Public Health Commons^™

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 …

The Context Of Sexual Risk Among African-American Female College Students, Lucy Annang, Shacara D. Johnson, Malaika A. Pepper-Washington

Journal of Health Disparities Research and Practice

Objective: To assess the sexually transmitted infection (STI) awareness, sexual risk behaviors, and related contextual factors of African-American female college students.

Participants: Eighty-nine African-American first year female students attending a majority public four-year college in the southern U.S. participated in the study in Spring, 2006.

Methods: Participants completed an anonymous self-administered paper-and-pencil survey and received a $15 cash incentive.

Results: Participants were highly knowledgeable and aware about STIs and their consequences. While this awareness translated into low levels of risk for many, still others engaged in behaviors and maintained beliefs that could potentially put them at high risk for contracting …

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 …

Recruitment Of African Americans For Obsessive Compulsive Disorder Treatment Research, Georgia Michalopoulou, Pamela Falzarano, David Rosenberg

Journal of Health Disparities Research and Practice

A systematic review of recruitment approaches was conducted as a step towards creating a culturally sensitive approach to enhance participation of African Americans into our Obsessive Compulsive Disorder (OCD) treatment research. From this review, a recruitment plan providing a collaborative partnership between the African American community and the clinical investigators was adopted. We sought to increase participation in OCD research by developing culturally sensitive educational materials, implementing strategies such as recruiter ethnic match, encouraging individuals to participate by a pastor, and providing education in the community that attempted to decrease stigmatization of mental illness and target cultural suspicion of institutional …

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 …

Association Of Vitamin D Deficiency With Hypertension In Uninsured Women, Sreenivasa R. Chandana, Lakshmi P. Kocharla, Susan S. Harris, Radhika R. Kakarala

Journal of Health Disparities Research and Practice

Vitamin D deficiency is an epidemic in the United States. Uninsured women are at high risk due to a lower intake of vitamin D and limited sun exposure. We examined the association between vitamin D deficiency and hypertension in 96 uninsured women at a County Free Medical Clinic in urban Michigan. Questionnaires were used to obtain information about demographics, medical history including hypertension, and dietary habits. Measurements including blood pressure and serum 25(OH)D level were also collected. Prevalence of hypertension was higher in subjects with 25(OH)D less than 50nmol/l compared with others (85% vs. 27.3%, p = 0.014). For every …

Race/Ethnicity As A Risk Factor Of Mother To Child Transmission Among Hiv Infected Mothers, Wei Yang, Fares Qeadan, Mona L. Brown, Michelle Chino, Scott Hall, Mary Guinan

Journal of Health Disparities Research and Practice

Objectives: African American women, living with HIV, exhibit a higher percentage of giving birth as compared to other race/ethnicity groups. The aim of this study is to understand the apparent black and non-black differences (health disparities) among the HIV Infected Mothers group and examine whether race/ethnicity can explain the high variation in different prenatal and HIV mother-to-child-transmission (MTCT) risk factors.

Methods: Data-Linkage was conducted on all women HIV+ cases, who delivered a child during the time period and reported to the Nevada state HIV with the live birth registries. Demographic and social data, separated into black and Non-black groups, were …

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), …

Multiple Peer Group Self-Identification And Adolescent Tobacco Use, C. Anderson Johnson, Juliana L. Fuqua, Peggy E. Gallaher, Jennifer B. Unger, Dennis R. Trinidad, Steve Sussman, Enrique Ortega

CGU Faculty Publications and Research

Associations between peer group self-identification and smoking were examined among 2,698 ethnically diverse middle school students in Los Angeles who self-identified with groups such as Rockers, Skaters, and Gamers. The sample was 47.1% male, 54.7% Latino, 25.4% Asian, 10.8% White, 9.1% Other ethnicity, and 59.3% children of immigrant parents. Multiple group self identification was common: 84% identified with two or more groups and 65% identified with three or more groups. Logistic regression analyses indicated that as students endorsed more high risk groups, the greater their risk of tobacco use. A classification tree analysis identified risk groups based on interactions among …

Securing South Africa's Future Grandmothers Against Poverty And Aids As A Model For Social Development Change, Savannah Lynn Eck

Graduate Program in International Studies Theses & Dissertations

Focusing on the role of elder women in South Africa as a lens to understand the central connections among HIV/ AIDS, poverty and Human Security provides a distinct approach to analyze women's contributions to community development and social change. Drawing from the theories of Gender and Development and Human Security, this research aims to highlight HIV/ AIDS as a social and political security issue, while underscoring the vitality of the inclusion of women in the processes of peace building, reconciliation, education and social development. Furthermore, the influential role of elder women in South Africa will serve as a model in …

Perceptions Of Barriers That Inhibit African American Women And Adolescent Girls From Participation In Physical Activity, Sonya Daniels Walker

UNLV Theses, Dissertations, Professional Papers, and Capstones

This study examined the barriers to leisure time physical activity for African American women and their adolescent daughters. Six mother-daughter dyads were interviewed who have access to physical activity opportunity. Three of the dyads participated in a follow-up focus group. A qualitative research design that utilized a grounded theory approach identified two themes for the women and two themes for the girls. Themes for the women include influence of culture and low physical activity IQ. Sub-themes of influence of culture are (a) hair and (b) body image. Sub-themes of low physical activity IQ are (a) mommy guilt, (b) perception of …

Research Brief: Technology And Health Education: An Exploratory Study Of Older Chinese Immigrants, Jenny H. Tsai, Vicky Taylor, Shin-Ping Tu

Journal of Health Disparities Research and Practice

Technology advances, especially in the Internet, provide new tools to deliver health education to limited English proficient immigrants. This paper presents the findings of a qualitative descriptive study of older limited English proficient Chinese immigrants’ perspectives regarding computer-based health education. The sample consisted of 33 foreign-born Chinese recruited in Seattle, Washington. Data were generated through six focus groups and an 18-item demographic questionnaire. The analyses revealed that the majority was not skillful in computer use and Internet browsing, and the Internet was not a common health information source. Nevertheless, participants were supportive of having computer-based health information designed for Chinese …

Preliminary Evaluation Of The Incharge Program Among Older African Americans In Rural Alabama, Cynthia Owsley, Gerald Mcgwin Jr., June Weston, Beth T. Stalvey, Karen Searcey, Christopher A. Girkin

Journal of Health Disparities Research and Practice

Objective: Blindness rates among older African Americans are two times higher than for older whites. Our purpose was to understand attitudes about eye care and perceived barriers to care among older African Americans living in rural Alabama and to determine whether an educational program reduced perceived barriers to care. InCHARGE, an eye health education program for older African Americans, promotes eye disease prevention by conveying the personal benefits of annual dilated comprehensive eye care and by teaching strategies to minimize barriers to eye care.

Design and Participants: InCHARGE was presented in five senior centers to 111 individuals. Using a questionnaire …

Obesity Prevalence, Weight-Related Beliefs And Behaviors Among Low-Income Ethnically Diverse National Job Corps Students, Jamie S. Bodenlos, Milagros C. Rosal, Diane Blake, Celeste Lemay, Diane Elfenbein

Journal of Health Disparities Research and Practice

The obesity rates of Job Corps students, a predominantly ethnic minority and low income group of youth, are unknown. The purpose of this project was to examine obesity rates among these youth as well as their weight-related perceptions and behavior. First, medical charts (N=641) of all Job Corps students (ages 16-25) who were enrolled in the program in the past year were examined for height and weight. In the second phase of the study, 344 Job Corp students were recruited and information on weight perceptions, knowledge of obesity consequences, and weight loss behavior were examined. Almost half of the participants …

The Significance Of A K-12 Diabetes-Based Science Education Program For Tribal Populations: Evaluating Cognitive Learning, Cultural Context, And Attitudinal Components, Carolee D. Francis, Doug Coulson, Bonnie Kalberer, Lemyra Debruyn, William Freeman, Janet Belcourt

Journal of Health Disparities Research and Practice

Preventing and reducing the onset of type 2 diabetes among American Indian/Alaska Native youth requires ground-breaking strategies to affect knowledge, attitudes, and cognitive decision-making skills. In an unparalleled endeavor to address the growing epidemic of type 2 diabetes in tribal communities, a K-12 Diabetes Education in Tribal Schools (DETS) curriculum was created by eight tribal colleges and three federal agencies. This article highlights the results of the implementation phase, the final evaluation step in acquiring and measuring student knowledge and attitude gains through pre-post standardized assessment.

Barriers, Control And Identity In Health Information Seeking Among African American Women, Jennifer R. Warren, Lynette Kvasny, Michael L. Hecht, Diana Burgess, Jasjit S. Ahluwalia, Kolawole S. Okuyemi

Journal of Health Disparities Research and Practice

Qualitative research methods were used to examine the role of racial, cultural, and socio-economic group (i.e., communal) identities on perceptions of barriers and control related to traditional and internet resources for seeking health information. Eighteen lower income, African American women participated in training workshops on using the internet for health, followed by two focus groups. Transcripts were analyzed using standardized coding methods. Results demonstrated that participants perceived the internet as a tool for seeking health information, which they believed would empower them within formal healthcare settings. Participants invoked racial, cultural, and socio-economic identities when discussing barriers to seeking health information …

Health Care Disparities For Persons With Limited English Proficiency: Relationships From The 2006 Medical Expenditure Panel Survey (Meps), Diane L. Smith

Journal of Health Disparities Research and Practice

Inadequate communication between patients with limited English proficiency (LEP) and providers can be associated with lower access to health care. The purpose of this research was to determine if there is a significant difference among those persons whose primary language is English and those with LEP in ability to access care and preventative screenings and perception of interaction with their physician. Chi square analysis was performed to determine if there was a significant relationship between primary language spoken and access to health care and patient-provider interaction. Data were obtained from the 2006 Medical Expenditure Panel Study. Results show that there …

Colorectal Cancer Brochure Development For African Americans, Kim L. Freeman, Lina Jandorf, Hayley Thompson, Katherine N. Duhamel

Journal of Health Disparities Research and Practice

Introduction: African Americans are more likely to die from colorectal cancer (CRC) than any other racial/ethnic group in the United States. Unfortunately, African Americans are also less likely to undergo screening for CRC than their White counterparts. Focus groups methodology was used to refine educational brochures designed to increase CRC screening among African Americans.

Methods: Two series of focus groups were completed, with a total of seven groups and 39 participants. Six different brochures (stage-matched and culturally sensitive) designed to promote CRC screening among African Americans were evaluated.

Results: All participants thought that the brochures motivated them …

Modeling Health Inequities Research In Context And The Minority Researcher’S Role, Ari Mwachofi, Ngure Wamwachofi

Journal of Health Disparities Research and Practice

Current health inequities research templates are flawed and self-defeating because they do not include historical inequalities as the central context that points to the root causes of health inequities. The context includes structural malformations which are products of the history of colonization and slavery that created racial separation and hierarchies which established Whites as the dominant group and non-Whites (minorities) as the subordinate group. Consequently it is difficult for mainstream researchers to capture the minorities’ core knowledge necessary for the creation of relevant and effective interventions for fundamental and sustainable improvement of their health. This paper proposes a health inequities …

Family Home Visitors: Increasing Minority Women’S Access To Health Services, Mechthild Meyer, Alma R. Estable, Lynne Maclean, Wendy E. Peterson

Journal of Health Disparities Research and Practice

The article describes how service access barriers (language, trust) were addressed at different levels (organization, service provider, community) by involving Family Home Visitors to support Nurse Practitioners in providing pre- and postnatal services to linguis­tic minority women in Ontario. The investigators undertook a secondary analysis of 18 semi-structured interviews with health unit informants, Nurse Practitioners, program us­ers, and community leaders, including Family Home Visitors. Health units facilitated col­laboration between two programs aimed at serving mothers with young children, result­ing in both programs using Family Home Visitors. They enhanced minority women’s trust in Nurse Practitioner services by providing interpretation, outreach and …

Hiv/Sti Risk Factors Among African-American Students Attending Predominantly White Universities, Marya L. Shegog, Lisa Lindley, Melva Thompson-Robinson, David Simmons, Donna Richter

Journal of Health Disparities Research and Practice

Introduction: The majority of African American college students in the U.S. attend predominantly white institutions (PWIs). However, there is minimal research examining this population’s HIV/STI risk behaviors. The purpose of this investigation was to assess HIV/STI behavioral risk factors among African American college students (aged 18 – 24years) attending PWIs. (n = 2,568)

Methods: Backwards step-wise logistic regression analyses were conducted to determine factors associated with a positive HIV/STI diagnosis (past year) among sexually active African American college students who participated in the Spring, 2006 National College Health Assessment.

Findings: Nine factors were significantly associated with an HIV/STI diagnosis among …

Using Concepts From Freire’S Pedagogy Of The Oppressed To Promote Colorectal Cancer Screening In An Urban Minority Population, Corey H. Brouse, Charles E. Basch, Randi L. Wolf

Journal of Health Disparities Research and Practice

This paper briefly introduces Freire’s philosophy of education, as well as examples of how this philosophy can be used in health education. Concepts from Freire’s work are highlighted along with how they are applicable to educating adults about colorectal cancer (CRC) screening, a health behavior that is less prevalent among poor and minority populations. Concepts highlighted in Freire’s writing can be directly applied to reducing disparities in health.

Prioritizing Interventions And Research To Address The Cancer Disparities Of Arizona’S American Indian Population, Norman J. Petersen, Sujata Joshi, Tim Flood, Kathryn Coe

Journal of Health Disparities Research and Practice

The aim of the Southwest American Indian Collaborative Network (SAICN) is to reduce cancer disparities by closing the gap between community needs and the promise of cancer prevention and cure through participatory education, training and research programs. In an effort to provide evidence-based recommendations and promote the use of relevant data in tribal communities, the SAICN Data and Evaluation Core developed two comparison matrices that present scientifically sound practices for use by community health decision makers in prioritizing activities likely to reduce the irrespective community’s burden of cancer. In their current configurations, Matrix A considers those cancers for which prevention …

A Communication Strategy To Address Health Inequities In Municipal Settings, Christine Unson, Ben Tyson, Angela Funaiole, Comfort Agaba

Journal of Health Disparities Research and Practice

This study assessed knowledge of health inequities, importance and benefits/barriers of addressing inequities, and ways of communicating information about inequities among municipal officials. Five focus groups (N=47) were conducted with officials from economic development, land use and housing, public safety, education, and environment departments. Discussions were recorded, transcribed and analyzed for key themes. Findings show that participants had an uneven understanding of the symptoms and causes of health inequities and identified limitations to participating in health equity initiatives and collaborating with local health departments. Recommendations are that a communication strategy to reduce health inequities should aim to increase awareness of …

Pap Test Follow-Up Pattern Among American Indian Women In Arizona, Merrill Eisenberg, Kathryn Coe, Charlton Wilson, Kathleen Evans, Elizabeth Brewer

Journal of Health Disparities Research and Practice

Objective: To quantify the loss to follow-up rate after abnormal Pap test results at the Phoenix Indian Medical Center, an Indian Health Service regional facility, and identify barriers to follow-up from the patients’ point of view.

Materials and Methods: Patient records were used to identify women who had abnormal Pap tests in 2002 and to document the status of their follow-up care. Women who had no clinical record of follow-up were contacted by telephone to arrange a follow-up appointment and to request participation in a structured qualitative interview to identify barriers to follow-up at the individual, family, community, and health …

Application Of The Pen-3 Model In A Diabetes Prevention Intervention, Joan E. Cowdery, Shandowyn Parker, Amy Thompson

Journal of Health Disparities Research and Practice

More effective strategies for addressing health issues in African American communities are needed. As part of a three year NIH funded Project Export grant, this community campus partnership used community-based participatory research principles and thePEN-3 Cultural Framework to develop a culturally specific, locally relevant intervention to prevent Diabetes among African-Americans. A comprehensive needs assessment which included 13 elicitation interviews, 3 focus groups, and 217 surveys resulted in identifying major themes including overall lack of knowledge regarding Diabetes,issues of denial and stigma, sense of inevitability, influence of family on perceptionsand behaviors, communication issues with health care providers, and lack of culturally …

Racial Differences In The Use Of Most Commonly Performed Medical Procedures In The United States, Syed S. Haque, Mohammad A. Faysel, Hafiz M. R. Khan

Journal of Health Disparities Research and Practice

Objective: This study investigates racial disparities in the use of commonly performed medical procedures in U.S. hospitals. Methods: To examine racial disparities, we calculated age-adjusted rate of procedures used by all Whites, Blacks, Hispanics, Asians or Pacific Islanders and Native Americans and calculated corresponding Relative Risks(RRs) of White vs. all other races based on procedure utilizations and insurance types using 20% random sample of Nationwide Inpatient Sample (NIS) data between 2001 and2003. Results: Whites were significantly more likely to receive 3 of the study procedures than Blacks, 3 of the procedures than Hispanics, 2 of the procedures than Asians or …

Racial Disparities In Cancer Screening Among Women With Chronic Joint Pain, Edith M. Williams, Laurene Tumiel-Berhalter, Christopher Purdy, Adrianne Ransom, Judith Anderson

Journal of Health Disparities Research and Practice

Chronic pain related disorders and breast and cervical cancer are more prevalent among African-American women compared with non-Hispanic White women. However, few studies address how racial differences in the context of comorbidity may compound these disparities. This study used secondary analysis of the National Health Interview Survey (NHIS) to assess racial differences in breast and cervical cancer screening and patient education among adult women with chronic joint pain conditions. Statistical analyses included chi-square and independent samples t-tests. African-American women compared with non-Hispanic White women were less likely to receive a pap smear or mammogram within the last two years and …

Comparing Risk Factors Of Hiv Among Hijra Sex Workers In Larkana And Other Cities Of Pakistan: An Analytical Cross Sectional Study, Arshad Altaf, Aysha Zahidie, Ajmal Agha

Community Health Sciences

Background

In 2005, Pakistan was first labeled as a country with concentrated epidemic of Human Immunodeficiency Virus (HIV). This was revealed through second generation surveillance conducted by HIV/AIDS Surveillance Project (HASP). While injection drug users (IDUs) were driving the epidemic, subsequent surveys showed that Hijra (transgender) sex workers (HSWs) were emerging as the second most vulnerable group with an average national prevalence of 6.4%. An exceptionally high prevalence (27.6%) was found in Larkana, which is a small town on the right bank of river Indus near the ruins of Mohenjo-Daro in the province of Sindh. This paper presents the risk …

Parallel Lives: Similarities Between The Lived Experiences Of Persons With Cancer And Hiv, Danielle Boyd '12

Honor Scholar Theses

Thave chosen to focus this analysis on the shared experiences of patients with the socially stigmatized and incurable illnesses of cancer and HIV. These people cannot have their patient experience ended by a nice little pill or vaccine. They must blindly put their hopes in painful treatment regimens that can offer only management of their condition. They often undergo the tremendously helpless experience of feeling one’s body decline. As their treatment or the illness itself progresses they must enlist the help of family and friends to help them with daily tasks. Obviously the shared experiences of these two patient populations …