Inequality and Stratification 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, …

The Rural-Urban Divide In Tanzania: Residential Context And Socioeconomic Inequalities In Maternal Health Care Utilization, Neema Langa, Tirth Bhatta

Sociology Faculty Research

Background Existing studies in Tanzania, based mostly on rural samples, have primarily focused on individual behaviors responsible for the lower utilization of maternal health care. Relatively less attention had been paid to inequalities in structural circumstances that contribute to reduced utilization of maternal health care. More importantly, scholarship concerning the impact of the rural-urban divide on socioeconomic disparities in the utilization of maternal health care is virtually nonexistent in Tanzania. Methods Drawing from the Demographic Health Survey (2015-2016) conducted in Tanzania, our study includes a total of 3,595 women aged between 15-49 years old, who had given birth in five …

Justice Served Fresh: Associations Between Food Insecurity, Community Gardening, And Property Value, Micajah Daniels, Courtney Coughenour Ph.D

McNair Poster Presentations

Numerous stakeholders in Nevada have used a variety of efforts to combat the growth of food insecurity facing Nevadans. The purpose of this research project is to understand the association between food insecurity, community gardens, and property value. Following the wealth of scholarship on these topics and data collected from community garden agencies in Southern Nevada, the research questions for this project include: (1) Where are community gardens located in SNV? (2) What efforts community gardens agencies are doing to address food insecurity (most interested in their efforts using community gardens)? (3) What are the perceptions of supports and barriers …

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 …

Education And Educational Attainment In Southern Nevada, Jennifer Pharr, Courtney Coughenour, Shawn Gerstenberger

Nevada Journal of Public Health

Failure to complete high school has a direct impact on a person’s earning potential and quality of life. Higher levels of education are associated with better health. Because of this association, it is important for children and adults to have access to quality education. The percentage of adults who have successfully pursued higher education in Southern Nevada is lower than the peer Mountain West metropolitan areas and the national average. Nevada high school graduation rates are the lowest in the nation. High school graduation rates and dropout rates vary by race/ethnicity in the Clark County School District. High school graduation …

Employment And Economic Development In Southern Nevada, Jennifer Pharr, Courtney Coughenour, Shawn Gerstenberger

Nevada Journal of Public Health

Wealth influences a person’s health. People who are higher on the socioeconomic scale tend to have better health outcomes. To improve the health of a community, it is important to understand the employment opportunities of the people living in the community.

Southern Nevada’s economy was hit hard between 2008 and 2012. Unemployment rates in the region exceeded national and peer regions between during this time period. Construction; leisure and hospitality; trade, transportation and utilities; and professional and business service sectors experienced the greatest job loss during the recession. The Education and Health Services sectors did not experience a decrease in …

Healthcare Access And Health Outcomes In Southern Nevada, Jennifer Pharr, Courtney Coughenour, Shawn Gerstenberger

Nevada Journal of Public Health

In a publication from the Robert Woods Johnson Foundation, it was recognized that a person’s zip code was a more important predictor of health than their genetic code. Where we live influences not only our access to health care, but other health indicators as well. Clark County has a low primary care physician to population ratio compared to other counties in Nevada and in the US. Clark County also has highest rates of uninsured in the Mountain West and among the highest in the nation.

Southern Nevada fared worse than other Mountain West Metropolitan areas in health indicators and preventative …

Demographic Makeup And Population Projections For Southern Nevada: Understanding The Emerging Healthcare Needs In Our Community, Jennifer Pharr, Courtney Coughenour, Shawn Gerstenberger

Nevada Journal of Public Health

Even with a leveling-off of population growth from 2008 to 2011, Southern Nevada had one of the fastest growing populations in the nation over the past decade. While population growth is projected to increase for the next ten years, the rate of growth will be slower than in the past decade. The Hispanic population, as a percentage of the total population, is projected to surpass the White population somewhere near the year 2030. The Southern Nevada population is aging, as the median age in the region increased between 2000 and 2010. The 65+ age group is projected to increase as …

Utilization Of Preventative Health Services By Nevadans With Disabilities, Jennifer R. Pharr, Sheniz Moonie

Nevada Journal of Public Health

Health disparities are differences in access to health care, quality of health care and health outcomes observed between population-specific groups of people (Health Resources and Services Administration, 2000). Previous research has found that people with disabilities experience unequal access to preventative health care services. The purpose of this study was to conduct a secondary data analysis using data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) to determine differences in utilization of preventative health services between adults with and without disabilities in Nevada. Nevadans with disabilities were significantly more likely to have access to health insurance and to have …

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 …