Medicine and Health Sciences Commons^™

Did Medicaid Expansion Close African American-White Health Care Disparities Nationwide? A Scoping Review, Lonnie R. Snowden, Genevieve Graaf, Latocia Keyes, Katherine Kitchens, Amanda Ryan, Neal Wallace

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objectives: To investigate the impact of the Affordable Care Act’s (ACA) Medicaid expansion on African Americanwhite disparities in health coverage, access to healthcare, receipt of treatment, and health outcomes. Design: A search of research reports, following the PRISMA-ScR guidelines, identified twenty-six national studies investigating changes in health care disparities between African American and white non-disabled, non-elderly adults before and after ACA Medicaid expansion, comparing states that did and did not expand Medicaid. Analysis examined research design and findings. Results: Whether Medicaid eligibility expansion reduced African American-white health coverage disparities remains an open question: Absolute disparities in coverage appear to have …

Employment Loss And Food Insecurity - Race And Sex Disparities In The Context Of Covid-19, Jacquelyn V Coats, Sarah Humble, Kimberly J Johnson, Havisha Pedamallu, Bettina F Drake, Elvin Geng, Charles W Goss, Kia L Davis

2020-Current year OA Pubs

INTRODUCTION: Applying an intersectional framework, we examined sex and racial inequality in COVID-19-related employment loss (ie, job furlough, layoff, and reduced pay) and food insecurity (ie, quality and quantity of food eaten, food worry, and receipt of free meals or groceries) among residents in Saint Louis County, Missouri.

METHODS: We used cross-sectional data from adults aged 18 or older (N = 2,146), surveyed by using landlines or cellular phones between August 12, 2020, and October 27, 2020. We calculated survey-weighted prevalence of employment loss and food insecurity for each group (Black female, Black male, White female, White male). Odds ratios …

Gene-Based Polygenic Risk Scores Analysis Of Alcohol Use Disorder In African Americans, Dongbing Lai, Arpana Agrawal, Et Al

2020-Current year OA Pubs

Genome-wide association studies (GWAS) in admixed populations such as African Americans (AA) have limited sample sizes, resulting in poor performance of polygenic risk scores (PRS). Based on the observations that many disease-causing genes are shared between AA and European ancestry (EA) populations, and some disease-causing variants are located within the boundaries of these genes, we proposed a novel gene-based PRS framework (PRS

Genetic Evaluation For Hereditary Cancer Syndromes Among African Americans: A Critical Review, Ambreen Khan, Charles R Rogers, Carson D Kennedy, Ana Maria Lopez, Joanne Jeter

Department of Medical Oncology Faculty Papers

While hereditary cancer syndromes have been described and studied for centuries, the completion of the human genome project fueled accelerated progress in precision medicine due to the introduction of genetic testing in the 1990s, creating avenues for tailored treatments and medical management options. However, genetic testing has not benefited everyone equitably, with nearly all of the published work based on individuals of non-Hispanic White/European ancestry. There remains a gap in knowledge regarding the prevalence, penetrance, and manifestations of common hereditary cancer syndromes in the African-American population due to significant disparities in access and uptake of genetic testing. This review summarizes …

Disparities In Awareness Of And Willingness To Participate In Cancer Clinical Trials Between African American And White Cancer Survivors, Gaurav Kumar, Jungyoon Kim, Paraskevi A. Farazi, Hongmei Wang, Dejun Su

Journal Articles: Epidemiology

BACKGROUND: Cancer clinical trials (CCTs) are essential for cancer care, yet the evidence is scarce when it comes to racial disparities in CCT participation among cancer survivors in the Midwest. This study aimed to 1) assess disparities in the awareness of and willingness to participate in CCTs between African American and White cancer survivors; and 2) compare perceptions about CCTs between the two racial groups.

METHODS: The study was based on cross-sectional data from the survey "Minority Patient Participation in Cancer Clinical Trials" that collected information from 147 Black and White cancer survivors from Nebraska between 2015 and 2016. Chi-square …

Genetic Contributors Of Incident Stroke In 10,700 African Americans With Hypertension: A Meta-Analysis From The Genetics Of Hypertension Associated Treatments And Reasons For Geographic And Racial Differences In Stroke Studies, Nicole D. Armstrong, Vinodh Srinivasasainagendra, Amit Patki, Rikki M. Tanner, Bertha A. Hidalgo, Hemant K. Tiwari, Nita A. Limdi, Ethan M. Lange, Leslie A. Lange, Donna K. Arnett, Marguerite R. Irvin

Epidemiology and Environmental Health Faculty Publications

Background: African Americans (AAs) suffer a higher stroke burden due to hypertension. Identifying genetic contributors to stroke among AAs with hypertension is critical to understanding the genetic basis of the disease, as well as detecting at-risk individuals.

Methods: In a population comprising over 10,700 AAs treated for hypertension from the Genetics of Hypertension Associated Treatments (GenHAT) and Reasons for Geographic and Racial Differences in Stroke (REGARDS) studies, we performed an inverse variance-weighted meta-analysis of incident stroke. Additionally, we tested the predictive accuracy of a polygenic risk score (PRS) derived from a European ancestral population in both GenHAT and REGARDS AAs …

Mistrust, Neighborhood Deprivation, And Telehealth Use In African Americans With Diabetes., Barry W. Rovner, Robin J. Casten, Anna Marie Chang, Judd E. Hollander, Kristin Rising

Department of Emergency Medicine Faculty Papers

This study explored the relationship between trust in physicians and telehealth use during the COVID pandemic in 162 African Americans with diabetes. More than 90% of patients had internet-capable devices and internet service but only 61 patients (39%) had a telehealth visit. Compared to the latter, participants with no telehealth visits had less trust in physicians' ability to diagnose COVID, less trust in physicians' ability to treat via telehealth, and resided in more deprived neighborhoods. There were no differences in age, sex, education, nor literacy. For African Americans with diabetes, health disparities may increase unless fundamental issues such as trust …

The Role Of Healthcare Providers In Using The Knowledge Of Sickle Cell Trait To Mitigate Health Problems In African American Clients., Stella N. Udechukwu

Nicole Wertheim College of Nursing Student Projects

Abstract

Background: Sickle cell trait (SCT) for long has been regarded as a benign condition and as such healthcare providers do little to nothing to mitigate adverse health problems associated with sickle cell trait. An effective approach to improving health outcome for those with SCT is to educate providers on SCT, its complications and management. This study is aimed at evaluating the effectiveness of an educational intervention on providers’ knowledge, attitude and practice regarding sickle cell trait.

Method: A quasi experiment study was conducted in Jackson Health System on 30 providers belonging to internal medicine team to evaluate their …

Reproductive Justice And Black Lives: A Concept Analysis For Public Health Nursing, Kathryn Burger, Robin Evans‐Agnew, Susan L. Johnson

Nursing & Healthcare Leadership Publications

Inequities in maternal mortality in the US are a form of structural violence against Black women. The concept of reproductive justice has been employed in the social sciences for almost thirty years, yet nursing has been slow to adopt this concept in promoting maternal-child health. Objective: to analyze the concept of reproductive justice as used in peer-reviewed publications with the aim of reframing black maternal health in public health nursing scholarship, research, practice, and advocacy. Design: We conducted a systematic review of the social science literature. We analyzed selected articles though a principle-based concept analysis focusing on epistemological, pragmatic, linguistic, …

Neurological Complications Of Covid19 During March 2020 At Lcmc Health University Medical Center: Dataset, David Chachkhiani, Michael Y. Soliman, Delphi Barua, Marine Isakadze, Nicole R. Villemarette-Pittman, Deidre J. Devier, Jesus F. Lovera

School of Medicine Faculty Publications

We reviewed the electronic medical records (EMR) of patients hospitalized during the peak of the pandemic, March 1st through March 31st, to document the type and frequency of neurological problems seen in patients with COVID-19 at presentation to the emergency room. Secondary aims were to determine: 1) the frequency of neurological complaints during the hospital stay; 2) whether the presence of any neurological complaint at presentation or any of the individual types of neurological complaints at admission predicted three separate outcomes: death, length of hospital stay, or the need for intubation; and 3) if the presence of any neurological complaint …

Whole-Genome Sequencing Of African Americans Implicates Differential Genetic Architecture In Inflammatory Bowel Disease, Hari K Somineni, Rodney D Newberry, Et Al.

2020-Current year OA Pubs

Whether or not populations diverge with respect to the genetic contribution to risk of specific complex diseases is relevant to understanding the evolution of susceptibility and origins of health disparities. Here, we describe a large-scale whole-genome sequencing study of inflammatory bowel disease encompassing 1,774 affected individuals and 1,644 healthy control Americans with African ancestry (African Americans). Although no new loci for inflammatory bowel disease are discovered at genome-wide significance levels, we identify numerous instances of differential effect sizes in combination with divergent allele frequencies. For example, the major effect at PTGER4 fine maps to a single credible interval of 22 …

Whole-Exome Sequencing And Hipsc Cardiomyocyte Models Identify Myrip, Trappc11, And Slc27a6 Of Potential Importance To Left Ventricular Hypertrophy In An African Ancestry Population, Marguerite R. Irvin, Praful Aggarwal, Steven A. Claas, Lisa De Las Fuentes, Anh N. Do, C. Charles Gu, Andrea Matter, Benjamin S. Olson, Amit Patki, Karen Schwander, Joshua D. Smith, Vinodh Srinivasasainagendra, Hemant K. Tiwari, Amy J. Turner, Deborah A. Nickerson, Dabeeru C. Rao, Ulrich Broeckel, Donna K. Arnett

Epidemiology and Environmental Health Faculty Publications

Background: Indices of left ventricular (LV) structure and geometry represent useful intermediate phenotypes related to LV hypertrophy (LVH), a predictor of cardiovascular (CV) disease (CVD) outcomes.

Methods and Results: We conducted an exome-wide association study of LV mass (LVM) adjusted to height^2.7, LV internal diastolic dimension (LVIDD), and relative wall thickness (RWT) among 1,364 participants of African ancestry (AAs) in the Hypertension Genetic Epidemiology Network (HyperGEN). Both single-variant and gene-based sequence kernel association tests were performed to examine whether common and rare coding variants contribute to variation in echocardiographic traits in AAs. We then used a data-driven …

The Intersection Of Rural Residence And Minority Race/Ethnicity In Cancer Disparities In The United States, Whitney Zahnd, Cathryn Murphy, Marie Knoll, Gabriel A. Benavidez, Kelsey R. Day, Radhika Ranganathan, Parthenia Luke, Anja Zgodic, Kewei Shi, Melinda A. Merrell, Elizabeth L. Crouch, Heather M. Brandt, Jan Eberth

Faculty Publications

One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There …

Disparities In Sars-Cov-2 Positivity Rates: Associations With Race And Ethnicity, Harvey W Kaufman, Justin K Niles, David B. Nash

College of Population Health Faculty Papers

Numerous reports indicate that African Americans and Latinos are being affected disproportionately by coronavirus disease 2019 (COVID-19). Positivity rates have not been analyzed on scale because only 4 states report race/ethnicity as part of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. Previous studies also have had little ability to control for many known risk factors to better identify the effects of COVID-19 on racial and ethnic communities. Using test results from a large national reference laboratory database that included patients from all 50 states and the District of Columbia, this study compared positivity rates for SARS-CoV-2 nucleic acid amplification …

Critical Importance Of Using Fibroscan To Identify Patients With Cirrhosis In A Predominantly African American Patient Population, Sarah Nasser, Katherine Wong, Paul Naylor, Murray Ehrinpreis, Milton Mutchnick

Medical Student Research Symposium

Introduction: Identifying patients with cirrhosis is complicated, but the availability of Transient Elastography by FibroScan for non-invasive assessment of fibrosis appears to have resolved this issue. The objective of our study was to use a Fibroscan database to identify patients with cirrhosis in our primarily African American Hepatitis C patients and to track outcome especially of patients with Hepatitis C (HCV).

Methods: The electronic medical records of 79 out of the 332 individuals (24%) with a Fibroscan between 2014 and 2016 and a score of >12.5 kPa laboratory values recorded, and etiology and outcomes evaluated. AST to Platelet …

The Effect Of Lifestyle Modification Educational Intervention On Increasing Knowledge Of Hypertension Management Among African American Adults, Margaret Josiah

Graduate Research Showcase

Abstract

Hypertension is a public health crisis that disproportionately affects the African American population more than other races (CDC, 2019). There is a direct link between hypertension and an increased risk for cardiovascular disease in the United States (CDC, 2019). Though tremendous efforts have been made in the treatment and management of hypertension, it continues to be a challenge worldwide. African Americans that receive only pharmacological therapy have not shown significant control over hypertension (Kimani, 2019). Therefore, to improve the health outcomes in the African American community, a systematic comprehensive approach that includes lifestyle modification and medication adherence is crucial. …

Managing Hypertension With Lifestyle Modifications, Ladonna D. Willis

MSN Capstone Projects

Cardiovascular disease has taken the lives of millions of Americans, specifically, African Americans who do not have access to health care, which leads to morbidity and increased mortality. This benchmark project proposes to provide cardiovascular educational packets to patients who are admitted to the hospital and have been diagnosed with hypertension.

The Effect Of Neighborhood Social Environment On Prostate Cancer Development In Black And White Men At High Risk For Prostate Cancer, Shannon M Lynch, Elizabeth Handorf, Kristen A Sorice, Elizabeth Blackman, Lisa Bealin, Veda N. Giri, Elias Obeid, Camille Ragin, Mary Daly

Department of Medical Oncology Faculty Papers

INTRODUCTION: Neighborhood socioeconomic (nSES) factors have been implicated in prostate cancer (PCa) disparities. In line with the Precision Medicine Initiative that suggests clinical and socioenvironmental factors can impact PCa outcomes, we determined whether nSES variables are associated with time to PCa diagnosis and could inform PCa clinical risk assessment.

MATERIALS AND METHODS: The study sample included 358 high risk men (PCa family history and/or Black race), aged 35-69 years, enrolled in an early detection program. Patient variables were linked to 78 nSES variables (employment, income, etc.) from previous literature via geocoding. Patient-level models, including baseline age, prostate specific antigen (PSA), …

Ua94/6/1 My Story: Wku Women's Basketball's Sherry Porter, Sherry Porter

Student/Alumni Personal Papers

My Story is a series of first-person feature articles written by WKU student-athletes. The student-athletes will be telling their own stories in their own words. This article written by women’s basketball senior Sherry Porter. Porter reflects on the state of current events going on nationwide.

Chancellor Messages_An Imperative For Change, Dannel P. Malloy

Chancellor

Message to the University of Maine System community from Chancellor Dannel P. Malloy affirming the University of Maine System's condemnation of racial injustice and violence against Black Americans, in light of the death of George Floyd.

Ua94/6/1 My Story: Wku Track & Field's Adarian Gray, Adarian Gray

Student/Alumni Personal Papers

My Story is a series of first-person feature articles written by WKU student-athletes. The student-athletes will be telling their own stories in their own words. This article written by track & field senior thrower Adarian Gray, who has represented both WKU softball and track & field during her career on the Hill.

Formative Research To Design A Culturally-Appropriate Cancer Clinical Trial Education Program To Increase Participation Of African American And Latino Communities, Jennifer Cunningham-Erves, Claudia Barajas, Tilicia Mayo-Gamble, Caree R. Mcafee, Pamela Hull, Maureen Sanderson, Juan Canedo, Katina Beard, Consuelo H. Wilkins

Department of Health Policy and Community Health Faculty Publications

Background: Addressing knowledge deficiencies about cancer clinical trials and biospecimen donation can potentially improve participation among racial and ethnic minorities. This paper describes the formative research process used to design a culturally-appropriate cancer clinical trials education program for African American and Latino communities. We characterized community member feedback and its integration into the program.

Methods: We incorporated three engagement approaches into the formative research process to iteratively develop the program: including community-based organization (CBO) leaders as research team members, conducting focus groups and cognitive interviews with community members as reviewers/consultants, and interacting with two community advisory groups. An …

Ua94/6/1 My Story: Wku Basketball's Kenny Cooper, Kenny Cooper

Student/Alumni Personal Papers

My Story is a series of first-person feature articles written by WKU student-athletes. The student-athletes will be telling their own stories in their own words. This article written by basketball senior guard Kenny Cooper, who redshirted as a transfer in 2019-20 but will play his final college season this upcoming year.

Ua94/6/1 My Story: Wku Football's Malik Staples, Malik Staples

Student/Alumni Personal Papers

My Story is a series of first-person feature articles written by WKU student-athletes. The student-athletes will be telling their own stories in their own words. This article written by football graduate senior Malik Staples, who – along with his teammates – has navigated through a different type of Spring Ball over the past two months.

Greater Social Cohesion Is Associated With Lower Body Mass Index Among African American Adults, Adolfo G. Cuevas, Ichiro Kawachi, Kasim Ortiz, Mariam Pena, Lorraine R. Reitzel, Lorna H. Mcneill

Publications and Research

Obesity remains a public health issue, especially for Blacks (or African Americans). Obesity is thought to reflect a complex interaction of socioenvironmental, biological, and cognitive factors. Yet, insufficient attention has been given to psychosocial factors like social cohesion within the African American community. Using multivariable linear regression, we examined the association between social cohesion, measured by the Social Cohesion and Trust scale, and body mass index (BMI) with cross-sectional data (n = 1467) from a cohort study (2008–2009). Greater social cohesion was associated with lower BMI (b = -0.88; 95% CI: −1.45, −0.32) in an unadjusted model. The association was …

Ua94/6/1 My Story: Wku Mens Basketball's Taveion Hollingsworth, Taveion Hollingsworth

Student/Alumni Personal Papers

My Story is a series of first-person feature articles written by WKU student-athletes. The student-athletes will be telling their own stories in their own words. This article written by men’s basketball junior guard Taveion Hollingsworth, whose mission of advancing to the NCAA Tournament with his teammates was halted when the Covid-19 pandemic hit.

Ua94/6/1 My Story: Wku Women's Basketball's Sandra Skinner, Sandra Skinner

Student/Alumni Personal Papers

My Story is a series of first-person feature articles written by WKU student-athletes. The student-athletes will be telling their own stories in their own words. This article written by women’s basketball redshirt senior Sandra Skinner, whose final season was cut short because of the cancellation of the Conference USA Tournament earlier this month.

Effects Of Medications On Cognitive Function And Falls In Older African Americans With Diabetes, Diana Alnemri, Robin J. Casten

Phase 1

Introduction: Potentially-inappropriate medications (PIMs) are medications that have increased rates of adverse drug events in older adults. Medications with anticholinergic activity are classified as PIMs since they can lead to cognitive dysfunction and increased fall risk. PIM use is higher among African Americans (AA) than Whites.

Methods: This study explored relationships among cognitive function, falls, and PIMs in AAs with diabetes. This study recruited AAs with diabetes (n=99, age ≥60yrs) who were seen in the Emergency Department (ED), and were enrolled in a trial of a behavioral intervention to improve diabetes management. PIMs were based on the Beer’s criteria …

From Suffrage To The Senate: Expanding Inclusion In Women's Rights To Achieve Women's Health Equality., Frances Grimstad

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Culturally Appropriate Education In Managing Hypertension In African Americans, Kristina Jones

Doctoral Dissertations and Projects

Abstract The historical treatment of African Americans with events such as the Tuskegee experiment and Jim Crow laws combined with distrust of the healthcare system may be affecting health outcomes in African Americans with hypertension. Cultural appropriate education by a provider of the same race is a method that can be utilized to bridge the trust gap between African Americans and providers and assist African Americans in managing their hypertension. A community based culturally appropriate educational intervention by a provider of the same race was implemented over the course of eight weeks to assist African Americans with hypertension to improve …