African American Women’s Limited Knowledge and Experiences with Genetic Counseling for Hereditary Breast Cancer

Genetic counseling and testing for hereditary breast cancer have the potential benefit of early detection and early interventions in African American women. However, African American women have low use of these services compared to White women. We conducted two focus groups with African American women diagnosed with breast cancer (affected group, n?=?13) and women with at least one first-degree relative with breast/ovarian cancer (unaffected group, n?=?8). A content analysis approach was employed to analyze interview data. Breast cancer survivors had more knowledge about genetic counseling and testing than participants who were unaffected with cancer. However, knowledge about genetic counseling was limited in both groups. Barriers to pursuing genetic counseling and testing included poor understanding of the genetic counseling and testing process, fear of carrying the mutation, concerns about discrimination, and cost. Motivators to participate in genetic counseling and testing included desire to help family members, insurance coverage, and potential of benefiting the larger African American community. Education efforts are needed to increase genetic counseling and testing awareness in the African American community.     

Sexual Health Counselor Preferences of African American and European American Women: A Brief Report

African American women (n = 42) and European American women (n = 46) were queried regarding their comfort level discussing various sexual health topics with hypothetical counselors who were varied by race (African American vs. European American) or counseling value (culturally sensitive vs. knowledgeable). Contrary to hypotheses, European American participants were more comfortable with the knowledgeable African American counselor and the culturally sensitive European American counselor, while African American women showed no preference. Implications are discussed for improving sexual health counseling services for African American and European American women with consideration of client sexual attitude and race of counselor in order to reduce disparities in sexual health.     

Effects of Counseling and Ethnic Identity on Perceived Risk and Cancer Worry in African American Women

Improving breast screening behaviors in African American women is an important public health goal. To increase participation in screening, it is necessary to identify factors that contribute to reduced screening, including perceived risk and cancer worry. This paper presents predictors of changes perceived in risk and worry among African American women of differing ethnic identities as they undergo breast cancer risk counseling. Participants (n = 113) were recruited from community sources to a study of counseling for breast cancer risk. They completed a baseline assessment, randomly received breast cancer risk counseling or served as a control group, and completed a follow-up assessment. Counseling produced significant differences in perceived risk and cancer worry. Predictors of risk and worry changes, as a result of counseling, included income and ethnic identity. These data can guide better services for African American women and research into the complexity of the effects of ethnic identity on health.     

“Getting to Know”: Exploring How Urban African American Women Conceptualize Safer and Risky Sexual Behaviors

The surge in the rate of the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) cases continues to be most prevalent for African American women between the ages of 18 and 29, with heterosexual transmission remaining the primary cause of HIV spread for this population. The high rates of HIV/AIDS among African American women continue to emphasize the need for understanding how members of this population conceptualize sexual safety and risk. A qualitative research study using grounded theory methods was conducted to explore how African American women define safer and risky sexual behaviors. Interviews were conducted with 14 African American women between the ages of 18 and 29. The study findings suggest that African American women’s definitions of safer and risky sexual behaviors, while in a consensual sexual relationship, are consistently influenced by sex partner type. The information garnered from this study can help inform the development of HIV prevention strategies, health education, counseling and reproductive health services that support African American women’s wellness.     

Providers’ Perceptions and Practices Regarding <Emphasis Type="BoldItalic">BRCA1/2</Emphasis> Genetic Counseling and Testing in African American Women

We examined healthcare providers’ perceptions of genetic counseling and testing in African American women at moderate to high-risk of carrying a BRCA1/2 mutation. We conducted 20 in-depth interviews with genetic counselors (n = 5), medical oncologists (n = 8), obstetrician/gynecologists (n = 2) and surgeons (n = 5). Interviews were audiotaped, transcribed and independently coded by two individuals using a content analysis approach. Seven themes emerged relevant to providers’ perceptions of African American women’s use of BRCA1/2 genetic services: access factors, cultural beliefs and preferences, effects of testing, patient motivators for genetic counseling and testing, patient-provider communication, reasons for provider referral, and reasons for patient refusal. Providers identified individual- and system-level barriers to African American women’s use of genetic services, including lack of follow-up after referrals to genetic specialists and challenges to obtaining financial coverage for under- and uninsured high-risk women. Results have implications for physician and patient education regarding appropriate referrals to and uptake of genetic services in at-risk African American women.     

Womanist Spirituality as a Response to the Racism‐Sexism Double Bind in African American Women

Many African American women begin counseling stigmatized by race and gender and may be targets of additional discrimination on the basis of sexual orientation, class, age, and other social variables. In this article, the authors discuss “womanist” spirituality as a means for African American women to cope with racism, sexism, and multiple social stigmas.     

Factors Influencing Perceptions of Breast Cancer Genetic Counseling among Women in an Urban Health Care System

The study assessed perceptions of breast cancer genetic counseling. Focus groups were conducted with twenty women (ages < = 50 years) in a Midwestern, urban health system identified as at above average risk of developing hereditary breast cancer and referred for breast cancer genetic counseling following mammography. All participants associated the words “breast cancer” with fear. African American women who received breast cancer genetic counseling may have channeled their fear into increased vigilance related to breast health. African American women who did not receive breast cancer genetic counseling were most knowledgeable about it. In contrast, Caucasian women who did not receive it reported uncertainty about the role of genetic counseling and testing in assessing breast cancer risk, mistrust in medical professionals, and lack of trust in the accuracy of genetic tests. The results could be used to help develop interventions to improve informed decision-making regarding breast cancer genetic counseling.     

Low Rates of African American Participation in Genetic Counseling and Testing for BRCA1/2 Mutations: Racial Disparities or Just a Difference?

Low rates of genetic counseling among African American women have generated concerns about disparities; however, to the extent that women's decisions to accept or decline counseling are consistent with their values, then lower participation may reflect preferences and not disparities. We evaluated the extent to which women were satisfied with their decision about participating in genetic counseling for BRCA1/2 mutations and identified variables that were associated significantly with satisfaction. Prospective study of decision satisfaction with 135 African American women who had a minimum 5% prior probability of having a BRCA1/2 mutation. Decision satisfaction was evaluated one month after women were offered participation in genetic counseling using a structured questionnaire. Women were satisfied with their participation decision; more than 80% reported that their decision was consistent with their family values. However, women who declined pre-test counseling had significantly lower satisfaction scores. Our findings highlight the importance ensuring that racial differences that are due to preferences and values are not misclassified as disparities in order to identify and address the root causes of disparate treatment.     

Mental health service use by African American women: exploration of subpopulation differences

Studies focusing on mental health service use have consistently viewed African American women as a homogeneous population, and very few studies have examined subgroup differences. However, important differences exist both within and between groups in lifestyle, stressors, type and availability of support resources, societal interactions, and risk-taking behaviors. This study examined rates and patterns of mental health service use by African American lesbian women and a matched sample of heterosexual women. Results suggest both similarities and differences in factors associated with use of services. Despite evidence of substantial emotional distress, relatively few African American lesbian and heterosexual women reported current use of mental health services. These findings are consistent with past reports on African American heterosexual women but differ from other published reports on lesbians' use of therapy. Findings from this study, including clear differences between lesbians and heterosexual women in past use of therapy and preferences for mental health providers, have important implications for service provision.     

Counseling African American Women: Multiple Identities—Multiple Constraints

Multicultural counseling models have limitations in synthesizing multiple cultural variables such as race, gender, class, and sexual orientation. The author describes 3 multicultural models—Afrocentric, feminist, and “womanist”—and their application to psychotherapy with African American women. Using a case illustration of an African American lesbian client, the author offers strategies for assisting clients to integrate multiple cultural identities.     

Intimate partner violence against African American women: An examination of the socio-cultural context

Intimate partner violence (IPV) is a significant public health concern that affects an alarmingly high percentage of women. There is evidence to suggest that African American women are impacted by IPV at higher rates than are Caucasian women, yet little of the IPV literature addresses the cultural and structural factors that differentially affect African American and Caucasian couples. The present paper reviews the existing literature on IPV towards African American women, including prevalence, theories, risk factors for victimization, victims' psychological sequelae, barriers to service utilization, coping strategies, and interventions for survivors and perpetrators of IPV. Recommendations for counseling, research, and policy are explored.     

Participation in Breast Cancer Genetic Counseling: The Influence of Educational Level, Ethnic Background, and Risk Perception

Genetic counseling has been suggested as a means of providing information and support to women with a family history of breast cancer. Yet women who undergo cancer genetic counseling in the United States generally consist of only a subset of those at risk, namely well-educated, upper-middle class, European American and Jewish women. We report outcomes from a study that provided a unique opportunity to determine whether women of African American, European American, Native American, or Ashkenazi Jewish ancestry have varying interest in having cancer genetic counseling. The study offered a genetic counseling session to 97 women with a family history of breast cancer who were participating in a larger interview study designed to assess attitudes toward genetic testing for breast cancer. The study offered genetic counseling free of charge to all study participants with a family history of breast cancer, removing the potential barriers of cost, the need for a physician referral, and lack of awareness of genetic counseling. Fifty women out of the 97 women offered genetic counseling (52%) accepted the offer by completing a session. Those who accepted genetic counseling had a higher educational level, a higher perceived risk of breast cancer, and were more likely to expect a positive BRCA1 or BRCA2 genetic test if they were to undergo genetic testing. When controlling for education level, there was no correlation between the participants' ethnic background and acceptance of a genetic counseling session. Outreach efforts to minority populations may increase awareness of the availability of genetic counseling and may facilitate participation by such populations.     

Extreme Social Isolation, Use of Community-Based Senior Support Services, and Mortality Among African American Elderly Women

The effect of extreme social isolation and use of community-based senior services on longevity was examined in a national sample of African American elderly women (ages 55–96). Consistent with previous research on the social integration/mortality link, African American elderly women who were extremely socially isolated were hypothesized to have a higher 5-year mortality rate. It was also hypothesized that use of community senior services would be negatively associated with 5-year mortality. Results of logistic regression analysis controlling for age, education, income, and health status found that extremely socially isolated African American elderly women were three times more likely than the nonisolated women to die within the 5-year period from the initial survey. Use of community senior services did not have a relationship on mortality. Results are discussed in terms of directions for future research and intervention.     

Are Religious Women More Likely to Have Breast Cancer Screening?

The study objective was to investigate whether women who frequently attend religious services are more likely to have breast cancer screening—mammography and clinical breast examinations—than other women. Multivariate logistic regression models show that white women who attended religious services frequently had more than twice the odds of breast cancer screening than white women who attended less frequently (Odds Ratio (OR) = 2.61; 95% Confidence Interval (CI) = 1.12, 6.06). The behavior of white women was different from African American women (religious attendance-race interaction term p-value = 0.008); African American women who attended religious services frequently were possibly less likely to have breast cancer screening (OR 0.49; CI = 0.19–1.31).     

The Use of Self-Pleasure: Masturbation and Body Image among African American and European American Women

The current investigation examined the relationship between masturbation and body image among 96 women seeking services at a local family planning clinic in a mid-southern U.S. city. Participants completed a questionnaire that assessed body image and masturbatory practices. Ethnic differences were found with European American women reporting greater masturbation frequencies and higher rates of body dissatisfaction than African American women. Among European American women, there was a positive relationship between women's sexual self-pleasuring and positive body image. For African American participants, body image was not related to masturbation practice or frequency.     

A Phenomenological Study: Black Clergy Leaders’ Response to Violence against Women

Violence against women and religious participation are two phenomena that are pervasive across many African American communities. African American women experience intimate partner violence at a rate higher than the majority of racial groups in the United States. Although many African American women highly depend on their faith and church to navigate their experiences with intimate partner violence, scant attention has been given to the role that Black clergy leaders have in responding to intimate partner violence against women. The current study utilized phenomenological methodology to understand better Black American clergy leaders’ responses to intimate partner violence against women. Findings from clergy leaders’ narratives suggested that they serve primarily four roles when responding to intimate partner violence against women: spiritual advisor, pastoral care/counselor, compassionate leaders, and uninformed responders. Overall, these themes indicate that although African American clergy acknowledge the prevalence of intimate partner violence within their communities, and are trained in pastoral counseling, they lack knowledge and training to respond to intimate partner violence. Discussion centers on the need for clergy to be trained in the area of intimate partner violence response given their position within the church. The results in this study can help clergy leaders understand the basics of intimate partner violence and identify gaps in their practices with abused women.     

Counseling African Americans: Integrating Spirituality in Therapy

African American culture is rich with religious and spiritual traditions and practices that largely have been ignored in traditional approaches to counseling with this population. The purpose of this article is to describe the religious and spiritual dimensions of African American culture and to offer strategies for incorporating them into counseling African American clients.     

The Voice of the Voiceless: An Interview With Thelma Daley

Thelma Thomas Daley, through leadership, service, teaching, and publication, has been committed to the counseling profession for over 40 years. Daley was a pioneer in the counseling field as the 1st African American president of the American School Counselor Association in 1971 and the 1st African American and 3rd female president of the American Personnel and Guidance Association (now American Counseling Association [ACA]) in 1975. In this interview, she recounts her experiences as an organizational leader committed to enhancing the multicultural growth and professional excellence of ACA.     

Critical Race Theory as a Decisional Framework for the Ethical Counseling of African American Clients

The authors introduce critical race theory as a decisional framework for ethical counseling, with a focus on racial disparities when working particularly with African American clients. The authors provide a fictional case example that explains how this framework can be implemented when conducting cross‐cultural counseling with African American clients. Implications for counselors are provided.     

A Family Strengths Model of Adjustment to Disability for African American Clients

Sociocultural factors germane to African American families need to be recognized and incorporated into the counseling process of African Americans with disabilities. It is imperative that counseling professionals develop a thorough understanding of the family, community, and cultural ecologies of African Americans who are disabled. This article includes an analysis of the African American family system and its inherent strengths. A family strengths model of adjustment to disability for African American clients is presented, and potential applications of the model to the adjustment process are provided.