Immune System Diseases Commons^™

Formative Development Of A Culturally Appropriate Mammography Screening Campaign For Low-Income African-American Women., Kimberly D. Leeks, Ingrid J. Hall, C. Ashani Johnson-Turbes, Ngozi Kamalu, Yasmine Zavahir

Journal of Health Disparities Research and Practice

The purpose of this qualitative study was to conduct a formative evaluation of messages and materials to inform the development of a promotional, health campaign designed to increase breast cancer screening awareness and utilization among low-income, uninsured African American women through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in Savannah and Macon, Georgia (GA). A priority of CDC is to understand why women eligible for screening through the NBCCEDP do not participate in NBCCEDP screening services as well as to identify effective strategies for increasing enrollment among NBCCEDP-eligible women who have never received breast cancer screening. As …

Ambiguity, Ambivalence, And Apprehensions Of Taking Hiv-1 Pre-Exposure Prophylaxis Among Male Couples In San Francisco: A Mixed Methods Study, Parya Saberi, Kristine Elizabeth Gamarel, Torsten B. Neilands, Megan Comfort, Nicolas Sheon, Lynae A. Darbes, Mallory O. Johnson

Publications and Research

Objective: We conducted a mixed-methods study to examine serodiscordant and seroconcordant (HIV-positive/HIVpositive) male couples’ PrEP awareness, concerns regarding health care providers offering PrEP to the community, and correlates of PrEP uptake by the HIV-negative member of the couple.

Design: Qualitative sub-study included one-on-one interviews to gain a deeper understanding of participants’ awareness of and experiences with PrEP and concerns regarding health care providers offering PrEP to men who have sex with men (MSM). Quantitative analyses consisted of a cross-sectional study in which participants were asked about the likelihood of PrEP uptake by the HIV-negative member of the couple and level …

Patient Satisfaction In A Statewide Cervical Cancer Screening Program, Christopher R. Cochran, Salome Kapella

Nevada Journal of Public Health

A cross-sectional study of patients participating in the Nevada State Health Division’s Women Health Connection Program (WHC) was conducted to assess patient satisfaction for cervical cancer screening. In this study, 528 WHC program patients provided information regarding their satisfaction with the treatment services they received, accessibility issues, breast and cervical cancer health education and information, and overall program satisfaction. A large majority of patients reported high levels of satisfaction with the program services and clinic personnel. Significant positive correlations were found when comparing satisfaction with services received at the clinic to treatment received by physicians, nurses, and admissions personnel, how …

Chronic Hepatitis B And C Co-Infection Increased All-Cause Mortality In Haart-Naive Hiv Patients In Northern Thailand, N. Tsuchiya, P. Pathipvanich, A. Rojanawiwat, N. Wichukchinda, I. Koga, M. Koga, W. Auwanit, P. E. Kilgore, K. Ariyoshi, P. Sawanpanyalert

Department of Pharmacy Practice

A total of 755 highly active antiretroviral therapy (HAART)-naive HIV-infected patients were enrolled at a government hospital in Thailand from 1 June 2000 to 15 October 2002. Census date of survival was on 31 October 2004 or the date of HAART initiation. Of 700 (92.6%) patients with complete data, the prevalence of hepatitis B virus (HBV) surface antigen and anti-hepatitis C virus (HCV) antibody positivity was 11.9% and 3.3%, respectively. Eight (9.6%) HBV co-infected patients did not have anti-HBV core antibody (anti-HBcAb). During 1166.7 person-years of observation (pyo), 258 (36.9%) patients died [22.1/100 pyo, 95% confidence interval (CI) 16.7–27.8]. HBV …

Effects Of The Master Settlement Agreement On Smoking Among Nevada Teens: A Decade After Implementation And Implications Of Reduced Funding, Christina A. Demopoulos, Christopher R. Cochran

Nevada Journal of Public Health

Background: Tobacco control programs that have adapted the Centers for Disease Control and Prevention (CDC) Best Practices for a Comprehensive Tobacco Control Program (CTCP) have been effective in reducing the rates of tobacco use. This paper investigates the effectiveness that Nevada’s tobacco control programs have had on teen tobacco use and rates to date and examines changes to programs given reduced Master Settlement Agreement (MSA) funding.

Methods: Aggregate data from the Nevada Department of Health and Human Services/Fund for a Healthy Nevada program was analyzed to determine if the tobacco control programs adapted the CDC’s Best Practices for a CTCP. …

Pepfar Problems: How Does The United States’ Presidential Emergency Program For Aids Relief Empower Women?, Caitlin H.

Independent Study Project (ISP) Collection

This study looks to examine how the Presidential Emergency Program for AIDS Relief (PEPFAR) works to achieve one of its key goals, the empowerment of women, in the Western Cape. Human immunodeficiency virus (HIV) affects women disproportionately, around the world and in South Africa. Thus, women should be a key focus of Acquired Immunodeficiency Syndrome (AIDS) relief and HIV prevention. This paper analyzes the work of PEPFAR to empower women through three lenses. Women’s empowerment in general is discussed, to see how organizations view their own methods of empowerment. PEPFAR’s work with sex workers is examined, as they are often …

Storytelling And Healing: The Influence Of Narrative On Identity Construction Among Hiv Positive Individuals In Kisumu, Kenya, Kimberly Leon

Independent Study Project (ISP) Collection

The principle objective of this Independent Study Project is to investigate the influence of storytelling as a counseling method on conceptions of HIV among HIV positive individuals in the city of Kisumu. Interviews with counselors, community health workers, and HIV support group members were used to determine the role of storytelling in the counseling process. Stories and life experiences were gathered and analyzed in order to extract themes and draw a relationship between the act of storytelling and a person’s perception of their HIV status. Data was collected at various support groups in the Kisumu area and through the help …

The Role Of Dental Hygienists In Conducting Rapid Hiv Testing, Anthony J. Santella, Susan H. Davide, Marilyn Cortell, Winnie Furnari, Janet Tuthill

Publications and Research

Expanding rapid HIV testing in the dental setting may increase the number of individuals who are aware of their HIV status and can begin medical care and social support services if seropositive and appropriate.

Health Disparities Experienced By People With Disabilities In The Us: A Behavioral Risk Factor Surveillance System Study, Jennifer Renee Pharr, Timothy J. Bungum

Environmental & Global Health Faculty Research

The Americans with Disabilities Act became law in 1990; since then research has shown that people with disabilities continue to experience barriers to health care. The purpose of this study was to compare utilization of preventive services, chronic disease rates, and engagement in health risk behaviors of participants with differing severities of disabilities to those without disabilities. This study was a secondary analysis of 2010 data collected in the Behavioral Risk Factor Surveillance System national survey in the United States. Rao Chi square test and logistic regression were employed. Participants with disabilities had significantly higher adjusted odds ratios for all …

Optimizing Network Connectivity For Mobile Health Technologies In Sub-Saharan Africa, Mark J. Siedner, Alexander J. Lankowski, Derrick Musinga, Jonathan Jackson, Conrad Muzoora, Peter W. Hunt, Jeffrey N. Martin, David Bangsberg, Jessica E. Haberer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Mobile health (mHealth) technologies hold incredible promise to improve healthcare delivery in resourcelimited settings. Network reliability across large catchment areas can be a major challenge. We performed an analysis of network failure frequency as part of a study of real-time adherence monitoring in rural Uganda. We hypothesized that the addition of short messaging service (SMS+GPRS) to the standard cellular network modality (GPRS) would reduce network disruptions and improve transmission of data.

Methods: Participants were enrolled in a study of real-time adherence monitoring in southwest Uganda. In June 2011, we began using Wisepill devices that transmit data each time the …

Breast Milk From Tanzanian Women Has Divergent Effects On Cell-Free And Cell-Associated Hiv-1 Infection In Vitro, Magdalena A. Lyimo, Matilda Ngarina Mosi, Molly L. Housman, Muhammad Zain-Ul-Abideen, Frederick V. Lee, Alexandra L. Howell, Ruth I. Connor

Dartmouth Scholarship

Transmission of HIV-1 during breastfeeding is a significant source of new pediatric infections in sub-Saharan Africa. Breast milk from HIV-positive mothers contains both cell-free and cell-associated virus; however, the impact of breast milk on HIV-1 infectivity remains poorly understood. In the present study, breast milk was collected from HIV-positive and HIV-negative Tanzanian women attending antenatal clinics in Dar es Salaam. Milk was analyzed for activity in vitro against both cell-free and cell-associated HIV-1. Potent inhibition of cell-free R5 and X4 HIV-1 occurred in the presence of milk from all donors regardless of HIV-1 serostatus. Inhibition of cell-free HIV-1 infection positively …

From Engagement To Action: Assessing Community Readiness For Disparities Mobilization, Linda S. Sprague Martinez, Elmer Freeman, Flavia C. Perea

Journal of Health Disparities Research and Practice

In an effort to engage communities across the state of Massachusetts in tackling health disparities, Critical MASS (CM), in partnership with local researchers piloted a readiness assessment to identify community assets, perceptions of disparities, and interest in partnership. The research process was used to facilitate the development of partnerships between outside organizers, researchers, and community stakeholders. Partnership outcomes included a disparities conference aimed at bringing attention to concerns in the community, and a grant submission aimed at addressing community identified disparities. Despite the successes the partnership faced challenges. Logistics and limited resources hindered partner efforts to sustain the relationship. This …

Racial And Ethnic Health Disparities In Incarcerated Populations, Meghan E. Borysova, Ojmarrh Mitchell, Dawood H. Sultan, Arthur R. Williams

Journal of Health Disparities Research and Practice

Alarming disparities in population health and wellness in the United States have led to multi-disciplinary research efforts to create health equity. Identifying disparities, elucidating the etiological bases of disparities, and implementing solutions to eliminate disparities are part of the U.S. national health agenda. Racial and ethnic disparities have been identified throughout the cancer control continuum, in cardiovascular disease, diabetes and a multitude of other conditions. The causes of disparities are complex, condition specific, and conjectured to result from combinations of biological and socio-behavioral factors. Racial and ethnic health disparities within the vast incarcerated communities have been excluded from most studies, …

Disparities In Mental Health Utilization Among Persons With Chronic Diseases, Saundra Glover, Keith Elder, Sudha Xirasagar, Jong-Deuk Baek, Crystal Piper, Dayna Campbell

Journal of Health Disparities Research and Practice

This study used Aday and Andersen’s Behavioral Model of Health Services Use to examine the role of chronic disease and the joint impact of race and chronic disease type on mental health utilization. Using data from Community Tracking Survey Household Survey, we tested the assumption that chronic disease, chronic disease type, and race are related to lower rates of mental health visits when adjusted for predisposing, enabling, and need factors. After adjusting for population characteristics, we found that race significantly moderated the impact of chronic disease type on mental health utilization, showing that African Americans with cardiovascular disease were half …

Developing A Preference Assessment Tool For Use Among Minority And Low Literacy Primary Care Patients, Sarah T. Hawley, Maria Jibaja-Weiss, Partha Krishnamurthy, Sally W. Vernon, Natoshia Hebert, Robert Volk

Journal of Health Disparities Research and Practice

Incorporating patients’ preferences into healthcare decisions has been identified as one mechanism for reducing health disparities. Some research suggests that providers need to tailor medical recommendations to the preferences of their patients. Yet there are few tools to facilitate clarification of preferences for health services. This paper reports the process of testing an innovative preference elicitation technique—conjoint analysis—among minorities and low literacy patients using the example of colorectal cancer (CRC) screening. CRC screening exemplifies preference-sensitive healthcare as there exist several screening options. However, screening rates among minorities are low. Better methods for preference assessment could improve patient-provider communication and increase …

Brief Communications

Journal of Health Disparities Research and Practice

No abstract provided.

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 …

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 …

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 …

Cumulative Risk And A Call For Action In Environmental Justice Communities, H. P. Hynes, Russ Lopez

Journal of Health Disparities Research and Practice

Health disparities, social inequalities, and environmental injustice cumulatively affect individual and community vulnerability and overall health; yet health researchers, social scientists and environmental scientists generally study them separately. Cumulative risk assessment in poor, racially segregated, economically isolated and medically underserved communities needs to account for their multiple layers of vulnerability, including greater susceptibility, greater exposure, less preparedness to cope, and less ability to recover in the face of exposure. Recommendations for evidence-based action in environmental justice communities include: reducing pollution in communities of highest burden; building on community resources; redressing inequality when doing community-based research; and creating a screening framework …

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 …

The Emerging Hiv Epidemic On The Mexico-U.S. Border: An International Case Study Characterizing The Role Of Epidemiology In Surveillance And Response, Steffaine Strathdee, Carlos Magis-Rodriguez, Richard Jimenez

Walden Faculty and Staff Publications

Purpose

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome surveillance data are critical for monitoring epidemic trends, but they can mask dynamic subepidemics, especially in vulnerable populations that underuse HIV testing. In this case study, we describe community-based epidemiologic data among injection drug users (IDUs) and female sex workers (FSWs) in two northern Mexico-U.S. border states that identified an emerging HIV epidemic and generated a policy response.

Methods

We draw from quantitative and qualitative cross-sectional and prospective epidemiologic studies and behavioral intervention studies among IDUs and FSWs in Tijuana, Baja California, and Ciudad Juarez, Chihuahua.

Results

The recognition that the HIV epidemic …

Rethinking The “Pre” In Pre-Therapy Counseling: No Benefit Of Additional Visits Prior To Therapy On Adherence Or Viremia In Ugandans Initiating Arvs, Mark J. Siedner, Alexander J. Lankowski, Jessica E. Haberer, Annet Kembabazi, Nneka Emenyonu, Alexander C. Tsai, Conrad Muzoora, Elvin H. Geng, Jeffrey N. Martin, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Many guidelines recommend adherence counseling prior to initiating antiretrovirals (ARVs), however the additional benefit of pre-therapy counseling visits on early adherence is not known. We sought to assess for a benefit of adherence counseling visits prior to ARV initiation versus adherence counseling during the early treatment period.

Methods: We performed a secondary analysis of data from a prospective cohort of HIV-infected patients in Mbarara, Uganda. Adults were enrolled upon initiation of ARVs. Our primary exposure of interest was ARV adherence counseling prior to initiating therapy (versus concurrent with initiation of therapy). Our outcomes of interest were: 1) average adherence …

High Acceptability For Cell Phone Text Messages To Improve Communication Of Laboratory Results With Hiv-Infected Patients In Rural Uganda: A Cross-Sectional Survey Study, Mark J. Siedner, Jessica E. Haberer, Mwebesa B. Bwana, Norma C. Ware, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Patient-provider communication is a major challenge in resource-limited settings with large catchment areas. Though mobile phone usership increased 20-fold in Africa over the past decade, little is known about acceptability of, perceptions about disclosure and confidentiality, and preferences for cell phone communication of health information in the region.

Methods: We performed structured interviews of fifty patients at the Immune Suppression Syndrome clinic in Mbarara, Uganda to assess four domains of health-related communication: a) cell phone use practices and literacy, b) preferences for laboratory results communication, c) privacy and confidentiality, and d) acceptability of and preferences for text messaging to …

Mean Cd4 Cell Count Changes In Patients Failing A First-Line Antiretroviral Therapy In Resource-Limited Settings, Alexandra Calmy, Eric Balestre, Fabrice Bonnet, Andrew Boulle, Eduardo Sprinz, Robin Wood, Eric Delaporte, Eugène Messou, James Mcintyre, Kamal Marhoum El Filali, Mauro Schechter, N. Kumarasamy, David Bangsberg, Patrick Mcphail, Stefaan Van Der Borght, Carlos Zala, Matthias Egger, Rodolphe Thiébaut, François Dabis, Art-Linc Of Iedea Collaboration (Asia, South America, East, Southern And West Africa)

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Changes in CD4 cell counts are poorly documented in individuals with low or moderate-level viremia while on antiretroviral treatment (ART) in resource-limited settings. We assessed the impact of on-going HIV-RNA replication on CD4 cell count slopes in patients treated with a first-line combination ART.

Method: Naïve patients on a first-line ART regimen with at least two measures of HIV-RNA available after ART initiation were included in the study. The relationships between mean CD4 cell count change and HIV-RNA at 6 and 12 months after ART initiation (M6 and M12) were assessed by linear mixed models adjusted for gender, age, …

Surveillance Of Infectious Diseases Among American Indians And Alaska Natives, Jeanne Bertolli, Amy Roussel, Jennie Harris, Dan Lentine, Julia Gable, Ron Fichtner, Joann Kauffman, Michael Landen, Ralph T. Bryan

Journal of Health Disparities Research and Practice

We assessed participation in public health surveillance networks among Indian Health Service, tribal, and urban (I/T/U) Indian health facilities for a group of infectious diseases, and barriers to participation. We conducted surveys of I/T/U facilities and key informant interviews with representatives of tribal, urban, and national American Indian/Alaska Native (AI/AN) agencies. For the surveys, frequencies and percentages of responses in each response category were calculated. Qualitative methods were used to analyze interview content. The proportion of facilities participating in case reporting is suboptimal across facility types and diseases. Even when reporting is occurring, there is little feedback to tribal agencies. …

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 …

A Geospatial Analysis Of Cdc-Funded Hiv Prevention Programs For African Americans In The United States, G. A. Gilliam, Carol L. Hanchette, Kieran J. Fogarty, Deborah A. Gibbs

Journal of Health Disparities Research and Practice

Given the increase in HIV/AIDS infection rates among racial and ethnic minorities, particularly African Americans, this study was undertaken as part of a larger research effort to examine the distribution of HIV prevention services focusing on African American populations within the United States. Data were gathered via a national survey of community-based organizations (CBOs) funded by the Centers for Disease Control and Prevention (CDC). A geocoded national database was constructed to identify, locate, and map these HIV prevention programs. A total of 1,020 CBOs responded to the survey, yielding a response rate of 70.3%. These CBOs administered a total of …

Beyond The It Magic Bullet: Hiv Prevention Education And Public Policy, Fay C. Payton

Journal of Health Disparities Research and Practice

Analytic applications are vital in the assessments of public health and surveillance as these applications can drive resource allocation, community assessment and public policy. Using a dataset of nearly 90,000 patient hospital encounters, the number of instances with an ICD code of HIV and co-morbidities was identified. Blacks accounted for 75 percent of HIV hospital encounters in the dataset. While business analytic applications informed this study of cross-tabulations and interaction effects among race, age and gender, there appears to be a significant relationship among HIV diagnoses and substance abuse. Payer data is informed by the Healthcare Cost and Utilization Project …