Community-Based Research Commons^™

Equal Care, Unequal Outcomes: Experiences Of A Reach 2010 Community, Diane Neal, Barbara Carlson, Carolyn Jenkins, Gayenell Magwood

Journal of Health Disparities Research and Practice

Diabetes is growing in prevalence and costs. Guidelines for care have been available since 1983, yet diabetes care and outcomes remain less than ideal. CDC’s Racial and Ethnic Approaches to Community Health 2010 (REACH 2010) identified diabetes in African Americans as a priority for action. This article documents the activities, interventions, and current progress of the REACH 2010 diabetes coalition formed in Charleston and Georgetown counties, South Carolina, in reducing health care disparities and describes next steps for improving outcomes. The Chronic Care Model guided many of the implementation activities, and chart audits were used to document outcomes. Ambulatory care …

Transdisciplinary Approaches To Ameliorating Racial Disparities In Prostate Cancer Outcomes, Chanita H. Halbert, Katrina Armstrong, John Holmes, David Fenstermacher, Janet Weiner, Carmen Guerra, J. S. Schwartz, Jerry C. Johnson, Edmund Weisberg, Chantal Montagnet, Benita Weathers, Charnita Zeigler-Johnson, Ernestine Delmoor, Timothy R. Rebbeck

Journal of Health Disparities Research and Practice

Though prostate cancer is the second leading cause of cause cancer deaths among men in the US, it ranks first among African American men in terms of incidence, morbidity, and mortality. To address this and other complex health issues, some researchers advocate transdisciplinary research as a framework for analysis; however, few examples exist that indicate how the framework should be applied. This report uses prostate cancer outcomes as a paradigm to describe how such a framework can be used to identify determinants of racial disparities. By integrating diverse scientific disciplines, methods, and analytic approaches from psychology, sociology, epidemiology and genetics, …

A Pilot Self-Care Group Intervention For Low-Income Hiv-Positive Women, Maithe Enriquez, Margaret S. Miles, Jacki Witt, Paul Gore, Nancy Lackey

Journal of Health Disparities Research and Practice

This article describes the development of a self-care intervention and examines its efficacy with low-income HIV-positive women (n=34) in the Midwestern United States. Adapted from an individual nurse-led intervention, this effort focused on increasing self-care behaviors through enhancing self-esteem and social support. The investigators used a community-based participatory approach and partnered with three HIV-positive women to adapt and pilot test the new group intervention. A within-group, repeated-measures, pre-/post-test design, together with participant interviews, was used to evaluate the intervention. Mean scores on measures of self-care behaviors, self-esteem, social support and depressive symptoms all changed in the clinically desirable direction. Group …

The Influence Of Patient-Centeredness On Minority And Socioeconomically-Disadvantaged Patients’ Trust In Their Physicians: An Evidence-Based Structural Equation Modeling Investigation, Stephen J. Aragon, Sylvia A. Flack, Cecil A. Holland, Racquel R. Ingram, Michael L. Clements

Journal of Health Disparities Research and Practice

The purpose of this investigation was to determine the effect of physician patient-centeredness on patient trust across randomly selected groups of patients from an inner city medical practice serving a preponderance of minority and socioeconomically-disadvantaged patients.

METHODS: A two-factor multigroup structural equation modeling design was employed, with randomly selected test (N = 300) and cross-validation (N = 300) samples of medical practice patients. Equality constraints were established to test the invariance of effects across groups. The model was compared to its unconstrained counterpart to further test its trustworthiness. An additional 5,000 nonparametric bootstrapped samples for each group were generated to …

Self-Rated Health Status Comparing Pacific Islanders To Asians, Maile Taualii

Journal of Health Disparities Research and Practice

Disease reporting for Asians/Pacific Islanders often conflicts and is, many cases, inaccurate because of the aggregation of Asians and Pacific Islanders. An analysis of 2005 Behavior Risk Factor Surveillance System data was performed to examine health status of Asians compared to Native Hawaiian or Other Pacific Islanders. Findings show a significant difference between Asians and Native Hawaiian or Other Pacific Islanders, with a greater likelihood for Native Hawaiians or Other Pacific Islanders to rate their health as poor. Conclusion: Asians and Native Hawaiians or Other Pacific Islanders do not have the same health status. By aggregating these two distinctly different …

Health Literacy As A Contributor To Immigrant Health Disparities, Jennifer B. Kimbrough

Journal of Health Disparities Research and Practice

The ability to obtain, understand and use the information needed to make wise health choices is known as health literacy. Low health literacy among members of populations with poor reading skills, limited mastery of the English language, members of ethnic or cultural minorities, and immigrants is likely a major contributor to health disparities in the US (Agency for Health Care Policy and Research 1997). A series of focus groups with East-Asian, African, Central and South American immigrants was conducted to better understand the perceptions of immigrants seeking health care services in an urban North Carolina county. Participants’ responses are reported …

Quality And Severity Of Lower Urinary Tract Symptoms Among African American Elders, Daniel L. Howard, Bennett G. Edwards, Kimberly Whitehead, M. A. Amamoo, Paul A. Godley

Journal of Health Disparities Research and Practice

Lack of population-based data on lower urinary tract symptoms (LUTS) among African American men represents a significant gap in understanding. This study examined LUTS among a racially over-sampled, mixed urban/rural, elderly cohort of African Americans and whites in the South to discern whether racial differences exist in the prevalence, severity, and associated risk factors of LUTS. Longitudinal analyses using generalized estimating equations (GEE) were conducted on the 1994–1998 EPESE dataset for 5 North Carolina counties. In 1994, the analytic cohort included 482 African Americans and 407 whites; by 1998, 249 and 222, respectively. In 1994, 49.4% of African Americans reported …

African American And Non-Hispanic White Births In Enhanced Prenatal Care Programs And Wic, Monica Cain

Journal of Health Disparities Research and Practice

North Carolina uses Maternity Care Coordination (MCC), an enhanced prenatal care program, to improve birth outcomes for high risk women. The WIC program provides similar services to achieve the same goal. Women in North Carolina Medicaid can choose to participate in either, both, or neither the MCC and WIC programs. The study compares the percentages of low birth weight (LBW)—less than 2500 grams—births and maternal risk characteristics of women: (1) participating in the MCC program only, (2) participating in WIC only, or (3) participating in both programs, to those women who receive conventional Medicaid prenatal care. The analysis is further …

Cumulative Risk And A Call For Action In Environmental Justice Communities, H. P. Hynes, Russ Lopez

Journal of Health Disparities Research and Practice

Health disparities, social inequalities, and environmental injustice cumulatively affect individual and community vulnerability and overall health; yet health researchers, social scientists and environmental scientists generally study them separately. Cumulative risk assessment in poor, racially segregated, economically isolated and medically underserved communities needs to account for their multiple layers of vulnerability, including greater susceptibility, greater exposure, less preparedness to cope, and less ability to recover in the face of exposure. Recommendations for evidence-based action in environmental justice communities include: reducing pollution in communities of highest burden; building on community resources; redressing inequality when doing community-based research; and creating a screening framework …

Consistency Of Minority And Socioeconomic Status As Predictors Of Health, Ari K. Mwachofi, Robert W. Broyles

Journal of Health Disparities Research and Practice

This paper examines the relative consistency of economic and racial status as predictors of the individual’s physical and emotional health. The focus of the study is the covariates of (1) limited activity resulting from poor physical and (2) limited activity resulting from poor emotional health. Using data from the 2003 Behavioral Risk Factor Surveillance System survey, the study was developed in two phases. In the first, logistic regression analysis was used to examine two binary variables that identified respondents who reported at least one day of limited activity that resulted from poor physical and then poor emotional or mental health. …

Seeking Cancer Information: An Appalachian Perspective, Robin C. Vanderpool, Bin Huang, Brent J. Shelton

Journal of Health Disparities Research and Practice

There are noted disparities by ethnicity, race, age, gender, and socioeconomic status in the reported use of and access to cancer information. Missing from this list of variables that predict these disparities are specific geographic locales, such as Appalachia, a region recognized as a medically underserved, “special population”. Through a secondary analysis of NCI’s 2003 HINTS dataset, we are able to describe the cancer information-seeking behaviors of Appalachians as compared to non-Appalachians with a focus on actual versus preferential information-seeking behaviors, information-seeking experiences, and demographics. In general, Appalachians and non-Appalachians do not significantly differ in their cancer information-seeking behaviors and …

Eliminating Racial/Ethnic Health Disparities: Reconsidering Comparative Approaches, Shawn M. Bediako, Derek M. Griffith

Journal of Health Disparities Research and Practice

The focus on eliminating racial/ethnic health disparities has brought critical attention to the poor health status of minority populations. Assessing the health outcomes of racial minority groups by comparing them to a racial majority standard is valuable for identifying and monitoring health inequities, but may not be the most effective approach to identifying strategies that can be used to improve minority health outcomes. Health promotion planning models and public health history both suggest that minority health promotion is more likely to be derived from interventions rooted in culturally and historically grounded contextual factors. In this essay, we highlight limitations of …

Increasing Rate Of Pneumonia Hospitalizations Among Older American Indian And Alaska Native Adults, Robert C. Holman, Krista L. Yorita, Rosalyn J. Singleton, James E. Cheek, Edna L. Paisano, Jay C. Butler, Larry J. Anderson, Alicia M. Fry

Journal of Health Disparities Research and Practice

Objective: To examine rates and trends of pneumonia hospitalization among older American Indian and Alaska Native (AI/AN) adults.

Methods: Pneumonia hospitalizations for older AI/AN adults ≥65 years of age living in the Alaska and Southwest Indian Health Service (IHS) regions during 1988 through 2002 from the IHS hospital discharge data were analyzed.

Results: The average annual hospitalization rate for first-listed pneumonia for older AI/AN adults in both the Alaska and the Southwest regions has increased (15.3 and 23.0 in 1988-1990 to 25.9 and 28.8 in 2000-2002 per 1,000 population, respectively), with the greatest increase seen among older AI/AN adults in …

Elevated Depressive Symptoms In A Community Sample Of African-Americans And Whites, Robert J. Jagers, Fernando A. Wagner, Pamela E. Scott-Johnson, Yan Wang, Dorothy C. Browne

Journal of Health Disparities Research and Practice

This study examined demographic and psychosocial correlates of elevated depressive symptoms among African-Americans and Whites from comparable socioeconomic and neighborhood backgrounds. 851 African-Americans and 597 Whites from adjacent census tracts were interviewed using previously validated indicators of depressive symptoms, social support, religious practices and various demographic characteristics. More Whites than African-Americans reported elevated depressive symptoms and the groups also differed on several demographic variables and psychosocial variables. Employment, marital status and age were salient demographic covariates for African Americans, while income was for Whites. For both groups, social support and church attendance were inversely associated with depressive symptoms. Prayer was …

Cancer-Related Disparities Among Residents Of Appalachia Ohio, James L. Fisher, Holly L. Engelhardt, Julie A. Stephens, Bette R. Smith, Georgette G. Haydu, Robert W. Indian, Electra D. Paskett

Journal of Health Disparities Research and Practice

The authors sought to identify cancer-related disparities in Appalachia Ohio and better understand reasons for the disparities. Data from the Ohio Cancer Incidence Surveillance System, among other sources, were used to examine potential cancer disparities among residents of Appalachia Ohio. Using Ohio census data, the authors examined contributions of household income, educational attainment and population density to disparities in cancer incidence. Results suggest the following disparities in Appalachia Ohio (compared to non-Appalachia Ohio): greater cancer incidence and mortality rates for cancers of the cervix, colon and rectum, lung and bronchus and melanoma of the skin; a later stage at diagnosis …

The Closure Of New Orleans' Charity Hospital After Hurricane Katrina: A Case Of Disaster Capitalism, Kenneth Brad Ott

LSU New Orleans Theses and Dissertations

Abstract

Amidst the worst disaster to impact a major U.S. city in one hundred years, New Orleans’ main trauma and safety net medical center, the Reverend Avery C. Alexander Charity Hospital, was permanently closed. Charity’s administrative operator, Louisiana State University (LSU), ordered an end to its attempted reopening by its workers and U.S. military personnel in the weeks following the August 29, 2005 storm. Drawing upon rigorous review of literature and an exhaustive analysis of primary and secondary data, this case study found that Charity Hospital was closed as a result of disaster capitalism. LSU, backed by Louisiana state officials, …

Feasibility And Acceptability Of An English-As-A-Second Language Curriculum On Hepatitis B For Older Chinese American Immigrants, Gloria D. Coronado, Elizabeth Acorda, H. H. Do, Victoria M. Taylor

Journal of Health Disparities Research and Practice

Asian immigrants to the U.S. have an increased prevalence of hepatitis B virus (HBV) infection compared to native born individuals; an estimated 10 percent of Chinese immigrants are infected with HBV. Using qualitative data from focus groups, we developed an English-as-a-Second Language (ESL) curriculum that aimed to improve knowledge about key hepatitis B facts. The curriculum was pilot-tested among 56 students aged 50 and older from intermediate-level ESL classes at a community-based organization that serves Chinese immigrants. Post-curriculum data showed increases in knowledge that hepatitis B can cause liver cancer (73% at pre-test vs. 91% at post-test; p value = …

Racial And Ethnic Differences In Cardiovascular Disease Risk Factors In U.S. Older Women: Findings From Behavioral Risk Factor Surveillance Survey, 2003 & 2004, Anita K. Kurian, Kristine Lykens, Sejong Bae, Karan P. Singh

Journal of Health Disparities Research and Practice

The purpose of this study was to examine racial and ethnic variations in the modifiable CVD risk factors in older women (65 years and older). The study data was drawn from the merged 2003 and 2004 national Behavioral Risk Factor Surveillance Survey (BRFSS). Multinomial regression analyses for indicator outcome and multiple logistic regression analyses for binary outcomes were performed to determine the relationship between each of the six dependent variable and the independent variables. Compared to older white women, older black women had significantly higher odds of hypertension, diabetes and obesity. No significant association was found between Hispanics and hypertension. …

Predictors Of Depression For Low-Income African American Single Mothers, Jennifer Hatcher, Mary K. Rayens, Ann R. Peden, Lynne A. Hall

Journal of Health Disparities Research and Practice

Purpose: To test a model of predictors of depression in low-income single African American mothers. Design: Secondary analysis of existing data collected as part of a study of women at risk for clinical depression.

Methods: Cross sectional secondary data analysis of a study of low-income African American single mothers with children ages 2-6. Path analysis was used to test a model of the potential mediating role of negative thinking. It was hypothesized that negative thinking mediates the effects of chronic stressors, general health status, and self-esteem on depressive symptoms

Finding: Negative thinking mediated the relationships of chronic stressors and self-esteem …

Evaluating “Not In Mama's Kitchen” Second-Hand Smoke Campaign In Georgia, Jonathan B. Vangeest, Verna L. Welch

Journal of Health Disparities Research and Practice

In 2003-2005, the Association of Black Cardiologists, Inc. initiated the Not in Mama’s Kitchen (NIMK) second-hand smoke (SHS) prevention campaign in Georgia as part of their effort to reduce exposure to SHS in African American communities statewide. This initiative was evaluated using baseline data from pledge cards as well as data from a self-administered mail survey of 1,000 campaign participants. 14,770 Georgians participated in NIMK, signing pledges to make their homes and cars smoke free. Majorities of those surveyed followed through with their pledge, banning tobacco use in their homes (76.1%) and cars (80.2%). The program was cited by 65.4% …

Evaluation Of A Tobacco Educational Intervention For Pregnant Alaska Native Women, Christi A. Patten, Carrie Enoch, Caroline C. Renner, Karin Larsen, Paul A. Decker, Kari J. Anderson, Caroline Nevak, Ann Glasheen, Kenneth P. Offord, Anne Lanier

Journal of Health Disparities Research and Practice

Tobacco cessation interventions developed and evaluated for Alaska Native women do not exist. As part of routine clinical care provided at a prenatal visit, a brief tobacco educational intervention for Alaska Native pregnant women (N=100; mean ± SD age = 25.9±6.2 years; mean 6.3± 2.6 months gestation) was piloted at the Y-K Delta Regional Hospital in Bethel, Alaska. This retrospective study reports on the evaluation of this clinical program. The intervention was consistent with the clinical practice guidelines (i.e., 5 A’s – ask, advise, assess, assist, arrange), with an average duration of 20.2 ± 6.8 minutes. The self-reported tobacco abstinence …

African American Adults’ Experiences With The Health Care System: In Their Own Words, Keri A. Jupka, Nancy L. Weaver, Vetta L. Sanders-Thompson, Nicole M. Caito, Matthew W. Kreuter

Journal of Health Disparities Research and Practice

African Americans suffer a disproportionate burden of death and illness from a number of different chronic diseases. Inequalities in health care practices and poor patient and provider communication between African American patients and health care professionals contribute to these disparities. We describe findings from focus groups with 79 urban African Americans in which the participants discussed their interactions with the healthcare system as well as beliefs and opinions of the healthcare system and professionals. Analysis revealed five major themes: (1) historical and contextual foundations; (2) interpersonal experiences with physicians and other health care workers; (3) discrimination; (4) trust, opinions and …

Examination Of Racial Disparities In Childhood Asthma Management Practices, Crystal N. Piper, Saundra Glover, Kieth Elder, Jong-Deuk Baek

Journal of Health Disparities Research and Practice

Objective: To analyze asthma management plan practices for children with asthma in the United States considering race and other demographic and person-level characteristics.

Methods: Univariate/Bivariate/Multivariate analysis was performed to examine asthma management plan physician recommendations among children in the United States utilizing secondary data analysis of the 2002 and 2003 National Health Interview Survey.

Results: The majority of the study participants reported not having an asthma management plan at (59.00%). In multivariate analysis using SAS callable SUDAAN, Whites were significantly more likely to have an asthma management plan (OR=1.66, p=.0031).

Conclusion: Findings from this study indicate that Black and Hispanic …

Pastors’ Influence On Research-Based Health Programs In Church Settings, Shirley M. Timmons

Journal of Health Disparities Research and Practice

Churches, in the United States, are recognized essential players in addressing our mounting health and social service needs. Yet, even though they implement a relatively large number of programs, few are research-based. Focus groups were conducted with pastors from 11 Baptist churches in a small Southeastern town to explore factors that influence the implementation of research-based health programs. Transcripts were coded for domains resulting in four themes: congregant needs, shared programming ethics, common understanding of programming processes, and care for the church and congregation. Pastors value research and seek church-based programs that enhance the health of congregants. Yet, future study …

Promoting Physical Activity In Low Income African Americans: Project Laps, Dorothy W. Pekmezi, Brooke L. Barbera, Jamie S. Bodenlos, Glenn N. Jones, Phillip J. Brantley

Journal of Health Disparities Research and Practice

Low income African Americans are at increased risk for physical inactivity and related chronic illnesses. Thus, effective interventions are needed to address these health disparities. The current study examined the efficacy of a home-based physical activity intervention among a low income African American sample with high rates of chronic illnesses (obesity, hypertension, diabetes, high cholesterol). Participants (n=214) were randomly assigned to either the home-based physical activity intervention (self-help print materials, five monthly newsletters, two telephone counseling sessions) or an attention control condition, which promoted healthy diet. Results indicated that the intervention did not produce significantly greater increases in physical activity …

Utilizing Community Resources To Reduce The Presence Of Type 2 Diabetes In Rural Youth, Antonia S. Mead, M. C. Nagy, Stephen Nagy

Journal of Health Disparities Research and Practice

The purpose of this study was to implement a program designed to promote diabetes prevention activities among preadolescents in a rural southern setting using a day camp intervention. Participants in the study were eleven youth from a rural Alabama county who participated in a week-long half-day camp administered by local and community volunteers. Change scores were used to compare pre- to post- to follow-up measures for camp participant responses. Program results consistently demonstrated that the day camp was theoretically sound and that program activities positively impacted behavioral antecedents. This study demonstrated the feasibility of conducting a diabetes prevention day camp …

Hepatitis C Diagnoses In An American Indian Primary Care Population, Hillary E. Norton, John T. Redd, Ralph T. Bryan

Journal of Health Disparities Research and Practice

BACKGROUND: Despite large disparities in the burden of chronic liver disease, data on hepatitis C virus (HCV) infection among American Indians (AIs) are lacking. We reviewed hepatitis C diagnoses in 35,712 AI/AN primary care patients.

MAIN FINDINGS: At least one HCV-associated ICD-9 code was recorded in 251 (1%) patients between October 1, 2001 and September 30, 2003. An HCV enzyme-linked immunoassay (HCVEIA) was sent in 209 (83.0%); 206/209 (99%) were positive. Confirmatory testing was performed in 144/206 (70%) HCV-EIA positive patients; HCV infection was confirmed in 144 (100%). In the 90/144 (63%) charts with risk factor documentation, injection drug use …

Tribally-Driven Participatory Research: State Of The Practice And Potential Strategies For The Future, Patricia Mariella, Eddie Brown, Michael Carter, Vanessa Verri

Journal of Health Disparities Research and Practice

This paper discusses current practice of research with and by American Indian tribal governments in the United States. It begins with a brief overview of Community-Based Participatory Research and compares and contrasts its principles and methods with what this paper terms Tribally-Driven Participatory Research. The paper analyzes current challenges and offers concepts for continuing to improve the effectiveness of Tribally-Driven Participatory Research.

Talking Glossary Of Genomics Terminology: A Genomics Education Module For American Indian Communities, Jill Peters, Pauline Davies, Naomi Lane, Kathryn Coe

Journal of Health Disparities Research and Practice

This paper describes the development of an audio visual genomics glossary that was designed as an education tool for American Indian communities. This “Talking Glossary of Genomics Terminology” is a multimedia DVD that was modeled on the “Talking Glossary of Genetics,” which was developed by the National Human Genome Research Institute (NHGRI). The NHGRI Glossary was modified and expanded with content designed to increase awareness among American Indians about cancer, genomics, and personalized medicine. Partners on the project include the Inter Tribal Council of Arizona, Inc., Phoenix Indian Medical Center, Arizona Cancer Center at the University of Arizona, the Translational …

Beyond The It Magic Bullet: Hiv Prevention Education And Public Policy, Fay C. Payton

Journal of Health Disparities Research and Practice

Analytic applications are vital in the assessments of public health and surveillance as these applications can drive resource allocation, community assessment and public policy. Using a dataset of nearly 90,000 patient hospital encounters, the number of instances with an ICD code of HIV and co-morbidities was identified. Blacks accounted for 75 percent of HIV hospital encounters in the dataset. While business analytic applications informed this study of cross-tabulations and interaction effects among race, age and gender, there appears to be a significant relationship among HIV diagnoses and substance abuse. Payer data is informed by the Healthcare Cost and Utilization Project …