of LEDGF/p75 in PC3 cells resulted in decreased GR expression, suggesting a functional interplay between these two proteins in PCa cells. Interestingly, we also observed, using ELISA, increased circulation levels of LEDGF/p75 in AA PCa patients compared to EA patients and non-PCa controls, suggesting that this stress oncoprotein might play a more prominent role in AA PCa patients. These findings imply that activation of GR-signaling by glucocorticoids contributes to the activation of stress survival pathways associated with PCa aggressiveness. These results add to the emerging contribution of GR signaling in PCa, particularly in the context of PCa health disparities. Citation Format: Leanne Woods-Burnham, Arthur Love, Christina K. Cajigas-Du Ross, Anamika Basu, Laura Stiel, Susanne Montgomery, Colwick Wilson, Carlos A. Casiano. Glucocorticoid-mediated upregulation of stress oncoproteins: Implications for prostate cancer health disparities. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C43.

Prostate cancer (PCa) is the most commonly diagnosed cancer and the second leading cause of cancer-related male deaths in the U.S. This cancer is more aggressive in African American (AA) men, who are twice as likely to die from the disease compared to other racial groups. Despite racial disparities in PCa mortality, immunoproteomic studies profiling sera from thousands of men for the presence of autoantibodies to tumor-associated antigens (TAA) have mostly used sera from European or Asian ancestry. These autoantibodies can serve as both cancer biomarkers and potential tools in anti-tumor immunotherapy. In this study we profiled sera of AA and European American (EA) men with (N=157) and without (N=183) PCa against protein lysates from aggressive PCa cell lines using one and two-dimensional Western blotting. Sera from AA-PCa patients showed stronger immunoreactivity to proteins in PC3 cell lysates compared to EA-PCa sera. Common bands of immunoreactivity were observed around 37, 40, 50, 55, 60, and 70 kD from the sera of multiple patients. Several AA-PCa sera showed common immunoreactivity against a 50 kD protein band (16 out of 24, 67%) which was identified by serological proteomic analysis (SERPA) as alpha-enolase (ENO1), an enzyme that participates in both the glycolysis and plasminogen pathways. ELISA using purified ENO1 was conducted on 360 sera and showed significantly elevated frequency in men with PCa compared to non-PCa controls. Interestingly, SERPA analysis of other strongly immunoreactive spots outside the 50 kD region recognized of the other highly reactive PCa sera revealed additional candidate TAAs involved in the glycolysis and plasminogen pathways. These included key glycolytic enzymes GAPDH, fructose bisphosphate aldolase, phosphoglycerate kinase and lactate dehydrogenase, and other members of the plasminogen system such as GRP78 and annexin A2. Autoantibodies to stress survival proteins HSP60 and STIP1 were also identified in multiple PCa sera. We then probed by immunoblotting representative sera recognizing some of these candidate TAAs against a panel of 12 PCa and non-PCa cell lines. Anti-STIP1 sera showed elevated immunoreactivity predominantly in docetaxel-resistant cell lines. In the anti-ENO1 positive sera, we observed a race-related differential immune response, with anti-ENO1 sera from AA-PCa men showing elevated immunoreactivity mostly in metastatic cell lines, and anti-ENO1 sera from EA-PCa men showing uniform immunoreactivity across the entire panel of prostate cell lines. Interestingly, while several anti-ENO1 positive sera from AA-PCa men had increased immunoreactivity to this protein in the metastatic PCa cell lines LNCaP, MDA-PC2b, PC3 and DU145, they lacked reactivity against ENO1 in the docetaxel-resistant PC3-DR and DU145-DR cells, or purified ENO1 used in the ELISA. Anti-ENO1 EA-PCa sera did not display this differential pattern of immunoreactivity. To better understand these differences in anti-ENO1 reactivity, we interrogated the pattern of ENO1 post-translational modifications (PTMs) from PC3, PC3-DR and purified ENO1. Several different acetylated, methylated, phosphorylated, citrullinated, and glycosylated ENO1 PTMs were identified in the PC3 cells that were not present in the PC3-DR cells nor purified ENO1 which might explain the differential reactivity of AA-PCa sera against these three sources of ENO1. Taken together, these data suggest the anti-ENO1 autoantibodies from AA-PCa men may target a modified form of ENO1 that is different from that recognized by EA-PCa men. These discrepancies point to racial differences in immune response to TAAs in prostate tumors, and may have implications for identifying immunobiological factors contributing to PCa health disparities. Citation Format: Tino W. Sanchez, Guangyu Zhang, Jitian Li, Liping Dai, Rowaid Kellow, Saied Mirshahidi, Nathan R. Wall, Clayton Yates, Colwick Wilson, Susanne Montgomery, Jian-Ying Zhang, Carlos Casiano. Differential autoimmune response to glycolysis and plasminogen antigens from aggressive prostate cancer cells in African American and European American men with prostate cancer. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B05.

African American (AA) men are more likely to develop and die from prostate cancer (PCa) yet less likely to receive information about screening from physicians. Although guidelines espouse shared decision-making regarding PCa screening and PSA testing, studies reveal lack of consistency. Several studies demonstrate that PCa knowledge strongly influences informed decisions, and that engaging interactions are especially important for AA men who are more likely to progress from early stage to aggressive end-stage PCa at an earlier age and faster rate than other populations. This study evaluated the frequency of physician-patient conversations among AA men and whether this translated into increased PCa knowledge and PSA testing. In this study, self-identified Black men ages 21-85 donated blood and completed a health survey (n=414) via Project C.H.A.N.G.E. (Changing Health in Adult Men with New and Great Experiences), a transdisciplinary cross-sectional study conducted at Loma Linda University. PCa knowledge following physician conversations in light of socio-economic and health care variables was evaluated using univariate, bivariate, and multiple regression analyses. PSA values were measured with ELISA. Our results revealed that 52.7% of participants had never discussed the pros and cons of PCa screening with their physicians. The likelihood of physician-patient conversations increased with age (p.001), and health insurance positively predicted these discussions (p.001). Multiple regression analysis indicated ethnicity and high school education as predictors of improved PCa knowledge (p.001). We found that 38.5% of men who had discussed PCa screening with a physician and 28.5% who had not discussed PCa screening had PSA values that could be considered high-risk for PCa diagnosis. These findings expose a remaining deficiency in physician compliance regarding national guidelines for shared decision-making conversations with high-risk men. This is problematic as a large group of AA men at evident risk for PCa have not ever discussed this disease with their physicians and may be harboring undetected PCa. Encouraging more effective interactions between AA men and their physicians concerning PCa screening and PSA testing has the potential to reduce PCa health disparities. Citation Format: Leanne Woods-Burnham, Laura Stiel, Colwick Wilson, Susanne Montgomery, Carlos A. Casiano. Physician consultations, prostate cancer knowledge, and PSA screening in African American men: Are the conversations effective? [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A56.

Breast cancer (BC) incidence rates for Black and non-Hispanic White women have recently converged; however, Black women continue to die at higher rates from the disease. Black women also use hair products containing hormonally active chemicals at higher rates than other races and ethnic groups. Studies now link chemical components in hair and personal care products to breast cancer risk. Using a community-based participatory research approach, this qualitative study explored community concerns about the role of hair products on breast cancer risk. Focus groups and key informant interviews using triangulation to assure relevant perspectives (women with and without breast cancer as well as younger and older women of differing SES, stylists) explored women’s perceived risk and knowledge of breast cancer risk factors. Data analysis used grounded theory methods of coding facilitated by QDA-Miner. Findings from 91 participants indicated varying levels of awareness but near universal concerns about the potential link of hair products to BC. Breast cancer is a significant concern for Black women and their loved ones. While women were concerned and some respondents believed ingredients in hair products may be harmful to their health, they wrestled with the idea of making changes as hair for most is aligned with beauty, individuality, and identity. For many altering their product use patterns to potentially less risky choices pits health against identity. Health education interventions to minimize harmful hair product usage must acknowledge and incorporate cultural normative beliefs of hair for Black women.

Prostate cancer (PCa) is the most frequently diagnosed cancer and the second leading cause of cancer-related male deaths in the U.S. This cancer is more aggressive in African American (AA) men, who are twice as likely to die from the disease when compared to other racial groups. Despite these racial disparities in PCa mortality, studies on PCa biology and biomarker discovery include mostly patients from European American (EA) backgrounds. There is a critical need to find minimally invasive PCa biomarkers that could aid in diagnosis and prognosis, especially in high risk populations like AA men. Immunoproteomics offers a minimally invasive approach to detect early malignant processes that trigger production of autoantibodies to tumor-associated antigens (TAA). We used serum samples from AA (n = 59) and EA (n = 50) men with PCa to probe one- and two-dimensional Western blots of protein lysates from aggressive PCa cell lines. AA PCa patient sera showed stronger immunoreactivity to proteins in PC3 cell lysates compared to the EA sera, with a 50 kD protein band frequently targeted by autoantibodies in several AA PCa sera. Serological proteomic analysis with mass spectrometry showed that these AA PCa autoantibodies recognized alpha-enolase (ENO1), a protein important in tumor formation, expansion, and glucose metabolism. In addition, several other glycolytic enzymes important for tumor proliferation were also identified as candidate prostate TAA, including GAPDH, bisphosphate aldolase, phosphoglycerate kinase, and lactate dehydrogenase. The ENO1 autoantibody frequency, measured by ELISA in sera from 400 racially diverse men with and without PCa, was four-fold higher in PCa compared to non-PCa patients. Interestingly, although sera from AA men with PCa had stronger WB reactivity to ENO1 present in PC3 lysates compared to EA men, and the ENO1 autoantibodies were initially discovered in eight AA PCa sera but only in two EA sera, the anti-ENO1 autoantibody frequency measured by ELISA, which used yeast-purified recombinant human ENO1 as a substrate, was higher in the EA PCa cohort. In addition, several anti-ENO1 positive sera from AA men with PCa showed increased immunoreactivity to this protein in the PCa cell lines LNCaP, MDA-PC2b, PC3, and DU145, but not against the purified ENO1 used in ELISA. The opposite was true in the EA PCa cohort, where strong reactivity against the purified ENO1 did not correlate with an equally strong immunoreactivity against the cellular ENO1. The EA PCa sera did not recognize the pattern of ENO1 expression observed with the AA sera in the same panel of prostate cell lines. These differences of immunoreactivity between AA and EA sera against PC3-ENO1 vs recombinant human ENO1 suggest that select AA sera may predominantly recognize ENO1 epitopes not displayed in the purified protein. These discrepancies point to racial differences in the immune response to prostate tumors. Citation Format: Tino Wilson Sanchez, Jian-Ying Zhang, Liping Dai, Susanne Montgomery, Colwick Wilson, Guangyu Zhang, Saied Mirshahidi, Nathan Wall, Carlos A. Casiano. Immunoproteomic profiling in African American men with prostate cancer: Evidence for an autoimmune response to glycolytic enzymes. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3895.

Introduction: Since 2003, the World Health Organization has recommended exclusive breastfeeding for the first 6 months of life. In the Northwest region of Cameroon approximately 90% of women initiate breastfeeding, yet only 34% of these women exclusively breastfeed for the recommended six months. Aim: To determine influences on women's exclusive breastfeeding practices. Methods: Semi-structured interviews were conducted with six women and six men followed by focus group discussions with three groups of women and three groups of men in the Kumbo West Health District, Northwest region, Cameroon. All participants were selected using theoretical sampling to assure triangulation. Results: Three themes emerged that influence exclusive breastfeeding practices: woman's readiness to exclusively breastfeed; cultural influences towards exclusive breastfeeding; and perceived constraints to exclusive breastfeeding. Conclusion: These emergent themes were used to create a theoretical framework that is useful for developing a breastfeeding health education intervention in non-Western settings.

Introduction. The high prevalence of complementary and alternative medicine (CAM) use among cancer patients (40%-83%) receiving conventional treatment and the complex relationship between the psychosocial factors that may contribute to or result from CAM use requires further understanding. The authors conducted a descriptive mixed-methods pilot study to understand CAM practices, attitudes, and beliefs among cancer patients at the Loma Linda University Medical Center. Methods. This was the qualitative phase of the study, and no hypotheses were set. A total of 23 face-to-face interviews were conducted, and thematic coding was used to analyze 22 interview transcriptions. There were 14 CAM users (64%) and 8 nonusers (36%). Findings. The themes present among those who used CAM were the following: physicians viewed as one aspect of health care options, a holistic view on well-being, satisfaction with CAM use, and 3 key coping methods (confrontive, supportive, and optimistic) to confront cancer. Themes were not independent of each other. Two themes were present among nonusers; nonusers trusted their physician and were more likely to express evasive coping methods. Discussion. Perceptions and behavioral patterns are complex predictors of CAM use. A better understanding of CAM, medical pluralism, and the perceptions of patients would help health care providers deliver a better quality of care. The promotion of integrative care may help health care providers better identify medical pluralism and would shift focus to patient-centered care.

Despite recent surveys reporting a decline in adolescents' use of alcohol and other drugs in the general population, substance abuse may actually be increasing among particular subgroups of high-risk youth. This study examined the prevalence of alcohol and other drug use reported by 1121 youth, ages 12–24 years, seen for an initial medical visit at a free community-based primary health clinic. The clinic, located in the Hollywood/Wilshire area of Los Angeles, serves both homeless (62%) and non-homeless (38%) youth. Bivariate and multivariate analyses revealed that the homeless youth were significantly more likely to report use of alcohol and illicit drugs (marijuana, stimulants, hallucinogens, and narcotics) and prior involvement in injecting drug use (IDU). Variables found to be significantly associated with substance use among the homeless youth included length of time homeless, an attempted suicide, physical and sexual abuse, and involvement in survival sex/prostitution. Among the non-homeless youth, age of first intercourse, a previous suicide attempt, and a history of physical and sexual abuse were significantly associated with substance use. These findings suggest that rates of alcohol and other drug use may be higher among youth seen at community-based primary health clinics, particularly homeless youth underscoring the need for screening for these risk variables.