Medicine and Health Commons^™

An Innovative Approach For Community Engagement: Using An Audience Response System, Jenna L. Davis, Kara E. Mcginnis, Margaret L. Walsh, Coni Williams, Kevin B. Sneed, Julie A. Baldwin, B. Lee Green

Journal of Health Disparities Research and Practice

Community-based participatory research methods allow for community engagement in the effort to reduce cancer health disparities. Community engagement involves health professionals becoming a part of the community in order to build trust, learn from the community and empower them to reduce disparities through their own initiatives and ideas. Audience Response Systems (ARS) are an innovative and engaging way to involve the community and obtain data for research purposes using keypads to report results via power point. The use of ARS within communities is very limited and serves to widen the disparity gap by not delivering new advances in medical knowledge …

The Hiv/Aids Pandemic In African American Msm: Targets For Intervention, Kelly Neff

Journal of Health Disparities Research and Practice

The Centers for Disease Control and Prevention estimated in 2005 that 46% of African American men who have sex with men (MSM) are HIV positive. This review explores the unique factors that contribute to risky sexual behavior and the spread of HIV within this population, suggesting that the disparate prevalence of HIV among African American MSM is rooted in experiences of stigmatization from multiple sources and lack of social support from society at large as well as from within the African American community. Beliefs in HIV conspiracy myths are also thought to hinder HIV education, awareness and prevention for African …

Racial Differences In Preventive And Complementary Health Behaviors And Attitudes, Steven E. Shive, Grace X. Ma, Yin Tan, Jamil I. Toubbeh, Lalitha Parameswaran, Lalitha Parameswaran, Joe Halowich

Journal of Health Disparities Research and Practice

Screening tests have been developed for many diseases—the presence of cancer, especially—but are differentially utilized among racial/ethnic groups. In addition to standard medical screening techniques, some patients opt to use Complementary and Alternative Medicine (CAM) for prevention and treatment. The purpose of the current study is to examine racial/ethnic disparities in primary and secondary preventive health behaviors, determine differences in use of complementary and alternative health regimens, and determine which health attitudes and health self-management factors are associated with use of complementary alternative medicine. If differences among ethnic/racial groups in perceived health status, preventive health care behaviors, and use of …

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 …

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 …

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 …

Process Evaluation In Action: Lessons Learned From Alabama Reach 2010, M. C. Nagy, Rhoda E. Johnson, Robin C. Vanderpool, Mona N. Fouad, Mark Dignan, Theresa A. Wynn, Edward E. Patridge, Isabel Scarinci, Cheryl Holt, Sharina D. Person

Journal of Health Disparities Research and Practice

The CDC-funded Alabama Racial and Ethnic Approaches to Community Health (REACH 2010) project is designed to reduce and eliminate disparities in breast and cervical cancer between African American and white women in six rural and three urban counties in Alabama. In this manuscript, we report on the development, implementation, results, and lessons learned from a process evaluation plan initiated during the Phase I planning period of the Alabama REACH 2010 program. The process evaluation plan for Alabama REACH 2010 focused on four main areas of activity that coincided with program objectives: assessing coalition development, building community capacity, conducting a needs …

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 …

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. …

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 …

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 …

Health Disparities In Kidney Transplantation: An Equity Analysis, Shirley A. Wells

Journal of Health Disparities Research and Practice

The growing incidence of end stage renal disease along with advances of the past 40 years that have improved the success rate of kidney transplantation have created an unprecedented demand for kidney transplant. Yet, certain racial and ethnic groups and women consistently have longer waiting times and lower rates of transplantation which makes a review of the kidney procurement and transplantation system in view of its equity imperative. Reasons given for these disparities have varied from cultural attitudes and beliefs on the part of patients and health care providers, socioeconomic status, rates of organ donation, and geographic location. The equity …

A Review Of Smoking Among Rural African Americans: Recommendations For Research And Cessation Interventions, Susan Hedgecock, Anita Fernander

Journal of Health Disparities Research and Practice

Objective: The purpose of this review is to synthesize the available literature on smoking among rural African Americans.

Methods: Using search terms “rural” “African American” “Black” and “smoking” 19 relevant articles were identified in the Medline data base. Findings gleaned from the 19 articles are presented in four categories: a) smoking prevalence, b) smoking behavior and patterns, c) smoking cessation interventions and quitting, and d) smoking-related outcomes.

Results: There may be gender differences, a pattern of late onset of smoking, and a preference for mentholated brands among rural African American smokers. There is no evidence that rural African Americans are …

Differential Effects Of Race And Poverty On Ambulatory Care Sensitive Conditions, Farrukh B. Hakeem, Daniel L. Howard, Timothy S. Carey, Yhenneko J. Taylor

Journal of Health Disparities Research and Practice

This study is a continuation of an earlier study that examined hospitalization rates for ambulatory care sensitive (ACS) conditions, as a proxy for quality of care, and found evidence of a racial disparity among African American and White Medicare beneficiaries. The current study sought to determine whether neighborhood socioeconomic status (SES) explained this disparity. Differences in rates of ACS hospitalizations by race were assessed using Cochran-Mantel Haenszel tests and Poisson regression. Unadjusted rate ratios for ACS hospitalization for African Americans vs. Whites were found to be higher in low poverty areas (rate ratio (RR)=1.13; 95% CI (1.08, 1.17)) than in …

Inflammatory Biomarkers And Subclinical Atherosclerosis In African-American Women With Systemic Lupus Erythematosus (Sle), Edith Williams, Carlos Crespo, Joan Dorn

Journal of Health Disparities Research and Practice

Women with lupus are at increased risk for developing cardiovascular disease (CVD). Previous studies of atherosclerosis in SLE have not been representative of the minority groups most affected by lupus and its complications. Therefore, a study of 41 lupus cases and 83 controls was conducted to investigate the relationship between carotid atherosclerosis and inflammation in African-American women. Participation consisted of a questionnaire, physical examination, fasting blood draw, and ultrasound of the carotid arteries. There were observed differences between cases and controls with regard to carotid intima media thickness (IMT) and traditional cardiovascular risk factors, although few reached statistical significance. Tumor …

A Human Capital Approach To Reduce Health Disparities, Saundra Glover, Sudha Xirasagar, Yunho Jeon, Keith Elder, Crystal N. Piper, Harris Pastides

Journal of Health Disparities Research and Practice

Objective: To introduce a human capital approach to reduce health disparities in South Carolina by increasing the number and quality of trained minority professionals in public health practice and research.

Methods: The conceptual basis and elements of Project EXPORT in South Carolina are described. Project EXPORT is a community based participatory research (CBPR) translational project designed to build human capital in public health practice and research. This project involves Claflin University (CU), a Historically Black College University (HBCU) and the African American community of Orangeburg, South Carolina to reduce health disparities, utilizing resources from the University of South Carolina (USC), …

Worry About Medical Care, Family Support, And Depression Of The Elders In Urban China, Rongjun Sun

Rongjun Sun

This study examines the role of family support in reducing the elders’s depression in the face of the perceived inadequate public medical care in urban China. Using data from the Survey on Aging and Intergenerational Relations in Baoding City, this article investigates the overall depression level, somatic symptoms, and affective symptoms, respectively. The findings suggest that perceived inadequate public medical care, which results from dramatic changes in China’s socioeconomic transformation, has a stressful impact on all measures of depression. Family support, by its structure and function, shows both direct and moderating effects in counteracting such stress from the public domain. …

Assessment Of Pneumonia In Older Adults: Effect Of Functional Status, Lona Mody, Rongjun Sun, Suzanne F. Bradley

Rongjun Sun

OBJECTIVES: Evaluate the effect of preadmission functional status on severity of pneumonia, length of hospital stay (LOS), and all-cause 30-day and 1-year mortality of adults aged 60 and older and to understand the effect of pneumonia on short-term functional impairment. DESIGN: Prospective cohort study. SETTING: University hospital. PARTICIPANTS: One hundred twelve patients with radiograph-proven pneumonia (mean age 74.6) were enrolled. MEASUREMENTS: Functional status and comorbidities were assessed using the Functional Autonomy Measurement System (SMAF) and Charlson Comorbidity Index. Clinical information was used to calculate the Pneumonia Prognostic Index (PPI). RESULTS: Eighty-four (75%) patients were functionally independent (FI) before admission, with …

The Influence Of Neighborhood Characteristics On The Existence Of Asthma In Children, Elizabeth Adejuyigbe

Annual Undergraduate Conference on Health and Society

Asthma is one of the leading chronic diseases in children 17 years of age and under with nine million American children suffering from it. Previous studies to understand causal factors of disease including asthma tend to focus on the individual and sociocultural characteristics but there is little to no research using neighborhood characteristics, a factor that does influence health. Research shows that other community‐level environmental factors like collective efficacy, community structural factors, and neighborhood safety can affect a persons’ psychosocial well-being, and in turn increase morbidity. For this reason, researchers suggest that the need to understand asthma and its associated …