Medicine and Health Sciences Commons^™

Covid-19 Severity Among American Indians And Alaska Natives In 16 States - January 1, 2020, To March 31, 2021, Jessica Arrazola, Scott Erickson, Chiao Wen Lan, Adrian Dominguez, Sujata Joshi, Andria Apostolou, Ashley Busacker, David Casey, Christiana Coyle, Kathryn Helfrich, Jennifer Kraszewski, Thomas Kim, Genelle Lamont, Richard Leman, Pamela Lemaster, Nick Lehnertz, Mike Mannell, Dakota Matson, Alex Merrill, Tracy Miller, Benjamin Schram, Ozair Naqvi, Samantha Rice, Samantha Hyde-Rolland, Alyssa Rowell, Dean Seneca, Victoria Warren-Mears, Laura Williamson

Journal of Health Disparities Research and Practice

Objective: To compare rates and risk factors of severe COVID-19-related outcomes between American Indian/Alaska Native (AI/AN) and non-Hispanic White people (NHW).

Methods: Aggregate Social Vulnerability Index (SVI), COVID-19-related risk factor, hospitalization, and mortality data were obtained from 16 states for January 1, 2020-March 31, 2021. Generalized estimating equation Poisson regression models calculated age-adjusted cumulative incidences, incidence ratios (IR), and 95% confidence intervals (CI) comparing AI/AN and NHW persons by age, sex, and county-level SVI status.

Results: Race data were missing for 42.7% of COVID-19 cases, 24.7% of hospitalizations, and 10.1% of deaths. Risk of AI/AN COVID-19 mortality …

Pili Pono Practice: A Qualitative Study On Reimagining Native Hawaiian Food Sovereignty Through Malama Backyard Aquaponics, Pahonu Coleman, Samantha Keaulana, J Kahaulahilahi Vegas, Phoebe W. Hwang, Leshay Keliiholokai, Jane J. Chung-Do, Ikaika Rogerson, Ilima Ho-Lastimosa

Journal of Health Disparities Research and Practice

Living in one of the most remote island chains in the world, Native Hawaiians developed sophisticated food cultivation systems that sustained a thriving and robust population for centuries. These systems were disrupted by colonization, which has contributed to the health disparities that Native Hawaiians face today. MALAMA, a culturally-grounded backyard aquaponics program, was developed to promote food sovereignty among Native Hawaiians. This study utilized participant interview and focus group data to identify how participating in the MALAMA program impacts the wellbeing. The findings demonstrate that MALAMA enhanced the participants’ pilina (relationship, connection) to traditional foods, land, cultural identity, family, and …

Does Using Sofa Score For Ventilator Triage Among Covid 19 Patients Result In Suboptimal Allocation Of Medical Ventilators For The Bipoc Population?, Alexandrea Mp Masocco, Elisabeth Michel, Ebbin Dotson

Journal of Health Disparities Research and Practice

Introduction: Since the COVID-19 pandemic in the United States, Black, and Latinx populations have been disproportionately affected by the COVID-19 pandemic. It can be inferred with high confidence that those most vulnerable are the least likely to receive essential care. Kidney transplant allocation and COVID-19 triage protocols share commonalities in that both protocols involve using multivariate scored criteria with objective and subjective inputs. As such, the similar conclusion in outcomes is concerning. It is worth questioning whether the racial inequalities demonstrated in the COVID-19 pandemic related to access to life-saving ventilators were associated with triage protocols.

Methodology: Using an exploratory …

Perspectives On Flu Vaccination Advertisement Messaging In The Era Of Covid-19: Thematic Analysis Centering Adult Black Voices, Krissy Moehling Geffel, Stephanie N. Christian, Andrea D. Casas, Harika P. Dyer, Tiffany L. Gary-Webb, Hannah E. Hardy, Roderick Harris, Dara D. Mendez

Journal of Health Disparities Research and Practice

Influenza (flu) is an infectious, respiratory disease that causes substantial burden and mortality, and Non-Hispanic Black people experience profound disparities in flu disease burden in the United States. One contributor to flu disease disparities is lower flu vaccination rates among Black populations. This qualitative study was conducted during the COVID-19 pandemic and used the Public Health Critical Race Praxis framework to center and elicit Black adults’ perspectives of desired flu vaccine messaging. This work builds upon efforts to increase access to flu vaccinations and recommendations are provided to aid in tailoring flu vaccine messaging via a health equity lens. Recommendations …

Diabetes Self-Management Support Program In Predominantly Hispanic Faith Community Settings: A Pilot Study, Leah Carrillo, Summer R. Wilmoth, Raymundo Mendoza, Ashton Balarin, Meixia Pan, Elena Martinez,, Erica T. Sosa, Zenong Yin, Sarah Ullevig, Meizi He

Journal of Health Disparities Research and Practice

Objectives: This study aimed to assess the feasibility, facilitators, barriers, and impact of adopting the Self-Management Resource Center Diabetes Self-Management Program (SMRC DSMP) on diabetes-related outcomes.

Methods: The SMRC DSMP was implemented in five churches in San Antonio, Texas. A single group pre-post-test design was used to evaluate program effect on improving T2D outcomes. The primary outcome was glycohemoglobin (HbA1c) and secondary outcomes included Self-Efficacy for Diabetes, health-related quality of life (HRQOL), and patterns of eating and physical activity. Program feasibility, facilitators, and barriers were assessed through documentation and in-person interviews with participants.

Results: A total of 96 participants were …

Associated Factors With Colorectal Cancer (Crc) Screening Awareness In The Black Belt Region Of Alabama: A Comparison Among Three Types Of Crc Screening, Hee Yun Lee, Yan Luo, Chiahung Chou, Mi Hwa Lee, Marion Bennett

Journal of Health Disparities Research and Practice

Objective: The present study aims to assess the levels of awareness of three types of CRC screening tests (FIT or FBOT, sigmoidoscopy, and colonoscopy) among African Americans living in the Black Belt area, and examine the factors associated with awareness of CRC screening tests among this population.

Methods: The current study utilized a survey research design. Univariate analysis was used to assess the awareness of three types of colorectal cancer screening: FIT or FOBT, sigmoidoscopy, and colonoscopy. Three sets of logistic regression analyses were conducted to examine the factors associated with the awareness level of each of the three colorectal …

When Keeping It Real Is Required: Challenging The Pandemic Of Racism In Lactation Land, Tameka Jackson-Dyer

Journal of Health Disparities Research and Practice

Human milk is the optimal source of nutrition for infants, but few are able to provide their milk to their babies for the minimum twelve months recommended by health experts. This is especially true for Black women. Due to structural racism embedded in medical care, implicit bias of healthcare providers and generational traumas that began during American chattel slavery, Black women are less likely than every other ethnic group to initiate breastfeeding. Those that do are often sabotaged by unsupportive systems and lack of access to clinically-skilled, culturally respectful lactation consultants. Calling out the racism that exists in Lactation Land …

Addressing Racial Disparities In Maternal Health: The Case For An Equity Birth Plan, Alice Trye, Damali Campbell Oparaji, Natalie Roche, Lisa Gittens Williams

Journal of Health Disparities Research and Practice

Birth equity can be defined as “The assurance of the conditions of optimal births for all people with a willingness to address racial and social inequities in a sustained effort.” (Birth Equity |California Maternal Quality Care Collaborative, n.d.). Complex explanations exist for adverse maternal outcomes, but unequal health care, socioeconomic and racial inequalities pose risks to women and their babies (“Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” 2003). The data is clear: Maternal death rates have increased and are 3 to 4 times higher for black women than white women (Zaharatos et al., 2018). These …

Editor's Notes, Nekeshia Jones, Sharla Smith, Melva Thompson-Robinson

Journal of Health Disparities Research and Practice

These Editors' Notes introduce the first special issue of the Journal of Health Disparities Research and Practice based on the work the National Maternal Health Research Network.

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. …

Association Between Insurance Status And Hospital Outcomes Among Acute Kidney Failure Patients, Khoa Truong, Thuan Thai, Lingling Zhang, Lu Shi, C. Jason Wang

Journal of Health Disparities Research and Practice

Objectives: To investigate the relationship between insurance status and the risk of acute kidney failure (AKF) and consequential hospitalization outcomes.

Methods: A cross-sectional regression analysis was conducted for inpatients ages 18-64 in South Carolina 2012–2013. One dichotomous dependent variable - diagnosed with AKF at hospital admission, and two continuous dependent variables of hospital outcomes - total charge and length of stay, were examined. The key explanatory variable was the patient’s insurance status. Other covariates included patient’s age, gender, and race as well as AKF risk factors - Type 2 diabetic mellitus (T2DM), chronic kidney disease (CKD), hypertension, and proteinuria.

Results: …

The Culture Factor: The Effects On Healthcare Decisions Among Guyanese Men, Harrynauth Persaud

Journal of Health Disparities Research and Practice

Culture, religious beliefs, and ethnic customs, all play a role in how patients make healthcare decisions. As the racial and ethnic diversity continues to increase in the United States, so does the culture, religious beliefs, and customs. This research aims to explore the cultural and other influences on making healthcare decisions among Indo-Guyanese immigrant men. In-depth interviews were conducted among participants residing in the neighborhood areas of Queens, New York. Thorough qualitative analyses were performed on the data for which three major themes emerged. Family influences on health behaviors, the use of alternative medicines, and religious beliefs were found to …

An Opportunity To Partner With Community Organizations To Collect Data On Asian Americans, Victoria Wang, Karen Kim

Journal of Health Disparities Research and Practice

Background: There is a shortage of health data for Asian American (AA) populations. This shortfall may be improved through the involvement of AA-serving community-based organizations (CBOs).

Objectives: This study assesses the feasibility of and interest among CBOs in creating a AA community-based data registry.

Methods: Leaders of CBOs were interviewed to assess their current data collection framework and their attitudes towards a shared data registry.

Results: Qualitative analysis shows CBOs are active in data collection, find data to be instrumental to their mission, and are interested in contributing to a broader data registry.

Discussion: The inclusion …

Disparities In Access To After-Hours Care In The U.S.: A National Study, Kavita Mosalpuria, Fernando A. Wilson, Mohammad Siahpush

Journal of Health Disparities Research and Practice

After-hours care provides timely access to continuity of care for chronic illnesses and episodic care for acute illness. Lack of timely access to primary care services is one of the main drivers of emergency department overuse. Our aim was to examine disparities in access to after-hours care based on race, income, geographic location, type of insurance, and health care setting. We used data from the 2010 Health Tracking Household Survey. Multivariable logistic regression was used to assess disparities in access to after-hours care. We found disparities by type of insurance, geographic location, and type of health care setting. People with …

Propelling Adolescents Toward Careers In Healthcare (Patch): A Medical Student Led Pipeline Program For High School Students Underrepresented In Medicine, Maggie Brownrigg, Sagar Patel Md, Kyle Roedersheimer Md, Melissa Wooten Md, Radhika Ghodasara Md, Banks Kooken Md, Iris Cheng Md

Journal of Health Disparities Research and Practice

Despite the growing diversity of the United States population, individuals from many racial and ethnic minority groups and low-income families continue to be underrepresented in the health professions. A diverse healthcare workforce would improve cultural competency and create a system better suited to address the vast health disparities in many disadvantaged communities, yet the current educational pipeline needs to expand opportunities to provide students traditionally underrepresented in medicine (UIM) a path to become a part of the healthcare field. The Propelling Adolescents Towards Careers in Healthcare (PATCH) program was founded to address this gap in the current health professions pipeline …

Relationship Between Psychosocial-Cultural Factors And African American Women Obesity., Francoise Knox-Kazimierczuk

Journal of Health Disparities Research and Practice

Objective: To determine associations between African American female obesity and SEM variables.

Design: Data from the National Survey of American Life Self-Administered Questionnaire (NSAL-SAQ), a 2001–2003 nationally representative cross-sectional survey was used to extract data for African American women.

Participants: African American females at a BMI of 18.5 kg/m2 or greater were included in the final sample (n = 2,100) for analysis.

Main Outcome Measure(s): BMI

Analysis: Measures for socioecological model (SEM) were analyzed using a regression model in SPSS.

Results: Intrapersonal and community/institutional levels were found to be significantly associated with BMI. Two multiple regression analyses models were developed …

The Early Impact Of The Affordable Care Act Upon Colorectal Cancer Screening Utilization In Florida, Aldenise P. Ewing, Laura Baum, Rosalyn Roker, Marlene Joannie Bewa, Tali Schneider, Claudia F. Parvanta, Clement K. Gwede, Cathy D. Meade, Dinorah Martinez Tyson

Journal of Health Disparities Research and Practice

Background: Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Although preventable and curable through screening, early detection and treatment, a lack of health insurance is a major obstacle to receiving colorectal cancer screening (CRCS). Despite the Affordable Care Act (ACA) increasing access to health insurance by mandating coverage of CRCS, disparities in utilization rates continue. Therefore, researchers sought to better understand ACA related facilitators and impediments that affect the utilization of CRCS and collect specific recommendations from healthcare professionals to increase screening utilization rates in Florida.

Methods: Researchers conducted in-depth interviews with …

Employing Position Generators To Assess Social Capital And Health: A Scoping Review Of The Literature And Recommendations For Measurement In Future Population-Based Surveillance, Steven Meanley, Candice Biernesser, Teagen O'Malley, Todd Bear, Jeanette Trauth

Journal of Health Disparities Research and Practice

Beneficial social connections are critical to individual-level health because they can be used to avoid or minimize the risks and consequences associated with diseases. How to best measure beneficial social connections to inform social network-level health interventions remains poorly understood. A scoping review of health surveillance studies was conducted to highlight the utility of employing position generators to assess how access to beneficial social connections was associated with population health and disparities. Our review yielded 39 articles conducted across 14 predominantly high-income countries. Most studies (77%) with composite measures for beneficial social connections exhibited health-protective associations. Of the remaining articles, …

Disparities In Health Behavior Risks Among Employed And Unemployed Black And White Older Adults, M. Courtney Hughes, Tamara A. Baker, Hansol Kim

Journal of Health Disparities Research and Practice

Objective: Examine health behavior risk rates and disparities in health behavior risks related to race and employment among older adults. Methods: A cross-sectional analysis of a representative sample of noninstitutionalized adults aged 65 and older (150,669 in 2015 and 168,011 in 2016) from the Behavioral Risk Factor Surveillance System. Self-reported health behavior risks were measured as well as multiple logistic regression analyses assessing the independent effects of demographic variables on health behavior risks. Results: Employed older adults have greater health behavior risks than unemployed older adults. Black employed older adults have greater health behavior risks than Black unemployed older adults …

A Lung Cancer Screening Personalized Decision-Aid Improves Knowledge And Reduces Decisional Conflict Among A Diverse Population Of Smokers At An Urban Academic Medical Center, Madeline Kaufman, Nilan Schnure, Andrea Nicholson, Frank Leone, Carmen Guerra

Journal of Health Disparities Research and Practice

Introduction: Few lung cancer screening decision aids have been tested in diverse populations. The study objective was to determine whether the online decision aid www.shouldiscreen.com impacts knowledge of and decisional conflict around lung cancer screening in a diverse population.

Methods: Eligible patients had significant smoking histories, were at increased risk for lung cancer (ages 45-80, >20 pack-years, smoking within last 15 years) and had no history of prior lung cancer or screening. Data was collected and analyzed in 2017.

Results: 40 patients were enrolled: 80% were female, 62.5% black, 33% white, and 48% had a high school …

Assets And Unmet Needs Of Diverse Older Adults: Perspectives Of Community-Based Service Providers In Minnesota, Hayley R. Mccarron, Alana Wright, Rajean P. Moone, Traci Toomey, Theresa L. Osypuk, Tetyana Shippee

Journal of Health Disparities Research and Practice

This paper examines assets and unmet needs of diverse older adults and highlights the need for programs and policies that address the social determinants of health. The United States is undergoing an unprecedented demographic shift, becoming increasingly diverse and aging rapidly. Given these changing demographics, it is important to understand the strengths and needs of our diverse population of older adults. This study captures perspectives of diverse service providers who work with older adults in communities, to identify existing assets as well as unmet needs and challenges facing diverse older adults in Minnesota. Qualitative data were collected using key informant …

Perceptions And Determinants Of Partnership Trust In The Context Of Community-Based Participatory Research, Arelis Moore De Peralta, Julie Smithwick, Myriam E. Torres

Journal of Health Disparities Research and Practice

Trust is difficult to conceptualize and define because of its diverse applications in different disciplines. Historic mistrust between vulnerable communities and researchers based on past adverse experiences can negatively affect the ability to collaborate and conduct effective research with such populations. Community Based-Participatory Research (CBPR) is a collaborative approach to research that can reduce historic mistrust and health disparities among minority populations. Although how trust development occurs in CBPR partnerships has been explored, there is a need to determine how to move from one stage to the next in fostering and maintaining that trust. The present study contributes to this …

Knowledge, Motivations And Concerns About Participation In Breast Cancer Clinical Trials In Puerto Rico, Marinilda Rivera-Díaz, Angélica N. García-Romero, Alelí M. Ayala-Marín, Camille Vélez-Alamo, Adrianna I. Acevedo-Fontánez, Mariana Arévalo, Vivian Colón-López

Journal of Health Disparities Research and Practice

Clinical trials (CT) in breast cancer have been crucial for new treatment discoveries. While participation in cancer CT is low, minorities are particularly underrepresented.This study aimed toidentify factors influencing the participation in CTs based on the experiences of Latina breast cancer survivors in Puerto Rico (PR), especially their CT knowledge, motivations, and concerns.Method:Focus groups (FG) were conducted by two social workers and the University of Puerto Rico/MD Anderson Community Health Educator. Participants were stratified into two subgroups: a) women with CT experience and b) those without CT experience. Seven FG were completed among breast cancer survivors (n=34) at …

Effect Of Poverty Level On The Relationship Between Hyperlipidemia And Cardiorenal Syndrome, Sri K. Banerjee Md, Phd, Raymond Panas, James Diegel, Karen Banerjee

Journal of Health Disparities Research and Practice

Purpose. Elevated cholesterol is known to be associated with chronic kidney disease (CKD) and cardiovascular disease (CVD) independently. Cardiorenal syndrome (CRS), a recently defined syndrome, is characterized by renal failure that is closely interrelated to cardiac dysfunction. The effect of socioeconomic status on cardiorenal syndrome has not been explored in a multi-ethnic population. In this retrospective secondary analysis, the hypothesis was tested if socioeconomic status modifies the effect of hyperlipidemia on CRS.

Methods. The National Health and Nutrition Examination Survey (NHANES) is a cross sectional survey done on the non-institutionalized population of the United States. All patients from the NHANES …

Estimating The Costs And Cost-Effectiveness Of Promoting Mammography Screening Among Us-Based Latinas, Yamilé Molina, Catherine M. Pichardo, Donald L. Patrick, Scott D. Ramsey, Sonia Bishop, Shirley A.A. Beresford Phd, Gloria Coronado

Journal of Health Disparities Research and Practice

Purpose: We characterize the costs and cost-effectiveness of a community health worker (CHW)-based intervention to promote screening mammography among US-based non-adherent Latinas.

Methods: The parent study was a randomized controlled trial for 536 Latinas aged 42-74 years old who had sought care within a safety net health center in Western Washington. Participants were block-randomized within clinic to the control arm (usual care) or intervention arm (CHW-led motivational interviewing intervention). We used the perspective of the organization implementing promotional activities to characterize costs and cost-effectiveness. Cost data were categorized as program set-up and maintenance (initial training, booster/annual training) program implementation (administrative …

Improving Community Advisory Board Engagement In Precision Medicine Research To Reduce Health Disparities, Erin Connors, Rebecca Selove, Juan Canedo, Maureen Sanderson, Pamela Hull, Marilyn Adams, Ila Mcdermott, Calvin Barlow, Denice Johns-Porter, Caree Mcafee, Karen Gilliam, Oscar Miller, Nora Cox, Mary Kay Fadden, Stephen King, Hilary Tindle

Journal of Health Disparities Research and Practice

Community Advisory Boards (CABs) are used in efforts to reduce health disparities; however, there is little documentation in the literature regarding their use in precision medicine research. In this case study, an academic-CAB partnership developed a questionnaire and patient educational materials for two precision smoking cessation interventions that involved use of genetic information. The community-engaged research (CEnR) literature provided a framework for enhancing benefits to CAB members involved in developing research documents for use with a low-income, ethnically diverse population of smokers. The academic partners integrated three CEnR strategies: 1) in-meeting statements acknowledging their desire to learn from community partners, …

Rural Primary Care And The Diagnostic Resolution Of Abnormal Screening Mammograms: A Mixed Methods Study In Rural Missouri, Jean Hunleth, Julia Maki, Amanda Lee, Aimee James, Rebecca Lobb

Journal of Health Disparities Research and Practice

Rural health clinics (RHCs) and federally qualified health centers (FQHCs) play a vital role in initiating cancer screening in underserved, rural settings. Yet there is limited information about their involvement in diagnostic tests when a mammogram result is abnormal. Diagnostic resolution of abnormal mammograms varies widely by geographic location and resources, and timely resolution is important for addressing rural-urban cancer disparities. This mixed methods study in a rural region of Missouri with high rates of cancer mortality examined the roles of primary care providers during follow-up after an abnormal mammogram, the processes they used, and the clinic specific variations among …

The Right To Vote, The Right To Health: Voter Suppression As A Determinant Of Racial Health Disparities, Anna K. Hing

Journal of Health Disparities Research and Practice

Civic participation is beneficial to one’s health. Conversely, being unable to participate, such as being unable to vote, may be detrimental for health. Barriers that prevent voting and civic participation, which constitute voter suppression, disproportionately impact people of color. Therefore, voter suppression may explain intractable racial health disparities. However, few studies have examined the connection between voter suppression and health. In consideration of the frequent, and increasing, reports of voter suppression in recent elections, including the rise in voter identification laws, the reduction in early voting opportunities, and the closing of polling places, the field of public health should address …

Factors Contributing To Domestic Violence Among Hindu Asian Indian Immigrant Women In Allegheny County, Pennsylvania: A Feasibility Study, Chelsea Pallatino, Todd Bear, Martha A. Terry

Journal of Health Disparities Research and Practice

While there is research on survivors of domestic violence in India and the United States (U.S.), little is known about the sociocultural factors related to domestic violence among Hindu Asian Indian immigrant women (AIIW) in the U.S. The objectives of this study were to a) test the feasibility of conducting domestic violence research among Hindu AIIW; b) investigate domestic violence prevalence and correlations with other characteristics; and c) test the cultural appropriateness of completed measures on social support, acculturation status, and domestic violence. Over 50% of respondents had experienced abuse, often perpetrated by family. Participants had high levels of social …

Accessing Young Black Stroke Survivors For Secondary Prevention, Mellanie V. Springer, James F. Burke, Devin L. Brown, Lesli E. Skolarus

Journal of Health Disparities Research and Practice

ABSTRACT

Background- Stroke rates and risk factors may be increasing in young adults aged 18-64, especially black individuals. We sought to identify whether young high risk stroke survivors could be found at community health centers.

Methods- This was a cross-sectional analysis of the National Ambulatory Medical Care Survey from 2006-2011. We used chi-square analyses, t-tests, and proportions to compare and describe stroke survivor visits at community health centers and private offices.

Results- Young stroke survivor visits comprise 48% of stroke survivor visits at community health centers compared to 31% of stroke survivor visits at the private office setting. Among young …