Identifying Factors Underlying the Decision for Sickle Cell Carrier Screening Among African Americans Within Middle Reproductive Age
Guidelines recommend that African Americans know their sickle cell trait status to inform reproductive health decisions. Few studies have applied a behavioral theory to identify factors associated with sickle cell trait screening to inform intervention targets to increase this behavior. We applied a Sickle Cell Trait Screening Framework to identify factors associated with African Americans’ intention to ask for sickle cell trait screening. Participants (N = 300), ages 18 to 35, completed a cross-sectional survey. A three-step sequential ordinary least squares regression analysis identified factors influencing intention. Results indicated socio-demographic factors (age, education), knowledge and fear beliefs (screening knowledge, perceived threat), and reasoned action approach (RAA) constructs were associated with intention. RAA constructs influenced intention over knowledge and fear beliefs with an increase in R2 of .468. Perceived behavioral control was more predictive of intention (β = .576, p < .001). Attitude and perceived norm also had significant weights (β = .325 and β = .192, both p < .001, respectively). Findings from this study can inform strategies (e.g., eliminating costs associated with screening, reducing fear of painful tests) to increase sickle cell trait screening among African Americans. Ultimately, more sickle cell carriers will become aware of their trait status and be able to make informed reproductive health decisions.
KeywordsSickle cell trait Genetic screening Reasoned action approach Intention Health behavior Carrier
This work was conducted in part to fulfill a degree requirement.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with Ethical Standards
Conflict of Interest
Tilicia L. Mayo-Gamble, Susan E. Middlestadt, Hsien-Chang Lin, Jennifer Cunningham-Erves, Priscilla Barnes, and Pamela Braboy Jackson declare that they have no conflict of interest.
Human Studies and Inform Consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all participants for being included in the study.
No animal studies were carried out by the authors for this article.
- Centers for Disease Control and Prevention (CDC) (2015). What you should know about sickle cell trait. Retrieved from http://www.cdc.gov/ncbddd/sicklecell/documents/factsheet_sickle_cell_trait.pdf.
- Fishbein, M. A., & Ajzen, I. (2010). Predicting and changing behavior: the reasoned action approach. New York: Psychology Press (Taylor & Francis).Google Scholar
- Gallo, A. M., Wilkie, D., Suarez, M., Labotka, R., Molokie, R., Thompson, A., Hershberger, P., & Johnson, B. (2010). Reproductive decisions in people with sickle cell disease or sickle cell trait. Western Journal of Nursing Research, 32(8), 1073–1090. https://doi.org/10.1177/0193945910371482.CrossRefPubMedPubMedCentralGoogle Scholar
- Gallo, A. M., Wilkie, D. J., Yao, Y., Molokie, R. E., Stahl, C., Hershberger, P. E., et al. (2016). Reproductive health CHOICES for young adults with sickle cell disease or trait: randomized controlled trial outcomes over two years. Journal of Genetic Counseling, 25(2), 325–336. https://doi.org/10.1007/s10897-015-9874-0.CrossRefPubMedGoogle Scholar
- Goldsmith, J. C., Bonham, V. L., Joiner, C. H., Kato, G. J., Noonan, A. S., & Steinberg, M. H. (2012). Framing the research agenda for sickle cell trait: building on the current understanding of clinical events and their potential implications. American Journal of Hematology, 87(3), 340–346. https://doi.org/10.1002/ajh.22271.CrossRefPubMedPubMedCentralGoogle Scholar
- Grant, A. M., Parker, C. S., Jordan, L. B., Hulihan, M. M., Creary, M. S., Lloyd-Puryear, M. A., Goldsmith, J. C., & Atrash, H. K. (2011). Public health implications of sickle cell trait: a report of the CDC meeting. American Journal of Preventive Medicine, 41(6), S435–S439.CrossRefPubMedGoogle Scholar
- Health Resources and Services Administration (HRSA). (2010). Screening U.S. In College athletes for their sickle cell disease carrier status.Google Scholar
- Kavanagh, P. L., Wang, C. J., Therrell, B. L., Sprinz, P. G., & Bauchner, H. (2008). Communication of positive newborn screening results for sickle cell disease and sickle cell trait: variation across states. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics, 148c(1), 15–22. https://doi.org/10.1002/ajmg.c.30160.CrossRefPubMedGoogle Scholar
- Lawrence, R. H., & Shah, G. H. (2014). Athletes' perceptions of National Collegiate Athletic Association-mandated sickle cell trait screening: insight for academic institutions and college health professionals. Journal of American College Health, 62(5), 343–350. https://doi.org/10.1080/07448481.2014.902840.CrossRefPubMedGoogle Scholar
- Long, K. A., Thomas, S. B., Grubs, R. E., Gettig, E. A., & Krishnamurti, L. (2011). Attitudes and beliefs of African-Americans toward genetics, genetic testing, and sickle cell disease education and awareness. Journal of Genetic Counseling, 20(6), 572–592. https://doi.org/10.1007/s10897-011-9388-3.CrossRefPubMedGoogle Scholar
- Lyimo, F. S., & Beran, T. N. (2012). Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: three public policy implications. BMC Public Health, 12(1), 22. https://doi.org/10.1186/1471-2458-12-22.CrossRefPubMedPubMedCentralGoogle Scholar
- Mayo-Gamble, T. L., Barnes, P. A., Cunningham Erves, J., Middlestadt S. E., & Lin, H.-C. (2017). ‘It means everyone should know their status’: exploring lay conceptions of sickle cell trait and sickle cell trait screening among African Americans within middle reproductive age. Ethnicity & Health. https://doi.org/10.1080/13557858.2017.1295135.CrossRefGoogle Scholar
- Pass, K. A., Lane, P. A., Fernhoff, P. M., Hinton, C. F., Panny, S. R., Parks, J. S., et al. (2000). US newborn screening system guidelines II: Follow-up of children, diagnosis, management, and evaluation. Statement of the Council of Regional Networks for genetic services (CORN). Journal of Pediatrics, 137(4), 46.CrossRefGoogle Scholar
- Wilkie, D. J., Gallo, A. M., Yao, Y., Molokie, R. E., Stahl, C., Hershberger, P. E., et al. (2013). Reproductive health choices for young adults with sickle cell disease or trait: randomized controlled trial immediate posttest effects. Nursing Research, 62(5), 352–361. https://doi.org/10.1097/NNR.0b013e3182a0316b.CrossRefPubMedPubMedCentralGoogle Scholar
- Witte, K., Meyer, G., & Martell, D. (2001). Effective health risk messages: A step by step guide. London: Sage Publications.Google Scholar