Community Health and Preventive Medicine Commons^™

Investigation Of The Cultural Context Of Sugars Consumption Behavior In Low-Income Mexican-American Women, Tanya J. Benitez, Colleen Keller, Kathryn Coe, Natasha Tasevska

Journal of Health Disparities Research and Practice

Despite the recent federal dietary recommendations to limit consumption of added sugars to less than ten percent of daily caloric intake, there is a gap in published literature examining the influence of food preparation behaviors on sugars consumption among low-income Mexican-American women. The purpose of the study was to describe the cultural context of Mexican-American women in procuring, preparing and presenting added sugars in their families’ diets.

Five focus groups were conducted to examine sugars consumption behavior in thirteen overweight/obese low-income Mexican-American women ages 27-40 years. Themes that emerged during the sessions included: changes in food procurement to include high-sugar …

Exposure To Secondhand Smoke And The Development Of Childhood Caries: Nhanes (2011-2012), Deborah Mattheus Phd, Msn, Pnp, Krupa Gandhi Mph, Eunjung Lim Phd, Maureen Shannon Cnm, Fnp, Phd

Journal of Health Disparities Research and Practice

Dental caries continue to plague young children worldwide with numerous adverse effects including pain, poor growth and development, decreased quality of life as well as the potential for the development of life threatening secondary infections. Factors associated with the development of childhood caries are complex as they relate to social, economic and/or cultural behaviors. Recent evidence has linked secondhand smoke to the development of childhood dental caries. The purpose of the study is to re-examine the association between the frequency and extent of exposure to secondhand smoke with the development of childhood caries in the United States. Cross-sectional data of …

Community-Level Characteristics Of High Infant Mortality: A Tool To Identify At-Risk Communities, Brandi M. White, Lee S. Horton, Kit N. Simpson

Journal of Health Disparities Research and Practice

Infant mortality (IM) rate is a key indicator of population health and has been gradually improving in the United States. However, it is still a public health problem among minority and low-income communities. Maternal factors explain some of the variation, but community-level factors may also be a contributor. This study examines measures to identify a set of indicators that explain variations in IM at the community-level. Data for 77 communities in a city were obtained from local health databases. We used multivariable linear regression models to examine the strength of the association between IM and maternal, population, community wealth, and …

The Patient Perspective: Receiving Care In The Post-Aca Era, Melanie F. Molina, Medell Briggs-Malonson

Journal of Health Disparities Research and Practice

The purpose of this study was to explore patients’ experiences and perceptions regarding the accessibility of healthcare services within a low-income, culturally diverse community in the post-Affordable Care Act era. We conducted a cross-sectional qualitative analysis of 32 interviews with patients that presented to a community emergency department in South L.A with one or more adult ambulatory care sensitive conditions. Both insured and uninsured patients shared many of the same experiences and perceptions when accessing healthcare services. The most prominent commonalities were related to healthcare cost, difficulty qualifying for insurance, lack of awareness of existing services, and healthcare service availability. …

Priority Hypertension Management Strategies For At-Risk African Americans As Perceived By Medical Clinicians And Academic Scholars, Shirley M. Timmons, Lu Shi, Amin Khademi

Journal of Health Disparities Research and Practice

African American adults, in the United States (US), bear the greatest burden of high blood pressure (HBP)--a primary risk factor for cardiovascular disease and premature death. Current research does not adequately inform the design of multi-level interventions that work to control HBP in this at-risk population. The purpose of this study was to uncover information about priority strategies recommended for HBP control in African American adults. Research questions are 1) what are factors that reduce or manage HBP in at-risk African Americans and 2) what factors are important to the design and implementation of successful HBP interventions in at-risk African …

Identifying Corners Stores As The Future Of Healthy Food Access In African American Communities, Victor Romano, Jennifer Lee, Elliott Royal, Katherine Metzo, William Ruth, Theodore Hartsook

Journal of Health Disparities Research and Practice

For many people, the corner store remains the main grocer, or the only source of sustenance in minority communities. This study examined the distribution of corner stores as a future reference point to provide healthy food access to predominantly African American communities that lack full service grocery stores. Business data was obtained from respective county by use of Standard Industrial Codes. Each corner store was then categorized by either being Full Service (Stores that sell fresh produce, fresh meat, fresh dairy, and processed foods) or Non-Full Service (stores that do not sell all four categories of foods included in the …

Prenatal Care Providers’ Perspectives And Practices: Informed Consent For Hiv Screening Among Latinas With Limited English Proficiency In South Carolina, Edena G. Meetze

Journal of Health Disparities Research and Practice

Abstract

The rapid increase in Latinos in South Carolina that has occurred within the past 15 years is associated with both in-migrationand high birth rates. Limited ethnic-specific data and communication barriers betweenLatinas with limited English proficiency have contributed to difficulties in assessing theprovision of recommended routine prenatal HIV screening among this vulnerablepopulation. This qualitative descriptive study examined providers' perceptions andpractices related to obtaining informed consent for routine HIV screening for pregnantLatinas with limited English proficiency. Findings indicate the need for focused educational interventionswith providers and patients and implementation of culturally and linguistically tailoredpractice guidelines to improve patient understanding and acceptance …

Exploring The Life Course Perspective In Maternal And Child Health Through Community-Based Participatory Focus Groups: Social Risks Assessment, Abraham Salinas-Miranda, Lindsey M. King, Hamisu M. Salihu, Estrellita "Lo" Berry, Deborah Austin, Susan Nash, Kenneth Scarborough, Evangeline Best, Lillian Cox, Georgette King, Carrie Hepburn, Conchita Burpee, Eugene Richardson, Marlo Ducket, Richard Briscoe, Julie Baldwin

Journal of Health Disparities Research and Practice

Little is known about the patterns of risk factors experienced by communities of color and how diverse community contexts shape the health trajectory of women from the early childhood period to the time of their pregnancies. Thus, we conducted a focus group study to identify social risks over the life course that contribute to maternal and child health from the perspective of community members residing in low income urban areas.

Ten community-based participatory focus groups were conducted with residents from selected communities in Tampa, Florida, from September to November 2013. We used the life course perspective to illuminate and explain …

Gender And Racial/Ethnic Disparities: Cumulative Screening Of Health Risk Indicators In 20-50 Year Olds In The United States, Alissa Cordner, Adrien A. Wilkie, Timothy J. Wade, Edward E. Hudgens, Rebecca J. Birch, Jane E. Gallagher

Journal of Health Disparities Research and Practice

This study explored potential gender and racial/ethnic disparities in overall health risk related to 24 health risk indicators selected across six domains: socioeconomic, health status and health care, lifestyle, nutritional, clinical, and environmental. Using the 2003-2006 National Health and Nutrition Examination Surveys (NHANES), it evaluated cross-sectional data for 5,024 adults in the United States. Logistic regression models were developed to estimate prevalence odds ratios (PORs) adjusted for smoking, health insurance status, and age. Analyses evaluated disparities associated with 24 indicator variables of health risk, comparing females to males and four racial/ethnic groups to non-Hispanic Whites. Non-Hispanic Blacks and Mexican Americans …

The Impact Of The Patient-Centered Medical Home On Health Disparities In Adults: A Systematic Review Of The Evidence, J. Nwando Olayiwola 2062970, Sonali Sheth, Victor Mleczko, Anna L. Choi, Anjana E. Sharma

Journal of Health Disparities Research and Practice

Introduction: The objective of this study was to review the empirical evidence on Patient-Centered Medical Home (PCMH) impact on health disparities in adults.

Methods: We searched PubMed, Scopus, and Google Scholar to identify studies on PCMH/health homes and health disparities published in English between January 1, 2009 and December 31, 2014. Articles met inclusion criteria if they investigated at least one component of PCMH or health homes in vulnerable populations, defined by PROGRESS-PLUS criteria, and reported differences in one of five clinical quality measures.

Results: 964 articles were identified through database searching and subsequent snowballing. 60 articles underwent full text …

Sociocultural Risk Factors For Elevated Perceived Stress Among African American Smokers, Monica Webb Hooper, Noella A. Dietz, Joseph C. Wilson

Journal of Health Disparities Research and Practice

Introduction: African Americans experience unique stressors that may inhibit smoking cessation and enhance relapse rates. Few studies, however, have focused on risk factors for perceived stress among treatment seekers. Because African Americans are less likely to quit compared to the larger community, understanding factors associated with perceived stress among smokers has the potential to improve intervention outcomes. This study examined psychosocial and cultural correlates of stress in a sample of African American participants in a randomized controlled trial.

Methods: At baseline, participants reported demographic factors and completed assessments of smoking history, alcohol use, friend and household smoking, weight concerns, acculturation, …

Emergency Department Utilization: A Qualitative Analysis Of Illinois Medical Home Network Patients., Crystal M. Glover, Yanina A. Purim-Shem-Tov

Journal of Health Disparities Research and Practice

Background

Inappropriate emergency department (ED) use continues to plague healthcare in terms of disease management and costs. In 2012, the State of Illinois implemented Medical Home Network (MHN) where Medicaid recipients were assigned to primary care providers to, in part, reduce overreliance on EDs. However, MHN patients have continued to use EDs.

Objective

The purpose of this study is to provide a qualitative analysis of Medicaid patient-identified barriers to primary care, facilitators of emergency use, and related mental health and psychosocial factors.

Methods

Patients who presented themselves at the ED located at an urban, academic medical center participated in one-time, …

A Comparison Of Measured And Self-Reported Blood Pressure Status Among Low-Income Housing Residents In New York City, James H. Williams Ab, Dustin T. Duncan Scd, Jonathan Cantor Ms, Brian Elbel Phd Mph, Gbenga Ogedegbe Md Ms Mph, Joseph Ravenell Md Ms

Journal of Health Disparities Research and Practice

Self-report is widely used to measure hypertension prevalence in population-based studies, but there is little research comparing self-report with measured blood pressure among low-income populations. The objective of this study was to compare self-reported and measured blood pressure status among a sample of low-income housing residents in New York City (n=118). We completed a cross-sectional analysis comparing self-report with measured blood pressure status. We determined the sensitivity, specificity, and positive predictive value (PPV) of each self-report metric. Of the sample, 68.1% was Black, 71.1% had a household income under $25,000/year, and 28.5% did not complete high school. In our study, …

Healthcare Reform In Latino Rhode Island: Perspectives Of Spanish Speakers And Insurance Navigators, Haiyan Ramírez Batlle, Roberta E. Goldman, Amed Logroño, Joseph A. Diaz

Journal of Health Disparities Research and Practice

Latinos have the highest uninsurance rates of any ethnic or racial group in the US despite recent health insurance expansion reform. In addition to immigration and language barriers, health literacy and attitudes may impact coverage disparities. Focus groups with Spanish-speaking community members and semi-structured interviews with health insurance navigators were conducted to explore knowledge, awareness, and attitudes towards healthcare reform among Latinos in Rhode Island. Sessions were audio recorded, transcribed, and analyzed employing standard qualitative methods. Thirty-two focus group participants and six navigators were enrolled in the study. Spanish-speaking participants demonstrated limited knowledge of the cost implications of the Medicaid …

Overcoming Recruitment Challenges: A Pilot Study In Arab Americans, Nawar M. Shara, Sayf A. Yassin, Soleman H. Abu-Bader, Asqual Getaneh, Shaunagh Browning, Alexander Zeymo, Barbara V. Howard, Zeid Abudiab, Anas Shahrour, Jason G. Umans

Journal of Health Disparities Research and Practice

While diabetes prevalence and cardiovascular risk factors have been increasing among Arab populations worldwide, few studies of Arab Americans have been conducted because of the difficulty in recruiting Arab American participants. Cultural sensitivity and social awareness of different immigrant groups could ensure successful recruitment and retention in clinical studies. While the primary objective of our overall research project was to determine the prevalence of metabolic syndrome in Arab Americans, the focus of this article is to describe the methodology used to overcome challenges in recruiting and enrolling Arab Americans for a community-based study. We used novel methods, including open houses, …

Relationship Of Associated Cardiovascular Risk Factors And Chronic Kidney Disease With Participants Enrolled In The National Kidney Foundation Of Hawai'i Kidney Early Detection Screening (Keds) Program, Merle R. Kataoka-Yahiro, Victoria Page, Dongmei Li

Journal of Health Disparities Research and Practice

Objective The objective of this study was to further examine the relationship of associated cardiovascular risk factors and chronic kidney disease (CKD) with a large cross-sectional sample of Native Hawaiians, Japanese, Chinese, Filipino, and White participants who were enrolled in the National Kidney Foundation of Hawai'i Kidney Early Detection Screening (KEDS) program.

Methods Data for this cross-sectional study was collected between 2006 and 2009 from the National Kidney Foundation of Hawaii (NKFH). Nine hundred and fifteen participants who attended the NKFH KEDS program were 18 years and older, and residents of the State of Hawaii. Data included demographic information, clinical …

Assessing Feasibility And Readiness To Address Obesity Through Policy In American Indian Reservations, Valarie Blue Bird Jernigan, Gail Boe, Carolyn Noonan, Leslie Carroll, Dedra Buchwald

Journal of Health Disparities Research and Practice

The Institute of Medicine and Centers for Disease Control and Prevention (CDC) have identified policy and environmental strategies as critical to the prevention and control of obesity. However such strategies are rare in American Indian communities despite significant obesity-related disparities. Tribal policymaking processes differ by tribal nation and are often poorly understood by researchers and public health practitioners, hindering the dissemination, implementation, and successful scale-up of evidence-base obesity strategies in tribal communities. To address these gaps in knowledge we surveyed 138 diverse stakeholders in two American Indian reservations to assess the feasibility of and readiness to implement CDC-recommended obesity policy …

Reducing Disparities By Way Of A Cancer Disparities Research Training Program, Lee S. Caplan, Tabia H. Akintobi, Tandeca K. Gordon, Tiffany Zellner, Selina A. Smith, Daniel S. Blumenthal

Journal of Health Disparities Research and Practice

Background: For minority populations, there is a continuing disparity in the burden of death and illness from cancer. Research to address this disparity should be conducted by investigators who can best understand and address the needs of culturally diverse communities. However, minorities are under-represented in health-related research. The goal of this project was to develop and evaluate an approach to motivating and preparing master’s degree students for careers dedicated to cancer disparities research.

Method: A Cancer Disparities Research Training Program (CDRTP) was initiated in 2010. The program consists of coursework, practicum experiences, and research opportunities. Assessment of the curriculum is …

Brighter Sights: Using Photovoice For A Process Evaluation Of A Food Co-Op Style Nutrition Intervention, Margaret P. Raber, Kimberly Kay Lopez, Mike Pomeroy, Avni Mody, Christine Markham, Shreela V. Sharma

Journal of Health Disparities Research and Practice

Access to healthy food is a critical factor impacting childhood obesity. Brighter Bites is a school-based program that addresses the issue of fresh food access among low-income families living in food deserts using a food co-op model. The aim of this study is to evaluate initial parent participant reactions to the ongoing Brighter Bites program using Photovoice. A predominately Hispanic, economically disadvantaged, urban school was chosen as the site for the Photovoice project. A total of seven Brighter Bites parent participants were enrolled and six completed the study. The participants developed research questions, took documentary photographs, completed a group analysis …

Feasibility Of A Community-Based Sickle Cell Trait Testing And Counseling Program, Ashley Housten, Regina Abel, Terianne Lindsey, Allison King

Journal of Health Disparities Research and Practice

Background: Sickle cell trait (SCT) screening is required at birth in the United States; however, adults rarely know their SCT status prior to having children.

Purpose: Assess feasibility of a community-based SCT education and testing intervention.

Methods: Participants were recruited from eight community sites to complete an educational program and offered a hemoglobin analysis. A genetic counselor met individually with participants to discuss lab results.

Results: Between July 14, 2010 and May 31, 2012, 637 participants completed the educational program. Five hundred seventy (89.5%) provided a blood sample, and 61 (10.9%) had SCT or other hemoglobinopathies. The genetic counselor met …

Physical Activity Among Older American Indians And Alaska Natives, David Hodgins, Linda Larkey, Barbara E. Ainsworth, Colleen Keller

Journal of Health Disparities Research and Practice

Introduction: Life style behaviors contribute to poor health among older Americans Indians/Alaska Native (AI/AN) in the United States, with low levels of physical activity (PA) particularly tied to the chronic disease profile of this population. Searched reviews of physical activity among AI/ANs are limited in assessing prevalence and correlates to PA among older adults > 40 years.

Methods: A literature search of reported physical activity studies among older AI/AN was assessed for prevalence and predictive factors associated with levels of physical activity.

Results: Fourteen studies were included in this review that either specifically quantified the amount of physical activity among older …

Blood Pressure Control For African American Parents And Children: Feasibility And Initial Outcomes Of A Faith-Based Intervention Pilot Study, Penny A. Ralston Ph.D., Tammye Farmer M.S., Iris Young-Clark Ph.D., Catherine Coccia Ph.D., R.D.

Journal of Health Disparities Research and Practice

The overall purpose was to determine the feasibility and initial outcomes of a faith-based intervention to improve blood pressure (BP) control in African American (AA) parents/guardians and their children, using a pre/post without control group design. Sample included AA parents and children (n=17) from three churches in North Florida. Health behaviors (daily servings of fruits/vegetables [F/V], minutes of physical activity [PA]) and physical health (BMI, systolic BP and diastolic SB) were examined. Data were analyzed using descriptive statistics, paired t-tests, and correlations. Feasibility outcomes showed high attendance (91% children, 88% parents) and completion (100%) rates. F/V significantly increased at post-test …

An Examination Of Early Colorectal Cancer Screening Guidelines For African Americans: Hints From The Hints Data, Torhonda C. Lee, Arlesia L. Mathis, Matthew T. Dutton

Journal of Health Disparities Research and Practice

Background: Despite the overall gains in reducing colorectal cancer (CRC) deaths due to the increase in screening, minority racial/ethnic groups who have disparately higher rates of death compared to Whites, also have disproportionately lower screening rates. Patient-provider communication about screening has a strong influence on the uptake of screening. In much the same way that gradual impact was made after the 1996 implementation of guidelines recommending screening starting at age 50 for those at average risk, it may be expected that the American College of Gastroenterology (ACG) guidelines suggesting screening start at 45 for Blacks combined with a recent …

Community-Engagement To Support Cardiovascular Disease Prevention In Disparities Populations: Three Case Studies, Deborah C. Glik, Mienah Zulfacar Sharif, Katherine L. Tucker, Shirley A. Tejada, Michael L. Prelip, Alice S. Ammerman, Thomas C. Keyserling, Shioban E. Torres, Stephanie Jilcott Pitts

Journal of Health Disparities Research and Practice

Cardiovascular diseases remain the leading cause of death in the United States, and are characterized by socioeconomic, geographic, ethnic, and gender disparities in risk, morbidity and mortality. In response, public health efforts have moved beyond approaches focusing on individual-level behavior change toward culturally appropriate community-focused efforts. In specific, engagement of community partners is now recognized as essential to facilitate changes at multiple levels to improve cardiovascular disease outcomes.

This paper shares lessons learned to deepen appreciation for the unique challenges community-engagement in health disparities research entails, including variations in practice, time commitment, and complexity. This paper presents three case studies …

Sex Disparities In Access To Acute Stroke Care: Can Telemedicine Mitigate This Effect?, Catherine Wolff, Amelia K. Boehme, Karen Albright, Tzu-Ching Wu, Michael Mullen, Sean Savitz, Charles Branas, James Grotta, Brendan Carr

Journal of Health Disparities Research and Practice

Background: Women have more frequent and severe ischemic strokes than men, and are less likely to receive treatment for acute stroke. Primary stroke centers (PSCs) have been shown to utilize treatment more frequently. Further, as telemedicine (TM) has expanded access to acute stroke care we sought to investigate the association between PSC, TM and access to acute stroke care in the state of Texas.

Methods: Texas hospitals and resources were identified from the 2009 American Hospital Association Annual Survey. Hospitals were categorized as: (1) stand-alone PSCs not using telemedicine for acute stroke care, (2) PSCs using telemedicine for acute stroke …

The Construct And Predictive Validity Of Psychosocial Correlates Of Television Viewing, Raheem Paxton, Pascal Jean-Pierre, Saehwan Park, Yong Gao Dr., Stephen Herrmann, G J. Norman

Journal of Health Disparities Research and Practice

Background: Many studies have examined the consequences of prolonged television viewing, but few studies have examined the psychological states that contribute to this behavior. In this study, we evaluated the construct and predictive validity of psychosocial correlates of television viewing in a population of African American (AA) breast cancer survivors (BCS).

Methods: AA BCS (N = 342, Mean age = 54 years) completed measures of decisional balance, self-efficacy, family support, and time spent watching television online. Exploratory structural equation modeling (ESEM) was used to examine the construct and predictive validity as well as the differential item functioning of the instruments …

Hawai‘I’S Caring Communities Initiative: Mobilizing Rural And Ethnic Minority Communities For Youth Suicide Prevention, Jane J. Chung-Do, Deborah A. Goebert, Kris Bifulco, Tasha Tydingco, Antonia Alvarez, Davis Rehuher, Jeanelle Sugimoto-Matsuda, Bridget Arume, Pohai Wilcox

Journal of Health Disparities Research and Practice

Youth suicide is a serious, yet preventable, public health concern for ethnic minorities and rural communities. This paper describes the youth leadership model utilized by Hawai‘i’s Caring Communities Initiative (HCCI) and provides reflections on the important factors for success in implementing a youth and community advocacy project for youth suicide prevention. HCCI partnered with six youth and community organizations who serve ethnic minority and rural communities across the State of Hawai‘i to train youth leaders and community members in suicide prevention, in order to develop community awareness activities that are grounded in each community’s strengths and needs. The work of …

The Role Of Trauma In Disparities For Cancer-Related Health: A Call To Action, Megan Bair-Merritt

Journal of Health Disparities Research and Practice

Cancer is the second leading cause of death in the United States. In this brief report, we describe the current literature on interpersonal trauma (i.e., sexual abuse and intimate partner violence) and cancer. Concordant with the general population, between 20% and 50% of cancer patients have experienced interpersonal trauma. Experiences with interpersonal trauma not only appear to increase risk for developing cancer, but may also act as a roadblock to accessing appropriate preventive testing and to receiving adequate support during cancer care. Healthcare providers can play an important role in making cancer-related care more trauma-informed.

Social Determinants Of Late Stage Hiv Diagnosis And Its Distributions Among African Americans And Latinos: A Critical Literature Review, Alison M. Chopel, Meredith Minkler, Amani Nuru-Jeter, Megan Dunbar

Journal of Health Disparities Research and Practice

ABSTRACT

This critical literature review was conducted to identify both individual- and environmental-level social determinants of health using an ecological framework as a way to contextualize risk for, and distributions of, late HIV diagnosis among African Americans and Latinos in the United States.

Background: Late diagnosis, defined as a diagnosis of AIDS simultaneously with or within one year of an initial HIV diagnosis,¹ disproportionately affects African American and Latino communities;^2,3 disparities in this health problem thus represent a preventable inequity. Such disparities affect not only late diagnosed individuals but also population levels of HIV incidence, as transmission is …

Assessment Of The Perceived Role And Function Of A Community Advisory Board In A Nih Center Of Excellence: Lessons Learned, Margaret L. Walsh, Desiree Rivers, Maria Pinzon, Nina Entrekin, Emily M. Hite, Julie A. Baldwin

Journal of Health Disparities Research and Practice

Background: The Community Advisory Board (CAB) was a vital component of the Center for Equal Health. The center addressed health disparities through community-based research and educational outreach initiatives. Objectives: To evaluate the perceived relationship of the CAB and Center, explore members’ perceptions of the CAB’s role, and elicit feedback on how to enhance the relationship between the Center and the CAB. Methods: Ten in-depth, semi-structured interviews were conducted. All interviews were transcribed verbatim and analyzed with a focus on predetermined codes. Results: Main themes focused on perception of CAB roles and need for utilization of board members; overall center challenges; …