Medicine and Health Sciences Commons^™

The Role Of Socioeconomic Status, Race, And Gender In Patient-Reported Outcomes Following Total Hip Arthroplasty, Allyn M. Bove, James Porter, Aatif Sayeed, Clair Smith, Brian A. Klatt

Journal of Health Disparities Research and Practice

Background

Disparities in total joint arthroplasty are well-documented. However, much of the research regarding disparities in vulnerable populations receiving total hip arthroplasty (THA) have focused on short-term outcomes. The purpose of this study was to examine the effects of race, gender, and socioeconomic status (SES) on patient-reported outcomes six months following THA.

Methods

Electronic health record data were retrospectively analyzed for 269 individuals who underwent THA at a large urban hospital from 2013-16. Data retrieved included patient demographics, baseline health information, data regarding hospital length of stay when undergoing THA, post-operative complications, and patient-reported function, measured by the Harris Hip …

Understanding Disparities In Clinical Trials For Native Hawaiian Men, Gabriela A. Layi, Kevin Cassel, Maile Taualii, Jeffrey L. Berenberg, Erin O. Bantum

Journal of Health Disparities Research and Practice

Understanding low rates of participation by minority populations in clinical trials is critical for reducing and eliminating disparities. We examined beliefs and attitudes of Native Hawaiian men related to illness and cancer to better understand their rates of participation in clinical trials. We conducted face-to-face interviews with Native Hawaiian key informants throughout the State of Hawai‘i using quota sampling methods to obtain a range of perspectives about attitudes towards health care seeking to provide insight into low clinical trials participation. Interviews were audio-taped, transcribed, and independently coded by researchers. Thematic analysis guided the extraction of relevant data from the discussions. …

An Exploratory Study Of The Likelihood Of Adopting Genetic Counseling And Testing For Lynch Syndrome-Related Colorectal Cancer Among Primary Care Physicians In Florida, Vanessa B. Crowther, Sandra G. Suther, Jullet A. Weaver, Clement K. Gwede, Matthew Dutton, Dongming Cui, Ivette A. Lopez

Journal of Health Disparities Research and Practice

Genetic counseling and testing for inherited cancer syndromes have the potential to save lives and may be an avenue for addressing health care disparities among African Americans newly diagnosed with colorectal cancer (CRC); and their close relatives. African Americans are more likely to be diagnosed with CRC at younger ages (under age 50 years), and diagnosed at later stages when cancer is more aggressive and difficult to treat, which are factors associated with hereditary cancers such as Lynch syndrome-related CRC. Considering the benefits of genetic testing for hereditary cancer syndromes - risk stratification, preventive surveillance, targeted treatment, and subsequent reduction …

Examining Race Differences In Blood Pressure Control Among People With Chronic Kidney Disease, Jayme Savoy, Roland J. Thorpe, Jr., Phd

Journal of Health Disparities Research and Practice

Of Chronic Kidney Disease (CKD) patients, 20% of them also have hypertension (HTN). African Americans (AA) are known to be more at risk of CKD development and poor HTN control compared to Whites, largely due to their higher prevalence of diabetes and HTN. While those health conditions are a known risk factor to CKD, it is less clear if there is a race difference in HTN control among CKD patients.

Using a combined 1999-2014 data set from The National Health and Nutrition Examination Survey (NHANES), we sought to determine if there is an association between race and HTN control among …

A Collaborative Effort To Assess Disparities Associated With Behavioral Health In The North Texas Region, Sushma Sharma

Journal of Health Disparities Research and Practice

Objective: This study aimed to provide an assessment of 16 North Texas Counties’ behavioral health access disparities and provide details of the percentage of hospital patient visits from each county diagnosed with mental health and drug issues. The gender, age, race-ethnicity and insurance status of each patient, the zip codes where they live and patient migration between different providers was also detailed. Furthermore, the number of psychiatric beds for each county is listed.

Methods: This study utilized the DFWHC Foundation's data warehouse which contains comprehensive hospital visit data from 96 partner hospitals, to understand the clinical trends of mental health …

Determinants Of Disparities In The Colorectal Cancer Burden, Karen Elizabeth Callahan

UNLV Theses, Dissertations, Professional Papers, and Capstones

Colorectal cancer (CRC) is the third leading cause of cancer incidence and mortality in the United States, with an estimated 140,000 new cases and 51,000 deaths expected in 2018. Like most cancers, the burden of CRC is unequally distributed among population groups. The current dissertation included two studies filling gaps in knowledge about CRC disparities. Study 1 characterized the relationship between educational attainment and CRC mortality by race/ethnicity. Six years of CRC mortality data (2012-2017) from the diverse state of California, with 30,180 deaths were analyzed. Sex-specific mortality rate ratios (MRR) stratified by race/ethnicity as well as by educational level …

Comparison Of Compliance With Cervical Cancer Screening Among Women Aged 18 And Above In Arkansas And The United States, Sarah N. O'Connor, Jun Tao, L. Joseph Su

Journal of Health Disparities Research and Practice

Introduction: Cervical cancer preys on women without access to preventative screening. Any woman who has developed an invasive case of cervical cancer should be regarded as a failure of screening. Disparities in access to screening, triage, and treatment fuel an uneven distribution in the burden of cervical cancer within the United States; weighing unusually heavy on the Southern States like Arkansas. The purpose of this study was to evaluate demographic and behavioral risk factors for cervical cancer and identify potential barriers which may influence the likelihood of complying with current Pap test recommendations on a state level, in Arkansas, and …

Disparities In Access To Primary Care And Emergency Department Utilization In A Large Medicaid Program, Natasha Parekh, Marian Jarlenski, David Kelley

Journal of Health Disparities Research and Practice

Identifying and eliminating disparities are priorities for State Medicaid programs, especially in the context of increased enrollment through Medicaid expansion. We assessed racial, ethnic, regional, and managed care organization (MCO) differences, as well as time trends before and after Medicaid expansion, in primary care and emergency department (ED) utilization in a large Medicaid program. We performed a cross-sectional evaluation of data from Pennsylvania Medicaid from 2011-2015. Three primary care outcomes included: 1) adult access to primary care; 2) adolescent access to primary care; and 3) pediatric access to dental care. Our fourth outcome reflected ED utilization. We observed significant racial …

Promoting Community And Population Health In Public Health And Medicine: A Stepwise Guide To Initiating And Conducting Community-Engaged Research, Scott D. Rhodes, Amanda E. Tanner, Lilli Mann-Jackson, Jorge Alonzo, Florence Siman, Eunyoung Y. Song, Jonathan Bell, Megan B. Irby, Aaron T. Vissman, Robert E. Aronson

Journal of Health Disparities Research and Practice

Various methods, approaches, and strategies designed to understand and reduce health disparities, increase health equity, and promote community and population health have emerged within public health and medicine. One such approach is community-engaged research. While the literature describing the theory, principles, and rationale underlying community engagement is broad, few models or frameworks exist to guide its implementation. We abstracted, analyzed, and interpreted data from existing project documentation including proposal documents, project-specific logic models, research team and partnership meeting notes, and other materials from 24 funded community-engaged research projects conducted over the past 17 years. We developed a 15-step process designed …

Estimates Of Female Breast Cancer Mortality-To-Incidence Ratio (Mir) Of The Counties And The Senatorial Districts Grouped To County Boundaries (Sdgcs) In Missouri 2008 - 2012, Awatef A. Ben Ramadan, Jeannette Jackson-Thompson, Chester L. Schmaltz

Journal of Health Disparities Research and Practice

Purpose: To measure Mortality-to-Incidence Ratios (MIRs) on Senatorial Districts Grouped to County Boundaries (SDGCs) to explore the female breast cancer (FBC) racial and age disparities in Missouri.

Methods: The MIRs and their 95% CI by age and race were calculated for the 20 SDGCs for the period from 2008-2012.

Results: For the 65+ years old FBC cases, the MIRs for whole Missouri and the 20 SDGCs were typically twice the MIR for thewhites.

Conclusions: FBC MIRs can be used as a measure of cancer inequalities in Missouri. These measures might be informative for policy makers to assess the existing policies …

Are Parent Activation And Health Literacy Distinct Concepts? A Study In Low Income Urban Populations, Harita S. Shah, Kate Leifheit, Sarah Polk, Elizabeth Sloand, Tina L. Cheng, Lisa Decamp

Journal of Health Disparities Research and Practice

Patient activation (the knowledge, confidence, willingness, and skills to manage one’s healthcare) and health literacy have well-established associations with health and healthcare outcomes in adults. However, little is known about parent activation on behalf of children and its relation to health literacy. Our objective was to examine relations between parent activation, health literacy, and parent-provider relationship quality. We surveyed 316 Spanish- or English-speaking parents of publicly-insured patients of a general pediatrics clinic. Surveys included the Parent-Patient Activation Measure (P-PAM), the Newest Vital Sign (NVS), and parent-provider relationship measures. We used chi-square analyses and logistic regression to explore associations stratified by …

The Effects Of Insurance Status On Pediatric Traumatic Brain Injury Outcomes: A Literature Review, Anthony Fabio, Austin Murray, Michelle Mellers, Stephen Wisniewski, Michael Bell

Journal of Health Disparities Research and Practice

Objective: To review the literature that describes the effects of insurance status on traumatic brain injury (TBI) outcomes among pediatric patients to understand how policies related to access to health insurance changes TBI outcomes. Method: This review was conducted using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA). A search of OVID Medline was conducted in May of 2016 for all years for peer-reviewed articles that included keywords related to “brain injuries” and “insurance status”. Articles were included if authors conducted a separate analysis of children aged 0 to 18. Articles were excluded if the TBI was the …

The Effects Of Patient Characteristics On Clinician’S Adherence To Preventive Practice Guidelines, Deshana A. Collett Ph.D,Pa-C, Kenneth M. Tyler Ph.D.

Journal of Health Disparities Research and Practice

ABSTRACT

BACKGROUND: The existence of health disparities confirms that not all patients, regardless of differences in patient demographics, are provided quality healthcare (Agency of Health Care Research and Quality, 2003). Moreover, research suggests that health disparities may be present due to the inadequate delivery of medical services (S. Haist, J. Wilson, M. Lineberry, & C. Griffith, 2007; Van Ryn, Burgess, Malat, & Griffin, 2006). The differences in the delivery of care and services to ethnic minorities and those of low socioeconomic status warrant examining the role healthcare providers play in the causation of these health disparities (Smedley, Stith, & Nelson, …

Asian/White Differences In The Relationship Of Maternal Age To Low Birth Weight: Analysis Of The Prams Survey, 2004–2011, Sangmi Kim

Asian/Pacific Island Nursing Journal

This study aimed to examine (a) maternal age patterns of low birth weight (LBW; birth weight < 2,500 g) for non-Hispanic (N-H) Asian and N-H White women, and (b) Asian–White gaps in LBW risk by maternal age and their mechanisms. Logistic regression analyses were performed on the Pregnancy Risk Assessment Monitoring System data of N-H Asian and N-H White women who delivered their first singleton birth without birth defects in 13 states between 2004 and 2011. Age- and race/ethnicity-specific LBW risk was estimated, unadjusted and adjusted for maternal risk factors (e.g., marital status, maternal education, pregnancy intention, stress, maternal morbidities, smoking, and prenatal care) and their interactions with maternal age or race/ethnicity. The interaction between maternal age and race/ethnicity was statistically significant (p < .0001) with covariates and interactions held constant. N-H Asian women showed a reverse W-shaped maternal-age pattern of LBW with the highest risk in their late 30s (OR = 1.56, 95% CI [1.26, 1.94]) whereas N-H White women experienced a maternal age-related increase in LBW. N-H Asian women were more likely to deliver LBW infant than their N-H White counterparts between their late 20s and late 30s, with the greatest racial/ethnic gap in their late 20s (OR = 4.19, 95% CI [3.33, 5.29]). Preventive strategies should be developed targeting N-H Asian women aged 25 to 39 years to reduce the Asian–White disparities in LBW. Considering the known maternal risk …

Community-Engagement To Support Cardiovascular Disease Prevention In Disparities Populations: Three Case Studies, Deborah C. Glik, Mienah Zulfacar Sharif, Katherine L. Tucker, Shirley A. Tejada, Michael L. Prelip, Alice S. Ammerman, Thomas C. Keyserling, Shioban E. Torres, Stephanie Jilcott Pitts

Journal of Health Disparities Research and Practice

Cardiovascular diseases remain the leading cause of death in the United States, and are characterized by socioeconomic, geographic, ethnic, and gender disparities in risk, morbidity and mortality. In response, public health efforts have moved beyond approaches focusing on individual-level behavior change toward culturally appropriate community-focused efforts. In specific, engagement of community partners is now recognized as essential to facilitate changes at multiple levels to improve cardiovascular disease outcomes.

This paper shares lessons learned to deepen appreciation for the unique challenges community-engagement in health disparities research entails, including variations in practice, time commitment, and complexity. This paper presents three case studies …

Obstetrician-Gynecologists’ Knowledge Of Health Disparities And Barriers Among American Indian/Alaska Native Women In Washington State, Katherine M. Jones, Greta B. Raglan, Sophia M. Lannon, Jay Schulkin

Journal of Health Disparities Research and Practice

Background: Health disparities between American Indian/Alaska Native (AI/AN) women and other races/ethnicities have long been noted. Obstetricians-Gynecologists (Ob-Gyn) play a significant role in well-woman care and are often the first and most frequent point of medical contact for women, particularly among minority and low-income women.

Objective: This study aimed to assess Ob-Gyns’ knowledge, beliefs, and practices related to health disparities among AI/AN women.

Method: A self-administered questionnaire, consisting of questions about knowledge, beliefs, and practices of health disparities among AI/AN women, was mailed to 722 members of The American College of Obstetricians and Gynecologists (ACOG) practicing in the state of …

Addressing Disparities In Access To Information For Hispanic Families Of Children With Special Health Care Needs, Suzanne M. Bronheim, Sandra Soto, Bruno J. Anthony

Journal of Health Disparities Research and Practice

Objectives: Utilizing a diffusion of innovation (DOI) framework, the study seeks to increase access to information for Hispanic families of children with special health care needs (SHCN) by increasing their use of Family-to-family Centers (F2Fs) in their states. Methods: Focus groups were implemented of both English-speaking and Spanish-speaking Hispanic families in two states with a confirming Delphi procedure exploring factors within DOI framework related to using F2Fs and the nature of current family communication networks. Results: Families seeking information at key change points turn to formal sources, although Spanish-speaking families, noted that due to language barriers, they also turned to …

The Voices Of The People: Lower Sioux Indian Community Members Speak Out On What They Need And Want In A Primary Health Care Clinic On The Reservation, Darin Michael Prescott

UNLV Theses, Dissertations, Professional Papers, and Capstones

American Indian/Alaska Native (AI/AN) people who live on reservations or in urban areas typically receive their health care in clinics that are operated by their tribe or are affiliated with Indian Health Service (IHS), a federal agency that provides care to AI/AN people. The Lower Sioux Indian Community (LSIC) is a federally recognized tribe located in southwest Minnesota near Morton, MN. LSIC members currently receive health care from outside providers at various locations near the reservation. The outsourced services include primary care, emergency care, hospitalization, surgery, dentistry, and podiatry. Because the providers are independent groups and do not work for …

Environmental Disparities Present A Challenge For Diabetes Prevention And Management Efforts In Dallas County, Theresa Mendoza, Sushma Sharma, Pamela Daughty, Crystee Cooper, Carol Young, Larry Tubb, Kristin Jenkins, Community Health Collaborative Of North Texas (Chc)

Journal of Health Disparities Research and Practice

The State of Texas is home to nearly 2 million men, women and children with diabetes, over half a million of which reside in the Dallas-Fort Worth (DFW) region. Recognizing the rising need to identify the disparities in implementing the diabetes prevention and management efforts and adopting the healthy life style in high diabetes prevalence areas in Dallas County, we explored the potential of Geographic Information System (GIS) methodology to analyze the data at zip code level from Dallas-Fort Worth Hospital Council (DFWHC) Research Foundation’s data registry. The objectives of this research were to identify the zip codes with the …

Environmental And Health Disparities In Appalachian Ohio: Perceptions And Realities, Michele Morrone, Natalie A. Kruse, Amy E. Chadwick

Journal of Health Disparities Research and Practice

Background. Appalachia is a region of the United States that faces significant environmental and health disparities. Understanding these disparities and the social determinants that contribute to them will help public health practitioners make better decisions. The purpose of this research is two-fold. First, through secondary data analysis, we document environmental and health disparities as well as demographic and economic conditions that may contribute to these disparities between Appalachian and non-Appalachian Ohio. Second, we examine perceptions of environmental health practitioners about the differences in environmental conditions between Appalachian and non-Appalachian Ohio.

Methods. We gathered secondary data about economics, health, and the …

Lung Cancer Survival Disparities In Nevada, Chima Osuoha

UNLV Theses, Dissertations, Professional Papers, and Capstones

Lung cancer is the leading cause of cancer death in both men and women in the United States. Nevada shows moderate incidence rates of lung cancer for men but high rates for women. Little is known about the lung cancer experience and survival characteristics of the nearly 2000 new cases occurring every year in the State. The purpose of this study was to measure the extent to which geographic area of residency, gender, race, health insurance, social economic status (SES) and stage at diagnosis were associated with survival in patients diagnosed with lung cancer in Nevada. This was a retrospective …

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 …

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 …

Racial/Ethnic Disparities In Infectious Disease Hospitalizations In Arizona, Laura Callinan, Robert Holman, Douglas Esposito, Marian Mcdonald

Journal of Health Disparities Research and Practice

Infectious disease (ID) hospitalizations in Arizona, a diverse population with nearly complete race/ethnicity data, were analyzed using the State Inpatient Database for 2005-2008. ID hospitalizations rates were calculated and compared by ID group, race/ethnicity, age, and sex. During 2005-2008, there were 383,597 ID hospitalizations reported in Arizona, resulting in an age-adjusted rate of 1498.1 per 100,000 persons. A range of racial/ethnic disparities in ID hospitalization rates were noted. Persons of Native American and black race/ethnicity had overall ID hospitalization rates higher than the rate for persons of white race/ethnicity; persons of Asian or Pacific Islander race/ethnicity had a lower rate. …

The Convergence Of Science And Culture: Developing A Framework For Diabetes Education In Tribal Communities, Michelle Chino Dr, Carolee Dodge Francis, Lemyra Debruyn, Lynn Short, Dawn Satterfield

Journal of Health Disparities Research and Practice

In an unprecedented effort to address the epidemic of diabetes in tribal communities, the Diabetes Education in Tribal Schools project brought together a group of individuals from eight tribal colleges and three federal agencies to develop a diabetes prevention curriculum for American Indian and Alaska Native school children. The curriculum incorporates Western and Native science with culturally responsive teaching techniques. Both the project and its evaluation process have reached beyond conventional bounds to acknowledge fundamental issues of tribal culture, history and health and the integration of science, culture, and community. This article will discuss the challenges and rewards of the …

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 …

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 …