The majority of people with alcohol use disorders do not seek formal treatment. Research on barriers to help-seeking have only recently focused on ethnic minority populations. The present study investigated the extent to which an adult American Indian (AI) sample experienced similar and/or unique barriers to help-seeking as have been reported in the literature. Using both qualitative and quantitative methods, 56 (54% male) AIs with lifetime alcohol dependence completed a semistructured face-to-face interview and a self-administered written survey. Interviews were tape recorded, transcribed, and coded for four major themes: personal barriers, pragmatic barriers, concerns about seeking help, and social network barriers. Quantitative data provided percentage endorsing each survey item and strength of each barrier, which were categorized according to the four major themes. In previous research, most barriers questionnaires have not queried for cultural concerns or how the specific type of help may be a mismatch from the client's perspective. Given the rapidly changing racial/ethnic demography in the United States, further research addressing cultural and spiritual concerns as well as more common barriers is indicated. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

BACKGROUND This study evaluates predictors of BRCA1/2 testing among breast and ovarian cancer survivors who received genetic counseling as part of a randomized trial and evaluates moderators of counseling mode on testing uptake. METHODS Predictors of BRCA1/2 testing within 1-year post-counseling were evaluated using multivariable logistic regression in a population-based sample of breast and ovarian cancer survivors at increased hereditary risk randomly assigned to in-person (IPC; n = 379) vs. telephone counseling (TC; n = 402). Variables that moderated the association between counseling mode and testing were identified by subgroup analysis. RESULTS Testing uptake was associated with higher perceived comparative mutation risk (OR = 1.32, 95% CI = 1.11, 1.57) in the adjusted analysis. Those without cost barriers had higher testing uptake (OR = 18.73, 95% CI = 7.09, 49.46). Psychological distress and perceived comparative mutation risk moderated the effect of counseling and testing. Uptake between IPC vs. TC did not differ at low levels of distress and risk, but differed at high distress (26.3% TC vs. 44.3% IPC) and high perceived comparative risk (33.9% TC vs. 50.5% IPC). CONCLUSIONS Cost concerns are a strong determinant of testing. Differences in testing uptake by counseling mode may depend on pre-counseling distress and risk perceptions. IMPACT Cost concerns may contribute to low testing in population-based samples of at risk cancer survivors. Pre-counseling psychosocial characteristics should be considered when offering in-person vs. telephone counseling.

NCT03326713; clinicaltrials.gov.

BackgroundThe paper examines the role of community-based participatory research (CBPR) within the context of social justice literature and practice.MethodsTwo CBPR case studies addressing health inequities related to Type 2 Diabetes and Cardiovascular disease were selected from a national cross-site study assessing effective academic-community research partnerships. One CBPR partnership works with African Americans in rural Pemiscot County, Missouri and the other CBPR partnership works with African American and Latinos in urban South Bronx, New York City. Data collection included semi-structured key informant interviews and focus groups. Analysis focused on partnerships’ context/history and their use of multiple justice-oriented strategies to achieve systemic and policy changes in order to address social determinants of health in their communities.ResultsCommunity context and history shaped each partnership’s strategies to address social determinants. Four social justice approaches (identity/recognition, procedural, distributive, and structural justice) used by both partnerships were identified. These social justice approaches were employed to address underlying causes of inequitable distribution of resources and power structures, while remaining within a scientific research framework.ConclusionCBPR can bridge the role of science with civic engagement and political participation, empowering community members to become political agents who integrate evidence into their social justice organizing strategies.