Papers by Marjorie Kagawa-singer
Cancer Epidemiology, Biomarkers & Prevention, 2014
Culture is currently poorly defined and even more poorly operationalized in cancer research. Such... more Culture is currently poorly defined and even more poorly operationalized in cancer research. Such practice renders culture irrelevant to the risk factors known or suspected to impact disease prevalence, morbidity, and mortality in diverse population groups. Consequently, it is not surprising that analyses of study data finds culture to contribute negligible explanatory weight to the variance of health outcomes for diverse populations who bear an undue burden of cancer, and the opportunity to identify the pathways of this panhuman process remain invisible. Research studies miss scientifically-grounded concepts and methods that likely account for both population and individual variations in health outcomes. NIH's OBSSR funded a report to change science when researchers consider culture, a fundamental human process, as a factor in health outcomes. This report provides multiple scientifically proven approaches by which to integrate the dynamic and adaptive nature of culture into res...
Introduction Over 1,500 studies are in Medline today on the psychosocial impact and quality of li... more Introduction Over 1,500 studies are in Medline today on the psychosocial impact and quality of life (QOL) of breast cancer (BC) survivors. Only a small percentage of these studies have been conducted with women of color, yet most of these studies appear to use the same psycho-social theories for intervention and outcomes, developed and validated with non-Hispanic white women. This assumed universality of (EA) cultural beliefs and practices undermines the importance of cultural differences in cancer research. Often standardized questionnaires are tested for reliability in diverse groups with an α score, but many validated scales have rarely been tested for cross-cultural equivalence of concepts and metrics in diverse populations. The absence of research exploring and testing the cross cultural equivalence of EA developed concepts, such as, self-integrity and well-being of BC survivors thwarts our ability to effectively address the QOL of diverse populations, and hinders our ability to promote health equity. Therefore, this presentation will first briefly present a consensus definition of culture, second, discuss the general lack of attention to cross-cultural equivalence of concepts and measures used in cancer survivor research, last, present an example of a mixed paradigm and mixed method study designed to identify and test such potential cultural differences in among Asian American (AA) breast cancer (BC) survivors. AA BC survivors are reported to suffer significant emotional and social problems, but do not avail themselves of existing and available EA based services, even if they have been in the U.S. for multiple generations and/or are proficient in English. Yet, few studies have been conducted to identify why AA BC survivors do not use existing support services and how to better design high-quality programs that provide that needed support. Breast cancer support groups are designed to increase self-integrity, and well-being, but the cross-cultural equivalence of concepts of self-integrity and well-being have not been tested in breast cancer survivorship. Study Design This mixed paradigm and mixed method study was developed to 1) test the cultural equivalence and validity of standard measures of distress and well-being in order to investigate such potential cultural differences in the BC survivorship experience among three groups of Asian American women in three different geographic areas, 2) identify potential cultural differences in their perceptions of the cancer experience and degree of satisfaction with their strategies to manage the experience by providing context and meaning to our deductive findings, and 3) test if the cultural specific constructs and measures provide greater explanatory power to the QOL of the AA women than the set of standardized tools currently used. We conducted, in depth ethnographic interviews with 35 key informants, 118 BC survivors and 57 family members. We also surveyed 450 Chinese-, Japanese-, Vietnamese- and European American BC survivors. Implications for Health Disparities Research in Cancer The findings from this study will demonstrate how mixed-paradigms and methods are essential to develop a culturally informed understanding of the lives of women with cancer from diverse cultural backgrounds. Such study designs are crucial to inform the science and practice of BC survivorship in AA communities by mobilizing more culturally appropriate assessment tools built on culturally valid concepts and constructs. Such tools may aid in designing culturally grounded and congruent programs that more adequately meet the needs of those in underrepresented communities, and, thereby, improve the QOL of BC survivors from diverse populations as well as facilitate the elimination of health disparities. Citation Format: Marjorie Kagawa-Singer. How does Cultural Equivalence Impact Asian American Cancer Survivors? [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr IA17.
Psycho-oncology, Jul 1, 2015
Cancer, 2006
... This project represented the first time any Special Populations Network had submitted a hypot... more ... This project represented the first time any Special Populations Network had submitted a hypotheses ... under the guidance of AANCART senior faculty, thus expanding the 'pipeline' of new ... that are being produced will advance the field of Asian American cancer control research. ...
PubMed, 1993
Cancer treatment requires a comprehensive team of multidisciplinary health care professionals, an... more Cancer treatment requires a comprehensive team of multidisciplinary health care professionals, and especially nursing is central to provide the complementary care aspect of the cure objective. Nurses involved in cancer care provide public education about the disease, its prevention, screening and early diagnosis. Also they have an important role for patients with any stage of cancer. Oncology nursing as a specialty in the U.S.A. is relatively recent as an organized profession. There have been an increasing number of researches in this field, since the first national cancer nursing conference was held in 1973 and the first national Oncology Nursing Society Congress in 1975. Psychosocial issue is a major area in oncology nursing research, which is discussed in more details in this article.
We conducted a cross-cultural comparison of the recovery of sexual function and bother during the... more We conducted a cross-cultural comparison of the recovery of sexual function and bother during the first 2 years after radical prostatectomy (RP) between American and Japanese men. A total of 275 Japanese and 283 American men who underwent RP alone were prospectively enrolled into longitudinal cohort studies of health-related quality of life outcomes. Sexual function and bother (distress) were estimated with English and validated Japanese versions of the UCLA Prostate Cancer Index before RP and 1, 2-3, 4-6, 12, 18 and 24 months after RP. Each subject served as his own control. Japanese men reported lower sexual function scores at baseline, even after adjusted for age, prostate-specific antigen (PSA) and comorbidity (38 vs 61, Po0.001). The two groups had similar baseline sexual bother (70 vs 69, P ¼ 0.84). Japanese men had a smaller improvement in sexual function (b ¼ 0.8 vs b ¼ 5.3) and bother (b ¼ 0.2 vs b ¼ 2.9) over time than did the American men postoperatively, after adjusting for baseline score, age, baseline PSA and nerve-sparing. American men were more likely than Japanese men to regain their baseline sexual function by 24 months after surgery (hazard ratio (HR) ¼ 1.60; 95% confidence interval (CI) ¼ 1.06-2.42). In contrast, American men were less likely than Japanese men to return to baseline sexual bother (HR ¼ 0.57; 95% CI ¼ 0.44-0.75). This study demonstrates that Japanese and American men experience different patterns of recovery of their sexual function and bother after RP. Ethnicity may be a contributing factor.
PubMed, Oct 1, 2000
To describe how multicultural knowledge and skills are applied in culturally competent practice t... more To describe how multicultural knowledge and skills are applied in culturally competent practice to develop and deliver available, accessible, acceptable, and appropriate programs in early cancer detection and screening programs in ethnic communities. Literature and clinical community practice reports. Successful community screening programs can be conducted within ethnic minority populations. Practitioners must tailor care based on salient cultural differences of the population of focus. Culturally based practice results in the (a) increased ability to think critically in community and individual assessments, (b) development of more accurate program plans and designs, and (c) increased likelihood that appropriate outcomes will be used in the evaluation of care. Greater cultural competence increases the accuracy of care and thereby its effectiveness, efficiency, and success in providing acceptable and optimal programs. The first step in a cultural assessment is to know one's own beliefs and attitudes. The second step, conducted in parallel, requires knowledge about the groups that make up the patient and staff populations within the practice setting and then integrating those perspectives into practice. Practitioners then can begin the third step of negotiation of all stages of the project with members of the various communities on an equal basis that recognizes the expertise and integrity of all parties.
Journal of Public Health Policy, 1997
... Social Science and Medicine, 33 ( 3), 37-45. -xxviii-. I Poverty and Adolescent Health. LaRue... more ... Social Science and Medicine, 33 ( 3), 37-45. -xxviii-. I Poverty and Adolescent Health. LaRue Allen and Christina M. Mitchell. An adolescent lacking money in the United States is at increased risk for getting sick, having no medical care, and dying young ( Miller & Coulter, 1984). ...
SAGE Publications Ltd eBooks, Feb 17, 2017
PubMed, Sep 1, 1998
Purpose/objectives: To describe the process of establishing a multisite team to conduct research ... more Purpose/objectives: To describe the process of establishing a multisite team to conduct research with a multicultural focus on fatigue. Data sources: Articles, book chapters, personal experience. Data synthesis: Teamwork facilitated development of a productive professional working group, sharing of resources, and data collection culminating in a research proposal for studying cancer-related fatigue in a multicultural population. Conclusions: Establishing a common goal by investing time, committing to the process, and establishing trust was the secret to effective team functioning. Implications for nursing practice: The prospect of multi-institutional collaboration has implications for oncology nurses in the areas of research and practice. Goals that could not be achieved easily in the setting of a single institution are reached more easily with multisite collaboration and teamwork.
Psycho-oncology, Jul 1, 2015
Prostate Cancer and Prostatic Diseases, Oct 2, 2007
We conducted a cross-cultural comparison of the recovery of sexual function and bother during the... more We conducted a cross-cultural comparison of the recovery of sexual function and bother during the first 2 years after radical prostatectomy (RP) between American and Japanese men. A total of 275 Japanese and 283 American men who underwent RP alone were prospectively enrolled into longitudinal cohort studies of health-related quality of life outcomes. Sexual function and bother (distress) were estimated with English and validated Japanese versions of the UCLA Prostate Cancer Index before RP and 1, 2-3, 4-6, 12, 18 and 24 months after RP. Each subject served as his own control. Japanese men reported lower sexual function scores at baseline, even after adjusted for age, prostate-specific antigen (PSA) and comorbidity (38 vs 61, Po0.001). The two groups had similar baseline sexual bother (70 vs 69, P ¼ 0.84). Japanese men had a smaller improvement in sexual function (b ¼ 0.8 vs b ¼ 5.3) and bother (b ¼ 0.2 vs b ¼ 2.9) over time than did the American men postoperatively, after adjusting for baseline score, age, baseline PSA and nerve-sparing. American men were more likely than Japanese men to regain their baseline sexual function by 24 months after surgery (hazard ratio (HR) ¼ 1.60; 95% confidence interval (CI) ¼ 1.06-2.42). In contrast, American men were less likely than Japanese men to return to baseline sexual bother (HR ¼ 0.57; 95% CI ¼ 0.44-0.75). This study demonstrates that Japanese and American men experience different patterns of recovery of their sexual function and bother after RP. Ethnicity may be a contributing factor.
Cancer disparities are differences in incidence, survival, and survivorship due to societal inequ... more Cancer disparities are differences in incidence, survival, and survivorship due to societal inequities, all of which disproportionately affect people of color and those of low socioeconomic status. For over 3 decades, research across a broad spectrum of disciplines has sought to measure, explain, and reduce cancer disparities—with little impact. One reason is that most of the research is conceived and conducted not by members of the affected communities, but by “outsiders” who have the privileges of education and opportunities at the highest levels of science and policy. Because most NIH-funded research is conducted by Euro-Americans, and populations of color are greatly under-represented among students who seek and attain advanced degrees and who succeed in the world of competitive science, the NIH established large and long-standing programs to diversify the research pipeline—in the STEM fields. No such support exists, however, for the translational population sciences of public health and social-behavioral research. These are the disciplines with the theories and methods needed to engage and to, among many other functions, communicate effectively with patients and the public about health, medical care, and participation in research. In 1998, an investigator-initiated NCI training grant established the Minority Training Program in Cancer Control Research (MTPCCR), with the goal of increasing diversity among students at the doctoral level in public health and social-behavioral research and subsequently among those conducting cancer disparities research. Through 4 successive grants over 20 years, the program was conducted in two sites (UCSF and UCLA), and a replication was established at U Texas (Exito!). The program model includes a five-day Summer Institute (SI) and paid research internships for those SI participants for whom a match could be made with a role model (under-represented) preceptor or researcher working on cancer disparities. The SI is a place where participants' ancestors and cultures are brought forward and honored, establishing a strong emotional bond among participants and with the staff/faculty. This is further strengthened by a series of highly interactive sessions. The first three SI days address the need for under-represented researchers and the range of opportunities and disciplines through which one can have a lasting impact on disparities. The last two days provide tools for applying to doctoral programs. The MTPCCR also provides Doctoral Application Support Awards designed to offset costs of the doctoral application process. A total of 759 master's-level students and professionals have participated in the MTPCCR. To date, 237 (33%) have entered doctoral programs (74 African American/Black, 6 American Indian, 82 Asian American, 45 Latino/Hispanic, 2 Native Hawaiian/Pacific Islander, 9 Other, 18 mixed race/ethnicity, 1 White), 138 of whom have now graduated. A large majority report that the program strongly influenced their academic path. Citation Format: Rena J. Pasick, Marjorie Kagawa-Singer, Sherry Kidd, Vanessa Mercado, Karen Llave. The bridge less traveled: Diversity training in public health and social/behavioral research [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA15.
BJUI, Oct 1, 2009
To assess the association of lower urinary tract symptoms (LUTS) with sexual function, and estima... more To assess the association of lower urinary tract symptoms (LUTS) with sexual function, and estimate the correlates of LUTS among Japanese and American men with localized prostate cancer. In all, 343 Japanese men and 307 American men with prostate cancer were enrolled in the study. Sexual function and sexual bother were measured separately with the University of California-Los Angeles Prostate Cancer Index and obstructive/irritative voiding symptoms were measured with the American Urological Association Symptom Index (AUA SI). Japanese men had worse sexual function scores than the American men before treatment, whereas no differences were reported between Japanese and American men in sexual bother scores. Japanese and American men also did not differ meaningfully in AUA SI. However, those with moderate to severe LUTS reported significantly worse sexual bother scores than those with mild symptoms in both Japanese and American men (P = 0.004 and <0.001, respectively). The Japanese men were more likely to have LUTS than were American men (odds ratio 1.60, P = 0.029). Age and sexual function were highly associated with LUTS (odds ratio 1.35, P = 0.027; and 0.652, P = 0.001, respectively). The comorbidity count was independently associated with worse urinary symptoms (odds ratio 1.23, P = 0.015). We posit that cultural differences in the meaning or salience of sexual functioning, and the interpretation of the questionnaire in quality-of-life surveys, might explain the different profiles in the association of LUTS with sexual activity in Japanese and American men with localized prostate cancer.
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Papers by Marjorie Kagawa-singer