Social and Behavioral Sciences Commons^™

Environmentally Marginalized Populations: The "Perfect Storm" For Infectious Disease Pandemics, Including Covid-19, Gabriella Y. Meltzer, Oyemwenosa Avenbuan, Christina Awada, Oluwakemi B. Oyetade, Tricia Blackman, Simona Kwon Drph, Mph, Esther Erdei Phd, Judith T. Zelikoff Phd

Journal of Health Disparities Research and Practice

COVID-19 has exacted a severe toll on the United States population’s physical and mental health and its effects have been felt most severely among people of color and low socioeconomic status. Using illustrative case studies, this commentary argues that in addition to COVID-19 health disparities created by psychosocial stressors such as the inability to socially distance and access quality healthcare, environmental justice communities have the additional burden of disproportionate exposure to toxic contaminants that contribute to their higher risk of COVID-19. Environmental contaminants including heavy metals and persistent organic pollutants found contaminating their nearby environments can alter the immune response, …

Structural Justice: A Critical Feminist Framework Exploring The Intersection Between Justice, Equity And Structural Reconciliation., Camille Burnett, Michael Swanberg, Ashley Hudson, Donna Schminkey

Journal of Health Disparities Research and Practice

Violence against women is a human rights violation (UN, 2006). It affects the health of women globally (UN, 2009) and its elimination is at the heart of many international and national goals. Intimate partner violence (IPV), one of the most common forms of gender-based violence, affects one in three women worldwide (WHO, 2013). The consequences of IPV create negative health outcomes for women that diminish their quality of life and their overall well-being. Abused women access community supports such as shelters to seek safe refuge from the abuse and restore their lives. While shelters play an extensive role in helping …

An Ambivalent Embrace: Service Needs And Gaps For Asian Immigrants In New Destinations, John J. Chin

Journal of Health Disparities Research and Practice

Asian immigrants to the U.S. are settling in "new destinations," but there has been little research on their health care and social service needs. Our analysis of Census data to identify cities with the fastest Asian immigrant population growth (1990-2000) yielded 33 smaller cities in 13 states. The cities ranged in population from 7,677 to 86,660; were spread across 13 states in the Northeast, South, and Midwest regions of the US; and varied widely demographically. Pilot surveys conducted in 2009 indicated that, although many residents had positive attitudes towards immigrants, many were also concerned about job competition and dilution of …

Social Determinants Of Health Associated With Hbv Testing And Access To Care Among Foreign-Born Persons Residing In The United States: 2009 - 2012, Kevin M. Greene, Wayne A. Duffus, Jian Xing, Hope King

Journal of Health Disparities Research and Practice

Objectives: To describe how select Social Determinants of Health (SDH) are associated with the burden of hepatitis B virus (HBV) infection among foreign-born persons residing in the United States.

Methods: Multivariate logistic regression was used to examine the Racial and Ethnic Approaches to Community Health (REACH) 2010 Risk Factor Survey data to investigate the independent relationship between SDH and HBV testing and access to care.

Results: HBV infected persons with insurance were more likely to see a physician than those without. Respondents worried about money to pay rent or mortgage were more likely to report HBV infection than …

Race, Age, And Neighborhood Socioeconomic Status In Low Birth Weight Disparities Among Adolescent Mothers: An Intersectional Inquiry, Sheryl L. Coley, Tracy R. Nichols

Journal of Health Disparities Research and Practice

Introduction: Few studies examined socioeconomic contributors to racial disparities in low birth weight outcomes between African-American and Caucasian adolescent mothers. This cross-sectional study examined the intersections of maternal racial status, age, and neighborhood socioeconomic status in explaining these disparities in low birth weight outcomes across a statewide sample of adolescent mothers.

Methods: Using data from the North Carolina State Center of Health Statistics for 2010-2011, birth cases for 16,472 adolescents were geocoded by street address and linked to census-tract information from the 2010 United States Census. Multilevel models with interaction terms were used to identify significant associations between maternal racial …

Self-Care And Mobility Disability At Mid-Life In Lucky Few, Early-, And Late-Baby Boom Birth-Cohorts, Carlos Siordia

Journal of Health Disparities Research and Practice

Disability is related in definite ways with makers of social stratum, as it can be influenced by and has the potential to contribute to the production and reproduction of social stratification. Intersectional markers of social stratification processes are ignored determinants of health. The Class, Race, Sex (CRS) hypothesis presented here argues that a low-education, racial-minority, and female disadvantage will compound to affect the prevalence and risks of disability. The evidence presented validates the CRS hypothesis by showing that disability prevalence and risk clusters first by class, race, and then sex. The cross-sectional study of community-dwelling adults in the Unites States, …

Using The Theory Of Fundamental Causes To Show The Potential Effects Of Socioeconomic Status On Surgical Outcomes, Mehwish Qasim, A.B.D.

Journal of Health Disparities Research and Practice

Surgical procedures are both costly and common. There are large differences in surgical outcomes both within and between hospitals based on patient characteristics such as measures of income. In both 2000 and 2009, patients residing in low-income communities had worse morbidity and mortality rates, across a wide range of quality indicators. In this review, the author will explicate the Theory of Fundamental Causes as it relates to surgical care, review key empirical findings and address potential limitations of the theory. This review will provide a platform for researchers to discuss current research in surgical disparities using the Theory of Fundamental …

Cultural Competence: New Conceptual Insights Into Its Limits And Potential For Addressing Health Disparities, Shireen S. Rajaram, Susan Bockrath

Journal of Health Disparities Research and Practice

The increasing interest in the role of racism and racialization in health disparities, calls for exploring new paradigms in addressing and eliminating health disparities related to race/ethnicity. Cultural competence is conceptualized as one of the keys ways to address racial/ethnic disparities in public health and healthcare. However, for cultural competence to fulfill this role, it requires a critical understanding of the underlying socio-political and economic processes of power, privilege and institutional racism that create, support and maintain existing health disparities. This paper outlines how the concept of cultural competence can be made more robust, by incorporating concepts such as Public …

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 …

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

Journal of Health Disparities Research and Practice

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

Racial Differences In Preventive And Complementary Health Behaviors And Attitudes, Steven E. Shive, Grace X. Ma, Yin Tan, Jamil I. Toubbeh, Lalitha Parameswaran, Lalitha Parameswaran, Joe Halowich

Journal of Health Disparities Research and Practice

Screening tests have been developed for many diseases—the presence of cancer, especially—but are differentially utilized among racial/ethnic groups. In addition to standard medical screening techniques, some patients opt to use Complementary and Alternative Medicine (CAM) for prevention and treatment. The purpose of the current study is to examine racial/ethnic disparities in primary and secondary preventive health behaviors, determine differences in use of complementary and alternative health regimens, and determine which health attitudes and health self-management factors are associated with use of complementary alternative medicine. If differences among ethnic/racial groups in perceived health status, preventive health care behaviors, and use of …

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

Journal of Health Disparities Research and Practice

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

Transdisciplinary Approaches To Ameliorating Racial Disparities In Prostate Cancer Outcomes, Chanita H. Halbert, Katrina Armstrong, John Holmes, David Fenstermacher, Janet Weiner, Carmen Guerra, J. S. Schwartz, Jerry C. Johnson, Edmund Weisberg, Chantal Montagnet, Benita Weathers, Charnita Zeigler-Johnson, Ernestine Delmoor, Timothy R. Rebbeck

Journal of Health Disparities Research and Practice

Though prostate cancer is the second leading cause of cause cancer deaths among men in the US, it ranks first among African American men in terms of incidence, morbidity, and mortality. To address this and other complex health issues, some researchers advocate transdisciplinary research as a framework for analysis; however, few examples exist that indicate how the framework should be applied. This report uses prostate cancer outcomes as a paradigm to describe how such a framework can be used to identify determinants of racial disparities. By integrating diverse scientific disciplines, methods, and analytic approaches from psychology, sociology, epidemiology and genetics, …

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

Journal of Health Disparities Research and Practice

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

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

Journal of Health Disparities Research and Practice

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

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

Self-Rated Health Status Comparing Pacific Islanders To Asians, Maile Taualii

Journal of Health Disparities Research and Practice

Disease reporting for Asians/Pacific Islanders often conflicts and is, many cases, inaccurate because of the aggregation of Asians and Pacific Islanders. An analysis of 2005 Behavior Risk Factor Surveillance System data was performed to examine health status of Asians compared to Native Hawaiian or Other Pacific Islanders. Findings show a significant difference between Asians and Native Hawaiian or Other Pacific Islanders, with a greater likelihood for Native Hawaiians or Other Pacific Islanders to rate their health as poor. Conclusion: Asians and Native Hawaiians or Other Pacific Islanders do not have the same health status. By aggregating these two distinctly different …

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

Journal of Health Disparities Research and Practice

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

Consistency Of Minority And Socioeconomic Status As Predictors Of Health, Ari K. Mwachofi, Robert W. Broyles

Journal of Health Disparities Research and Practice

This paper examines the relative consistency of economic and racial status as predictors of the individual’s physical and emotional health. The focus of the study is the covariates of (1) limited activity resulting from poor physical and (2) limited activity resulting from poor emotional health. Using data from the 2003 Behavioral Risk Factor Surveillance System survey, the study was developed in two phases. In the first, logistic regression analysis was used to examine two binary variables that identified respondents who reported at least one day of limited activity that resulted from poor physical and then poor emotional or mental health. …

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

Journal of Health Disparities Research and Practice

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

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

Journal of Health Disparities Research and Practice

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

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

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

Gay And Lesbian Health Disparities: Evidence And Recommendations For Elimination, M. R. Barker

Journal of Health Disparities Research and Practice

Research suggests that significant health disparities exist among the gay and lesbian population in the United States. These disparities impact both the short- and long-term health outcomes of this population. This study first provides a current literature review of available research on gay and lesbian health disparities and organizes these findings according to health topic. The paper then investigates recommendations for the elimination of racial and ethnic health disparities and examines their applicability in eliminating sexual minority disparities. While many recommendations are valid, this paper analyzes the six thought to have the greatest potential in eliminating gay and lesbian health …

Feasibility And Acceptability Of An English-As-A-Second Language Curriculum On Hepatitis B For Older Chinese American Immigrants, Gloria D. Coronado, Elizabeth Acorda, H. H. Do, Victoria M. Taylor

Journal of Health Disparities Research and Practice

Asian immigrants to the U.S. have an increased prevalence of hepatitis B virus (HBV) infection compared to native born individuals; an estimated 10 percent of Chinese immigrants are infected with HBV. Using qualitative data from focus groups, we developed an English-as-a-Second Language (ESL) curriculum that aimed to improve knowledge about key hepatitis B facts. The curriculum was pilot-tested among 56 students aged 50 and older from intermediate-level ESL classes at a community-based organization that serves Chinese immigrants. Post-curriculum data showed increases in knowledge that hepatitis B can cause liver cancer (73% at pre-test vs. 91% at post-test; p value = …

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

Journal of Health Disparities Research and Practice

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

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

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

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

Journal of Health Disparities Research and Practice

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

Promoting Physical Activity In Low Income African Americans: Project Laps, Dorothy W. Pekmezi, Brooke L. Barbera, Jamie S. Bodenlos, Glenn N. Jones, Phillip J. Brantley

Journal of Health Disparities Research and Practice

Low income African Americans are at increased risk for physical inactivity and related chronic illnesses. Thus, effective interventions are needed to address these health disparities. The current study examined the efficacy of a home-based physical activity intervention among a low income African American sample with high rates of chronic illnesses (obesity, hypertension, diabetes, high cholesterol). Participants (n=214) were randomly assigned to either the home-based physical activity intervention (self-help print materials, five monthly newsletters, two telephone counseling sessions) or an attention control condition, which promoted healthy diet. Results indicated that the intervention did not produce significantly greater increases in physical activity …

Hepatitis C Diagnoses In An American Indian Primary Care Population, Hillary E. Norton, John T. Redd, Ralph T. Bryan

Journal of Health Disparities Research and Practice

BACKGROUND: Despite large disparities in the burden of chronic liver disease, data on hepatitis C virus (HCV) infection among American Indians (AIs) are lacking. We reviewed hepatitis C diagnoses in 35,712 AI/AN primary care patients.

MAIN FINDINGS: At least one HCV-associated ICD-9 code was recorded in 251 (1%) patients between October 1, 2001 and September 30, 2003. An HCV enzyme-linked immunoassay (HCVEIA) was sent in 209 (83.0%); 206/209 (99%) were positive. Confirmatory testing was performed in 144/206 (70%) HCV-EIA positive patients; HCV infection was confirmed in 144 (100%). In the 90/144 (63%) charts with risk factor documentation, injection drug use …

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

Journal of Health Disparities Research and Practice

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

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

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

Differential Effects Of Race And Poverty On Ambulatory Care Sensitive Conditions, Farrukh B. Hakeem, Daniel L. Howard, Timothy S. Carey, Yhenneko J. Taylor

Journal of Health Disparities Research and Practice

This study is a continuation of an earlier study that examined hospitalization rates for ambulatory care sensitive (ACS) conditions, as a proxy for quality of care, and found evidence of a racial disparity among African American and White Medicare beneficiaries. The current study sought to determine whether neighborhood socioeconomic status (SES) explained this disparity. Differences in rates of ACS hospitalizations by race were assessed using Cochran-Mantel Haenszel tests and Poisson regression. Unadjusted rate ratios for ACS hospitalization for African Americans vs. Whites were found to be higher in low poverty areas (rate ratio (RR)=1.13; 95% CI (1.08, 1.17)) than in …

Race/Ethnicity As A Risk Factor Of Mother To Child Transmission Among Hiv Infected Mothers, Wei Yang, Fares Qeadan, Mona L. Brown, Michelle Chino, Scott Hall, Mary Guinan

Journal of Health Disparities Research and Practice

Objectives: African American women, living with HIV, exhibit a higher percentage of giving birth as compared to other race/ethnicity groups. The aim of this study is to understand the apparent black and non-black differences (health disparities) among the HIV Infected Mothers group and examine whether race/ethnicity can explain the high variation in different prenatal and HIV mother-to-child-transmission (MTCT) risk factors.

Methods: Data-Linkage was conducted on all women HIV+ cases, who delivered a child during the time period and reported to the Nevada state HIV with the live birth registries. Demographic and social data, separated into black and Non-black groups, were …

A Human Capital Approach To Reduce Health Disparities, Saundra Glover, Sudha Xirasagar, Yunho Jeon, Keith Elder, Crystal N. Piper, Harris Pastides

Journal of Health Disparities Research and Practice

Objective: To introduce a human capital approach to reduce health disparities in South Carolina by increasing the number and quality of trained minority professionals in public health practice and research.

Methods: The conceptual basis and elements of Project EXPORT in South Carolina are described. Project EXPORT is a community based participatory research (CBPR) translational project designed to build human capital in public health practice and research. This project involves Claflin University (CU), a Historically Black College University (HBCU) and the African American community of Orangeburg, South Carolina to reduce health disparities, utilizing resources from the University of South Carolina (USC), …