Medicine and Health Sciences Commons^™

Identifying Disparities In Colorectal Cancer Screening Rates In Milwaukee-Based Academic And Nonacademic Clinics, Jasmine Wiley, Jonathan J. Blaza, Will Lehmann, Deborah Simpson, Jeffrey A. Stearns, Shelby L. Pischke, Tracy L. Greiten

Aurora Family Medicine Residents

Background: The Institute for Healthcare Improvement’s Triple Aim focuses on improving the patient’s experience of care, improving population health and reducing the per capita cost of health care. Health care systems and providers continuously seek to improve quality of care through understanding what percentage of their patients are achieving quality-of-care standards for various indicators, including immunizations, tobacco cessation, asthma and cancer screening. As health care moves toward reimbursing for value-based care, deepening our understanding of patient population characteristics within each of these conditions is vital to continuous quality improvement.

Purpose: To determine if there are race/ethnicity/age/preferred language (REAL) disparities in …

Identifying Disparities In Colorectal Cancer Screening Rates In Milwaukee-Based Academic And Nonacademic Clinics, Jasmine Wiley, Jonathan J. Blaza, Will Lehmann, Deborah Simpson, Jeffrey A. Stearns, Shelby L. Pischke, Tracy L. Greiten

Journal of Patient-Centered Research and Reviews

Background: The Institute for Healthcare Improvement’s Triple Aim focuses on improving the patient’s experience of care, improving population health and reducing the per capita cost of health care. Health care systems and providers continuously seek to improve quality of care through understanding what percentage of their patients are achieving quality-of-care standards for various indicators, including immunizations, tobacco cessation, asthma and cancer screening. As health care moves toward reimbursing for value-based care, deepening our understanding of patient population characteristics within each of these conditions is vital to continuous quality improvement.

Purpose: To determine if there are race/ethnicity/age/preferred language (REAL) disparities in …

Does Travel Time To A Radiation Facility Impact Patient Decision-Making Regarding Treatment For Prostrate Cancer? A Study Of The New Hampshire State Cancer Registry, Fady Ghali, Maria Celaya, Michael Laviolette, Johann Ingimarsson, Heather Carlos, Judy R. Rees, Elias Hyams

Dartmouth Scholarship

Purpose: We sought to determine whether further distance from a radiation center is associated with lower utilization of external beam radiation therapy (XRT). Methods: We retrospectively identified patients with a new diagnosis of localized prostate cancer (CaP) within the New Hampshire State Cancer Registry from 2004 to 2011. Patients were categorized by age, D’Amico risk category, year of treatment, marital status, season of diagnosis, urban/rural residence, and driving time to the nearest radiation facility. Treatment decisions were stratified into those requiring multiple trips (XRT) or a single trip (surgery or brachytherapy). Multivariable regression analysis was performed. Results: A total of …

Racial Differences In Renal Replacement Therapy Initiation Among Children With A Nonglomerular Cause Of Chronic Kidney Disease., Derek K. Ng, Marva Moxey-Mims, Bradley A. Warady, Susan L. Furth, Alvaro Muñoz

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: African American (AA) adults with chronic kidney disease (CKD) have a faster progression to end-stage renal disease and are less likely to receive a kidney transplant. It is unclear whether AA children experience renal replacement therapy (RRT) for end-stage renal disease sooner than non-AA children after accounting for socioeconomic status (SES).

METHODS: Among children with nonglomerular CKD in the Chronic Kidney Disease in Children study, we investigated time to RRT (i.e., first dialysis or transplant) after CKD onset using parametric survival models and accounted for SES differences by inverse probability weights.

RESULTS: Of 110 AA and 493 non-AA children …

Women’S Experiences With Prenatal Care: A Mixed-Methods Study Exploring The Influence Of The Social Determinants Of Health, Karen A. D'Angelo, Janelle K. Bryan, Brenda Kurz

Journal of Health Disparities Research and Practice

Background & Purpose: Racial and ethnic disparities pervade birth outcomes in the United States and the state of Connecticut. While Connecticut’s infant mortality rate is less than the national average, rates for the state’s Black/African American and Hispanic/Latino communities exceed it. This study explored how prenatal care in Connecticut may be enhanced to address these disparities.

Methods: In spring 2013, seven focus groups and two semi-structured interviews were conducted (n=47). Participants also self-administered brief surveys. Recruited by local service providers, participants were 18 or older, pregnant and/or in the first year post-partum at the time. Most self-identified as …

Defining And Targeting Health Disparities In Chronic Obstructive Pulmonary Disease, Roy A. Pleasants, Isaretta L. Riley, David M. Mannino

Preventive Medicine and Environmental Health Faculty Publications

The global burden of chronic obstructive pulmonary disease (COPD) continues to grow in part due to better outcomes in other major diseases and in part because a substantial portion of the worldwide population continues to be exposed to inhalant toxins. However, a disproportionate burden of COPD occurs in people of low socioeconomic status (SES) due to differences in health behaviors, sociopolitical factors, and social and structural environmental exposures. Tobacco use, occupations with exposure to inhalant toxins, and indoor biomass fuel (BF) exposure are more common in low SES populations. Not only does SES affect the risk of developing COPD and …

Pubh 3138 - Multicultural Factors & Social Determinants Of Health, Joseph Telfair

Jiann-Ping Hsu College of Public Health Syllabi

Introduction to the characteristics, causes, and effects of health disparities in the U.S. health care system. Provides students with a foundation to develop the knowledge, attitudes, and skills to become culturally competent health care providers. Explores how health education and promotion is shaped by the cultural, social and economic contexts in which individuals function.

Predictors Of Mammogram And Pap Screenings Among Us Women, Sewuese Akuse, Koren Tate, Tiffany Addison, Tierra Drayton, Deborah Kanda, Kelly Sullivan

Journal of the Georgia Public Health Association

Background: The most common cancers among women are breast and cervical cancer. Although early detection of cancer has been shown to increase the likelihood of survival, many women are not screened for these cancers as often as practice guidelines recommend. The objective of this study was to examine the mammography and Papanicolaou (Pap) smear screening practices among women within the United States, and to determine predictors of screening.

Methods: Data from the 2012 and 2014 Behavioral Risk Factor Surveillance System were used. The association between demographic predictors (age, marital status, education level, employment status, income, health insurance, and medical cost …

Educational Attainment And Self-Rated Health Among African-Americans In Pitt County, Nc, Eeshwar K. Chandrasekar, Zimo Z. Banta, Kathleen R. Ragan, Michelle M. Schmitz, Sherman A. James

Journal of the Georgia Public Health Association

Background: To help fill the knowledge gap regarding relationships between educational attainment and self-rated health (SRH) in minority populations, we analyzed the data of a community-based cohort of African-Americans residing in Pitt County, NC, between 1988 and 2001.

Methods: Data from the Pitt County Study (a community-based, longitudinal survey of risk factors for hypertension and related disorders disproportionately affecting African-Americans) were used to explore associations between educational attainment and SRH, stratified by sex, in a cohort of individuals from 1988 (n=1,773), 1993 (n=1,195), and 2001 (n=1,117) using continuous, ordinal, and binary correlated data analyses.

Results: For males and females with …

The Importance Of Scientific Mentoring Programs For Underrepresented Youth, Bonnie Halpren-Felsher, Phd, Sheila Mclaughlin, Mfa

Journal of Health Disparities Research and Practice

This article introduces the work that was done through the Coordinating Center at Standford University.

Decolonize Your Diet, Jasmine A. Deras

Master's Projects and Capstones

With the industrialization of the food system in past decades, convenience foods have become the cornerstone of the standard American diet. This spike in obesity rates has been more impactful for some populations than for others. In low-income communities of color, fast and processed foods are often the most accessible and affordable source of sustenance. Critical indicators of status and well-being, health disparities are one example of the social barriers faced by predominately low-income people of color.

The Decolonize Your Diet project channels principles of resistance into its mission to improve the health of people of color in Oakland, California. …

Appalachian Research Day: Come Sit On The Porch [2016], Frances J. Feltner, Beth Bowling, Wayne Noble

Center of Excellence in Rural Health Presentations

Rural Appalachian communities in eastern Kentucky suffer from some of the Nation’s most concerning health disparities. Community-based research can be an effective way to address health disparities by identifying problems and sharing innovative solutions. However, challenges exist in recruiting and retaining research participants in rural populations that can often be difficult to reach. Partnerships between researchers and communities are essential to the success of the research process, particularly translation of findings back into the community.

A Systematic Review Of Recruitment For Older Chinese Immigrants Into Clinical Trials, Wen-Wen Li, Yuaner Wu, Angela Chia-Chen Chen

Asian/Pacific Island Nursing Journal

Purpose: To identify barriers and discuss strategies for recruitment of older Chinese immigrants into clinical research studies.

Methods: A systematic review was conducted using Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). PubMed, WEB of Science, CINAHL Plus, and the Cochrane Central Register of Controlled Trials were searched from 2001 to 2014. Empirical studies with Chinese immigrants aged 60 or older were identified and analyzed. Numerical analysis, such as calculation of response rates as indexes for recruitment outcomes, was conducted. Content analyses for recruitment barriers were abstracted.

Results: Thirteen studies of 4753 subjects were analyzed. Response rates ranged from …

A New Look At Successful Aging : Exploring A Mid-Range Nursing Theory Among Older Adults In A Low-Income Retirement Community., Valerie Lander Mccarthy

Valerie L. McCarthy

The current view of successful aging excludes elders with disease or disability, limits the potential for success among disadvantaged populations, and fails to consider older adults’ own criteria for success, especially in the existential or spiritual domain. This cross-sectional study was a preliminary investigation of a mid-range nursing theory (Flood, 2005) of successful aging. A random, stratified sample (N= 112) was used. Questionnaires were administered to small groups of non-demented older adults. Relationships among study variables were examined using hierarchical multiple regression. Adaptation and transcendence explained 45.4% of the variance in successful aging, independent of age, income, function, and health. …

Geographic Health Disparities In Kentucky: Starting A Conversation About Local Solutions, Steven H. Woolf, Derek A. Chapman, F. Douglas Scutchfield Md

Frontiers in Public Health Services and Systems Research

A recently released map of Kentucky demonstrates how life expectancy varies across the state’s 120 counties. The map vividly shows a decline in life expectancy as one travels east from the “Golden Triangle” in central urban Kentucky to the mountains of Appalachia. The lowest life expectancies are largely in the far southeastern portion of the state, where residents of the Central Highlands have confronted adverse social determinants of health for generations. Indeed, companion maps released by the Center on Society and Health, which plot median household income, poverty, and educational attainment at the census tract level, show the stark socioeconomic …

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, …

Addressing Health Disparities Among Homeless In Alachua County Through Community-Based Participatory Research., Meron Hirpa, Omar Iqbal, Haider Ali, Sama I. Ilyas, Nabeel Iqbal, Jeena A. Kar, Tiffany Splatt, Brendan Shortley, Nancy Hardt

Journal of Health Disparities Research and Practice

Introduction. In states such as Florida that did not expand Medicaid, a large number of economically disadvantaged individuals do not qualify for subsidies to buy health insurance through the Affordable Care Act (ACA) ². This leaves the health needs of Florida’s homeless population largely unaddressed. Nearly 48.1% of Alachua County’s homeless population has disabling conditions ¹⁶. This confirms a pressing need to understand the homeless population's healthcare needs, knowledge, and barriers in accessing healthcare. Methods. We used a Community-Based Participatory Research model in conducting health fairs and needs assessment surveys, incentivizing participation, and providing education about existing resources. …

Racial And Ethnic Disparities In Dermatology Office Visits Among Insured Patients, 2005-2010, Valerie M. Harvey, Joan Paul, L. Ebony Boulware,

Journal of Health Disparities Research and Practice

Objective:To determine whether differences in race and ethnicity affect the usage of dermatological services.

Methods: Data from the National Ambulatory Medical Care Survey were used to study trends in ethnic/race rates of outpatient dermatology office visits among publicly and privately insured patients from 2005-2010. In multivariable models, we explored the magnitude of ethnic/race differences in dermatology visit attendance for patients with public vs. private insurance.

Results: From 2005-2010, dermatology visit utilization increased among insured Hispanics, but not among insured non-Hispanic Blacks or whites. Visits were less frequent by those with public insurance compared to private insurance. Privately and publicly …

Local Efforts Toward Addressing Health Disparities In Dekalb County, Georgia, April Hermstad, Erikka Gilliam, Sedessie Spivey, Zipatly Mendoza

Journal of the Georgia Public Health Association

Background: In underserved African American communities throughout DeKalb County, the DeKalb County Board of Health (DCBOH) is implementing community-based initiatives using policy, systems, and environmental improvement approaches to reduce racial and ethnic health disparities by increasing opportunities for nutrition and physical activity.

Methods: The initiatives are being implemented in priority census tracts where the population is at least 40% African American, 30% live below federal poverty level, and 25% did not graduate from high school. Communications promote awareness of the programs, and evaluation activities document processes and outcomes.

Results: To date, implementation of five interventions has affected approximately 276,000 DeKalb …

Consistency Of Hemoglobin A1c Testing And Cardiovascular Outcomes In Medicare Patients With Diabetes, Philip P. Goodney, Karina A. Newhall, Kimon Bekelis, Daniel Gottlieb, Richard Comi, Sushela Chaudrain, Adrienne E. Faerber, Todd A. Mackenzie, Jonathan S. Skinner

Dartmouth Scholarship

Background:

Annual hemoglobin A1c testing is recommended for patients with diabetes mellitus. However, it is unknown how consistently patients with diabetes mellitus receive hemoglobin A1c testing over time, or whether testing consistency is associated with adverse cardiovascular outcomes.

Methods and Results:

We identified 1 574 415 Medicare patients (2002–2012) with diabetes mellitus over the age of 65. We followed each patient for a minimum of 3 years to determine their consistency in hemoglobin A1C testing, using 3 categories: low (testing in 0 or 1 of 3 years), medium (testing in 2 of 3 years), and high (testing in all 3 …

Ethnicity Matters: Implications For Understanding And Acting Upon Disparities In Health Affecting Black Men In The United States, Helen V. S. Cole

Dissertations, Theses, and Capstone Projects

Compared to non-Hispanic whites, non-Hispanic blacks have higher rates of mortality from heart disease, cancer, cardiovascular disease, and HIV/AIDS. Black men have a life expectancy approximately 4.7 years than the life expectancy of non-Hispanic white men, due in part to higher prevalence of chronic disease among black men. Many factors are hypothesized to contribute to disparities in health between races, including differences in socioeconomic status; culturally-linked behaviors such as diet, substance use, and physical activity; access to quality healthcare and other resources; and experiences of racism, both institutional and interpersonal. However, in public health research, race is usually treated as …

Why-The-United-States-Needs-A-National-Birth-Cohort-Study.Pdf, Ezekiel J. Dixon-Román

Ezekiel J Dixon-Román

Disparities Among Minority Women With Breast Cancer Living In Impoverished Areas Of California, Sundus Haji-Jama, Kevin M. Gorey, Isaac N. Luginaah, Guangyong Zou, Caroline Hamm, Eric J. Holowaty

Social Work Publications

Background: Interaction effects of poverty and health care insurance coverage on overall survival rates of breast cancer among women of color and non-Hispanic white women were explored. Methods: We analyzed California registry data for 2,024 women of color (black, Hispanic, Asian, Pacific Islander, American Indian, or other ethnicity) and 4,276 non-Hispanic white women (Anglo-European ancestries and no Hispanic-Latin ethnic backgrounds) diagnosed with breast cancer between the years 1996 and 2000 who were then followed until 2011. The 2000 US census categorized rates of neighborhood poverty. Health care insurance coverage was either private, Medicare, Medicaid, or none. Cox regression was used …

Becoming A Bridge, Elizabeth Tutu

Senior Honors Projects

Ghana is a developing country in West Africa with a population of approximately 25 million people. Although this beautiful and fruitful nation has made strides to better the economy by ways of improving the politics, the infrastructure of the nation, the education system and the healthcare system, Ghana is still suffering. Similar to many other developing countries, illness and mortality are still commonly faced struggles in the nation of Ghana. The healthcare system is falling short of its potential; it needs people who are willing to catalyze change. Healthcare providers must identify how they can satisfy the medical needs of …

"Paying For Success": Structuring Reimbursement Of Free Healthcare For Pre-Insured Patients Using The Social Equity Bond Model, Nikkole Turgeon

Senior Honors Projects

Millions of Americans without insurance under the Affordable Care Act expansion fall into two categories: the ‘coverage gap’ and the ‘citizenship gap’. These two groups are disproportionately affected by health disparities due to low-income or legal status. Health disparities affect individuals in many aspects of their lives, including their health, finances, and overall quality of life. To improve the lives of uninsured individuals in Providence, Rhode Island Clínica Esperanza/Hope Clinic (CEHC) proposes to set up a Social Investment Bond Pay for Success program. CEHC has teamed with the Rhode Island Office of Health and Human Services and other RI organizations …

Quality Rated Childcare Programs And Social Determinants Of Health In Rural And Non-Rural Georgia, Nancy C. Webb, Madison L. Gates

Journal of the Georgia Public Health Association

Background: Early childhood is linked to school readiness and early school achievement. Through its Quality Rated (QR) program, which was designed to improve the quality of care in early childhood programs, the state of Georgia has been a trailblazer in funding universal preschool and in improving the quality of childcare programs. We have assessed differences in the availability of QR childcare programs in Georgia to learn if, in rural versus non-rural counties, there is a relationship between QR childcare programs and health-related outcomes.

Methods: This cross-sectional study evaluated county-level data to evaluate the relationship between QR childcare programs and social …

Facilitators And Barriers To Type 2 Diabetes Self-Management Among Rural African American Adults, Dina Byers, Katy Garth, Dana Manley, Diane Chlebowy

Journal of Health Disparities Research and Practice

Purpose: The purpose of this study was to identify facilitators and barriers to self-management of type 2 diabetes mellitus (T2DM) among African American adults living in rural communities. Research indicates that African Americans experience higher rates of T2DM and diabetes-related complications than other ethnic groups. In Kentucky, diabetes is now the fourth leading cause of death by disease among African Americans.

Methods: Twenty-two African American adults with T2DM were recruited from three churches in rural communities in Kentucky. Three focus groups were conducted to identify factors that made managing diabetes easier (facilitators) and factors that made managing diabetes more …

Developing Capacity, Skills, And Tobacco Control Networks To Address Tobacco-Related Disparities: Leadership And Advocacy Institute To Advance Minnesota’S Parity For Priority Populations (Laampp), Linda M. Bosma, Raffaele Vacca, Raymond G. Boyle, Jaime L. Martinez, Rod Lew

Journal of Health Disparities Research and Practice

Priority populations disproportionately experience tobacco-related disparities, despite population level declines in tobacco use. The Leadership and Advocacy Institute to Advance Minnesota’s Parity for Priority Populations (LAAMPP) recruits and trains African immigrants/African Americans, Asian Americans/Pacific Islanders, American Indians, Chicano/Latinos, and LGBTQ community members to develop leaders to address tobacco harms in their communities. This paper describes and evaluates the LAAMPP Institute, and discusses lessons learned through the Institute and future directions for community-based tobacco-control efforts.

The mixed-methods evaluation included qualitative key informant interviews with LAAMPP Fellows and community and project contacts, a Skills Assessment Tool, project case studies, and a social …

Sex Disparities In Access To Acute Stroke Care: Can Telemedicine Mitigate This Effect?, Catherine Wolff, Amelia K. Boehme, Karen Albright, Tzu-Ching Wu, Michael Mullen, Sean Savitz, Charles Branas, James Grotta, Brendan Carr

Journal of Health Disparities Research and Practice

Background: Women have more frequent and severe ischemic strokes than men, and are less likely to receive treatment for acute stroke. Primary stroke centers (PSCs) have been shown to utilize treatment more frequently. Further, as telemedicine (TM) has expanded access to acute stroke care we sought to investigate the association between PSC, TM and access to acute stroke care in the state of Texas.

Methods: Texas hospitals and resources were identified from the 2009 American Hospital Association Annual Survey. Hospitals were categorized as: (1) stand-alone PSCs not using telemedicine for acute stroke care, (2) PSCs using telemedicine for acute stroke …

Development And Implementation Of A Culturally Tailored, Community-Based Intervention To Raise Awareness Of Brain Health Among African Americans, Mary Ann K. Hall, Ashani Johnson-Turbes, Felicia T. Fuller, Petra Niles, Shileah Cantey-Mcdonald

Journal of Health Disparities Research and Practice

African Americans bear a disproportionate burden of age-related cognitive impairment in the United States compared to Whites or Hispanics. African Americans experience greater prevalence, higher risk, and lower rates of treatment and diagnosis for dementia. In response to these health disparities the Alzheimer’s Association developed and implemented the Healthy Brain Initiative (HBI) demonstration project, the first community-level intervention to help reduce health disparities related to cognitive impairment among African Americans. The HBI promotes awareness of brain health, understanding of the heart-brain connection, and seeks to increase African American baby boomers engagement in health-protective behaviors to promote brain and overall health. …