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Medical Mistrust among the Intersection of Race and Gender of Black Individuals as Moderated by Patient-Centered Care

Description
Every year an alarming number of deaths for the Black community are a result of disparities and inequalities in health outcomes. While literature has largely focused on social determinants of heath (e.g., economic, environmental, biological, and behavioral structures) as contributing factors to disparate health outcomes for Black people, literature on…

Every year an alarming number of deaths for the Black community are a result of disparities and inequalities in health outcomes. While literature has largely focused on social determinants of heath (e.g., economic, environmental, biological, and behavioral structures) as contributing factors to disparate health outcomes for Black people, literature on medical mistrust has been on the rise. Medical mistrust is defined as the belief that health care entities and providers act against a patient's best interest and well-being, and is associated with lower rates of service utilization, inadequate management of health conditions, lower levels of involvement in research, and treatment nonadherence. Only recently has patient-centered care been examined as a construct that may reduce the negative effects of medical mistrust. This study examined Black identifying patients (N = 174) across gender and their reported levels of medical mistrust, and if the perception of a patient-centered health care environment would moderate the association. The findings indicated that Black females, compared to Black males, endorsed higher levels of medical mistrust that may be indicative of intersectional influences. While there were significant effects of gender and perceived patient-centered care on medical mistrust, perceived patient-centered care was not found to significantly moderate the relationship between gender identity and medical mistrust. This may be indicative of the varying degrees of medical maladies that may be stronger determinants of perceived patient-centered care, despite gender or other demographic characteristics. Implications for practice and future research on the intersectional influences on medical mistrust and perceived patient-centered care in the Black communities are discussed.
ContributorsMatthews, Tianna (Author) / Warner, Cheryl (Thesis advisor) / Randall, Ashley K (Committee member) / Dillon, Frank (Committee member) / Arizona State University (Publisher)
Created2021
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Caveolin-1: a potential biomarker of aggressive triple-negative breast cancer in African American women

Description
In the U.S., breast cancer (BC) incidences among African American (AA) and CA (CA) women are similar, yet AA women have a significantly higher mortality rate. In addition, AA women often present with tumors at a younger age, with a higher tumor grade/stage and are more likely to be diagnosed…

In the U.S., breast cancer (BC) incidences among African American (AA) and CA (CA) women are similar, yet AA women have a significantly higher mortality rate. In addition, AA women often present with tumors at a younger age, with a higher tumor grade/stage and are more likely to be diagnosed with the highly aggressive triple-negative breast cancer (TNBC) subtype. Even within the TNBC subtype, AA women have a worse clinical outcome compared to CA. Although multiple socio-economic and lifestyle factors may contribute to these observed health disparities, it is essential that the underlying biological differences between CA and AA TNBC are identified. In this study, gene expression profiling was performed on archived FFPE samples, obtained from CA and AA women diagnosed with early stage TNBC. Initial analysis revealed a pattern of differential expression in the AA cohort compared to CA. Further molecular characterization results showed that the AA cohort segregated into 3-TNBC molecular subtypes; Basal-like (BL2), Immunomodulatory (IM) and Mesenchymal (M). Gene expression analyses resulted in 190 differentially expressed genes between the AA and CA cohorts. Pathway enrichment analysis demonstrated that differentially expressed genes were over-represented in cytoskeletal remodeling, cell adhesion, tight junctions, and immune response in the AA TNBC -cohort. Furthermore, genes in the Wnt/β-catenin pathway were over-expressed. These results were validated using RT-qPCR on an independent cohort of FFPE samples from AA and CA women with early stage TNBC, and identified Caveolin-1 (CAV1) as being significantly expressed in the AA-TNBC cohort. Furthermore, CAV1 was shown to be highly expressed in a cell line panel of TNBC, in particular, those of the mesenchymal and basal-like molecular subtype. Finally, silencing of CAV1 expression by siRNA resulted in a significant decrease in proliferation in each of the TNBC cell lines. These observations suggest that CAV1 expression may contribute to the more aggressive phenotype observed in AA women diagnosed with TNBC.
ContributorsGetz, Julie (Author) / Baumbach-Reardon, Lisa L (Thesis advisor) / Lake, Douglas F (Thesis advisor) / Bussey, Kimberly (Committee member) / Kusumi, Kenro (Committee member) / Arizona State University (Publisher)
Created2015