Breast cancer is the
most commonly diagnosed cancer among Latinas. In the South Texas border
region, only about three out of every five women 40 years of age and
over have had a mammogram in the previous two years. Achieving
appropriate screening for breast cancer in this region represents a
significant opportunity to reduce breast cancer morbidity/mortality in
one of the poorest geographic areas of the U.S.
This project seeks to establish a research and training collaborative
partnership between the Institute for Population Health Policy (IPHP) at
the University of Texas-Pan American—a Minority Institution—and the
Leonard Davis Institute of Health Economics (LDI) at the University of
Pennsylvania (Penn). The UTPA-Penn breast cancer research/training
partnership will focus on understanding and ameliorating disparities in
breast cancer screening among Latinas in the U.S.-Mexico border region.
Our objectives are (1) to develop a competitive and successful breast
cancer research program that focuses in cancer control and population
sciences at UTPA; (2) to develop and complete a research project on
barriers to breast cancer screening among Latinas in the U.S.-Mexico
border region; (3) to develop the research infrastructure that will
enable UTPA investigators to submit competitive breast cancer research
proposals.
Latinas face many potential barriers to
undergoing breast cancer screening. Lack of health insurance is one of
the greatest barriers to mammography utilization but, nonetheless,
financial barriers alone do not explain the limited screening in this
population. As such, our specific aim in this proposal is to identify
socio-demographic correlates of underutilization of mammography
screening among border Latina populations. Our primary hypothesis is
that poor health literacy skills, high health system distrust, lack of
health insurance coverage, knowledge, cultural beliefs and attitudes
about mammography, perceived risk, language, years in the U.S., and
acculturation are each independently associated with low mammography
uptake. These relationships are being analyzed by conducting a
population-based survey of Latinas ages 40 and over who reside in the
South Texas border region (n=877). The results from the survey will
identify interventions that may increase mammography screening in
border-dwelling Latinas thereby reducing the burden of breast cancer in
this population.
This partnership provides UTPA investigators
with the opportunity to collaborate with nationally-recognized breast
cancer researchers at Penn. UTPA investigators have acquired the
research experience and skills necessary to develop competitive research
proposals in breast cancer detection, diagnosis, and treatment, and the
IPHP is now able to develop the research infrastructure necessary to
build an effective transdisciplinary program in breast cancer research.
The use of
complementary and alternative medicine (CAM) in the U.S. has increased
substantially in recent years and there are significant CAM utilization
differences across ethnic/racial minority groups. The increasing use of
CAM has been previously linked to factors such as the need for
individual empowerment over healthcare use and the philosophical
congruence between CAM and personal beliefs, spirituality and values of
patients. However, CAM use may also be related to minority
subpopulation-specific experiences with the healthcare system and their
prior experiences with CAM in other countries and/or with different
cultures in the U.S. The objective of this research project is to
characterize the use of different CAM therapies among racial and ethnic
groups and to study how these differences in utilization rates arise. The central hypothesis is that
differences in CAM use and the effectiveness of CAM across different racial and ethnic
groups are driven by socioeconomic status, personal experiences with the
conventional healthcare system, access/cost of conventional healthcare,
race/ethnic-specific cultural beliefs, CAM legislation/regulation and
personal beliefs as to what conventional medicine can effectively
accomplish to improve health. The specific aims of this research are: to
analyze CAM utilization and perceived effectiveness across racial/ethnic
minority subpopulations; to determine how the cost of conventional
medicine is related to CAM use differences across racial/ethnic groups;
and to characterize race/ethnic-specific patterns of CAM use by
insurance status and state-based regulatory measures. Data from the 2002
National Health Interview Survey will be used to investigate the
differences in CAM use across different racial/ethnic minority
subpopulations. Logistic and count data models will be estimated to
assess the factors that are related to CAM utilization and the perceived
effectiveness of the different modalities of CAM. Results will be used to develop
testable hypotheses regarding the mechanisms underlying the usage of specific CAM
therapies by members of racial/ethnic minority groups.
PI (UTPA): José A. Pagán, PhD
Subproject PIs: Cynthia J. Brown, PhD; Dejun Su, PhD; Daniel Sutter, PhD.
Other Investigators: David A. Asch, MD (Penn); H. Shelton Brown, PhD (UTHSCH); Damian Damianov, PhD; Chad Richardson, PhD
Funding Agency
Agency for Healthcare Research and Quality
Project Period
9/1/2007 – 8/31/2010
Abstract
The University of Texas-Pan American (UTPA) is the second largest Hispanic Serving Institution in the U.S. and it educates more Mexican American students than any other institution of higher education in the country. UTPA serves the educational needs of one of the poorest regions in the U.S.—the U.S.-Mexico border communities located in the Rio Grande Valley of South Texas. According to The University of Texas-Pan American Compact with the University of Texas System, the highest priority long-term initiative of UTPA for the next ten years is to become the doctoral research university of South Texas. In order to achieve this objective, UTPA is interested in developing new graduate degree programs and in increasing the research capacity and productivity of its faculty, especially in areas of regional strategic significance such as health services research. This AHRQ M-RISP application seeks to develop a Health Services Research (HSR) Initiative within the UTPA Institute for Population Health Policy (IPHP) to strengthen the research environment at UTPA and to enhance the competitiveness of faculty members in health services research. The research activities to be undertaken under the HSR Initiative primarily focus on health disparities and health care utilization/access for priority populations—more specifically, low-income minority populations in the U.S.-Mexico border and the uninsured. The HSR Initiative also takes advantage of an ongoing collaborative partnership between the IPHP and the Leonard Davis Institute (LDI) of Health Economics at the University of Pennsylvania. The LDI will provide technical expertise, mentoring and support to the proposed HSR Initiative. The Specific Aims of this M-RISP application are: (1) to develop a Health Services Research Initiative at UTPA, (2) to enhance the capacity of individual faculty members to undertake health services research, with a focus on research in low-income minority populations and the uninsured, and (3) to develop and foster research dedicated to reducing health and health care access disparities among Latino populations, particularly in the U.S.-Mexico border region. The HSR Initiative will support four individual investigator research projects which deal with community uninsurance and health care access, the use of health care services in the U.S.-Mexico border region, severe weather and health care use by low-income and uninsured vulnerable populations, and the cost-effectiveness and net-benefits of school-based health promotion programs. The proposed HSR Initiative will also actively promote the development of research projects by junior faculty and graduate students which focus on the U.S. Latino population and are consistent with the goals and objectives of both AHRQ and the UTPA-IPHP HSR Initiative.
Direct-to-consumer-advertising: Do Television Pharmaceutical Ads Prompt More than Just Prescription Requests?
PI (UCLA): Dominick L. Frosch, PhD
Co-PI: José A. Pagán, PhD
Funding Agency
Robert Wood Johnson Foundation (Investigator Award in Health Policy Research)
Project Period
6/1/2007 – 5/31/2010
Abstract
Direct-to-consumer advertising (DTCA) of prescription drugs has become ubiquitous in the US, one of only two countries that permit this type of marketing. The prominence of drug marketing in the televised media landscape is less than a decade old and the direct result of a relaxation of regulations by the Food and Drug Administration. Evidence that ads contribute to increased drug expenditures—combined with the market withdrawal of the widely advertised drug Vioxx following reports of it causing fatal cardiovascular events—has brought renewed attention on DTCA regulation from policy makers. However, little is known about the extent to which this marketing has effects, positive or negative, that go beyond prescription requests. Many ads refer to healthy lifestyle activities, mentioning the importance of dietary change and showing characters engaging, often vigorously, in physical activity. The high levels of exposure to these ads in the population may encourage healthy lifestyle activities by modeling these behaviors or discourage them by promoting an alternative solution in the form of a pill. The objective of the proposed research is to examine the impact of DTCA on healthy behaviors using mixed qualitative and quantitative methods to more comprehensively inform the policy debate. In-depth interviews after viewing a selection of ads will be used to explore interpretations of ad content by consumers. A randomized experiment will test dose-response effects of selected ads on consumers’ food and activity choices. Cross-sectional and longitudinal survey data will be used to examine the effects of ad exposure on health behaviors in a nationally representative sample. Primary data collection efforts will sample equally from two distinct groups, individuals with health insurance and the uninsured, to test the potential differential effects of DTCA exposure. Health insurance status will also be tested in analytic models of secondary survey data. Policy-oriented statistical simulations will be used to model the magnitude of identified effects at different levels of DTCA exposure. Findings, combined with analysis of the ongoing DTCA policy debate in New Zealand, will help inform how DTCA regulation in the US should be modified to maximize positive and minimize negative effects. The project will last three years. Findings will be disseminated through 3-4 publications in peer reviewed journals, presentations at national conferences and other channels such as policy briefs and op-eds.
