Public Health Commons^™

Factors Influencing Healthy Eating Habits Among Low-Income African Americans In Tennessee, Kushal Patel, Jonathon Smith, Jemal Gishe 9637046, Mohamed Kanu, Rosemary Theriot, Jianguo Liu, Yuan Zhou, Margaret Hargreaves

Journal of Health Disparities Research and Practice

Introduction: Poor nutrition and diet are significant contributors to the development of chronic illnesses such as cancer and diabetes, particularly among individuals of lower socioeconomic status (SES).This study examined demographic and lifestyle factors that influenced decisions to engage in healthy eating behaviors among low-income African Americans in three urban Tennessee cities.

Methods: As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics and eating behaviors among low-income African Americans. The total sample size was 1116. The primary outcome of interest was the healthy eating habits score which was calculated …

Comparison Of Compliance With Cervical Cancer Screening Among Women Aged 18 And Above In Arkansas And The United States, Sarah N. O'Connor, Jun Tao, L. Joseph Su

Journal of Health Disparities Research and Practice

Introduction: Cervical cancer preys on women without access to preventative screening. Any woman who has developed an invasive case of cervical cancer should be regarded as a failure of screening. Disparities in access to screening, triage, and treatment fuel an uneven distribution in the burden of cervical cancer within the United States; weighing unusually heavy on the Southern States like Arkansas. The purpose of this study was to evaluate demographic and behavioral risk factors for cervical cancer and identify potential barriers which may influence the likelihood of complying with current Pap test recommendations on a state level, in Arkansas, and …

Who Speaks For Me?: Addressing Variability In Informed Consent Practices For Minimal Risk Research Involving Foster Youth, Mary V. Greiner, Sarah J. Beal, Antonio Allen, Vikash Patel, Jareen Meinzen-Derr, Armand Antommaria

Journal of Health Disparities Research and Practice

Background: Youth in protective custody (i.e., foster care) are at higher risk for poorer physical and mental health outcomes compared with those who are not. These differences may be due in part to the lack of research on the population to create evidence-based recommendations for health care delivery. A potential contributor to this lack of research is difficulties in obtaining informed consent for empirical studies in this population. The objective of this study was to describe the approaches to obtaining informed consent in minimal risk studies of foster youth and provide recommendations for future requirements.

Methods: We conducted a …

Racial Discrimination And Preterm Birth Among African American Women: The Important Role Of Posttraumatic Stress Disorder, Amelia Gavin, Nancy Grote, Kyaien Conner, Taurmini Fentress

Journal of Health Disparities Research and Practice

Among African American infants, preterm birth (PTB) is the most frequent cause of infant mortality. In the United States, there remains a stark African American-Non-Hispanic White difference in PTB (< 37 weeks of completed gestation). When compared to Non-Hispanic White infants, African American infants have greater than three times the risk of preterm-related mortality. Prior research studies have examined whether traditional prenatal risk factors explain the African American-Non-Hispanic White difference in PTB. However identification of these factors fails to explain the disparity. The lack of progress in addressing the African American - Non-Hispanic White difference in PTB suggests that exposures to risk factors across the life-course may be vital to addressing the African American-Non-Hispanic White difference in PTB. One potential life-course risk exposure is racial discrimination, which has been shown to influence the increased risk of PTB among African American women. However, research is needed to reveal the mechanisms that underlie the association between racial discrimination and PTB. Posttraumatic stress disorder (PTSD) may be one potential mechanism by which African American women's exposure to racial discrimination contributes to increased risk of PTB. This concept paper strives to advance our understanding of the increased risk of PTB among African American women. Recommendations are suggested to mitigate the impact of racial discrimination and PTSD on the PTB risk among African American women.

Exploring The Cultural Perceptions Of Physical Activity Among Transnational Nigerian Immigrants, Kelechi D. Ibe-Lamberts, Daudet Ilunga Tshiswaka, Abi Fapohunda

Journal of Health Disparities Research and Practice

Background: Transnational Nigerian Immigrants, as other Transnational African Immigrants, are a subset of African immigrants with the unique ability to sustain multi-national ties. These ties could potentially affect health behavior choices and participation in physical activity. Physical Activity has the potential to improve health and prevent chronic diseases; however, there is a lack of literature regarding physical activity and its determinants within the Transnational African Immigrant population in general. This study investigated the cultural factors that shape Transnational Nigerian Immigrants’ perceptions and attitudes towards physical activity.

Methods: Semi-structured, individual interviews supported by photo-elicitation were conducted on 24 Transnational …

Prehypertensive Risk Among African-American Undergraduates: Do The Extra Pounds Really Matter?, Cecile N. Yancu, Amber Debono, Anna K. Lee, Correll Mcrae, Daphne Witherspoon

Journal of Health Disparities Research and Practice

The objective of this study is to examine prehypertension among young African American adults and evaluate the predictive value of easily obtained standard measures of adiposity. Data for this study of 155 primarily African-American undergraduates was collected between April 2010-11. Participants provided family health history and anthropometric measures, including body weight, body mass index (BMI), and waist to hip (WHR) ratio. Percentages were calculated for demographics. The average systolic blood pressure measured over two time periods within a single semester generated prehypertension rates. Univariate and multivariate logistic regression examined the impact of BMI, WHR, weight, and family medical history on …

Disparities In Access To Primary Care And Emergency Department Utilization In A Large Medicaid Program, Natasha Parekh, Marian Jarlenski, David Kelley

Journal of Health Disparities Research and Practice

Identifying and eliminating disparities are priorities for State Medicaid programs, especially in the context of increased enrollment through Medicaid expansion. We assessed racial, ethnic, regional, and managed care organization (MCO) differences, as well as time trends before and after Medicaid expansion, in primary care and emergency department (ED) utilization in a large Medicaid program. We performed a cross-sectional evaluation of data from Pennsylvania Medicaid from 2011-2015. Three primary care outcomes included: 1) adult access to primary care; 2) adolescent access to primary care; and 3) pediatric access to dental care. Our fourth outcome reflected ED utilization. We observed significant racial …

The Privilege Of Healthy Eating: A Qualitative Study Exploring The Local Food Choices Of Low-Income Families From Appalachia, Iryna Sharaievska Dr., Stephanie West Dr., Melissa Weddell Dr.

Journal of Health Disparities Research and Practice

Using qualitative semi-structured interviews, 15 low-income women of different ages were asked to discuss their perceptions of healthy eating, local farmers’ markets, as well as their visitation of farmers’ markets. The participants were also asked to share what features of farmers’ markets they found appealing. The results showed that most of the participants had either a deep or moderate understanding of what it means to eat healthy. However, many of them also believed they could improve their own patterns of eating. The data also showed that the low-income women who took part in the study had positive attitudes overall toward …

Tumor Biology And Racial Disparities In Reconstruction After Mastectomy: A Seer Database Analysis, Sarah J. Ullrich, Michael C. Smith, Paul J. Chung, Sara Y. Kim, Gainosuke Sugiyama

Journal of Health Disparities Research and Practice

Introduction:

Significant disparities in immediate breast reconstruction after mastectomy have persisted, and may even be increasing, despite large-scale efforts to minimize them, such as the Women’s Health and Cancer Rights Act of 1998. Immediate breast reconstruction has been shown to lead to higher rates of surgical satisfaction, minimize delay in post-operative cancer treatment, and improve the quality of life and overall well-being of mastectomy patients. However only 25-40% of eligible women in the United States receive reconstruction. The rate of reconstruction is even lower in African American and Hispanic women compared to White women. To better understand this disparity, …

Children As Agents Of Change: Parent Perceptions Of Child-Driven Environmental Health Communication In The Apsáalooke (Crow Indian) Community, Jessica Milakovich, Vanessa W. Simonds, Frances L. Kim, Deborah Laveaux, Velma Pickett, Suzanne Held, Christine Martin, Jason Cummins, Lynn Kelting-Gibson

Journal of Health Disparities Research and Practice

While previous research suggests children have successfully acted as health change agents, no studies have examined the role of children in promoting environmental health knowledge and awareness. This study describes parent perceptions of the impact of a five-day water-focused environmental health summer camp on elementary school children in an American Indian community. We interviewed parents about their perception of changes in their child's environmental health knowledge, attitudes, and behaviors. Parents in this study confirmed that their child had shared information related to the camp activities. In addition, parents perceived that their children had increased knowledge and positive changes in attitudes …

An Examination Of Active Commuting By Race/Ethnicity, Income And Location, Dangaia Sims, Melissa Bopp

Journal of Health Disparities Research and Practice

Introduction

Active commuting (AC; walking and biking to work) is associated with a number of positive health outcomes, low participation remains low in the USA. Our objective was to examine the multi-level influences on AC considering social determinants of health: race/ethnicity, income level and location.

Methods

We conducted a cross-sectional survey examining correlates of AC in the Mid-Atlantic region of the United States. The sample consisted of 1,310 adults over the age of 18 who were employed part- or full-time outside of the home and physically able to walk and bike. One-way ANOVAs, t-tests, and Pearson correlation analyses were run …

Racial Disparities In Breast Cancer Survival: The Mediating Effects Of Macro-Social Context And Social Network Factors, Ganga Vijayasiri, Yamile Molina, Ifeanyi B. Chukwudozie, Silvia Tejeda, Heather Pauls, Garth Rauscher, Richard T. Campbell, Richard B. Warnecke

Journal of Health Disparities Research and Practice

ABSTRACT

This study attempts to clarify the associations between macro-social and social network factors and continuing racial disparities in breast cancer survival. The study improves on prior methodologies by using a neighborhood disadvantage measure that assesses both economic and social disadvantage and an ego-network measurement tool that assesses key social network characteristics. Our population-based sample included 786 breast cancer patients (nHWhite=388; nHBlack=398) diagnosed during 2005-2008 in Chicago, IL. The data included census-derived macro-social context, self-reported social network, self-reported demographic and medically abstracted health measures. Mortality data from the National Death Index (NDI) were used to determine 5-year survival.

Based on …

Promoting Community And Population Health In Public Health And Medicine: A Stepwise Guide To Initiating And Conducting Community-Engaged Research, Scott D. Rhodes, Amanda E. Tanner, Lilli Mann-Jackson, Jorge Alonzo, Florence Siman, Eunyoung Y. Song, Jonathan Bell, Megan B. Irby, Aaron T. Vissman, Robert E. Aronson

Journal of Health Disparities Research and Practice

Various methods, approaches, and strategies designed to understand and reduce health disparities, increase health equity, and promote community and population health have emerged within public health and medicine. One such approach is community-engaged research. While the literature describing the theory, principles, and rationale underlying community engagement is broad, few models or frameworks exist to guide its implementation. We abstracted, analyzed, and interpreted data from existing project documentation including proposal documents, project-specific logic models, research team and partnership meeting notes, and other materials from 24 funded community-engaged research projects conducted over the past 17 years. We developed a 15-step process designed …

Estimates Of Female Breast Cancer Mortality-To-Incidence Ratio (Mir) Of The Counties And The Senatorial Districts Grouped To County Boundaries (Sdgcs) In Missouri 2008 - 2012, Awatef A. Ben Ramadan, Jeannette Jackson-Thompson, Chester L. Schmaltz

Journal of Health Disparities Research and Practice

Purpose: To measure Mortality-to-Incidence Ratios (MIRs) on Senatorial Districts Grouped to County Boundaries (SDGCs) to explore the female breast cancer (FBC) racial and age disparities in Missouri.

Methods: The MIRs and their 95% CI by age and race were calculated for the 20 SDGCs for the period from 2008-2012.

Results: For the 65+ years old FBC cases, the MIRs for whole Missouri and the 20 SDGCs were typically twice the MIR for thewhites.

Conclusions: FBC MIRs can be used as a measure of cancer inequalities in Missouri. These measures might be informative for policy makers to assess the existing policies …

Measuring Inequity: A Systematic Review Of Methods Used To Quantify Structural Racism, Maya Groos, Maeve Wallace, Rachel Hardeman, Katherine P. Theall

Journal of Health Disparities Research and Practice

Abstract

Objective: To summarize the ways in which researchers have quantified measures of structural racism for the purposes of empirical, quantitative investigation of its associations with physical and mental health outcomes.

Methods: Systematic review of literature published January 1, 2007-June 30, 2017. We searched PubMed and EMBASE databases for studies including at least one of the following search terms in the title or abstract: “structural racism”, “systemic racism”, “institutional racism”, “institutionalized racism”. Excluded studies were not original research, not US based, did not quantify an explicitly named indicator of structural racism, or were qualitative designs. Data from full …

Impact Of Race And Insurance On Door-To-Appendectomy Time Among Pediatric Patients, Carla M. Lopez, Emily R. Christison-Lagay, Daniel Solomon

Journal of Health Disparities Research and Practice

Racial and ethnic disparities in the rate of appendiceal rupture have been widely reported among the pediatric population. The main reasons for this remain largely unknown given that previous explanations pointing to signs of poor health care access have recently been shown to account for only a small percentage of the difference in perforation rates between white and minority children. Because the risk of perforation increases with time, racial disparities in time delay from emergency department presentation to OR appendectomy may help account for the higher appendiceal perforation rates observed among minority children. This is the first study dedicated to …

Effectiveness Of Community Health Workers In Healthcare Delivery: Evidence From The Field, Mohammad Shahbazi Professor, Mukesh Kumar, Anthony Mawson, Donna Antoine Lavigine, Cassandra Dove

Journal of Health Disparities Research and Practice

Evidence suggests that health care in the United States could benefit from including the services of Community Health Workers (CHW), provided through Community Health Houses, in the delivery of care. This research project evaluated the impact of three newly-established Health Houses and the services provided to patients by Community Health Workers at three locations in the Mississippi Delta. The patients were current enrollees in the Medicare administered by United Healthcare. The program began in February 2014 and continued through September 2015. After analyzing data for payments made for each enrollee, emergency room visits and hospital admissions for the years of …

Exploring H.Pylori Seropositivity As A Risk Factor For Type 2 Diabetes, Virginia Chaidez, Yumou Qiu

Journal of Health Disparities Research and Practice

Background: In the US, the percentage of adults with diagnosed diabetes are higher in members of racial and ethnic minority groups compared to non-Latino Whites. Understanding why such disparities exist has been less forthcoming.

Methods: Secondary data analysis was conducted using the National Health and Nutrition Examination Survey (NHANES) 1999-2000 cross-sectional data.

Results: H.pylori seropositivity was highest in Mexican Americans (43.7%), lowest in non-Hispanic Whites (18.1%). Diabetes was highest in non-Hispanic Blacks (5.9%); lowest in non-Hispanic whites (4.3%). H.pylori seropositivity was associated with greater likelihood of having type 2 diabetes (1.927, 95% CI 1.142, 3.257) compared to H.pylori negative in …

Alternative Financial Services And Health Status In U.S. Metropolitan Statistical Areas, Courtney Hundley, Richard W. Wilson 8520196, John Chenault

Journal of Health Disparities Research and Practice

Abstract

Alternative financial services (AFS) such as, payday lenders, pawn brokers, tax refund loans, and check cashers are more prevalent in minority and lower income neighborhoods. These are neighborhoods also found to have disparities in health, compared to more affluent neighborhoods and communities. The focus of this paper is to determine if any relationship exists between use of AFS and health disparities.

Using data from a survey performed by the Federal Deposit Insurance Corporation (FDIC), we compared four banking variables to several measures of health for 85 metropolitan statistical areas (MSA) across the nation. The four banking variables all related …

Implementing A Pre-Exposure Prophylaxis Intervention For Safer Conception Among Hiv Serodiscordant Couples: Recommendations For Health Care Providers, Mari-Lynn Drainoni, Dea L. Biancarelli, Ashley A. Leech, Meg Sullivan, Angela R. Bazzi

Journal of Health Disparities Research and Practice

Couples in HIV serodiscordant relationships frequently desire children. Although partners who are virally suppressed pose almost no risk of transmitting HIV to their partners, partners who are inconsistently on therapy may transmit HIV to their partners when attempting to conceive. Pre-exposure prophylaxis (PrEP) is an available safer conception strategy for these couples but is not consistently offered. We sought to better understand barriers to PrEP implementation for couples seeking conception and patient perceptions on what providers could do to encourage use. We conducted in-depth, qualitative interviews with 11 participants representing six couples taking PrEP for safer conception in a safety-net …

Human Papillomavirus Infections In The Southern And Other United States Regions, Dudith Pierre-Victor, Mary Jo Trepka, Dionne Stephens, Tan Li, Timothy Page, Purnima Madhivanan

Journal of Health Disparities Research and Practice

Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide and has been linked to several cancers, including cervical cancer. In the United States, the Southern region has a disproportionate burden of cervical cancer, and research about the epidemiology of HPV in the region is scarce. This study estimates the prevalence and correlates of HPV infection among 14–59 year-old females.

Data from 4,250 females aged 14–59 years collected during the 2007–2010 National Health and Nutrition Examination Survey (NHANES) were used. We estimated the prevalence of HPV infection for the South and the rest of the country. We performed …

Hiv Mortality Difference Between Black And White Women, Carlos O. Nesbeth, Rajiv Kandala, Syed Najeeb, Ruksana Nazneen, Banglore Murthy

Journal of Health Disparities Research and Practice

OBJECTIVE

In the United States, human immunodeficiency virus (HIV) continues to be among the top 10 leading causes of mortality for black women between the ages of 20 and 54¹, but does not rank among the top 10 leading causes of death for white women amongst all age groups^². This study describes the HIV mortality difference between black and white women and formulate hypotheses that may reduce or eliminate disparities.

METHODS

Information was accessed through public data, the US Census, and the US Compressed Mortality File.

RESULTS

In these descriptive data from 1987 through 2015, including reliable HIV …

Asian Americans’ Cancer Information Seeking, Fatalistic Belief, And Perceived Risk: Current Status And Relationships With Cancer Prevention And Detection Behaviors, Jungmi Jun, Xiaoli Nan

Journal of Health Disparities Research and Practice

This study pursues four research goals: (1) to examine Asian Americans and Asian ethnic groups’ (i.e., Chinese, Filipinos, Japanese, Koreans, Vietnamese) information seeking, fatalistic belief, and perceived risk of cancer, in comparison to non-Hispanic Whites; (2) to identify characteristics of Asian Americans who seek cancer information, hold fatalistic cancer belief, and perceive cancer risk; (3) to assess cancer prevention and detection behavior gaps between Asian Americans and Whites, and (4) to explore whether such gaps can be explained by cancer information seeking, fatalistic belief, and perceived risk. Data from 2011-2014 Health Information National Trends Surveys (HINTS) were analyzed. Asian Americans …

Household Financial Assets Inequity And Health Disparities Among Young Adults: Evidence From The National Longitudinal Study Of Adolescent To Adult Health, Shiyou Wu, Xiafei Wang, Qi Wu, Kathleen Mullan Harris

Journal of Health Disparities Research and Practice

Introduction: Research has established a strong relationship between financial resources and health outcomes. Yet, little is known about the effects of assets disparities on health outcomes, especially during the critical period when adolescents transition to adults.

Methods: Using data from the National Longitudinal Study of Adolescent to Adult Health (n = 10,861), this study investigated the relationships between three household total assets value groups (low, moderate, and high assets) and three net worth groups (negative, neutral, and positive) on young adults’ general health, obese, and depression.

Results: Both assets and debts were related to young adults’ health status, …

Graduating Into Lower Risk: Chlamydia And Trichomonas Prevalance Among Community College Students And Graduates, Janet E. Rosenbaum

Journal of Health Disparities Research and Practice

Background: Community colleges enable youth from economically disadvantaged and minority populations to access college and may enable social mobility including improved health outcomes. However, educational health disparities studies rarely assess the health outcomes for community college graduates.

Methods: Chlamydia and trichomonas prevalence were assessed with nucleic acid based tests in a nationally representative sample of 6233 high school graduates (ages 18–25) from five educational levels: young adults without post-secondary credentials who were not enrolled in college, community college students, 4-year college students, associate’s degree, and bachelor’s degree. To reduce confounding between educational attainment and STI status, we used full matching …

A Cohort Study Of Public Health Insurance Coverage Loss Among Oregon Adolescents, Heather Angier Mph, Carrie Tillotson Mph, Lorraine Wallace Phd, Miguel Marino Phd, Jean O'Malley Mph, Aleksandra Sumic Mph, Lynn Baker Bsee, Christine Nelson Phd, Rn, Nathalie Huguet Phd, Andrew Suchocki Md, Mph, Heather Holderness Mph, Jennifer E. Devoe Md, Dphil

Journal of Health Disparities Research and Practice

ABSTRACT

Introduction: Churning on and off and/or experiencing coverage gaps is common among public health insurance recipients. Although the Affordable Care Act (ACA) provisions to extend parental coverage for adolescents transitioning to young adulthood on private insurance plans were implemented in 2010, no such protection was mandated for adolescents with public health insurance.

Methods: Oregon public health insurance enrollment and electronic health record data from community health centers were used to conduct a retrospective, observational cohort study of Oregon adolescents (17-19 years of age) with public coverage [January 1, 2011-December 31, 2013 (n=51,988)] to assess loss. Time-to-event methods determined the …

Food Insecurity And Pre-Hypertension, Pre-Diabetes In Adult Women: Results From The 2007-2010 National Health And Nutrition Examination Survey, Michelle L. Redmond, Phd, Ms, Fanglong Dong, Phd, Philip Twumasi-Ankrah, Phd, Robert B. Hines, Phd, Mph, Lisette T. Jacobson, Phd, Mpa, Ma, Elizabeth Ablah, Phd, Mph, Judy Johnston, Ms, Rd/Ld, Tracie C. Collins, Md, Mph, Mhcds

Journal of Health Disparities Research and Practice

Background

Being food insecure is generally defined as the limited or uncertain availability of safe and nutritious foods and is linked to poor nutrition and fully progressed diet-sensitive chronic diseases. However, little is known about the association between food insecurity and pre-clinical disease such as pre-hypertension and pre-diabetes. This study sought to examine the associations between food insecurity and pre-clinical disease among a racially/ethnically diverse population of women.

Methods

Using data from 2007-2010 NHANES, we examined associations between food security and pre-clinical disease among women 18-65 years. Chi-square tests were used to examine differences in demographic variables. Bivariate and multivariable …

Nativity Differences In Stress Among Asian And Pacific Islander American Women, Brittany N. Morey, Gilbert C. Gee, Salma Shariff-Marco, Gem M. Le, Alison J. Canchola, Juan Yang, Laura Allen, Sandra Lee, Roxanna Bautista, Trish Quema La Chica, Winston Tseng, Pancho Chang, Scarlett Lin Gomez

Journal of Health Disparities Research and Practice

According to the Stress Process Theory, people who are marginalized in society encounter more stress than those in more advantaged positions. Immigrants are one such marginalized group in the United States (US) who may experience greater psychological stress than their US-born counterparts due to (1) severing of social ties; (2) social disadvantage and marginalization; and (3) adaptation to a new environment. This study examines the disparity in stress by nativity, and how social factors contribute to this disparity for Asian and Pacific Islander (API) women. Data come from the Asian Community Health Initiative, which included a sample of 291 foreign-born …

Application Of The Imb Model To The Reported Intake Of Fruits And Vegetables Of Native American Children, Rachel C. Sinley, Julie A. Albrecht

Journal of Health Disparities Research and Practice

The purpose of this study was to evaluate the applicability of the Information-Motivation-Behavioral Skills (IMB) model to identify variables that are associated with fruit and vegetable intake among Native American children. A cross-sectional study design was employed with a convenience sample of 92 English-speaking caregivers of Native American children between the ages of 2 and 5 from several tribes representing the Midwest, including Omaha, Santee Sioux, Ponca and Winnebago. Caregivers completed an IMB model survey, fruit and vegetable food frequency questionnaire and demographic survey. Multivariate linear regression and path analysis were conducted to assess association between model constructs and fruit …

Are Parent Activation And Health Literacy Distinct Concepts? A Study In Low Income Urban Populations, Harita S. Shah, Kate Leifheit, Sarah Polk, Elizabeth Sloand, Tina L. Cheng, Lisa Decamp

Journal of Health Disparities Research and Practice

Patient activation (the knowledge, confidence, willingness, and skills to manage one’s healthcare) and health literacy have well-established associations with health and healthcare outcomes in adults. However, little is known about parent activation on behalf of children and its relation to health literacy. Our objective was to examine relations between parent activation, health literacy, and parent-provider relationship quality. We surveyed 316 Spanish- or English-speaking parents of publicly-insured patients of a general pediatrics clinic. Surveys included the Parent-Patient Activation Measure (P-PAM), the Newest Vital Sign (NVS), and parent-provider relationship measures. We used chi-square analyses and logistic regression to explore associations stratified by …