Faculty Bibliography

Background: We conducted a focus group study to assess the influence of partner communication on breast and cervical cancer screening and the perceived existing and potential support from male partners in participating in cancer screening. Secondarily, Mexican male and female views on health care and cancer were explored. Methods: Seven focus groups (two female-only, three male-only, and two couples) were conducted in Spanish. Results: Findings suggest that knowledge about cervical cancer was significantly less than knowledge about breast cancer among both men and women. Barriers to cancer screening included language barriers, lack of health insurance, and lack of awareness of the need for screening. Male partners expressed willingness to support their female partners in cancer screening activities. Conclusion: Cervical cancer education is desperately needed, including education on the availability of free and low cost screening services. Education efforts should include the male community members, especially as the males perceive themselves as responsible for the financial burden of care.

OBJECTIVES: Profound and growing disparities exist in oral health among certain US populations. We sought here to determine the prevalence of oral health complaints among Harlem adults by measures of social class, as well as their access to oral health care. METHODS: A population-based survey of adults in Central Harlem was conducted from 1992 to 1994. Two questions on oral health were included: whether participants had experienced problems with their teeth or gums during the past 12 months and, if so, whether they had seen a dentist. RESULTS: Of 50 health conditions queried about, problems with teeth or gums were the chief complaint among participants (30%). Those more likely to report oral health problems than other participants had annual household incomes of less than $9000 (36%), were unemployed (34%), and lacked health insurance (34%). The privately insured were almost twice as likely to have seen a dentist for oral health problems (87%) than were the uninsured (48%). CONCLUSIONS: There is an urgent need to provide oral health services for adults in Harlem. Integrating oral health into comprehensive primary care is one promising mechanism

BACKGROUND: Haitian immigrants, among the fastest growing immigrant communities in the United States, have low cancer screening rates. Several patient barriers have been identified and associated with low screening rates but little is known on provider barriers for cancer screening. To address this gap, we assessed the cancer screening practices, attitudes, and beliefs of primary care providers serving the Haitian community. METHODS: We surveyed a random sample of physicians serving first generation Haitian immigrants in New York City, identified through their zip codes of practice. Participants completed a questionnaire to assess their beliefs, attitudes and practices surrounding cancer screening, and their perceptions of patient barriers to screening. RESULTS: 50 of 87 physicians (58%) consented to participate in the study. Cancer site-specific and overall cancer screening scores were created for breast, cervical, and colorectal cancer screening. 75% of providers followed breast cancer screening guidelines, 16% for cervical cancer, and 30% for colorectal cancer. None of the providers in the sample were following guidelines for all three cancer sites. Additionally, 97% reported recommending digital rectal exam and PSA annually to patients 50 years or older with no family history, and 100% to patients over 50 years old with family history. CONCLUSIONS: The reported practices of providers serving the Haitian immigrant community in New York City are not fully consistent with practice guidelines. Efforts should be made to reinforce screening guideline knowledge in physicians serving the Haitian immigrant community, to increase the utilization of systems that increase cancer screening, and to implement strategies to overcome patient barriers

OBJECTIVES: We explored an innovative strategy for targeted testing and disease management among immigrant communities at risk for tuberculosis. METHODS: Taxi drivers were recruited at an airport holding lot to undergo tuberculin skin testing (Mantoux). After receiving their test results in a location convenient for them, drivers with positive results were referred for evaluation and treatment. We conducted baseline and follow-up assessments. RESULTS: Of 123 drivers who participated, two thirds (82) were at high risk for tuberculosis. Seventy-eight (63%) of the 123 returned for test readings; 62% of these drivers had positive test results. All drivers with positive results received a complete physician evaluation, but 64% of those evaluated were not treated for latent TB infection. Of the untreated drivers, 37.5% were at high risk. Systemic and physician barriers (e.g., lack of knowledge, erroneous beliefs regarding vaccines) affected adherence to evaluation and treatment. CONCLUSIONS: Targeted testing and treatment are important to the control of tuberculosis. The results of this study highlight the need for an aggressive physician educational campaign to identify latent tuberculosis infection and to tailor service delivery to meet the unique needs of foreign-born communities

Despite the recent approval of lamivudine for the treatment of children with chronic hepatitis B virus (HBV) infection, there is insufficient information on the kinetics of HBV clearance and the factors that predict a favorable treatment response to lamivudine in this population. In a small retrospective study of 16 HBV-infected children treated with lamivudine, we examined changes in virus load and other factors associated with hepatitis B e antigen (HBeAg) clearance. High pretherapy alanine aminotransferase level, low serum HBV DNA load, and age at the start of treatment were independently associated with HBeAg clearance. HBeAg clearance was also associated with the achievement of specific levels of virus suppression, and failure to achieve those levels was associated with the development of lamivudine resistance. Additional studies are necessary to provide better indications and guidelines for the treatment of children with chronic HBV infection

Asylum seekers arriving in the USA are likely to be held in detention for months or years pending adjudication of their asylum claims. We interviewed 70 asylum seekers detained in New York, New Jersey, and Pennsylvania. We used self-report questionnaires to assess symptoms of anxiety, depression, and post-traumatic stress disorder. At baseline, 54 (77%) participants had clinically significant symptoms of anxiety, 60 (86%) of depression, and 35 (50%) of post-traumatic stress disorder; all symptoms were significantly correlated with length of detention (p=0.004, 0.017, and 0.019, respectively). At follow-up, participants who had been released had marked reductions in all psychological symptoms, but those still detained were more distressed than at baseline. Our findings suggest detention of asylum seekers exacerbates psychological symptoms

Asylum seekers arriving in the United States are often imprisoned for months or years while their asylum claims are processed. Recently, Physicians for Human Rights and the Bellevue/New York University Program for Survivors of Torture released the findings of the first systematic study examining the health of detained asylum seekers. The study found that the mental health of asylum seekers interviewed was extremely poor, including high levels of symptoms for anxiety, depression, and posttraumatic stress disorder, which worsened the longer individuals were in detention. The study also raises concerns about the manner in which asylum seekers are treated upon arrival in the United States and then while in detention. These findings support assertions that detention has a harmful effect on the health and well-being of asylum seekers. Policies regarding the long-term detention of asylum seekers should be reconsidered