Public Health Commons^™

Health Disparities In Kidney Transplantation: An Equity Analysis, Shirley A. Wells

Journal of Health Disparities Research and Practice

The growing incidence of end stage renal disease along with advances of the past 40 years that have improved the success rate of kidney transplantation have created an unprecedented demand for kidney transplant. Yet, certain racial and ethnic groups and women consistently have longer waiting times and lower rates of transplantation which makes a review of the kidney procurement and transplantation system in view of its equity imperative. Reasons given for these disparities have varied from cultural attitudes and beliefs on the part of patients and health care providers, socioeconomic status, rates of organ donation, and geographic location. The equity …

A Review Of Smoking Among Rural African Americans: Recommendations For Research And Cessation Interventions, Susan Hedgecock, Anita Fernander

Journal of Health Disparities Research and Practice

Objective: The purpose of this review is to synthesize the available literature on smoking among rural African Americans.

Methods: Using search terms “rural” “African American” “Black” and “smoking” 19 relevant articles were identified in the Medline data base. Findings gleaned from the 19 articles are presented in four categories: a) smoking prevalence, b) smoking behavior and patterns, c) smoking cessation interventions and quitting, and d) smoking-related outcomes.

Results: There may be gender differences, a pattern of late onset of smoking, and a preference for mentholated brands among rural African American smokers. There is no evidence that rural African Americans are …

Differential Effects Of Race And Poverty On Ambulatory Care Sensitive Conditions, Farrukh B. Hakeem, Daniel L. Howard, Timothy S. Carey, Yhenneko J. Taylor

Journal of Health Disparities Research and Practice

This study is a continuation of an earlier study that examined hospitalization rates for ambulatory care sensitive (ACS) conditions, as a proxy for quality of care, and found evidence of a racial disparity among African American and White Medicare beneficiaries. The current study sought to determine whether neighborhood socioeconomic status (SES) explained this disparity. Differences in rates of ACS hospitalizations by race were assessed using Cochran-Mantel Haenszel tests and Poisson regression. Unadjusted rate ratios for ACS hospitalization for African Americans vs. Whites were found to be higher in low poverty areas (rate ratio (RR)=1.13; 95% CI (1.08, 1.17)) than in …

Inflammatory Biomarkers And Subclinical Atherosclerosis In African-American Women With Systemic Lupus Erythematosus (Sle), Edith Williams, Carlos Crespo, Joan Dorn

Journal of Health Disparities Research and Practice

Women with lupus are at increased risk for developing cardiovascular disease (CVD). Previous studies of atherosclerosis in SLE have not been representative of the minority groups most affected by lupus and its complications. Therefore, a study of 41 lupus cases and 83 controls was conducted to investigate the relationship between carotid atherosclerosis and inflammation in African-American women. Participation consisted of a questionnaire, physical examination, fasting blood draw, and ultrasound of the carotid arteries. There were observed differences between cases and controls with regard to carotid intima media thickness (IMT) and traditional cardiovascular risk factors, although few reached statistical significance. Tumor …

A Human Capital Approach To Reduce Health Disparities, Saundra Glover, Sudha Xirasagar, Yunho Jeon, Keith Elder, Crystal N. Piper, Harris Pastides

Journal of Health Disparities Research and Practice

Objective: To introduce a human capital approach to reduce health disparities in South Carolina by increasing the number and quality of trained minority professionals in public health practice and research.

Methods: The conceptual basis and elements of Project EXPORT in South Carolina are described. Project EXPORT is a community based participatory research (CBPR) translational project designed to build human capital in public health practice and research. This project involves Claflin University (CU), a Historically Black College University (HBCU) and the African American community of Orangeburg, South Carolina to reduce health disparities, utilizing resources from the University of South Carolina (USC), …

The Influence Of Neighborhood Characteristics On The Existence Of Asthma In Children, Elizabeth Adejuyigbe

Annual Undergraduate Conference on Health and Society

Asthma is one of the leading chronic diseases in children 17 years of age and under with nine million American children suffering from it. Previous studies to understand causal factors of disease including asthma tend to focus on the individual and sociocultural characteristics but there is little to no research using neighborhood characteristics, a factor that does influence health. Research shows that other community‐level environmental factors like collective efficacy, community structural factors, and neighborhood safety can affect a persons’ psychosocial well-being, and in turn increase morbidity. For this reason, researchers suggest that the need to understand asthma and its associated …

Physical Activity Effects On Depressive Symptoms In Black Adults, Elisa R. Torres, Carolyn M. Sampselle, Kimberlee A. Gretebeck, David L. Ronis, Harold W. Neighbors

Journal of Health Disparities Research and Practice

Objectives: Randomized trials found physical activity (PA) effective in decreasing depressive symptoms. Few studies included Black participants. The purpose of this systematic literature review was to determine the effects of PA on depressive symptoms in Black adults. Methods: Articles were abstracted by conducting a computer and hand search of eligible studies. Results: Eight of 13 studies found a significant inverse relationship between PA and depressive symptoms in Black adults. Sources for the heterogeneity were explored. Conclusion: Future studies should include representative samples of Black adults, incorporate a theory which considers multiple levels of influence, account for genetic factors in the …

Preventable Asthma Episodes Among Urban/Rural Children And Adolescents: A Comparative Study, Saundra Glover, Crystal N. Piper, Edith Williams, Kevin Bennett, Winifred Thompson, Lucy Annang, Shaniece Charlemagne, Rahnuma Hassan

Journal of Health Disparities Research and Practice

Context: Asthma is a chronic respiratory illness that is increasing in prevalence among children in the United States. A limited number of studies have examined the relationship between rurality and the prevalence of asthma in minority children, and those studies found mixed results. The aim of this study is to examine urban/rural locality and its impact on asthma episodes and preventable emergency department visits, and to provide quantitative evidence concerning the relationship between patient characteristics and geographic location. Methods: This is a retrospective study and secondary data analysis of the 2000 National Health Interview Survey. Parametric testing using Univariate/Bivariate/Multivariate analysis …

Not Always Black And White: Racial Bias For Birth Disparities From Excluding Hispanic Identification, Barbara L. Wilson, Cristi Coursen, Matthew Butler

Journal of Health Disparities Research and Practice

Despite gains in prenatal care (PNC) usage and birth outcomes for minority women during the past few decades, observed disparities between non-Hispanic Whites, Blacks, and Hispanics persist. Using the National Center for Health Statistics’ (NCHS) natality files from 1981 through 1998, Alexander, Kogan, & Nabukera (2002) examined live births of U.S. residents by trimester in which PNC was initiated and the appropriateness of that care based on the Adequacy of Prenatal Care Utilization Index (APNCU) (Kotelchuck, 1994). They found racial disparities between White and Black women in both the trimester of PNC initiation and the number of PNC visits made. …

Self-Stigma, Stress, And Smoking Among African American And American Indian Female Smokers: An Exploratory Qualitative Study, Diana Burgess, Rachel Widome, Michelle Van Ryn, Sean Phelan, Steven Fu

Journal of Health Disparities Research and Practice

Research suggests that negative emotions and difficulty coping with stressful events might impede women’s ability to quit smoking. This study uses qualitative methods to explore interrelationships between smoking behavior and negative emotions among a sample of racial/ethnic minority female smokers with the aims of theory-building and hypothesis generation. Data were derived from a larger study involving sixteen focus groups with current and former smokers from ethnic minority communities. The present study consisted of three focus groups of female African American and American Indian smokers (N = 16). Data was analyzed following standard methods for in vivo coding of qualitative data. …

Asthma Management: An Ecosocial Framework For Disparity Research, Robin A. Evans-Agnew

Journal of Health Disparities Research and Practice

Background: Asthma management disparities (AMD) between African and White Americans are significant and alarming. Various determinants have been suggested by research frameworks that affect the unfair distribution of resources for asthma management to groups who are more or less advantaged socially. Ecosocial models organize determinants into individual/family, healthcare, community, and sociocultural levels. Multilevel interventions can affect AMD through simultaneous actions on different levels and pathways between determinants.

Objective: Provide a comprehensive summary of the known determinants of AMD.

Method: Peer reviewed research frameworks of AMD from 1998-2009 were retrieved from PubMed/ Web of Science databases using (“Socioeconomic Factors”[Mesh] OR (“Healthcare …

Poverty And Mortality Disparities In Central Appalachia: Mountaintop Mining And Environmental Justice, Michael Hendryx

Journal of Health Disparities Research and Practice

Objectives. This study investigated the associations between poverty rates, Appalachian mountaintop coal mining, and age-adjusted total mortality rates to determine if persons exposed to this form of mining experience greater poverty and higher death rates compared to other types of mining or other areas of Appalachia.

Methods. Mortality rates, poverty rates, Appalachian designation and mining activity were examined for counties in Kentucky, Tennessee, Virginia and West Virginia (N=403). Linear least squares models tested for annual group differences from 2000-2007 in total and child poverty, and total mortality, based on mining type and Appalachian location. Nested linear models accounting for state-level …

The Experiences Of Men Engaged In Transactional Sex With Other Men In Urban Nigeria—A Size Estimation And Qualitative Study, Population Council

HIV and AIDS

Reports on a mixed-method research study to estimate the population size and understand the experiences of a sub-group of men who have sex with men presumed to be at particularly high risk of infection with HIV and other sexually transmitted infections: men who engage in transactional sex with other men.

Using Capture-Recapture Methodology For Enumerating Most-At-Risk Populations (Marps), Population Council

HIV and AIDS

Populations at higher risk for HIV infection are often the most difficult to reach and this is particularly true of men who have sex with men (MSM), injecting drug users, and female sex workers in sub-Saharan Africa. These subpopulations are frequently marginalized by society because of the illicit and/or illegal activities they engage in. Estimating the size of hard-to-reach populations is important to effectively plan, implement, monitor, and evaluate HIV and AIDS prevention and care programs. “Capture-recapture” is a method of estimating the prevalence of a trait in a population or more simply it’s a method that provides a good …

An Assessment Of Individual And Institutional Research Utilization By Policy-Makers And Programme Managers At State And National Levels In Nigeria, National Agency For The Control Of Aids

HIV and AIDS

This report undertakes a systematic assessment of the need for evidence by decision-makers working on HIV and AIDS funding and policymaking, and implementing organizations at the national and subnational levels in Nigeria. The assessment identifies barriers and constraints to data use, identifies best practices, and offers recommendations for the design and prioritization of strategic approaches to address barriers and constraints in data use and production. Tools to monitor the adoption of evidence in policy and practice are also offered. The need for evidence-based practice in the national response to HIV and AIDS has been widely acknowledged and incorporated into policy …

An Ethnographic Study Of Injecting Drug Users And Men Who Have Sex With Men In Selected States In Nigeria, Enhancing Nigeria's Hiv/Aids Response (Enr) Programme

HIV and AIDS

An ethnographic pre-assessment study of the behavioral dynamics of men who have sex with men (MSM) and injecting drug users (IDU) was conducted in 2009 as an integral part of the 2010 Integrated Biological and Behavioural Surveillance Survey (IBBSS). The study took place in Northern and Southern Nigeria and provided rich contextual information on the logistic and scientific factors that would aid successful conduct of the IBBSS and secure buy-in for it among study respondents. The study utilized a combination of rapid assessment procedures that were suitable to prevailing time exigencies and could foster preliminary understanding of the local contexts …

Marps Sensitization: A Diversity Training Guide For Health Care Providers In Nigeria, Enhancing Nigeria's Hiv/Aids Response (Enr) Programme

HIV and AIDS

Men who have sex with men (MSM) present specific diagnostic and management challenges to counselors and health-care providers. High prevalence of HIV infection has been reported among MSM in Nigeria, driven partly by stigma, discrimination, lack of appropriate prevention strategies, limited research evidence, little recognition by policymakers, and inadequate knowledge and skills in dealing with MSM clients. In Nigeria, where homosexuality is illegal, the risk embodied in same-sex activities is high and makes hiding MSM activities almost a norm. Currently, health-care provider training materials that address most at-risk populations’ (MARPs) specific health needs are nonexistent in Nigeria. Knowledge of these …

Le Consensus De Bellagio : Recommandations Pour Améliorer L'Accès Aux Méthodes De Contraception Efficaces, Réversibles À Longue Durée D'Action, Population Council

Reproductive Health

Ce communiqué et cette déclaration proposent des recommandations pour améliorer l'accès aux méthodes de contraception efficaces, réversibles à longue durée d'action (LARC) et accélérer les progrès vers la réalisation de l'Objectif du Millénaire pour le développement relatif à l'accès universel aux services de santé reproductive.

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This brief and statement offers recommendations for action to increase access to highly effective, long-acting, reversible contraception (LARCs) and accelerate progress toward meeting the Millennium Development Goal of universal access to reproductive health services.

Prevalence And Correlates Of Hiv Infection In A Cohort Of Male Injection Drug Users In Delhi, Waimar Tun, Vartika Sharma, Mary Philip Sebastian, Ira Madan, Amita Yadav, Meredith Sheehy, Dean Lewis, Ibou Thior, Avina Sarna

HIV and AIDS

Baseline assessment of HIV infection among male injection drug users to understand the correlates of HIV infection and high risk injection practices and sexual behavior in Delhi, India.

Expanding Access To Comprehensive Reproductive Health And Hiv Information And Services For Married Adolescent Girls In Nyanza Province, Chi-Chi Undie, Harriet Birungi, Francis Obare, Ben Ochieng, Wilson Liambila, Erick Oweya, Ian Askew, Rob Burnet, Bridget Deacon, Aisha Mohamed

Reproductive Health

The objectives of this operations research study, conducted by the Population Council’s APHIA II Operations Research Project in Kenya, were to: 1) identify and design a set of interventions that promote the uptake of comprehensive reproductive health (RH)/family planning (FP) and HIV prevention services and information among married adolescent girls; and 2) expand access to comprehensive RH/FP and HIV prevention services and information among this population. The study demonstrated that the combined use of interactive media and community health worker visitation, health information provision, and referrals, is an effective means of reinforcing RH/FP and HIV messages, and of increasing access …

Hiv/Aids In The Muslim-Majority Countries: Formula For Low Prevalence, Kaoru Yamaguchi

Political Science Theses and Capstones

The Muslim-majority countries long had been considered to be free of HIV/AIDS epidemic because of their strict religious and moral codes. However, the HIV prevalence rates are increasing in some Islamic states, and even more or so rapidly in a several cases that it is no longer valid to assume the Islamic religion protects its followers from the risks of contracting HIV. Contrary to the popular belief concerning the prevention of the HIV/AIDs epidemic, data collected from well-recognized international organizations such as the WHO and Freedom House indicate that democratization, strong government leadership, and wider and equal human rights for …

Household Survey To Evaluate The Zambia-Led Prevention Initiative: Baseline Report, Zambia-Led Prevention Initiative

HIV and AIDS

With an estimated HIV prevalence of 14.3 percent among men and women age 15–49, Zambia is one of the sub-Saharan African countries most affected by the HIV and AIDS pandemic. The Zambia-led Prevention Initiative Program (ZPI) was developed by a consortium led by FHI360, with the Population Council as the evaluation partner. This study determined baseline levels of key indicators related to HIV, gender-based violence, and reproductive health. Additionally, the baseline findings provide critical insights into key areas for interventions in Zambia and highlights variability in the populations across provinces and between males and females that provide valuable guidance for …

Youth Perspectives On Entrepreneurship In Egypt: Barriers To Entrepreneurship As A Means To Combat Youth Unemployment, Maia Sieverding

Poverty, Gender, and Youth

This brief examines a range of factors that Egyptian youth perceive to be barriers to starting their own business, including high risk, limited access to finance, complexity of micro-credit schemes, lack of business and marketing training, and the need for connections in order to succeed. According to results from the Survey of Young People in Egypt, these factors combine to create the view among many youth that entrepreneurship is not a viable means of labor-market entry. Rather, youth see entrepreneurship as either a supplemental income-generating activity while also having a “regular” job, or as a later-life employment option once they …

Who Is Covered And Who Under-Reports: An Empirical Analysis Of Access To Social Insurance On The Egyptian Labor Market, Rania Roushdy, Irene Selwaness

Poverty, Gender, and Youth

This working paper investigates the dynamics and determinants of having access to social insurance coverage on the Egyptian labor market among wage and non-wage workers. The results show that men, older, married, better educated, and white collar highly skilled workers are more likely to have social insurance coverage. Access to social insurance is more likely to exist in the public sector and in large private enterprises. Furthermore, acquiring social insurance coverage in the private wage work sector does not often come at first entry; but it takes some time to gain such access. In contrast, experience is not important for …

Providers' And Key Opinion Leaders' Attitudes, Beliefs, And Practices Regarding Emergency Contraception In India: Final Survey Report, M.E. Khan, Deepthi S. Varma, Isha Bhatnagar, Anvita Dixit, Martha Brady

Reproductive Health

The Population Council undertook this study to assess the knowledge, attitudes, and practices regarding emergency contraception (ECPs) among providers in public and private facilities and pharmacies in India. This study’s objectives were: 1) to assess providers’ knowledge of ECP’s biological mechanism; 2) to understand providers’ knowledge and attitudes about ECP’s safety, effectiveness, and availability as an over-the-counter drug; and 3) to identify providers’ definitions of “repeated use” and profiling of women who are “repeated users” of ECP. The study recommends intervention programs and advocacy strategies to increase knowledge and access to ECP.

The Reproductive Health Of Young People In Egypt, Nahla G. Abdel-Tawab, Noha Roushdy, Maia Sieverding

Poverty, Gender, and Youth

This Population Council brief presents results from the Survey of Young People in Egypt (SYPE) on reproductive health (RH). The SYPE results underscore the need for: the assessment of state and civil society initiatives to transmit RH information; a national, comprehensive, age-appropriate reproductive health module to be integrated into the educational program; a national campaign on HIV/AIDS and other sexually transmitted infections that targets young people of reproductive age; the integration of female circumcision into a broader approach to youth reproductive health and bodily rights; specialized reproductive health services for married adolescent girls; and further research on sexuality and reproductive …

Challenges Facing The Egyptian Education System: Access, Quality, And Inequality [Arabic], Caroline Krafft

Poverty, Gender, and Youth

This brief analyzes and summarizes young people's responses to the 2009 Survey of Young People in Egypt (SYPE) to identify the greatest challenges facing the Egyptian educational system, focusing specifically on primary through secondary schooling. Results show that access to school has improved, but some youth, especially females in rural Upper Egypt, remain outside the school system and are increasingly marginalized. The Egyptian school system is delivering low-quality education that is irrelevant to the labor market and has problems with repetition, absenteeism, and drop out which reduce the efficiency of the education system. Unequal distribution of resources in the education …

A Life Course Perspective On Social Protection Among The Working Poor Of Egypt, Maia Sieverding

Poverty, Gender, and Youth

This paper employs a generational comparison to examine how increasing labor market informality has affected how poor households in Egypt gain access to and rely on social protection schemes. The results indicate that among the generation of Egyptians approaching retirement, the expansion of public employment and a policy allowing easy access to survivors’ benefits among female dependents served as important means of increasing social insurance coverage. However, many young households do not have even one member enrolled in the public pension system. Labor market instability and informality have also lowered the perceived value of social protection among this generation. The …

Social Protection In Egypt: A Policy Overview, Maia Sieverding, Irene Selwaness

Poverty, Gender, and Youth

The need to address the shortcomings of Egypt’s current social protection system as part of a broader process of developing a new social contract between the Egyptian government and its citizens has been noted for a number of years. With a new government recently put in place, Egypt is now at a potential turning point in terms of implementing unfinished reforms to the system or proposing alternative ones. The aim of this paper is therefore to provide an overview and assessment of current public social protection mechanisms and suggest directions for new policy measures. The social and health insurance systems …

Addis Birhan Wendoch ('New Light Boys'): Working With Boys And Young Men To Create Healthier Futures, Woldemariam Girma, Diane Rubino, Annabel Erulkar, Worku Ambelu, Ayenechew Kerie

Poverty, Gender, and Youth

The Population Council and the Ethiopian Ministry of Women, Children, and Youth Affairs designed Addis Birhan Wendoch to impart life skills and promote gender-equitable, nonviolent, and healthy behaviors among boys and young men aged 10 to 24. The program helps out-of school boys and young men in Ethiopia navigate toward a healthier future by providing them with trained, compassionate mentors and safe environments in which they can find the support needed to share ideas and take positive actions. Through frank and open discussions, boys have the opportunity to get the facts on a range of essential topics from financial literacy …