Digital Commons Network^™

From Awareness To Action: Understanding And Addressing Health Disparities, Aamira Shah

The Cardinal Edge

In the United States, marginalized groups consistently face barriers to healthcare services necessary for maintaining quality of life and achieving positive health outcomes. Health disparities can be defined as “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been disadvantaged by their social or economic status, geographic location, or environment” (CDC, 2008). With input from insightful interviews, this article seeks to investigate specific challenges faced by marginalized groups in the healthcare setting and provide potential solutions to reduce health disparities.

Hierarchy Of Life: Whose Lives Do We Value?, Jessica Wiggins

International Journal on Responsibility

COVID-19 has heightened already existing health disparities amongst marginalized communities within the United States. In crisis, whose lives do healthcare systems value most and how are these decisions rooted in ableism and racism? Who is responsible for these inequities and in what ways? This multimedia presentation and companion paper explore these important questions.

Advancing Health Equity In The Us Military, James D. Mancuso, John Young, Jennifer Rusiecki, Shauna Stahlman, Natasha Schvey, Toya Randolph, Candy Wilson, Catherine Witkop, Patrick Hyde, Althea Green, Patcho Santiago, Donald Shell, Tracy Sbrocco

Journal of Health Disparities Research and Practice

Eliminating health disparities and achieving health equity are central to US national health objectives and the Military Health System’s “quadruple aim,” which has readiness as its core aim. Because military service members enjoy universal eligibility for health care, it is sometimes assumed that health disparities do not exist in the Department of Defense (DoD). However, while some studies have shown that disparities have been attenuated or eliminated in the DoD, others suggest that significant disparities remain. Reasons these disparities may remain include that universal eligibility for care does not necessarily result in equal to access to care, and that equal …

Affirmatively Furthering Health Equity, Mary Crossley

Articles

Pervasive health disparities in the United States undermine both public health and social cohesion. Because of the enormity of the health care sector, government action, standing alone, is limited in its power to remedy health disparities. This Article proposes a novel approach to distributing responsibility for promoting health equity broadly among public and private actors in the health care sector. Specifically, it recommends that the Department of Health and Human Services issue guidance articulating an obligation on the part of all recipients of federal health care funding to act affirmatively to advance health equity. The Fair Housing Act’s requirement that …

Predicting Flossing Through The Application Of The Multi-Theory Model (Mtm) Of Health Behavior Change Among Minority Adolescents In The United States, Manoj Sharma, Kavita Batra, Ching-Chen Chen, Chia-Liang Dai, Ravi Batra, David Cappelli

Social & Behavioral Health Faculty Publications

Adolescents from minority groups are particularly susceptible to poor oral hygiene behaviors, including lack of daily flossing. This cross-sectional study aimed to conduct an exploratory behavioral research to identify evidence-based (theory-based) approaches to promote flossing behavior among African American/Black and Latinx/Hispanic (minority) adolescents. A 39-item psychometrically valid web-based questionnaire was used to collect responses from a nationwide sample of minority adolescents aged 10–17 years residing in the United States. The data were analyzed using bivariate and multivariate statistical methods. Of 520 minority adolescents (260 African American/Black and 260 Latinx/Hispanic adolescents), the proportion of flossing was nearly equally split in the …

American Indians And Covid-19: Morbidity And Mortality Disparities Among Indigenous Populations In The Rural South, Leslie Musshafen, Thomas E. Dobbs, Aaron Robinson, Thomas Wyatt, Michael Puskarich, Richard Summers, Seth Lirette, Caroline Compretta

Journal of Public Health in the Deep South

Background The COVID-19 pandemic has highlighted health inequities among indigenous populations, with those in rural settings facing compounded barriers.Purpose To investigate morbidity and mortality experiences among hospitalized, COVID-19+ American Indian adults from rural and urban settings.Methods The described cross-sectional study used retrospective discharge data from the University of Mississippi Medical Center and Hennepin County Medical Center. Adults (≥ age 18) admitted from January 1, 2020 to August 8, 2021with a COVID-19 diagnosis and known race were included.Results A total of 3,659 inpatients met inclusion criteria. Among adults hospitalized with COVID-19 at the University of Mississippi Medical Center, American Indians (n=73) …

Establishing A Sustainable Occupational Therapy Student-Led Pro Bono Clinic At The University Of Saint Augustine In Austin, Texas, Daija Chumley

Student Capstone Papers

Under-resourced and underserved communities across the United States experience significant health disparities. These communities lack access to valuable services resulting in health inequities that impinge on their health, quality of life, and engagement in meaningful occupations. There is a need for occupational therapy to provide valuable services to the under-resourced and underserved community to address the historical inequity that impacts their overall quality of life. Universities have the potential to fulfill the gaps within these communities by establishing a pro bono clinic. The purpose of this capstone project is to establish a sustainable occupational therapy pro bono clinic at the …

Improving Patient Satisfaction And Preventative Health Service Utilization For Limited English Proficiency Immigrants At Pearl Medical Centr, Chioma Holland

Graduate Theses, Dissertations, and Capstones

Background: Despite research efforts to address health disparities within immigrant communities, immigrant health continues to lack the attention from healthcare stakeholders it needs. Many immigrants already face dire health threats like extreme poverty, political unrest, and mental health concerns in their countries of origin, making them even more vulnerable to poor physical, mental, and social health outcomes upon arrival to the United States (U.S.). The purpose of this project was to improve patient satisfaction and increase immigrant use of preventative care by utilizing appropriate interpreter services. Method: The Quality improvement (QI) project involved surveying limited English proficiency (LEP) immigrants older …

Perception Of Health Care Access In Rural Georgia: Findings From A Community Health Needs Assessment Survey, Elisa M. Childs, Tiffany R. Washington

Journal of the Georgia Public Health Association

Background: Limited access to health care services has been cited as a barrier to care for individuals who live in rural areas, contributing to significant health disparities in this population. While perception of services has been cited as a determinant of utilization of health services, it is unknown how perception of services influences health care access in rural areas. The paucity of studies specific to areas in the United States that are medically underserved, necessitated this study and its quantification of the issues that are relevant to individuals living in rural Georgia.

Methods: This study examined the perception of health …

Academic Health Science Centers And Health Disparities: A Qualitative Review Of The Intervening Role Of The Electronic Health Record And Social Determinants Of Health, Wies Rafi

Theses and Dissertations

Literature on the magnitude of negative health outcomes from health disparities is voluminous. Defined as the health effects of racism, environmental injustice, forms of discrimination, biases in science, and sociological or socioeconomic predictors across populations, health disparities are part of an ongoing and complicated national problem that health equity programs are specifically designed to address. Academic Health Science Centers (AHC) institutions are a complex and unique educational-healthcare ecosystem that often serves as a safety net for patients in vulnerable and lower-income communities. These institutions are often viewed as one of the most uniquely positioned entities in the U.S. with an …

Rural Hospital Closures And Perceived Access To Care: A Qualitative Descriptive Study In An Appalachian County Of Tennessee, Amanda M. Letheren

Doctoral Dissertations

Background: Tennessee has suffered more hospital closures per capita than anywhere else in the nation. The impact of hospital closures on access to care in rural and economically distressed Appalachian counties of Tennessee is of particular concern because these communities experience great health disparities. Hospital closures may exacerbate these disparities and create additional barriers when accessing care.

Objectives: The aim of this study was to describe community residents’ perceptions of health and access to care following a hospital closure in a rural and economically distressed Appalachian county of Tennessee.

Methods: This study used a qualitative descriptive approach to present community …

Evaluating Research Centers In Minority Institutions: Framework, Metrics, Best Practices, And Challenges, Angela Sy, Traci Hayes, Kelly Laurila, Carlamarie Noboa, Robbert J. Langwerden, Michelle M. Hospital, Doris A. Andújar-Pérez, Lakesha Stevenson, Suzanne M.Randolph Cunningham, Latrice Rollins, Hala Madanat, Tanya Penn, Shiva Mehravaran

Faculty Publications

The NIH-funded Research Centers in Minority Institutions (RCMI) program is currently funding 18 academic institutions to strengthen the research environment and contribution to health disparities research. The purpose of this multiphase mixed-methods study was to establish a uniform evaluation framework for demonstrating the collective success of this research consortium. Methods included discussions of aims and logic models at the RCMI Evaluators’ Workshop, a literature review to inform an evaluation conceptual framework, and a case study survey to obtain evaluation-related information and metrics. Ten RCMIs participated in the workshop and 14 submitted responses to the survey. The resultant RCMI Evaluation Conceptual …

Barriers To Integrated Primary Care And Specialty Mental Health Services: Perspectives From Latinx And Non-Latinx White Primary Care Patients, Elizabeth A. Anastasia

Graduate Theses and Dissertations

High need, low access, and rising health care costs reveal the inadequacies of the current mental health system in the U.S. Racial/ethnic minorities, including Latinxs, face substantial disparities in accessing mental health treatment compared with non-Latinx Whites. Integrated primary care (IPC) offers an alternate model for meeting mental health needs by providing care in a way that is accessible to the general population. Though it has been suggested that IPC may reduce health disparities by decreasing barriers to mental health treatment, empirical data relevant to this question are limited. A series of three studies were conducted using a mixed methodology …

Knitting Service-Learning And Professional Training: Advocating For Dental Care For People With Intellectual Disabilities, Raj Gandhi

The International Undergraduate Journal For Service-Learning, Leadership, and Social Change

No abstract provided.

Lifestyle Risk Factor Related Disparities In Oral Cancer Examination In The U.S: A Population-Based Cross-Sectional Study, Aderonke A. Akinkugbe, Dina T. Garcia, Tegwyn H. Brickhouse, Maghboeba Mosavel

Dental Public Health and Policy Publications

Background: Oral cancers account for 3% of annual U.S. cancer diagnosis, 2 in 5 of which are diagnosed late when prognosis is poor. The purpose of this study was to report the population-level prevalence of oral cancer examination among adult smokers and alcohol drinkers and assess if these modifiable lifestyle factors are associated with receiving an oral cancer examination.

Methods: Adult participants ≥30 years (n = 9374) of the 2013–2016 cycles of the National Health and Nutrition Examination Survey were included. Oral cancer examination (yes/no), smoking (never, former, current) and alcohol use (abstainers, former, current) were self-reported. Survey-logistic regression …

Challenges To Diabetes Self-Management For Adults With Type 2 Diabetes In Low-Resource Settings In Mexico City: A Qualitative Descriptive Study, Robin Whittemore, Mireya Vilar-Compte, Selene De La Cerda, Denise Marron, Rosabelle Conover, Roberta Delvy, Annel Lozano-Marrufo, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Background: The prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City.

Methods: This was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach.

Results: The …

Mitigating Barriers To Chronic Disease Risk Factor Prevention And Management In Disadvantaged Communities, Krys M. Johnson

USF Tampa Graduate Theses and Dissertations

Background: The incidence and prevalence of chronic disease (CD) has increased in recent decades due to the advent of CD management and life-extending technologies. To address this burden on the population and healthcare system, evidence-based CD prevention programs have been developed to reduce the incidence and therefore the prevalence of these diseases. Despite the development and dissemination of effective interventions, African-Americans and Hispanics have disproportionately higher prevalence of CD and associated risk factors and disproportionately lower participation in CD prevention programs. Overweight/obesity and CDs may have intergenerational effects, with overweight adults being more likely to have overweight children who are …

Women’S Experiences With Prenatal Care: A Mixed-Methods Study Exploring The Influence Of The Social Determinants Of Health, Karen A. D'Angelo, Janelle K. Bryan, Brenda Kurz

Janelle K. Bryan

Background & Purpose: Racial and ethnic disparities pervade birth outcomes in the United States and the state of Connecticut. While Connecticut’s infant mortality rate is less than the national average, rates for the state’s Black/African American and Hispanic/Latino communities exceed it. This study explored how prenatal care in Connecticut may be enhanced to address these disparities.

Methods: In spring 2013, seven focus groups and two semi-structured interviews were conducted (n=47). Participants also self-administered brief surveys. Recruited by local service providers, participants were 18 or older, pregnant and/or in the first year post-partum at the time. Most self-identified as …

Examining The Impact Of Race And Rurality On Health Differences Among Overweight Youth Accessing Pediatric Endocrinology Care, Kelsee Halpin, Janelle R. Noel-Macdonnell, Yun Yan

Journal of Health Disparities Research and Practice

Methods: This study examines the impact of race and rurality on health differences, including prevalence of prediabetes and type 2 diabetes (T2D), among overweight children accessing pediatric endocrine specialty care. Cross-sectional analysis of overweight/obese youth 10 to 18 years of age receiving pediatric endocrinology consultation for weight gain, hyperglycemia, and/or T2D from 2013 to 2016 at a Midwest tertiary pediatric center.

Results: The 722 patients were 42% white, 25% black, 22% Hispanic; 88% lived in urban areas and 12% in rural areas. Rurality was determined using zip code approximation of Rural-Urban Commuting Area (RUCA) codes. After adjusting for confounders, black …

Cultural Competence Of Public Health Nurses Who Care For Diverse Populations, Althea Michelle Otuata

Walden Dissertations and Doctoral Studies

Despite advances in health, science, and technology, U.S. healthcare lags in providing access to care and quality care to racial and ethnic minorities. Cultural competence has been noted as a strategy to improve access and quality. The purpose of this project was to assess public health nurses' cultural competence before and after participating in cultural competence informational modules. Two conceptual models were used in this project for theoretical guidance: Leininger's cultural care diversity and universality theory and Campinha-Bacote's process of cultural competence. To assess the nurses' cultural competence, the Cultural Competence Self-Assessment Checklist questionnaire was e-mailed to 57 public health …

Oral Health Care: An Autoethnography Reflecting On Dentistry's Collective Neglect And Changes In Professional Education Resulting In The Dental Hygienist Being The Prevention-Focused Primary Oral Health Care Provider, Maureen Patricia Mcweeney Harrington

University of the Pacific Theses and Dissertations

Many factors influence poor oral health among disadvantaged populations including socioeconomic circumstances, knowledge of disease prevention strategies and ability to implement those strategies, public policies, insurance status, insurance policies, dental providers and other challenges to accessing dental care. Often these issues converge and result in early disadvantages to achieving good oral health (Horton & Barker, 2010). Addressing even some of the factors that contribute to poor oral health may provide ways to change the dental health status of historically underserved populations. The purpose of this research is to explore my role as a practitioner and researcher in the creation of …

Integrating Students Into Interdisciplinary Health And Health Disparities Research Teams, Tanya M. Coakley, Allyson Kelley, Robin Bartlett, Terri Shelton, Schenita D. Randolph, Debra C. Wallace

Journal of Health Disparities Research and Practice

Major initiatives by the U.S. Department of Health and Human Services as well as the World Health Organization have produced a large and compelling body of evidence on how to reduce health disparities, which entails having a clear understanding of how social factors shape health and healthcare outcomes. Specifically, there is a need for healthcare professionals to understand social determinants of health (e.g., low socioeconomic status, lack of health insurance, and poor education) and how these lead to disparities in health for people of minority racial and ethnic groups. Little is known about how students are developed as health disparities …

Using Photovoice As A Tool For Community Engagement To Assess The Environment And Explore Environmental Health Disparities, Heather M. Brandt, Venice E. Haynes, Lashanta J. Rice, Dayna Campbell, Edith Williams, *Sacoby Wilson, Saundra H. Glover

Journal of Health Disparities Research and Practice

Photovoice was used as a participatory research method to document perceived local environmental hazards, pollution sources, and potential impact on health among community members to address environmental health disparities. A convenience sample of 16 adults in Orangeburg, South Carolina participated in Photovoice. Photos depicted positive and negative implications of the environment across seven themes: recreation and leisure; food access; hazards and pollution; health, human, and social services; economic issues; beautification; and accommodation and accessibility. Positive and negative photos demonstrated a high level of interest among community members in considering how the environment influences health and health disparities.

Improving Access And Utilization Of Data To Support Research And Programs Intended To Eliminate Disparities And Promote Health Equity, Rosaly Correa-De-Araujo

Journal of Health Disparities Research and Practice

Numerous Federal initiatives are addressing health and health care disparities. The ultimate goal is to achieve “a nation free of disparities in health and health care.” Social determinants of health remain mostly responsible for health/health care disparities among population groups within and between countries. In the United States, there is little evidence that disparities associated with such determinants are decreasing, with only 10% of those associated with race/ethnicity and income having demonstrated improvement in recent years. A variety of data sources are available from the Federal and private sectors to support research on disparities, but no single national survey seems …

Women’S Experiences With Prenatal Care: A Mixed-Methods Study Exploring The Influence Of The Social Determinants Of Health, Karen A. D'Angelo, Janelle K. Bryan, Brenda Kurz

Journal of Health Disparities Research and Practice

Background & Purpose: Racial and ethnic disparities pervade birth outcomes in the United States and the state of Connecticut. While Connecticut’s infant mortality rate is less than the national average, rates for the state’s Black/African American and Hispanic/Latino communities exceed it. This study explored how prenatal care in Connecticut may be enhanced to address these disparities.

Methods: In spring 2013, seven focus groups and two semi-structured interviews were conducted (n=47). Participants also self-administered brief surveys. Recruited by local service providers, participants were 18 or older, pregnant and/or in the first year post-partum at the time. Most self-identified as …

Addressing Health Disparities Among Homeless In Alachua County Through Community-Based Participatory Research., Meron Hirpa, Omar Iqbal, Haider Ali, Sama I. Ilyas, Nabeel Iqbal, Jeena A. Kar, Tiffany Splatt, Brendan Shortley, Nancy Hardt

Journal of Health Disparities Research and Practice

Introduction. In states such as Florida that did not expand Medicaid, a large number of economically disadvantaged individuals do not qualify for subsidies to buy health insurance through the Affordable Care Act (ACA) ². This leaves the health needs of Florida’s homeless population largely unaddressed. Nearly 48.1% of Alachua County’s homeless population has disabling conditions ¹⁶. This confirms a pressing need to understand the homeless population's healthcare needs, knowledge, and barriers in accessing healthcare. Methods. We used a Community-Based Participatory Research model in conducting health fairs and needs assessment surveys, incentivizing participation, and providing education about existing resources. …

Improving The Health Of African Americans In The Usa: An Overdue Opportunity For Social Justice, Allan S. Noonan, Hector Eduardo Velasco-Mondragon, Fernando A. Wagner

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Using a modified social ecological model, we conducted a review of the literature and nationwide statistics on African American health. We discuss the main social determinants of health and main health disparities, risk factors, the leading causes of morbidity and mortality, and access to health services for blacks in the USA. The mechanisms through which social determinants, including racism, exert their deleterious effects on black health are discussed at the macro and individual levels. Incarceration and mental health care issues are highlighted as priorities to be addressed. African Americans remain the least healthy ethnic group in the USA, a somber …

Fruit And Vegetable Availability, Nutrition Education And Access Amongst Food Pantries In California, Maine, Mississippi And South Dakota, Sarah L. Fowler

All Graduate Theses, Dissertations, and Other Capstone Projects

This descriptive study explored the views of food pantry directors in four states regarding pantry fruit and vegetable stock and supply, nutrition education offered, and current practices and perceived barriers to providing access to food pantries to low-income individuals and families in need. This study examined these variables by surveying staff at the food pantries who have direct contact with the individuals and families who utilize the pantries. All survey responses were collected utilizing Qualtrics software and then analyzed in SPSS. There were 87 respondents from four different states, California, Maine, Mississippi, and South Dakota.

The reporting for both fresh …

Racial/Ethnic Disparities Related To Health Insurance Coverage, Access To Care And Ease In Health Care Services Among Children In 2012 Cchaps Data, Jacquelynn Meeks, Sweety Baidhya

Journal of Health Disparities Research and Practice

nObjective:The aim of this study was to examine racial/ethnic disparities in unmet medical care, dental care and prescription medications and ease of using heath care services.

Methods:This is a cross sectional study of households in a six-county service region in Texas (Tarrant, Johnson, Hood, Parker, Wise and Denton Counties). The participants included the parents/guardians of children aged 1-15 years. In 2012, a total of 8,439 parents completed the survey. In 2012, 4194 completed the version containing the health insurance type and unmet medical, prescription and dental health care and ease/difficulty in access to health care questions.The dependent variables …

Association Analysis Of Reported Attitudes And Culturally Competent Behavior Engagement Among Public Health Department Employees, Marla B. Hall Phd, Jeffrey J. Guidry Phd, E. Lisako Mckyer Phd, Corliss Outley Phd, Danny Ballard Phd

Journal of Health Disparities Research and Practice

Objective: The purpose of this research is to analyze the association of attitudes and beliefs on engaging in culturally competent behavior.

Design: Explorational case study of individuals employed within an urban public health department.

Participants: Employees (n=90) from four metropolitan clinical sites of an urban public health department located in the southwest region of the United States were solicited and recruited during a monthly staff meeting. This sample is representative of 84% of the total employees which is comprised of 107 individuals.

Main Outcome Measures: The Cultural Competence Assessment is designed to explore individual knowledge, feelings …