Public Health Commons^™

Diabetes Disparities In African Americans: A Cry For Help To Primary Care Providers, Pandora Goode

Journal of Health Disparities Research and Practice

Diabetes is a national public health problem. Low socioeconomic status influence access to quality care for African Americans with Diabetes who must rely on government assisted insurance or are uninsured. Inadequate access and poor quality care for African Americans contributes to increased morbidity and negative health outcomes. This manuscript will examine the existence of diabetes disparities in African Americans pertaining to the role of low socioeconomic status, access, and poor quality care, and suggest some practical strategies for reducing diabetes disparities in this population.

Perceptions Of Chronic Disease Among Older African Americans: A Qualitative Analysis, Karon Phillips, Charles Rogers, Adrienne Morgan

Journal of Health Disparities Research and Practice

Research has documented that African Americans suffer disproportionately from chronic diseases when compared to the general population. Yet, limited research examines older African Americans’ perceptions about having chronic diseases. Accordingly, the first aim of the study provided insight into this disparity with the intent of revealing how older African Americans feel about their overall health, and how much they understand about their individual chronic disease(s). The second aim was to gather information about strategies and coping mechanisms older African Americans use to manage their chronic diseases. The purpose of this aim was to determine if any of the strategies they …

Type Of Multimorbidity And Propensity To Seek Care Among Elderly Medicare Beneficiaries, Rahul Garg, Chan Shen, Nethra Sambamoorthi, Usha Sambamoorthi

Journal of Health Disparities Research and Practice

Greater propensity to seek care is critical for improving health of elderly individuals with multimorbidity. We used the Medicare Current Beneficiary Survey (2012) to assess propensity to seek care among community-dwelling elderly Medicare beneficiaries (> 65 yrs.; N=11,270) having (1) no physical or mental illness; (2) single physical or mental condition; (3) multimorbidity with physical conditions only; and (4) multimorbidity with both physical and mental conditions. As compared to multimorbidity with physical conditions, elderly with no multimorbidity were less likely (Adjusted Odds Ratio [95% CI]: 0.50 [0.36, 0.68]) and elderly with both physical and mental conditions were more likely …

Examining The Impact Of Food Environment Changes On County-Level Obesity Prevalence In The Appalachian Region, Jaime Booth, Kai Wei, Allison Little

Journal of Health Disparities Research and Practice

The aim of the present study was to understand the impact of changes in the food environment on county-level obesity prevalence in the Appalachian Region. We examined the food environment in 412 counties across the Appalachian Region using data from the Behavioral Risk Factor Surveillance System, the American Community Survey, and the Food Environment Atlas. We found there was an overall decrease of per capita food stores from 2007 to 2011 in this region. There was also a significant relationship between the decrease of grocery stores per capita from 2007 to 2011 and the increase of county-level obesity in 2012. …

Calidad De Vida: An Exploratory Investigation Of Latino Breast Cancer Survivors And Intimate Partners, Sejal Barden, Daniel Gutierrez, Jessica Gonzalez, Shainna Ali

Journal of Health Disparities Research and Practice

Advances in addressing psychosocial issues related to cancer treatment and prevention are not reaching all survivors equally. Latina breast cancer survivors and intimate partners are underrepresented in psychosocial interventions, and there is a scarcity of research on the influence of cancer on Latino couples’ quality of life. The purpose of this manuscript is to present findings from a trans-linguistic, dyadic qualitative research study aimed at exploring the influence of cancer on quality of life for Latina breast cancer survivors and their intimate partners. Results highlight several areas that are helpful and hindering to supporting survivorship.

Barriers To Addressing Hiv-Associated Neurocognitive Disorder (Hand): Community-Based Service Provider Perspectives, Renato M. Liboro, Francisco Ibanez-Carrasco, Sean B. Rourke, Andrew Easton, Claudia Medina, Daniel Pugh, Allan Rae, Lori E. Ross, Paul A. Shuper

Psychology Faculty Research

HIV-Associated Neurocognitive Disorder (HAND) is an emergent public health issue in developed countries. Consequently, people living with HIV who experience HAND will increasingly require support from community-based HIV service providers. The objective of our qualitative study was to identify barriers service providers face in addressing HAND among people living with HIV. Thirty-three providers from 22 AIDS service organizations across Ontario, Canada, were interviewed. Using thematic analysis, three types of barriers were identified: (a) personal/professional, (b) service access, and (c) systemic. This paper draws attention to HAND-related obstacles that service providers encounter in their work and presents options to overcome them.

Perceptions Of Sexual Health Interventions Among Urban, Midwestern Female African American Youth, Melissa Tibbits, Marisa Rosen, Shireen Rajaram

Journal of Health Disparities Research and Practice

Pregnancy and sexually transmitted diseases (STDs) among youth ages 15-24 persist as important public health issues in spite of significant investments in the development and implementation of evidence-based preventive interventions. Further, female African American youth are disproportionately affected by teen pregnancy and STDs. The purpose of this study was to better understand female African American youth’s perceptions of teen pregnancy and STDs, and the characteristics they desire in sexual and reproductive health interventions. Interviews with 19 African American females ages 13-24 were conducted. Results indicated that participants perceived teen pregnancy to be common, but STDs to be rare. Overall, participants …

Deconstructing The Model Minority Myth: Exploring Health Risk Behaviors Of American Asian And Pacific Islander Young Adults, Todd M. Sabato

Journal of Health Disparities Research and Practice

The model minority stereotype describes Asian and Pacific Islanders (API) as the epitome of assimilation into U.S. culture using hard work, intelligence, high educational attainment, and economic success to overcome the challenges of discrimination and recent immigration. Adopted model minority pressures assume a life of their own, with origins in childhood that are amplified during adolescence and young adulthood. In response to evidence of increased vulnerability to HIV and other sexually transmitted infection exposure, the present study compared prevalence estimates of health risk behaviors of API and cross-ethnic college students (N = 1,880). Self-reported alcohol use and abuse tendencies, …

An Ambivalent Embrace: Service Needs And Gaps For Asian Immigrants In New Destinations, John J. Chin

Journal of Health Disparities Research and Practice

Asian immigrants to the U.S. are settling in "new destinations," but there has been little research on their health care and social service needs. Our analysis of Census data to identify cities with the fastest Asian immigrant population growth (1990-2000) yielded 33 smaller cities in 13 states. The cities ranged in population from 7,677 to 86,660; were spread across 13 states in the Northeast, South, and Midwest regions of the US; and varied widely demographically. Pilot surveys conducted in 2009 indicated that, although many residents had positive attitudes towards immigrants, many were also concerned about job competition and dilution of …

Addressing Health Disparities And Cultural Competency In Reproductive Health Through Active Learning In The University Of Puerto Rico, School Of Medicine, Ines E. Garcia-Garcia, Kary M. Bouet Md, Lourdes Garcia-Fragoso, Juan Rivera-Gonzalez

Journal of Health Disparities Research and Practice

Introduction: Lesbian, gay, bisexual, transgender and queer (LGBTQ) individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights which impact reproductive health. Previous pregnancy, induced abortion, and hormonal contraceptive use are common among women who report sex with women, regardless of self-identification as lesbian. LGBTQ have higher risk of smoking, use illicit drugs or have alcohol related problems. Methods: A faculty development training addressed methods and skills for teaching cultural competence and eliminate health disparities. Faculty facilitated a small group active learning activity, including a vignette and a reflective self-evaluation, for medical students …

Effectiveness Of A Federal Healthy Start Program In Reducing Infant Mortality, Ronee E. Wilson, Hamisu M. Salihu, Jason L. Salemi, Priyanshi Patel, Rana Daas, Estrellita "Lo" Berry

Journal of Health Disparities Research and Practice

Objective: Infant mortality is an important indicator of the health status of a community. In this analysis, we aimed to evaluate temporal changes in infant mortality rates (IMR) in the Central Hillsborough Healthy Start (CHHS) program service area in Tampa, Florida compared to rates in the rest of Hillsborough County and the state.

Method: We conducted a five-year (2010-2014) trends analysis using birth and infant death data extracted from the Florida Community Health Assessment Resource Tool Set (CHARTS). The number of infant deaths and live births were used to calculate and compare IMRs in the CHHS catchment area to those …

Using Photovoice As A Tool For Community Engagement To Assess The Environment And Explore Environmental Health Disparities, Heather M. Brandt, Venice E. Haynes, Lashanta J. Rice, Dayna Campbell, Edith Williams, *Sacoby Wilson, Saundra H. Glover

Journal of Health Disparities Research and Practice

Photovoice was used as a participatory research method to document perceived local environmental hazards, pollution sources, and potential impact on health among community members to address environmental health disparities. A convenience sample of 16 adults in Orangeburg, South Carolina participated in Photovoice. Photos depicted positive and negative implications of the environment across seven themes: recreation and leisure; food access; hazards and pollution; health, human, and social services; economic issues; beautification; and accommodation and accessibility. Positive and negative photos demonstrated a high level of interest among community members in considering how the environment influences health and health disparities.

Race And “Hotspots” Of Preventable Hospitalizations, Caryn N. Bell, Janice V. Bowie, Roland J. Thorpe Jr.

Journal of Health Disparities Research and Practice

Abstract

Preventable hospitalizations (PHs) are those for ambulatory care-sensitive conditions that indicate insufficiencies in local primary healthcare. PH rates tend to be higher among African Americans, in urban centers, rural areas and areas with more African American residents. The objective of this study is to determine geographic clusters of high PH rates (“spatial clusters”) by race. Data from Maryland hospitals were utilized to determine the rates of PHs in zip code tabulation areas (ZCTAs) by race in 2010. Geographic clusters of ZCTAs with higher than expected PH rates were identified using Scan Statistic and Anselin’s Local Moran’s I. 10 PH …

Disparities In Breast Cancer Stage At Diagnosis: Importance Of Race, Poverty, And Age, Faustine Williams, Emmanuel Thompson

Journal of Health Disparities Research and Practice

This study investigated the association of race, age, and census tract area poverty level on breast cancer stage at diagnosis. The study was limited to women residing in Missouri, aged 18 years and older, diagnosed with breast cancer, and whose cases were reported to the Cancer Registry between 2003 and 2008. The risk, relative risk, and increased risk of late-stage at diagnosis by race, age, and census tract area poverty level were computed. We found that the odds of late-stage breast cancer among African-American women were higher when compared with their white counterpart (OR 1.433; 95% CI, 1.316, 1.560). In …

Persistence With Mammography Screening And Stage At Breast Cancer Diagnosis Among Elderly Appalachia-West Virginia Women, Ami Vyas, Suresh Madhavan, Usha Sambamoorthi

Journal of Health Disparities Research and Practice

The objective of this study is to evaluate the association between persistence with mammography screening and stage at breast cancer diagnosis in elderly Appalachia-West Virginia women diagnosed with first incident breast cancer. The study utilized West Virginia Cancer Registry-Medicare linked database to identify women age 70 and above diagnosed with first incident breast cancer in 2007. Persistence to mammography screening was defined as having had at least three mammography screenings before breast cancer diagnosis. A multiple logistic regression was conducted to assess the association between persistence with mammography screening and stage at breast cancer diagnosis in these women. Of the …

Examining Differences In Hpv Awareness And Knowledge And Hpv Vaccine Awareness And Acceptability Between U.S. Hispanic And Island Puerto Rican Women, Daisy Y. Morales-Campos Phd, Robin Vanderpool

Journal of Health Disparities Research and Practice

Background: In 2015, only 42% of Puerto Rican (PR) girls aged 13-17 and 44% of U.S. Hispanic girls aged 13-17 were vaccinated with all three Human Papillomavirus (HPV) vaccine doses. These percentages were far lower than the Healthy People 2020 goal of 80% of girls aged 13-15 completing the vaccine series. The purpose of this study was to examine potential differences in HPV awareness and knowledge and HPV vaccine awareness and acceptability between a population-based sample of U.S. Hispanic and island Puerto Rican women.

Methods: We restricted our analyses to female respondents from the Health Information National Trends Survey (HINTS) …

Demographics And Cardiovascular Risk Factors In A Bi-Ethnic Church-Based Intervention: Baseline Results Of The Stroke Health And Risk Education (Share) Project, Lesli Skolarus

Journal of Health Disparities Research and Practice

Objectives: Hispanics have a higher incidence of cardiovascular disease (CVD) than non-Hispanic whites (NHWs). Despite proven benefits in other minority populations, few interventions have been conducted in partnership with Churches with substantial Hispanic membership. In this context, we describe the baseline demographics and CVD risk factors among participants of a bi-ethnic Catholic Church-based CVD prevention trial.

Methods: The Stroke Health and Risk Education (SHARE) project was a cluster-randomized, multi-component, faith-based, behavioral intervention that enrolled Mexican Americans (MAs) and NHWs from Catholic Churches in Corpus Christi, Texas. Strategies to ensure MA recruitment included bilingual staff and materials and partnership with Catholic …

The Price Of Progress: Funding And Financing Alzheimer's Disease Drug Development, Jeffrey Cummings, Carl Reiber, Parvesh Kumar

School of Medicine Faculty Research

Introduction Advancing research and treatment for Alzheimer's disease (AD) and the search for effective treatments depend on a complex financial ecosystem involving federal, state, industry, advocacy, venture capital, and philanthropy funding approaches. Methods We conducted an expert review of the literature pertaining to funding and financing of translational research and drug development for AD. Results The federal government is the largest public funder of research in AD. The National Institute on Aging, National Institute of Mental Health, National Institute of General Medical Sciences, and National Center for Advancing Translational Science all fund aspects of research in AD drug development. Non-National …

Statistical Advances In Clinical Trials And Clinical Research, Guogen Shan, Sarah Banks, Justin B. Miller, Aaron Ritter, Charles Bernick, Joseph Lombardo, Jeffrey L. Cummings

School of Public Health Faculty Research

Introduction New treatments for neurodegenerative disease are urgently needed, and clinical trial methods are an essential component of new drug development. Although a parallel-group study design for neurological disorder clinical trials is commonly used to test the effectiveness of a new treatment as compared to placebo, it does not efficiently use information from the on-going study to increase the success rate of a trial or to stop a trial earlier when the new treatment is indeed ineffective. Methods We review some recent advances in designs for clinical trials, including futility designs and adaptive designs. Results Futility designs and noninferiority designs …

Biomedical Informatics Applications For Precision Management Of Neurodegenerative Diseases, Justin B. Miller, Guogen Shan, Joseph Lombardo, Gustavo Jimenez-Maggoria

School of Public Health Faculty Research

Modern medicine is in the midst of a revolution driven by “big data,” rapidly advancing computing power, and broader integration of technology into healthcare. Highly detailed and individualized profiles of both health and disease states are now possible, including biomarkers, genomic profiles, cognitive and behavioral phenotypes, high-frequency assessments, and medical imaging. Although these data are incredibly complex, they can potentially be used to understand multi-determinant causal relationships, elucidate modifiable factors, and ultimately customize treatments based on individual parameters. Especially for neurodegenerative diseases, where an effective therapeutic agent has yet to be discovered, there remains a critical need for an interdisciplinary …

Vietnamese American Women’S Beliefs And Perceptions On Cervical Cancer, Cervical Cancer Screening, And Cancer Prevention Vaccines: A Community-Based Participatory Study, Connie Kim Yen Nguyen-Truong, Kim Quy Vo Nguyen, Thai Hien Nguyen, Tuong Vy Le, Anthony My Truong, Keara Rodela, Rachael Allan

Asian/Pacific Island Nursing Journal

Cervical cancer remains commonly diagnosed in Vietnamese American women. Despite efforts to increase cervical cancer screening among Vietnamese American women, participation rates are persistently lower than the national goal. The objective of this study is to explore beliefs of Vietnamese American women about cervical cancer, cervical cancer screening, and cancer prevention vaccines. A qualitative descriptive investigation captured group perceptions about meaning and beliefs of cervical cancer, screening, and cancer prevention vaccines, and participants’ stories using a community-based participatory research approach.

Forty Vietnamese American women were recruited from the Portland, Oregon metropolitan area into four focus groups. Using a process of …

The Role Of Pre-Existing Type 2 Diabetes Mellitus In Colorectal Cancer Stage And Survival In Elderly Americans: A Seer-Medicare Population-Based Study 2002-~2011, Sanae El Ibrahimi

UNLV Theses, Dissertations, Professional Papers, and Capstones

Diabetes is a common comorbid condition among colorectal cancer (CRC) patients, yet its effects in CRC outcomes, particularly stage at diagnosis, risk of death and variations by diabetes severity (complications vs no complications) and Hispanic ethnicity have not been adequately studied. The purpose of this study was to investigate the association between pre-existing T2DM and advanced stage at diagnosis in elderly patients with CRC; to examine whether diabetes is an independent predictor of poor survival from all-cause and CRC-specific mortality; to assess whether variations exist by diabetes severity and to analyze the outcomes for the Hispanic group.

The Surveillance Epidemiology …

The Impact Of Economic Recession On The Health Of Adult Nevadans, Ariana Goertz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Recessions are generally considered to cause negative consequences, but recent studies have provided evidence that some health outcomes improve as the economy deteriorates. The relationship between economic downfalls and health is not straightforward; it is important to look at how health has been impacted in one of the areas hit hardest by the recession. Las Vegas, Nevada was previously considered recession-proof, seemingly unaffected by previous economic downturns exhibited by the rest of the country. However, during the Great Recession of 2007-2009, Las Vegas led the country in highest rates of unemployment and foreclosures. This was quite a collapse for a …

Acculturation And Causes Of Death Among Filipinos In The Us: Focus On Cancer, Abegail Terso Reyes

UNLV Theses, Dissertations, Professional Papers, and Capstones

Filipinos in the US are 3.4 million, yet the main causes of death among this primarily immigrant population have not been well characterized nor compared with the mortality experience of their counterparts in the Philippines. Age-adjusted mortality rates were computed for the main causes of death for three populations: Filipinos living in the Philippines (FPHs), Filipinos living in California (FCAs), and non-Hispanic whites in California (WCAs). Regression-derived mortality rate ratios stratified by sex were used to compare the populations, using WCA as the referent population. Included causes of death were ischemic heart disease, stroke, cancer and chronic lower respiratory disease, …

Hospice Utilization Of Medicare Beneficiaries In Hawai‘I Compared To Other States, Deborah Taira, Merle Kataoka-Yahiro, Angela Sy

Asian/Pacific Island Nursing Journal

The objective is to examine hospice utilization among Medicare beneficiaries in Hawai‘i compared to other states. Data were from the 2014 Medicare Hospice Utilization and Payment Public Use File, which included information on 4,025 hospice providers, more than 1.3 million hospice beneficiaries, and over $15 billion in Medicare payments. Multivariable linear regression models were estimated to compare hospice utilization in Hawai‘i to that of other states. Control variables included age, gender, and type of Medicare coverage. Medicare beneficiaries using hospice in Hawai‘i differed significantly from beneficiaries in other states in several ways. Hawai‘i beneficiaries were more likely to be Asian …

Insights Into How Hias Are Characterized In The Press: Findings From A Media Analysis Of Widely Circulated United States Newspapers, Maxim Gakh Jd, Mph, Courtney Coughenour Phd, Jennifer Pharr Phd, Aaliyah Goodie, Samantha To

School of Public Health Faculty Research

Background: Health impact assessments (HIAs) are burgeoning tools in the policy process, where the media plays a critical role by focusing attention on issues, informing consumers, and influencing positions. Examining how media portrays HIAs is critical to understanding HIAs in the policy context. Methods: This study considered how widely circulated, U.S. newspapers represent HIAs. After searching newspaper databases, we used a qualitative document analysis method consisting of open and axial coding to examine specific phrases of HIA depictions. Results: In coding over 1,000 unique phrases from the 62 documents generated in our search, we found an uptick in HIA-related publications …

A Roundtable On Cross-Sector Collaboration And Resource Alignment For Health Equity: Meeting Summary, Onyemaechi Nweke

Journal of Health Disparities Research and Practice

Cross-sector collaboration is a highly recommended strategy to eliminate health inequities nationally and globally. In the federal sector, it is evolving into an important approach for solving complex social problems, as evidenced by its steady proliferation the past few decades. Despite the increased adoption of cross-sector collaboration, it is still not a default strategy or preeminent option for managing complex social problems. In September 2015, the Federal Interagency Health Equity Team (FIHET) hosted a Roundtable event to discuss opportunities and strategies to foster widespread adoption of cross-sector collaboration and resource alignment. The Roundtable featured several expert panelists and participants from …

An Assessment Of Funding And Other Capacity Needs For Health Equity Programming Within State-Level Chronic Disease Programs, Tiffany Pertillar, Ann Pobutsky, Phd, Gail Brandt, Edd, Mph, Marisa New, Otr, Mph, Jamielou Delavan, Ba, Robyn Taylor, Mba, Amishi Shah, Mpa, Ma, Folasaya Adunola, Dds, Mph, Onyemaechi Nweke

Journal of Health Disparities Research and Practice

Background: Chronic diseases are an important contributor to morbidity and mortality among racial/ethnic minority, low-income, and other under-resourced populations. Given that state health departments (and their chronic disease programs) play a significant role in providing population and preventive health services, their capacity to promote health equity is an important consideration in national efforts to address chronic diseases. The purpose of this study was to examine capacity needs of state chronic disease programs with respect to promoting health equity.

Methods: In 2015, the National Association of Chronic Disease Directors (NACDD) conducted a survey of its members that work within a …

Achieving Health Equity For Indian Country, Jamie Ishcomer

Journal of Health Disparities Research and Practice

The essence of health equity is giving resources where they are needed most. American Indians and Alaska Natives (AI/AN) continue to have the worst health outcomes, live in some of the most desperate of conditions, and lack access to even basic amenities that many other Americans could not survive without. Although Tribes have been plagued with social, economic and political injustice for centuries, there is an opportunity to put a stop to the systematic oppression and build up the first peoples of this country. A partnership between the National Indian Health Board (NIHB) and the National Partnership for Action to …

Rhode Island’S Health Equity Zones: Addressing Local Problems With Local Solutions, Nicole Alexander-Scott, Md, Mph, Ana P. Novais, Ma, Carol Hall-Walker, Mpa, Angela B. Ankoma, Mph, Msw, John P. Fulton, Phd

Journal of Health Disparities Research and Practice

The Rhode Island Department of Health (RIDOH) describes the strategies and infrastructure it has developed to fund its placed-based initiatives to address the social determinants of health to eliminate health disparities. Using a data driven and community-led approach, RIDOH funded 10 local collaboratives, each with its own, geographically-defined “Health Equity Zone,” or “HEZ,” and, to support the collaboratives, created a new “Health Equity Institute,” a “HEZ Team” of 9 seasoned project managers, and direct lines of communications between these assets and the Office of the Director of Health.