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African American (AA)/Black men are more likely to develop aggressive prostate cancer (PCa), yet less likely to be screened despite guidelines espousing shared decision-making regarding PCa screening and prostate-specific antigen (PSA) testing. Given the documented racial disparities in PCa incidence and mortality, engaging interactions with physicians are especially important for AA/Black men. Thus, this study evaluated occurrence of physician–patient conversations among AA/Black men, and whether such conversations were associated with PCa knowledge. We also quantified the serum PSA values of participants who had, and had not, discussed testing with their physicians. Self-identified AA/Black men living in California and New York, ages 21–85, donated blood and completed a comprehensive sociodemographic and health survey (n = 414). Less than half (45.2%) of participants had discussed PCa screening with their physicians. Multivariate analyses were used to assess whether physician–patient conversations predicted PCa knowledge after adjusting for key sociodemographic/economic and health-care variables. Increased PCa knowledge was correlated with younger age, higher income and education, and having discussed the pros and cons of PCa testing with a physician. Serum PSA values were measured by ELISA. Higher-than-normal PSA values were found in 38.5% of men who had discussed PCa screening with a physician and 29.1% who had not discussed PCa screening. Our results suggest that physician–AA/Black patient conversations regarding PCa risk need improvement. Encouraging more effective communication between physicians and AA/Black men concerning PCa screening and PSA testing has the potential to reduce PCa health disparities.

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.

•Changes in screening mammography are not consistent across the U.S.•Screening mammography decreased more in White women overall.•Black women had higher magnitude increases and decreases in screening by region.•Changes in screening among White women demonstrate more clustering across the U.S.•Screening disparities existed for Black women compared to Whites in 2008 and 2012. U.S. Black women have higher breast cancer mortality compared to White women while their rate of ever having a mammogram has become equal to or slightly surpassed that of Whites. We mapped the distribution of change in screening mammography for Black and White female Medicare enrollees ages 67–69 from 2008 to 2012 by hospital referral region across the contiguous U.S., performed cluster analysis to assess spatial autocorrelation, and examined the screening differences between these groups in 2008 and 2012 respectively. Changes in screening mammography are not consistent across the U.S.: Black and White women have increased and decreased their use of mammography in different regions and Black women’s change patterns vary more widely.

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.” Within the context of breast cancer health disparities, this review presents a growing body of evidence linking: (1) environmental estrogen and endocrine disrupting chemical 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 to breast cancer risk in African American women. This issue is also a source of increasing concern in the lay community, and there is an urgent need for additional research, including through strategic partnerships using community‐collaborative approaches.

Glucocorticoid receptor (GR) is emerging as a key driver of prostate cancer (PCa) progression and therapy resistance in the absence of androgen receptor (AR) signaling. Acting as a bypass mechanism, GR activates AR-regulated genes, although GR-target genes contributing to PCa therapy resistance remain to be identified. Emerging evidence also shows that African American (AA) men, who disproportionately develop aggressive PCa, have hypersensitive GR signaling linked to cumulative stressful life events. Using racially diverse PCa cell lines (MDA-PCa-2b, 22Rv1, PC3, and DU145) we examined the effects of glucocorticoids on the expression of two stress oncoproteins associated with PCa therapy resistance, Clusterin (CLU) and Lens Epithelium-Derived Growth Factor p75 (LEDGF/p75). We observed that glucocorticoids upregulated LEDGF/p75 and CLU in PCa cells. Blockade of GR activation abolished this upregulation. We also detected increased GR transcript expression in AA PCa tissues, compared to European American (EA) tissues, using Oncomine microarray datasets. These results demonstrate that glucocorticoids upregulate the therapy resistance-associated oncoproteins LEDGF/p75 and CLU, and suggest that this effect may be enhanced in AA PCa. This study provides an initial framework for understanding the contribution of glucocorticoid signaling to PCa health disparities.

Black women have the highest mortality rate due to breast cancer compared to any other racial/ethnic group in the U.S. and are more likely to be diagnosed with late- stage breast cancer compared to White women. Though the causes of these disparities are multifactorial, early detection by mammography, in combination with improved treatment, is related to improved breast cancer survival outcomes. Recently, the rate of Black women reporting having had a screening mammogram in the last two years has increased, and by some accounts surpassed, that of White women. This dissertation assesses this change in mammography among Black women in order to help inform future policies impacting preventive health care, which can lead to early diagnoses, and thus improvements in women’s health and reductions in the economic impact of treatment costs. The objective of the study was to identify factors, including geographic place and space, associated with the spatial variation of the increased screening mammography observed for Black women in the U.S. from 2008 to 2012. The central hypothesis was that the spatial distribution of the change in screening utilization is not random, and that the geospatial pattern of change is associated with changes in access to health care when controlling for education, income, demographic factors, and the larger ecological sociodemographic context. The central hypothesis was tested by pursuing the following aims: 1) Assess whether the geographic pattern of change from 2008-2012 of screening mammography among Black women in the U.S. is spatially clustered; and 2) Identify individual- and ecological-level factors associated with the geographic pattern of change from 2008-2012 of screening mammography among Black women in the U.S. Statistical software was used for assessing aspatial data, and Geographic Information Systems (GIS) was used for descriptive mapping and implementing spatial statistical analyses. Results indicate that changes in screening are not consistent across the U.S., Black and White women have increased and decreased screening in different regions, and the impact of variables associated with screening varies by location.

We explored potential barriers and facilitators for prostate cancer screening choices among high-risk black men. In our sample of 264 black men over 45 years of age living in the United States who met the American Cancer Society criteria for screening, we found that only 49.6% had ever been screened. We investigated potential barriers, including screening intention, access to care, medical mistrust, and fatalism. Potential facilitating factors investigated were provider–patient conversations encompassing the pros and cons of screening, ethnicity taken into account, insurance, and previous prostate cancer screening. Recommendations and resources are suggested to increase screening of high-risk black men. •Recent U.S. Preventive Services Task Force prostrate cancer (PCa) screening guideline changes have negatively affected black men.•To encourage screening is not enough for high-risk black men.•Provider discussion of pros and cons increases screening behavior.•Shared informed decision-making (SIDM) is encouraged between providers and patients.•Black men with PCa family history require SIDM and screening beginning at age 40.

Purpose Psychedelic‐assisted therapy (PAT) is becoming a clinically available treatment for patients with treatment‐resistant conditions such as depression and post‐traumatic stress disorder (PTSD) in several countries. As PAT transitions from research settings into routine clinical practice, there is a growing need for coherent clinical frameworks and evidence‐based guidelines to support its safe, effective, and integrated delivery. This paper examines how external therapists and psychiatrists can best support patients throughout the PAT journey; the different models for involving external therapists in PAT; the challenges and opportunities associated with collaboration between external therapists and PAT teams; beneficial characteristics of external therapy; and priority areas for future research. Method A literature review was conducted, including empirical studies, theoretical papers, and position statements that explored the role of external therapies alongside PAT. This information was integrated with multidisciplinary clinical experiences to develop a series of guiding principles and practical considerations for clinicians. Findings There is currently no cohesive framework to guide collaboration or care coordination between external therapists and PAT teams. The review suggests that PAT should not generally be conceptualized as a standalone treatment for patients with treatment‐resistant conditions. External therapists play a critical role across preparation, dosing, and integration phases, contributing to patient safety, continuity of care, and therapeutic integration. Models for involving external therapists in PAT are identified, each with opportunities and challenges. Practical strategies are outlined to mitigate risks and address challenges associated with interprofessional collaboration. Further research is required to refine clinical frameworks and inform best practices. Conclusion While scientific and public narratives often portray PAT as a discrete or self‐contained intervention, clinical practice indicates it is most effective when embedded within a broader, integrated therapeutic process. Effective collaboration between external therapists and PAT teams is essential to maximize therapeutic outcomes and ensure patient safety. External therapists play a pivotal role in supporting patients undergoing psychedelic‐assisted therapy (PAT), offering continuity of care, support, and integration. Co‐operation and collaboration between external therapists and PAT teams is vital to ensure patient safety and optimal treatment outcomes. Further research is needed to establish best practice guidelines.

Purpose The availability of psychosocial support measures has a significant impact on the quality of life of terminally ill and dying patients and the burden experienced by their relatives. To date, no intervention has specifically focused on promoting interaction within the dyads of the following: (1) terminally ill adult children and their parents and (2) terminally ill parents and their adult children. A national Delphi study was conducted to provide appropriate recommendations for dyadic psychosocial support measures. Methods Recommendations were formulated from qualitative interview data on the experiences and wishes of patients and family caregivers within these two dyads. Experts from palliative and hospice care providers rated the relevance and feasibility of 21 recommendations on two 4-point Likert-type scales, respectively. Additional suggestions for improvement were captured via free text fields. Individual items were considered consented when ≥ 80% of participants scored 1 (strongly agree) or 2 (somewhat agree) regarding both relevance and feasibility. Results A total of 27 experts (35% response rate) completed two Delphi rounds. Following the first round, 13 recommendations were adjusted according to participants’ comments. After the second round, consensus was achieved for all 21 of the initially presented recommendations. Conclusion The Delphi-consented recommendations for parents and adult children at the end of life provide the first guidance for hands-on dyadic psychosocial support measures for parent–adult child relationships, specifically. The next step could involve the structured implementation of the recommendations, accompanied by scientific research. This study was registered on October 27, 2017, with the German Clinical Trials Register (DRKS00013206).

Being terminally ill affects not only the life of patients but also that of their loved ones. Dyads of adult children and their parents at the end of life may face specific challenges with regard to their relationship and interactions that need to be further examined. The aim was to identify, describe and summarise available evidence on adult child-parent interaction and psychosocial support needs at the end of life. Research gaps in the existing literature are disclosed and recommendations for future research are presented. A type 4 scoping review according to Arksey and O'Malley's (2005) methodological framework was conducted. The review includes studies regardless of study design and provides a descriptive account of foci of available research. The PubMed, PsycINFO, CINAHL, Google Scholar and Web of Science databases were searched from inception to 16 August 2018. An additional hand search was conducted. A highly sensitive search strategy was employed to cover all potentially relevant results. The authors screened 1832 records by title and abstract, retrieved 216 full-text articles and included 15 studies from the database search. One study was identified by way of hand search. The review identified six major themes: (1) adult child-parent relationship, (2) adult child-parent communication, (3) involvement in caregiving, (4) benefit and burden of caregiving, (5) coping strategies and (6) support and information for caregivers. The scoping review accentuates the paucity of studies that address both patients' and their parent/adult child caregivers' relationship, interaction and psychosocial support needs.