Digital Commons Network^™

Ethnic And Gender Differences In Psychosocial Factors In Native Hawaiian, Other Pacific Islanders, And Asian American Adults With Type 2 Diabetes, Jillian Inouye, Dongmei Li, James Davis, Richard Arakaki

Journal of Health Disparities Research and Practice

This study examined the differences between 207 Asians and Native Hawaiian, other Pacific Islanders (NHOPI) with type 2 diabetes among various psychosocial measures. Responses to five multivariable regression models including the Diabetes Quality of Life Questionnaire (DQOL) and Short Form -36® Health Survey (SF-36) were analyzed. Differences were determined by linear contrasts in the multivariate linear regression models after adjusted for multiple demographic and socioeconomic variables. Compared to Asians, NHOPIs perceived a lower impact of diabetes on their quality of life; highlighting differences in perceptions of self-efficacy and self-care activities. Females did better on their diet while males perceived better …

Racial Disparities In Pain Management In Primary Care, Miriam Ezenwa

Journal of Health Disparities Research and Practice

This descriptive, cross-sectional, secondary data analysis was conducted to examine racial disparities in pain management of primary care patients with chronic nonmalignant pain using chronic opioid therapy. Data from 891 patients, including 201 African Americans and 691 Caucasians were used to test an explanatory model for these disparities. We predicted that: (1) African American patients would report worse pain management and poor quality of life (QOL) than Caucasians; (2) the association between race and pain management would be mediated by perceived discrimination relating to hopelessness; and (3) poor pain management would negatively affect QOL. Results revealed significant differences between African …

From Engagement To Action: Assessing Community Readiness For Disparities Mobilization, Linda S. Sprague Martinez, Elmer Freeman, Flavia C. Perea

Journal of Health Disparities Research and Practice

In an effort to engage communities across the state of Massachusetts in tackling health disparities, Critical MASS (CM), in partnership with local researchers piloted a readiness assessment to identify community assets, perceptions of disparities, and interest in partnership. The research process was used to facilitate the development of partnerships between outside organizers, researchers, and community stakeholders. Partnership outcomes included a disparities conference aimed at bringing attention to concerns in the community, and a grant submission aimed at addressing community identified disparities. Despite the successes the partnership faced challenges. Logistics and limited resources hindered partner efforts to sustain the relationship. This …

Racial And Ethnic Health Disparities In Incarcerated Populations, Meghan E. Borysova, Ojmarrh Mitchell, Dawood H. Sultan, Arthur R. Williams

Journal of Health Disparities Research and Practice

Alarming disparities in population health and wellness in the United States have led to multi-disciplinary research efforts to create health equity. Identifying disparities, elucidating the etiological bases of disparities, and implementing solutions to eliminate disparities are part of the U.S. national health agenda. Racial and ethnic disparities have been identified throughout the cancer control continuum, in cardiovascular disease, diabetes and a multitude of other conditions. The causes of disparities are complex, condition specific, and conjectured to result from combinations of biological and socio-behavioral factors. Racial and ethnic health disparities within the vast incarcerated communities have been excluded from most studies, …

Building Trust And Collaboration With Rural Minorities: Experiences With Minority Farmers In The Mississippi Delta, Ari Mwachofi

Journal of Health Disparities Research and Practice

The paper focuses on the question “What research approach is effective in building trust with minority farmers?” The question is answered through a documentation of researchers’ experiences building trust and collaboration with minority farmers in the lower Mississippi Delta. The researchers applied two research paradigms -logical positivism and paradigm of praxis. The logical positivism research approach was met with mistrust and open animosity and had to be abandoned for one based on the paradigm of praxis. Through this approach, and cognizant of the historical-social-political context, the researchers included insiders from the focus population as collaborators and researchers and succeeded in …

American Indian Community Leader And Provider Views Of Needs And Barriers To Colorectal Cancer Screening, Christine M. Daley

Journal of Health Disparities Research and Practice

Colorectal cancer is a great concern for the American Indian/Alaska Native (AI/AN) community, as incidence and mortality rates remain high and screening rates stay low. We conducted interviews with community leaders (n=13) and with providers from the Indian Health Service (IHS), tribal clinics, and urban safety-net clinics (n=17) in Northeast Kansas and the Kansas City Metro Area to determine their understanding of needs and barriers to colorectal cancer screening among American Indians. Using a community-based participatory research (CBPR) approach for this pilot study, community leaders and providers identified similar needs, including: culturally-appropriate education about colorectal cancer and screenings, the potential …

An Innovative Approach For Community Engagement: Using An Audience Response System, Jenna L. Davis, Kara E. Mcginnis, Margaret L. Walsh, Coni Williams, Kevin B. Sneed, Julie A. Baldwin, B. Lee Green

Journal of Health Disparities Research and Practice

Community-based participatory research methods allow for community engagement in the effort to reduce cancer health disparities. Community engagement involves health professionals becoming a part of the community in order to build trust, learn from the community and empower them to reduce disparities through their own initiatives and ideas. Audience Response Systems (ARS) are an innovative and engaging way to involve the community and obtain data for research purposes using keypads to report results via power point. The use of ARS within communities is very limited and serves to widen the disparity gap by not delivering new advances in medical knowledge …

Disparities In Mental Health Utilization Among Persons With Chronic Diseases, Saundra Glover, Keith Elder, Sudha Xirasagar, Jong-Deuk Baek, Crystal Piper, Dayna Campbell

Journal of Health Disparities Research and Practice

This study used Aday and Andersen’s Behavioral Model of Health Services Use to examine the role of chronic disease and the joint impact of race and chronic disease type on mental health utilization. Using data from Community Tracking Survey Household Survey, we tested the assumption that chronic disease, chronic disease type, and race are related to lower rates of mental health visits when adjusted for predisposing, enabling, and need factors. After adjusting for population characteristics, we found that race significantly moderated the impact of chronic disease type on mental health utilization, showing that African Americans with cardiovascular disease were half …

Assessing Behavioral Health Risks, Health Conditions, And Preventive Health Practices Among American Indians/Alaska Natives In Nevada, Gwen Hosey, Shirley A. Llorens-Chen, Fares Qeadan, Daryl Crawford, Charlton Wilson, Wei Yang

Journal of Health Disparities Research and Practice

The 2004 Behavioral Risk Factor Surveillance System (BRFSS) survey was administered to American Indian/Alaska Native (AI/AN) adults in Nevada to determine whether health disparities exist between AI/ANs and the state’s general population. Results showed AI/ANs were 1.5 times more likely to smoke cigarettes, 3.5 times more likely to be exposed to secondhand smoke, 3.2 times more likely to lack leisure-time physical activity, 9.7 times more likely to report fair/poor health status, and 7.7 times more likely to have a disability. In addition, AI/ANs were more likely to have current asthma (OR=5.0) and diabetes (OR=1.8). AI/AN women were 4.8 times as …

Hispanic Ethnicity, Male Gender And Age Predict Restraint Use And Hospital Resource Utilization In Pediatric Trauma, Deborah A. Kuhls, Lynne Fullerton-Gleason, Virginia A. Landry, Julie A. Rabeau, Elizabeth Snavely, John J. Fildes

Journal of Health Disparities Research and Practice

Child restraint reduces the severity of injuries in motor vehicle crashes. Racial/ethnic groups appear to have differing restraint use rates. The objective of this study was to identify restraint use differences between ethnic and other demographic subgroups of pediatric trauma patients. Prospective data were analyzed for 1072 consecutive pediatric patients aged 19 or less who were involved in motor vehicle crashes and brought to our Trauma Center over a 42 month period. The demographic breakdown of this study cohort was 55.3% male, 21.4% Hispanic, 9.7% African American, 64.5% Caucasian, 2.2% Asian and 2.2% other. The highest rates of restraint use …

The Hiv/Aids Pandemic In African American Msm: Targets For Intervention, Kelly Neff

Journal of Health Disparities Research and Practice

The Centers for Disease Control and Prevention estimated in 2005 that 46% of African American men who have sex with men (MSM) are HIV positive. This review explores the unique factors that contribute to risky sexual behavior and the spread of HIV within this population, suggesting that the disparate prevalence of HIV among African American MSM is rooted in experiences of stigmatization from multiple sources and lack of social support from society at large as well as from within the African American community. Beliefs in HIV conspiracy myths are also thought to hinder HIV education, awareness and prevention for African …

Equal Care, Unequal Outcomes: Experiences Of A Reach 2010 Community, Diane Neal, Barbara Carlson, Carolyn Jenkins, Gayenell Magwood

Journal of Health Disparities Research and Practice

Diabetes is growing in prevalence and costs. Guidelines for care have been available since 1983, yet diabetes care and outcomes remain less than ideal. CDC’s Racial and Ethnic Approaches to Community Health 2010 (REACH 2010) identified diabetes in African Americans as a priority for action. This article documents the activities, interventions, and current progress of the REACH 2010 diabetes coalition formed in Charleston and Georgetown counties, South Carolina, in reducing health care disparities and describes next steps for improving outcomes. The Chronic Care Model guided many of the implementation activities, and chart audits were used to document outcomes. Ambulatory care …

A Pilot Self-Care Group Intervention For Low-Income Hiv-Positive Women, Maithe Enriquez, Margaret S. Miles, Jacki Witt, Paul Gore, Nancy Lackey

Journal of Health Disparities Research and Practice

This article describes the development of a self-care intervention and examines its efficacy with low-income HIV-positive women (n=34) in the Midwestern United States. Adapted from an individual nurse-led intervention, this effort focused on increasing self-care behaviors through enhancing self-esteem and social support. The investigators used a community-based participatory approach and partnered with three HIV-positive women to adapt and pilot test the new group intervention. A within-group, repeated-measures, pre-/post-test design, together with participant interviews, was used to evaluate the intervention. Mean scores on measures of self-care behaviors, self-esteem, social support and depressive symptoms all changed in the clinically desirable direction. Group …

The Influence Of Patient-Centeredness On Minority And Socioeconomically-Disadvantaged Patients’ Trust In Their Physicians: An Evidence-Based Structural Equation Modeling Investigation, Stephen J. Aragon, Sylvia A. Flack, Cecil A. Holland, Racquel R. Ingram, Michael L. Clements

Journal of Health Disparities Research and Practice

The purpose of this investigation was to determine the effect of physician patient-centeredness on patient trust across randomly selected groups of patients from an inner city medical practice serving a preponderance of minority and socioeconomically-disadvantaged patients.

METHODS: A two-factor multigroup structural equation modeling design was employed, with randomly selected test (N = 300) and cross-validation (N = 300) samples of medical practice patients. Equality constraints were established to test the invariance of effects across groups. The model was compared to its unconstrained counterpart to further test its trustworthiness. An additional 5,000 nonparametric bootstrapped samples for each group were generated to …

Health Literacy As A Contributor To Immigrant Health Disparities, Jennifer B. Kimbrough

Journal of Health Disparities Research and Practice

The ability to obtain, understand and use the information needed to make wise health choices is known as health literacy. Low health literacy among members of populations with poor reading skills, limited mastery of the English language, members of ethnic or cultural minorities, and immigrants is likely a major contributor to health disparities in the US (Agency for Health Care Policy and Research 1997). A series of focus groups with East-Asian, African, Central and South American immigrants was conducted to better understand the perceptions of immigrants seeking health care services in an urban North Carolina county. Participants’ responses are reported …

Quality And Severity Of Lower Urinary Tract Symptoms Among African American Elders, Daniel L. Howard, Bennett G. Edwards, Kimberly Whitehead, M. A. Amamoo, Paul A. Godley

Journal of Health Disparities Research and Practice

Lack of population-based data on lower urinary tract symptoms (LUTS) among African American men represents a significant gap in understanding. This study examined LUTS among a racially over-sampled, mixed urban/rural, elderly cohort of African Americans and whites in the South to discern whether racial differences exist in the prevalence, severity, and associated risk factors of LUTS. Longitudinal analyses using generalized estimating equations (GEE) were conducted on the 1994–1998 EPESE dataset for 5 North Carolina counties. In 1994, the analytic cohort included 482 African Americans and 407 whites; by 1998, 249 and 222, respectively. In 1994, 49.4% of African Americans reported …

Seeking Cancer Information: An Appalachian Perspective, Robin C. Vanderpool, Bin Huang, Brent J. Shelton

Journal of Health Disparities Research and Practice

There are noted disparities by ethnicity, race, age, gender, and socioeconomic status in the reported use of and access to cancer information. Missing from this list of variables that predict these disparities are specific geographic locales, such as Appalachia, a region recognized as a medically underserved, “special population”. Through a secondary analysis of NCI’s 2003 HINTS dataset, we are able to describe the cancer information-seeking behaviors of Appalachians as compared to non-Appalachians with a focus on actual versus preferential information-seeking behaviors, information-seeking experiences, and demographics. In general, Appalachians and non-Appalachians do not significantly differ in their cancer information-seeking behaviors and …

Eliminating Racial/Ethnic Health Disparities: Reconsidering Comparative Approaches, Shawn M. Bediako, Derek M. Griffith

Journal of Health Disparities Research and Practice

The focus on eliminating racial/ethnic health disparities has brought critical attention to the poor health status of minority populations. Assessing the health outcomes of racial minority groups by comparing them to a racial majority standard is valuable for identifying and monitoring health inequities, but may not be the most effective approach to identifying strategies that can be used to improve minority health outcomes. Health promotion planning models and public health history both suggest that minority health promotion is more likely to be derived from interventions rooted in culturally and historically grounded contextual factors. In this essay, we highlight limitations of …

Hungry For Respect: Discrimination Among Adults Using Emergency Food Services, Gilbert C. Gee, Kathryn J. Lively, Larissa Larsen, Jennifer Keith, Jana Stone, Kara Macleod

Journal of Health Disparities Research and Practice

Objectives: We examined how adults using emergency food services report discrimination and how these reports may be associated with well-being.

Methods: Data come from a survey (n=318) and from five focus groups of adults using emergency food services, conducted between 2003-2004. The survey included measures derived from the Everyday Discrimination Scale and the Centers for Epidemiologic Studies Depression Scale (CES-D). Focus groups were analyzed with content analysis.

Results: The survey data suggest that everyday discrimination was associated with the CES-D, conditional on covariates. Focus group data are consistent with the survey results and suggest several avenues for future research, including …

Research Brief: An Examination Of The Social And Clinical Influences In Prostate Cancer Treatment In African American And White Men, Keith Elder, Bettina F. Drake, Sara Wagner, James Hebert

Journal of Health Disparities Research and Practice

BACKGROUND: The death rate for prostate cancer (PrCA), the most commonly diagnosed cancer in African-American (AA) men, is twice the rate of European-American (EA) men. AA men in South Carolina have the highest age-adjusted death rate in the nation. Studies have shown that treatment offered to AA men with PrCA is systematically different from that offered to EA men. METHODS: Surveys were mailed to 1,866 men in South Carolina with a diagnosis of PrCA. South Carolina men diagnosed with PrCA between 1996 and 2002 were eligible to participate. We performed a descriptive assessment of the factors that influenced …

Cancer-Related Disparities Among Residents Of Appalachia Ohio, James L. Fisher, Holly L. Engelhardt, Julie A. Stephens, Bette R. Smith, Georgette G. Haydu, Robert W. Indian, Electra D. Paskett

Journal of Health Disparities Research and Practice

The authors sought to identify cancer-related disparities in Appalachia Ohio and better understand reasons for the disparities. Data from the Ohio Cancer Incidence Surveillance System, among other sources, were used to examine potential cancer disparities among residents of Appalachia Ohio. Using Ohio census data, the authors examined contributions of household income, educational attainment and population density to disparities in cancer incidence. Results suggest the following disparities in Appalachia Ohio (compared to non-Appalachia Ohio): greater cancer incidence and mortality rates for cancers of the cervix, colon and rectum, lung and bronchus and melanoma of the skin; a later stage at diagnosis …

Family Breast Cancer Education: A Model For African American Women, Frankie D. Powell, Edwin D. Bell, Jamilla Shepperson, Thomas Coaxum

Journal of Health Disparities Research and Practice

The purpose of this study, funded by the American Cancer Society, was to increase knowledge and understanding, i.e., the willingness and ability to discuss, of breast cancer in southern minority women and their families. A family model of health education guided the research questions. (a) To what extent will an action research intervention increase knowledge about the causes and treatment of breast cancer in minority women? (b) To what extent will an action research intervention increase willingness to talk with family members? The t-test analysis of a 67-item, self- administered survey indicated significant increases in knowledge of cancer and in …

Educating And Empowering Elders: Improving The Health Of Senior Latino Diabetics Through Community Collaboration, G. D. Cleghorn, Jean Lussier, Martha Velez, Marianna Canovitch, Marilyn Licciardello, Sarah Stanlick

Journal of Health Disparities Research and Practice

According to the American Diabetes Association (ADA), diabetes is the sixth leading cause of death among Americans.1 As of 2005, estimates indicate 20.8 million people – 7 percent of the population – afflicted by diabetes, 6.2 million of which are undiagnosed. 1 While diabetes is a growing problem for the United States as a whole, older, poverty-stricken Latinos and other minority groups have felt the encumbrance of this trend most intensely.2 In Massachusetts, the burden of diabetes among Caribbean Latinos is 11.8 percent, which is 2.5 times greater than the prevalence for the majority of the population in the state …

Predictors Of Depression For Low-Income African American Single Mothers, Jennifer Hatcher, Mary K. Rayens, Ann R. Peden, Lynne A. Hall

Journal of Health Disparities Research and Practice

Purpose: To test a model of predictors of depression in low-income single African American mothers. Design: Secondary analysis of existing data collected as part of a study of women at risk for clinical depression.

Methods: Cross sectional secondary data analysis of a study of low-income African American single mothers with children ages 2-6. Path analysis was used to test a model of the potential mediating role of negative thinking. It was hypothesized that negative thinking mediates the effects of chronic stressors, general health status, and self-esteem on depressive symptoms

Finding: Negative thinking mediated the relationships of chronic stressors and self-esteem …

African American Adults’ Experiences With The Health Care System: In Their Own Words, Keri A. Jupka, Nancy L. Weaver, Vetta L. Sanders-Thompson, Nicole M. Caito, Matthew W. Kreuter

Journal of Health Disparities Research and Practice

African Americans suffer a disproportionate burden of death and illness from a number of different chronic diseases. Inequalities in health care practices and poor patient and provider communication between African American patients and health care professionals contribute to these disparities. We describe findings from focus groups with 79 urban African Americans in which the participants discussed their interactions with the healthcare system as well as beliefs and opinions of the healthcare system and professionals. Analysis revealed five major themes: (1) historical and contextual foundations; (2) interpersonal experiences with physicians and other health care workers; (3) discrimination; (4) trust, opinions and …

Examination Of Racial Disparities In Childhood Asthma Management Practices, Crystal N. Piper, Saundra Glover, Kieth Elder, Jong-Deuk Baek

Journal of Health Disparities Research and Practice

Objective: To analyze asthma management plan practices for children with asthma in the United States considering race and other demographic and person-level characteristics.

Methods: Univariate/Bivariate/Multivariate analysis was performed to examine asthma management plan physician recommendations among children in the United States utilizing secondary data analysis of the 2002 and 2003 National Health Interview Survey.

Results: The majority of the study participants reported not having an asthma management plan at (59.00%). In multivariate analysis using SAS callable SUDAAN, Whites were significantly more likely to have an asthma management plan (OR=1.66, p=.0031).

Conclusion: Findings from this study indicate that Black and Hispanic …

Pastors’ Influence On Research-Based Health Programs In Church Settings, Shirley M. Timmons

Journal of Health Disparities Research and Practice

Churches, in the United States, are recognized essential players in addressing our mounting health and social service needs. Yet, even though they implement a relatively large number of programs, few are research-based. Focus groups were conducted with pastors from 11 Baptist churches in a small Southeastern town to explore factors that influence the implementation of research-based health programs. Transcripts were coded for domains resulting in four themes: congregant needs, shared programming ethics, common understanding of programming processes, and care for the church and congregation. Pastors value research and seek church-based programs that enhance the health of congregants. Yet, future study …

Utilizing Community Resources To Reduce The Presence Of Type 2 Diabetes In Rural Youth, Antonia S. Mead, M. C. Nagy, Stephen Nagy

Journal of Health Disparities Research and Practice

The purpose of this study was to implement a program designed to promote diabetes prevention activities among preadolescents in a rural southern setting using a day camp intervention. Participants in the study were eleven youth from a rural Alabama county who participated in a week-long half-day camp administered by local and community volunteers. Change scores were used to compare pre- to post- to follow-up measures for camp participant responses. Program results consistently demonstrated that the day camp was theoretically sound and that program activities positively impacted behavioral antecedents. This study demonstrated the feasibility of conducting a diabetes prevention day camp …

Talking Glossary Of Genomics Terminology: A Genomics Education Module For American Indian Communities, Jill Peters, Pauline Davies, Naomi Lane, Kathryn Coe

Journal of Health Disparities Research and Practice

This paper describes the development of an audio visual genomics glossary that was designed as an education tool for American Indian communities. This “Talking Glossary of Genomics Terminology” is a multimedia DVD that was modeled on the “Talking Glossary of Genetics,” which was developed by the National Human Genome Research Institute (NHGRI). The NHGRI Glossary was modified and expanded with content designed to increase awareness among American Indians about cancer, genomics, and personalized medicine. Partners on the project include the Inter Tribal Council of Arizona, Inc., Phoenix Indian Medical Center, Arizona Cancer Center at the University of Arizona, the Translational …

A Review Of Smoking Among Rural African Americans: Recommendations For Research And Cessation Interventions, Susan Hedgecock, Anita Fernander

Journal of Health Disparities Research and Practice

Objective: The purpose of this review is to synthesize the available literature on smoking among rural African Americans.

Methods: Using search terms “rural” “African American” “Black” and “smoking” 19 relevant articles were identified in the Medline data base. Findings gleaned from the 19 articles are presented in four categories: a) smoking prevalence, b) smoking behavior and patterns, c) smoking cessation interventions and quitting, and d) smoking-related outcomes.

Results: There may be gender differences, a pattern of late onset of smoking, and a preference for mentholated brands among rural African American smokers. There is no evidence that rural African Americans are …