Digital Commons Network^™

Changing The Narrative: Developing Evidence-Based, Communication Strategies To Address Health Disparities Of Black Women In The United States, Emmerline Francesca Nelson-Rogers

Doctoral Dissertations and Projects

Black women experience health issues at disparate rates when compared to their racial counterparts. Although these health disparities can be linked to health behaviors, they are deeply rooted in historic, racial systems that govern our lives today. More often than not, changes in health behaviors are at the forefront of addressing these health disparities rather than historical health trends of Black women in the U.S. This study aims to discuss why the change needed is a change in the narrative for why these health disparities exist and persist as well as a change in narrative about the role Black women …

Emergency Department Utilization By South Carolina Patients With Type 2 Diabetes: A Needs Assessment To Inform Primary Care Access And Telehealth Improvement, Beverly Wilson Holmes

MUSC Theses and Dissertations

BACKGROUND: Type 2 diabetes (T2D) is a major population health issue that affects 9.4% of the United States (US) while disproportionately affecting minority populations. T2D is highly prevalent and correlated with increased morbidity as well as early mortality rates, making it the seventh leading cause of death in the US in 2019. There is a high prevalence of T2D in the US and approximately 7 million people are undiagnosed.

OBJECTIVE: To assess if race plays a role in ED utilization and identify geographic areas where improvement in primary care and support by telehealth would be of greatest value. …

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.

Report: Oral Health In North Dakota: Opportunities And Need To Promote Oral Health Equity, Tonya Connor, Shawnda Schroeder, Anastasia Stepanov, Olivia Persinger

Indigenous Health Faculty Publications

THIS BOOKLET DESCRIBES THE CURRENT OPPORTUNITIES TO ADDRESS AND PROMOTE GOOD ORAL HEALTH IN NORTH DAKOTA Research and funding agencies stress the importance of using data to guide, develop, and implement effective and targeted activities to promote health equity. The data presented in this resource can aid decision makers, program developers, health professionals, dental teams, state agencies, and others when responding to the needs of North Dakota communities. USING THIS BOOKLET Countless providers, dental teams, local public health units, clinicians, agencies, and programs in the state are doing amazing work to ensure a healthy North Dakota. However, there are still …

A Scoping Review Of Health Research With Racially/Ethnically Minoritized Adults With Intellectual And Developmental Disabilities, Heather J. Williamson, Tara Chico-Jarillo, Samantha Sasse, Leticia Rennie, Jennifer R. Etcitty, Carol L. Howe, Michele Sky Lee, Julie S. Armin

Developmental Disabilities Network Journal

Living with intersectional identities, having a disability, and being a member of a racial or ethnic minoritized group in the U.S., contributes to marginalization that may result in health disparities and health inequities. The purpose of this scoping review is to describe health research regarding adult racial/ethnic minoritized individuals in the U.S with intellectual and developmental disabilities (I/DD). Eight electronic databases were searched to identify literature on the topic published since 2000. Of the 5,229 records, 35 articles were included in the review. Eligible studies included research conducted in the U.S., published in English, and research focused on adults with …

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) …

Micro-Scale Pedestrian Streetscapes And Physical Activity In Hispanic/Latino Adults: Results From Hchs/Sol., James F. Sallis, Jordan A. Carlson, Adrian Ortega, Matthew A. Allison, Carrie M. Geremia, Daniela Sotres-Alvarez, Marta M. Jankowska, Stephen J. Mooney, Earle C. Chambers, David B. Hanna, Krista M. Perreira, Martha L. Daviglus, Linda C. Gallo

Manuscripts, Articles, Book Chapters and Other Papers

We examined associations of micro-scale environment attributes (e.g., sidewalks, street crossings) with three physical activity (PA) measures among Hispanic/Latino adults (n = 1776) living in San Diego County, CA. Systematic observation was used to quantify micro-scale environment attributes near each participant's home. Total PA was assessed with accelerometers, and PA for transportation and recreation were assessed by validated self-report. Although several statistically significant interactions between individual and neighborhood characteristics were identified, there was little evidence micro-scale attributes were related to PA. An important limitation was restricted environmental variability for this sample which lived in a small area of a single …

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 …

“There's So Much They Don't Cover:” Limitations Of Healthcare Coverage For Indigenous Women In A Non-Federally Recognized Tribe, Jessica L. Liddell, Jenn M. Lilly

Social Service Faculty Publications

Access to healthcare is an essential component in addressing health disparities. However, the limitations of insurance coverage, and other barriers in paying for and accessing healthcare have seldom been researched for Indigenous peoples. In addition, state recognized tribes do not have access to the healthcare services provided by the Indian Health Service, and there is a need for research documenting their unique healthcare needs. Qualitative description was used to conduct 31 semi-structured interviews with women from an Indigenous tribe in the Gulf South to understand their experiences in paying for healthcare services. Participants described: (1) Discrimination Based on Perceived Ability …

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 …

Learner-Centered Teaching To Educate College Students About Rural Health Disparities, Anuli Njoku

Journal of University Teaching & Learning Practice

Geographically, rural U.S. communities have higher rates of disease and health problems, compared to urban areas. This encourages development of effective, learner-centred curricula to enable students to address disparate health outcomes as future health professionals. This three-year study evaluated the effect of an undergraduate rural public health course on health disparities-related perceptions among students at a rural Midwestern U.S. university. Students reported statistically significant increases in mean scores for several survey items pre- to post-survey. Post-survey response rate was 90%. This paper details the processes, outcomes, and lessons learned from incorporating learner-centred strategies to teach health disparities material in a …

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 …

The Prevalence Of Chronic Disease Risk Behaviors And Their Association With Hypertension In Racial/Ethnic Minorities: An Examination Of Nhanes Data 2015-2016, Oluyemi Farinu

Public Health Theses

INTRODUCTION: Insufficient physical activity, poor diet, tobacco use, and excessive alcohol consumption are each associated with the prevalence of chronic diseases such as hypertension. However, the clustering or co-occurrence of these chronic disease risk behaviors with the prevalence of hypertension among different racial/ethnic groups has not been fully investigated. Understanding the significance of this relationship is essential for efforts in prevention, as well as the alleviation of disparities in hypertension.

AIM: To examine racial/ethnic differences in the relationship between clustered chronic disease risk behaviors and hypertension.

METHODS: Data was obtained from the 2015-2016 National Health and Nutrition …

A Disparity Analysis Of Health Determinants And Outcomes In 500 Cities In The United States, Margaret Boateng

Geosciences Theses

Health disparity is an issue of global concern necessitating diverse studies. This study thus, investigated intra city and inter-city health disparity for the 500 largest cities in the United States using the health determinant and outcome data at census tract level from the Centers for Disease Control and Prevention. The Urban Health Index (UHI) approach for small area assessment was used to compute for the UHI and disparity ratios for all 500 cities. Data for socioeconomic status was obtained from 2013-2017 American Community Survey 5-year estimate data. Urban sprawl data was collected from National Cancer Institute. Cities were ranked based …

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 …

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 …

Beyond Access: Predictors Of Unmet Need For Health Care From Adolescence To Young Adulthood, Sarah B. Rutland

All ETDs from UAB

Background: Unmet need (UN) can be characterized as a person not getting care even when they think they need it. Younger populations are understudied for UN, even though UN can emerge as early as adolescence. The aim of this dissertation is to use the national Longitudinal Study of Adolescent to Adult Health (Add Health) to examine whether adolescent socioeconomic status (SES) or health factors better predict UN over time, and how UN differs by race/ethnicity. Life course perspective, cumulative advantage and disadvantage hypothesis, and fundamental cause theory inform my hypotheses. Primary hypotheses: 1) The likelihood of UN will increase over …