Digital Commons Network^™

Perspectives From Community-Based Doulas And Mothers: Neighborhood Context And Pregnancy, Dara D. Mendez, Jessica Burke, Jennifer Jones, Cynthia Salter

Journal of Health Disparities Research and Practice

Objectives: Limited research explores the potential pathways by which neighborhoods influence pregnancy or how community members conceptualize and interpret how neighborhood contexts and living environments influence pregnancy and birth.

Study Design: We applied participatory Concept Mapping and a series of focused discussions with community-based doulas and mothers.

Methods: We collaborated with a community-based doula program to investigate how mothers and community doulas perceived the neighborhood to influence reproductive health. We conducted a series of focused discussions including ‘Brainstorming’ to uncover key themes related to how neighborhood context influenced pregnancy, ‘Sorting and Rating’ of key themes in association with pregnancy and …

Retention Of Low Income Children In Three Dental Studies Investigating Early Childhood Caries, Ann H. Saba, John J. Warren, Karin Weber-Gasparoni, Deborah V. Dawson

Journal of Health Disparities Research and Practice

Background: To our knowledge no dental studies have looked closely at subject retention, which is crucial to better understand oral health disparities. In this paper, we report retention rates and review and attempt to assess which retention strategies utilized in 3 dental research studies investigating ECC were effective for retaining WIC-enrolled children. The purpose of this paper is to discuss challenges that were encountered when working with these populations, describe characteristics of those not retained, and summarize some recommendations for future dental studies working at WIC sites. Methods: Three dental studies were conducted at WIC clinics in Iowa. Retention strategies …

Can Mhealth Improve Risk Assessment In Underserved Populations? Acceptability Of A Breast Health Questionnaire App In Ethnically Diverse, Older, Low-Income Women., Carolina Bravo, Cristina O’Donoghue, Celia P. Kaplan, Judith Luce, Elissa Ozanne

Journal of Health Disparities Research and Practice

Background: Use of mobile health (mHealth) tools has expanded rapidly but little research has been done on its acceptability by low-income, diverse, older patient populations.

Objective: To assess the attitudes of a diverse group of underserved women on the acceptability and usability of mHealth tools in a clinical setting using a breast health questionnaire application (app) at a public hospital mammography clinic.

Methods: Semi-structured interviews were conducted in a breast-imaging center of an urban safety net institution from July-August 2012. Interviews included pre- and post-questions. Women completed the Athena breast health questionnaire app on an iPad and were asked about …

A Community Conversation On Adolescent Pregnancy And Parenting Services: Networks Of Support, Gatekeepers To Care, And Non-Compulsory Fathering In A Black Urban Community, Tamara G.J. Leech, Elizabeth A. Adams, Marci Bounds Littlefield

Journal of Health Disparities Research and Practice

This study employed Community-Based Participatory Research (CBPR) methods to document needs and capacity around adolescent pregnancy and parenting in one predominately Black, low-income urban community. Using an iterative focus group method, we engaged 60 participants in a two-day community conversation. Quantitative data from an enrollment questionnaire and qualitative transcripts of the discussions are analyzed. Our results indicate that the community’s greatest capacity lies in a network of women. Men tend to participate in parenting more holistically once formal paternity is established. Neighborhood women typically introduce adolescents to prenatal care, so delays in revealing the pregnancy to them serves as a …

Strengthening Hiv Knowledge And Awareness Among Undergraduate Students At Historically Black Colleges And Universities, Ashley Murray, Monica J. Huang, Felicia Hardnett, Madeline Y. Sutton

Journal of Health Disparities Research and Practice

Objective: We describe baseline HIV knowledge among students at historically black colleges and universities (HBCUs) to inform and strengthen HIV education efforts at HBCUs.

Methods: We surveyed 1,230 African American HBCU students from 24 HBCUs; 1,051 responses (85.4 %) were analyzable.

Results: Although general HIV knowledge was high among respondents (95% of students correctly responded that having sex without a condom constituted unsafe sex), knowledge deficits were noted (only 25% of students reported that multiple sex partners is a form of unsafe sex, while 25% of students reported that withdrawal of the penis before ejaculation reduced HIV …

The Association Between Distances Traveled For Care And Treatment Choices For Pelvic Floor Disorders In A Rural Southwestern Population, Gena Dunivan, Pamela Fairchild, Sara Cichowski, Rebecca Rogers

Journal of Health Disparities Research and Practice

OBJECTIVES: To determine if distance traveled for care influenced patient choice for conservative vs. surgical treatment for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI).

METHODS: Retrospective chart review of all new patients seen in the Urogynecology clinic at the University of New Mexico Hospital (UNMH) from January 2007 through September 2011. Data collected included medical history, Pelvic Organ Prolapse Quantification (POPQ) examination, and validated quality of life questionnaires.

RESULTS: 1384 women were identified with POP and/or SUI. Women traveled an average of 50 miles to receive care at UNMH. After multivariable analysis, greater distance traveled was associated with …

Documenting Nursing And Medical Students’ Stereotypes About Hispanic And American Indian Patients, Meghan G. Bean, Elizabeth S. Focella, Rebecca Covarrubias, Jeff Stone, Gordon B. Moskowitz, Terry A. Badger

Journal of Health Disparities Research and Practice

Objective: Hispanic Americans and American Indians face significant health disparities compared with White Americans. Research suggests that stereotyping of minority patients by members of the medical community is an important antecedent of race and ethnicity-based health disparities. This work has primarily focused on physicians’ perceptions, however, and little research has examined the stereotypes healthcare personnel associate with Hispanic and American Indian patients. The present study assesses: 1) the health-related stereotypes both nursing and medical students hold about Hispanic and American Indian patients, and 2) nursing and medical students’ motivation to treat Hispanic and American Indian patients in an unbiased …

Health Literate Organizations: Are Clinical Trial Sites Equipped To Recruit Minority And Limited Health Literacy Patients?, Jennifer Livaudais-Toman, Nancy J. Burke, Anna Napoles, Celia P. Kaplan

Journal of Health Disparities Research and Practice

Background. Racial/ethnic minority patients are less likely than non-Latino white patients to participate in cancer clinical trials. A key barrier to participation is limited health literacy which is more common among minorities. At the organizational level, it is important that clinical trials sites become better equipped to recruit minority patients by expanding their organizational health literacy including language competency and outreach efforts. We explored the characteristics of clinical trial sites that are associated with these health literate behaviors.

Methods. We identified 353 breast clinical trials recruiting participants in 2006 from four states (California, Florida, Illinois, and New York) through the …

Racial And Ethnic Disparities In Time To Cure Of Incontinence Present At Nursing Home Admission, Donna Z. Bliss, Olga Gurvich, Kay Savik, Lynn Eberly, Susan Harms, Jean F. Wyman

Journal of Health Disparities Research and Practice

Abstract

As many as half of older people that are admitted to nursing homes (NHs) are incontinent of urine and/or feces. Not much is known about the rate of cure of incontinence present at NH admission, but available reports suggest the rate is low. There have been racial and ethnic disparities in incontinence treatment, but the role of disparities in the cure of incontinence is understudied. Using the Peters-Belson method and multilevel predictors, our findings showed that there were disparities in the time to cure of incontinence for Hispanic NH admissions. A significantly smaller proportion of older Hispanic admissions were …

Disparities In Access To Health Insurance And Workers’ Compensation Benefit Between Non-Contingent And Contingent Farm Workers In U.S. Agriculture, Abay Asfaw

Journal of Health Disparities Research and Practice

The share of contingent employment has increased significantly in the last two decades. Not much is known about the impact of this shift on disparities in access to health insurance and other benefits. I examined disparities in access to any type of health insurance, employer-sponsored health insurance and workers’ compensation (WC) benefits between contingent and non-contingent workers in U.S. agriculture. I used the National Agricultural Workers Survey and the extended Oaxaca-Blinder decomposition technique to estimate disparities. Contingent employment could be a barrier to access of health insurance and WC benefit, which in turn could contribute to health inequalities in the …

Physicians' Attitudes About Recommending Surgery For Early Stage Lung Cancer And Possible Reasons For Racial Disparities, Franklin R. Mcguire

Journal of Health Disparities Research and Practice

PHYSICIANS’ ATTITUDES ABOUT RECOMMENDING SURGERY FOR EARLY STAGE LUNG CANCER AND POSSIBLE REASONS FOR RACIAL DISPARITIES

ABSTRACT

Purpose: Patient refusal for lung cancer surgery is significant, but other factors, such as negative framing of the treatment discussion, may be involved. Physician attitudes could influence the nuances of and therefore the conclusions of these discussions. We determined physicians’ attitudes and the influence it has on possible decisions against lung cancer surgery, particularly surgical rates for blacks, using a companion survey.

Methods: The study is a prospective, multicenter observational trial conducted at five sites in North and South Carolina from December …

Internet Use For Health Information Among American Indians: Facilitators And Inhibitors, Melissa K. Filippi, Christina M. Pacheco, Charlotte Mccloskey, Rebecca Jeanne Crosthwait, Justin Begaye, Jb Kinlacheeny, Won S. Choi, K Allen Greiner, Christine M. Daley

Journal of Health Disparities Research and Practice

Our research team explored Internet use among a heterogeneous American Indian (AI) population to determine Internet use in relation to health information seeking behaviors. Participants examined an AI culturally-tailored tobacco website as an example to explain what they wanted in an AI Internet health site. Using community-based participatory research, we conducted 10 focus groups with non-college AI men and women (N=96), stratified by age (18-29, 30-49, and 50 and over) to better understand their perceptions of Internet use and health information needs. We found that Internet use varied greatly among all strata. Participants referenced WebMD^© more than any other …

American Indian Men's Perceptions Of Breast Cancer Screening For American Indian Women, Melissa K. Filippi, Joseph Pacheco, Aimee S. James, Travis Brown, Florence Ndikum-Moffor, Won S. Choi, K Allen Greiner, Christine M. Daley

Journal of Health Disparities Research and Practice

Screening, especially screening mammography, is vital for decreasing breast cancer incidence and mortality. Screening rates in American Indian women are low compared to other racial/ethnic groups. In addition, American Indian women are diagnosed at more advanced stages and have lower 5-year survival rate than others. To better address the screening rates of American Indian women, focus groups (N=8) were conducted with American Indian men (N=42) to explore their perceptions of breast cancer screening for American Indian women. Our intent was to understand men’s support level toward screening. Using a community-based participatory approach, focus groups were audio-taped, transcribed verbatim, and analyzed …

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 …

Trauma Patient Satisfaction Survey Opens Discussion About Bias In Health Care, Marie Crandall

Journal of Health Disparities Research and Practice

Background

Patient satisfaction is an important part of quality care, and patient backgrounds can influence satisfaction with care. Since trauma disproportionately affects the underserved, this study aimed to determine the effects of race and insurance status on trauma patient satisfaction.

Methods

The validated Trauma Patient Satisfaction Survey (TPSS) was administered to 143 hospitalized trauma patients. ANOVA and Chi2 statistics were used to compare demographics with patient satisfaction. Qualitative data were analyzed with EZ-Text.

Results

Of the 143 patients surveyed, 95 (66%) were African American, 33 (23%) were Caucasian, and 15 (10%) were Latino. Sixty-one patients (43%) were uninsured. No statistically …

Strategic Planning For Recruitment And Retention Of Older African Americans In Health Promotion Research Programs, Laura Dreer, Cynthia Owsley, June Weston

Journal of Health Disparities Research and Practice

The purpose of this study was to 1) describe a strategic plan for recruitment and retention used in conducting eye health education research with African-Americans living in urban and rural areas of Alabama and 2) characterize recruitment and retention patterns for this project.

We evaluated an eye health education program tailored specifically to older African Americans. InCHARGE was designed to promote eye disease prevention by conveying the personal benefits of annual dilated comprehensive eye care and teaching strategies to minimize barriers to eye care. The InCHARGEÓ program or a social contact control program was delivered at 20 senior centers in …

A Qualitative Examination Of Barriers And Motivators To Smoking Cessation Among Hiv Positive African American Msm Smokers, Alicia Kaye Matthews, Maria Vargas, Lisa Kuhns, Nitin Shappiva, Andrea C. King

Journal of Health Disparities Research and Practice

Purpose: To identify barriers and motivators to smoking cessation among HIV-positive African American men-who-have-sex with men (MSM) who smoke.

Procedures: A convenience sample of smokers was recruited for this study using a range of outreach approaches. Focus groups (N = 4) were conducted that examined: quit experiences, barriers to and motivators of cessation, cultural beliefs, and community norms. Established qualitative methods were used to conduct and analyze the focus groups.

Main Findings: Participants (N = 31) reporting being diagnosed with HIV+ for M = 12 years. More than 60% reported a quit attempt in the past year. Knowledge was about …

Trends And Disparities In Tb Among U.S.-Born Black And White Chicago Residents, 1998-2008, Susan A. Lippold, Lori Armstrong, Jennifer M. Carter, Xiomara Hardison

Journal of Health Disparities Research and Practice

ABSTRACT

OBJECTIVE: To describe the decline of tuberculosis (TB) cases among U.S.-born non-Hispanic (NH) black and white Chicago residents.

METHODS: Data from the National TB Surveillance System was used to analyze trends and characteristics of reported TB cases among U.S.-born NH black and U.S.-born NH white Chicago residents from 1998-2008.

RESULTS: Chicago reported a total of 3,821 TB cases over the 11-year time period. Of these, 1,916 were U.S.-born NH black and 235 were U.S.-born NH white. The proportion of cases attributable to U.S.-born NH blacks was 63% (294/469) in 1998 and 34% in 2008 (72/213). Analysis for trends from …

Gendered Violence, Hiv Acquisition, And Clinical/Behavioral Research, Liz Barr, Michele Peake Andrasik, Claire Rappoport, Jessica Mooney, Annet Davis Vogel, Lisa Rossi, Amina Alio

Journal of Health Disparities Research and Practice

HIV incidence and prevalence rates for US women continue to increase, especially among Black and Latina women. In addition, the link between violence and HIV acquisition has been well documented. However, the interaction between violence, HIV risk, and HIV acquisition remains an under-addressed issue in current clinical and behavioral HIV research designs. Because violence against women plays an important role in HIV acquisition and transmission, it is imperative for clinical research to address violence in trial design and implementation. In this article, we discuss the prevalence of violence in women’s lives; the role violence plays in HIV acquisition; and the …

A Transdisciplinary Approach To Eliminate Cancer Disparities: An Overview Of Community Engagement And Outreach Efforts In An National Institute Of Health Center For Excellence, Maisha Standifer, Mph, Julie Baldwin, Phd, Jenna Davis, Mph, Clemente Gwede, Phd, Coni Williams, Ma, Lolita Dash-Pitts, Johnetta Goldsmith, Ms, Thometta Cozart Brooks Ms, Mph, Deanna Wathington, Md, B. Lee Green, Phd, Kevin Sneed, Phamd

Journal of Health Disparities Research and Practice

Creating health equity and eliminating health disparities are considered national priorities for improving the health of Americans (U.S. Department of Health and Human Services, n.d.). Health disparities are a primary public health concern, yet are complex phenomena and challenging to research (Harper & Lynch, 2005). The National Institute on Minority Health and Health Disparities (NIMHD), under the National Institute of Health (NIH), is committed to finding solutions to achieve this goal through the creation of interdisciplinary Centers of Excellence. In 2009, the University of South Florida (USF) and Moffitt Cancer Center (Moffitt) received a NIMHD Exploratory Center of Excellence award …

The Association Between Health Literacy And Diet Adherence Among Primary Care Patients With Hypertension, Jenny A. Hutchison Ms., Jan Warren-Findlow Dr., Michael Dulin Dr., Hazel Tapp Dr., Lindsay Kuhn

Journal of Health Disparities Research and Practice

This study examines the association between health literacy and adherence to low-salt diet practices among individuals with hypertension. Health literacy is the ability of individuals to understand and utilize health information. We surveyed 238 patients with hypertension from a primary care clinic in Charlotte, NC. We assessed health literacy and self-reported low-salt diet. Logistic regression was used to model the relationship between health literacy and low-salt diet adherence. Respondents were primarily female (67.3%) and black (80%). Black Americans were less likely to have adequate health literacy as compared to white Americans (21.8% vs. 55.8%). The study found no association between …

Developing An Action Learning Community Advocacy/Leadership Training Program For Community Health Workers And Their Agencies To Reduce Health Disparities In Arizona Border Communities, Kenneth A. Schachter Md, Mba, Maia Ingram Mph, Laurel Jacobs Drph, Mph, Hannah Hafter Mph, Jill Guernsey De Zapien Ba, Scott Carvajal Phd, Mph

Journal of Health Disparities Research and Practice

Community health workers (CHWs) make unique and important contributions to society. They serve as patient advocates, educators, and navigators in our health care system and a growing body of research indicates that they play an important role in the effective delivery of prevention and treatment services in underserved communities. CHWs also serve as informal community leaders and advocates for organizational and community change, providing valuable insiders' insights about health promotion and the interrelatedness of individuals, their community, its institutions, and the surrounding environment. Accion Para La Salud or Action for Health (Accion) is a CDC-funded community based participatory research (CBPR) …

What Do Parents In Mississippi Really Think About Sex Education In School?: Results Of A State-Level Survey, Colleen Mckee, Kathleen Ragsdale, Linda H. Southward

Journal of Health Disparities Research and Practice

Purpose: Despite broad public support for comprehensive sex education, its implementation remains controversial in the United States, especially in states such as Mississippi that have been identified as politically conservative. This study examined parental opinions regarding the implementation of age-appropriate sex-related education (SRE) (i.e., abstinence-plus education) in Mississippi public schools.

Methods: Data were used from the first state-level survey of a randomized sample of parents (N = 3,600) of public school students in Mississippi. The sample was relatively equally distributed between non-Hispanic whites (52.8%) and African Americans (48.2%). Bivariate and multivariate analyses were conducted to determine parental support for …

Prevalence And Correlates Of Hiv-Risk Behaviors Among Homeless Adults In A Southern City, Kristen R. Morrell, Latrice C. Pichon, Theresa Chapple-Mcgruder, Jennifer M. Kmet, Amanda Chandler, Marvell L. Terry Ii

Journal of Health Disparities Research and Practice

This paper aims to describe the prevalence and correlates of HIV-risk behaviors among adults receiving transitional and emergency housing services in Memphis, Tennessee. A cross-sectional, interviewer-administered survey was conducted with a convenience-based sample (N=116) of homeless adults. Sex without a condom, sex while on drugs or drunk, and sex with an unknown person emerged as the three most prevalent HIV-risk behaviors. Sex while drunk or high on drugs was also assessed as a significant predictor for sex without a condom and sex with an unknown person. Multivariate logistic regressions revealed that mental health status, duration of homelessness, incarceration history, and …

Mi Cuerpo, Nuestra Responsabilidad: Using Photovoice To Describe The Assets And Barriers To Sexual And Reproductive Health Among Latinos In North Carolina, Barbara Baquero, Shira Goldman, Florence Siman, Sadiya Muqueeth, Laura Villa-Torres, Eugenia Eng, Scott D. Rhodes

Journal of Health Disparities Research and Practice

Latinos in North Carolina experience disparities in sexual and reproductive health. To identify and explore assets for and barriers to sexual and reproductive health in the Latino community, an academic-community partnership engaged community health workers (CHW) in Photovoice, a participatory qualitative research methodology. Five sessions were completed in which CHW agreed on photo assignments and discussed the photos. Themes included the role of men, cultural taboos, and the effect of undocumented immigrant status on access to resources. Findings were presented at a community forum. Building on the strengths of CHW to reduce barriers to sexual and reproductive health is a …

Sexual Dysfunction Among Latino Men And Women With Poorly Controlled Diabetes, Sonjia Kenya, Cynthia N. Lebron, Hua Li, Yisel Alonzo, Ernesto Reyes, Olveen Carrasquillo

Journal of Health Disparities Research and Practice

Latinos are the largest minority population in the United States and are diagnosed with diabetes at nearly twice the rate of non-Hispanic whites. Latinos not only suffer disproportionately from diabetes but also from diabetes related complications, including sexual dysfunction. Much of the existing literature on sexual dysfunction among Latinos with diabetes has focused on erectile dysfunction (ED). There is a dearth of information on sexual functioning among Latina women with diabetes or information on both genders in other sexual domains. Our study examined the prevalence of sexual dysfunction among a cohort of 106 poorly controlled Latino diabetics in South Florida …

Hiv And Sti Risk For Young Blacks In High Prevalence Areas: Implications For Health Equity In Communities Hosting Historically Black Colleges And Universities (Hbcus), Tanya Telfair Leblanc, Madeline Y. Sutton, Peter Thomas, Wayne A. Duffus

Journal of Health Disparities Research and Practice

Background

Every year, thousands of young, black, high school graduates who are seeking higher education, attend one of the 105 historically black colleges and universities (HBCUs) located primarily in the south and east. The objective of the research was to examine the geographic proximity of HBCUs to areas of high HIV and STI disease burden among college age people to assess infectivity of potential sex partners in the areas surrounding HBCUs.

Methods

We examined the 14 states reporting the greatest HIV diagnoses burden among persons age 20-24 years old and STI burden among persons age 15 to 24 years old …

Social Determinants Of Late Presentation To Hiv Care, Connie Leeper, Michael Mugavero, James Willig, Eric Chamot, Shatomi Kerbawy, Anne Zinski

Journal of Health Disparities Research and Practice

Background: In recent years, increased attention has shifted toward evaluating social determinants of health, and understanding how community, environment, and system factors affect health outcomes. HIV policies and guidelines emphasize the importance of earlier HIV diagnosis and presentation for care. This study evaluated the role of individual and community-level factors in late presentation to HIV care.

Methods: HIV-infected patients newly initiating outpatient HIV medical care at an academic medical center between 2005-2010 were included. Patients' self-reported addresses at their first clinic visit were geocoded using geographic information systems software to the appropriate United States census block group. Using …

Sexual And Reproductive Health Disparities In A National Sample Of Hispanic And Non-Hispanic White U.S. College Students, Eric R. Buhi, Stephanie L. Marhefka, Christopher W. Wheldon, David L. Tilley, Natalie Klinkenberger, Celia Lescano, Mary T. Hoban

Journal of Health Disparities Research and Practice

Hispanic students are the fastest growing minority population on U.S. college campuses. The purpose of this study was to examine differences in the sexual and reproductive health behaviors and outcomes between Hispanic and non-Hispanic White college students. Analyses utilized data from 15,518 non-married undergraduates (aged 18-24 years) responding to the Fall 2009 American College Health Association-National College Health Assessment II, a national sample of U.S. college students. Binary logistic regression analyses were used to examine disparities in sexual and reproductive health behaviors and outcomes, including sexual behavior, contraceptive and condom use, HIV testing, and STD and unintended pregnancy history, between …

To Test Or Not To Test: Barriers And Solutions To Testing African American College Students For Hiv At A Historically Black College/University, Naomi M. Hall-Byers, Jennifer Peterson, Malynnda Johnson

Journal of Health Disparities Research and Practice

Young African Americans are disproportionately affected by sexually transmitted infections, including HIV. The purpose was to identify reasons that African American college students at a historically Black college/university (HBCU) identified as barriers to HIV testing, and how these barriers can be removed. Fifty-seven heterosexual-identified undergraduate students (ages 18-25) attending an HBCU in the southeastern US participated in the study. Latent content analytic techniques were used to code the transcripts for themes and categories, and representative quotations were used in the findings. Qualitative data indicates three main themes used to avoid testing and three themes to encourage testing. Students were forthcoming …