Melody Goodman
Melody Goodman
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Interim Dean, School of Global Public Health
Professor of Biostatistics
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Professional overview
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Dr. Melody S. Goodman is a biostatistician and research methodologist. Her research interest is identifying the origins of health inequities and developing, as necessary, evidence-informed primary prevention strategies to reduce these health inequities. Dr. Goodman’s research efforts seek to develop a more rigorous understanding of the social risk factors contributing to urban health inequities to develop culturally competent, region-specific solutions through collaborative activities with community members, community-based organizations, faith-based organizations, and other community health stakeholders. Her work aims to develop solutions for improving health in minoritized and medically underserved communities.
Dr. Goodman led the team that developed and comprehensively evaluated the Research Engagement Survey Tool, a quantitative survey measure to assess the level of community engagement in research studies from the community partner perspective. She is the Founding Director of the Center for Antiracism, Social Justice, & Public Health. With numerous funders supporting her work (e.g., National Institutes of Health, Robert Wood Johnson Foundation, Verizon Foundation, Long Island Community Foundation, Patient-Centered Outcomes Research Institute, and Susan G. Komen), she has published over 100 peer-reviewed journal articles and two books (2018 Routledge/Taylor & Francis Group): 1) Public Health Research Methods for Partnerships and Practice and 2) Biostatistics for Clinical and Public Health Research. She is a Fellow of the American Statistical Association and the inaugural recipient of the Societal Impact Award from the Caucus for Women in Statistics (2021).
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Education
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BS, Economics and Applied Mathematics & Statistics, State University of New York at Stony Brook, Stony Brook, NYMS, Biostatistics, Harvard University, Cambridge, MAPhD, Biostatistics (Minors: Social Determinants of Health Disparities and Theoretical Statistics), Harvard University, Cambridge, MA
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Honors and awards
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Fellow, American Statistical Association (2021)Societal Impact Award, Caucus for Women in Statistics (2021)Network Builder Award, Robert Wood Johnson Foundation New Connections (2019)Siteman Cancer Center “Rock Doc” (2013)Satcher Health Leadership Institute - Morehouse School of Medicine, Community Health Leadership Institute Intensive Cohort II (2013)Women of the Year - Health, National Coalition of 100 Black Women, Inc. - Suffolk Chapter (2010)President’s Award for Teaching Excellence - Stony Brook University (2009)President’s Award for Excellence in Team Achievement - Stony Brook University (2008)
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Areas of research and study
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BiostatisticsCommunity HealthCommunity-based Participatory ResearchDissemination and Implementation of Evidence-based ProgramsHealth DisparitiesHealth EquityMinoritiesMinority HealthQuantitative Research
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Publications
Publications
Public Health Research Methods for Partnerships and Practice
AbstractAbstractTranslating research into practice involves creating interventions that are relevant to improving the lives of a target population. Community engaged research has emerged as an evidence-based approach to better address the complex issues that affect the health of marginalized populations. Written by leading community-engaged researchers across disciplines, each chapter covers a different topic with comprehensive guides for start-to-finish planning and execution. The book provides a training curriculum that supports a common vision among stakeholders as well as a survey of methods based on core MPH curriculum. Practical appendices and homework samples can be found online. Public Health Research Methods for Partnerships and Practice will appeal to researchers and practitioners in community or government sectors interested in conducting community-engaged work.Quantitative research methods
AbstractGoodman, M. S., & Zhang, L. (n.d.). In Public Health Research Methods for Partnerships and Practice (1–).Publication year
2017Page(s)
188-219AbstractQuantitative research methods are often used in public health research and evaluation to determine the needs of a community or population, examine associations among multiple factors, and compare outcomes across subpopulations based on demographic characteristics (e.g., age, gender, race, education, income). Quantitative data and analysis can be used to provide strong evidence, but a basic understanding of the use and misuse of approaches is necessary to understand and interpret data. In this chapter, we discuss the strengths and weaknesses of quantitative research methods with a focus on survey research, questionnaire design, graphic methods, sampling methods, hypothesis testing, p-values, and odds ratios. The key elements and terminology (e.g., validity, reliability) of quantitative research methods and areas for concern (e.g., bias) are defined. Real-world examples are used to demonstrate concepts.Reducing health disparities by removing cost, access, and knowledge barriers
AbstractGoodman, M., Onwumere, O., Milam, L., & Peipert, J. F. (n.d.).Publication year
2017Journal title
American Journal of Obstetrics and GynecologyVolume
216Issue
4Page(s)
382.e1-382.e5AbstractBackground While the rate of unintended pregnancy has declined in the United States in recent years, unintended pregnancy among teens in the United States is the highest among industrialized nations, and disproportionately affects minority teens. Objective Our objective of this secondary analysis was to estimate the risk of unintended pregnancy for both Black and White teens age 15-19 years when barriers to access, cost, and knowledge are removed. Our hypothesis was that the Black-White disparities would be reduced when access, education, and cost barriers are removed. Study Design We performed an analysis of the Contraceptive CHOICE Project database. CHOICE is a longitudinal cohort study of 9256 sexually active girls and women ages 14-45 years in the St Louis, MO, region from 2007 through 2013. Two measures of disparities were used to analyze teenage pregnancy rates and pregnancy risk from 2008 through 2013 among teens ages 15-19 years. These rates were then compared to the rates of pregnancy among all sexually active teens in the United States during the years 2008, 2009, 2010, and 2011. We estimated an absolute measure (rate difference) and a relative measure (rate ratio) to examine Black-White disparities in the rates of unintended pregnancy. Results While national rates of unintended pregnancy are decreasing, racial disparities in these rates persist. The Black-White rate difference dropped from 158.5 per 1000 in 2008 to 120.1 per 1000 in 2011; however, the relative ratio disparity decreased only from 2.6-2.5, suggesting that Black sexually active teens in the United States have 2.5 times the rate of unintended pregnancy as White teenagers. In the CHOICE Project, there was a decreasing trend in racial disparities in unintended pregnancy rates among sexually active teens (age 15-19 years): 2008 through 2009 (rate difference, 18.2; rate ratio, 3.7), 2010 through 2011 (rate difference, 4.3; rate ratio, 1.2), and 2012 through 2013 (rate difference, –1.5; rate ratio, 1.0). Conclusion When barriers to cost, access, and knowledge were removed, such as in the Contraceptive CHOICE Project, Black-White disparities in unintended pregnancy rates among sexually active teens were reduced on both absolute and relative scales. The rate of unintended pregnancy was almost equal between Black and White teens compared to large Black-White disparities on the national level.Systematic Review of Quantitative Measures of Stakeholder Engagement
Bowen, D. J., Hyams, T., Goodman, M., West, K. M., Harris-Wai, J., & Yu, J. H. (n.d.).Publication year
2017Journal title
Clinical and translational scienceVolume
10Issue
5Page(s)
314-336Breast reconstruction after mastectomy at a comprehensive cancer center
AbstractConnors, S. K., Goodman, M. S., Myckatyn, T., Margenthaler, J., & Gehlert, S. (n.d.).Publication year
2016Journal title
SpringerPlusVolume
5Issue
1AbstractBackground: Breast reconstruction after mastectomy is an integral part of breast cancer treatment that positively impacts quality of life in breast cancer survivors. Although breast reconstruction rates have increased over time, African American women remain less likely to receive breast reconstruction compared to Caucasian women. National Cancer Institute-designated Comprehensive Cancer Centers, specialized institutions with more standardized models of cancer treatment, report higher breast reconstruction rates than primary healthcare facilities. Whether breast reconstruction disparities are reduced for women treated at comprehensive cancer centers is unclear. The purpose of this study was to further investigate breast reconstruction rates and determinants at a comprehensive cancer center in St. Louis, Missouri. Methods: Sociodemographic and clinical data were obtained for women who received mastectomy for definitive surgical treatment for breast cancer between 2000 and 2012. Logistic regression was used to identify factors associated with the receipt of breast reconstruction. Results: We found a breast reconstruction rate of 54 % for the study sample. Women who were aged 55 and older, had public insurance, received unilateral mastectomy, and received adjuvant radiation therapy were significantly less likely to receive breast reconstruction. African American women were 30 % less likely to receive breast reconstruction than Caucasian women. Conclusion: These findings suggest that racial disparities in breast reconstruction persist in comprehensive cancer centers. Future research should further delineate the determinants of breast reconstruction disparities across various types of healthcare institutions. Only then can we develop interventions to ensure all eligible women have access to breast reconstruction and the improved quality of life it affords breast cancer survivors.Comparing treatment and outcomes of ductal carcinoma in situ among women in Missouri by race
AbstractMadubata, C. C., Liu, Y., Goodman, M. S., Yun, S., Yu, J., Lian, M., & Colditz, G. A. (n.d.).Publication year
2016Journal title
Breast Cancer Research and TreatmentVolume
160Issue
3Page(s)
563-572AbstractPurpose: To investigate whether treatment (surgery, radiation therapy, and endocrine therapy) contributes to racial disparities in outcomes of ductal carcinoma in situ (DCIS). Patients and methods: The analysis included 8184 non-Hispanic White and 954 non-Hispanic Black women diagnosed with DCIS between 1996 and 2011 and identified in the Missouri Cancer Registry. Logistic regression models were used to estimate odds ratios (ORs) of treatment for race. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) of ipsilateral breast tumor (IBT) and contralateral breast tumor (CBT) for race. Results: There was no significant difference between Black and White women in utilization of mastectomy (OR 1.16; 95 % CI 0.99–1.35) or endocrine therapy (OR 1.19; 95 % CI 0.94–1.51). Despite no significant difference in underutilization of radiation therapy (OR 1.14; 95 % CI 0.92–1.42), Black women had higher odds of radiation delay, defined as at least 8 weeks between surgery and radiation (OR 1.92; 95 % CI 1.55–2.37). Among 9138 patients, 184 had IBTs and 326 had CBTs. Black women had a higher risk of IBTs (HR 1.69; 95 % CI 1.15–2.50) and a comparable risk of CBTs (HR 1.19; 95 % CI 0.84–1.68), which were independent of pathological features and treatment. Conclusion: Racial differences in DCIS treatment and outcomes exist in Missouri. This study could not completely explain the higher risk of IBTs in Black women. Future studies should identify differences in timely initiation and completion of treatment, which may contribute to the racial difference in IBTs after DCIS.Differences in preferences for models of consent for biobanks between Black and White women
AbstractBrown, K. M., Drake, B. F., Gehlert, S., Wolf, L. E., DuBois, J., Seo, J., Woodward, K., Perkins, H., Goodman, M. S., & Kaphingst, K. A. (n.d.).Publication year
2016Journal title
Journal of Community GeneticsVolume
7Issue
1Page(s)
41-49AbstractBiobanks are essential resources, and participation by individuals from diverse groups is needed. Various models of consent have been proposed for secondary research use of biospecimens, differing in level of donor control and information received. Data are needed regarding participant preferences for models of consent, particularly among minorities. We conducted qualitative semi-structured interviews with 60 women to examine their attitudes about different models of consent. Recruitment was stratified by race (Black/White) and prior biobank participation (yes/no). Two coders independently coded interview transcripts. Qualitative thematic analysis was conducted using NVivo 10. The majority of Black and White participants preferred “broad” consent (i.e., blanket permission for secondary research use of biospecimens), and the second most preferred model for both groups was “study-specific” consent (i.e., consent for each future research study). The qualitative analysis showed that participants selected their most preferred model for 3 major reasons: having enough information, having control over their sample, and being asked for permission. Least preferred was notice model (i.e., participants notified that biospecimens may be used in future research). Attitudes toward models of consent differed somewhat by race and prior biobank participation. Participants preferred models of consent for secondary research use of biospecimens that provided them with both specific and general information, control over their biospecimens, and asked them to give permission for use. Our findings suggest that it will be important for researchers to provide information about future uses of biospecimens to the extent possible and have an explicit permission step for secondary research use.Does learning about race prevent substance abuse? Racial discrimination, racial socialization and substance use among African Americans
Thompson, A. B., Goodman, M. S., & Kwate, N. O. A. (n.d.).Publication year
2016Journal title
Addictive BehaviorsVolume
61Page(s)
1-7Estimates of mental health problems in a vulnerable population within a primary care setting
AbstractHudson, D. L., Kaphingst, K. A., Croston, M. A., Blanchard, M. S., & Goodman, M. S. (n.d.).Publication year
2016Journal title
Journal of health care for the poor and underservedVolume
27Issue
1Page(s)
308-326AbstractWe examined the prevalence of mental disorders in a primary care setting affiliated with a large academic medical center. We also examined whether there were racial differences in mental health disorders. Patients were seeking medical care in an outpatient medical clinic; mental health data were available for them via medical records (n=767). Overall, 45% of patients had a diagnosed mental health problem; the most commonly reported form of mental disorder was depression. African Americans (OR= 1.88; CI: 1.21– 2.91) were more likely than Whites to have a diagnosed mental health problem. These results suggest a strong mental health treatment need among patients seeking primary care in urban settings. The evidence garnered from this study underscores the need to detect and treat mental health problems systematically within outpatient primary care clinics that serve similarly vulnerable populations.How, who, and when: Preferences for delivery of genome sequencing results among women diagnosed with breast cancer at a young age
AbstractKaphingst, K. A., Ivanovich, J., Elrick, A., Dresser, R., Matsen, C., & Goodman, M. S. (n.d.).Publication year
2016Journal title
Molecular Genetics and Genomic MedicineVolume
4Issue
6Page(s)
684-695AbstractBackground The increasing use of genome sequencing with patients raises a critical communication challenge: return of secondary findings. While the issue of what sequencing results should be returned to patients has been examined, much less attention has been paid to developing strategies to return these results in ways that meet patients’ needs and preferences. To address this, we investigated delivery preferences (i.e., who, how, when) for individual genome sequencing results among women diagnosed with breast cancer at age 40 or younger. Methods We conducted 60 semistructured, in-person individual interviews to examine preferences for the return of different types of genome sequencing results and the reasons underlying these preferences. Two coders independently coded interview transcripts; analysis was conducted using NVivo 10. Results The major findings from the study were that: (1) many participants wanted sequencing results as soon as possible, even at the time of breast cancer diagnosis; (2) participants wanted an opportunity for an in-person discussion of results; and (3) they put less emphasis on the type of person delivering results than on the knowledge and communicative skills of that person. Participants also emphasized the importance of a results return process tailored to a patient’s individual circumstances and one that she has a voice in determining. Conclusions A critical goal for future transdisciplinary research including clinicians, patients, and communication researchers may be to develop decision-making processes to help patients make decisions about how they would like various sequencing results returned.Importance of race and ethnicity in individuals' use of and responses to genomic information
Kaphingst, K. A., & Goodman, M. S. (n.d.).Publication year
2016Journal title
Personalized MedicineVolume
13Issue
1Page(s)
1-4Preferences for return of incidental findings from genome sequencing among women diagnosed with breast cancer at a young age
AbstractKaphingst, K. A., Ivanovich, J., Biesecker, B. B., Dresser, R., Seo, J., Dressler, L. G., Goodfellow, P. J., & Goodman, M. S. (n.d.).Publication year
2016Journal title
Clinical GeneticsVolume
89Issue
3Page(s)
378-384AbstractWhile experts have made recommendations, information is needed regarding what genome sequencing results patients would want returned. We investigated what results women diagnosed with breast cancer at a young age would want returned and why. We conducted 60 semi-structured, in-person individual interviews with women diagnosed with breast cancer at age 40 or younger. We examined interest in six types of incidental findings and reasons for interest or disinterest in each type. Two coders independently coded interview transcripts; analysis was conducted using NVivo 10. Most participants were at least somewhat interested in all six result types, but strongest interest was in actionable results (i.e. variants affecting risk of a preventable or treatable disease and treatment response). Reasons for interest varied between different result types. Some participants were not interested or ambivalent about results not seen as currently actionable. Participants wanted to be able to choose what results are returned. Participants distinguished between types of individual genome sequencing results, with different reasons for wanting different types of information. The findings suggest that a focus on actionable results can be a common ground for all stakeholders in developing a policy for returning individual genome sequencing results.Racial and ethnic heterogeneity in self-reported diabetes prevalence trends across hispanic subgroups, National Health Interview Survey, 1997-2012
AbstractArroyo-Johnson, C., Mincey, K. D., Ackermann, N., Milam, L., Goodman, M. S., & Colditz, G. A. (n.d.).Publication year
2016Journal title
Preventing Chronic DiseaseVolume
13Issue
1AbstractIntroduction: We examined racial/ethnic heterogeneity in self-reported diabetes prevalence over 15 years. Methods: We used National Health Interview Survey data for 1997 through 2012 on 452,845 adults aged 18 years or older. Annual self-reported diabetes prevalence was estimated by race/ethnicity and education. We tested for trends over time by education and race/ethnicity. We also analyzed racial/ethnic and education trends in average annual prevalence. Results: During the 15 years studied, diabetes prevalence differed significantly by race/ethnicity (P < .001) and by Hispanic subgroup (P < .001). Among participants with less than a high school education, the 5-year trend in diabetes prevalence was highest among Cubans and Cuban Americans (β5YR = 4.8, P = .002), Puerto Ricans (β5YR = 2.2, P = .06), non-Hispanic blacks (β5YR = 2.2, P < .001), and non-Hispanic whites (β5YR = 2.1, P < .001). Among participants with more than a high school education, non-Hispanic blacks had the highest average annual prevalence (5.5%) and Puerto Ricans had the highest 5-year trend in annual diabetes prevalence (β5YR = 2.6, P = .001). Conclusions: In this representative sample of US adults, results show ethnic variations in diabetes prevalence. The prevalence of diabetes is higher among Hispanics than among non-Hispanic whites, unevenly distributed across Hispanic subgroups, and more pronounced over time and by education. Findings support disaggregation of data for racial/ethnic populations in the United States to monitor trends in diabetes disparities and the use of targeted, culturally appropriate interventions to prevent diabetes.Relationship Between Health Literacy and Unintentional and Intentional Medication Nonadherence in Medically Underserved Patients With Type 2 Diabetes
AbstractFan, J. H., Lyons, S. A., Goodman, M. S., Blanchard, M. S., & Kaphingst, K. A. (n.d.).Publication year
2016Journal title
Diabetes EducatorVolume
42Issue
2Page(s)
199-208AbstractPurpose: The purpose of this study was to investigate the relationship between health literacy and overall medication nonadherence, unintentional nonadherence, and intentional nonadherence. Limited health literacy may be associated with worse diabetes outcomes, but the literature shows mixed results, and mechanisms remain unclear. Medication adherence is associated with diabetes outcomes and may be a mediating factor. Distinguishing between unintentional and intentional nonadherence may elucidate the relationship between health literacy and nonadherence in patients with type 2 diabetes. Methods: Cross-sectional study of 208 patients with type 2 diabetes recruited from a primary care clinic in St. Louis, Missouri. Information was obtained from written questionnaire and patient medical records. Bivariate and multivariable regression were used to examine predictors of medication nonadherence. Results: The majority of patients in the study were low income, publicly insured, and African American, with limited health literacy and a high school/GED education or less. In multivariable models, limited health literacy was significantly associated with increased unintentional nonadherence but not intentional nonadherence. Conclusions: Results suggest differences in factors affecting intentional and unintentional nonadherence. The findings also suggest interventions are needed to decrease unintentional nonadherence among patients with type 2 diabetes and limited health literacy. Efforts to address unintentional medication nonadherence among patients with type 2 diabetes with limited health literacy may improve patient health.Relationships between health literacy and genomics-related knowledge, self-efficacy, perceived importance, and communication in a medically underserved population
AbstractKaphingst, K. A., Blanchard, M., Milam, L., Pokharel, M., Elrick, A., & Goodman, M. S. (n.d.).Publication year
2016Journal title
Journal of Health CommunicationVolume
21Page(s)
58-68AbstractThe increasing importance of genomic information in clinical care heightens the need to examine how individuals understand, value, and communicate about this information. Based on a conceptual framework of genomics-related health literacy, we examined whether health literacy was related to knowledge, self-efficacy, and perceived importance of genetics and family health history (FHH) and communication about FHH in a medically underserved population. The analytic sample was composed of 624 patients at a primary care clinic in a large urban hospital. About half of the participants (47%) had limited health literacy; 55% had no education beyond high school, and 58% were Black. In multivariable models, limited health literacy was associated with lower genetic knowledge (β = -0.55, SE = 0.10, p <.0001), lower awareness of FHH (odds ratio [OR] = 0.50, 95% confidence interval [CI; 0.28, 0.90], p =.020), and greater perceived importance of genetic information (OR = 1.95, 95% CI [1.27, 3.00], p =.0022) but lower perceived importance of FHH information (OR = 0.47, 95% CI [0.26, 0.86], p =.013) and more frequent communication with a doctor about FHH (OR = 2.02, 95% CI [1.27, 3.23], p =.0032). The findings highlight the importance of considering domains of genomics-related health literacy (e.g., knowledge, oral literacy) in developing educational strategies for genomic information. Health literacy research is essential to avoid increasing disparities in information and health outcomes as genomic information reaches more patients.Still Separate, Still Unequal: Social Determinants of Playground Safety and Proximity Disparities in St. Louis
AbstractArroyo-Johnson, C., Woodward, K., Milam, L., Ackermann, N., Komaie, G., Goodman, M. S., & Hipp, J. A. (n.d.).Publication year
2016Journal title
Journal of Urban HealthVolume
93Issue
4Page(s)
627-638AbstractPhysical activity among youth is shaped by the natural and built environment within which they live; however, few studies have focused on assessing playground safety and proximity in detail as part of the built environment for youth physical activity. We analyzed data on 100 publicly accessible playgrounds from Play Across St. Louis, a community-partnered study of the built environment for youth physical activity. Outcomes included overall playground safety, maintenance, and construction scores; distance to nearest playground; and distance to nearest top playground. Independent variables included neighborhood % youth, % black residents, % owner-occupied units, and % vacant units. Playgrounds in the city have varying degrees of safety and proximity. Mean overall playground safety score was 67.0 % (CI = 63.5, 70.4). Neighborhood % youth and % black residents were inversely associated with overall playground safety (p = 0.03 and p < 0.01) and maintenance (p < 0.01 and p < 0.0001). Mean distance to nearest playground was 638.1 and 1488.3 m to nearest top playground. Clusters of low safety scores were found in the northern and central areas while all high safety score clusters were found in the southern part of St. Louis. Public playground safety and proximity vary across St. Louis neighborhoods, especially by neighborhood demographics. Disparities in playground safety and proximity reveal an opportunity to develop community-wide interventions focused on playgrounds for youth activity. Further work is needed to examine the association between playground safety, proximity, and use and youth physical activity and weight.A Community Coalition to Address Cancer Disparities: Transitions, Successes and Challenges
AbstractThompson, V. L., Drake, B., James, A. S., Norfolk, M., Goodman, M., Ashford, L., Jackson, S., Witherspoon, M., Brewster, M., & Colditz, G. (n.d.).Publication year
2015Journal title
Journal of Cancer EducationVolume
30Issue
4Page(s)
616-622AbstractCommunity-based participatory (CBP) strategies are considered important to efforts to eliminate disparities. This paper outlines how the Program for the Elimination of Cancer Disparities (PECaD) uses CBP strategies as a part of a long-term cancer education, prevention, and control strategy in an urban community. Community partnerships have proved to be vital resources to inform PECaD’s agenda and the research practice of academic partners. We begin with a description of PECaD governance and partnership structures. The paper then describes programmatic activities and successes, including efforts to monitor clinical trials, deployment of mammography resources, anti-smoking, and prostate and colorectal cancer (CRC) screening education. The influence of changes in funding priorities, preventive screening policy, and community partner development on the partnership process over time is discussed. PECaD community partners have grown and expanded beyond the Program’s mission and developed additional partnerships, resulting in a reevaluation of relationships. The impact of these external and internal changes and pressures on the partnerships are noted. The evolution of the evaluation process and what it has revealed about needed improvements in PECaD activities and operations is presented. A summary of the lessons learned and their implications for CBP practice are provided.A Community-Based Partnership to Successfully Implement and Maintain a Breast Health Navigation Program
AbstractDrake, B. F., Tannan, S., Anwuri, V. V., Jackson, S., Sanford, M., Tappenden, J., Goodman, M. S., & Colditz, G. A. (n.d.).Publication year
2015Journal title
Journal of Community HealthVolume
40Issue
6Page(s)
1216-1223AbstractBreast cancer screening combined with follow-up and treatment reduces breast cancer mortality. However, in the study clinic, only 12 % of eligible women ≥40 years received a mammogram in the previous year. The objective of this project was to implement patient navigation, in our partner health clinic to (1) identify women overdue for a mammogram; and (2) increase mammography utilization in this population over a 2-year period. Women overdue for a mammogram were identified. One patient navigator made navigation attempts over a 2-year period (2009–2011). Navigation included working around systems- and individual-level barriers to receive a mammogram as well as the appropriate follow-up post screening. Women were contacted up to three times to initiate navigation. The proportion of women navigated and who received a mammogram during the study period were compared to women who did not receive a mammogram using Chi square tests for categorical variables and t tests for continuous variables with an α = 0.05. Barriers to previous mammography were also assessed. With 94.8 % of eligible women navigated and 94 % of these women completing mammography, the implementation project reached 89 % of the target population. This project was a successful implementation of an evidence-based patient navigation program that continues to provide significant impact in a high-need area. Cost was the most commonly cite barrier to mammography. Increasing awareness of resources in the community for mammography and follow-up care remains a necessary adjunct to removing structural and financial barriers to accessing preventive services.A tale of two community networks program centers: Operationalizing and assessing CBPR principles and evaluating partnership outcomes
AbstractArroyo-Johnson, C., Allen, M. L., Colditz, G. A., Ali Hurtado, G., Davey, C. S., Thompson, V. L., Drake, B. F., Svetaz, M. V., Rosaslee, M., & Goodman, M. S. (n.d.).Publication year
2015Journal title
Progress in Community Health Partnerships: Research, Education, and ActionVolume
9Page(s)
61-69AbstractBackground: Community Networks Program (CNP) centers are required to use a community-based participatory research (CBPR) approach within their specific priority communities. Not all communities are the same and unique contextual factors and collaborators’ priorities shape each CBPR partnership. There are also established CBPR and community engagement (CE) principles shown to lead to quality CBPR in any community. However, operationalizing and assessing CBPR principles and partnership outcomes to understand the conditions and processes in CBPR that lead to achieving program and project level goals is relatively new in the science of CBPR. Objectives: We sought to describe the development of surveys on adherence to and implementation of CBPR/CE principles at two CNP centers and examine commonalities and differences in program- versus project-level CBPR evaluation. Methods: A case study about the development and application of CBPR/CE principles for the Missouri CNP, Program for the Elimination of Cancer Disparities, and Minnesota CNP, Padres Informados/Jovenes Preparados, surveys was conducted to compare project versus program operationalization of principles. Survey participant demographics were provided by CNP. Specific domains found in CBPR/CE principles were identified and organized under an existing framework to establish a common ground. Operational definitions and the number of survey items were provided for each domain by CNP. Conclusion: There are distinct differences in operational definitions of CBPR/CE principles at the program and project levels of evaluation. However, commonalities support further research to develop standards for CBPR evaluation across partnerships and at the program and project levels.Breast Cancer Treatment among African American Women in North St. Louis, Missouri
AbstractConnors, S. K., Goodman, M. S., Noel, L., Chavakula, N. N., Butler, D., Kenkel, S., Oliver, C., McCullough, I., & Gehlert, S. (n.d.).Publication year
2015Journal title
Journal of Urban HealthVolume
92Issue
1Page(s)
67-82AbstractSimilar to disparities seen at the national and state levels, African American women in St. Louis, Missouri have higher breast cancer mortality rates than their Caucasian counterparts. We examined breast cancer treatment (regimens and timing) in a sample of African American breast cancer patients diagnosed between 2000 and 2008 while residing in a North St. Louis cluster (eight zip codes) of late stage at diagnosis. Data were obtained from medical record extractions of women participating in a mixed-method study of breast cancer treatment experiences. The median time between diagnosis and initiation of treatment was 27 days; 12.2 % of the women had treatment delay over 60 days. These findings suggest that treatment delay and regimens are unlikely contributors to excess mortality rates for African American women diagnosed in early stages. Conflicting research findings on treatment delay may result from the inconsistent definitions of treatment delay and variations among study populations. Breast cancer treatment delay may reduce breast cancer survival; additional research is needed to better understand the points at which delays are most likely to occur and develop policies, programs, and interventions to address disparities in treatment delay. There may also be differences in treatment-related survivorship quality of life; approximately 54 % of the women in this sample treated with mastectomies received breast reconstruction surgery. Despite the high reconstruction rates, most women did not receive definitive completion. African American women have higher reconstruction complication rates than Caucasian women; these data provide additional evidence to suggest a disparity in breast reconstruction outcomes by race.Changes in symptoms during urologic chronic pelvic pain syndrome symptom flares: Findings from one site of the MAPP Research Network
AbstractSutcliffe, S., Colditz, G. A., Pakpahan, R., Bradley, C. S., Goodman, M. S., Andriole, G. L., & Lai, H. H. (n.d.).Publication year
2015Journal title
Neurourology and UrodynamicsVolume
34Issue
2Page(s)
188-195AbstractAims To provide the first description and quantification of symptom changes during interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome symptom exacerbations ("flares"). Methods Participants at one site of the Trans-Multidisciplinary Approaches to the study of chronic Pelvic Pain Epidemiology and Phenotyping Study completed two 10-day diaries over the 1-year study follow-up period, one at baseline and one during their first flare (if not at baseline). On each day of the diary, participants reported whether they were currently experiencing a flare, defined as "symptoms that are much worse than usual" for at least 1 day, and their levels of urination-related pain, pelvic pain, urgency, and frequency on a scale of 0-10. Linear mixed models were used to calculate mean changes in symptoms between non-flare and flare days from the same participant. Results Eighteen of 27 women and 9 of 29 men reported at least one flare during follow-up, for a total of 281 non-flare and 210 flare days. Of these participants, 44.4% reported one flare, 29.6% reported two flares, and 25.9% reported ≥3 flares over the combined 20-day diary observation period, with reported flares ranging in duration from 1 day to >2 weeks. During these flares, each of the main symptoms worsened significantly by a mean of at least two points and total symptoms worsened by a mean of 11 points for both sexes (all P ≤ 0.01). Conclusions Flares are common and correspond to a global worsening of urologic and pelvic pain symptoms. Neurourol. Urodynam. 34:188-195, 2015.Cross-sectional and longitudinal effects of racism on mental health among residents of Black neighborhoods in New York City
AbstractKwate, N. O. A., & Goodman, M. S. (n.d.).Publication year
2015Journal title
American journal of public healthVolume
105Issue
4Page(s)
711-718AbstractObjectives. We investigated the impact of reported racism on the mental health of African Americans at cross-sectional time points and longitudinally, over the course of 1 year. Methods. The Black Linking Inequality, Feelings, and the Environment (LIFE) Study recruited Black residents (n = 144) from a probability sample of 2 predominantly Black New York City neighborhoods during December 2011 to June 2013. Respondents completed self-report surveys, including multiple measures of racism. We conducted assessments at baseline, 2-month follow-up, and 1-year follow-up. Weighted multivariate linear regression models assessed changes in racism and health over time. Results. Cross-sectional results varied by time point and by outcome, with only some measures associated with distress, and effects were stronger for poor mental health days than for depression. Individuals who denied thinking about their race fared worst. Longitudinally, increasing frequencies of racism predicted worse mental health across all 3 outcomes. Conclusions. These results support theories of racism as a health-defeating stressor and are among the few that show temporal associations with health.Diagnostic accuracy of self-reported racial composition of residential neighborhood
AbstractHidalgo, B., Kaphingst, K. A., Stafford, J., Lachance, C., & Goodman, M. S. (n.d.).Publication year
2015Journal title
Annals of EpidemiologyVolume
25Issue
8Page(s)
597-604AbstractPurpose: To examine the diagnostic accuracy of self-reported measures of individuals' perceptions of the racial and ethnic composition of their communities with objective data (i.e., census) as the criterion standard and assess differences in concordance in subjective and objective measures of segregation by race and ethnicity. Methods: We examined data from 943 adult community health center visitors in Suffolk County, New York to assess differences between self-reported racial composition of current neighborhood and 2010 U.S. Census data. A cross-sectional convenience sample was obtained; questionnaires were used to compare participant responses about the racial composition of their current neighborhood and their town of residence. Results: Respondents who self-identified as white were more likely to self-report racial composition of their neighborhood consistent with 2010 Census estimates. Relative to census estimates, 93.1% of blacks overestimated the proportion of their current neighborhood that was black, and 69.8% of Hispanics overestimated the proportion that was Hispanic. Conclusions: There were statistically significant differences between the participants' self-reported neighborhood racial composition and census data across race and ethnicity groups. Future studies are needed to validate self-reported measures of individuals' perceptions of the racial and ethnic composition of their communities to examine the association between individual segregation experience and health.Do subjective measures improve the ability to identify limited health literacy in a clinical setting?
AbstractGoodman, M. S., Griffey, R. T., Carpenter, C. R., Blanchard, M., & Kaphingst, K. A. (n.d.).Publication year
2015Journal title
Journal of the American Board of Family MedicineVolume
28Issue
5Page(s)
584-594AbstractBackground: Existing health literacy assessments developed for research purposes have constraints that limit their utility for clinical practice, including time requirements and administration protocols. The Brief Health Literacy Screen (BHLS) consists of 3 self-administered Single-Item Literacy Screener (SILS) questions and obviates these clinical barriers. We assessed whether the addition of SILS items or the BHLS to patient demographics readily available in ambulatory clinical settings reaching underserved patients improves the ability to identify limited health literacy. Methods: We analyzed data from 2 cross-sectional convenience samples of patients from an urban academic emergency department (n = 425) and a primary care clinic (n = 486) in St. Louis, Missouri. Across samples, health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine- Revised (REALM-R), Newest Vital Sign (NVS), and the BHLS. Our analytic sample consisted of 911 adult patients, who were primarily female (62%), black (66%), and had at least a high school education (82%); 456 were randomly assigned to the estimation sample and 455 to the validation sample. Results: The analysis showed that the best REALM-R estimation model contained age, sex, education, race, and 1 SILS item (difficulty understanding written information). In validation analysis this model had a sensitivity of 62%, specificity of 81%, a positive likelihood ratio (LR+) of 3.26, and a negative likelihood ratio (LR-) of 0.47; there was a 28% misclassification rate. The best NVS estimation model contained the BHLS, age, sex, education and race; this model had a sensitivity of 77%, specificity of 72%, LR+ of 2.75, LR- of 0.32, and a misclassification rate of 25%. Conclusions: Findings suggest that the BHLS and SILS items improve the ability to identify patients with limited health literacy compared with demographic predictors alone. However, despite being easier to administer in clinical settings, subjective estimates of health literacy have misclassification rates >20% and do not replace objective measures; universal precautions should be used with all patients.Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients
AbstractSeo, J., Goodman, M. S., Politi, M., Blanchard, M., & Kaphingst, K. A. (n.d.).Publication year
2015Journal title
Medical Decision MakingVolume
36Issue
4Page(s)
550-556AbstractIntroduction. Participation in the decision-making process and health literacy may both affect health outcomes; data on how these factors are related among diverse groups are limited. This study examined the relationship between health literacy and decision-making preferences in a medically underserved population. Methods. We analyzed a sample of 576 primary care patients. Multivariable logistic regression was used to examine the independent association of health literacy (measured by the Rapid Estimate of Adult Literacy in Medicine-Revised) and patients' decision-making preferences (physician directed or patient involved), controlling for age, race/ethnicity, and gender. We tested whether having a regular doctor modified this association. Results. Adequate health literacy (odds ratio [OR] = 1.7; P = 0.009) was significantly associated with preferring patient-involved decision making, controlling for age, race/ethnicity, and gender. Having a regular doctor did not modify this relationship. Males were significantly less likely to prefer patient-involved decision making (OR = 0.65; P = 0.024). Discussion. Findings suggest health literacy affects decision-making preferences in medically underserved patients. More research is needed on how factors, such as patient knowledge or confidence, may influence decision-making preferences, particularly for those with limited health literacy.