Differences in TB Knowledge & Attitudes Among Non-Hispanic Black and White US-Born Tuberculosis Patients
Methods: This retrospective cohort study assessed factors associated with time to TB diagnosis through interviews with U.S. born, non-Hispanic black and white persons diagnosed with TB between mid-2009 and December 2010. The study was conducted at 8 CDC-funded TB Epidemiologic Studies Consortium sites. Blacks and whites were sampled in proportion to the distribution of TB cases in each group. Through interviews, information was collected on participants’ demographic and disease characteristics, substance use, and knowledge and attitudes. Multivariable regression was used to examine factors predicting better TB knowledge.
Results: Of 477 participants, 368 (77%) were non-Hispanic black and 109 (23%) were non-Hispanic white. The overall mean age was 49.9 years and 324 (68%) were male. In univariate analysis, blacks had significantly lower overall knowledge scores, with greater endorsement of misconceptions about transmission, TB testing, and the distinction between TB infection and disease. Regarding attitudes, both groups were neither embarrassed nor felt stigmatized by their TB diagnosis and felt comfortable talking to others about TB. Blacks were more likely to say they would stop TB medicines if the medicines made them feel sick and that they knew better than doctors when to stop taking TB medicines. Majorities of both groups recalled being given information on TB transmission, treatment, and protection of family and friends; having received such information was highly correlated with correct responses on corresponding knowledge items. In multivariable linear regression, lower knowledge scores were found among participants who were black, older, had not completed high school, and who used alcohol to excess (all p values <0.05).
Conclusions and Implications: This study is the first to compare differences in knowledge and attitudes between US-born racial groups with the highest and lowest rates of TB. Certainly poorer TB knowledge among non-Hispanic blacks compared to whites is not the sole cause of health disparities in TB rates; however, these findings suggest that greater efforts are needed to provide blacks, and other groups, with accurate information about how TB is transmitted and how TB tests are used. Further exploratory work is needed to address the role of certain attitudes in encouraging such health behaviors as help-seeking and medication adherence.
Funding Source: Tuberculosis Epidemiological Studies Consortium, Centers for Disease Control & Prevention