WorldWideScience

Sample records for ethnic health disparities

  1. Do wealth disparities contribute to health disparities within racial/ethnic groups?

    Science.gov (United States)

    Pollack, Craig Evan; Cubbin, Catherine; Sania, Ayesha; Hayward, Mark; Vallone, Donna; Flaherty, Brian; Braveman, Paula A

    2013-05-01

    Though wide disparities in wealth have been documented across racial/ethnic groups, it is largely unknown whether differences in wealth are associated with health disparities within racial/ethnic groups. Data from the Survey of Consumer Finances (2004, ages 25-64) and the Health and Retirement Survey (2004, ages 50+), containing a wide range of assets and debts variables, were used to calculate net worth (a standard measure of wealth). Among non-Hispanic black, Hispanic and non-Hispanic white populations, we tested whether wealth was associated with self-reported poor/fair health status after accounting for income and education. Except among the younger Hispanic population, net worth was significantly associated with poor/fair health status within each racial/ethnic group in both data sets. Adding net worth attenuated the association between education and poor/fair health (in all racial/ethnic groups) and between income and poor/fair health (except among older Hispanics). The results add to the literature indicating the importance of including measures of wealth in health research for what they may reveal about disparities not only between but also within different racial/ethnic groups.

  2. Health Benefits Mandates and Their Potential Impacts on Racial/Ethnic Group Disparities in Insurance Markets.

    Science.gov (United States)

    Charles, Shana Alex; Ponce, Ninez; Ritley, Dominique; Guendelman, Sylvia; Kempster, Jennifer; Lewis, John; Melnikow, Joy

    2017-08-01

    Addressing racial/ethnic group disparities in health insurance benefits through legislative mandates requires attention to the different proportions of racial/ethnic groups among insurance markets. This necessary baseline data, however, has proven difficult to measure. We applied racial/ethnic data from the 2009 California Health Interview Survey to the 2012 California Health Benefits Review Program Cost and Coverage Model to determine the racial/ethnic composition of ten health insurance market segments. We found disproportional representation of racial/ethnic groups by segment, thus affecting the health insurance impacts of benefit mandates. California's Medicaid program is disproportionately Latino (60 % in Medi-Cal, compared to 39 % for the entire population), and the individual insurance market is disproportionately non-Latino white. Gender differences also exist. Mandates could unintentionally increase insurance coverage racial/ethnic disparities. Policymakers should consider the distribution of existing racial/ethnic disparities as criteria for legislative action on benefit mandates across health insurance markets.

  3. Epidemiology, Policy, and Racial/Ethnic Minority Health Disparities

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    Carter-Pokras, Olivia; Offutt-Powell, Tabatha; Kaufman, Jay S.; Giles, Wayne; Mays, Vickie

    2013-01-01

    Purpose Epidemiologists have long contributed to policy efforts to address health disparities. Three examples illustrate how epidemiologists have addressed health disparities in the U.S. and abroad through a “social determinants of health” lens. Methods To identify examples of how epidemiologic research has been applied to reduce health disparities, we queried epidemiologists engaged in disparities research in the U.S., Canada, and New Zealand, and drew upon the scientific literature. Results Resulting examples covered a wide range of topic areas. Three areas selected for their contributions to policy were: 1) epidemiology's role in definition and measurement, 2) the study of housing and asthma, and 3) the study of food policy strategies to reduce health disparities. While epidemiologic research has done much to define and quantify health inequalities, it has generally been less successful at producing evidence that would identify targets for health equity intervention. Epidemiologists have a role to play in measurement and basic surveillance, etiologic research, intervention research, and evaluation research. However, our training and funding sources generally place greatest emphasis on surveillance and etiologic research. Conclusions: The complexity of health disparities requires better training for epidemiologists to effectively work in multidisciplinary teams. Together we can evaluate contextual and multilevel contributions to disease and study intervention programs in order to gain better insights into evidenced-based health equity strategies. PMID:22626003

  4. Racial and ethnic disparities in children's oral health: the National Survey of Children's Health.

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    Dietrich, Thomas; Culler, Corinna; Garcia, Raul I; Henshaw, Michelle M

    2008-11-01

    The authors evaluated racial/ethnic differences and their socioeconomic determinants in the oral health status of U.S. children, as reported by parents. The authors used interview data from the 2003 National Survey of Children's Health, a large representative survey of U.S. children. They calculated weighted, nationally representative prevalence estimates for non-Hispanic whites, non-Hispanic blacks and Hispanics, and they used logistic regression to explore the association between parents' reports of fair or poor oral health and various socioeconomic determinants of oral health. The results showed significant racial/ethnic differences in parental reports of fair or poor oral health, with prevalences of 6.5 percent for non-Hispanic whites, 12.0 percent for non-Hispanic blacks and 23.4 percent for Hispanics. Although adjustments for family socioeconomic status (poverty level and education) partially explained these racial/ethnic disparities, Hispanics still were twice as likely as non-Hispanic whites to report their children's oral health as fair or poor, independent of socioeconomic status. The authors did find differences in preventive-care attitudes among groups. However, in multivariate models, such differences did not explain the disparities. Significant racial/ethnic disparities exist in parental reports of their children's oral health, with Hispanics being the most disadvantaged group. Disparities appear to exist independent of preventive-care attitudes and socioeconomic status.

  5. Racial Ethnic Health Disparities: A Phenomenological Exploration of African American with Diabetes Complications

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    Okombo, Florence A.

    2017-01-01

    Racial/ethnic minority groups experience a higher mortality rate, a lower life expectancy, and worse mental health outcomes than non-Hispanic in the United States. There is a scarcity of qualitative studies on racial/ethnic health disparities. The purpose of this hermeneutic phenomenological study was to explore the personal experiences,…

  6. Racial/ethnic disparities and culturally competent health care among youth and young men.

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    Vo, Dzung X; Park, M Jane

    2008-06-01

    Racial/ethnic disparities in health and health care are receiving increasing national attention from the fields of public health and medicine. Efforts to reduce disparities should adopt a life-span approach and recognize the role of gender. During adolescence, young people make increasingly independent decisions about health-related behavior and health care, while developing gender identity. Little is known about how cultural context shapes gender identity and gender identity's influence on health-related behavior and health care utilization. The authors review disparities in health status and health care among adolescents, especially young men, by reviewing health care access, clinical services, and issues related to culture, identity, and acculturation. Significant differences in health status by gender exist in adolescence, with young men faring worse on many health markers. This article discusses gaps in research and offers recommendations for improving health care quality and strengthening the research base on gender and disparities during adolescence.

  7. Understanding ethnic/racial health disparities in youth and families in the US.

    Science.gov (United States)

    Carlo, Gustavo; Crockett, Lisa J; Carranza, Miguel A; Martinez, Miriam M

    2011-01-01

    To summarize, ethnic and social class disparities are evident across a spectrum of markers of psychological, behavioral, and physical health. Furthermore, the pattern is often complex such that disparities are sometimes found within ethnic/racial groups as well as across those groups. Indeed, it is likely that the causes of health disparities may be different across specific subgroups. Moreover, theoretical models are needed that examine biological, contextual, and person-level variables (including culture-specific variables) to account for health disparities. The scholars in the present volume provide exemplary research that moves us towards more comprehensive and integrative models of health disparities. A brief glance at the work summarized by these scholars yields some common elements of focus for future researchers regarding risk (e.g., poverty, lack of contextual diversity) and protective (e.g., family support, cultural identity) factors yet they also identify aspects (e.g., genetic vulnerabilities) that may be unique to specific ethnic/racial groups. In addition to employing more integrative and culturally sensitive models of health disparities, future research studies could expand the scope of investigation to include transnational studies of health disparities and the processes contributing to them. They might also consider culture-specific health problems and syndromes such as "nervios" in Latino cultures. Within nations, further attention might be directed to the community contexts in which ethnic minority and low SES families reside, not only urban areas but the much less studied rural areas. Finally, efforts to assess health disparities and the factors contributing to them across cultural and ethnic groups need to attend closely to the issue of measurement equivalence in order to ensure valid cross-group comparisons. We would add that future research on health disparities will need to examine markers of positive health outcomes and well being (e

  8. Measuring Racial and Ethnic Disparities in Health Care: Efforts to Improve Data Collection.

    OpenAIRE

    Patricia Collins Higgins; Erin Fries Taylor

    2009-01-01

    Disparities in the quality of health care contribute to higher rates of disease, disability, and mortality in racial and ethnic minority groups. A new policy brief examines recent federal and state activities aimed at strengthening the collection of health-related data on race, ethnicity, and primary language. It highlights three states—California, Massachusetts, and New Jersey—that implemented laws or regulations guiding data collection activities by hospitals, health plans, and governme...

  9. Social Determinants of Racial/Ethnic Health Disparities in Children and Adolescents

    Science.gov (United States)

    Price, James H.; McKinney, Molly A.; Braun, Robert E.

    2011-01-01

    Too many racial/ethnic minorities do not reach their full potential for a healthy and rewarding life. This paper addresses the social determinants that impact, either directly or indirectly, child and adolescent health disparities. Understanding the role social determinants play in the life course of health status can help guide educational…

  10. Health Disparities and Relational Well-Being between Multi- and Mono-Ethnic Asian Americans

    Science.gov (United States)

    Zhang, Wei

    2013-01-01

    Focusing on Hawaii, a state with 21.3% of the population being multi-racial according to the 2010 U.S. Census, this study aims to examine the existence and nature of health disparities between mono- and multi-ethnic Asian Americans and the importance of Relational Well-Being in affecting the health of Asian Americans. A series of ordinary least…

  11. Factors influencing the effectiveness of interventions to reduce racial and ethnic disparities in health care.

    Science.gov (United States)

    Jones, Rhys G; Trivedi, Amal N; Ayanian, John Z

    2010-02-01

    Reducing racial and ethnic disparities in health care has become an important policy goal in the United States and other countries, but evidence to inform interventions to address disparities is limited. The objective of this study was to identify important dimensions of interventions to reduce health care disparities. We used qualitative research methods to examine interventions aimed at improving diabetes and/or cardiovascular care for patients from racial and ethnic minority groups within five health care organizations. We interviewed 36 key informants and conducted a thematic analysis to identify important features of these interventions. Key elements of interventions included two contextual factors (external accountability and alignment of incentives to reduce disparities) and four factors related to the organization or intervention itself (organizational commitment, population health focus, use of data to inform solutions, and a comprehensive approach to quality). Consideration of these elements could improve the design, implementation, and evaluation of future interventions to address racial and ethnic disparities in health care. Copyright 2009 Elsevier Ltd. All rights reserved.

  12. Racial and ethnic health disparities: evidence of discrimination's effects across the SEP spectrum.

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    D'Anna, Laura Hoyt; Ponce, Ninez A; Siegel, Judith M

    2010-04-01

    Perceived discrimination is a psychosocial stressor that plays a role in explaining racial/ethnic disparities in self-reported physical and mental health. The purpose of this paper is: (1) to investigate the association between perceived discrimination in receiving healthcare and racial/ethnic disparities in self-rated health status, physical, and emotional functional limitations among a diverse sample of California adults; (2) to assess whether discrimination effects vary by racial/ethnic group and gender; and (3) to evaluate how the effects of discrimination on health are manifest across the socioeconomic position (SEP) spectrum. Data were drawn from the 2001 California Health Interview Survey adult file (n=55,428). The analytic approach employed multivariate linear and logistic regressions. Discrimination is qualitatively identified into two types: (1) discrimination due to race/ethnicity, language, or accent, and (2) other discrimination. Findings show that both types of discrimination negatively influenced self-rated health, and were associated with a two to three-fold odds of limitations in physical and emotional health. Further, these effects varied by racial/ethnic group and gender, and the effects were mixed. Most notably, for emotional health, racial/ethnic discrimination penalized Latinas more than non-Latina Whites, but for physical health, other discrimination was less detrimental to Latinas than it was to non-Latina Whites. At higher levels of SEP, the effects of racial/ethnic discrimination on self-rated health and other discriminations' effects on physical health were attenuated. Higher SEP may serve as an important mitigator, particularly when comparing the medium to the low SEP categories. It is also possible that SEP effects cannot be extracted from the relationships of interest in that SEP is an expression of social discrimination. In fact, negative health effects associated with discrimination are evident across the SEP spectrum. This study

  13. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care.

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    Betancourt, Joseph R; Green, Alexander R; Carrillo, J Emilio; Ananeh-Firempong, Owusu

    2003-01-01

    Racial/ethnic disparities in health in the U.S. have been well described. The field of "cultural competence" has emerged as one strategy to address these disparities. Based on a review of the relevant literature, the authors develop a definition of cultural competence, identify key components for intervention, and describe a practical framework for implementation of measures to address racial/ethnic disparities in health and health care. The authors conducted a literature review of academic, foundation, and government publications focusing on sociocultural barriers to care, the level of the health care system at which a given barrier occurs, and cultural competence efforts that address these barriers. Sociocultural barriers to care were identified at the organizational (leadership/workforce), structural (processes of care), and clinical (provider-patient encounter) levels. A framework of cultural competence interventions--including minority recruitment into the health professions, development of interpreter services and language-appropriate health educational materials, and provider education on cross-cultural issues--emerged to categorize strategies to address racial/ethnic disparities in health and health care. Demographic changes anticipated over the next decade magnify the importance of addressing racial/ethnic disparities in health and health care. A framework of organizational, structural, and clinical cultural competence interventions can facilitate the elimination of these disparities and improve care for all Americans.

  14. A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care.

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    Chin, Marshall H; Clarke, Amanda R; Nocon, Robert S; Casey, Alicia A; Goddu, Anna P; Keesecker, Nicole M; Cook, Scott C

    2012-08-01

    Over the past decade, researchers have shifted their focus from documenting health care disparities to identifying solutions to close the gap in care. Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation, is charged with identifying promising interventions to reduce disparities. Based on our work conducting systematic reviews of the literature, evaluating promising practices, and providing technical assistance to health care organizations, we present a roadmap for reducing racial and ethnic disparities in care. The roadmap outlines a dynamic process in which individual interventions are just one part. It highlights that organizations and providers need to take responsibility for reducing disparities, establish a general infrastructure and culture to improve quality, and integrate targeted disparities interventions into quality improvement efforts. Additionally, we summarize the major lessons learned through the Finding Answers program. We share best practices for implementing disparities interventions and synthesize cross-cutting themes from 12 systematic reviews of the literature. Our research shows that promising interventions frequently are culturally tailored to meet patients' needs, employ multidisciplinary teams of care providers, and target multiple leverage points along a patient's pathway of care. Health education that uses interactive techniques to deliver skills training appears to be more effective than traditional didactic approaches. Furthermore, patient navigation and engaging family and community members in the health care process may improve outcomes for minority patients. We anticipate that the roadmap and best practices will be useful for organizations, policymakers, and researchers striving to provide high-quality equitable care.

  15. Bridging the digital divide in health care: the role of health information technology in addressing racial and ethnic disparities.

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    López, Lenny; Green, Alexander R; Tan-McGrory, Aswita; King, Roderick; Betancourt, Joseph R

    2011-10-01

    Racial and ethnic disparities in health care have been consistently documented in the diagnosis, treatment, and outcomes of many common clinical conditions. There has been an acceleration of health information technology (HIT) implementation in the United States, with health care reform legislation including multiple provisions for collecting and using health information to improve and monitor quality and efficiency in health care. Despite an uneven and generally low level of implementation, research has demonstrated that HIT has the potential to improve quality of care and patient safety. If carefully designed and implemented, HIT also has the potential to eliminate disparities. Several root causes for disparities are amenable to interventions using HIT, particularly innovations in electronic health records, as well as strategies for chronic disease management. Recommendations regardinghealth care system, provider, and patient factors can help health care organizations address disparities as they adopt, expand, and tailor their HIT systems. In terms of health care system factors, organizations should (1) automate and standardize the collection of race/ethnicity and language data, (2) prioritize the use of the data for identifying disparities and tailoring improvement efforts, (3) focus HIT efforts to address fragmented care delivery for racial/ethnic minorities and limited-English-proficiency patients, (4) develop focused computerized clinical decision support systems for clinical areas with significant disparities, and (5) include input from racial/ethnic minorities and those with limited English proficiency in developing patient HIT tools to address the digital divide. As investments are made in HIT, consideration must be given to the impact that these innovations have on the quality and cost of health care for all patients, including those who experience disparities.

  16. Ethnic Disparities in Oral Health Related Quality of Life among Adults in London, England.

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    Abdelrahim, R; Delgado-Angulo, E K; Gallagher, J E; Bernabé, E

    2017-06-01

    To explore ethnic disparities in oral health related quality of life (OHQoL) among adults, and the role that socioeconomic factors play in that association. Data from 705 adults from a socially deprived, ethnically diverse metropolitan area of London (England) were analysed for this study. Ethnicity was self-assigned based on the 2001 UK Census categories. OHQoL was measured using the Oral Health Impact Profile (OHIP-14), which provides information on the prevalence, extent and intensity of oral impacts on quality of life in the previous 12 months. Ethnic disparities were assessed in logistic regression models for prevalence of oral impacts and negative binomial regression models for extent and intensity of oral impacts. The prevalence of oral impacts was 12.7% (95% CI: 10.2-15.1) and the mean OHIP-14 extent and severity scores were 0.27 (95% CI: 0.20-0.34) and 4.19 (95% CI: 3.74-4.64), respectively. Black adults showed greater and Asian adults lower prevalence, extent and severity of oral impacts than White adults. However, significant differences were only found for the extent of oral impacts; Black adults reporting more and Asian adults fewer OHIP-14 items affected than their White counterparts. After adjustments for socioeconomic factors, Asian adults had significantly fewer OHIP-14 items affected than White adults (rate ratio: 0.28; 95%CI: 0.08-0.94). This study found disparities in OHQoL between the three main ethnic groups in South East London. Asian adults had better and Black adults had similar OHQoL than White adults after accounting for demographic and social factors. Copyright© 2017 Dennis Barber Ltd.

  17. Health Disparities

    Science.gov (United States)

    ... Health and Health Disparities conduct transdisciplinary research involving social, behavioral, biological, and genetic research to improve knowledge of the causes of health disparities and devise effective methods of preventing, diagnosing, and treating disease and promoting ...

  18. Can the Medical Home eliminate racial and ethnic disparities for transition services among Youth with Special Health Care Needs?

    Science.gov (United States)

    Richmond, Nicole E; Tran, Tri; Berry, Susan

    2012-05-01

    The Medical Home (MH) is shown to improve health outcomes for Youth with Special Health Care Needs (YSHCN). Some MH services involve Transition from pediatric to adult providers to ensure YSHCN have continuous care. Studies indicate racial/ethnic disparities for Transition, whereas the MH is shown to reduce health disparities. This study aims to (1) Determine the Transition rate for YSHCN with a MH (MH Transition) nationally, and by race/ethnicity (2) Identify which characteristics are associated with MH Transition (3) Determine if racial/ethnic disparities exist after controlling for associated characteristics, and (4) Identify which characteristics are uniquely associated with each race/ethnic group. National survey data were used. YSCHN with a MH were grouped as receiving Transition or not. Characteristics included race, ethnicity (Non-Hispanic (NH), Hispanic), sex, health condition effect, five special health care need categories, education, poverty, adequate insurance, and urban/rural residence. Frequencies, chi-square, and logistic regression were used to calculate rates and define associations. Alpha was set to 0.05. About 57.0% of YSHCN received MH Transition. Rates by race/ethnicity were 59.0, 45.5, 60.2, 41.9, and 44.6% for NH-White, NH-Black, NH-Multiple race, NH-Other, and Hispanic YSHCN, respectively. Disparities remained between NH-White and NH-Black YSHCN. All characteristics except urban/rural status were associated. Adequate insurance was associated for all race/ethnic groups, except NH-Black YSHCN. Almost 57.0% of YSHCN received MH Transition. Disparities remained. Rates and associated characteristics differed by race/ethnic group. Culturally tailored interventions incorporating universal factors to improve MH Transition outcomes are warranted.

  19. Socioeconomic and racial/ethnic oral health disparities among US older adults: oral health quality of life and dentition.

    Science.gov (United States)

    Huang, Deborah L; Park, Mijung

    2015-01-01

    This study aims to examine if older adults living in poverty and from minority racial/ethnic groups experienced disproportionately high rates of poor oral health outcomes measured by oral health quality of life (OHQOL) and number of permanent teeth. Cross-sectional analysis of 2,745 community-dwelling adults aged ≥65 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2008. Oral health outcomes were assessed by questionnaire using the NHANES-Oral Health Impact Profile for OHQOL and standardized examination for dentition. Logistic and linear regression analyses were used to determine the association between oral health outcomes and predictors of interest. All analyses were weighted to account for complex survey sampling methods. Both poverty and minority race/ethnicity were significantly associated with poor oral health outcomes in OHQOL and number of permanent teeth. Distribution of scores for each OHQOL domain varied by minority racial/ethnic group. Oral health disparities persist in older adults living in poverty and among those from minority racial/ethnic groups. The racial/ethnic variation in OHQOL domains should be further examined to develop interventions to improve the oral health of these groups. © 2014 American Association of Public Health Dentistry.

  20. Dietary supplement use in the context of health disparities: cultural, ethnic and demographic determinants of use.

    Science.gov (United States)

    Jasti, Sunitha; Siega-Riz, Anna Maria; Bentley, Margaret E

    2003-06-01

    Women of African American, Hispanic, Asian, Pacific Islander, Native American and Alaskan descent constitute 29% of the female population in the United States but they experience health problems disproportionately. Compared with white women as a group, they are in poorer health and use fewer health services. We know from recent studies that the daily use of multivitamins has been associated with lower risk of coronary disease, colon cancer and breast cancer, particularly for alcohol drinkers. In addition, daily multivitamin and multimineral usage by the elderly can reduce the number of days of illness due to infections by 50%. However, supplement use among women tends to be more prevalent among the middle and older age categories; white, well-educated and higher income women; and those residing in the western part of the United States. This examination of the current health disparities and usage patterns indicates that the women who could benefit most from supplements are not typical users. Qualitative data collected on iron and folic acid supplementation programs in developing countries indicate that diverse cultural practices, attitudes and beliefs among vulnerable populations may influence supplement use. However, data in the U.S literature that describe these factors by culture or ethnicity are sparse. If we are to promote dietary supplements to women who are most vulnerable, more research is warranted in the area of health beliefs, attitudes and sociodemographic determinants of supplement use by culture and or ethnicity, particularly among underprivileged groups.

  1. ETHNIC DISPARITIES IN HEALTH-RELATED QUALITY OF LIFE AMONG OLDER RURAL ADULTS WITH DIABETES

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    Quandt, Sara A.; Graham, Christopher N.; Bell, Ronny A.; Snively, Beverly M.; Golden, Shannon L.; Stafford, Jeanette M.; Arcury, Thomas A.

    2008-01-01

    Diabetes mellitus disproportionately affects ethnic minorities and has serious economic, social, and personal implications. This study examines the effect of diabetes disease burden and social resources on health-related quality of life (HRQOL) among older rural adults with diabetes. Data come from a population-based cross-sectional survey of 701 adults (age ≥65 years) with diabetes in North Carolina from three ethnic groups: African American, Native American, and White. HRQOL was assessed using the 12-item short-form health survey (SF-12). Mean scores were 35.1 ± 11.4 and 50.5 ± 10.8 for the physical and mental components of the SF-12, respectively. In bivariate analyses, scores were significantly lower for Native Americans than Whites for both components. In multivariate analyses, higher physical HRQOL was associated with male sex, greater mobility ability, fewer chronic conditions, exercising vs not exercising, fewer depressive symptoms, and not receiving process assistance. Higher mental HRQOL was associated with greater mobility ability, fewer chronic conditions, and a high school education or more. Diabetes appears to have a substantial effect on physical HRQOL. Physical disability associated with diabetes may have a greater impact in the rural environment than in other areas. Aspects of rural social milieu may help to keep mental HRQOL high, even in the face of severe chronic disease. Ethnic differences in HRQOL are largely accounted for by diabetes disease burden and, to a lesser extent, social resources. Strategies to reduce diabetes-related complications (long term) and assist mobility (short term) may reduce ethnic disparities in HRQOL. (Ethn Dis. 2007;17:471–476) PMID:17985500

  2. Development of an attribution of racial/ethnic health disparities scale.

    Science.gov (United States)

    Price, James H; Braun, Robert E; Khubchandani, Jagdish; Payton, Erica; Bhattacharjee, Prasun

    2014-08-01

    The purpose of this study was to develop an Attribution of Racial/Ethnic Health Disparities (AREHD) scale. A convenience sample of undergraduate college students (n = 423) at four Midwestern universities was recruited to respond to the survey. A pilot test with undergraduate students (n = 23) found the survey had good acceptability and readability level (SMOG = 11th grade). Using exploratory factor analysis we found the two a priori subscales were confirmed: individual responsibility and social determinants. Internal reliabilities of the subscales were: individual responsibility (alpha = 0.87) and social determinants (alpha = 0.90). Test-retest stability reliabilities were: individual responsibility (r = 0.72) and social determinants (r = 0.69). The AREHD subscales are satisfactory for assessing college student's AREHD.

  3. The influence of active coping and perceived stress on health disparities in a multi-ethnic low income sample

    Directory of Open Access Journals (Sweden)

    Tomar Scott L

    2008-01-01

    Full Text Available Abstract Background Extensive research has shown that ethnic health disparities are prevalent and many psychological and social factors influence health disparities. Understanding what factors influence health disparities and how to eliminate health disparities has become a major research objective. The purpose of this study was to examine the impact of coping style, stress, socioeconomic status (SES, and discrimination on health disparities in a large urban multi-ethnic sample. Methods Data from 894 participants were collected via telephone interviews. Independent variables included: coping style, SES, sex, perceived stress, and perceived discrimination. Dependent variables included self-rated general and oral health status. Data analysis included multiple linear regression modeling. Results Coping style was related to oral health for Blacks (B = .23, p Conclusion Our results indicate that perceived stress is a critical component in understanding health outcomes for all ethnoracial groups. While SES related significantly to general health for Whites and Hispanics, this relationship was mediated by perceived stress. Active coping was associated only with oral health.

  4. Racial/Ethnic and socioeconomic disparities in mental health in Arizona

    Directory of Open Access Journals (Sweden)

    Luis Arturo Valdez

    2015-07-01

    Full Text Available Background: Mental health issues are a rapidly increasing problem in the United States. Little is known about mental health and healthcare among Arizona’s Hispanic population.Methods: We assess differences in mental health service need, mental health diagnoses and illicit drug use among 7,578 White and Hispanic participants in the 2010 Arizona Health Survey. Results: Prevalence of mild, moderate, or severe psychological distress was negatively associated with SES among both Whites and Hispanics. Overall, Hispanics were less likely than Whites to have been diagnosed with a mental health condition; however, diagnosis rates were negatively associated with SES among both populations. Hispanics had considerably lower levels of lifetime illicit drug use than their White counterparts. Illicit drug use increased with SES among Hispanics but decreased with SES among Whites. After adjustment for relevant socio-demographic characteristics, multivariable linear regression suggested that Hispanics have significantly lower Kessler scores than Whites. These differences were largely explained by lower Kessler scores among non-English proficient Hispanics relative to English-speaking populations. Moreover, logistic regression suggests that Hispanics, the foreign born, and the non-English language proficient have lower odds of lifetime illicit drug use than Whites, the US born, and the English-language proficient, respectively. Conclusions: The unique social and political context in Arizona may have important but understudied effects on the physical and mental health of Hispanics. Our findings suggest mental health disparities between Arizona Whites and Hispanics, which should be addressed via culturally- and linguistically-tailored mental health care. More observational and intervention research is necessary to better understand the relationship between race/ethnicity, socioeconomic status, healthcare, and mental health in Arizona.

  5. A Study of National Physician Organizations’ Efforts to Reduce Racial and Ethnic Health Disparities in the United States

    Science.gov (United States)

    Peek, Monica E.; Wilson, Shannon C.; Bussey-Jones, Jada; Lypson, Monica; Cordasco, Kristina; Jacobs, Elizabeth A.; Bright, Cedric; Brown, Arleen F.

    2012-01-01

    Purpose To characterize national physician organizations’ efforts to reduce health disparities and identify organizational characteristics associated with such efforts. Method This cross-sectional study was conducted between September 2009 and June 2010. The authors used two-sample t tests and chi-square tests to compare the proportion of organizations with disparity-reducing activities between different organizational types (e.g., primary care versus subspecialty organizations, small [5,000 members]). Inclusion criteria required physician organizations to be (1) focused on physicians, (2) national in scope, and (3) membership based. Results The number of activities per organization ranged from 0 to 22. Approximately half (53%) of organizations had 0 or 1 disparity-reducing activities. Organiza-tional characteristics associated with having at least 1 disparity-reducing effort included membership size (88% of large groups versus 58% of small groups had at least 1 activity; P = .004) and the presence of a health disparities committee (95% versus 59%; P organizations and racial/ethnic minority physician organizations were more likely to have disparity-reducing efforts, although findings were not statistically significant. Common themes addressed by activities were health care access, health care disparities, workforce diversity, and language barriers. Common strategies included education of physicians/trainees and patients/general public, position statements, and advocacy. Conclusions Despite the national priority to eliminate health disparities, more than half of national physician organizations are doing little to address this problem. Primary care and minority physician organizations, and those with disparities committees, may provide leadership to extend the scope of disparity-reduction efforts. PMID:22534593

  6. Racial/Ethnic Disparities in Chronic Diseases of Youths and Access to Health Care in the United States

    Directory of Open Access Journals (Sweden)

    James H. Price

    2013-01-01

    Full Text Available Racial/ethnic minorities are 1.5 to 2.0 times more likely than whites to have most of the major chronic diseases. Chronic diseases are also more common in the poor than the nonpoor and this association is frequently mediated by race/ethnicity. Specifically, children are disproportionately affected by racial/ethnic health disparities. Between 1960 and 2005 the percentage of children with a chronic disease in the United States almost quadrupled with racial/ethnic minority youth having higher likelihood for these diseases. The most common major chronic diseases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention-deficit/hyperactivity disorder, mental illness, cancers, sickle-cell anemia, cystic fibrosis, and a variety of genetic and other birth defects. This review will focus on the psychosocial rather than biological factors that play important roles in the etiology and subsequent solutions to these health disparities because they should be avoidable and they are inherently unjust. Finally, this review examines access to health services by focusing on health insurance and dental insurance coverage and access to school health services.

  7. Ethnic disparities in children's oral health: findings from a population-based survey of grade 1 and 2 schoolchildren in Alberta, Canada.

    Science.gov (United States)

    Shi, Congshi; Faris, Peter; McNeil, Deborah A; Patterson, Steven; Potestio, Melissa L; Thawer, Salima; McLaren, Lindsay

    2018-01-04

    Although oral health has improved remarkably in recent decades, not all populations have benefited equally. Ethnic identity, and in particular visible minority status, has been identified as an important risk factor for poor oral health. Canadian research on ethnic disparities in oral health is extremely limited. The aim of this study was to examine ethnic disparities in oral health outcomes and to assess the extent to which ethnic disparities could be accounted for by demographic, socioeconomic and caries-related behavioral factors, among a population-based sample of grade 1 and 2 schoolchildren (age range: 5-8 years) in Alberta, Canada. A dental survey (administered during 2013-14) included a mouth examination and parent questionnaire. Oral health outcomes included: 1) percentage of children with dental caries; 2) number of decayed, extracted/missing (due to caries) and filled teeth; 3) percentage of children with two or more teeth with untreated caries; and 4) percentage of children with parental-ratings of fair or poor oral health. We used multivariable regression analysis to examine ethnic disparities in oral health, adjusting for demographic, socioeconomic and caries-related behavioral variables. We observed significant ethnic disparities in children's oral health. Most visible minority groups, particularly Filipino and Arab, as well as Indigenous children, were more likely to have worse oral health than White populations. In particular, Filipino children had an almost 5-fold higher odds of having severe untreated dental problems (2 or more teeth with untreated caries) than White children. Adjustment for demographic, socioeconomic, and caries-related behavior variables attenuated but did not eliminate ethnic disparities in oral health, with the exception of Latin American children whose outcomes did not differ significantly from White populations after adjustment. Significant ethnic disparities in oral health exist in Alberta, Canada, even when adjusting for

  8. Stigma and Racial/Ethnic HIV Disparities: Moving toward Resilience

    Science.gov (United States)

    Earnshaw, Valerie A.; Bogart, Laura M.; Dovidio, John F.; Williams, David R.

    2013-01-01

    Prior research suggests that stigma plays a role in racial/ethnic health disparities. However, there is limited understanding about the mechanisms by which stigma contributes to HIV-related disparities in risk, incidence and screening, treatment, and survival and what can be done to reduce the impact of stigma on these disparities. We introduce…

  9. Disparities by ethnicity, language, and immigrant status in occupational health experiences among Las Vegas hotel room cleaners.

    Science.gov (United States)

    Premji, Stéphanie; Krause, Niklas

    2010-10-01

    We examined disparities in workers' occupational health experiences. We surveyed 941 unionized Las Vegas hotel room cleaners about their experiences with work-related pain and with employers, physicians, and workers' compensation. Data were analyzed for all workers and by ethnicity, language, and immigrant status. Hispanic and English as second language (ESL) workers were more likely than their counterparts to report work-related pain and, along with immigrant workers, to miss work because of this pain. Hispanic, ESL, and immigrant workers were not consistently at a disadvantage with regard to their own responses to work-related pain but were so with respect to reported responses by workers' compensation, physicians, and employers. There are indications of disparities in occupational health experiences within this job title. The use of different group classifications, while implying different mechanisms, produced similar results. © 2010 Wiley-Liss, Inc.

  10. Racial/Ethnic Disparities in Mental Health Care Utilization among U.S. College Students: Applying the Institution of Medicine Definition of Health Care Disparities.

    Science.gov (United States)

    Hunt, Justin B; Eisenberg, Daniel; Lu, Liya; Gathright, Molly

    2015-10-01

    The authors apply the Institute of Medicine's definition of health care disparities to college students. The analysis pools data from the first two waves of the Healthy Minds Study, a multicampus survey of students' mental health (N = 13,028). A probit model was used for any past-year service utilization, and group differences in health status were adjusted by transforming the entire distribution for each minority population to approximate the white distribution. Disparities existed between whites and all minority groups. Compared to other approaches, the predicted service disparities were greater because this method included the effects of mediating SES variables. Health care disparities persist in the college setting despite improved access and nearly universal insurance coverage. Our findings emphasize the importance of investigating potential sources of disparities beyond geography and coverage.

  11. Gender and ethnic health disparities among the elderly in rural Guangxi, China: estimating quality-adjusted life expectancy

    Directory of Open Access Journals (Sweden)

    Tai Zhang

    2016-11-01

    Full Text Available Background: Ethnic health inequalities for males and females among the elderly have not yet been verified in multicultural societies in developing countries. The aim of this study was to assess the extent of disparities in health expectancy among the elderly from different ethnic groups using quality-adjusted life expectancy. Design: A cross-sectional community-based survey was conducted. A total of 6,511 rural elderly individuals aged ≥60 years were selected from eight different ethnic groups in the Guangxi Zhuang Autonomous Region of China and assessed for health-related quality of life (HRQoL. The HRQoL utility value was combined with life expectancy at age 60 years (LE60 data by using Sullivan's method to estimate quality-adjusted life expectancy at age 60 years (QALE60 and loss in quality-adjusted life years (QALYs for each group. Results: Overall, LE60 and QALE60 for all ethnic groups were 20.9 and 18.0 years in men, respectively, and 24.2 and 20.3 years in women. The maximum gap in QALE60 between ethnic groups was 3.3 years in males and 4.6 years in females. The average loss in QALY was 2.9 years for men and 3.8 years for women. The correlation coefficient between LE60 and QALY lost was −0.53 in males and 0.12 in females. Conclusion: Women live longer than men, but they suffer more; men have a shorter life expectancy, but those who live longer are healthier. Attempts should be made to reduce suffering in the female elderly and improve longevity for men. Certain ethnic groups had low levels of QALE, needing special attention to improve their lifestyle and access to health care.

  12. Racial and Ethnic Disparities in Health and Health Care: an Assessment and Analysis of the Awareness and Perceptions of Public Health Workers Implementing a Statewide Community Transformation Grant in Texas.

    Science.gov (United States)

    Akinboro, Oladimeji; Ottenbacher, Allison; Martin, Marcus; Harrison, Roderick; James, Thomas; Martin, Eddilisa; Murdoch, James; Linnear, Kim; Cardarelli, Kathryn

    2016-03-01

    Little is known about the awareness of public health professionals regarding racial and ethnic disparities in health in the United States of America (USA). Our study objective was to assess the awareness and perceptions of a group of public health workers in Texas regarding racial health disparities and their chief contributing causes. We surveyed public health professionals working on a statewide grant in Texas, who were participants at health disparities' training workshops. Multivariable logistic regression was employed in examining the association between the participants' characteristics and their perceptions of the social determinants of health as principal causes of health disparities. There were 106 respondents, of whom 38 and 35 % worked in health departments and non-profit organizations, respectively. The racial/ethnic groups with the highest incidence of HIV/AIDS and hypertension were correctly identified by 63 and 50 % of respondents, respectively, but only 17, and 32 % were knowledgeable regarding diabetes and cancer, respectively. Seventy-one percent of respondents perceived that health disparities are driven by the major axes of the social determinants of health. Exposure to information about racial/ethnic health disparities within the prior year was associated with a higher odds of perceiving that social determinants of health were causes of health disparities (OR 9.62; 95 % CI 2.77, 33.41). Among public health workers, recent exposure to information regarding health disparities may be associated with their perceptions of health disparities. Further research is needed to investigate the impact of such exposure on their long-term perception of disparities, as well as the equity of services and programs they administer.

  13. Ethnic Disparities in Liver Transplantation

    OpenAIRE

    Kemmer, Nyingi

    2011-01-01

    End-stage liver disease is a major cause of morbidity and mortality among ethnic minorities. In the United States, ethnic minorities comprise approximately 30% of all adult liver transplantations performed annually. Several studies have suggested that ethnic populations differ with respect to access and outcomes in the pre- and post-transplantation setting. This paper will review the existing literature on ethnic variations in the adult liver transplantation population.

  14. Lifecourse approach to racial/ethnic disparities in childhood obesity.

    Science.gov (United States)

    Dixon, Brittany; Peña, Michelle-Marie; Taveras, Elsie M

    2012-01-01

    Eliminating racial/ethnic disparities in health and health care is a national priority, and obesity is a prime target. During the last 30 y in the United States, the prevalence of obesity among children has dramatically increased, sparing no age group. Obesity in childhood is associated with adverse cardio-metabolic outcomes such as hypertension, hyperlipidemia, and type II diabetes and with other long-term adverse outcomes, including both physical and psychosocial consequences. By the preschool years, racial/ethnic disparities in obesity prevalence are already present, suggesting that disparities in childhood obesity prevalence have their origins in the earliest stages of life. Several risk factors during pregnancy are associated with increased risk of offspring obesity, including excessive maternal gestational weight gain, gestational diabetes, smoking during pregnancy, antenatal depression, and biological stress. During infancy and early childhood, rapid infant weight gain, infant feeding practices, sleep duration, child's diet, physical activity, and sedentary practices are associated with the development of obesity. Studies have found substantial racial/ethnic differences in many of these early life risk factors for childhood obesity. It is possible that racial/ethnic differences in early life risk factors for obesity might contribute to the high prevalence of obesity among minority preschool-age children and beyond. Understanding these differences may help inform the design of clinical and public health interventions and policies to reduce the prevalence of childhood obesity and eliminate disparities among racial/ethnic minority children.

  15. Minority Health and Health Disparities

    Science.gov (United States)

    ... ik People" People Awakening Resilience Project (PARP), Cuqyun "Measuring" Treatment and Health Services Research Alcohol Treatment and ... addressing Health Disparities . 1 2009-2013 Health Disparities Strategic Plan, p.4 2 Ibid, p.4 3 ...

  16. Perceived Health Status and Utilization of Specialty Care: Racial and Ethnic Disparities in Patients with Chronic Diseases

    Science.gov (United States)

    Glover, Saundra; Bellinger, Jessica D.; Bae, Sejong; Rivers, Patrick A.; Singh, Karan P.

    2010-01-01

    Objective: The objective of this study is to determine racial and ethnic variations in specialty care utilization based on (a) perceived health status and (b) chronic disease status. Methods: Variations in specialty care utilization, by perceived health and chronic disease status, were examined using the Commonwealth Fund Health Care Quality…

  17. Poverty and elimination of urban health disparities: challenge and opportunity.

    Science.gov (United States)

    Thomas, Stephen B; Quinn, Sandra Crouse

    2008-01-01

    The aim of this article is to examine the intersection of race and poverty, two critical factors fueling persistent racial and ethnic health disparities among urban populations. From the morass of social determinants that shape the health of racial and ethnic communities in our urban centers, we will offer promising practices and potential solutions to eliminating racial and ethnic health disparities.

  18. Self-rated health disparities among disadvantaged older adults in ethnically diverse urban neighborhoods in a Middle Eastern country.

    Science.gov (United States)

    Sibai, Abla Mehio; Rizk, Anthony; Chemaitelly, Hiam

    2017-10-01

    This paper examines differentials in self-rated health (SRH) among older adults (aged 60+ years) across three impoverished and ethnically diverse neighborhoods in post-conflict Lebanon and assesses whether variations are explained by social and economic factors. Data were drawn from the Older Adult Component (n = 740) of the Urban Health Survey, a population-based cross-sectional study conducted in 2003 in a formal community (Nabaa), an informal settlement (Hey El-Sellom), and a refugee camp for Palestinians (Burj El-Barajneh) in Beirut, Lebanon. The role of the social capital and economic security constructs in offsetting poor SRH was assessed using multivariate ordinal logistic regression analyses. Older adults in Nabaa fared better in SRH compared to those in Hey El-Sellom and Burj El-Barajneh, with a prevalence of good, average, and poor SRH being respectively, 41.5%, 37.0%, and 21.5% in Nabaa, 33.3%, 23.9%, and 42.7% in Hey El-Sellom, and 25.2%, 31.3%, and 43.5% in Burj El-Barajneh. The economic security construct attenuated the odds of poorer SRH in Burj El-Barajneh as compared to Nabaa from 2.57 (95% confidence interval, CI: 1.89-3.79) to 1.42 (95% CI: 0.96-2.08), but had no impact on this association in Hey El-Sellom (odds ratio, OR: 2.12, 95% CI: 1.39-3.24). The incorporation of the social capital construct in the fully adjusted model rendered this association insignificant in Hey El-Sellom (OR: 1.49, 95% CI: 0.96-2.32), and led to further reductions in the magnitude of the association in Burj El-Barajneh camp (OR: 1.18, 95% CI: 0.80-1.76). The social context in which older adults live and their financial security are key in explaining disparities in SRH in marginalized communities. Social capital and economic security, often overlooked in policy and public health interventions, need to be integrated in dimensions of well-being of older adults, especially in post-conflict settings.

  19. The Biology of Cancer Health Disparities

    Science.gov (United States)

    These examples show how biology contributes to health disparities (differences in disease incidence and outcomes among distinct racial and ethnic groups, ), and how biological factors interact with other relevant factors, such as diet and the environment.

  20. Ethnic and Racial Disparities in Education: Psychology's Role in Understanding and Reducing Disparities

    Science.gov (United States)

    Quintana, Stephen M.; Mahgoub, Lana

    2016-01-01

    We review the scope and sources of ethnic and racial disparities in education with a focus on the the implications of psychological theory and research for understanding and redressing these disparities. We identify 3 sources of ethnic and racial disparities including (a) social class differences, (b) differential treatment based on ethnic and…

  1. Literacy and Health Disparities

    Science.gov (United States)

    Prins, Esther; Mooney, Angela

    2014-01-01

    This chapter explores the relationship between literacy and health disparities, focusing on the concept of health literacy. Recommendations are provided for ways to bridge the health literacy gap for learners in adult basic education and family literacy programs.

  2. Racial and ethnic disparities in antidepressant drug use.

    Science.gov (United States)

    Chen, Jie; Rizzo, John A

    2008-12-01

    Little is known about racial and ethnic disparities in health care utilization, expenditures and drug choice in the antidepressant market. This study investigates factors associated with the racial and ethnic disparities in antidepressant drug use. We seek to determine the extent to which disparities reflect differences in observable population characteristics versus heterogeneity across racial and ethnic groups. Among the population characteristics, we are interested in identifying which factors are most important in accounting for racial and ethnic disparities in antidepressant drug use. Using Medical Expenditure Panel Survey (MEPS) data from 1996-2003, we have an available sample of 10,416 Caucasian, 1,089 African American and 1,539 Hispanic antidepressant drug users aged 18 to 64 years. We estimate individual out-of-pocket payments, total prescription drug expenditures, drug utilization, the probability of taking generic versus brand name antidepressants, and the share of drugs that are older types of antidepressants (e.g., TCAs and MAOIs) for these individuals during a calendar year. Blinder-Oaxaca decomposition techniques are employed to determine the extent to which disparities reflect differences in observable population characteristics versus unobserved heterogeneity across racial and ethnic groups. Caucasians have the highest antidepressant drug expenditures and utilization. African-Americans have the lowest drug expenditures and Hispanics have the lowest drug utilization. Relative to Caucasians and Hispanics, African-Americans are more likely to purchase generics and use a higher share of older drugs (e.g., TCAs and MAOIs). Differences in observable characteristics explain most of the racial/ethnic differences in these outcomes, with the exception of drug utilization. Differences in health insurance and education levels are particularly important factors in explaining disparities. In contrast, differences in drug utilization largely reflect unobserved

  3. The moral problem of health disparities.

    Science.gov (United States)

    Jones, Cynthia M

    2010-04-01

    Health disparities exist along lines of race/ethnicity and socioeconomic class in US society. I argue that we should work to eliminate these health disparities because their existence is a moral wrong that needs to be addressed. Health disparities are morally wrong because they exemplify historical injustices. Contractarian ethics, Kantian ethics, and utilitarian ethics all provide theoretical justification for viewing health disparities as a moral wrong, as do several ethical principles of primary importance in bioethics. The moral consequences of health disparities are also troubling and further support the claim that these disparities are a moral wrong. The Universal Declaration of Human Rights provides additional support that health disparities are a moral wrong, as does an analogy with the generally accepted duty to provide equal access to education. In this article, I also consider and respond to 3 objections to my thesis.

  4. Engendering health disparities.

    Science.gov (United States)

    Spitzer, Denise L

    2005-01-01

    How is gender implicated in our exploration of health disparities in Canada? Set against the backdrop of federal government policy, this review paper examines the ways in which gender intersects with other health determinants to produce disparate health outcomes. An overview of salient issues including the impact of gender roles, environmental exposures, gender violence, workplace hazards, economic disparities, the costs of poverty, social marginalization and racism, aging, health conditions, interactions with health services, and health behaviours are considered. This review suggests health is detrimentally affected by gender roles and statuses as they intersect with economic disparities, cultural, sexual, physical and historical marginalization as well as the strains of domestic and paid labour. These conditions result in an unfair health burden borne in particular by women whose access to health determinants is--in various degrees--limited. While progress has certainly been made on some fronts, the persistence of health disparities among diverse populations of women and men suggests a postponement of the vision of a just society with health for all that was articulated in the Federal Plan on Gender Equality. Commitment, creativity and collaboration from stakeholders ranging from various levels of government, communities, academics, non-governmental agencies and health professionals will be required to reduce and eliminate health disparities between and among all members of our society.

  5. Global health disparities: crisis in the diaspora.

    Science.gov (United States)

    Cox, Raymond L.

    2004-01-01

    The United States spends more than the rest of the world on healthcare. In 2000, the U.S. health bill was 1.3 trillion dollars, 14.5% of its gross domestic product. Yet, according to the WHO World Health Report 2000, the United States ranked 37th of 191 member nations in overall health system performance. Racial/ethnic disparities in health outcomes are the most obvious examples of an unbalanced healthcare system. This presentation will examine health disparities in the United States and reveal how health disparities among and within countries affect the health and well-being of the African Diaspora. PMID:15101675

  6. Disparities in Hypertension Prevalence, Awareness, Treatment and Control between Bouyei and Han: Results from a Bi-Ethnic Health Survey in Developing Regions from South China.

    Science.gov (United States)

    Dong, Fen; Wang, Dingming; Pan, Li; Yu, Yangwen; Wang, Ke; Li, Ling; Wang, Li; Liu, Tao; Zeng, Xianjia; Sun, Liangxian; Zhu, Guangjin; Feng, Kui; Zhang, Biao; Xu, Ke; Pang, Xinglong; Chen, Ting; Pan, Hui; Ma, Jin; Zhong, Yong; Ping, Bo; Shan, Guangliang

    2016-02-19

    Hypertension is highly prevalent in low-income population. This study aims to investigate ethnic disparities in hypertension and identify modifiable factors related to its occurrence and control in developing regions in South China. Blood pressure was measured in the Bouyei and Han populations during a community-based health survey in Guizhou, 2012. A multistage stratified sampling method was adopted to recruit Bouyei and Han aged from 20 to 80 years. Taking mixed effects into consideration, multilevel logistic models with random intercept were used for data analysis. The prevalence rates of hypertension were 35.3% for the Bouyei and 33.7% for the Han. Among the hypertensive participants, 30.1% of the Bouyei and 40.2% of the Han were aware of their hypertensive conditions, 19.7% of the Bouyei and 31.1% of the Han were receiving treatment, and only 3.6% of the Bouyei and 9.9% of the Han had their blood pressure under control. Age-sex standardized rates of awareness, treatment, and control were consistently lower in the Bouyei than the Han. Such ethnic disparities were more evident in the elderly population. Avoidance of excessive alcohol consumption and better education were favorable lifestyle for reduction in risk of hypertension. Moderate physical activity improved control of hypertension in Bouyei patients under treatment. Conclusively, hypertension awareness, treatment, and control were substantially lower in Bouyei than Han, particularly in the elderly population. Such ethnic disparities indicate that elderly Bouyei population should be targeted for tailored interventions in the future.

  7. Identifying health disparities across the tobacco continuum.

    Science.gov (United States)

    Fagan, Pebbles; Moolchan, Eric T; Lawrence, Deirdre; Fernander, Anita; Ponder, Paris K

    2007-10-01

    Few frameworks have addressed work-force diversity, inequities and inequalities as part of a comprehensive approach to eliminating tobacco-related health disparities. This paper summarizes the literature and describes the known disparities that exist along the tobacco disease continuum for minority racial and ethnic groups, those living in poverty, those with low education and blue-collar and service workers. The paper also discusses how work-force diversity, inequities in research practice and knowledge allocation and inequalities in access to and quality of health care are fundamental to addressing disparities in health. We examined the available scientific literature and existing public health reports to identify disparities across the tobacco disease continuum by minority racial/ethnic group, poverty status, education level and occupation. Results indicate that differences in risk indicators along the tobacco disease continuum do not explain fully tobacco-related cancer consequences among some minority racial/ethnic groups, particularly among the aggregate groups, blacks/African Americans and American Indians/Alaska Natives. The lack of within-race/ethnic group data and its interactions with socio-economic factors across the life-span contribute to the inconsistency we observe in the disease causal paradigm. More comprehensive models are needed to understand the relationships among disparities, social context, diversity, inequalities and inequities. A systematic approach will also help researchers, practitioners, advocates and policy makers determine critical points for interventions, the types of studies and programs needed and integrative approaches needed to eliminate tobacco-related disparities.

  8. Ethnic and Racial Disparities in HPV Vaccination Attitudes.

    Science.gov (United States)

    Otanez, Staci; Torr, Berna M

    2017-12-20

    There are substantial racial and ethnic disparities in the vaccination rate for human papillomavirus (HPV), which helps protect against cervical cancer. Using data from the 2007 Health Information National Trends Survey, we explore differences between Whites, Blacks, Hispanics, and Asians in attitudes toward vaccinating adolescent girls for HPV. We use logistic regression models to explore whether racial/ethnic differences in attitudes toward HPV vaccinations are explained by HPV knowledge, demographic and socioeconomic status, and/or general distrust of the healthcare system. We include interactions to explore whether the effects of HPV knowledge and doctor distrust vary by racial/ethnic group. We find that greater HPV knowledge increases general willingness to vaccinate for all groups except Blacks. Our findings point to a need for additional research and design of culturally appropriate interventions that address barriers to vaccination.

  9. LAUGHING AT OURSELVES: REFLECTING MALAYSIAN ETHNIC DISPARITIES

    Directory of Open Access Journals (Sweden)

    SWAGATA SINHA ROY

    2014-05-01

    Full Text Available Malaysia’s various ethnic groups make interesting study both sociologically and culturally. With such a heady mix of cultural elements to explore, it is often natural that the many groups stumble upon ‘rare gems’ that reflect their ‘Malaysianess’. Have Malaysians really ever appreciated the many and varied aspects of culture that they are seemingly suddenly thrown into? Do we embrace these happily or are we constantly rejecting them? Fortunately, through the medium of film, we are, from time to time, allowed to reflect on our obvious similarities and even more apparent disparities. In this paper, we explore the culture and perceptions of people from the major ethnic groups that are the human base of this very country. When was it we have last laughed at ourselves … heartily? Nasi Lemak 2.0 provides an interesting, if not disturbing insight into the workings of the Malaysian ‘mind’. Nasi Lemak 2.0 was released on 8th September 2011 and impacted a whole generation of Malaysians. The characters have been well chosen and have done a wonderful job of being representations of the various communities in this nation. Ethnocentrism is a reality and often rears its head, ‘ugly’ or otherwise in several situations. Are we able to grapple with the levels of ethnocentrism that we encounter? These are some of the issues that will trigger much debate and discussion among ourselves and perhaps also reflect our cores.

  10. Racial/ethnic differences in perceived need for mental health care and disparities in use of care among those with perceived need in 1990-1992 and 2001-2003.

    Science.gov (United States)

    Ault-Brutus, Andrea; Alegria, Margarita

    2018-02-01

    This study examines whether there are racial/ethnic differences in perceived need for mental health care among those with a mood and/or anxiety disorder in 1990-1992 and 2001-2003 in the US. Then among those with perceived need, we examine whether racial/ethnic disparities in use of mental health care existed in both time periods. Using data from the 1990-1992 National Comorbidity Survey (NCS) and 2001-2003 National Comorbidity Survey - Replication (NCS-R), the study analyzes whether whites differed from blacks and Latinos in rates of perceived need among those with a mood and/or anxiety disorder in 1990-1992 and 2001-2003. Then among those with a disorder and perceived need, rates of mental health care use for whites are compared to black rates and Latino rates in within the 1990-1992 cohort and then within the 2001-2003 cohort. There were no statistical racial/ethnic differences in perceived need in both time periods. Among those with perceived need in 1990-1992, there were no statistical racial/ethnic disparities in the use of mental health care. However, in 2001-2003, disparities in mental health care use existed among those with perceived need. The emergence of racial/ethnic disparities in use of mental health care among those with a perceived need for care in 2001-2003 suggests that personal/cultural belief along with issues concerning access and quality of mental health care may create barriers to receiving perceived needed care. More research is needed to understand why these disparities emerged among those with perceived need in the latter time period and whether these disparities continue to exist in more recent years.

  11. Mind the gap: race/ethnic and socioeconomic disparities in obesity.

    Science.gov (United States)

    Krueger, Patrick M; Reither, Eric N

    2015-11-01

    Race/ethnic and socioeconomic status (SES) disparities in obesity are substantial and may widen in the future. We review nine potential mechanisms that recent research has used to explain obesity disparities. Those nine mechanisms fall into three broad groups-health behaviors, biological factors, and the social environment-which incorporate both proximate and upstream determinants of obesity disparities. Efforts to reduce the prevalence of obesity in the US population and to close race/ethnic and SES disparities in obesity will likely require the use of multifaceted interventions that target multiple mechanisms simultaneously. Unfortunately, relatively few of the mechanisms reviewed herein have been tested in an intervention framework.

  12. Disparities in Birth Weight and Gestational Age by Ethnic Ancestry in South American countries

    Science.gov (United States)

    Wehby, George L.; Gili, Juan A.; Pawluk, Mariela; Castilla, Eduardo E.; López-Camelo, Jorge S.

    2015-01-01

    Objective We examine disparities in birth weight and gestational age by ethnic ancestry in 2000–2011 in eight South American countries. Methods The sample included 60480 singleton live-births. Regression models were estimated to evaluate differences in birth outcomes by ethnic ancestry controlling for time trends. Results Significant disparities were found in seven countries. In four countries – Brazil, Ecuador, Uruguay, and Venezuela – we found significant disparities in both low birth weight and preterm birth. Disparities in preterm birth alone were observed in Argentina, Bolivia, and Colombia. Several differences in continuous birth weight, gestational age, and fetal growth rate were also observed. There were no systematic patterns of disparities between the evaluated ethnic ancestry groups across the study countries, in that no racial/ethnic group consistently had the best or worst outcomes in all countries. Conclusions Racial/ethnic disparities in infant health are common in several South American countries. Differences across countries suggest that racial/ethnic disparities are driven by social and economic mechanisms. Researchers and policymakers should acknowledge these disparities and develop research and policy programs to effectively target them. PMID:25542227

  13. Rural Health Disparities

    Science.gov (United States)

    ... in the Delta Region for specific data. U.S. – Mexico Border While life expectancy in many counties of ... documents the successes, challenges, and relevant information for planning. ... on rural/urban disparities see What sources cover health behaviors and ...

  14. The human face of health disparities.

    Science.gov (United States)

    Green, Alexander R

    2003-01-01

    In the last 20 years, the issue of disparities in health between racial/ethnic groups has moved from the realm of common sense and anecdote to the realm of science. Hard, cold data now force us to consider what many had long taken for granted. Not only does health differ by race/ethnicity, but our health care system itself is deeply biased. From lack of diversity in the leadership and workforce, to ethnocentric systems of care, to biased clinical decision-making, the American health care system is geared to treat the majority, while the minority suffers. The photos shown here are of patients and scenes that recall some of the important landmarks in research on racial/ethnic disparities in health. The purpose is to put faces and humanity onto the numbers. While we now have great bodies of evidence upon which to lobby for change, in the end, each statistic still represents a personal tragedy or an individual triumph.

  15. Explaining Ethnic Disparities in Patient Safety: A Qualitative Analysis

    NARCIS (Netherlands)

    Suurmond, Jeanine; Uiters, Ellen; de Bruijne, Martine C.; Stronks, Karien; Essink-Bot, Marie-Louise

    2010-01-01

    Objectives. We explored characteristics of in-hospital care and treatment of immigrant patients to better understand the processes underlying ethnic disparities in patient safety. Methods. We conducted semistructured interviews with care providers regarding patient safety events involving immigrant

  16. Disparities in Healthcare for Racial, Ethnic, and Sexual Minorities

    Science.gov (United States)

    Collins, Joshua C.; Rocco, Tonette S.

    2014-01-01

    This chapter situates healthcare as a concern for the field of adult education through a critique of disparities in access to healthcare, quality of care received, and caregiver services for racial, ethnic, and sexual minorities.

  17. Mind the Gap: Race\\Ethnic and Socioeconomic Disparities in Obesity

    OpenAIRE

    Krueger, Patrick M.; Reither, Eric N.

    2015-01-01

    Race/ethnic and socioeconomic status (SES) disparities in obesity are substantial and may widen in the future. We review seven potential mechanisms that recent research has used to explain obesity disparities. Those seven mechanisms fall into three broad groups—health behaviors, biological and developmental factors, and the social environment—which incorporate both proximate and upstream determinants of obesity disparities. Efforts to reduce the prevalence of obesity in the U.S. population an...

  18. Health disparities through a psychological lens.

    Science.gov (United States)

    Adler, Nancy E

    2009-11-01

    There is growing concern in the United States about avoidable, unjust differences in health associated with sociodemographic characteristics, such as socioeconomic status and race/ethnicity. This concern has sparked research to identify how disparities develop and how they can be reduced. Studies showing that disparities occur at all levels of socioeconomic status, not simply at the very bottom, suggest that psychosocial factors play an important role. The author discusses both content and process issues in psychological research on disparities. Copyright 2009 by the American Psychological Association

  19. Race, ethnicity, concentrated poverty, and low birth weight disparities.

    Science.gov (United States)

    Sims, Mario; Sims, Tammy L; Bruce, Marino A

    2008-07-01

    This study examines the extent to which the relationship between area socioeconomic position (SEP) and low birth weight (LBW) varies by race and ethnicity. A cross-sectional, secondary data analysis was performed with 1992-1994 Vital Statistics and 1990 U.S. Census data for selected metropolitan areas. Low birth weight (rates were calculated for non-Hispanic Black, Latino, and non-Hispanic White live singleton births. Concentrated poverty was defined as poor persons living in neighborhoods with 40% or more poverty in metropolitan areas. The results showed that the relationship between concentrated poverty and LBW varied by race and ethnicity. Concentrated poverty was significant for Latinos, even when controlling for maternal health and MSA-level factors. By contrast, maternal health characteristics, such as pre-term birth, teen birth and tobacco use, explained much of the variance in African-American and White LBW These findings extend the discussion about race, class, and health disparities to include Latinos and shows how the relationship between SEP and LBW can vary within an ethnic group.

  20. Decomposing Racial/Ethnic Disparities in Influenza Vaccination among the Elderly

    Science.gov (United States)

    Yoo, Byung-Kwang; Hasebe, Takuya; Szilagyi, Peter G.

    2015-01-01

    While persistent racial/ethnic disparities in influenza vaccination have been reported among the elderly, characteristics contributing to disparities are poorly understood. This study aimed to assess characteristics associated with racial/ethnic disparities in influenza vaccination using a nonlinear Oaxaca-Blinder decomposition method. We performed cross-sectional multivariable logistic regression analyses for which the dependent variable was self-reported receipt of influenza vaccine during the 2010–2011 season among community dwelling non-Hispanic African-American (AA), non-Hispanic White (W), English-speaking Hispanic (EH) and Spanish-speaking Hispanic (SH) elderly, enrolled in the 2011 Medicare Current Beneficiary Survey (MCBS) (un-weighted/weighted N= 6,095/19.2million). Using the nonlinear Oaxaca-Blinder decomposition method, we assessed the relative contribution of seventeen covariates—including socio-demographic characteristics, health status, insurance, access, preference regarding healthcare, and geographic regions —to disparities in influenza vaccination. Unadjusted racial/ethnic disparities in influenza vaccination were 14.1 percentage points (pp) (W-AA disparity, p.8). The Oaxaca-Blinder decomposition method estimated that the unadjusted W-AA and W-SH disparities in vaccination could be reduced by only 45% even if AA and SH groups become equivalent to Whites in all covariates in multivariable regression models. The remaining 55% of disparities were attributed to (a) racial/ethnic differences in the estimated coefficients (e.g., odds ratios) in the regression models and (b) characteristics not included in the regression models. Our analysis found that only about 45% of racial/ethnic disparities in influenza vaccination among the elderly could be reduced by equalizing recognized characteristics among racial/ethnic groups. Future studies are needed to identify additional modifiable characteristics causing disparities in influenza vaccination. PMID

  1. Cancer Genomics: Diversity and Disparity Across Ethnicity and Geography.

    Science.gov (United States)

    Tan, Daniel S W; Mok, Tony S K; Rebbeck, Timothy R

    2016-01-01

    Ethnic and geographic differences in cancer incidence, prognosis, and treatment outcomes can be attributed to diversity in the inherited (germline) and somatic genome. Although international large-scale sequencing efforts are beginning to unravel the genomic underpinnings of cancer traits, much remains to be known about the underlying mechanisms and determinants of genomic diversity. Carcinogenesis is a dynamic, complex phenomenon representing the interplay between genetic and environmental factors that results in divergent phenotypes across ethnicities and geography. For example, compared with whites, there is a higher incidence of prostate cancer among Africans and African Americans, and the disease is generally more aggressive and fatal. Genome-wide association studies have identified germline susceptibility loci that may account for differences between the African and non-African patients, but the lack of availability of appropriate cohorts for replication studies and the incomplete understanding of genomic architecture across populations pose major limitations. We further discuss the transformative potential of routine diagnostic evaluation for actionable somatic alterations, using lung cancer as an example, highlighting implications of population disparities, current hurdles in implementation, and the far-reaching potential of clinical genomics in enhancing cancer prevention, diagnosis, and treatment. As we enter the era of precision cancer medicine, a concerted multinational effort is key to addressing population and genomic diversity as well as overcoming barriers and geographical disparities in research and health care delivery. © 2015 by American Society of Clinical Oncology.

  2. Are Ethnic Disparities in HbA1c Levels Explained by Mental Wellbeing? Analysis of Population-Based Data from the Health Survey for England.

    Science.gov (United States)

    Umeh, Kanayo

    2018-02-01

    It is unclear how ethnic differences in HbA 1c levels are affected by individual variations in mental wellbeing. Thus, the aim of this study was to assess the extent to which HbA 1c disparities between Caucasian and South Asian adults are mediated by various aspects of positive psychological functioning. Data from the 2014 Health Survey for England was analysed using bootstrapping methods. A total of 3894 UK residents with HbA 1c data were eligible to participate. Mental wellbeing was assessed using the Warwick-Edinburgh Mental Well-being Scale. To reduce bias BMI, blood pressure, diabetes status, and other factors were treated as covariates. Ethnicity directly predicted blood sugar control (unadjusted coefficient -2.15; 95% CI -3.64, -0.67), with Caucasians generating lower average HbA 1c levels (37.68 mmol/mol (5.6%)) compared to South Asians (39.87 mmol/mol (5.8%)). This association was mediated by positive mental wellbeing, specifically concerning perceived vigour (unadjusted effect 0.30; 95% CI 0.13, 0.58): South Asians felt more energetic than Caucasians (unadjusted coefficient -0.32; 95% CI -0.49, -0.16), and greater perceived energy predicted lower HbA 1c levels (unadjusted coefficient -0.92; 95% CI -1.29, -0.55). This mediator effect accounted for just over 14% of the HbA 1c variance and was negated after adjusting for BMI. Caucasian experience better HbA 1c levels compared with their South Asian counterparts. However, this association is partly confounded by individual differences in perceived energy levels, which is implicated in better glycaemic control, and appears to serve a protective function in South Asians.

  3. Racial/ethnic disparity in obesity among US youth, 1999-2013.

    Science.gov (United States)

    An, Ruopeng

    2015-11-04

    One fundamental goal in the Healthy People 2020 is to achieve health equity and eliminate disparities. To examine the annual trends in racial/ethnic disparity in obesity among US youth from 1999 to 2013. Nationally representative sample of 108,811 students in grades 9th-12th from the Youth Risk Behavior Surveillance System (YRBSS) 1999-2013 surveys. Body mass index (BMI) was calculated based on self-reported height and weight. Obesity in youth is defined as BMI at or above 95th sex- and age-specific percentile of the 2000 Centers for Disease Control and Prevention growth charts. Multiple logistic regressions were conducted to estimate the annual prevalence of obesity by race/ethnicity, adjusted for gender and age group and accounted for the YRBSS survey design. Between-group variance (BGV) was used to measure absolute racial/ethnic disparity in obesity, and the mean log deviation (MLD) and the Theil Index (T) were used to measure relative racial/ethnic disparity in obesity, weighted by corresponding racial/ethnic population size. The obesity prevalence among non-Hispanic Whites, non-Hispanic African Americans, non-Hispanic other race or multi-race, and Hispanic increased from 10.05%, 12.31%, 10.25%, and 13.24% in 1999 to 13.14%, 15.76%, 10.87%, and 15.20% in 2013, respectively. Both absolute and relative racial/ethnic disparity in obesity increased initially since 1999 but then steadily declined starting from mid-2000s back to around its original level by 2013. The obesity epidemic in youth is marked by salient and persistent disparity pertaining to race/ethnicity. No improvement on racial/ethnic disparity in obesity among American youth was observed during 1999-2013.

  4. Understanding environmental health inequalities through comparative intracategorical analysis: racial/ethnic disparities in cancer risks from air toxics in El Paso County, Texas.

    Science.gov (United States)

    Collins, Timothy W; Grineski, Sara E; Chakraborty, Jayajit; McDonald, Yolanda J

    2011-01-01

    This paper contributes to the environmental justice literature by analyzing contextually relevant and racial/ethnic group-specific variables in relation to air toxics cancer risks in a US-Mexico border metropolis at the census block group-level. Results indicate that Hispanics' ethnic status interacts with class, gender and age status to amplify disproportionate risk. In contrast, results indicate that non-Hispanic whiteness attenuates cancer risk disparities associated with class, gender and age status. Findings suggest that a system of white-Anglo privilege shapes the way in which race/ethnicity articulates with other dimensions of inequality to create unequal cancer risks from air toxics. Copyright © 2010 Elsevier Ltd. All rights reserved.

  5. Integrating intersectionality and biomedicine in health disparities research.

    Science.gov (United States)

    Kelly, Ursula A

    2009-01-01

    Persisting health disparities have lead to calls for an increase in health research to address them. Biomedical scientists call for research that stratifies individual indicators associated with health disparities, for example, ethnicity. Feminist social scientists recommend feminist intersectionality research. Intersectionality is the multiplicative effect of inequalities experienced by nondominant marginalized groups, for example, ethnic minorities, women, and the poor. The elimination of health disparities necessitates integration of both paradigms in health research. This study provides a practical application of the integration of biomedical and feminist intersectionality paradigms in nursing research, using a psychiatric intervention study with battered Latino women as an example.

  6. Health and healthcare disparities among U.S. women and men at the intersection of sexual orientation and race/ethnicity: a nationally representative cross-sectional study.

    Science.gov (United States)

    Trinh, Mai-Han; Agénor, Madina; Austin, S Bryn; Jackson, Chandra L

    2017-12-19

    Research has shown that sexual minorities (SMs) (e.g. lesbian, gay, and bisexual individuals), compared to their heterosexual counterparts, may engage in riskier health behaviors, are at higher risk of some adverse health outcomes, and are more likely to experience reduced health care access and utilization. However, few studies have examined how the interplay between race and sexual orientation impacts a range of health measures in a nationally representative sample of the U.S. To address these gaps in the literature, we sought to investigate associations between sexual orientation identity and health/healthcare outcomes among U.S. women and men within and across racial/ethnic groups. Using 2013-2015 National Health Interview Survey data (N = 91,913) we employed Poisson regression with robust variance to directly estimate prevalence ratios (PR) comparing health and healthcare outcomes among SMs of color to heterosexuals of color and white heterosexuals, stratified by gender and adjusting for potential confounders. The sample consisted of 52% women, with approximately 2% of each sex identifying as SMs. Compared to their heterosexual counterparts, white (PR = 1.25 [95% confidence interval (CI): 1.08-1.45]) and black (1.54 [1.07, 2.20]) SM women were more likely to report heavy drinking. Hispanic/Latino SM women and men were more likely to experience short sleep duration compared to white heterosexual women (1.33 [1.06, 1.66]) and men (1.51 [1.21, 1.90). Black SM women had a much higher prevalence of stroke compared to black heterosexual women (3.25 [1.63, 6.49]) and white heterosexual women (4.51 [2.16, 9.39]). White SM women were more likely than white heterosexual women to be obese (1.31 [1.15, 1.48]), report cancer (1.40 [1.07, 1.82]) and report stroke (1.91 [1.16, 3.15]. White (2.41 [2.24, 2.59]), black (1.40[1.20, 1.63]), and Hispanic/Latino SM (2.17 [1.98, 2.37]) men were more likely to have been tested for HIV than their heterosexual counterparts

  7. RACIAL DISPARITIES IN HEALTH

    Science.gov (United States)

    Sternthal, Michelle J.; Slopen, Natalie; Williams, David R.

    2017-01-01

    Despite the widespread assumption that racial differences in stress exist and that stress is a key mediator linking racial status to poor health, relatively few studies have explicitly examined this premise. We examine the distribution of stress across racial groups and the role of stress vulnerability and exposure in explaining racial differences in health in a community sample of Black, Hispanic, and White adults, employing a modeling strategy that accounts for the correlation between types of stressors and the accumulation of stressors in the prediction of health outcomes. We find significant racial differences in overall and cumulative exposure to eight stress domains. Blacks exhibit a higher prevalence and greater clustering of high stress scores than Whites. American-born Hispanics show prevalence rates and patterns of accumulation of stressors comparable to Blacks, while foreign-born Hispanics have stress profiles similar to Whites. Multiple stressors correlate with poor physical and mental health, with financial and relationship stressors exhibiting the largest and most consistent effects. Though we find no support for the stress-vulnerability hypothesis, the stress-exposure hypothesis does account for some racial health disparities. We discuss implications for future research and policy.

  8. The Neighborhood Context of Racial and Ethnic Disparities in Arrest

    OpenAIRE

    KIRK, DAVID S.

    2008-01-01

    This study assesses the role of social context in explaining racial and ethnic disparities in arrest, with a focus on how distinct neighborhood contexts in which different racial and ethnic groups reside explain variations in criminal outcomes. To do so, I utilize a multilevel, longitudinal research design, combining individual-level data with contextual data from the Project on Human Development in Chicago Neighborhoods (PHDCN). Findings reveal that black youths face multiple layers of disad...

  9. Examining the Impact of Structural Racism on Food Insecurity: Implications for Addressing Racial/Ethnic Disparities.

    Science.gov (United States)

    Odoms-Young, Angela; Bruce, Marino A

    Food insecurity is defined as "a household-level economic and social condition of limited or uncertain access to adequate food." While, levels of food insecurity in the United States have fluctuated over the past 20 years; disparities in food insecurity rates between people of color and whites have continued to persist. There is growing recognition that discrimination and structural racism are key contributors to disparities in health behaviors and outcomes. Although several promising practices to reduce food insecurity have emerged, approaches that address structural racism and discrimination may have important implications for alleviating racial/ethnic disparities in food insecurity and promoting health equity overall.

  10. Ethnic disparities in metabolic syndrome in malaysia: an analysis by risk factors.

    Science.gov (United States)

    Tan, Andrew K G; Dunn, Richard A; Yen, Steven T

    2011-12-01

    This study investigates ethnic disparities in metabolic syndrome in Malaysia. Data were obtained from the Malaysia Non-Communicable Disease Surveillance-1 (2005/2006). Logistic regressions of metabolic syndrome health risks on sociodemographic and health-lifestyle factors were conducted using a multiracial (Malay, Chinese, and Indian and other ethnic groups) sample of 2,366 individuals. Among both males and females, the prevalence of metabolic syndrome amongst Indians was larger compared to both Malays and Chinese because Indians are more likely to exhibit central obesity, elevated fasting blood glucose, and low high-density lipoprotein cholesterol. We also found that Indians tend to engage in less physical activity and consume fewer fruits and vegetables than Malays and Chinese. Although education and family history of chronic disease are associated with metabolic syndrome status, differences in socioeconomic attributes do not explain ethnic disparities in metabolic syndrome incidence. The difference in metabolic syndrome prevalence between Chinese and Malays was not statistically significant. Whereas both groups exhibited similar obesity rates, ethnic Chinese were less likely to suffer from high fasting blood glucose. Metabolic syndrome disproportionately affects Indians in Malaysia. Additionally, fasting blood glucose rates differ dramatically amongst ethnic groups. Attempts to decrease health disparities among ethnic groups in Malaysia will require greater attention to improving the metabolic health of Malays, especially Indians, by encouraging healthful lifestyle changes.

  11. Ethnic disparities in the graduate labour market

    NARCIS (Netherlands)

    Zorlu, A.

    2011-01-01

    This paper examines ethnic wage differentials for the entire population of students enrolled in 1996 using unique administrative panel data for the period 1996 to 2005 from the Dutch tertiary education system. The study decomposes wage differentials into two components: a component which can be

  12. Ethnic Disparities in the Graduate Labour Market

    NARCIS (Netherlands)

    Zorlu, A.

    2012-01-01

    This paper examines ethnic wage differentials for the entire population of workers who enrolled for the first time as students at Dutch universities (WO) and colleges (HBO) in 1996 using unique administrative panel data for the period 1996 to 2005 from the Dutch tertiary education system. The study

  13. Lifecourse Approach to Racial/Ethnic Disparities in Childhood Obesity123

    Science.gov (United States)

    Dixon, Brittany; Peña, Michelle-Marie; Taveras, Elsie M.

    2012-01-01

    Eliminating racial/ethnic disparities in health and health care is a national priority, and obesity is a prime target. During the last 30 y in the United States, the prevalence of obesity among children has dramatically increased, sparing no age group. Obesity in childhood is associated with adverse cardio-metabolic outcomes such as hypertension, hyperlipidemia, and type II diabetes and with other long-term adverse outcomes, including both physical and psychosocial consequences. By the preschool years, racial/ethnic disparities in obesity prevalence are already present, suggesting that disparities in childhood obesity prevalence have their origins in the earliest stages of life. Several risk factors during pregnancy are associated with increased risk of offspring obesity, including excessive maternal gestational weight gain, gestational diabetes, smoking during pregnancy, antenatal depression, and biological stress. During infancy and early childhood, rapid infant weight gain, infant feeding practices, sleep duration, child’s diet, physical activity, and sedentary practices are associated with the development of obesity. Studies have found substantial racial/ethnic differences in many of these early life risk factors for childhood obesity. It is possible that racial/ethnic differences in early life risk factors for obesity might contribute to the high prevalence of obesity among minority preschool-age children and beyond. Understanding these differences may help inform the design of clinical and public health interventions and policies to reduce the prevalence of childhood obesity and eliminate disparities among racial/ethnic minority children. PMID:22332105

  14. The neighborhood context of racial and ethnic disparities in arrest.

    Science.gov (United States)

    Kirk, David S

    2008-02-01

    This study assesses the role of social context in explaining racial and ethnic disparities in arrest, with afocus on how distinct neighborhood contexts in which different racial and ethnic groups reside explain variations in criminal outcomes. To do so, I utilize a multilevel, longitudinal research design, combining individual-level data with contextual data from the Project on Human Development in Chicago Neighborhoods (PHDCN). Findings reveal that black youths face multiple layers of disadvantage relative to other racial and ethnic groups, and these layers work to create differences in arrest. At the family level, results show that disadvantages in the form of unstable family structures explain much of the disparities in arrest across race and ethnicity. At the neighborhood level, black youths tend to reside in areas with both significantly higher levels of concentrated poverty than other youths as well as lower levels of collective efficacy than white youths. Variations in neighborhood tolerance of deviance across groups explain little of the arrest disparities, yet tolerance of deviance does influence the frequency with which a crime ultimately ends in an arrest. Even after accounting for relevant demographic, family, and neighborhood-level predictors, substantial residual arrest differences remain between black youths and youths of other racial and ethnic groups.

  15. HIV Infection among People Who Inject Drugs: The Challenge of Racial/Ethnic Disparities

    Science.gov (United States)

    Des Jarlais, Don C.; McCarty, Dennis; Vega, William A.; Bramson, Heidi

    2013-01-01

    Racial/ethnic disparities in HIV infection, with minority groups typically having higher rates of infection, are a formidable public health challenge. In the United States, among both men and women who inject drugs, HIV infection rates are elevated among Hispanics and non-Hispanic Blacks. A meta-analysis of international research concluded that…

  16. Ethnic disparity in severe acute maternal morbidity: A nationwide cohort study in the Netherlands

    NARCIS (Netherlands)

    Zwart, J.J.; Jonkers, M.D.; Richters, A.; Öry, F.; Bloemenkamp, K.W.; Duvekot, J.J.; Roosmalen, J. van

    2011-01-01

    Background: There are concerns about ethnic disparity in outcome of obstetric health care in high-income countries. Our aim was to assess these differences in a large cohort of women having experienced severe acute maternal morbidity (SAMM) during pregnancy, delivery and puerperium. Methods: All

  17. Ethnic disparity in severe acute maternal morbidity: a nationwide cohort study in the Netherlands

    NARCIS (Netherlands)

    Zwart, J.J.; Jonkers, M.D.; Richters, A.; Öry, F.; Bloemenkamp, K.W.; Duvekot, J.J.; van Roosmalen, J.

    2011-01-01

    Background: There are concerns about ethnic disparity in outcome of obstetric health care in high-income countries. Our aim was to assess these differences in a large cohort of women having experienced severe acute maternal morbidity (SAMM) during pregnancy, delivery and puerperium. Methods: All

  18. Racial/Ethnic, socioeconomic, and geographic disparities of cervical cancer advanced-stage diagnosis in Texas.

    Science.gov (United States)

    Zhan, F Benjamin; Lin, Yan

    2014-01-01

    Advanced-stage diagnosis is among the primary causes of mortality among cervical cancer patients. With the wide use of Pap smear screening, cervical cancer advanced-stage diagnosis rates have decreased. However, disparities of advanced-stage diagnosis persist among different population groups. A challenging task in cervical cancer disparity reduction is to identify where underserved population groups are. Based on cervical cancer incidence data between 1995 and 2008, this study investigated advanced-stage cervical cancer disparities in Texas from three social domains: Race/ethnicity, socioeconomic status (SES), and geographic location. Effects of individual and contextual factors, including age, tumor grade, race/ethnicity, as well as contextual SES, spatial access to health care, sociocultural factors, percentage of African Americans, and insurance expenditures, on these disparities were examined using multilevel logistic regressions. Significant variations by race/ethnicity and SES were found in cervical cancer advanced-stage diagnosis. We also found a decline in racial/ethnic disparities of advanced cervical cancer diagnosis rate from 1995 to 2008. However, the progress was slower among African Americans than Hispanics. Geographic disparities could be explained by age, race/ethnicity, SES, and the percentage of African Americans in a census tract. Our findings have important implications for developing effective cervical cancer screening and control programs. We identified the location of underserved populations who need the most assistance with cervical cancer screening. Cervical cancer intervention programs should target Hispanics and African Americans, as well as individuals from communities with lower SES in geographic areas where higher advanced-stage diagnosis rates were identified in this study. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  19. Health Disparities in Veterans: A Map of the Evidence.

    Science.gov (United States)

    Kondo, Karli; Low, Allison; Everson, Teresa; Gordon, Christine D; Veazie, Stephanie; Lozier, Crystal C; Freeman, Michele; Motu'apuaka, Makalapua; Mendelson, Aaron; Friesen, Mark; Paynter, Robin; Friesen, Caroline; Anderson, Johanna; Boundy, Erin; Saha, Somnath; Quiñones, Ana; Kansagara, Devan

    2017-09-01

    Goals for improving the quality of care for all Veterans and eliminating health disparities are outlined in the Veterans Health Administration Blueprint for Excellence, but the degree to which disparities in utilization, health outcomes, and quality of care affect Veterans is not well understood. To characterize the research on health care disparities in the Veterans Health Administration by means of a map of the evidence. We conducted a systematic search for research studies published from 2006 to February 2016 in MEDLINE and other data sources. We included studies of Veteran populations that examined disparities in 3 outcome categories: utilization, quality of health care, and patient health. We abstracted data on study design, setting, population, clinical area, outcomes, mediators, and presence of disparity for each outcome category. We grouped the data by population characteristics including race, disability status, mental illness, demographics (age, era of service, rural location, and distance from care), sex identity, socioeconomic status, and homelessness, and created maps illustrating the evidence. We reviewed 4249 citations and abstracted data from 351 studies which met inclusion criteria. Studies examining disparities by race/ethnicity comprised by far the vast majority of the literature, followed by studies examining disparities by sex, and mental health condition. Very few studies examined disparities related to lesbian, gay, bisexual, or transgender identity or homelessness. Disparities findings vary widely by population and outcome. Our evidence maps provide a "lay of the land" and identify important gaps in knowledge about health disparities experienced by different Veteran populations.

  20. Health Psychology special series on health disparities

    NARCIS (Netherlands)

    Kazak, A.E.; Bosch, J.; Klonoff, E.A.

    2012-01-01

    With the initiation of this new ongoing special series in Health Psychology on health disparities, we will publish articles that highlight ways in which health psychology can contribute to understanding and ameliorating these disparities. We welcome articles for this new special series and

  1. Disparities in pedestrian streetscape environments by income and race/ethnicity

    Directory of Open Access Journals (Sweden)

    Christina M. Thornton

    2016-12-01

    and efficiently allocate pedestrian infrastructure resources to ensure access and physical activity opportunities for all residents, regardless of race, ethnicity, or income level. Keywords: Health disparity, Physical activity, Exercise, Walkability, Built environment, Esthetics, Sidewalk, Public health

  2. Health & access to care among working-age lower income adults in the Great Recession: Disparities across race and ethnicity and geospatial factors.

    Science.gov (United States)

    Towne, Samuel D; Probst, Janice C; Hardin, James W; Bell, Bethany A; Glover, Saundra

    2017-06-01

    In the United States (US) and elsewhere, residents of low resource areas face health-related disparities, and may experience different outcomes throughout times of severe economic flux. We aimed to identify individual (e.g. sociodemographic) and environmental (e.g. region, rurality) factors associated with self-reported health and forgone medical care due to the cost of treatment in the US across the Great Recession (2008-2009). We analyzed nationally representative data (2004-2010) using the Behavioral Risk Factor Surveillance System in the US. Individual and geospatial factors (rurality, census region) were used to identify differences in self-reported health and forgone medical care due to the cost. Adjusted-analyses taking into account individual and geospatial factors among those with incomes Recession were more likely to report forgone care than before the Recession. Having insurance and/or being employed (versus unemployed) was a protective factor in terms of reporting fair/poor health and having to forgo health care due to cost. Policies affecting improvements in health and access for vulnerable populations (e.g., low-income minority adults) are critical. Monitoring trends related to Social Determinants of Health, including the relationship between health and place (e.g. Census region, rurality), is necessary in efforts targeted towards ameliorating disparities. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Racial/ethnic disparities in the associations between environmental quality and mortality in the contiguous U.S.

    Science.gov (United States)

    Introduction: Understanding racial/ethnic disparities in mortality is an important goal for public health in the U.S. We examined the role environmental quality may have on mortality across race/ethnicity. Methods: The Environmental Quality Index (EQI) and its domain indices (air...

  4. Lifecourse Approach to Racial/Ethnic Disparities in Childhood Obesity123

    OpenAIRE

    Dixon, Brittany; Peña, Michelle-Marie; Taveras, Elsie M.

    2012-01-01

    Eliminating racial/ethnic disparities in health and health care is a national priority, and obesity is a prime target. During the last 30 y in the United States, the prevalence of obesity among children has dramatically increased, sparing no age group. Obesity in childhood is associated with adverse cardio-metabolic outcomes such as hypertension, hyperlipidemia, and type II diabetes and with other long-term adverse outcomes, including both physical and psychosocial consequences. By the presch...

  5. Environmental Health Disparities in Housing

    Science.gov (United States)

    2011-01-01

    The physical infrastructure and housing make human interaction possible and provide shelter. How well that infrastructure performs and which groups it serves have important implications for social equity and health. Populations in inadequate housing are more likely to have environmental diseases and injuries. Substantial disparities in housing have remained largely unchanged. Approximately 2.6 million (7.5%) non-Hispanic Blacks and 5.9 million Whites (2.8%) live in substandard housing. Segregation, lack of housing mobility, and homelessness are all associated with adverse health outcomes. Yet the experience with childhood lead poisoning in the United States has shown that housing-related disparities can be reduced. Effective interventions should be implemented to reduce environmental health disparities related to housing. PMID:21551378

  6. Ethnic disparities in the prevalence of metabolic syndrome and its risk factors in the Suriname Health Study: a cross-sectional population study.

    Science.gov (United States)

    Krishnadath, Ingrid S K; Toelsie, Jerry R; Hofman, Albert; Jaddoe, Vincent W V

    2016-12-07

    The metabolic syndrome (MetS) indicates increased risk for cardiovascular disease and type 2 diabetes. We estimated the overall and ethnic-specific prevalence of MetS and explored the associations of risk factors with MetS among Amerindian, Creole, Hindustani, Javanese, Maroon and Mixed ethnic groups. We used the 2009 Joint Interim Statement (JIS) to define MetS in a subgroup of 2946 participants of the Suriname Health Study, a national survey designed according to the WHO Steps guidelines. The prevalences of MetS and its components were determined for all ethnicities. Hierarchical logistic regressions were used to determine the associations of ethnicity, sex, age, marital status, educational level, income status, employment, smoking status, residence, physical activity, fruit and vegetable intake with MetS. The overall estimated prevalence of MetS was 39.2%. From MetS components, central obesity and low high-density lipoprotein cholesterol (HDL-C) had the highest prevalences. The prevalence of MetS was highest for the Hindustanis (52.7%) and lowest for Maroons (24.2%). The analyses showed that in the overall population sex (women: OR 1.4; 95% CI 1.2 to 1.6), age (OR 5.5 CI 4.3 to 7.2), education (OR 0.7 CI 0.6 to 0.9), living area (OR 0.6 CI 0.5 to 0.8), income (OR 0.7 CI 0.5 to 0.9) and marital status (OR 1.3 CI 1.1 to 1.6) were associated with MetS. Variations observed in the associations of the risk factors with MetS in the ethnic groups did not materially influence the associations of ethnicities with MetS. The prevalence of MetS was high and varied widely among ethnicities. Overall, central obesity and low HDL-C contributed most to MetS. Further studies are needed to assess the prospective associations of risk factors with MetS in different ethnic groups. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  7. Sex disparities in acute myocardial infarction incidence: do ethnic minority groups differ from the majority population?

    Science.gov (United States)

    van Oeffelen, Aloysia A M; Vaartjes, Ilonca; Stronks, Karien; Bots, Michiel L; Agyemang, Charles

    2015-02-01

    The incidence of acute myocardial infarction (AMI) in men exceeds that in women. The extent of this sex disparity varies widely between countries. Variations may also exist between ethnic minority groups and the majority population, but scientific evidence is lacking. A nationwide register-based cohort study was conducted (n = 7,601,785) between 1997 and 2007. Cox Proportional Hazard Models were used to estimate sex disparities in AMI incidence within the Dutch majority population and within ethnic minority groups, stratified by age (30-54, 55-64, ≥65 years). AMI incidence was higher in men than in women in all groups under study. Compared with the majority population (hazard ratio (HR): 2.23; 95% confidence interval (95% CI): 2.21-2.25), sex disparities were similar among minorities originating from the immediate surrounding countries (Belgium, Germany), whereas they were greater in most other minority groups. Most pronounced results were found among minorities from Morocco (HR: 3.48; 95% CI: 2.48-4.88), South Asia (HR: 3.92; 95% CI: 2.45-6.26) and Turkey (HR: 3.98; 95% CI: 3.51-4.51). Sex disparity differences were predominantly evident in those below 55 years of age, and were mainly provoked by a higher AMI incidence in ethnic minority men compared with men belonging to the Dutch majority population. Sex disparities in AMI incidence clearly varied between ethnic minorities and the Dutch majority population. Health prevention strategies may first target at a reduction of AMI incidence in young ethnic minority men, especially those originating from Turkey and South Asia. Furthermore, an increase in AMI incidence in their female counterparts should be prevented. © The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  8. Can school income and racial/ethnic composition explain the racial/ethnic disparity in adolescent physical activity participation?

    Science.gov (United States)

    Richmond, Tracy K; Hayward, Rodney A; Gahagan, Sheila; Field, Alison E; Heisler, Michele

    2006-06-01

    Our goal was to determine if racial/ethnic disparities in adolescent boys' and girls' physical activity participation exist and persist once the school attended is considered. We performed a cross-sectional analysis of 17,007 teens in the National Longitudinal Study of Adolescent Health. Using multivariate linear regression, we examined the association between adolescent self-reported physical activity and individual race/ethnicity stratified by gender, controlling for a wide range of sociodemographic, attitudinal, behavioral, and health factors. We used multilevel analyses to determine if the relationship between race/ethnicity and physical activity varied by the school attended. Participants attended racially segregated schools; approximately 80% of Hispanic and black adolescent boys and girls attended schools with student populations that were schools that were >94% white. Black and Hispanic adolescent girls reported lower levels of physical activity than white adolescent girls. There were more similar levels of physical activity reported in adolescent boys, with black boys reporting slightly more activities. Although black and Hispanic adolescent girls were more likely to attend poorer schools with overall lower levels of physical activity in girls; there was no difference within schools between black, white, and Hispanic adolescent girls' physical activity levels. Within the same schools, both black and Hispanic adolescent boys had higher rates of physical activity when compared with white adolescent boys. In this nationally representative sample, lower physical activity levels in Hispanic and black adolescent girls were largely attributable to the schools they attended. In contrast, black and Hispanic males had higher activity levels than white males when attending the same schools. Future research is needed to determine the mechanisms through which school environments contribute to racial/ethnic disparities in adolescent physical activity and will need to

  9. Racial/ethnic disparities in service utilization for individuals with co-occurring mental health and substance use disorders in the general population: results from the national epidemiologic survey on alcohol and related conditions.

    Science.gov (United States)

    Hatzenbuehler, Mark L; Keyes, Katherine M; Narrow, William E; Grant, Bridget F; Hasin, Deborah S

    2008-07-01

    This study sought to determine whether black/white disparities in service utilization for mental health and substance use disorders persist or are diminished among individuals with psychiatric comorbidity in the general population. The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions was used to identify individuals with lifetime co-occurring substance use disorders and mood/anxiety disorders (N = 4250; whites, N = 3597; blacks, N = 653). Lifetime service utilization for problems with mood, anxiety, alcohol, and drugs was assessed. Compared to whites, blacks with co-occurring mood or anxiety and substance use disorders were significantly less likely to receive services for mood or anxiety disorders, equally likely to receive services for alcohol use disorders, and more likely to receive some types of services for drug use disorders. Regardless of race/ethnicity, individuals with these co-occurring disorders were almost twice as likely to use services for mood/anxiety disorders than for substance use disorders. Despite the fact that comorbidity generally increases the likelihood of service use, black/white disparities in service utilization among an all-comorbid sample were found, although these disparities differed by type of disorder. Further research is warranted to understand the factors underlying these differences. Prevention and intervention strategies are needed to address the specific mental health needs of blacks with co-occurring disorders, as well as the overall lack of service use for substance use disorders among individuals with co-occurring psychiatric conditions.

  10. Racial and ethnic disparities in U.S. cancer screening rates

    Science.gov (United States)

    The percentage of U.S. citizens screened for cancer remains below national targets, with significant disparities among racial and ethnic populations, according to the first federal study to identify cancer screening disparities among Asian and Hispanic gr

  11. Economic, racial and ethnic disparities in breast cancer in the US: towards a more comprehensive model.

    Science.gov (United States)

    Campbell, Richard T; Li, Xue; Dolecek, Therese A; Barrett, Richard E; Weaver, Kathryn E; Warnecke, Richard B

    2009-09-01

    Using cancer registry data, we focus on racial and ethnic disparities in stage of breast cancer diagnosis in Cook County, IL. The county health system is the "last resort" health-care provider for low-income persons. Socioeconomic status is measured using empirical Bayes estimates of tract-level poverty, specific to non-Hispanic whites, non-Hispanic blacks or Hispanics in one of three age groups. We use ordinal logistic regression with non-proportional odds to model stage. Blacks and Hispanics are at greater risk for regional and distant stage diagnosis, but the disparity declines with age. Women in high-poverty areas are at substantially greater risk for late-stage diagnosis. The effects of poverty do not differ by age or across racial and ethnic groups.

  12. Association Between Perceived Discrimination and Racial/Ethnic Disparities in Problem Behaviors Among Preadolescent Youths

    Science.gov (United States)

    Elliott, Marc N.; Kanouse, David E.; Klein, David J.; Davies, Susan L.; Cuccaro, Paula M.; Banspach, Stephen W.; Peskin, Melissa F.; Schuster, Mark A.

    2013-01-01

    Objectives. We examined the contribution of perceived racial/ethnic discrimination to disparities in problem behaviors among preadolescent Black, Latino, and White youths. Methods. We used cross-sectional data from Healthy Passages, a 3-community study of 5119 fifth graders and their parents from August 2004 through September 2006 in Birmingham, Alabama; Los Angeles County, California; and Houston, Texas. We used multivariate regressions to examine the relationships of perceived racial/ethnic discrimination and race/ethnicity to problem behaviors. We used values from these regressions to calculate the percentage of disparities in problem behaviors associated with the discrimination effect. Results. In multivariate models, perceived discrimination was associated with greater problem behaviors among Black and Latino youths. Compared with Whites, Blacks were significantly more likely to report problem behaviors, whereas Latinos were significantly less likely (a “reverse disparity”). When we set Blacks’ and Latinos’ discrimination experiences to zero, the adjusted disparity between Blacks and Whites was reduced by an estimated one third to two thirds; the reverse adjusted disparity favoring Latinos widened by about one fifth to one half. Conclusions. Eliminating discrimination could considerably reduce mental health issues, including problem behaviors, among Black and Latino youths. PMID:23597387

  13. Gender disparities in health care.

    Science.gov (United States)

    Kent, Jennifer A; Patel, Vinisha; Varela, Natalie A

    2012-01-01

    The existence of disparities in delivery of health care has been the subject of increased empirical study in recent years. Some studies have suggested that disparities between men and women exist in the diagnoses and treatment of health conditions, and as a result measures have been taken to identify these differences. This article uses several examples to illustrate health care gender bias in medicine. These examples include surgery, peripheral artery disease, cardiovascular disease, critical care, and cardiovascular risk factors. Additionally, we discuss reasons why these issues still occur, trends in health care that may address these issues, and the need for acknowledgement of the current system's inequities in order to provide unbiased care for women in the future. © 2012 Mount Sinai School of Medicine.

  14. Disparities in Oral Health

    Science.gov (United States)

    ... Private Wells Infant Formula Fluorosis Public Health Service Recommendation Water Operators & Engineers Water Fluoridation Additives Shortages of Fluoridation Additives Drinking Water Pipe Systems CDC-Sponsored Water Fluoridation Training Links to Other ...

  15. Disparities in Arctic Health

    Centers for Disease Control (CDC) Podcasts

    Life at the top of the globe is drastically different. Harsh climate devoid of sunlight part of the year, pockets of extreme poverty, and lack of physical infrastructure interfere with healthcare and public health services. Learn about the challenges of people in the Arctic and how research and the International Polar Year address them.

  16. Disparities in Arctic Health

    Centers for Disease Control (CDC) Podcasts

    2008-02-04

    Life at the top of the globe is drastically different. Harsh climate devoid of sunlight part of the year, pockets of extreme poverty, and lack of physical infrastructure interfere with healthcare and public health services. Learn about the challenges of people in the Arctic and how research and the International Polar Year address them.  Created: 2/4/2008 by Emerging Infectious Diseases.   Date Released: 2/20/2008.

  17. Anabolic Steroid Misuse Among US Adolescent Boys: Disparities by Sexual Orientation and Race/Ethnicity.

    Science.gov (United States)

    Blashill, Aaron J; Calzo, Jerel P; Griffiths, Scott; Murray, Stuart B

    2017-02-01

    To examine the prevalence of anabolic steroid misuse among US adolescent boys as a function of sexual orientation and race/ethnicity. We analyzed boys from the 2015 Youth Risk Behavior Survey (n = 6248; mean age = 16), a representative sample of US high school students. Lifetime prevalence of anabolic steroid misuse was dichotomized as never versus 1 or more times. Sexual minority boys reported elevated misuse compared with heterosexual boys, within each level of race/ethnicity. Black, Hispanic, and White sexual minority boys reported misuse at approximately 25%, 20%, and 9%, respectively. Sexual orientation health disparities in anabolic steroid misuse disproportionally affect Black and Hispanic sexual minority adolescent boys, but more research is needed to understand the mechanisms driving these disparities.

  18. The Impact of Educational Attainment on Observed Race/Ethnic Disparities in Inflammatory Risk in the 2001–2008 National Health and Nutrition Examination Survey

    Directory of Open Access Journals (Sweden)

    Gniesha Y. Dinwiddie

    2015-12-01

    Full Text Available Inflammation has shown to be an independent predictor of cardiovascular disease (CVD and growing evidence suggests Non-Hispanic Blacks (NHBs and certain Hispanic subgroups have higher inflammation burden compared to Non-Hispanic Whites (NHWs. Socioeconomic status (SES is a hypothesized pathway that may account for the higher inflammation burden for race/ethnic groups yet little is known about the biological processes by which SES “gets under the skin” to affect health and whether income and education have similar or distinct influences on elevated inflammation levels. The current study examines SES (income and education associations with multiple levels of C-Reactive Protein (CRP, an important biomarker of inflammation, in a sample of 13,362 NHWs, 7696 NHBs and 4545 Mexican Americans (MAs in the United States from the 2001 to 2008 National Health and Nutrition Examination Survey. After adjusting for age, sex, and statin use, NHBs and MAs had higher intermediate and high CRP levels compared to NHWs. Income lessened the magnitude of the association for both race/ethnic groups. The greater intermediate and high CRP burden for NHBs and MAs was strongly explained by educational attainment. MAs were more vulnerable to high CRP levels for the lowest (i.e., less than nine years and post high school (i.e., associates degree educational levels. After additional adjustment for smoking, heavy drinking, high waist circumference, high blood pressure, diabetes and statin use, the strength of the association between race/ethnicity and inflammation was reduced for NHBs with elevated intermediate (RR = 1.31; p ≤ 0.001 and high CRP levels (RR = 1.14; p ≤ 0.001 compared to NHWs but the effect attenuated for MAs for both intermediate (RR = 0.74; p ≤ 0.001 and high CRP levels (RR = 0.38; p ≤ 0.001. These findings suggest educational attainment is a powerful predictor of elevated CRP levels in race/ethnic populations and challenges studies to move beyond

  19. Integrating the 3Ds—Social Determinants, Health Disparities, and Health-Care Workforce Diversity

    Science.gov (United States)

    Pierre, Geraldine

    2014-01-01

    The established relationships among social determinants of health (SDH), health disparities, and race/ethnicity highlight the need for health-care professionals to adequately address SDH in their encounters with patients. The ethnic demographic transition slated to occur during the next several decades in the United States will have numerous effects on the health-care sector, particularly as it pertains to the need for a more diverse and culturally aware workforce. In recent years, a substantial body of literature has developed, exploring the extent to which diversity in the health-care workforce may be used as a tool to eliminate racial/ethnic disparities in health and health care in the U.S. We explore existing literature on this topic, propose a conceptual framework, and identify next steps in health-care policy for reducing and eliminating health disparities by addressing SDH and diversification of the health-care workforce. PMID:24385659

  20. Integrating the 3Ds--social determinants, health disparities, and health-care workforce diversity.

    Science.gov (United States)

    LaVeist, Thomas A; Pierre, Geraldine

    2014-01-01

    The established relationships among social determinants of health (SDH), health disparities, and race/ethnicity highlight the need for health-care professionals to adequately address SDH in their encounters with patients. The ethnic demographic transition slated to occur during the next several decades in the United States will have numerous effects on the health-care sector, particularly as it pertains to the need for a more diverse and culturally aware workforce. In recent years, a substantial body of literature has developed, exploring the extent to which diversity in the health-care workforce may be used as a tool to eliminate racial/ethnic disparities in health and health care in the U.S. We explore existing literature on this topic, propose a conceptual framework, and identify next steps in health-care policy for reducing and eliminating health disparities by addressing SDH and diversification of the health-care workforce.

  1. Ethnic disparities among food sources of energy and nutrients of public health concern and nutrients to limit in adults in the United States: NHANES 2003-2006.

    Science.gov (United States)

    O'Neil, Carol E; Nicklas, Theresa A; Keast, Debra R; Fulgoni, Victor L

    2014-01-01

    Identification of current food sources of energy and nutrients among US non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Mexican American (MA) adults is needed to help with public health efforts in implementing culturally sensitive and feasible dietary recommendations. The objective of this study was to determine the food sources of energy and nutrients to limit [saturated fatty acids (SFA), added sugars, and sodium] and nutrients of public health concern (dietary fiber, vitamin D, calcium, and potassium) by NHW, NHB, and MA adults. This was a cross-sectional analysis of a nationally representative sample of NWH (n=4,811), NHB (2,062), and MA (n=1,950) adults 19+ years. The 2003-2006 NHANES 24-h recall (Day 1) dietary intake data were analyzed. An updated USDA Dietary Source Nutrient Database was developed using current food composition databases. Food grouping included ingredients from disaggregated mixtures. Mean energy and nutrient intakes from food sources were sample-weighted. Percentages of total dietary intake contributed from food sources were ranked. Multiple differences in intake among ethnic groups were seen for energy and all nutrients examined. For example, energy intake was higher in MA as compared to NHB; SFA, added sugars, and sodium intakes were higher in NHW than NHB; dietary fiber was highest in MA and lowest in NHB; vitamin D was highest in NHW; calcium was lowest in NHB; and potassium was higher in NHW as compared to NHB. Food sources of these nutrients also varied. Identification of intake of nutrients to limit and of public health concern can help health professionals implement appropriate dietary recommendations and plan interventions that are ethnically appropriate.

  2. Migrant and Ethnic Minority Health

    DEFF Research Database (Denmark)

    Essink-Bot, Marie-Louise; Agyemang, Charles; Stronks, Karien

    2015-01-01

    in health related to migration and ethnicity. Thereto we will first define the concepts of migration and ethnicity, briefly review the various groups of migrants and ethnic minorities in Europe, and introduce a conceptual model that specifies the link and causal pathways between ethnicity and health......European populations have become increasingly ethnically diverse as a result of migration, and evidence supports the existence of health inequalities between ethnic groups in Europe. This chapter addresses two main issues. First, we examine the pathways that are considered causal to inequalities....... Then we use the example of ethnic inequalities in cardiovascular disease and diabetes to illustrate the conceptual model. The second issue concerns the potential contribution from the health-care system to minimize the ethnic inequalities in health. As a public health sector, we should do all we can...

  3. Racial/ethnic disparities in history of incarceration, experiences of victimization, and associated health indicators among transgender women in the U.S.

    Science.gov (United States)

    Reisner, Sari L; Bailey, Zinzi; Sevelius, Jae

    2014-01-01

    Limited national data document the prevalence of incarceration among transgender women, experiences of victimization while incarcerated, and associations of transgender status with health. Data were from the National Transgender Discrimination Survey (NTDS), a large convenience sample of transgender adults in the U.S., collected between September 2008 and March 2009. Respondents who indicated a transfeminine gender identity were included in the current study (n = 3,878). Multivariable logistic regression was used to model ever being incarcerated and experiencing victimization while incarcerated as a function of race/ethnicity and health-related indicators. Overall, 19.3% reported having ever been incarcerated. Black and Native American/Alaskan Native transgender women were more likely to report a history of incarceration than White (non-Hispanic) respondents, and those with a history of incarceration were more likely to report negative health-related indicators, including self-reporting as HIV-positive. Among previously incarcerated respondents, 47.0% reported victimization while incarcerated. Black, Latina, and mixed race transgender women were more likely to report experiences of victimization while incarcerated. Transgender women reported disproportionately high rates of incarceration and victimization while incarcerated, as well as associated negative health-related indicators. Interventions and policy changes are needed to support transgender women while incarcerated and upon release.

  4. Vitamin D and Cardiovascular Disease: Potential Role in Health Disparities

    Science.gov (United States)

    Artaza, Jorge N.; Contreras, Sandra; Garcia, Leah A.; Mehrotra, Rajnish; Gibbons, Gary; Shohet, Ralph; Martins, David; Norris, Keith C.

    2012-01-01

    Cardiovascular disease (CVD), which includes coronary artery disease and stroke, is the leading cause of mortality in the nation. Excess CVD morbidity and premature mortality in the African American community is one of the most striking examples of racial/ethnic disparities in health outcomes. African Americans also suffer from increased rates of hypovitaminosis D, which has emerged as an independent risk factor for all-cause and cardiovascular mortality. This overview examines the potential role of hypovitaminosis D as a contributor to racial and ethnic disparities in cardiovascular disease (CVD). We review the epidemiology of vitamin D and CVD in African Americans and the emerging biological roles of vitamin D in key CVD signaling pathways that may contribute to the epidemiological findings and provide the foundation for future therapeutic strategies for reducing health disparities. PMID:22102304

  5. Ethnic disparities in access to care in post-apartheid South Africa.

    Science.gov (United States)

    Kon, Zeida R; Lackan, Nuha

    2008-12-01

    We investigated ethnic disparities in obtaining medical care among the 4 major ethnic groups (Blacks, Whites, Coloreds [i.e., those of mixed race], and Asians) in post-apartheid South Africa. Data for the study came from the 2002 Afrobarometer: Round II Survey of South Africa. Bivariate and multivariate analyses were used to examine differences across racial and ethnic groups in how often respondents went without medical care. A total of 40.8% of Blacks and 22.9% of Coloreds reported going without medical care at some point in the past year, compared with 10.9% of Whites and 6.9% of Asians. Disparities were found not only in health but in education, income, and basic public health infrastructures. Sociodemographic characteristics and perceptions regarding democracy, markets, and civil society were similar for Blacks and Coloreds and for Whites and Asians. Fourteen years after the end of apartheid, Blacks and Coloreds in South Africa are still underserved and disadvantaged compared with their White and Asian counterparts, especially regarding health care.

  6. Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome.

    Science.gov (United States)

    Gadson, Alexis; Akpovi, Eloho; Mehta, Pooja K

    2017-08-01

    Rates of maternal morbidity and mortality are rising in the United States. Non-Hispanic Black women are at highest risk for these outcomes compared to those of other race/ethnicities. Black women are also more likely to be late to prenatal care or be inadequate users of prenatal care. Prenatal care can engage those at risk and potentially influence perinatal outcomes but further research on the link between prenatal care and maternal outcomes is needed. The objective of this article is to review literature illuminating the relationship between prenatal care utilization, social determinants of health, and racial disparities in maternal outcome. We present a theoretical framework connecting the complex factors that may link race, social context, prenatal care utilization, and maternal morbidity/mortality. Prenatal care innovations showing potential to engage with the social determinants of maternal health and address disparities and priorities for future research are reviewed. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Racial/Ethnic Differences in Use of Health Care Services for Diabetes Management

    Science.gov (United States)

    Chandler, Raeven Faye; Monnat, Shannon M.

    2015-01-01

    Research demonstrates consistent racial/ethnic disparities in access to and use of health care services for a variety of chronic conditions. Yet we know little about whether these disparities exist for use of health care services for diabetes management. Racial/ethnic minorities disproportionately suffer from diabetes, complications from diabetes,…

  8. Racial and ethnic disparities in depression care in community-dwelling elderly in the United States.

    Science.gov (United States)

    Akincigil, Ayse; Olfson, Mark; Siegel, Michele; Zurlo, Karen A; Walkup, James T; Crystal, Stephen

    2012-02-01

    We investigated racial/ethnic disparities in the diagnosis and treatment of depression among community-dwelling elderly. We performed a secondary analysis of Medicare Current Beneficiary Survey data (n = 33,708) for 2001 through 2005. We estimated logistic regression models to assess the association of race/ethnicity with the probability of being diagnosed and treated for depression with either antidepressant medication or psychotherapy. Depression diagnosis rates were 6.4% for non-Hispanic Whites, 4.2% for African Americans, 7.2% for Hispanics, and 3.8% for others. After we adjusted for a range of covariates including a 2-item depression screener, we found that African Americans were significantly less likely to receive a depression diagnosis from a health care provider (adjusted odds ratio [AOR] = 0.53; 95% confidence interval [CI] = 0.41, 0.69) than were non-Hispanic Whites; those diagnosed were less likely to be treated for depression (AOR = 0.45; 95% CI = 0.30, 0.66). Among elderly Medicare beneficiaries, significant racial/ethnic differences exist in the diagnosis and treatment of depression. Vigorous clinical and public health initiatives are needed to address this persisting disparity in care.

  9. Child Health Disparities: What Can a Clinician Do?

    OpenAIRE

    Cheng, Tina L.; Emmanuel, Mickey; Levy, Daniel J.; Jenkins, Renee R.

    2015-01-01

    Pediatric primary and specialty practice has changed with more to do, more regulation and more family needs. Similarly, the needs of patients have changed with more demographic diversity, family stress and continued health disparities by race, ethnicity and socioeconomic status. How can clinicians continue their dedicated service to children and ensure health equity in the face of these changes? This paper outlines specific, practical, actionable and evidence-based activities for clinicians t...

  10. Ethnic disparities in the prevalence of metabolic syndrome and its risk factors in the Suriname Health Study: A cross-sectional population study

    NARCIS (Netherlands)

    I.S.K. Krishnadath (Ingrid S.K.); J.R. Toelsie (Jerry R.); A. Hofman (Albert); V.W.V. Jaddoe (Vincent)

    2016-01-01

    textabstractBackground The metabolic syndrome (MetS) indicates increased risk for cardiovascular disease and type 2 diabetes. We estimated the overall and ethnic-specific prevalence of MetS and explored the associations of risk factors with MetS among Amerindian, Creole, Hindustani, Javanese, Maroon

  11. Infant mortality: a call to action overcoming health disparities in the United States

    Directory of Open Access Journals (Sweden)

    Allison A. Vanderbilt

    2013-09-01

    Full Text Available Among all of the industrialized countries, the United States has the highest infant mortality rate. Racial and ethnic disparities continue to plague the United States with a disproportionally high rate of infant death. Furthermore, racial disparities among infant and neonatal mortality rates remain a chronic health problem in the United States. These risks are based on the geographical variations in mortality and disparities among differences in maternal risk characteristics, low birth weights, and lack of access to health care.

  12. Racial/ethnic disparities in obesity among US-born and foreign-born adults by sex and education.

    Science.gov (United States)

    Barrington, Debbie S; Baquero, Maria C; Borrell, Luisa N; Crawford, Natalie D

    2010-02-01

    This study examines sex and education variations in obesity among US- and foreign-born whites, blacks, and Hispanics utilizing 1997-2005 data from the National Health Interview Survey on 267,585 adults aged > or =18 years. After adjusting for various demographic, health, and socioeconomic factors via logistic regression, foreign-born black men had the lowest odds for obesity relative to US-born white men. The largest racial/ethnic disparity in obesity was between US-born black and white women. High educational attainment diminished the US-born black-white and Hispanic-white disparities among women, increased these disparities among men, and had minimal effect on foreign-born Hispanic-white disparities among women and men. Comprehension of these relationships is vital for conducting effective obesity research and interventions within an increasingly diverse United States.

  13. Assessing the Racial and Ethnic Disparities in Breast Cancer Mortality in the United States.

    Science.gov (United States)

    Yedjou, Clement G; Tchounwou, Paul B; Payton, Marinelle; Miele, Lucio; Fonseca, Duber D; Lowe, Leroy; Alo, Richard A

    2017-05-05

    Breast cancer is the second leading cause of cancer related deaths among women aged 40-55 in the United States and currently affects more than one in ten women worldwide. It is also one of the most diagnosed cancers in women both in wealthy and poor countries. Fortunately, the mortality rate from breast cancer has decreased in recent years due to increased emphasis on early detection and more effective treatments in White population. Although the mortality rates have declined in some ethnic populations, the overall cancer incidence among African American and Hispanic populations has continued to grow. The goal of the present review article was to highlight similarities and differences in breast cancer morbidity and mortality rates primarily among African American women compared to White women in the United States. To reach our goal, we conducted a search of articles in journals with a primary focus on minority health, and authors who had published articles on racial/ethnic disparity related to breast cancer patients. A systematic search of original research was conducted using MEDLINE, PUBMED and Google Scholar databases. We found that racial/ethnic disparities in breast cancer may be attributed to a large number of clinical and non-clinical risk factors including lack of medical coverage, barriers to early detection and screening, more advanced stage of disease at diagnosis among minorities, and unequal access to improvements in cancer treatment. Many African American women have frequent unknown or unstaged breast cancers than White women. These risk factors may explain the differences in breast cancer treatment and survival rate between African American women and White women. New strategies and approaches are needed to promote breast cancer prevention, improve survival rate, reduce breast cancer mortality, and ultimately improve the health outcomes of racial/ethnic minorities.

  14. Racial and ethnic disparities in stroke outcomes: a scoping review of post-stroke disability assessment tools.

    Science.gov (United States)

    Burns, Suzanne Perea; White, Brandi M; Magwood, Gayenell; Ellis, Charles; Logan, Ayaba; Jones Buie, Joy N; Adams, Robert J

    2018-03-23

    To identify how post-stroke disability outcomes are assessed in studies that examine racial/ethnic disparities and to map the identified assessment content to the International Classification of Functioning, Disability, and Health (ICF) across the time course of stroke recovery. We conducted a scoping review of the literature. Articles published between January 2001 and July 2017 were identified through Scopus, PubMed, CINAHL, and PsycINFO according to predefined inclusion and exclusion criteria. We identified 1791 articles through database and hand-searching strategies. Of the articles, 194 met inclusion criteria for full-text review, and 41 met inclusion criteria for study inclusion. The included studies used a variety of outcome measures encompassing domains within the ICF: body functions, activities, participation, and contextual factors across the time course of stroke recovery. We discovered disproportionate representation among racial/ethnic groups in the post-stroke disability disparities literature. A wide variety of assessments are used to examine disparities in post-stroke disability across the time course of stroke recovery. Several studies have identified disparities through a variety of assessments; however, substantial problems abound from the assessments used including inconsistent use of assessments, lacking evidence on the validity of assessments among racial/ethnic groups, and inadequate representation among all racial/ethnic populations comprising the US. Implications for Rehabilitation An enhanced understanding of racial/ethnic disparities in post-stroke disability outcomes is inherently important among rehabilitation practitioners who frequently engage with racial/ethnic minority populations across the time course of stroke recovery. Clinicians should carefully consider the psychometric properties of assessment tools to counter potential racial bias. Clinicians should be aware that many assessments used in stroke rehabilitation lack cultural

  15. Perspectives of Orthopedic Surgeons on Racial/Ethnic Disparities in Care.

    Science.gov (United States)

    Adelani, Muyibat A; O'Connor, Mary I

    2017-08-01

    Racial/ethnic disparities in healthcare, including orthopedics, have been extensively documented. However, the level of knowledge among orthopedic surgeons regarding racial/ethnic disparities is unknown. The purpose of this study is to determine the views of orthopedic surgeons on (1) the extent of racial/ethnic disparities in orthopedic care, (2) patient and system factors that may contribute, and (3) the potential role of orthopedic surgeons in the reduction of disparities. Three hundred five members of the American Orthopaedic Association completed a survey to assess their knowledge of racial/ethnic disparities and their perceptions about the underlying causes. Twelve percent of respondents believe that patients often receive different care based on race/ethnicity in healthcare in general, while 9 % believe that differences exist in orthopedic care in general, 3 % believe that differences exist within their hospitals/clinics, and 1 % reported differences in their own practices. Despite this, 68 % acknowledge that there is evidence of disparities in orthopedic care. Fifty-one percent believe that a lack of insurance significantly contributes to disparities. Thirty-five percent believe that diversification of the orthopedic workforce would be a "very effective" strategy in addressing disparities, while 25 % percent believe that research would be "very effective" and 24 % believe that surgeon education would be "very effective." Awareness regarding racial/ethnic disparities in musculoskeletal care is low among orthopedic surgeons. Additionally, respondents were more likely to acknowledge disparities within the practices of others than their own. Increased diversity, research, and education may help improve knowledge of this problem.

  16. Prevalence and risk factors associated with Entamoeba histolytica/dispar/moshkovskii infection among three Orang Asli ethnic groups in Malaysia.

    Directory of Open Access Journals (Sweden)

    Tengku Shahrul Anuar

    Full Text Available Entamoeba histolytica/Entamoeba dispar/Entamoeba moshkovskii infection is still prevalent in rural Malaysia especially among Orang Asli communities. Currently, information on prevalence of this infection among different ethnic groups of Orang Asli is unavailable in Malaysia. To contribute to a better comprehension of the epidemiology of this infection, a cross-sectional study aimed at providing the first documented data on the prevalence and risk factors associated with E. histolytica/E. dispar/E. moshkovskii infection was carried out among three Orang Asli ethnic groups (Proto-Malay, Negrito, and Senoi in selected villages in Negeri Sembilan, Perak, and Pahang states, Malaysia.Faecal samples were examined by formalin-ether sedimentation and trichrome staining techniques. Of 500 individuals, 8.7% (13/150 of Proto-Malay, 29.5% (41/139 of Negrito, and 18.5% (39/211 of Senoi were positive for E. histolytica/E. dispar/E. moshkovskii, respectively. The prevalence of this infection showed an age-dependency relationship, with higher rates observed among those aged less than 15 years in all ethnic groups studied. Multivariate analysis confirmed that not washing hands after playing with soils or gardening and presence of other family members infected with E. histolytica/E. dispar/E. moshkovskii were significant risk factors of infection among all ethnic groups. However, eating with hands, the consumption of raw vegetables, and close contact with domestic animals were identified as significant risk factors in Senoi.Essentially, the findings highlighted that E. histolytica/E. dispar/E. moshkovskii parasites are still prevalent in Malaysia. Further studies using molecular approaches to distinguish the morphologically identical species of pathogenic, E. histolytica from the non-pathogenic, E. dispar and E. moshkovskii are needed. The establishment of such data will be beneficial for the public health authorities in the planning and implementation of specific

  17. Racial/Ethnic Disparities in Nursing Home Quality of Life Deficiencies, 2001 to 2011

    Directory of Open Access Journals (Sweden)

    Lauren J. Campbell MA

    2016-06-01

    Full Text Available Objectives: Racial/ethnic disparities in nursing homes (NHs are associated with lower quality of care, and state Medicaid payment policies may influence NH quality. However, no studies analyzing disparities in NH quality of life (QoL exist. Therefore, this study aims to estimate associations at the NH level between average number of QoL deficiencies and concentrations of racial/ethnic minority residents, and to identify effects of state Medicaid payment policies on racial/ethnic disparities. Method: Multivariable Poisson regression with NH random effects was used to determine the association between NH minority concentration in 2000 to 2010 and average number of QoL deficiencies in 2001 to 2011 at the NH level, and the effect of state NH payment policies on QoL deficiencies and racial/ethnic disparities in QoL deficiencies across NH minority concentrations. Results: Racial/ethnic disparities in QoL between high and low minority concentration NHs decrease over time, but are not eliminated. Case mix payment was associated with an increased disparity between high and low minority concentration NHs in QoL deficiencies. Discussion: NH managers and policy makers should consider initiatives targeting minority residents or low-performing NHs with higher minority concentrations for improvement to reduce disparities and address QoL deficiencies.

  18. Health Disparities in Pediatric Asthma: Comprehensive Tertiary Care Center Experience.

    Science.gov (United States)

    Holmes, Laurens; Kalle, Fanta; Grinstead, Laura; Jimenez, Maritza; Murphy, Meghan; Oceanic, Pat; Fitzgerald, Diane; Dabney, Kirk

    2015-03-01

    Study conducted at Nemours /Alfred I. duPont Hospital for Children, Wilmington, DE 19803 BACKGROUND: Although the treatment and management of asthma hasimproved over time, incidence and prevalence among children continues to rise in the United States. Asthma prevalence, health services utilization, and mortality rate demonstrate remarkable disparities. The underlying causes of these disparities are not fully understood. We aimed to examine racial/ethnic variances in pediatric asthma prevalence/admission. We retrospectively reviewed data on 1070 patients and applied a cross-sectional design to assess asthma admission between 2010 and 2011. Information was available on race/ethnicity, sex, insurance status, severity of illness (SOI), and length of stay/hospitalization (LOS).Chi-square statistic was used for the association between race and other variables in an attempt to explain the racial/ethnic variance. The proportionate morbidity of asthma was highest amongCaucasians (40.92%) and African Americans (40.54%), intermediate among others (16.57%), and lowest among Asian (0.56%), American Indian/Alaska Native (0.28%), and Hawaiian Native/Pacific Islander (0.28%). Overall there were disparities by sex, with more boys (61.80%) diagnosed with asthma than girls (38.20%), χ2(7)=20.1, p=0.005. Insurance status, and SOI varied by race/ethnicity, but not LOS. Caucasian children were more likely to have private insurance, while African Americans and Hispanics were more likely to have public insurance (p<0.005). Asthma was more severe among non-Hispanic children, χ2(14)=154.6, p<0.001. While the overall readmission proportion was 2.8%, readmission significantly varied by race/ethnicity. Racial/ethnic disparities in asthma admission exist among children in the Delaware Valley. There were racial/ethnic disparities in insurance status, asthma severity, and sex differed by race/ethnicity, but not in length of hospitalization. © 2015 National Medical Association. Published by

  19. Racial, Ethnic, and Socioeconomic Disparities in the Prevalence of Cerebral Palsy

    Science.gov (United States)

    Xing, Guibo; Fuentes-Afflick, Elena; Danielson, Beate; Smith, Lloyd H.; Gilbert, William M.

    2011-01-01

    OBJECTIVE: Racial and ethnic disparities in cerebral palsy have been documented, but the underlying mechanism is poorly understood. We determined whether low birth weight accounts for ethnic disparities in the prevalence of cerebral palsy and whether socioeconomic factors impact cerebral palsy within racial and ethnic groups. METHODS: In a retrospective cohort of 6.2 million births in California between 1991 and 2001, we compared maternal and infant characteristics among 8397 infants with cerebral palsy who qualified for services from the California Department of Health Services and unaffected infants. RESULTS: Overall, black infants were 29% more likely to have cerebral palsy than white infants (relative risk: 1.29 [95% confidence interval: 1.19–1.39]). However, black infants who were very low or moderately low birth weight were 21% to 29% less likely to have cerebral palsy than white infants of comparable birth weight. After we adjusted for birth weight, there was no difference in the risk of cerebral palsy between black and white infants. In multivariate analyses, women of all ethnicities who did not receive any prenatal care were twice as likely to have infants with cerebral palsy relative to women with an early onset of prenatal care. Maternal education was associated with cerebral palsy in a dose-response fashion among white and Hispanic women. Hispanic adolescent mothers (aged cerebral palsy. CONCLUSIONS: The increased risk of cerebral palsy among black infants is primarily related to their higher risk of low birth weight. Understanding how educational attainment and use of prenatal care impact the risk of cerebral palsy may inform new prevention strategies. PMID:21339278

  20. The influence of health disparities on targeting cancer prevention efforts.

    Science.gov (United States)

    Zonderman, Alan B; Ejiogu, Ngozi; Norbeck, Jennifer; Evans, Michele K

    2014-03-01

    Despite the advances in cancer medicine and the resultant 20% decline in cancer death rates for Americans since 1991, there remain distinct cancer health disparities among African Americans, Hispanics, Native Americans, and the those living in poverty. Minorities and the poor continue to bear the disproportionate burden of cancer, especially in terms of stage at diagnosis, incidence, and mortality. Cancer health disparities are persistent reminders that state-of-the-art cancer prevention, diagnosis, and treatment are not equally effective for and accessible to all Americans. The cancer prevention model must take into account the phenotype of accelerated aging associated with health disparities as well as the important interplay of biological and sociocultural factors that lead to disparate health outcomes. The building blocks of this prevention model will include interdisciplinary prevention modalities that encourage partnerships across medical and nonmedical entities, community-based participatory research, development of ethnically and racially diverse research cohorts, and full actualization of the prevention benefits outlined in the 2010 Patient Protection and Affordable Care Act. However, the most essential facet should be a thoughtful integration of cancer prevention and screening into prevention, screening, and disease management activities for hypertension and diabetes mellitus because these chronic medical illnesses have a substantial prevalence in populations at risk for cancer disparities and cause considerable comorbidity and likely complicate effective treatment and contribute to disproportionate cancer death rates. Published by Elsevier Inc.

  1. Pharmacogenomics and the challenge of health disparities.

    Science.gov (United States)

    Lee, S S

    2009-01-01

    This paper examines emerging technologies and recent research on population differences in pharmacogenomics and the perspectives of scientists, community advocates, policymakers, and social critics on the use of race as a proxy for genetic variation. The discussion focuses on how recent developments in genomic science impact social understandings of racial difference and the public health goal to eliminate ongoing health disparities among racially identified groups. This paper examines how factors such as governmental policies--requiring the use of racial and ethnic categories in genetic research and increasing interest in identifying untapped racial market niches by the pharmaceutical and biotechnology industries--and weak governmental oversight of race-based therapeutics converge to create an 'infrastructure of racialization' that may alter the vision of personalized medicine that has been so highly anticipated. This paper argues that significant public investment in pharmacogenomics requires careful consideration of the emerging discourse that tethers racial justice to notions of racial biology and discusses the social and ethical implications for the pendulum shift towards a geneticization of race in drug development. Copyright 2009 S. Karger AG, Basel.

  2. Prioritizing health disparities in medical education to improve care

    Science.gov (United States)

    Awosogba, Temitope; Betancourt, Joseph R.; Conyers, F. Garrett; Estapé, Estela S.; Francois, Fritz; Gard, Sabrina J.; Kaufman, Arthur; Lunn, Mitchell R.; Nivet, Marc A.; Oppenheim, Joel D.; Pomeroy, Claire; Yeung, Howa

    2015-01-01

    Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities. PMID:23659676

  3. Prioritizing health disparities in medical education to improve care.

    Science.gov (United States)

    Awosogba, Temitope; Betancourt, Joseph R; Conyers, F Garrett; Estapé, Estela S; Francois, Fritz; Gard, Sabrina J; Kaufman, Arthur; Lunn, Mitchell R; Nivet, Marc A; Oppenheim, Joel D; Pomeroy, Claire; Yeung, Howa

    2013-05-01

    Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities. © 2013 New York Academy of Sciences.

  4. Examples of Cancer Health Disparities

    Science.gov (United States)

    ... and the bacterium H. pylori (stomach cancer) in immigrant countries of origin contributes to these disparities. ( ACS ) ... Cancer.gov en español Multimedia Publications Site Map Digital Standards for NCI Websites POLICIES Accessibility Comment Policy ...

  5. Racial-Ethnic Disparities in Maternal Parenting Stress: The Role of Structural Disadvantages and Parenting Values

    OpenAIRE

    Nomaguchi, Kei; House, Amanda N.

    2013-01-01

    Although researchers contend that racial-ethnic minorities experience more stress than whites, knowledge of racial-ethnic disparities in parenting stress is limited. Using a pooled time-series analysis of data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998–99 (n = 11,324), we examine racial-ethnic differences in maternal parenting stress, with a focus on structural and cultural explanations and variations by nativity and child age. In kindergarten, black mothers, albe...

  6. Racial and ethnic disparities in meeting MTM eligibility criteria among patients with asthma.

    Science.gov (United States)

    Lu, Degan; Qiao, Yanru; Johnson, Karen C; Wang, Junling

    2017-06-01

    Asthma is one of the most frequently targeted chronic diseases in the medication therapy management (MTM) programs of the Medicare prescription drug (Part D) benefits. Although racial and ethnic disparities in meeting eligibility criteria for MTM services have been reported, little is known about whether there would be similar disparities among adults with asthma in the United States. Adult patients with asthma (age ≥ 18) from Medical Expenditure Panel Survey (2011-2012) were analyzed. Bivariate analyses were conducted to compare the proportions of patients who would meet Medicare MTM eligibility criteria between non-Hispanic Blacks (Blacks), Hispanics and non-Hispanic Whites (Whites). Survey-weighted logistic regression was performed to adjust for patient characteristics. Main and sensitivity analyses were conducted to cover the entire range of the eligibility thresholds used by Part D plans in 2011-2012. The sample included 4,455 patients with asthma, including 2,294 Whites, 1,218 Blacks, and 943 Hispanics. Blacks and Hispanics had lower proportions of meeting MTM eligibility criteria than did Whites (P asthma. Future studies should examine the implications of such disparities on health outcomes of patients with asthma and explore alternative MTM eligibility criteria.

  7. The role of health-related behaviors in the socioeconomic disparities in oral health.

    Science.gov (United States)

    Sabbah, Wael; Tsakos, Georgios; Sheiham, Aubrey; Watt, Richard G

    2009-01-01

    This study aimed to examine the socioeconomic disparities in health-related behaviors and to assess if behaviors eliminate socioeconomic disparities in oral health in a nationally representative sample of adult Americans. Data are from the US Third National Health and Nutrition Examination Survey (1988-1994). Behaviors were indicated by smoking, dental visits, frequency of eating fresh fruits and vegetables and extent of calculus, used as a marker for oral hygiene. Oral health outcomes were gingival bleeding, loss of periodontal attachment, tooth loss and perceived oral health. Education and income indicated socioeconomic position. Sex, age, ethnicity, dental insurance and diabetes were adjusted for in the regression analysis. Regression analysis was used to assess socioeconomic disparities in behaviors. Regression models adjusting and not adjusting for behaviors were compared to assess the change in socioeconomic disparities in oral health. The results showed clear socioeconomic disparities in all behaviors. After adjusting for behaviors, the association between oral health and socioeconomic indicators attenuated but did not disappear. These findings imply that improvement in health-related behaviors may lessen, but not eliminate socioeconomic disparities in oral health, and suggest the presence of more complex determinants of these disparities which should be addressed by oral health preventive policies.

  8. Calculating expected years of life lost for assessing local ethnic disparities in causes of premature death

    Directory of Open Access Journals (Sweden)

    Katcher Brian S

    2008-04-01

    Full Text Available Abstract Background A core function of local health departments is to conduct health assessments. The analysis of death certificates provides information on diseases, conditions, and injuries that are likely to cause death – an important outcome indicator of population health. The expected years of life lost (YLL measure is a valid, stand-alone measure for identifying and ranking the underlying causes of premature death. The purpose of this study was to rank the leading causes of premature death among San Francisco residents, and to share detailed methods so that these analyses can be used in other local health jurisdictions. Methods Using death registry data and population estimates for San Francisco deaths in 2003–2004, we calculated the number of deaths, YLL, and age-standardized YLL rates (ASYRs. The results were stratified by sex, ethnicity, and underlying cause of death. The YLL values were used to rank the leading causes of premature death for men and women, and by ethnicity. Results In the years 2003–2004, 6312 men died (73,627 years of life lost, and 5726 women died (51,194 years of life lost. The ASYR for men was 65% higher compared to the ASYR for women (8971.1 vs. 5438.6 per 100,000 persons per year. The leading causes of premature deaths are those with the largest average YLLs and are largely preventable. Among men, these were HIV/AIDS, suicide, drug overdose, homicide, and alcohol use disorder; and among women, these were lung cancer, breast cancer, hypertensive heart disease, colon cancer, and diabetes mellitus. A large health disparity exists between African Americans and other ethnic groups: African American age-adjusted overall and cause-specific YLL rates were higher, especially for homicide among men. Except for homicide among Latino men, Latinos and Asians have comparable or lower YLL rates among the leading causes of death compared to whites. Conclusion Local death registry data can be used to measure, rank, and

  9. Age and racial/ethnic disparities in arthritis-related hip and knee surgeries.

    Science.gov (United States)

    Dunlop, Dorothy D; Manheim, Larry M; Song, Jing; Sohn, Min-Woong; Feinglass, Joseph M; Chang, Huan J; Chang, Rowland W

    2008-02-01

    Nearly 18 million Americans experience limitations due to their arthritis. Documented disparities according to racial/ethnic groups in the use of surgical interventions such as knee and hip arthroplasty are largely based on data from Medicare beneficiaries age 65 or older. Whether there are disparities among younger adults has not been previously addressed. This study assesses age-specific racial/ethnic differences in arthritis-related knee and hip surgeries. Longitudinal (1998-2004) Health and Retirement Study. National probability sample of US community-dwelling adults. A total of 2262 black, 1292 Hispanic, and 13,159 white adults age 51 and older. The outcome is self-reported 2-year use of arthritis-related hip or knee surgery. Independent variables are demographic (race/ethnicity, age, gender), health needs (arthritis, chronic diseases, obesity, physical activity, and functional limitations), and medical access (income, wealth, education, and health insurance). Longitudinal data methods using discrete survival analysis are used to validly account for repeated (biennial) observations over time. Analyses use person-weights, stratum, and sampling error codes to provide valid inferences to the US population. Black adults under the age of 65 years report similar age/gender adjusted rates of hip/knee arthritis surgeries [hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 0.87-2.38] whereas older blacks (age 65+) have significantly lower rates (HR = 0.38, CI = 0.16-0.55) compared with whites. These relationships hold controlling for health and economic differences. Both under age 65 years (HR = 0.64, CI = 0.12-1.44) and older (age 65+) Hispanic adults (HR = 0.60, CI = 0.32-1.10) report lower utilization rates, although not statistically different than whites. A large portion of the Hispanic disparity is explained by economic differences. These national data document lower rates of arthritis-related hip/knee surgeries for older black versus white adults age 65 or

  10. Ethnic disparities in diabetes management and pay-for-performance in the UK: the Wandsworth Prospective Diabetes Study.

    Directory of Open Access Journals (Sweden)

    Christopher Millett

    2007-06-01

    Full Text Available Pay-for-performance rewards health-care providers by paying them more if they succeed in meeting performance targets. A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay-for-performance seen in any health-care system. The contract provides an important opportunity to address disparities in chronic disease management between ethnic and socioeconomic groups. We examined disparities in management of people with diabetes and intermediate clinical outcomes within a multiethnic population in primary care before and after the introduction of the new contract in April 2004.We conducted a population-based longitudinal survey, using electronic general practice records, in an ethnically diverse part of southwest London. Outcome measures were prescribing levels and achievement of national treatment targets (HbA1c < or = 7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol < or = 5 mmol/l or 193 mg/dl. The proportion of patients reaching treatment targets for HbA1c, BP, and total cholesterol increased significantly after the implementation of the new contract. The extents of these increases were broadly uniform across ethnic groups, with the exception of the black Caribbean patient group, which had a significantly lower improvement in HbA1c (adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.57-0.97 and BP control (AOR 0.65, 95% CI 0.53-0.81 relative to the white British patient group. Variations in prescribing and achievement of treatment targets between ethnic groups present in 2003 were not attenuated in 2005.Pay-for-performance incentives have not addressed disparities in the management and control of diabetes between ethnic groups. Quality improvement initiatives must place greater emphasis on minority communities to avoid continued disparities in mortality from cardiovascular disease and the other major complications of diabetes.

  11. Health disparities among health care workers.

    Science.gov (United States)

    Mawn, Barbara; Siqueira, Eduardo; Koren, Ainat; Slatin, Craig; Devereaux Melillo, Karen; Pearce, Carole; Hoff, Lee Ann

    2010-01-01

    In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field.

  12. Ethnic Differences in Bone Health

    Directory of Open Access Journals (Sweden)

    Ayse eZengin

    2015-03-01

    Full Text Available There are differences in bone health between ethnic groups in both men and in women. Variations in body size and composition are likely to contribute to reported differences. Most studies report ethnic differences in areal bone mineral density (aBMD which do not consistently parallel ethnic patterns in fracture rates. This suggests that other parameters beside aBMD should be considered when determining fracture risk between and within populations, including other aspects of bone strength: bone structure and microarchitecture as well muscle strength (mass, force generation, anatomy and fat mass. We review what is known about differences in bone-densitometry derived outcomes between ethnic groups and the extent to which they account for the differences in fracture risk. Studies are included that were published primarily between 1994 – 2014. A ‘one size fits all approach’ should not be used to understand better ethnic differences in fracture risk.

  13. Psychiatrists' attitudes toward and awareness about racial disparities in mental health care.

    Science.gov (United States)

    Mallinger, Julie B; Lamberti, J Steven

    2010-02-01

    Psychiatrists may perpetuate racial-ethnic disparities in health care through racially biased, albeit unconscious, behaviors. Changing these behaviors requires that physicians accept that racial-ethnic disparities exist and accept their own contributions to disparities. The purposes of this study were to assess psychiatrists' awareness of racial disparities in mental health care, to evaluate the extent to which psychiatrists believe they contribute to disparities, and to determine psychiatrists' interest in participating in disparities-reduction programs. A random sample of psychiatrists, identified through the American Psychiatric Association's member directory, was invited to complete the online survey. The survey was also distributed to psychiatrists at a national professional conference. Of the 374 respondents, most said they were not familiar or only a little familiar with the literature on racial disparities. Respondents tended to believe that race has a moderate influence on quality of psychiatric care but that race is more influential in others' practices than in their own practices. One-fourth had participated in any type of disparities-reduction program within the past year, and approximately one-half were interested in participating in such a program. Psychiatrists may not recognize the pervasiveness of racial inequality in psychiatric care, and they may attribute racially biased thinking to others but not to themselves. Interventions to eliminate racial-ethnic disparities should focus on revealing and modifying unconscious biases. Lack of physician interest may be one barrier to such interventions.

  14. The coalition to reduce racial and ethnic disparities in cardiovascular disease outcomes (credo): why credo matters to cardiologists.

    Science.gov (United States)

    Yancy, Clyde W; Wang, Tracy Y; Ventura, Hector O; Piña, Ileana L; Vijayaraghavan, Krishnaswami; Ferdinand, Keith C; Hall, Laura Lee

    2011-01-18

    This report reviews the rationale for the American College of Cardiology's Coalition to Reduce Racial and Ethnic Disparities in Cardiovascular Disease Outcomes (credo) and the tools that will be made available to cardiologists and others treating cardiovascular disease (CVD) to better meet the needs of their diverse patient populations. Even as the patient population with CVD grows increasingly diverse in terms of race, ethnicity, age, and sex, many cardiologists and other health care providers are unaware of the negative influence of disparate care on CVD outcomes and do not have the tools needed to improve care and outcomes for patients from different demographic and socioeconomic backgrounds. Reviewed published reports assessed the need for redressing CVD disparities and the evidence concerning interventions that can assist cardiology care providers in improving care and outcomes for diverse CVD patient populations. Evidence points to the effectiveness of performance measure-based quality improvement, provider cultural competency training, team-based care, and patient education as strategies to promote the elimination of disparate CVD care and in turn might lead to better outcomes. credo has launched several initiatives built on these evidence-based principles and will be expanding these tools along with research. credo will provide the CVD treatment community with greater awareness of disparities and tools to help close the gap in care and outcomes for all patient subpopulations. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  15. Environmental supports for walking/biking and traffic safety: income and ethnicity disparities.

    Science.gov (United States)

    Yu, Chia-Yuan

    2014-10-01

    The present study investigates the influence of income, ethnicity, and built environmental characteristics on the percentages of workers who walk/bike as well as on pedestrian/cyclist crash rates. Furthermore, income and ethnicity disparities are also explored. This study chose 162 census tracts in Austin as the unit of analysis. To explore income and ethnicity differences in built environments, this study examined the associations of the poverty rate, the percentage of white population, and the percentage of Hispanic population to each built environmental variable. Path models were applied to examine environmental supports of walking/biking and pedestrian/cyclist safety. Areas with high poverty rates had more biking trips and experienced more cyclist crashes, while areas with a high percentage of white population generated more walking trips and fewer pedestrian crashes. Sidewalk completeness and mixed land uses promoted walking to work but increased the crash risk for pedestrians as well. In terms of biking behaviors, road density and transit stop density both increased biking trips and cyclist crashes. Environmental designs that both encourage walking/biking trips and generate more safety threats should attract more attention from policy makers. Policies should also be more devoted to enhancing the mobility and health for areas with high poverty rates. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. CDC Health Disparities and Inequalities Report--U.S. 2013

    Science.gov (United States)

    ... Women's Health Health Literacy Health Equity CDC Health Disparities & Inequalities Report (CHDIR) Recommend on Facebook Tweet Share ... 2011 Report More Information CDC Releases Second Health Disparities & Inequalities Report - United States, 2013 CDC and its ...

  17. Child Health Disparities: What Can a Clinician Do?

    Science.gov (United States)

    Cheng, Tina L; Emmanuel, Mickey A; Levy, Daniel J; Jenkins, Renee R

    2015-11-01

    Pediatric primary and specialty practice has changed, with more to do, more regulation, and more family needs than in the past. Similarly, the needs of patients have changed, with more demographic diversity, family stress, and continued health disparities by race, ethnicity, and socioeconomic status. How can clinicians continue their dedicated service to children and ensure health equity in the face of these changes? This article outlines specific, practical, actionable, and evidence-based activities to help clinicians assess and address health disparities in practice. These tools may also support patient-centered medical home recognition, national and state cultural and linguistic competency standards, and quality benchmarks that are increasingly tied to payment. Clinicians can play a critical role in (1) diagnosing disparities in one's community and practice, (2) innovating new models to address social determinants of health, (3) addressing health literacy of families, (4) ensuring cultural competence and a culture of workplace equity, and (5) advocating for issues that address the root causes of health disparities. Culturally competent care that is sensitive to the needs, health literacy, and health beliefs of families can increase satisfaction, improve quality of care, and increase patient safety. Clinical care approaches to address social determinants of health and interrupting the intergenerational cycle of disadvantage include (1) screening for new health "vital signs" and connecting families to resources, (2) enhancing the comprehensiveness of services, (3) addressing family health in pediatric encounters, and (4) moving care outside the office into the community. Health system investment is required to support clinicians and practice innovation to ensure equity. Copyright © 2015 by the American Academy of Pediatrics.

  18. Sexual Orientation Disparities in BMI among US Adolescents and Young Adults in Three Race/Ethnicity Groups

    Directory of Open Access Journals (Sweden)

    Sabra L. Katz-Wise

    2014-01-01

    Full Text Available Obesity is a key public health issue for US youth. Previous research with primarily white samples of youth has indicated that sexual minority females have higher body mass index (BMI and sexual minority males have lower BMI than their same-gender heterosexual counterparts, with sexual orientation differences in males increasing across adolescence. This research explored whether gender and sexual orientation differences in BMI exist in nonwhite racial/ethnic groups. Using data from Waves I–IV (1995–2009 of the US National Longitudinal Study of Adolescent Health (N = 13,306, ages 11–34 years, we examined associations between sexual orientation and BMI (kg/m2 over time, using longitudinal linear regression models, stratified by gender and race/ethnicity. Data were analyzed in 2013. Among males, heterosexual individuals showed greater one-year BMI gains than gay males across all race/ethnicity groups. Among females, white and Latina bisexual individuals had higher BMI than same-race/ethnicity heterosexual individuals regardless of age; there were no sexual orientation differences in black/African Americans. Sexual orientation disparities in BMI are a public health concern across race/ethnicity groups. Interventions addressing unhealthy weight gain in youth must be relevant for all sexual orientations and race/ethnicities.

  19. An Approach to Integrating Health Disparities within Undergraduate Biomedical Engineering Education.

    Science.gov (United States)

    Vazquez, Maribel; Marte, Otto; Barba, Joseph; Hubbard, Karen

    2017-11-01

    Health disparities are preventable differences in the incidence, prevalence and burden of disease among communities targeted by gender, geographic location, ethnicity and/or socio-economic status. While biomedical research has identified partial origin(s) of divergent burden and impact of disease, the innovation needed to eradicate health disparities in the United States requires unique engagement from biomedical engineers. Increasing awareness of the prevalence and consequences of health disparities is particularly attractive to today's undergraduates, who have undauntedly challenged paradigms believed to foster inequality. Here, the Department of Biomedical Engineering at The City College of New York (CCNY) has leveraged its historical mission of access-and-excellence to integrate the study of health disparities into undergraduate BME curricula. This article describes our novel approach in a multiyear study that: (i) Integrated health disparities modules at all levels of the required undergraduate BME curriculum; (ii) Developed opportunities to include impacts of health disparities into undergraduate BME research projects and mentored High School summer STEM training; and (iii) Established health disparities-based challenges as BME capstone design and/or independent entrepreneurship projects. Results illustrate the rising awareness of health disparities among the youngest BMEs-to-be, as well as abundant undergraduate desire to integrate health disparities within BME education and training.

  20. Determinants of health disparities between Italian regions

    Directory of Open Access Journals (Sweden)

    Giannoni Margherita

    2010-06-01

    Full Text Available Abstract Background Among European countries, Italy is one of the countries where regional health disparities contribute substantially to socioeconomic health disparities. In this paper, we report on regional differences in self-reported poor health and explore possible determinants at the individual and regional levels in Italy. Methods We use data from the "Indagine Multiscopo sulle Famiglie", a survey of aspects of everyday life in the Italian population, to estimate multilevel logistic regressions that model poor self-reported health as a function of individual and regional socioeconomic factors. Next we use the causal step approach to test if living conditions, healthcare characteristics, social isolation, and health behaviors at the regional level mediate the relationship between regional socioeconomic factors and self-rated health. Results We find that residents living in regions with more poverty, more unemployment, and more income inequality are more likely to report poor health and that poor living conditions and private share of healthcare expenditures at the regional level mediate socioeconomic disparities in self-rated health among Italian regions. Conclusion The implications are that regional contexts matter and that regional policies in Italy have the potential to reduce health disparities by implementing interventions aimed at improving living conditions and access to quality healthcare.

  1. Semantic Modeling for SNPs Associated with Ethnic Disparities in HapMap Samples

    Directory of Open Access Journals (Sweden)

    HyoYoung Kim

    2014-03-01

    Full Text Available Single-nucleotide polymorphisms (SNPs have been emerging out of the efforts to research human diseases and ethnic disparities. A semantic network is needed for in-depth understanding of the impacts of SNPs, because phenotypes are modulated by complex networks, including biochemical and physiological pathways. We identified ethnicity-specific SNPs by eliminating overlapped SNPs from HapMap samples, and the ethnicity-specific SNPs were mapped to the UCSC RefGene lists. Ethnicity-specific genes were identified as follows: 22 genes in the USA (CEU individuals, 25 genes in the Japanese (JPT individuals, and 332 genes in the African (YRI individuals. To analyze the biologically functional implications for ethnicity-specific SNPs, we focused on constructing a semantic network model. Entities for the network represented by "Gene," "Pathway," "Disease," "Chemical," "Drug," "ClinicalTrials," "SNP," and relationships between entity-entity were obtained through curation. Our semantic modeling for ethnicity-specific SNPs showed interesting results in the three categories, including three diseases ("AIDS-associated nephropathy," "Hypertension," and "Pelvic infection", one drug ("Methylphenidate", and five pathways ("Hemostasis," "Systemic lupus erythematosus," "Prostate cancer," "Hepatitis C virus," and "Rheumatoid arthritis". We found ethnicity-specific genes using the semantic modeling, and the majority of our findings was consistent with the previous studies - that an understanding of genetic variability explained ethnicity-specific disparities.

  2. Racial and ethnic disparity in food allergy in the United States: a systematic review.

    Science.gov (United States)

    Greenhawt, Matthew; Weiss, Christopher; Conte, Marisa L; Doucet, Marlie; Engler, Amy; Camargo, Carlos A

    2013-01-01

    The prevalence of food allergy is rising among US children. Little is known about racial/ethnic disparities in food allergy. We performed a systematic literature review to understand racial/ethnic disparities in food allergy in the United States. We searched PubMed/MEDLINE, Embase, and Scopus for original data about racial/ethnic disparities in the diagnosis, prevalence, treatment, or clinical course of food allergy or sensitization, with a particular focus on black (African American) race. Articles were analyzed by study methodology, racial/ethnic composition, food allergy definition, outcomes, summary statistic used, and covariate adjustment. Twenty of 645 identified articles met inclusion criteria. The studies used multiple differing criteria to define food allergy, including self-report, sensitization assessed by serum food-specific IgE to selected foods without corroborating history, discharge codes, clinic chart review, and event-reporting databases. None used oral food challenge. In 12 studies, black persons (primarily children) had significantly increased adjusted odds of food sensitization or significantly higher proportion or odds of food allergy by self-report, discharge codes, or clinic-based chart review than white children. Major differences in study methodology and reporting precluded calculation of a pooled estimate of effect. Sparse and methodologically limited data exist about racial/ethnic disparity in food allergy in the United States. Available data lack a common definition for food allergy and use indirect measures of allergy, not food challenge. Although data suggest an increased risk of food sensitization, self-reported allergy, or clinic-based diagnosis of food allergy among black children, no definitive racial/ethnic disparity could be found among currently available studies. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  3. Ethnic and Gender Disparities in Premature Adult Mortality in Belize 2008-2010.

    Directory of Open Access Journals (Sweden)

    Francis Morey

    Full Text Available Data on disparities in mortality within low and middle income countries are limited, with little published data from the Caribbean or Central America. Our aim was to investigate disparities in overall and cause specific premature adult mortality in the multi-ethnic middle income country of Belize.Mortality data from Belize 2008-2010 classified using the International Classification of Diseases 10 and the 2010 census stratified by age and ethnicity were used to calculate age, sex, and ethnic specific mortality rates for those 15-59 years, and life table analysis was used to estimate the probability of death between the ages of 15 and 59 (45q15.The probability of death among those aged 15 to 59 years was 18.1% (women 13.5%, men 22.7%. Creole and Garifuna ethnic groups have three times the 45q15 probability of death compared to Mayan and Mestizo groups (Creole 31.2%, Garifuna 31.1%, Mayan 10.2%, Mestizo 12.0%. This pattern of ethnic disparity existed in both sexes but was greater in men. The probability of death from injuries was 14.8% among Creole men, more than twice the rate of other ethnicities and peaks among young Creole men. These deaths are dominated by homicides and unspecified deaths involving firearms.Marked disparities in mortality between ethnic groups exist in this Central American/Caribbean country, from rates that are typical of high-income countries to those of low-income countries. The pattern of these extreme differences likely suggests that they reflect underlying social determinants rooted in the country's colonial past.

  4. Sex disparities in acute myocardial infarction incidence : Do ethnic minority groups differ from the majority population?

    NARCIS (Netherlands)

    Van Oeffelen, Aloysia A M; Vaartjes, Ilonca; Stronks, Karien; Bots, Michiel L.; Agyemang, Charles

    2015-01-01

    Background: The incidence of acute myocardial infarction (AMI) in men exceeds that in women. The extent of this sex disparity varies widely between countries. Variations may also exist between ethnic minority groups and the majority population, but scientific evidence is lacking. Methods: A

  5. Sex disparities in acute myocardial infarction incidence: do ethnic minority groups differ from the majority population?

    NARCIS (Netherlands)

    van Oeffelen, Aloysia A. M.; Vaartjes, Ilonca; Stronks, Karien; Bots, Michiel L.; Agyemang, Charles

    2015-01-01

    The incidence of acute myocardial infarction (AMI) in men exceeds that in women. The extent of this sex disparity varies widely between countries. Variations may also exist between ethnic minority groups and the majority population, but scientific evidence is lacking. A nationwide register-based

  6. Racial and Ethnic Disparities in Police-Reported Intimate Partner Violence Perpetration: A Mixed Methods Approach

    Science.gov (United States)

    Lipsky, Sherry; Cristofalo, Meg; Reed, Sarah; Caetano, Raul; Roy-Byrne, Peter

    2012-01-01

    The objectives of this study were to examine racial and ethnic disparities in perpetrator and incident characteristics and discrepancies between police charges and reported perpetrator behaviors in police-reported intimate partner violence (IPV). This cross-sectional study used standardized police data and victim narratives of IPV incidents…

  7. Ethnic disparities in the risk of adverse neonatal outcome after spontaneous preterm birth

    NARCIS (Netherlands)

    Schaaf, Jelle M.; Mol, Ben-Willem J.; Abu-Hanna, Ameen; Ravelli, Anita C. J.

    2012-01-01

    Objective. To describe ethnic disparities in the risk of spontaneous preterm birth and related adverse neonatal outcome. Design. Nationwide prospective cohort study. Setting. The Netherlands, 19992007. Population. Nine hundred and sixty-nine thousand, four hundred and ninety-one singleton

  8. Minding the Gaps in Absenteeism: Disparities in Absenteeism by Race/Ethnicity, Poverty and Disability

    Science.gov (United States)

    Gee, Kevin A.

    2018-01-01

    Children from certain racial and ethnic minority backgrounds, in poverty, and/or with a disability, often face distinct challenges in attending school, leading them to miss more school relative to their non-minority, more socio-economically advantaged and non-disabled peers. This brief describes these disparities in absenteeism in the US,…

  9. The Effectiveness of a School-Based Intervention for Adolescents in Reducing Disparities in the Negative Consequences of Substance Use Among Ethnic Groups.

    Science.gov (United States)

    Stewart, David G; Moise-Campbell, Claudine; Chapman, Meredith K; Varma, Malini; Lehinger, Elizabeth

    2017-06-01

    Ethnic minority youth are disproportionately affected by substance use-related consequences, which may be best understood through a social ecological lens. Differences in psychosocial consequences between ethnic majority and minority groups are likely due to underlying social and environmental factors. The current longitudinal study examined the outcomes of a school-based motivational enhancement treatment intervention in reducing disparities in substance use consequences experienced by some ethnic minority groups with both between and within-subjects differences. Students were referred to the intervention through school personnel and participated in a four-session intervention targeting alcohol and drug use. Participants included 122 youth aged 13-19 years. Participants were grouped by ethnicity and likelihood of disparate negative consequences of substance use. African American/Hispanic/Multiethnic youth formed one group, and youth identifying as White or Asian formed a second group. We hypothesized that (1) there would be significant disparities in psychosocial, serious problem behavior, and school-based consequences of substance use between White/Asian students compared to African American/Hispanic/Multiethnic students at baseline; (2) physical dependence consequences would not be disparate at baseline; and (3) overall disparities would be reduced at post-treatment follow-up. Results indicated that African American/Hispanic/Multiethnic adolescents demonstrated statistically significant disparate consequences at baseline, except for physical dependency consequences. Lastly, significant reductions in disparities were evidenced between groups over time. Our findings highlight the efficacy of utilizing school-based substance use interventions in decreasing ethnic health disparities in substance use consequences.

  10. Racial/Ethnic and Income Disparities in Child and Adolescent Exposure to Food and Beverage Television Ads across U.S. Media Markets

    OpenAIRE

    Powell, Lisa M.; Wada, Roy; Kumanyika, Shiriki K.

    2014-01-01

    Obesity prevalence and related health burdens are greater among U.S. racial/ethnic minority and low-income populations. Targeted advertising may contribute to disparities. Designated market area (DMA) spot television ratings were used to assess geographic differences in child/adolescent exposure to food-related advertisements based on DMA-level racial/ethnic and income characteristics. Controlling for unobserved DMA-level factors and time trends, child/adolescent exposure to food-related ads,...

  11. Race, Ethnicity, Concentrated Poverty, and Low Birth Weight Disparities

    OpenAIRE

    Sims, Mario; Sims, Tammy L.; Bruce, Marino A.

    2008-01-01

    This study examines the extent to which the relationship between area socioeconomic position (SEP) and low birth weight (LBW) varies by race and ethnicity. A cross-sectional, secondary data analysis was performed with 1992-1994 Vital Statistics and 1990 U.S. Census data for selected metropolitan areas. Low birth weight (< 2500 grams) rates were calculated for non-Hispanic Black, Latino, and non-Hispanic White live singleton births. Concentrated poverty was defined as poor persons living in ne...

  12. Food insecurity and adult overweight/obesity: Gender and race/ethnic disparities.

    Science.gov (United States)

    Hernandez, Daphne C; Reesor, Layton M; Murillo, Rosenda

    2017-10-01

    The majority of the food insecurity-obesity research has indicated a positive association among women, especially minority women. Less research has been conducted on men, and the findings are inconsistent. The aim was to assess whether gender and race/ethnic disparities exists between the food insecurity and overweight/obesity relationship among adults ages 18-59. We used the cross-sectional 2011 and 2012 National Health Interview Survey data (N = 19,990). Three or more affirmative responses on the 10-item USDA Food Security Scale indicated food insecure experiences. Self-reported height and weight were used to calculate body mass index according to the Centers for Disease Control and Prevention. Multivariate logistic regression models were stratified by gender and race/ethnicity to estimate the association between food insecurity and overweight/obesity controlling for several demographic characteristics. Adults on average were 36 years of age (51% female; 56% white, 27% Hispanic, and 17% black), 27% were food insecure, and 65% were overweight/obese. Food insecurity was most prevalent among blacks and Hispanics, regardless of gender. A greater percentage of food insecure women were overweight/obese compared to food secure women among all race/ethnicity groups; while similar proportions of white, black, and Hispanic men were overweight/obese irrespective of their food security status. In covariate-adjusted models, food insecurity was associated with a 41% and 29% higher odds of being overweight/obese among white and Hispanic women, respectively. Food insecurity was not related to overweight/obesity among black women nor among white, black, and Hispanic men. The complex relationship between food insecurity and obesity suggests a need to investigate potential behavioral and physiological mechanisms, and moderators of this relationship. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Socioeconomic Disparities and Health: Impacts and Pathways

    Science.gov (United States)

    Kondo, Naoki

    2012-01-01

    Growing socioeconomic disparity is a global concern, as it could affect population health. The author and colleagues have investigated the health impacts of socioeconomic disparities as well as the pathways that underlie those disparities. Our meta-analysis found that a large population has risks of mortality and poor self-rated health that are attributable to income inequality. The study results also suggested the existence of threshold effects (ie, a threshold of income inequality over which the adverse impacts on health increase), period effects (ie, the potential for larger impacts in later years, specifically after the 1990s), and lag effects between income inequality and health outcomes. Our other studies using Japanese national representative survey data and a large-scale cohort study of Japanese older adults (AGES cohort) support the relative deprivation hypothesis, namely, that invidious social comparisons arising from relative deprivation in an unequal society adversely affect health. A study with a natural experiment design found that the socioeconomic gradient in self-rated health might actually have become shallower after the 1997–98 economic crisis in Japan, due to smaller health improvements among middle-class white-collar workers and middle/upper-income workers. In conclusion, income inequality might have adverse impacts on individual health, and psychosocial stress due to relative deprivation may partially explain those impacts. Any study of the effects of macroeconomic fluctuations on health disparities should also consider multiple potential pathways, including expanding income inequality, changes in the labor market, and erosion of social capital. Further studies are needed to attain a better understanding of the social determinants of health in a rapidly changing society. PMID:22156290

  14. Socioeconomic disparities and health: impacts and pathways.

    Science.gov (United States)

    Kondo, Naoki

    2012-01-01

    Growing socioeconomic disparity is a global concern, as it could affect population health. The author and colleagues have investigated the health impacts of socioeconomic disparities as well as the pathways that underlie those disparities. Our meta-analysis found that a large population has risks of mortality and poor self-rated health that are attributable to income inequality. The study results also suggested the existence of threshold effects (ie, a threshold of income inequality over which the adverse impacts on health increase), period effects (ie, the potential for larger impacts in later years, specifically after the 1990s), and lag effects between income inequality and health outcomes. Our other studies using Japanese national representative survey data and a large-scale cohort study of Japanese older adults (AGES cohort) support the relative deprivation hypothesis, namely, that invidious social comparisons arising from relative deprivation in an unequal society adversely affect health. A study with a natural experiment design found that the socioeconomic gradient in self-rated health might actually have become shallower after the 1997-98 economic crisis in Japan, due to smaller health improvements among middle-class white-collar workers and middle/upper-income workers. In conclusion, income inequality might have adverse impacts on individual health, and psychosocial stress due to relative deprivation may partially explain those impacts. Any study of the effects of macroeconomic fluctuations on health disparities should also consider multiple potential pathways, including expanding income inequality, changes in the labor market, and erosion of social capital. Further studies are needed to attain a better understanding of the social determinants of health in a rapidly changing society.

  15. Special Issue on Global Health Disparities Focus on Cancer.

    Science.gov (United States)

    Lee, Haeok

    2016-01-01

    Haeok Lee, PhD, RN, FAAN who is a Korean-American nurse scientist, received her doctor al degree from the Nursing Physiology Department, College of Nursing, University of California, San Francisco (UCSF), in 1993, and her post doctor al training from College of Medicine, UCSF. Dr. Lee worked at Case Western Reserve University and University of Colorado Health Sciences Center. She has worked at the UMass Boston since 2008. Dr. Lee has established a long-term commitment to minority health, especially Asian American Pacific Islanders, as a community leader, community health educator, and community researcher, and all these services have become a foundation for her community-based participatory research. Dr. Lee's research addresses current health problems framed in the context of social, political, and economic settings, and her studies have improved racial and ethnic data and developed national health policies to address health disparities in hepatitis B virus (HBV) infections and liver cancer among minorities. Dr. Lee's research, which is noteworthy for its theoretical base, is clearly filling the gap. Especially, Dr. Lee's research is beginning to have a favorable impact on national and international health policies and continuing education programs directed toward the global elimination of cervical and liver cancer-related health disparities in underserved and understudied populations.

  16. Ethnic and Socioeconomic Disparities in Recalled Exposure to and Self-Reported Impact of Tobacco Marketing and Promotions.

    Science.gov (United States)

    Moran, Meghan Bridgid; Heley, Kathryn; Pierce, John P; Niaura, Ray; Strong, David; Abrams, David

    2017-12-13

    The role of tobacco marketing in tobacco use, particularly among the vulnerable ethnic and socioeconomic sub-populations is a regulatory priority of the U.S. Food and Drug Administration. There currently exist both ethnic and socioeconomic disparities in the use of tobacco products. Monitoring such inequalities in exposure to tobacco marketing is essential to inform tobacco regulatory policy that may reduce known tobacco-related health disparities. We use data from the Population Assessment of Tobacco and Health (PATH) Wave 1 youth survey to examine (1) recalled exposure to and liking of tobacco marketing for cigarettes, non-large cigars, and e-cigarettes, (2) self-reported exposure to specific tobacco marketing tactics, namely coupons, sweepstakes, and free samples, and (3) self-reported impact of tobacco marketing and promotions on product use. Findings indicate that African Americans and those of lower SES were more likely to recall having seen cigarette and non-large cigar ads. Reported exposure to coupons, sweepstakes and free samples also varied ethnically and socioeconomically. African Americans and those of lower SES were more likely than other respondents to report that marketing and promotions as played a role in their tobacco product use. Better understanding of communication inequalities and their influence on product use is needed to inform tobacco regulatory action that may reduce tobacco company efforts to target vulnerable groups. Tobacco education communication campaigns focusing on disproportionately affected groups could help counter the effects of targeted industry marketing.

  17. [Health disparities: local realities and future challenges].

    Science.gov (United States)

    Bodenmann, P; Green, A R

    2012-11-28

    Since 1887, the Policlinique Médicale Universitaire (PMU) has brought care to vulnerable populations who are at risk of poor physical, mental and social health. These include marginalised Swiss natives and immigrant communities (asylum seekers, undocumented immigrants). These patients are at risk of health disparities given their poor access to the health care system and lack of adapted quality care. Clinical approach must address these potential disparities, reinforced by a research describing them in order to explain their cause, and propose possible solutions, and a medical training addressing these topics from the undergraduate to the attending level. Through those holistic clinical approach, robust research and improved medical training, health providers will contribute to give quality care to all citizens, without exception!

  18. Evaluating the Population Impact on Racial/Ethnic Disparities in HIV in Adulthood of Intervening on Specific Targets: A Conceptual and Methodological Framework.

    Science.gov (United States)

    Howe, Chanelle J; Dulin-Keita, Akilah; Cole, Stephen R; Hogan, Joseph W; Lau, Bryan; Moore, Richard D; Mathews, W Christopher; Crane, Heidi M; Drozd, Daniel R; Geng, Elvin; Boswell, Stephen L; Napravnik, Sonia; Eron, Joseph J; Mugavero, Michael J

    2018-02-01

    Reducing racial/ethnic disparities in human immunodeficiency virus (HIV) disease is a high priority. Reductions in HIV racial/ethnic disparities can potentially be achieved by intervening on important intermediate factors. The potential population impact of intervening on intermediates can be evaluated using observational data when certain conditions are met. However, using standard stratification-based approaches commonly employed in the observational HIV literature to estimate the potential population impact in this setting may yield results that do not accurately estimate quantities of interest. Here we describe a useful conceptual and methodological framework for using observational data to appropriately evaluate the impact on HIV racial/ethnic disparities of interventions. This framework reframes relevant scientific questions in terms of a controlled direct effect and estimates a corresponding proportion eliminated. We review methods and conditions sufficient for accurate estimation within the proposed framework. We use the framework to analyze data on 2,329 participants in the CFAR [Centers for AIDS Research] Network of Integrated Clinical Systems (2008-2014) to evaluate the potential impact of universal prescription of and ≥95% adherence to antiretroviral therapy on racial disparities in HIV virological suppression. We encourage the use of the described framework to appropriately evaluate the potential impact of targeted interventions in addressing HIV racial/ethnic disparities using observational data. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Health Disparities Calculator (HD*Calc) - SEER Software

    Science.gov (United States)

    Statistical software that generates summary measures to evaluate and monitor health disparities. Users can import SEER data or other population-based health data to calculate 11 disparity measurements.

  20. The effects of telemedicine on racial and ethnic disparities in access to acute stroke care.

    Science.gov (United States)

    Lyerly, Michael J; Wu, Tzu-Ching; Mullen, Michael T; Albright, Karen C; Wolff, Catherine; Boehme, Amelia K; Branas, Charles C; Grotta, James C; Savitz, Sean I; Carr, Brendan G

    2016-03-01

    Racial and ethnic disparities have been previously reported in acute stroke care. We sought to determine the effect of telemedicine (TM) on access to acute stroke care for racial and ethnic minorities in the state of Texas. Data were collected from the US Census Bureau, The Joint Commission and the American Hospital Association. Access for racial and ethnic minorities was determined by summing the population that could reach a primary stroke centre (PSC) or telemedicine spoke within specified time intervals using validated models. TM extended access to stroke expertise by 1.5 million residents. The odds of providing 60-minute access via TM were similar in Blacks and Whites (prevalence odds ratios (POR) 1.000, 95% CI 1.000-1.000), even after adjustment for urbanization (POR 1.000, 95% CI 1.000-1.001). The odds of providing access via TM were also similar for Hispanics and non-Hispanics (POR 1.000, 95% CI 1.000-1.000), even after adjustment for urbanization (POR 1.000, 95% CI 1.000-1.000). We found that telemedicine increased access to acute stroke care for 1.5 million Texans. While racial and ethnic disparities exist in other components of stroke care, we did not find evidence of disparities in access to the acute stroke expertise afforded by telemedicine. © The Author(s) 2015.

  1. Shedding Light on the Mechanisms Underlying Health Disparities Through Community Participatory Methods: The Stress Pathway

    Science.gov (United States)

    Schetter, Christine Dunkel; Schafer, Peter; Lanzi, Robin Gaines; Clark-Kauffman, Elizabeth; Raju, Tonse N. K.; Hillemeier, Marianne M.

    2015-01-01

    Health disparities are large and persistent gaps in the rates of disease and death between racial/ethnic and socioeconomic status subgroups in the population. Stress is a major pathway hypothesized to explain such disparities. The Eunice Kennedy Shriver National Institute of Child Health and Human Development formed a community/research collaborative—the Community Child Health Network—to investigate disparities in maternal and child health in five high-risk communities. Using community participation methods, we enrolled a large cohort of African American/Black, Latino/Hispanic, and non-Hispanic/White mothers and fathers of newborns at the time of birth and followed them over 2 years. A majority had household incomes near or below the federal poverty level. Home interviews yielded detailed information regarding multiple types of stress such as major life events and many forms of chronic stress including racism. Several forms of stress varied markedly by racial/ethnic group and income, with decreasing stress as income increased among Caucasians but not among African Americans; other forms of stress varied by race/ethnicity or poverty alone. We conclude that greater sophistication in studying the many forms of stress and community partnership is necessary to uncover the mechanisms underlying health disparities in poor and ethnic-minority families and to implement community health interventions. PMID:26173227

  2. Shedding Light on the Mechanisms Underlying Health Disparities Through Community Participatory Methods: The Stress Pathway.

    Science.gov (United States)

    Dunkel Schetter, Christine; Schafer, Peter; Lanzi, Robin Gaines; Clark-Kauffman, Elizabeth; Raju, Tonse N K; Hillemeier, Marianne M

    2013-11-01

    Health disparities are large and persistent gaps in the rates of disease and death between racial/ethnic and socioeconomic status subgroups in the population. Stress is a major pathway hypothesized to explain such disparities. The Eunice Kennedy Shriver National Institute of Child Health and Human Development formed a community/research collaborative-the Community Child Health Network-to investigate disparities in maternal and child health in five high-risk communities. Using community participation methods, we enrolled a large cohort of African American/Black, Latino/Hispanic, and non-Hispanic/White mothers and fathers of newborns at the time of birth and followed them over 2 years. A majority had household incomes near or below the federal poverty level. Home interviews yielded detailed information regarding multiple types of stress such as major life events and many forms of chronic stress including racism. Several forms of stress varied markedly by racial/ethnic group and income, with decreasing stress as income increased among Caucasians but not among African Americans; other forms of stress varied by race/ethnicity or poverty alone. We conclude that greater sophistication in studying the many forms of stress and community partnership is necessary to uncover the mechanisms underlying health disparities in poor and ethnic-minority families and to implement community health interventions. © The Author(s) 2013.

  3. Ethnic disparities in educational and occupational gradients of estimated cardiovascular disease risk: The Healthy Life in an Urban Setting study.

    Science.gov (United States)

    Perini, Wilco; Agyemang, Charles; Snijder, Marieke B; Peters, Ron J G; Kunst, Anton E

    2018-03-01

    European societies are becoming increasingly ethnically diverse. This may have important implications for socio-economic inequalities in health due to the often disadvantaged position of ethnic minority groups in both socio-economic status (SES) and disease, especially cardiovascular disease (CVD). The aim of this study was to determine whether the socio-economic gradient of estimated CVD risk differs between ethnic groups. Using the Healthy Life in an Urban Setting study, we obtained data on SES and CVD risk factors among participants from six ethnic backgrounds residing in Amsterdam. SES was measured using educational level and occupational level. CVD risk was estimated based on the occurrence of CVD risk factors using the Dutch version of the systematic coronary risk evaluation algorithm. Ethnic disparities in socio-economic gradients for estimated CVD risk were determined using the relative index of inequality (RII). Among Dutch-origin men, the RII for estimated CVD risk according to educational level was 6.15% (95% confidence interval [CI] 4.35-7.96%), indicating that those at the bottom of the educational hierarchy had a 6.15% higher estimated CVD risk relative than those at the top. Among Dutch-origin women, the RII was 4.49% (CI 2.45-6.52%). The RII was lower among ethnic minority groups, ranging from 0.83% to 3.13% among men and -0.29% to 5.12% among women, indicating weaker associations among these groups. Results were similar based on occupational level. Ethnic background needs to be considered in associations between SES and disease. The predictive value of SES varies between ethnic groups and may be quite poor for some groups.

  4. Scalable Combinatorial Tools for Health Disparities Research

    Directory of Open Access Journals (Sweden)

    Michael A. Langston

    2014-10-01

    Full Text Available Despite staggering investments made in unraveling the human genome, current estimates suggest that as much as 90% of the variance in cancer and chronic diseases can be attributed to factors outside an individual’s genetic endowment, particularly to environmental exposures experienced across his or her life course. New analytical approaches are clearly required as investigators turn to complicated systems theory and ecological, place-based and life-history perspectives in order to understand more clearly the relationships between social determinants, environmental exposures and health disparities. While traditional data analysis techniques remain foundational to health disparities research, they are easily overwhelmed by the ever-increasing size and heterogeneity of available data needed to illuminate latent gene x environment interactions. This has prompted the adaptation and application of scalable combinatorial methods, many from genome science research, to the study of population health. Most of these powerful tools are algorithmically sophisticated, highly automated and mathematically abstract. Their utility motivates the main theme of this paper, which is to describe real applications of innovative transdisciplinary models and analyses in an effort to help move the research community closer toward identifying the causal mechanisms and associated environmental contexts underlying health disparities. The public health exposome is used as a contemporary focus for addressing the complex nature of this subject.

  5. Racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission.

    Science.gov (United States)

    Bliss, Donna Z; Gurvich, Olga; Savik, Kay; Eberly, Lynn E; Harms, Susan; Mueller, Christine; Garrard, Judith; Cunanan, Kristen; Wiltzen, Kjerstie

    2017-09-01

    Pressure ulcers increase the risk of costly hospitalization and mortality of nursing home residents, so timely healing is important. Disparities in healthcare have been identified in the nursing home population but little is known about disparities in the healing of pressure ulcers. To assess racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission. Multi-levels predictors, at the individual resident, nursing home, and community/Census tract level, were examined in three large data sets. Minimum Data Set records of older individuals admitted to one of 439 nursing homes of a national, for-profit chain over three years with a stages 2-4 pressure ulcer (n=10,861) were searched to the 90-day assessment for the first record showing pressure ulcer healing. Predictors of pressure ulcer healing were analyzed for White admissions first using logistic regression. The Peters-Belson method was used to assess racial or ethnic disparities among minority group admissions. A significantly smaller proportion of Black nursing home admissions had their pressure ulcer heal than expected had they been part of the White group. There were no disparities in pressure ulcer healing disadvantaging other minority groups. Significant predictors of a nonhealing of pressure ulcer were greater deficits in activities of daily living and pressure ulcer severity. Reducing disparities in pressure ulcer healing is needed for Blacks admitted to nursing homes. Knowledge of disparities in pressure ulcer healing can direct interventions aiming to achieve equity in healthcare for a growing number of minority nursing home admissions. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Approaching Environmental Health Disparities and Green Spaces: An Ecosystem Services Perspective

    Directory of Open Access Journals (Sweden)

    Viniece Jennings

    2015-02-01

    Full Text Available Health disparities occur when adverse health conditions are unequal across populations due in part to gaps in wealth. These disparities continue to plague global health. Decades of research suggests that the natural environment can play a key role in sustaining the health of the public. However, the influence of the natural environment on health disparities is not well-articulated. Green spaces provide ecosystem services that are vital to public health. This paper discusses the link between green spaces and some of the nation’s leading health issues such as obesity, cardiovascular health, heat-related illness, and psychological health. These associations are discussed in terms of key demographic variables—race, ethnicity, and income. The authors also identify research gaps and recommendations for future research.

  7. Health disparities and advertising content of women's magazines: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Victorio Maria

    2005-08-01

    Full Text Available Abstract Background Disparities in health status among ethnic groups favor the Caucasian population in the United States on almost all major indicators. Disparities in exposure to health-related mass media messages may be among the environmental factors contributing to the racial and ethnic imbalance in health outcomes. This study evaluated whether variations exist in health-related advertisements and health promotion cues among lay magazines catering to Hispanic, African American and Caucasian women. Methods Relative and absolute assessments of all health-related advertising in 12 women's magazines over a three-month period were compared. The four highest circulating, general interest magazines oriented to Black women and to Hispanic women were compared to the four highest-circulating magazines aimed at a mainstream, predominantly White readership. Data were collected and analyzed in 2002 and 2003. Results Compared to readers of mainstream magazines, readers of African American and Hispanic magazines were exposed to proportionally fewer health-promoting advertisements and more health-diminishing advertisements. Photographs of African American role models were more often used to advertise products with negative health impact than positive health impact, while the reverse was true of Caucasian role models in the mainstream magazines. Conclusion To the extent that individual levels of health education and awareness can be influenced by advertising, variations in the quantity and content of health-related information among magazines read by different ethnic groups may contribute to racial disparities in health behaviors and health status.

  8. Addressing health and health-care disparities: the role of a diverse workforce and the social determinants of health.

    Science.gov (United States)

    Jackson, Chazeman S; Gracia, J Nadine

    2014-01-01

    Despite major advances in medicine and public health during the past few decades, disparities in health and health care persist. Racial/ethnic minority groups in the United States are at disproportionate risk of being uninsured, lacking access to care, and experiencing worse health outcomes from preventable and treatable conditions. As reducing these disparities has become a national priority, insight into the social determinants of health has become increasingly important. This article offers a rationale for increasing the diversity and cultural competency of the health and health-care workforce, and describes key strategies led by the U.S. Department of Health and Human Services' Office of Minority Health to promote cultural competency in the health-care system and strengthen community-level approaches to improving health and health care for all.

  9. Health insurance coverage and racial disparities in breast reconstruction after mastectomy.

    Science.gov (United States)

    Shippee, Tetyana P; Kozhimannil, Katy B; Rowan, Kathleen; Virnig, Beth A

    2014-01-01

    Breast reconstruction after mastectomy offers clinical, cosmetic, and psychological benefits compared with mastectomy alone. Although reconstruction rates have increased, racial/ethnic disparities in breast reconstruction persist. Insurance coverage facilitates access to care, but few studies have examined whether health insurance ameliorates disparities. We used the Nationwide Inpatient Sample for 2002 through 2006 to examine the relationships between health insurance coverage, race/ethnicity, and breast reconstruction rates among women who underwent mastectomy for breast cancer. We examined reconstruction rates as a function of the interaction of race and the primary payer (self-pay, private health insurance, government) while controlling for patient comorbidity, and we used generalized estimating equations to account for clustering and hospital characteristics. Minority women had lower breast reconstruction rates than White women (adjusted odds ratio [AOR], 0.57 for African American; AOR, 0.70 for Hispanic; AOR, 0.45 for Asian; p women (AOR, 0.33) and those with public coverage were less likely to undergo reconstruction (AOR, 0.35; p women. Racial/ethnic disparities were less prominent within insurance types. Minority women, whether privately or publicly insured, had lower odds of undergoing reconstruction than White women. Among those without insurance, reconstruction rates did not differ by race/ethnicity. Insurance facilitates access to care, but does not eliminate racial/ethnic disparities in reconstruction rates. Our findings-which reveal persistent health care disparities not explained by patient health status-should prompt efforts to promote both access to and use of beneficial covered services for women with breast cancer. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  10. 78 FR 35837 - National Institute on Minority Health and Health Disparities Research Endowments

    Science.gov (United States)

    2013-06-14

    ... disparities research to close the disparity gap in the burden of illness and death experienced by racial and... Number NIH-2007-0931] RIN 0925-AA61 National Institute on Minority Health and Health Disparities Research... disparities research and other health disparities research. DATES: Comments must be received on or before...

  11. 77 FR 43850 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2012-07-26

    ... and Health Disparities Special Emphasis Panel; NIMHD Community-Based Participatory Research (CBPR... Review Officer, National Institute on Minority Healthand Health Disparities, 6707 Democracy Blvd., Suite...

  12. The role of food culture and marketing activity in health disparities.

    Science.gov (United States)

    Williams, Jerome D; Crockett, David; Harrison, Robert L; Thomas, Kevin D

    2012-11-01

    Marketing activities have attracted increased attention from scholars interested in racial disparities in obesity prevalence, as well as the prevalence of other preventable conditions. Although reducing the marketing of nutritionally poor foods to racial/ethnic communities would represent a significant step forward in eliminating racial disparities in health, we focus instead on a critical-related question. What is the relationship between marketing activities, food culture, and health disparities? This commentary posits that food culture shapes the demand for food and the meaning attached to particular foods, preparation styles, and eating practices, while marketing activities shape the overall environment in which food choices are made. We build on prior research that explores the socio-cultural context in which marketing efforts are perceived and interpreted. We discuss each element of the marketing mix to highlight the complex relationship between food culture, marketing activities, and health disparities. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. 75 FR 66114 - National Center on Minority Health and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2010-10-27

    ... Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; NCMHD Health Disparities Research on Minority and... Review Officer, National Institute on Minority Health and Health Disparities, 6707 Democracy Boulevard...

  14. 75 FR 12766 - National Center on Minority Health and Health Disparities; Notice of Closed Meetings

    Science.gov (United States)

    2010-03-17

    ... Health and Health Disparities; Notice of Closed Meetings Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel Loan Repayment Program for Health Disparities Research... Review, National Center on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800...

  15. 75 FR 9421 - National Center on Minority Health and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2010-03-02

    ... Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; Loan Repayment Program for Health Disparities Research..., National Center on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda...

  16. The Role of School Environments in Explaining Racial-Ethnic Disparities in Body Mass Index Among U.S. Adolescents.

    Science.gov (United States)

    Nicosia, Nancy; Shier, Victoria; Datar, Ashlesha

    2016-08-01

    Policymakers have focused substantial efforts on how school environments can be used to combat obesity. Given this intense focus, this article examined whether disparities in body mass index (BMI) noted among black and Hispanic adolescents relative to whites were explained by the well-documented differences in the school socioeconomic characteristics, and food and physical activity environment. Data from the fifth- and eighth-grade waves of the Early Childhood Longitudinal Study-Kindergarten Class were analyzed. Unadjusted linear regression models of BMI percentile that included only indicators for child's race/ethnicity were estimated first followed by adjusted models that iteratively added sets of child, family, and ultimately school covariates. Separate models were estimated by grade and gender. School covariates included detailed indicators for the school socioeconomic characteristics, and the food and physical activity environments. For Hispanic boys and girls and for black boys, substantial shares of the disparities in BMI were explained by differences in birth weight, BMI at school entry, and current child and family characteristics. Substantial disparities in BMI remained among black girls relative to white girls. Characteristics of the child's school during fifth and eighth grade-specifically, the schools' socioeconomic characteristics as well as measures of the food and physical activity environment-did not explain the disparities for any of the demographic groups. Differences in the school environment had little additional explanatory power suggesting that interventions seeking to reduce BMI disparities should focus on early school years and even before school entry. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  17. Religion and disparities: considering the influences of Islam on the health of American Muslims.

    Science.gov (United States)

    Padela, Aasim I; Curlin, Farr A

    2013-12-01

    Both theory and data suggest that religions shape the way individuals interpret and seek help for their illnesses. Yet, health disparities research has rarely examined the influence of a shared religion on the health of individuals from distinct minority communities. In this paper, we focus on Islam and American Muslims to outline the ways in which a shared religion may impact the health of a racially, ethnically, and socioeconomically diverse minority community. We use Kleinman's "cultural construction of clinical reality" as a theoretical framework to interpret the extant literature on American Muslim health. We then propose a research agenda that would extend current disparities research to include measures of religiosity, particularly among populations that share a minority religious affiliation. The research we propose would provide a fuller understanding of the relationships between religion and health among Muslim Americans and other minority communities and would thereby undergird efforts to reduce unwarranted health disparities.

  18. Mental Health Disparities Among Canadian Transgender Youth.

    Science.gov (United States)

    Veale, Jaimie F; Watson, Ryan J; Peter, Tracey; Saewyc, Elizabeth M

    2017-01-01

    This study documented the prevalence of mental health problems among transgender youth in Canada and made comparisons with population-based studies. This study also compared gender identity subgroups and age subgroups (14-18 and 19-25). A nonprobability sample of 923 transgender youth from Canada completed an online survey. Participants were recruited through community organizations, health care settings, social media, and researchers' networks. Mental health measures were drawn from the British Columbia Adolescent Health Survey and the Canadian Community Health Survey. Transgender youth had a higher risk of reporting psychological distress, self-harm, major depressive episodes, and suicide. For example, 65% of transgender 14- to 18-year olds seriously considered suicide in the past year compared with 13% in the British Columbia Adolescent Health Survey, and only a quarter of participants reported their mental health was good or excellent. Transgender boys/men and nonbinary youth were most likely to report self-harm and overall mental health remained stable across age subgroups. Although a notable minority of transgender youth did not report negative health outcomes, this study shows the mental health disparities faced by transgender youth in Canada are considerable. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  19. Challenges in covering health disparities in local news media: an exploratory analysis assessing views of journalists.

    Science.gov (United States)

    Wallington, Sherrie Flynt; Blake, Kelly D; Taylor-Clark, Kalahn; Viswanath, K

    2010-10-01

    News coverage of health topics influences knowledge, attitudes, and behaviors at the individual level, and agendas and actions at the institutional and policy levels. Because disparities in health often are the result of social inequalities that require community-level or policy-level solutions, news stories employing a health disparities news frame may contribute to agenda-setting among opinion leaders and policymakers and lead to policy efforts aimed at reducing health disparities. This study objective was to conduct an exploratory analysis to qualitatively describe barriers that health journalists face when covering health disparities in local media. Between June and October 2007, 18 journalists from television, print, and radio in Boston, Lawrence, and Worcester, Massachusetts, were recruited using a purposive sampling technique. In-depth, semi-structured interviews were conducted by telephone, and the crystallization/immersion method was used to conduct a qualitative analysis of interview transcripts. Our results revealed that journalists said that they consider several angles when developing health stories, including public impact and personal behavior change. Challenges to employing a health disparities frame included inability to translate how research findings may impact different socioeconomic groups, and difficulty understanding how findings may translate across racial/ethnic groups. Several journalists reported that disparities-focused stories are "less palatable" for some audiences. This exploratory study offers insights into the challenges that local news media face in using health disparities news frames in their routine coverage of health news. Public health practitioners may use these findings to inform communication efforts with local media in order to advance the public dialogue about health disparities.

  20. Race matters: a systematic review of racial/ethnic disparity in Society for Assisted Reproductive Technology reported outcomes.

    Science.gov (United States)

    Wellons, Melissa F; Fujimoto, Victor Y; Baker, Valerie L; Barrington, Debbie S; Broomfield, Diana; Catherino, William H; Richard-Davis, Gloria; Ryan, Mary; Thornton, Kim; Armstrong, Alicia Y

    2012-08-01

    To systematically review the reporting of race/ethnicity in Society for Assisted Reproductive Technology (SART) Clinic Outcome Reporting System (CORS) publications. Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology of literature published in PubMed on race/ethnicity that includes data from SART CORS. Not applicable. Not applicable. In vitro fertilization cycles reported to SART. Any outcomes reported in SART CORS. Seven publications were identified that assessed racial/ethnic disparities in IVF outcomes using SART data. All reported a racial/ethnic disparity. However, more than 35% of cycles were excluded from analysis because of missing race/ethnicity data. Review of current publications of SART data suggests significant racial/ethnic disparities in IVF outcomes. However, the potential for selection bias limits confidence in these findings, given that fewer than 65% of SART reported cycles include race/ethnicity. Our understanding of how race/ethnicity influences ART outcome could be greatly improved if information on race/ethnicity was available for all reported cycles. Copyright © 2012 American Society for Reproductive Medicine. All rights reserved.

  1. Persisting problems related to race and ethnicity in public health and epidemiology research

    Directory of Open Access Journals (Sweden)

    Jean-Claude Moubarac

    2013-02-01

    Full Text Available A recent and comprehensive review of the use of race and ethnicity in research that address health disparities in epidemiology and public health is provided. First it is described the theoretical basis upon which race and ethnicity differ drawing from previous work in anthropology, social science and public health. Second, it is presented a review of 280 articles published in high impacts factor journals in regards to public health and epidemiology from 2009-2011. An analytical grid enabled the examination of conceptual, theoretical and methodological questions related to the use of both concepts. The majority of articles reviewed were grounded in a theoretical framework and provided interpretations from various models. However, key problems identified include a a failure from researchers to differentiate between the concepts of race and ethnicity; b an inappropriate use of racial categories to ascribe ethnicity; c a lack of transparency in the methods used to assess both concepts; and d failure to address limits associated with the construction of racial or ethnic taxonomies and their use. In conclusion, future studies examining health disparities should clearly establish the distinction between race and ethnicity, develop theoretically driven research and address specific questions about the relationships between race, ethnicity and health. One argue that one way to think about ethnicity, race and health is to dichotomize research into two sets of questions about the relationship between human diversity and health.

  2. Foreword: Big Data and Its Application in Health Disparities Research.

    Science.gov (United States)

    Onukwugha, Eberechukwu; Duru, O Kenrik; Peprah, Emmanuel

    2017-01-01

    The articles presented in this special issue advance the conversation by describing the current efforts, findings and concerns related to Big Data and health disparities. They offer important recommendations and perspectives to consider when designing systems that can usefully leverage Big Data to reduce health disparities. We hope that ongoing Big Data efforts can build on these contributions to advance the conversation, address our embedded assumptions, and identify levers for action to reduce health care disparities.

  3. Health disparities between immigrant and Danish cleaners

    DEFF Research Database (Denmark)

    Jørgensen, Marie B; Rasmussen, Charlotte D N; Carneiro, Isabella G

    2011-01-01

    hundred and fifty-one cleaners, consisting of 166 Danes (88% women) and 179 immigrants (74% women) (6 with unknown ethnicity), from 9 workplaces in Denmark participated in the study. Health and work ability were obtained by objective (e.g., BMI and blood pressure) and self-reported measures (e.g., work......PURPOSE: It is unknown whether immigrants working in the cleaning industry have a poorer health and work ability than cleaners from the native population. The main aim was to investigate differences in objective and self-reported health measures between immigrant and Danish cleaners. METHODS: Three...... ability, self-rated health, and musculoskeletal symptoms). In order to investigate differences between Danish and immigrant cleaners, logistic regression analyses and General Linear Models were performed. RESULTS: When controlling for age, sex, workplace, job seniority, and smoking, more Danish compared...

  4. The role that graduate medical education must play in ensuring health equity and eliminating health care disparities.

    Science.gov (United States)

    Maldonado, Maria E; Fried, Ethan D; DuBose, Thomas D; Nelson, Consuelo; Breida, Margaret

    2014-05-01

    Despite the 2002 Institute of Medicine report that described the moral and financial impact of health care disparities and the need to address them, it is evident that health care disparities persist. Recommendations for addressing disparities include collecting and reporting data on patient race and ethnicity, supporting language interpretation services, increasing awareness of health care disparities through education, requiring cultural competency training for all health care professionals, and increasing diversity among those delivering health care. The Accreditation Council on Graduate Medical Education places strong emphasis on graduate medical education's role in eliminating health care disparities by asking medical educators to objectively evaluate and report on their trainees' ability to practice patient-centered, culturally competent care. Moreover, one of the objectives of the Accreditation Council on Graduate Medical Education Clinical Learning Environment Review visits as part of the Next Accreditation System is to identify how sponsoring institutions engage residents and fellows in the use of data to improve systems of care, reduce health care disparities, and improve patient outcomes. Residency and fellowship programs should ensure the delivery of meaningful curricula on cultural competency and health care disparities, for which there are numerous resources, and ensure resident assessment of culturally competent care. Moreover, training programs and institutional leadership need to collaborate on ensuring data collection on patient satisfaction, outcomes, and quality measures that are broken down by patient race, cultural identification, and language. A diverse physician workforce is another strategy for mitigating health care disparities, and using strategies to enhance faculty diversity should also be a priority of graduate medical education. Transparent data about institutional diversity efforts should be provided to interested medical students

  5. Individual, family background, and contextual explanations of racial and ethnic disparities in youths' exposure to violence.

    Science.gov (United States)

    Zimmerman, Gregory M; Messner, Steven F

    2013-03-01

    We used data from the Project on Human Development in Chicago Neighborhoods to examine the extent to which individual, family, and contextual factors account for the differential exposure to violence associated with race/ethnicity among youths. Logistic hierarchical item response models on 2344 individuals nested within 80 neighborhoods revealed that the odds of being exposed to violence were 74% and 112% higher for Hispanics and Blacks, respectively, than for Whites. Appreciable portions of the Hispanic-White gap (33%) and the Black-White gap (53%) were accounted for by family background factors, individual differences, and neighborhood factors. The findings imply that programs aimed at addressing the risk factors for exposure to violence and alleviating the effects of exposure to violence may decrease racial/ethnic disparities in exposure to violence and its consequences.

  6. Individual, Family Background, and Contextual Explanations of Racial and Ethnic Disparities in Youths’ Exposure to Violence

    Science.gov (United States)

    Messner, Steven F.

    2013-01-01

    We used data from the Project on Human Development in Chicago Neighborhoods to examine the extent to which individual, family, and contextual factors account for the differential exposure to violence associated with race/ethnicity among youths. Logistic hierarchical item response models on 2344 individuals nested within 80 neighborhoods revealed that the odds of being exposed to violence were 74% and 112% higher for Hispanics and Blacks, respectively, than for Whites. Appreciable portions of the Hispanic–White gap (33%) and the Black–White gap (53%) were accounted for by family background factors, individual differences, and neighborhood factors. The findings imply that programs aimed at addressing the risk factors for exposure to violence and alleviating the effects of exposure to violence may decrease racial/ethnic disparities in exposure to violence and its consequences. PMID:23327266

  7. Violence, schools, and dropping out: racial and ethnic disparities in the educational consequence of student victimization.

    Science.gov (United States)

    Peguero, Anthony A

    2011-12-01

    Without a doubt, exposure to violence and victimization can be profoundly detrimental to the overall well-being and development of all youth. Moreover, violence and victimization that occurs within a school context is particularly alarming because a successful educational process is essential toward establishing socioeconomic success later in life. The educational consequence of exposure to violence and victimization at school is uncertain for racial and ethnic minority students. This study utilizes data from the Education Longitudinal Study of 2002 and incorporates multilevel modeling techniques to examine the impact of violence and victimization at school on dropping out. The results indicate Black/African Americans and Latino American students who are victimized at school are at higher risk of dropping out. The implications of the evident racial and ethnic disparities in the relationship between victimization and dropping out within the U.S. school system are discussed.

  8. Changing Racial/Ethnic Disparities in Heavy Drinking Trajectories Through Young Adulthood: A Comparative Cohort Study.

    Science.gov (United States)

    Williams, Edwina; Mulia, Nina; Karriker-Jaffe, Katherine J; Lui, Camillia K

    2018-01-01

    There is evidence of racial/ethnic differences in the age at which young adults age out of heavy drinking. Some studies have found Black and Hispanic drinkers engage in more frequent heavy drinking than White people beyond adulthood. Yet, the alcohol-related disparities literature has produced contradictory findings on whether an age-crossover effect is evident among racial/ethnic groups; that is, whether racial/ethnic minorities' drinking levels or trajectories are lower than White people at young ages but later exceed (or crossover) those of White people. This study extends this scant literature by assessing whether racial/ethnic differences in heavy drinking have changed over time (possibly accounting for mixed findings from prior research); and tests for an age-crossover effect in heavy drinking using longitudinal data from 2 cohorts born 20 years apart. Data are from the 1979 (n = 10,963) and 1997 (n = 8,852) cohorts of the National Longitudinal Survey of Youth (NLSY). Generalized estimating equations were used to model trajectories of heavy drinking frequency from ages 17 to 31. Racial/ethnic differences were determined using sex-stratified models and 3-way interactions of race/ethnicity with age, age-squared, and cohort. Racial/ethnic differences in heavy drinking trajectories have changed over time in men and women. In the older NLSY cohort, Hispanic men and Black women surpassed White men's and women's heavy drinking frequency by age 31. This crossover was absent in the younger cohort, where trajectories of all racial-sex groups converged by age 31. Normative trajectories have changed in Hispanics and White people of both sexes, with a delay in age of peak frequency, and greater levels of heavy drinking in the younger cohort of women. Changes in heavy drinking trajectories over time suggest the need for targeted interventions during young adulthood. While disparities in young adult heavy drinking were no longer apparent in the more recent birth cohort

  9. Resurgent Ethnicity among Asian Americans: Ethnic Neighborhood Context and Health

    Science.gov (United States)

    Walton, Emily

    2012-01-01

    In this study I investigate the associations of neighborhood socioeconomic and social environments with the health of Asian Americans living in both Asian ethnic neighborhoods and non-Asian neighborhoods. I use a sample of 1962 Asian Americans from the National Latino and Asian American Study (NLAAS, 2003-04). Three key findings emerge. First,…

  10. A simulation model approach to analysis of the business case for eliminating health care disparities

    Directory of Open Access Journals (Sweden)

    Tunceli Kaan

    2011-03-01

    Full Text Available Abstract Background Purchasers can play an important role in eliminating racial and ethnic disparities in health care. A need exists to develop a compelling "business case" from the employer perspective to put, and keep, the issue of racial/ethnic disparities in health care on the quality improvement agenda for health plans and providers. Methods To illustrate a method for calculating an employer business case for disparity reduction and to compare the business case in two clinical areas, we conducted analyses of the direct (medical care costs paid by employers and indirect (absenteeism, productivity effects of eliminating known racial/ethnic disparities in mammography screening and appropriate medication use for patients with asthma. We used Markov simulation models to estimate the consequences, for defined populations of African-American employees or health plan members, of a 10% increase in HEDIS mammography rates or a 10% increase in appropriate medication use among either adults or children/adolescents with asthma. Results The savings per employed African-American woman aged 50-65 associated with a 10% increase in HEDIS mammography rate, from direct medical expenses and indirect costs (absenteeism, productivity combined, was $50. The findings for asthma were more favorable from an employer point of view at approximately $1,660 per person if raising medication adherence rates in African-American employees or dependents by 10%. Conclusions For the employer business case, both clinical scenarios modeled showed positive results. There is a greater potential financial gain related to eliminating a disparity in asthma medications than there is for eliminating a disparity in mammography rates.

  11. A simulation model approach to analysis of the business case for eliminating health care disparities.

    Science.gov (United States)

    Nerenz, David R; Liu, Yung-wen; Williams, Keoki L; Tunceli, Kaan; Zeng, Huiwen

    2011-03-19

    Purchasers can play an important role in eliminating racial and ethnic disparities in health care. A need exists to develop a compelling "business case" from the employer perspective to put, and keep, the issue of racial/ethnic disparities in health care on the quality improvement agenda for health plans and providers. To illustrate a method for calculating an employer business case for disparity reduction and to compare the business case in two clinical areas, we conducted analyses of the direct (medical care costs paid by employers) and indirect (absenteeism, productivity) effects of eliminating known racial/ethnic disparities in mammography screening and appropriate medication use for patients with asthma. We used Markov simulation models to estimate the consequences, for defined populations of African-American employees or health plan members, of a 10% increase in HEDIS mammography rates or a 10% increase in appropriate medication use among either adults or children/adolescents with asthma. The savings per employed African-American woman aged 50-65 associated with a 10% increase in HEDIS mammography rate, from direct medical expenses and indirect costs (absenteeism, productivity) combined, was $50. The findings for asthma were more favorable from an employer point of view at approximately $1,660 per person if raising medication adherence rates in African-American employees or dependents by 10%. For the employer business case, both clinical scenarios modeled showed positive results. There is a greater potential financial gain related to eliminating a disparity in asthma medications than there is for eliminating a disparity in mammography rates. © 2011 Nerenz et al; licensee BioMed Central Ltd.

  12. Association of a Policy Mandating Physician-Patient Communication With Racial/Ethnic Disparities in Postmastectomy Breast Reconstruction.

    Science.gov (United States)

    Mahmoudi, Elham; Lu, Yiwen; Metz, Allan K; Momoh, Adeyiza O; Chung, Kevin C

    2017-08-01

    With the stabilization of breast cancer incidence and substantial improvement in survival, more attention has focused on postmastectomy breast reconstruction (PBR). Despite its demonstrated benefits, wide disparities in the use of PBR remain. Physician-patient communication has an important role in disparities in health care, especially for elective surgical procedures. Recognizing this, the State of New York enacted Public Health Law (NY PBH Law) 2803-o in 2011 mandating that physicians communicate about reconstructive surgery with patients undergoing mastectomy. To evaluate whether mandated physician-patient communication is associated with reduced racial/ethnic disparities in immediate PBR (IPBR). This retrospective study used state inpatient data from January 1, 2008, through December 31, 2011, in New York and California to evaluate a final sample of 42 346 women aged 20 to 70 years, including 19 364 from New York (treatment group) and 22 982 from California (comparison group). The primary hypothesis tested the effect of the New York law on racial/ethnic disparities, using California as a comparator. The National Academy of Medicine's (formerly Institute of Medicine) definition of a disparity was applied, and a difference-in-differences method (before-and-after comparison design) was used to evaluate the association of NY PBH Law 2803-o mandating physician-patient communication with disparities in IPBR. Data were analyzed from July 1, 2016, to February 24, 2017. New York PBH Law 2803-o was implemented on January 1, 2011. The preexposure period included January 1, 2008, through December 31, 2010 (3 years); the postexposure period, January 1 through December 31, 2011 (1 year). The primary outcome was use of IPBR among white, African American, Hispanic, and other minority groups before and after the implementation of NY PBH Law 2803-o. Among the 42 346 women (mean [SD] age, 53 [10] years), 65.3% (27 654) were white, 12.7% (5365) were Hispanic, 9.4% (3976

  13. A new conceptualization of ethnicity for social epidemiologic and health equity research.

    Science.gov (United States)

    Ford, Chandra L; Harawa, Nina T

    2010-07-01

    Although social stratification persists in the US, differentially influencing the well-being of ethnically defined groups, ethnicity concepts and their implications for health disparities remain under-examined. Ethnicity is a complex social construct that influences personal identity and group social relations. Ethnic identity, ethnic classification systems, the groupings that compose each system and the implications of assignment to one or another ethnic category are place-, time- and context-specific. In the US, racial stratification uniquely shapes expressions of and understandings about ethnicity. Ethnicity is typically invoked via the term, 'race/ethnicity'; however, it is unclear whether this heralds a shift away from racialization or merely extends flawed racial taxonomies to populations whose cultural and phenotypic diversity challenge traditional racial classification. We propose that ethnicity be conceptualized as a two-dimensional, context-specific, social construct with an attributional dimension that describes group characteristics (e.g., culture, nativity) and a relational dimension that indexes a group's location within a social hierarchy (e.g., minority vs. majority status). This new conceptualization extends prior definitions in ways that facilitate research on ethnicization, social stratification and health inequities. While federal ethnic and racial categories are useful for administrative purposes such as monitoring the inclusion of minorities in research, and traditional ethnicity concepts (e.g., culture) are useful for developing culturally appropriate interventions, our relational dimension of ethnicity is useful for studying the relationships between societal factors and health inequities. We offer this new conceptualization of ethnicity and outline next steps for employing socially meaningful measures of ethnicity in empirical research. As ethnicity is both increasingly complex and increasingly central to social life, improving its

  14. Integrating Multiple Social Statuses in Health Disparities Research: The Case of Lung Cancer

    Science.gov (United States)

    Williams, David R; Kontos, Emily Z; Viswanath, K; Haas, Jennifer S; Lathan, Christopher S; MacConaill, Laura E; Chen, Jarvis; Ayanian, John Z

    2012-01-01

    Objective To illustrate the complex patterns that emerge when race/ethnicity, socioeconomic status (SES), and gender are considered simultaneously in health care disparities research and to outline the needed research to understand them by using disparities in lung cancer risks, treatment, and outcomes as an example. Principal Findings SES, gender, and race/ethnicity are social categories that are robust predictors of variations in health and health services utilization. These are usually considered separately, but intersectionality theory indicates that the impact of each depends on the others. Each reflects historically and culturally contingent variations in social, economic, and political status. Distinct patterns of risk and resilience emerge at the intersections of multiple social categories and shape the experience of health, health care access, utilization, quality, and outcomes where these categories intersect. Intersectional approaches call for greater attention to understand social processes at multiple levels of society and require the collection of relevant data and utilization of appropriate analytic approaches to understand how multiple risk factors and resources combine to affect the distribution of disease and its management. Conclusions Understanding how race/ethnicity, gender, and SES are interactive, interdependent, and social identities can provide new knowledge to enhance our efforts to effectively address health disparities. PMID:22568674

  15. How Health Care Organizations Are Using Data on Patients' Race and Ethnicity to Improve Quality of Care

    Science.gov (United States)

    Thorlby, Ruth; Jorgensen, Selena; Siegel, Bruce; Ayanian, John Z

    2011-01-01

    Context: Racial and ethnic disparities in the quality of health care are well documented in the U.S. health care system. Reducing these disparities requires action by health care organizations. Collecting accurate data from patients about their race and ethnicity is an essential first step for health care organizations to take such action, but these data are not systematically collected and used for quality improvement purposes in the United States. This study explores the challenges encountered by health care organizations that attempted to collect and use these data to reduce disparities. Methods: Purposive sampling was used to identify eight health care organizations that collected race and ethnicity data to measure and reduce disparities in the quality and outcomes of health care. Staff, including senior managers and data analysts, were interviewed at each site, using a semi-structured interview format about the following themes: the challenges of collecting and collating accurate data from patients, how organizations defined a disparity and analyzed data, and the impact and uses of their findings. Findings: To collect accurate self-reported data on race and ethnicity from patients, most organizations had upgraded or modified their IT systems to capture data and trained staff to collect and input these data from patients. By stratifying nationally validated indicators of quality for hospitals and ambulatory care by race and ethnicity, most organizations had then used these data to identify disparities in the quality of care. In this process, organizations were taking different approaches to defining and measuring disparities. Through these various methods, all organizations had found some disparities, and some had invested in interventions designed to address them, such as extra staff, extended hours, or services in new locations. Conclusion: If policymakers wish to hold health care organizations accountable for disparities in the quality of the care they

  16. The Military Health Care System May Have the Potential to Prevent Health Care Disparities.

    Science.gov (United States)

    Pierre-Louis, Bosny J; Moore, Angelo D; Hamilton, Jill B

    2015-09-01

    The existence of health disparities in military populations has become an important topic of research. However, to our knowledge, this is the first study to examine health disparities, as related to access to care and health status, among active duty soldiers and their families. Specifically, the purpose of this analysis was to evaluate whether health disparities exist in access to care and health outcomes of patient satisfaction, physical health status, and mental health status according to race, gender, and sponsor rank in the population of active duty soldiers and their family members. In this cross-sectional study, active duty army soldiers and family members were recruited from either one particular army health clinic where they received their health care or from an adjacent shopping center frequented by eligible participants. Data were collected using validated measures to assess concepts of access to care and health status. Statistical analysis, including one-way analysis of variance (ANOVA) was performed to investigate differences in study outcome measures across four key demographic subgroups: race, gender, sponsor rank, and component (active soldier or family member). A total of 200 participants completed the study questionnaires. The sample consisted of 45.5 % soldiers and 54.5 % family members, with 88.5 % reporting a sponsor rank in the category of junior or senior enlisted rank. Mean scores for access to care did not differ significantly for the groups race/ethnicity (p = 0.53), gender (p = 0.14), and sponsor rank (p = 0.10). Furthermore, no significant differences were observed whether respondents were active soldiers or their family members (p = 0.36). Similarly, there were no statistically significant subgroup (race/ethnicity, gender, sponsor rank, or component) differences in mean patient satisfaction, physical health, and mental health scores. In a health equity system of care such as the military health care system, active duty

  17. Organizational Change Management For Health Equity: Perspectives From The Disparities Leadership Program.

    Science.gov (United States)

    Betancourt, Joseph R; Tan-McGrory, Aswita; Kenst, Karey S; Phan, Thuy Hoai; Lopez, Lenny

    2017-06-01

    Leaders of health care organizations need to be prepared to improve quality and achieve equity in today's health care environment characterized by a focus on achieving value and addressing disparities in a diverse population. To help address this need, the Disparities Solutions Center at Massachusetts General Hospital launched the Disparities Leadership Program in 2007. The leadership program is an ongoing, year-long, executive education initiative that trains leaders from hospitals, health plans, and health centers to improve quality and eliminate racial and ethnic disparities in health care. Feedback from participating organizations demonstrates that health care leaders seem to possess knowledge about what disparities are and about what should be done to eliminate them. Data collection, performance measurement, and multifaceted interventions remain the tools of the trade. However, the barriers to success are lack of leadership buy-in, organizational prioritization, energy, and execution, which can be addressed through organizational change management strategies. Project HOPE—The People-to-People Health Foundation, Inc.

  18. "A NEW CONCEPTUALIZATION OF ETHNICITY FOR SOCIAL EPIDEMIOLOGIC AND HEALTH EQUITY RESEARCH"

    Science.gov (United States)

    Harawa, Nina T

    2010-01-01

    Although social stratification persists in the US, differentially influencing the well-being of ethnically defined groups, ethnicity concepts and their implications for health disparities remain under-examined. Ethnicity is a complex social construct that influences personal identity and group social relations. Ethnic identity, ethnic classification systems, the groupings that compose each system and the implications of assignment to one or another ethnic category are place-, time- and context-specific. In the US, racial stratification uniquely shapes expressions of and understandings about ethnicity. Ethnicity is typically invoked via the term, ‘race/ethnicity’; however, it is unclear whether this heralds a shift away from racialization or merely extends flawed racial taxonomies to populations whose cultural and phenotypic diversity challenge traditional racial classification. We propose that ethnicity be conceptualized as a two-dimensional, context-specific, social construct with an attributional dimension that describes group characteristics (e.g., culture, nativity) and a relational dimension that indexes a group’s location within a social hierarchy (e.g., minority vs. majority status). This new conceptualization extends prior definitions in ways that facilitate research on ethnicization, social stratification and health inequities. While federal ethnic and racial categories are useful for administrative purposes such as monitoring the inclusion of minorities in research, and traditional ethnicity concepts (e.g., culture) are useful for developing culturally appropriate interventions, our relational dimension of ethnicity is useful for studying the relationships between societal factors and health inequities. We offer a new conceptualization of ethnicity and outline next steps for employing socially meaningful measures of ethnicity in empirical research. Ethnicity is both increasingly complex and increasingly central to social life; therefore, improving

  19. Pilot Project to Integrate Community and Clinical Level Systems to Address Health Disparities in the Prevention and Treatment of Obesity among Ethnic Minority Inner-City Middle School Students: Lessons Learned

    Directory of Open Access Journals (Sweden)

    Jessica Rieder

    2018-01-01

    Full Text Available Effective obesity prevention and treatment interventions are lacking in the United States, especially for impoverished minority youths at risk for health disparities, and especially in accessible community-based settings. We describe the launch and pilot implementation evaluation of the first year of the B’N Fit POWER initiative as a middle school-based comprehensive wellness program that integrates weight management programming into existing onsite preventive and clinical services. Consistent with the existing implementation science literature, we focused on both the organizational structures that facilitate communication and the development of trust among stakeholders, students, and families and the development of realistic and timely goals to implement and integrate all aspects of the program. New implementation and programming strategies were developed and tested to increase the proportion of students screened, support the linkage of students to care, and streamline the integration of program clinical and afterschool components into routine services already offered at the school. We report on our initial implementation activities using the Standards for Reporting Implementation Studies (StaRI framework using hybrid outcomes combining the Reach element from the RE-AIM framework with a newly conceptualized Wellness Cascade.

  20. Geographic, Racial/Ethnic, and Sociodemographic Disparities in Parent-Reported Receipt of Family-Centered Care among US Children.

    Science.gov (United States)

    Azuine, Romuladus E; Singh, Gopal K; Ghandour, Reem M; Kogan, Michael D

    2015-01-01

    This study examined geographic, racial/ethnic, and sociodemographic disparities in parental reporting of receipt of family-centered care (FCC) and its components among US children aged 0-17 years. We used the 2011-2012 National Survey of Children's Health to estimate the prevalence and odds of not receiving FCC by covariates. Based on parent report, 33.4% of US children did not receive FCC. Children in Arizona, Mississippi, Nevada, California, New Jersey, Virginia, Florida, and New York had at least 1.51 times higher adjusted odds of not receiving FCC than children in Vermont. Non-Hispanic Black and Hispanic children had 2.11 and 1.58 times higher odds, respectively, of not receiving FCC than non-Hispanic White children. Children from non-English-speaking households had 2.23 and 2.35 times higher adjusted odds of not receiving FCC overall and their doctors not spending enough time in their care than children from English-speaking households, respectively. Children from low-education and low-income households had a higher likelihood of not receiving FCC. The clustering of children who did not receive FCC and its components in several Southern and Western US states, as well as children from poor, uninsured, and publicly insured and of minority background, is a cause for concern in the face of federal policies to reduce health care disparities.

  1. Challenges for Multilevel Health Disparities Research in a Transdisciplinary Environment

    Science.gov (United States)

    Holmes, John H.; Lehman, Amy; Hade, Erinn; Ferketich, Amy K.; Sarah, Gehlert; Rauscher, Garth H.; Abrams, Judith; Bird, Chloe E.

    2008-01-01

    Numerous factors play a part in health disparities. Although health disparities are manifested at the level of the individual, other contexts should be considered when investigating the associations of disparities with clinical outcomes. These contexts include families, neighborhoods, social organizations, and healthcare facilities. This paper reports on health disparities research as a multilevel research domain from the perspective of a large national initiative. The Centers for Population Health and Health Disparities (CPHHD) program was established by the NIH to examine the highly dimensional, complex nature of disparities and their effects on health. Because of its inherently transdisciplinary nature, the CPHHD program provides a unique environment in which to perform multilevel health disparities research. During the course of the program, the CPHHD centers have experienced challenges specific to this type of research. The challenges were categorized along three axes: sources of subjects and data, data characteristics, and multilevel analysis and interpretation. The CPHHDs collectively offer a unique example of how these challenges are met; just as importantly, they reveal a broad range of issues that health disparities researchers should consider as they pursue transdisciplinary investigations in this domain, particularly in the context of a large team science initiative. PMID:18619398

  2. 76 FR 31618 - National Center on Minority Health and Health Disparities; Notice of Meeting

    Science.gov (United States)

    2011-06-01

    ... Health and Health Disparities; Notice of Meeting Pursuant to section 10(d) of the Federal Advisory... Council on Minority Health and Health Disparities. The meeting will be open to the public as indicated... on Minority Health and Health Disparities. Date: June 14, 2011. Closed: 8 a.m. to 9:30 a.m. Agenda...

  3. 76 FR 6808 - National Center on Minority Health and Health Disparities; Notice of Meeting

    Science.gov (United States)

    2011-02-08

    ... Health and Health Disparities; Notice of Meeting Pursuant to section 10(d) of the Federal Advisory... Council on Minority Health and Health Disparities. The meeting will be open to the public as indicated... on Minority Health and Health Disparities. Date: February 22, 2011. Closed: 8 a.m. to 9:30 a.m...

  4. 77 FR 27784 - National Institute on Minority Health and Health Disparities; Notice of Meeting

    Science.gov (United States)

    2012-05-11

    ... Minority Health and Health Disparities; Notice of Meeting Pursuant to section 10(d) of the Federal Advisory... Council on Minority Health and Health Disparities. The meeting will be open to the public as indicated... on Minority Health and Health Disparities. Date: June 12, 2012. Closed: 8:00 a.m. to 9:30 a.m. Agenda...

  5. 78 FR 62638 - National Institute on Minority Health and Health Disparities; Notice of Closed Meetings

    Science.gov (United States)

    2013-10-22

    ... Minority Health and Health Disparities; Notice of Closed Meetings Pursuant to section 10(d) of the Federal... Institute on Minority Health and Health Disparities Special Emphasis Panel; NIMHD Technologies for Improving Minority Health and Eliminating Health Disparities (R41/ R42). Date: November 8, 2013. Time: 8:00 a.m. to 5...

  6. 77 FR 9676 - National Institute on Minority Health and Health Disparities; Notice of Meeting

    Science.gov (United States)

    2012-02-17

    ... Minority Health and Health Disparities; Notice of Meeting Pursuant to section 10(d) of the Federal Advisory... Council on Minority Health and Health Disparities. The meeting will be open to the public as indicated... on Minority Health and Health Disparities. Date: February 28, 2012. Closed: 8 a.m. to 9:30 a.m...

  7. 75 FR 28262 - National Center on Minority Health and Health Disparities; Notice of Meeting

    Science.gov (United States)

    2010-05-20

    ... Health and Health Disparities; Notice of Meeting Pursuant to section 10(d) of the Federal Advisory... Council on Minority Health and Health Disparities. The meeting will be open to the public as indicated... Advisory Council on Minority Health and Health Disparities. Date: June 8, 2010. Closed: 8 a.m. to 9 a.m...

  8. 76 FR 55075 - National Center on Minority Health and Health Disparities; Notice of Meeting

    Science.gov (United States)

    2011-09-06

    ... Health and Health Disparities; Notice of Meeting Pursuant to section 10(d) of the Federal Advisory... Council on Minority Health and Health Disparities. The meeting will be open to the public as indicated... on Minority Health and Health Disparities. Date: September 13, 2011. Closed: 8 to 9:30 a.m. Agenda...

  9. 77 FR 36564 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2012-06-19

    ... Minority Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel; NIMHD Support for Conference and Scientific meetings... Institutes of Health, National Institute on Minority Health and Health Disparities, 6707 Democracy Blvd...

  10. 78 FR 50428 - National Institute on Minority Health and Health Disparities; Notice of Meeting

    Science.gov (United States)

    2013-08-19

    ... Minority Health and Health Disparities; Notice of Meeting Pursuant to section 10(d) of the Federal Advisory... Council on Minority Health and Health Disparities. The meeting will be open to the public as indicated... on Minority Health and Health Disparities. Date: September 10, 2013. Closed: 8:00 a.m. to 9:30 a.m...

  11. 78 FR 9402 - National Institute on Minority Health and Health; Disparities Notice of Meeting

    Science.gov (United States)

    2013-02-08

    ... Minority Health and Health; Disparities Notice of Meeting Pursuant to section 10(d) of the Federal Advisory... Advisory Council on Minority Health and Health Disparities. The meeting will be open to the public as... on Minority Health and Health Disparities. Date: February 26, 2013. Closed: 8:00 a.m. to 9:30 a.m...

  12. 78 FR 28233 - National Institute on Minority Health and Health Disparities; Notice of Meeting

    Science.gov (United States)

    2013-05-14

    ... Minority Health and Health Disparities; Notice of Meeting Pursuant to section 10(d) of the Federal Advisory... Council on Minority Health and Health Disparities. The meeting will be open to the public as indicated... on Minority Health and Health Disparities. Date: June 11, 2013. Closed: 8:00 a.m. to 9:30 a.m. Agenda...

  13. 77 FR 50139 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2012-08-20

    ... Minority Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal... Advisory Council on Minority Health and Health Disparities. The meeting will be closed to the public in... Health and Health Disparities. Date: September 17, 2012. Time: 12 p.m. to 3 p.m. Agenda: To review and...

  14. 75 FR 53975 - National Center on Minority Health and Health Disparities; Notice of Meeting

    Science.gov (United States)

    2010-09-02

    ... Health and Health Disparities; Notice of Meeting Pursuant to section 10(a) of the Federal Advisory... Council on Minority Health and Health Disparities. The meeting will be open to the public as indicated... on Minority Health and Health Disparities. Date: September 14, 2010. Closed: 8 a.m. to 9:30 a.m...

  15. 77 FR 61611 - National Institute on Minority Health and Health Disparities; Notice of Closed Meetings

    Science.gov (United States)

    2012-10-10

    ... Minority Health and Health Disparities; Notice of Closed Meetings Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel; NIMHD Social, Behavioral, Health Services, and Policy Research on Minority Health and Health Disparities (R01). Date: November 7-9, 2012. Time: 8 a.m. to 3 p.m...

  16. Tuberculosis during pregnancy in the United States: Racial/ethnic disparities in pregnancy complications and in-hospital death.

    Science.gov (United States)

    Dennis, Erika M; Hao, Yun; Tamambang, Mabella; Roshan, Tasha N; Gatlin, Knubian J; Bghigh, Hanane; Ogunyemi, Oladimeji T; Diallo, Fatoumata; Spooner, Kiara K; Salemi, Jason L; Olaleye, Omonike A; Khan, Kashif Z; Aliyu, Muktar H; Salihu, Hamisu M

    2018-01-01

    Despite decades of efforts to eliminate tuberculosis (TB) in the United States (US), TB still contributes to adverse ill health, especially among racial/ethnic minorities. According to the Centers for Disease Control and Prevention, in 2016, about 87% of the TB cases reported in the US were among racial and ethnic minorities. The objective of this study is to explore the risks for pregnancy complications and in-hospital death among mothers diagnosed with TB across racial/ethnic groups in the US. This retrospective cohort study utilized National Inpatient Sample data for all inpatient hospital discharges in the US. We analyzed pregnancy-related hospitalizations and births in the US from January 1, 2002 through December 31, 2014 (n = 57,393,459). Multivariable logistic regression was applied to generate odds ratios for the association between TB status and the primary study outcomes (i.e., pregnancy complications and in-hospital death) across racial/ethnic categories. The prevalence of TB was 7.1 per 100,000 pregnancy-related hospitalizations. The overall prevalence of pregnancy complications was 80% greater among TB-infected mothers than their uninfected counterparts. Severe pre-eclampsia, eclampsia, placenta previa, post-partum hemorrhage, sepsis and anemia occurred with greater frequency among mothers with a TB diagnosis than those without TB, irrespective of race/ethnicity. The rate of in-hospital death among TB patients was 37 times greater among TB-infected than in non-TB infected mothers (468.8 per 100,000 versus 12.6 per 100,000). A 3-fold increased risk of in-hospital death was observed among black TB-negative mothers compared to their white counterparts. No racial/ethnic disparities in maternal morbidity or in-hospital death were found among mothers with TB disease. TB continues to be an important cause of morbidity and mortality among pregnant women in the US. Resources to address TB disease should also target pregnant women, especially racial/ethnic

  17. Assimilation and emerging health disparities among new generations of U.S. children

    Directory of Open Access Journals (Sweden)

    Erin Hamilton

    2011-12-01

    Full Text Available This article shows that the prevalence of four common child health conditions increases across generations (from first-generation immigrant children to second-generation U.S.-born children of immigrants to third-and-higher-generation children within each of four major U.S. racial/ethnic groups. In the third-plus generation, black and Hispanic children have higher rates of nearly all conditions. Health care, socioeconomic status, parents' health, social support, and neighborhood conditions influence child health and help explain third-and-higher-generation racial/ethnic disparities. However, these factors do not explain the generational pattern. The generational pattern may reflect cohort changes, selective ethnic attrition, unhealthy assimilation, or changing responses to survey questions among immigrant groups.

  18. Will "Combined Prevention" Eliminate Racial/Ethnic Disparities in HIV Infection among Persons Who Inject Drugs in New York City?

    Directory of Open Access Journals (Sweden)

    Don Des Jarlais

    Full Text Available It has not been determined whether implementation of combined prevention programming for persons who inject drugs reduce racial/ethnic disparities in HIV infection. We examine racial/ethnic disparities in New York City among persons who inject drugs after implementation of the New York City Condom Social Marketing Program in 2007. Quantitative interviews and HIV testing were conducted among persons who inject drugs entering Mount Sinai Beth Israel drug treatment (2007-2014. 703 persons who inject drugs who began injecting after implementation of large-scale syringe exchange were included in the analyses. Factors independently associated with being HIV seropositive were identified and a published model was used to estimate HIV infections due to sexual transmission. Overall HIV prevalence was 4%; Whites 1%, African-Americans 17%, and Hispanics 4%. Adjusted odds ratios were 21.0 (95% CI 5.7, 77.5 for African-Americans to Whites and 4.5 (95% CI 1.3, 16.3 for Hispanics to Whites. There was an overall significant trend towards reduced HIV prevalence over time (adjusted odd ratio = 0.7 per year, 95% confidence interval (0.6-0.8. An estimated 75% or more of the HIV infections were due to sexual transmission. Racial/ethnic disparities among persons who inject drugs were not significantly different from previous disparities. Reducing these persistent disparities may require new interventions (treatment as prevention, pre-exposure prophylaxis for all racial/ethnic groups.

  19. Ethnicity and Postmigration Health Trajectory in New Immigrants to Canada

    Science.gov (United States)

    Kim, Il-Ho; Carrasco, Christine; Muntaner, Carles; McKenzie, Kwame

    2013-01-01

    Objectives. In this prospective cohort study, we examined the trajectory of general health during the first 4 years after new immigrants’ arrival in Canada. We focused on the change in self-rated health trajectories and their gender and ethnic disparities. Methods. Data were derived from the Longitudinal Survey of Immigrants to Canada and were collected between April 2001 and November 2005 by Statistics Canada. We used weighted samples of 3309 men and 3351 women aged between 20 and 59 years. Results. At arrival, only 3.5% of new immigrants rated their general health as poor. Significant and steady increases in poor health were revealed during the following 4 years, especially among ethnic minorities and women. Specifically, we found a higher risk of poor health among West Asian and Chinese men and among South Asian and Chinese women than among their European counterparts. Conclusions. Newly arrived immigrants are extremely healthy, but the health advantage dissipates rapidly during the initial years of settlement in Canada. Women and minority ethnic groups may be more vulnerable to social changes and postmigration settlement. PMID:23409893

  20. Racial-Ethnic Disparities in Maternal Parenting Stress: The Role of Structural Disadvantages and Parenting Values

    Science.gov (United States)

    Nomaguchi, Kei; House, Amanda N.

    2013-01-01

    Although researchers contend that racial-ethnic minorities experience more stress than whites, knowledge of racial-ethnic disparities in parenting stress is limited. Using a pooled time-series analysis of data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998–99 (n = 11,324), we examine racial-ethnic differences in maternal parenting stress, with a focus on structural and cultural explanations and variations by nativity and child age. In kindergarten, black mothers, albeit U.S.-born only, report more parenting stress than white mothers due to structural disadvantages and authoritarian parenting values. The black-white gap increases from kindergarten to third grade, and in third grade, U.S.-born black mothers’ higher stress than white mothers’ persists after controlling for structural and parenting factors. Hispanic and Asian mothers, albeit foreign-born only, report more stress than white mothers at both ages due to structural disadvantages and authoritarian values. Despite structural disadvantages, American Indian mothers report less stress. PMID:24026535

  1. Racial-ethnic disparities in maternal parenting stress: the role of structural disadvantages and parenting values.

    Science.gov (United States)

    Nomaguchi, Kei; House, Amanda N

    2013-01-01

    Although researchers contend that racial-ethnic minorities experience more stress than whites, knowledge of racial-ethnic disparities in parenting stress is limited. Using a pooled time-series analysis of data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-99 (n = 11,324), we examine racial-ethnic differences in maternal parenting stress, with a focus on structural and cultural explanations and variations by nativity and child age. In kindergarten, black mothers, albeit U.S.-born only, report more parenting stress than white mothers due to structural disadvantages and authoritarian parenting values. The black-white gap increases from kindergarten to third grade, and in third grade, U.S.-born black mothers' higher stress than white mothers' persists after controlling for structural and parenting factors. Hispanic and Asian mothers, albeit foreign-born only, report more stress than white mothers at both ages due to structural disadvantages and authoritarian values. Despite structural disadvantages, American Indian mothers report less stress.

  2. Racial and Ethnic Disparities in Meeting MTM Eligibility Criteria Based on Star Ratings Compared with the Medicare Modernization Act.

    Science.gov (United States)

    Spivey, Christina A; Wang, Junling; Qiao, Yanru; Shih, Ya-Chen Tina; Wan, Jim Y; Kuhle, Julie; Dagogo-Jack, Samuel; Cushman, William C; Chisholm-Burns, Marie

    2018-02-01

    Previous research found racial and ethnic disparities in meeting medication therapy management (MTM) eligibility criteria implemented by the Centers for Medicare & Medicaid Services (CMS) in accordance with the Medicare Modernization Act (MMA). To examine whether alternative MTM eligibility criteria based on the CMS Part D star ratings quality evaluation system can reduce racial and ethnic disparities. This study analyzed the Beneficiary Summary File and claims files for Medicare beneficiaries linked to the Area Health Resource File. Three million Medicare beneficiaries with continuous Parts A, B, and D enrollment in 2012-2013 were included. Proposed star ratings criteria included 9 existing medication safety and adherence measures developed mostly by the Pharmacy Quality Alliance. Logistic regression and the Blinder-Oaxaca approach were used to test disparities in meeting MMA and star ratings eligibility criteria across racial and ethnic groups. Multinomial logistic regression was used to examine whether there was a disparity reduction by comparing individuals who were MTM-eligible under MMA but not under star ratings criteria and those who were MTM-eligible under star ratings criteria but not under the MMA. Concerning MMA-based MTM criteria, main and sensitivity analyses were performed to represent the entire range of the MMA eligibility thresholds reported by plans in 2009, 2013, and proposed by CMS in 2015. Regarding star ratings criteria, meeting any 1 of the 9 measures was examined as the main analysis, and various measure combinations were examined as the sensitivity analyses. In the main analysis, adjusted odds ratios for non-Hispanic blacks (backs) and Hispanics to non-Hispanic whites (whites) were 1.394 (95% CI = 1.375-1.414) and 1.197 (95% CI = 1.176-1.218), respectively, under star ratings. Blacks were 39.4% and Hispanics were 19.7% more likely to be MTM-eligible than whites. Blacks and Hispanics were less likely to be MTM-eligible than whites in some

  3. Educating clinicians about cultural competence and disparities in health and health care.

    Science.gov (United States)

    Like, Robert C

    2011-01-01

    An extensive body of literature has documented significant racial and ethnic disparities in health and health care. Cultural competency interventions, including the training of physicians and other health care professionals, have been proposed as a key strategy for helping to reduce these disparities. The continuing medical education (CME) profession can play an important role in addressing this need by improving the quality and assessing the outcomes of multicultural education programs. This article provides an overview of health care policy, legislative, accreditation, and professional initiatives relating to these subjects. The status of CME offerings on cultural competence/disparities is reviewed, with examples provided of available curricular resources and online courses. Critiques of cultural competence training and selected studies of its effectiveness are discussed. The need for the CME profession to become more culturally competent in its development, implementation, and evaluation of education programs is examined. Future challenges and opportunities are described, and a call for leadership and action is issued. Copyright © 2010 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  4. 78 FR 65345 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2013-10-31

    ... Minority Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel; NIMHD Research Center in Minority Institution Program... applications. Place: National Institute on Minority Health and Health Disparities, 6707 Democracy Blvd., Suite...

  5. 77 FR 9673 - National Institute on Minority Health and Health Disparities Notice of Closed Meeting

    Science.gov (United States)

    2012-02-17

    ... Minority Health and Health Disparities Notice of Closed Meeting Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel; R01. Date: February 16, 2012. Time: 8 a.m. to 5 p.m...., Scientific Review Officer, National Institute on Minority Health and Health Disparities, National Institutes...

  6. The Role of Data in Health Care Disparities in Medicaid...

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in The Role of Data in Health Care Disparities in Medicaid Managed Care, published in Volume 2, Issue 4 of the Medicare and Medicaid...

  7. Ethnic disparities in traumatic brain injury care referral in a Hispanic-majority population.

    Science.gov (United States)

    Budnick, Hailey C; Tyroch, Alan H; Milan, Stacey A

    2017-07-01

    Functional outcomes after traumatic brain injury (TBI) can be significantly improved by discharge to posthospitalization care facilities. Many variables influence the discharge disposition of the TBI patient, including insurance status, patient condition, and patient prognosis. The literature has demonstrated an ethnic disparity in posthospitalization care referral, with Hispanics being discharged to rehabilitation and nursing facilities less often than non-Hispanics. However, this relationship has not been studied in a Hispanic-majority population, and thus, this study seeks to determine if differences in neurorehabilitation referrals exist among ethnic groups in a predominately Hispanic region. This study is a retrospective cohort that includes 1128 TBI patients who presented to University Medical Center El Paso, Texas, between the years 2005 and 2015. The patients' age, sex, race, residence, admission Glasgow Coma Scale (GCS), GCS motor, Injury Severity Score (ISS), hospital and intensive care unit length of stay (LOS), mechanism of injury, and discharge disposition were analyzed in univariate and multivariate models. Our study population had an insurance rate of 55.5%. Insurance status and markers of injury severity (hospital LOS, intensive care unit LOS, ISS, GCS, and GCS motor) were predictive of discharge disposition to rehabilitation facilities. The study population was 70% Hispanic, yet Hispanics were discharged to rehabilitation facilities (relative risk: 0.56, P: 0.001) and to long-term acute care/nursing facilities (relative risk: 0.35, P < 0.0001) less than non-Hispanics even after LOS, ISS, ethnicity, insurance status, and residence were adjusted for in multivariate analysis. This study suggests that patients of different ethnicities but comparable traumatic severity and insurance status receive different discharge dispositions post-TBI even in regions in which Hispanics are the demographic majority. Copyright © 2017 Elsevier Inc. All rights

  8. Trends and Progress in Reducing Teen Birth Rates and the Persisting Challenge of Eliminating Racial/Ethnic Disparities.

    Science.gov (United States)

    Ngui, Emmanuel M; Greer, Danielle M; Bridgewater, Farrin D; Salm Ward, Trina C; Cisler, Ron A

    2017-08-01

    We examined progress made by the Milwaukee community toward achieving the Milwaukee Teen Pregnancy Prevention Initiative's aggressive 2008 goal of reducing the teen birth rate to 30 live births/1000 females aged 15-17 years by 2015. We further examined differential teen birth rates in disparate racial and ethnic groups. We analyzed teen birth count data from the Wisconsin Interactive Statistics on Health system and demographic data from the US Census Bureau. We computed annual 2003-2014 teen birth rates for the city and four racial/ethnic groups within the city (white non-Hispanic, black non-Hispanic, Hispanic/Latina, Asian non-Hispanic). To compare birth rates from before (2003-2008) and after (2009-2014) goal setting, we used a single-system design to employ two time series analysis approaches, celeration line, and three standard deviation (3SD) bands. Milwaukee's teen birth rate dropped 54 % from 54.3 in 2003 to 23.7 births/1000 females in 2014, surpassing the goal of 30 births/1000 females 3 years ahead of schedule. Rate reduction following goal setting was statistically significant, as five of the six post-goal data points were located below the celeration line and points for six consecutive years (2010-2014) fell below the 3SD band. All racial/ethnic groups demonstrated significant reductions through at least one of the two time series approaches. The gap between white and both black and Hispanic/Latina teens widened. Significant reduction has occurred in the overall teen birth rate of Milwaukee. Achieving an aggressive reduction in teen births highlights the importance of collaborative community partnerships in setting and tracking public health goals.

  9. January Monthly Spotlight: Cervical Health and Cervical Cancer Disparities

    Science.gov (United States)

    In January, CRCHD joins the nation in raising awareness for Cervical Health and Cervical Cancer Disparities. This month we share a special focus on NCI/CRCHD research programs that are trying to reduce cervical cancer disparities in underserved communities and the people who are spreading the word about the importance of early detection.

  10. 78 FR 13689 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2013-02-28

    ... Minority Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel. Date: March 8, 2013. Time: 8:00 a.m. to 5:00 p.m..., and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 496-3996...

  11. 78 FR 10621 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2013-02-14

    ... Minority Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel; NIMHD Conference Grant Review (R13). Date: March 15... Health Disparities, 6707 Democracy Blvd., Suite 800, Bethesda, MD 20892, (301) 594-7784, [email protected

  12. Addressing Health Care Disparities and Increasing Workforce Diversity: The Next Step for the Dental, Medical, and Public Health Professions

    Science.gov (United States)

    Mitchell, Dennis A.; Lassiter, Shana L.

    2006-01-01

    The racial/ethnic composition of our nation is projected to change drastically in the coming decades. It is therefore important that the health professions improve their efforts to provide culturally competent care to all patients. We reviewed literature concerning health care disparities and workforce diversity issues—particularly within the oral health field—and provide a synthesis of recommendations to address these issues. This review is highly relevant to both the medical and public health professions, because they are facing similar disparity and workforce issues. In addition, the recent establishment of relationships between oral health and certain systemic health conditions will elevate oral health promotion and disease prevention as important points of intervention in the quest to improve our nation’s public health. PMID:17077406

  13. Temporal Trends and Changing Racial/ethnic Disparities in Alcohol Problems: Results from the 2000 to 2010 National Alcohol Surveys.

    Science.gov (United States)

    Zemore, Sarah E; Karriker-Jaffe, Katherine J; Mulia, Nina

    2013-09-28

    Economic conditions and drinking norms have been in considerable flux over the past 10 years. Accordingly, research is needed to evaluate both overall trends in alcohol problems during this period and whether changes within racial/ethnic groups have affected racial/ethnic disparities. We used 3 cross-sectional waves of National Alcohol Survey data (2000, 2005, and 2010) to examine a) temporal trends in alcohol dependence and consequences overall and by race/ethnicity, and b) the effects of temporal changes on racial/ethnic disparities. Analyses involved bivariate tests and multivariate negative binomial regressions testing the effects of race/ethnicity, survey year, and their interaction on problem measures. Both women and men overall showed significant increases in dependence symptoms in 2010 (vs. 2000); women also reported increases in alcohol-related consequences in 2010 (vs. 2000). (Problem rates were equivalent across 2005 and 2000.) However, increases in problems were most dramatic among Whites, and dependence symptoms actually decreased among Latinos of both genders in 2010. Consequently, the long-standing disparity in dependence between Latino and White men was substantially reduced in 2010. Post-hoc analyses suggested that changes in drinking norms at least partially drove increased problem rates among Whites. Results constitute an important contribution to the literature on racial/ethnic disparities in alcohol problems. Findings are not inconsistent with the macroeconomic literature suggesting increases in alcohol problems during economic recession, but the pattern of effects across race/ethnicity and findings regarding norms together suggest, at the least, a revised understanding of how recessions affect drinking patterns and problems.

  14. Weight Misperceptions and Racial and Ethnic Disparities in Adolescent Female Body Mass Index

    Directory of Open Access Journals (Sweden)

    Ramona C. Krauss

    2012-01-01

    Full Text Available This paper investigated weight misperceptions as determinants of racial/ethnic disparities in body mass index (BMI among adolescent females using data from the National Survey of Youth 1997. Compared to their white counterparts, higher proportions of black and Hispanic adolescent females underperceived their weight status; that is, they misperceived themselves to have lower weight status compared to their clinically defined weight status. Compared to their black counterparts, higher proportions of white and Hispanic adolescent females misperceived themselves to be heavier than their clinical weight status. Oaxaca-Blinder decomposition analysis showed that accounting for weight misperceptions, in addition to individual and contextual factors, increased the total explained portion of the black-white female BMI gap from 44.7% to 54.3% but only slightly increased the total explained portion of the Hispanic-white gap from 62.8% to 63.1%. Weight misperceptions explained 13.0% of the black-white female BMI gap and 3.3% of the Hispanic-white female BMI gap. The regression estimates showed that weight underperceptions were important determinants of adolescent female BMI, particularly among black and Hispanic adolescents. Education regarding identification and interpretation of weight status may play an important role to help reduce the incidence and racial disparity of female adolescent obesity.

  15. Ethnic Disparities in Dental Caries among Six-Year-Old Children in the Netherlands

    NARCIS (Netherlands)

    Tas, J.T. van der; Kragt, L.; Veerkamp, J.J.; Jaddoe, V.W.; Moll, H.A.; Ongkosuwito, E.M.; Elfrink, M.E.; Wolvius, E.B.

    2016-01-01

    The aim of this study was to investigate potential differences in caries prevalence of children from ethnic minority groups compared to native Dutch children and the influence of socio-economic status (SES) and parent-reported oral health behaviour on this association. The study had a

  16. Racial and Ethnic Disparities in Obesity during the Transition to Adulthood: The Contingent and Nonlinear Impact of Neighborhood Disadvantage

    Science.gov (United States)

    Nicholson, Lisa M.; Browning, Christopher R.

    2012-01-01

    Neighborhood disadvantage in early adolescence may help explain racial and ethnic disparities in obesity during the transition to adulthood; however the processes may work differently for males and females and for minority groups compared to Whites. The present study examines the relationship between neighborhood disadvantage and young adult…

  17. Explaining Racial Disparities in Infant Health in Brazil

    Science.gov (United States)

    Nyarko, Kwame A.; Lopez-Camelo, Jorge; Castilla, Eduardo E.

    2015-01-01

    Objectives. We sought to quantify how socioeconomic, health care, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil. Methods. We employed a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (Public policies to improve children’s health should target prenatal care and geographic location differences to reduce health disparities between infants of African and European ancestries in Brazil. PMID:26313046

  18. Social, Economic, and Health Disparities Among LGBT Older Adults.

    Science.gov (United States)

    Emlet, Charles A

    2016-01-01

    LGBT older adults are a heterogeneous population with collective and unique strengths and challenges. Health, personal, and economic disparities exist in this group when compared to the general population of older adults, yet subgroups such as transgender and bisexual older adults and individuals living with HIV are at greater risk for disparities and poorer health outcomes. As this population grows, further research is needed on factors that contribute to promoting health equity, while decreasing discrimination and improving competent service delivery.

  19. Self-Rated Health Trajectories among Married Americans: Do Disparities Persist over 20 Years?

    Directory of Open Access Journals (Sweden)

    Terceira A. Berdahl

    2018-01-01

    Full Text Available The purpose of this study is to understand self-rated health (SRH trajectories by social location (race/ethnicity by gender by social class among married individuals in the United States. We estimate multilevel models of SRH using six observations from 1980 to 2000 from a nationally representative panel of married individuals initially aged 25–55 (Marital Instability Over the Life Course Study. Results indicate that gender, race/ethnicity, and social class are associated with initial SRH disparities. Women are less healthy than men; people of color are less healthy than whites; lower educated individuals are less healthy than higher educated individuals. Women’s health declined slower than men’s but did not differ by race/ethnicity or education. Results from complex intersectional models show that white men with any college had the highest initial SRH. Only women with any college had significantly slower declines in SRH compared to white men with any college. For married individuals of all ages, most initial SRH disparities persist over twenty years. Intersecting statuses show that education provides uneven health benefits across racial/ethnic and gender subgroups.

  20. Sociodemographic disparities in survival for adolescents and young adults with cancer differ by health insurance status.

    Science.gov (United States)

    DeRouen, Mindy C; Parsons, Helen M; Kent, Erin E; Pollock, Brad H; Keegan, Theresa H M

    2017-08-01

    To investigate associations of sociodemographic factors-race/ethnicity, neighborhood socioeconomic status (SES), and health insurance-with survival for adolescents and young adults (AYAs) with invasive cancer. Data on 80,855 AYAs with invasive cancer diagnosed in California 2001-2011 were obtained from the California Cancer Registry. We used multivariable Cox proportional hazards regression to estimate overall survival. Associations of public or no insurance with greater risk of death were observed for 11 of 12 AYA cancers examined. Compared to Whites, Blacks experienced greater risk of death, regardless of age or insurance, while greater risk of death among Hispanics and Asians was more apparent for younger AYAs and for those with private/military insurance. More pronounced neighborhood SES disparities in survival were observed among AYAs with private/military insurance, especially among younger AYAs. Lacking or having public insurance was consistently associated with shorter survival, while disparities according to race/ethnicity and neighborhood SES were greater among AYAs with private/military insurance. While health insurance coverage associates with survival, remaining racial/ethnic and socioeconomic disparities among AYAs with cancer suggest additional social factors also need consideration in intervention and policy development.

  1. Ethnic Disparities in Contraceptive Use and Its Impact on Family Planning Program in Nepal

    Directory of Open Access Journals (Sweden)

    Mukesh Mishra

    2010-09-01

    Full Text Available Objective: Regardless of three decades of implementation of family planning program in Nepal, need offamily planning services is largely unmet. Systematic studies, evaluating the impact of family program onseveral ethnic groups of Nepal has not been carried out in large scale. This study sheds light on theinvestigation of, whether the use of contraceptives varies among different ethnic groups in Nepal andwhat are the predictors of contraceptive variance in ethnic groups in Nepal.Materials and methods: The study is based on data collected from Nepal Demographic Health Survey(NDHS 2006. Multilevel logistic regression analyses of 10793 married women of reproductive agenested within 264 clusters from the surveys were considered as the sample size. Individual, household,and program variables were set and a multilevel logistic regression model was fitted to analyze thevariables, using GLLAMM command in STATA-9.Results: Multilevel logistic regression analysis indicated that Muslims, Dalits and Terai madheshi womenwere significantly less likely to use modern contraceptives compared to the Brahmins and Chhetries(Higher Castes. Women who were exposed to family planning information in radio were more likely touse modern contraceptives than women not exposed to radio information (OR=1.22, P> 0.01. An odd ofusing contraceptives by Newar was (OR 1.09, P>0.05, the highest among all ethnic groups. Exposure ofwomen to family planning messages through health facilities, family planning workers, and means ofcommunication, increased the odds of using modern contraceptives. However, impact of the familyplanning information on contraceptive use varied among ethnicity.Conclusion: Special attention need to be paid, in particular to the ethnicity, while formulating familyplanning policies in Nepal, for better success rate of family planning intervention programs.

  2. Disseminating Health Disparities Education Through Tele-Learning

    Directory of Open Access Journals (Sweden)

    LaSonya Knowles

    2008-08-01

    Full Text Available Twenty years of research demonstrate that there are wide disparities in health throughout America. Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist when specific population subgroups are compared. Health Disparities in America: Working Toward Social Justice is a course instructed every fall by Dr. Lovell Jones, director of The Center for Research on Minority Health (CRMH at UT M.D. Anderson Cancer Center. The CRMH has created a course that examines the social and societal factors that are fundamental in creating disparities in health. Students from 10 different academic programs and institutions participate in this course. The course is unique in the aspect that various, diverse speakers whom are experts in their field of study instruct each class. This health disparities course is conducted at one of three different academic institutions in the Houston area and broadcast via satellite to various academic institutions by means of teleeducation. Tele-education is defined as a mode of instruction utilizing different forms of media such as video, audio technology tools and computers. Video and audio technologies involve the transmission of interface between learners and instructors, either interactive or non-interactive. Tele-education technologies have an important role to play in addressing the dissemination of health disparities education. The purpose of this program is to determine the feasibility of tele-education as a mode of instruction to introduce the multi-disciplinary components of health disparities. Our findings suggest that tele-education is a useful tool in imparting health disparities education.

  3. Age and ethnic disparities in incidence of stroke over time: the South London Stroke Register.

    Science.gov (United States)

    Wang, Yanzhong; Rudd, Anthony G; Wolfe, Charles D A

    2013-12-01

    Data on continuous monitoring of stroke risk among different age and ethnic groups are lacking. We aimed to investigate age and ethnic disparities in stroke incidence over time from an inner-city population-based stroke register. Trends in stroke incidence and before-stroke risk factors were investigated with the South London Stroke Register, a population-based register covering a multiethnic population of 357 308 inhabitants. Age-, ethnicity-, and sex-specific incidence rates with 95% confidence intervals were calculated, assuming a Poisson distribution and their trends over time tested by the Cochran-Armitage test. Four thousand two hundred forty-five patients with first-ever stroke were registered between 1995 and 2010. Total stroke incidence reduced by 39.5% during the 16-year period from 247 to 149.5 per 100 000 population (Pstroke incidence were observed in men, women, white groups, and those aged>45 years, but not in those aged 15 to 44 years (12.6-10.1; P=0.2034) and black groups (310.1-267.5; P=0.3633). The mean age at stroke decreased significantly from 71.7 to 69.6 years (P=0.0001). The reduction in prevalence of before-stroke risk factors was mostly seen in white patients aged>55 years, whereas an increase in diabetes mellitus was observed in younger black patients aged 15 to 54 years. Total stroke incidence decreased during the 16-year time period. However, this was not seen in younger age groups and black groups. The advances in risk factor reduction observed in white groups aged>55 years failed to be transferred to younger age groups and black groups.

  4. Health-related disparities: influence of environmental factors.

    Science.gov (United States)

    Olden, Kenneth; White, Sandra L

    2005-07-01

    populations, but their frequency can vary substantially,rendering individuals or groups more or less susceptible to particular environmental exposures. Such findings are consistent with the highly publicized analogy, "genetics loads the gun, but the environment pulls the trigger." That is, one can inherit the genetic predisposition to develop a disease but will do so only if or when exposed to the environmental trigger. Poor people have approximately the same genetic makeup as everyone else,but they have the unfortunate experience of living and working in environments containing multiple and high levels of carcinogens or other toxicants capable of interacting with susceptibility genes to cause disease.Furthermore, certain disadvantaged ethnic groups may have a higher incidence of certain susceptible genes that render them more vulnerable to adverse effects of the environments they inhabit. For both of these reasons,much of the nation's disease burden could likely be reduced through better environmental protection practices, especially in low-income and minority communities. Of the many implications of polymorphisms and frequency variations for public health and the practice of medicine, however, none is more urgent than the choice of drugs in therapy. Using such knowledge,randomized trials have identified race-specific drug response differences between blacks and whites [42].To date, most knowledge of the health effects of environmental factors is derived from studies of single agents. The reality, though, is that environmental contributions to health disparities are mostly from multiple agents. These simultaneous exposures to multiple risk factors, which may accumulate or interact synergistically, remain to be fully explained and defined.Finally, health disparity is a significant public health problem that cannot be solved using "business as usual" approaches for funding and priority setting. The current emphasis on basic and clinical research at the exclusion of public

  5. Neighbourhood economic deprivation explains racial/ethnic disparities in overweight and obesity among children and adolescents in the U.S.A.

    Science.gov (United States)

    Rossen, Lauren M

    2014-02-01

    Low-income and some racial and ethnic subpopulations are more likely to suffer from obesity. Inequities in the physical and social environment may contribute to disparities in paediatric obesity, but there is little empirical evidence to date. This study explored whether neighbourhood-level socioeconomic factors attenuate racial and ethnic disparities in obesity among youth in the U.S.A. and whether individual-level socioeconomic status (SES) interacts with neighbourhood deprivation. This analysis used data from 17,100 youth ages 2-18 years participating in the 2001-2010 National Health and Nutrition Examination Survey linked to census tract-level socioeconomic characteristics. Multilevel logistic regression models were used to examine neighbourhood deprivation in association with odds of obesity (age-specific and sex-specific body mass index percentile ≥95). The unadjusted prevalence of obesity was 15% among non-Hispanic white children and 21% among non-Hispanic black and Mexican-American children. Adjustment for individual-level SES neighbourhood deprivation and the interaction between these two factors resulted in a 74% attenuation of the disparity in obesity between non-Hispanic black and non-Hispanic white children and a 49% attenuation of the disparity between Mexican-American and non-Hispanic white children. There was a significant interaction between individual-level SES and neighbourhood deprivation where higher individual-level income was protective for children living in low-deprivation neighbourhoods, but not for children who lived in high-deprivation areas. Conversely, area deprivation was associated with higher odds of obesity, but only among children who were above the poverty threshold. Future research on disparities in obesity and other health outcomes should examine broader contextual factors and social determinants of inequities.

  6. Asthma and Health Disparities | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... page please turn Javascript on. Feature: Breathing Easier Asthma and Health Disparities Past Issues / Fall 2013 Table ... under 18 years of age, who currently have asthma, 2010 Non-Hispanic Black Non-Hispanic White Non- ...

  7. Racial and ethnic disparities in dental care for publicly insured children.

    Science.gov (United States)

    Pourat, Nadereh; Finocchio, Len

    2010-07-01

    Poor oral health has important implications for the healthy development of children. Children in Medicaid, especially Latinos and African Americans, experience high rates of tooth decay, yet they visit dentists less often than privately insured children. Even Latino and African American children with private insurance are less likely than white children to visit dentists and have longer intervals between dental visits. Furthermore, Latino and African American children in Medicaid are more likely than white children in Medicaid to have longer intervals between visits. These findings raise concerns about Medicaid's ability to address disparities in dental care access and, more broadly, in health care.

  8. 75 FR 29357 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2010-05-25

    ... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special NCMHD Health Disparities Research on Minority and Underserved... Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892. (301) 594-8696...

  9. Feminist intersectionality: bringing social justice to health disparities research.

    Science.gov (United States)

    Rogers, Jamie; Kelly, Ursula A

    2011-05-01

    The principles of autonomy, beneficence, non-maleficence, and justice are well established ethical principles in health research. Of these principles, justice has received less attention by health researchers. The purpose of this article is to broaden the discussion of health research ethics, particularly the ethical principle of justice, to include societal considerations--who and what are studied and why?--and to critique current applications of ethical principles within this broader view. We will use a feminist intersectional approach in the context of health disparities research to firmly establish inseparable links between health research ethics, social action, and social justice. The aim is to provide an ethical approach to health disparities research that simultaneously describes and seeks to eliminate health disparities. © The Author(s) 2011

  10. Population changes, racial/ethnic disparities, and birth outcomes in Louisiana after Hurricane Katrina.

    Science.gov (United States)

    Harville, Emily W; Tran, Tri; Xiong, Xu; Buekens, Pierre

    2010-09-01

    To examine how the demographic and other population changes affected birth and obstetric outcomes in Louisiana, and the effect of the hurricane on racial disparities in these outcomes. Vital statistics data were used to compare the incidence of low birth weight (LBW) (birth (PTB) (37 weeks' gestation), cesarean section, and inadequate prenatal care (as measured by the Kotelchuck index), in the 2 years after Katrina compared to the 2 years before, for the state as a whole, region 1 (the area around New Orleans), and Orleans Parish (New Orleans). Logistic models were used to adjust for covariates. After adjustment, rates of LBW rose for the state, but preterm birth did not. In region 1 and Orleans Parish, rates of LBW and PTB remained constant or fell. These patterns were all strongest in African American women. Rates of cesarean section and inadequate prenatal care rose. Racial disparities in birth outcomes remained constant or were reduced. Although risk of LBW/PTB remained higher in African Americans, the storm does not appear to have exacerbated health disparities, nor did population shifts explain the changes in birth and obstetric outcomes.

  11. Socio-economic disparities in health system responsiveness in India.

    Science.gov (United States)

    Malhotra, Chetna; Do, Young Kyung

    2013-03-01

    To assess the magnitude of socio-economic disparities in health system responsiveness in India after correcting for potential reporting heterogeneity by socio-economic characteristics (education and wealth). Data from Wave 1 of the Study on Global Ageing and Adult Health (2007-2008) involving six Indian states were used. Seven health system responsiveness domains were considered for a respondent's last visit to an outpatient service in 12 months: prompt attention, dignity, clarity of information, autonomy, confidentiality, choice and quality of basic amenities. Hierarchical ordered probit models (correcting for reporting heterogeneity through anchoring vignettes) were used to assess the association of socio-economic characteristics with the seven responsiveness domains, controlling for age, gender and area of residence. Stratified analysis was also conducted among users of public and private health facilities. Our statistical models accounting for reporting heterogeneity revealed socio-economic disparities in all health system responsiveness domains. Estimates suggested that individuals from the lowest wealth group, for example, were less likely than individuals from the highest wealth group to report 'very good' on the dignity domain by 8% points (10% vs 18%). Stratified analysis showed that such disparities existed among users of both public and private health facilities. Socio-economic disparities exist in health system responsiveness in India, irrespective of the type of health facility used. Policy efforts to monitor and improve these disparities are required at the health system level.

  12. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities.

    Science.gov (United States)

    Chapman, Elizabeth N; Kaatz, Anna; Carnes, Molly

    2013-11-01

    Although the medical profession strives for equal treatment of all patients, disparities in health care are prevalent. Cultural stereotypes may not be consciously endorsed, but their mere existence influences how information about an individual is processed and leads to unintended biases in decision-making, so called "implicit bias". All of society is susceptible to these biases, including physicians. Research suggests that implicit bias may contribute to health care disparities by shaping physician behavior and producing differences in medical treatment along the lines of race, ethnicity, gender or other characteristics. We review the origins of implicit bias, cite research documenting the existence of implicit bias among physicians, and describe studies that demonstrate implicit bias in clinical decision-making. We then present the bias-reducing strategies of consciously taking patients' perspectives and intentionally focusing on individual patients' information apart from their social group. We conclude that the contribution of implicit bias to health care disparities could decrease if all physicians acknowledged their susceptibility to it, and deliberately practiced perspective-taking and individuation when providing patient care. We further conclude that increasing the number of African American/Black physicians could reduce the impact of implicit bias on health care disparities because they exhibit significantly less implicit race bias.

  13. 76 FR 63310 - National Center On Minority and Health Disparities Notice of Closed Meetings

    Science.gov (United States)

    2011-10-12

    ... and Health Disparities Notice of Closed Meetings Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; NIMHD Health Disparities Research (R01). Date: November... Disparities, National Institutes of Health, 6707 Democracy Blvd., MSC. 5465, Suite 800, Bethesda, MD 20892...

  14. Preventing Filipino Mental Health Disparities: Perspectives from Adolescents, Caregivers, Providers, and Advocates.

    Science.gov (United States)

    Javier, Joyce R; Supan, Jocelyn; Lansang, Anjelica; Beyer, William; Kubicek, Katrina; Palinkas, Lawrence A

    2014-12-01

    Filipino Americans are the second largest immigrant population and second largest Asian ethnic group in the U.S. Disparities in youth behavioral health problems and the receipt of mental health services among Filipino youth have been documented previously. However, few studies have elicited perspectives from community stakeholders regarding how to prevent mental health disparities among Filipino youth. The purpose of the current study is to identify intervention strategies for implementing mental health prevention programs among Filipino youth. We conducted semi-structured interviews (n=33) with adolescents, caregivers, advocates, and providers and focus groups (n=18) with adolescents and caregivers. Interviews were audio taped and transcribed verbatim. Transcripts were analyzed using a methodology of "coding consensus, co-occurrence, and comparison" and was rooted in grounded theory. Four recommendations were identified when developing mental health prevention strategies among Filipino populations: address the intergenerational gap between Filipino parents and children, provide evidence-based parenting programs, collaborate with churches in order to overcome stigma associated with mental health, and address mental health needs of parents. Findings highlight the implementation of evidence-based preventive parenting programs in faith settings as a community-identified and culturally appropriate strategy to prevent Filipino youth behavioral health disparities.

  15. Clinic access and teenage birth rates: Racial/ethnic and spatial disparities in Houston, TX.

    Science.gov (United States)

    Wisniewski, Megan M; O'Connell, Heather A

    2018-03-01

    Teenage motherhood is a pressing issue in the United States, and one that is disproportionately affecting racial/ethnic minorities. In this research, we examine the relationship between the distance to the nearest reproductive health clinic and teenage birth rates across all zip codes in Houston, Texas. Our primary data come from the Texas Department of State Health Services. We use spatial regression analysis techniques to examine the link between clinic proximity and local teenage birth rates for all females aged 15 to 19, and separately by maternal race/ethnicity. We find, overall, limited support for a connection between clinic distance and local teenage birth rates. However, clinics seem to matter most for explaining non-Hispanic white teenage birth rates, particularly in high-poverty zip codes. The racial/ethnic and economic variation in the importance of clinic distance suggests tailoring clinic outreach to more effectively serve a wider range of teenage populations. We argue social accessibility should be considered in addition to geographic accessibility in order for clinics to help prevent teenage pregnancy. Copyright © 2018. Published by Elsevier Ltd.

  16. Hidden Breast Cancer Disparities in Asian Women: Disaggregating Incidence Rates by Ethnicity and Migrant Status

    Science.gov (United States)

    Quach, Thu; Horn-Ross, Pamela L.; Pham, Jane T.; Cockburn, Myles; Chang, Ellen T.; Keegan, Theresa H. M.; Glaser, Sally L.; Clarke, Christina A.

    2010-01-01

    Objectives. We estimated trends in breast cancer incidence rates for specific Asian populations in California to determine if disparities exist by immigrant status and age. Methods. To calculate rates by ethnicity and immigrant status, we obtained data for 1998 through 2004 cancer diagnoses from the California Cancer Registry and imputed immigrant status from Social Security Numbers for the 26% of cases with missing birthplace information. Population estimates were obtained from the 1990 and 2000 US Censuses. Results. Breast cancer rates were higher among US- than among foreign-born Chinese (incidence rate ratio [IRR] = 1.84; 95% confidence interval [CI] = 1.72, 1.96) and Filipina women (IRR = 1.32; 95% CI = 1.20, 1.44), but similar between US- and foreign-born Japanese women. US-born Chinese and Filipina women who were younger than 55 years had higher rates than did White women of the same age. Rates increased over time in most groups, as high as 4% per year among foreign-born Korean and US-born Filipina women. From 2000–2004, the rate among US-born Filipina women exceeded that of White women. Conclusions. These findings challenge the notion that breast cancer rates are uniformly low across Asians and therefore suggest a need for increased awareness, targeted cancer control, and research to better understand underlying factors. PMID:20147696

  17. Designing a community-based lay health advisor training curriculum to address cancer health disparities.

    Science.gov (United States)

    Gwede, Clement K; Ashley, Atalie A; McGinnis, Kara; Montiel-Ishino, F Alejandro; Standifer, Maisha; Baldwin, Julie; Williams, Coni; Sneed, Kevin B; Wathington, Deanna; Dash-Pitts, Lolita; Green, B Lee

    2013-05-01

    Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. APPROACH AND STRATEGIES: Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic-community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.

  18. Investigating the relationship between socially-assigned ethnicity, racial discrimination and health advantage in New Zealand.

    Science.gov (United States)

    Cormack, Donna M; Harris, Ricci B; Stanley, James

    2013-01-01

    While evidence of the contribution of racial discrimination to ethnic health disparities has increased significantly, there has been less research examining relationships between ascribed racial/ethnic categories and health. It has been hypothesized that in racially-stratified societies being assigned as belonging to the dominant racial/ethnic group may be associated with health advantage. This study aimed to investigate associations between socially-assigned ethnicity, self-identified ethnicity, and health, and to consider the role of self-reported experience of racial discrimination in any relationships between socially-assigned ethnicity and health. The study used data from the 2006/07 New Zealand Health Survey (n = 12,488), a nationally representative cross-sectional survey of adults 15 years and over. Racial discrimination was measured as reported individual-level experiences across five domains. Health outcome measures examined were self-reported general health and psychological distress. The study identified varying levels of agreement between participants' self-identified and socially-assigned ethnicities. Individuals who reported both self-identifying and being socially-assigned as always belonging to the dominant European grouping tended to have more socioeconomic advantage and experience less racial discrimination. This group also had the highest odds of reporting optimal self-rated health and lower mean levels of psychological distress. These differences were attenuated in models adjusting for socioeconomic measures and individual-level racial discrimination. The results suggest health advantage accrues to individuals who self-identify and are socially-assigned as belonging to the dominant European ethnic grouping in New Zealand, operating in part through socioeconomic advantage and lower exposure to individual-level racial discrimination. This is consistent with the broader evidence of the negative impacts of racism on health and ethnic inequalities

  19. Impact of a Population Health Management Intervention on Disparities in Cardiovascular Disease Control.

    Science.gov (United States)

    James, Aisha; Berkowitz, Seth A; Ashburner, Jeffrey M; Chang, Yuchiao; Horn, Daniel M; O'Keefe, Sandra M; Atlas, Steven J

    2018-04-01

    Healthcare systems use population health management programs to improve the quality of cardiovascular disease care. Adding a dedicated population health coordinator (PHC) who identifies and reaches out to patients not meeting cardiovascular care goals to these programs may help reduce disparities in cardiovascular care. To determine whether a program that used PHCs decreased racial/ethnic disparities in LDL cholesterol and blood pressure (BP) control. Retrospective difference-in-difference analysis. Twelve thousdand five hundred fifty-five primary care patients with cardiovascular disease (cohort for LDL analysis) and 41,183 with hypertension (cohort for BP analysis). From July 1, 2014-December 31, 2014, 18 practices used an information technology (IT) system to identify patients not meeting LDL and BP goals; 8 practices also received a PHC. We examined whether having the PHC plus IT system, compared with having the IT system alone, decreased racial/ethnic disparities, using difference-in-difference analysis of data collected before and after program implementation. Meeting guideline concordant LDL and BP goals. At baseline, there were racial/ethnic disparities in meeting LDL (p = 0.007) and BP (p = 0.0003) goals. Comparing practices with and without a PHC, and accounting for pre-intervention LDL control, non-Hispanic white patients in PHC practices had improved odds of LDL control (OR 1.20 95% CI 1.09-1.32) compared with those in non-PHC practices. Non-Hispanic black (OR 1.15 95% CI 0.80-1.65) and Hispanic (OR 1.29 95% CI 0.66-2.53) patients saw similar, but non-significant, improvements in LDL control. For BP control, non-Hispanic white patients in PHC practices (versus non-PHC) improved (OR 1.13 95% CI 1.05-1.22). Non-Hispanic black patients (OR 1.17 95% CI 0.94-1.45) saw similar, but non-statistically significant, improvements in BP control, but Hispanic (OR 0.90 95% CI 0.59-1.36) patients did not. Interaction testing confirmed that disparities did not

  20. Racial/Ethnic and Income Disparities in Child and Adolescent Exposure to Food and Beverage Television Ads across U.S. Media Markets

    Science.gov (United States)

    Powell, Lisa M.; Wada, Roy; Kumanyika, Shiriki K.

    2015-01-01

    Obesity prevalence and related health burdens are greater among U.S. racial/ethnic minority and low-income populations. Targeted advertising may contribute to disparities. Designated market area (DMA) spot television ratings were used to assess geographic differences in child/adolescent exposure to food-related advertisements based on DMA-level racial/ethnic and income characteristics. Controlling for unobserved DMA-level factors and time trends, child/adolescent exposure to food-related ads, particularly for sugar-sweetened beverages and fast-food restaurants, was significantly higher in areas with higher proportions of black children/adolescents and lower-income households. Geographically targeted TV ads are important to consider when assessing obesity-promoting influences in black and low-income neighborhoods. PMID:25086271

  1. Racial/ethnic and income disparities in child and adolescent exposure to food and beverage television ads across the U.S. media markets.

    Science.gov (United States)

    Powell, Lisa M; Wada, Roy; Kumanyika, Shiriki K

    2014-09-01

    Obesity prevalence and related health burdens are greater among U.S. racial/ethnic minority and low-income populations. Targeted advertising may contribute to disparities. Designated market area (DMA) spot television ratings were used to assess geographic differences in child/adolescent exposure to food-related advertisements based on DMA-level racial/ethnic and income characteristics. Controlling for unobserved DMA-level factors and time trends, child/adolescent exposure to food-related ads, particularly for sugar-sweetened beverages and fast-food restaurants, was significantly higher in areas with higher proportions of black children/adolescents and lower-income households. Geographically targeted TV ads are important to consider when assessing obesity-promoting influences in black and low-income neighborhoods. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Racial/Ethnic Pay Disparities among Registered Nurses (RNs) in U.S. Hospitals: An Econometric Regression Decomposition.

    Science.gov (United States)

    Moore, Jean; Continelli, Tracey

    2016-04-01

    To detect the presence of racial and ethnic pay disparities between minority and white hospital RNs using a national sample. The National Sample Survey of Registered Nurses, 2008, which is representative at both the state and national level. Cross-sectional data were analyzed using multivariate regression and regression decomposition. Differences between groups were decomposed into differences in the possession of characteristics and differences in the value of the same characteristic between different groups, the latter being a commonly used measure of wage discrimination. As the majority of minority hospital RNs are employed within the most densely populated (central) counties of metropolitan statistical areas (MSAs), only hospital RNs employed in the central counties of MSAs were selected. Regression decomposition found that black and Hispanic RNs earned less than whites and Asians, while Asian RNs earned more than white RNs. The majority of pay variation between white RNs, versus Asian, black, or Hispanic RNs was due to unexplained differences in the value of the same characteristic between groups. Differences in earnings between underrepresented and overrepresented hospital RNs is suggestive of discrimination. © Health Research and Educational Trust.

  3. Aberrant DNA Methylation: Implications in Racial Health Disparity.

    Directory of Open Access Journals (Sweden)

    Xuefeng Wang

    Full Text Available Incidence and mortality rates of colorectal carcinoma (CRC are higher in African Americans (AAs than in Caucasian Americans (CAs. Deficient micronutrient intake due to dietary restrictions in racial/ethnic populations can alter genetic and molecular profiles leading to dysregulated methylation patterns and the inheritance of somatic to germline mutations.Total DNA and RNA samples of paired tumor and adjacent normal colon tissues were prepared from AA and CA CRC specimens. Reduced Representation Bisulfite Sequencing (RRBS and RNA sequencing were employed to evaluate total genome methylation of 5'-regulatory regions and dysregulation of gene expression, respectively. Robust analysis was conducted using a trimming-and-retrieving scheme for RRBS library mapping in conjunction with the BStool toolkit.DNA from the tumor of AA CRC patients, compared to adjacent normal tissues, contained 1,588 hypermethylated and 100 hypomethylated differentially methylated regions (DMRs. Whereas, 109 hypermethylated and 4 hypomethylated DMRs were observed in DNA from the tumor of CA CRC patients; representing a 14.6-fold and 25-fold change, respectively. Specifically; CHL1, 4 anti-inflammatory genes (i.e., NELL1, GDF1, ARHGEF4, and ITGA4, and 7 miRNAs (of which miR-9-3p and miR-124-3p have been implicated in CRC were hypermethylated in DNA samples from AA patients with CRC. From the same sample set, RNAseq analysis revealed 108 downregulated genes (including 14 ribosomal proteins and 34 upregulated genes (including POLR2B and CYP1B1 [targets of miR-124-3p] in AA patients with CRC versus CA patients.DNA methylation profile and/or products of its downstream targets could serve as biomarker(s addressing racial health disparity.

  4. Partnering health disparities research with quality improvement science in pediatrics.

    Science.gov (United States)

    Lion, K Casey; Raphael, Jean L

    2015-02-01

    Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction. Copyright © 2015 by the American Academy of Pediatrics.

  5. Breast and cervical cancer screening disparity among Asian American women: does race/ethnicity matter [corrected]?

    Science.gov (United States)

    Lee, Hee Yun; Ju, Eunsu; Vang, Pa Der; Lundquist, Melissa

    2010-10-01

    Ethnic minorities are frequently considered as one homogeneous group in research, and this trend is particularly true for Asian Americans. This article seeks to uncover the intragroup differences in cancer screening behavior among subgroups of Asian American women by disaggregating them into six subgroups. The subgroups were compared with non-Latina white women to examine differences in breast and cancer screening rates and relevant factors associated with receiving these screenings. Three-year merged data from the 2001, 2003, and 2005 California Health Interview Survey (CHIS) were used to investigate the subgroup differences. Samples for the current study were restricted to non-Latina white and Asian American women whose age was ≥ 18 years (n = 58,000) for cervical cancer screening and ≥ 40 years (n = 43,518) for breast cancer screening at the time of the interview. Results showed marked differences in cancer screening rates among Asian American subgroups and between cancer types. Cervical cancer screening rates were noticeably higher than breast cancer screening rates in all groups. The Korean group consistently showed the lowest rates of both cancer screenings. Japanese ranked the highest (79.5%) in breast cancer screening but the second lowest (79.7%) in cervical cancer screening. Enabling factors, such as having private health insurance and a usual source of care, were found to be the strongest predictors of receiving both breast and cervical cancer screening. Screenings for both types of cancer increased if a woman was married or was born in the United States. The findings of this study illustrate the heterogeneity that exists among Asian American subgroups in their cancer screening behaviors. Further development of culturally relevant and ethnic-specific cancer prevention strategies and policies that address the subgroup differences within the larger racial/ethnic population are needed. Public health outreach and cancer education should be prioritized to

  6. Racial and ethnic disparities in human papillomavirus-associated cancer burden with first-generation and second-generation human papillomavirus vaccines.

    Science.gov (United States)

    Burger, Emily A; Lee, Kyueun; Saraiya, Mona; Thompson, Trevor D; Chesson, Harrell W; Markowitz, Lauri E; Kim, Jane J

    2016-07-01

    In the United States, the burden of human papillomavirus (HPV)-associated cancers varies by racial/ethnic group. HPV vaccination may provide opportunities for primary prevention of these cancers. Herein, the authors projected changes in HPV-associated cancer burden among racial/ethnic groups under various coverage assumptions with the available first-generation and second-generation HPV vaccines to evaluate changes in racial/ethnic disparities. Cancer-specific mathematical models simulated the burden of 6 HPV-associated cancers. Model parameters, informed using national registries and epidemiological studies, reflected sex-specific, age-specific, and racial/ethnic-specific heterogeneities in HPV type distribution, cancer incidence, stage of disease at detection, and mortality. Model outcomes included the cumulative lifetime risks of developing and dying of 6 HPV-associated cancers. The level of racial/ethnic disparities was evaluated under each alternative HPV vaccine scenario using several metrics of social group disparity. HPV vaccination is expected to reduce the risks of developing and dying of HPV-associated cancers in all racial/ethnic groups as well as reduce the absolute degree of disparities. However, alternative metrics suggested that relative disparities would persist and in some scenarios worsen. For example, when assuming high uptake with the second-generation HPV vaccine, the lifetime risk of dying of an HPV-associated cancer for males decreased by approximately 60%, yet the relative disparity increased from 3.0 to 3.9. HPV vaccines are expected to reduce the overall burden of HPV-associated cancers for all racial/ethnic groups and to reduce the absolute disparity gap. However, even with the second-generation vaccine, relative disparities will likely still exist and may widen if the underlying causes of these disparities remain unaddressed. Cancer 2016;122:2057-66. © 2016 American Cancer Society. © 2016 American Cancer Society.

  7. Racial/Ethnic Differences in the Use of Primary Care Providers and Preventive Health Services at a Midwestern University.

    Science.gov (United States)

    Focella, Elizabeth S; Shaffer, Victoria A; Dannecker, Erin A; Clark, Mary J; Schopp, Laura H

    2016-06-01

    Many universities seek to improve the health and wellbeing of their faculty and staff through employer wellness programs but racial/ethnic disparities in health care use may still persist. The purpose of this research was to identify racial/ethnic disparities in the use of preventive health services at a Midwestern university. A record review was conducted of self-reported health data from University employees, examining the use of primary care and common screening procedures collected in a Personal Health Assessment conducted by the University's wellness program. Results show that there were significant racial/ethnic differences in the use of primary care and participation in screening. Notably, Asian employees in this sample were less likely to have a primary care provider and participate in routine cancer screenings. The observed racial/ethnic differences in screening behavior were mediated by the use of primary care. Together, these data show that despite equal access to care, racial and ethnic disparities in screening persist and that having a primary care provider is an important predictor of screening behavior. Results suggest that health communications designed to increase screening among specific racial/ethnic minority groups should target primary care use.

  8. A Scoping Review of Health Disparities in Autism Spectrum Disorder

    Science.gov (United States)

    Bishop-Fitzpatrick, Lauren; Kind, Amy J. H.

    2017-01-01

    Individuals with autism spectrum disorder (ASD) experience increased morbidity and decreased life expectancy compared to the general population, and these disparities are likely exacerbated for those individuals who are otherwise disadvantaged. We conducted a review to ascertain what is known about health and health system quality (e.g., high…

  9. Rigor, vigor, and the study of health disparities.

    Science.gov (United States)

    Adler, Nancy; Bush, Nicole R; Pantell, Matthew S

    2012-10-16

    Health disparities research spans multiple fields and methods and documents strong links between social disadvantage and poor health. Associations between socioeconomic status (SES) and health are often taken as evidence for the causal impact of SES on health, but alternative explanations, including the impact of health on SES, are plausible. Studies showing the influence of parents' SES on their children's health provide evidence for a causal pathway from SES to health, but have limitations. Health disparities researchers face tradeoffs between "rigor" and "vigor" in designing studies that demonstrate how social disadvantage becomes biologically embedded and results in poorer health. Rigorous designs aim to maximize precision in the measurement of SES and health outcomes through methods that provide the greatest control over temporal ordering and causal direction. To achieve precision, many studies use a single SES predictor and single disease. However, doing so oversimplifies the multifaceted, entwined nature of social disadvantage and may overestimate the impact of that one variable and underestimate the true impact of social disadvantage on health. In addition, SES effects on overall health and functioning are likely to be greater than effects on any one disease. Vigorous designs aim to capture this complexity and maximize ecological validity through more complete assessment of social disadvantage and health status, but may provide less-compelling evidence of causality. Newer approaches to both measurement and analysis may enable enhanced vigor as well as rigor. Incorporating both rigor and vigor into studies will provide a fuller understanding of the causes of health disparities.

  10. Pregnancy experiences of women in rural Romania: understanding ethnic and socioeconomic disparities.

    Science.gov (United States)

    LeMasters, Katherine; Baber Wallis, Anne; Chereches, Razvan; Gichane, Margaret; Tehei, Ciprian; Varga, Andreea; Tumlinson, Katherine

    2018-05-15

    Women in rural Romania face significant health disadvantages. This qualitative pilot study describes the structural disadvantage experienced during pregnancy by women in rural Romania, focusing on the lived experiences of Roma women. We explore how women in rural communities experience pregnancy, their interactions with the healthcare system, and the role that ethnic and social factors play in pregnancy and childbearing. We conducted 42 semi-structured interviews with health and other professionals, seven narrative interviews with Roma and non-Roma women and a focus group with Roma women. Data were analysed using thematic analysis. We identified intersectional factors associated with women's pregnancy experiences: women perceiving pregnancy as both unplanned and wanted, joyful, and normal; women's and professionals' differing prenatal care perceptions; transport and cost related barriers to care; socioeconomic and ethnic discrimination; and facilitators to care such as social support, having a health mediator and having a doctor. Talking directly with professionals and Roma and non-Roma women helped us understand these many factors, how they are interconnected, and how we can work towards improving the pregnancy experiences of Roma women in rural Romania.

  11. The Influence of Socioeconomic Status on Racial/Ethnic Disparities among the ER/PR/HER2 Breast Cancer Subtypes

    International Nuclear Information System (INIS)

    Parise, C. A.; Caggiano, V.Caggiano

    2015-01-01

    Background. The eight ER/PR/HER2 breast cancer subtypes vary widely in demographic and clinico pathologic characteristics and survival. This study assesses the contribution of SES to the risk of mortality for blacks, Hispanics, Asian/Pacific Islanders, and American Indians when compared with white women for each ER/PR/HER2 subtype. Methods. We identified 143,184 cases of first primary female invasive breast cancer from the California Cancer Registry between 2000 and 2012. The risk of mortality was computed for each race/ethnicity within each ER/PR/HER2 subtype. Models were adjusted for tumor grade, year of diagnosis, and age. SES was added to a second set of models. Analyses were conducted separately for each stage. Results. Race/ethnicity did not contribute to the risk of mortality for any subtype in stage 1 when adjusted for SES. In stages 2, 3, and 4, race/ethnicity was associated with risk of mortality and adjustment for SES changed the risk only in some subtypes. SES reduced the risk of mortality by over 45% for American Indians with stage 2 ER+/PR+/HER2-cancer, but it decreased the risk of mortality for blacks with stage 2 triple negative cancer by less than 4%. Conclusions. Racial/ethnic disparities do not exist in all ER/PR/HER2 subtypes and, in general, SES modestly alters these disparities.

  12. Cancer, culture, and health disparities: time to chart a new course?

    Science.gov (United States)

    Kagawa-Singer, Marjorie; Dadia, Annalyn Valdez; Yu, Mimi C; Surbone, Antonella

    2010-01-01

    Little progress has been made over the last 40 years to eliminate the racial/ethnic differences in incidence, morbidity, avoidable suffering, and mortality from cancer that result from factors beyond genetic differences. More effective strategies to promote equity in access and quality care are urgently needed because the changing demographics of the United States portend that this disparity will not only persist but significantly increase. Such suffering is avoidable. The authors posit that culture is a prime factor in the persistence of health disparities. However, this concept of culture is still poorly understood, inconsistently defined, and ineffectively used in practice and research. The role of culture in the causal pathway of disparities and the potential impact of culturally competent cancer care on improving cancer outcomes in ethnic minorities has, thus, been underestimated. In this article, the authors provide a comprehensive definition of culture and demonstrate how it can be used at each stage of the cancer care continuum to help reduce the unequal burden of cancer. The authors conclude with suggestions for clinical practice to eliminate the disconnection between evidence-based, quality, cancer care and its delivery to diverse population groups.

  13. Stigmatized ethnicity, public health, and globalization.

    Science.gov (United States)

    Ali, S Harris

    2008-01-01

    The prejudicial linking of infection with ethnic minority status has a long-established history, but in some ways this association may have intensified under the contemporary circumstances of the "new public health" and globalization. This study analyzes this conflation of ethnicity and disease victimization by considering the stigmatization process that occurred during the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) in Toronto. The attribution of stigma during the SARS outbreak occurred in multiple and overlapping ways informed by: (i) the depiction of images of individuals donning respiratory masks; (ii) employment status in the health sector; and (iii) Asian-Canadian and Chinese-Canadian ethnicity. In turn, stigmatization during the SARS crisis facilitated a moral panic of sorts in which racism at a cultural level was expressed and rationalized on the basis of a rhetoric of the new public health and anti-globalization sentiments. With the former, an emphasis on individualized self-protection, in the health sense, justified the generalized avoidance of those stigmatized. In relation to the latter, in the post-9/11 era, avoidance of the stigmatized other was legitimized on the basis of perceiving the SARS threat as a consequence of the mixing of different people predicated by economic and cultural globalization.

  14. Health Literacy, Health Disparities, and Sources of Health Information in U.S. Older Adults.

    Science.gov (United States)

    Cutilli, Carolyn Crane; Simko, Lynn C; Colbert, Alison M; Bennett, Ian M

    Low health literacy in older adults has been associated with poor health outcomes (i.e., mortality, decreased physical and cognitive functioning, and less preventive care utilization). Many factors associated with low health literacy are also associated with health disparities. Interaction with healthcare providers and sources of health information are influenced by an individual's health literacy and can impact health outcomes. This study examined the relationships between health literacy, sources of health information, and demographic/background characteristics in older adults (aged 65 years and older) related to health literacy and disparities. This descriptive, correlational study is a secondary analysis of the 2003 National Assessment of Adult Literacy, a large-scale national assessment. Older adults with lower health literacy have less income and education, rate their health as poor or fair, have visual or auditory difficulties, need help filling out forms, reading newspaper, or writing notes, and use each source of health information less (print and nonprint). Many of these characteristics and skills are predictive of health literacy and associated with health disparities. The results expand our knowledge of characteristics associated with health literacy and sources of health information used by older adults. Interventions to improve health outcomes including health disparities can focus on recognizing and meeting the health literacy demands of older adults.

  15. HSV-2 Infection as a Cause of Female/Male and Racial/Ethnic Disparities in HIV Infection.

    Directory of Open Access Journals (Sweden)

    Don C Des Jarlais

    Full Text Available To examine the potential contribution of herpes simplex virus 2 (HSV-2 infection to female/male and racial/ethnic disparities in HIV among non-injecting heroin and cocaine drug users. HSV-2 infection increases susceptibility to HIV infection by a factor of two to three.Subjects were recruited from entrants to the Beth Israel drug detoxification program in New York City 2005-11. All subjects reported current use of heroin and/or cocaine and no lifetime injection drug use. A structured questionnaire was administered and serum samples collected for HIV and HSV-2 testing. Population-attributable risk percentages (PAR%s were calculated for associations between HSV-2 infection and increased susceptibility to HIV.1745 subjects were recruited from 2005-11. Overall HIV prevalence was 14%. Females had higher prevalence than males (22% vs. 12% (p<0.001, African-Americans had the highest prevalence (15%, Hispanics an intermediate prevalence (12%, and Whites the lowest prevalence (3% (p<.001. There were parallel variations in HSV-2 prevalence (females 86%, males 51%, African-Americans 66%, Hispanics 47%, Whites 36%, HSV-2 prevalence was strongly associated with HIV prevalence (OR  =  3.12 95% CI 2.24 to 4.32. PAR%s for HSV-2 as a cause of HIV ranged from 21% for Whites to 50% for females. Adjusting for the effect of increased susceptibility to HIV due to HSV-2 infection greatly reduced all disparities (adjusted prevalence  =  males 8%, females 11%; Whites 3%, African-Americans 10%, Hispanics 9%.Female/male and racial/ethnic variations in HSV-2 infection provide a biological mechanism that may generate female/male and racial/ethnic disparities in HIV infection among non-injecting heroin and cocaine users in New York City. HSV-2 infection should be assessed as a potential contributing factor to disparities in sexually transmitted HIV throughout the US.

  16. Selected preconception health indicators and birth weight disparities in a national study.

    Science.gov (United States)

    Strutz, Kelly L; Richardson, Liana J; Hussey, Jon M

    2014-01-01

    This analysis explored the effect of timing, sequencing, and change in preconception health across adolescence and young adulthood on racial/ethnic disparities in birth weight in a diverse national cohort of young adult women. Data came from Waves I (1994-1995), III (2001-2002), and IV (2007-2008) of the National Longitudinal Study of Adolescent Health. Eligibility was restricted to all singleton live births to female non-Hispanic White, non-Hispanic Black, Mexican-origin Latina, or Asian/Pacific Islander participants (n = 3,014) occurring between the Wave III (ages 18-26 years) and IV (ages 24-32 years) interviews. Birth weight was categorized into low (4,000 g). Preconception health indicators were cigarette smoking, heavy alcohol consumption, overweight or obesity, and inadequate physical activity, measured in adolescence (Wave I, ages 11-19 years) and early adulthood (Wave III) and combined into four-category variables to capture the timing and sequencing of exposure. Measures of preconception health did not explain the Black-White disparity in low birth weight, which increased after adjustment for confounders (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.33-3.53) and effect modification by overweight/obesity (OR, 3.58; 95% CI, 1.65-7.78). A positive association between adult-onset overweight/obesity and macrosomia was modified by race (OR, 3.83; 95% CI, 1.02-14.36 for Black women). This longitudinal analysis provides new evidence on preconception health and racial/ethnic disparities in birth weight. Specifically, it indicates that interventions focused on prevention of overweight/obesity and maintenance of healthy weight during the transition to adulthood, especially among Black females, may be warranted. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  17. Racial and ethnic disparities in the control of cardiovascular disease risk factors in Southwest American veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study

    Directory of Open Access Journals (Sweden)

    Duckworth William C

    2006-05-01

    Full Text Available Abstract Background Racial/ethnic disparities in cardiovascular disease complications have been observed in diabetic patients. We examined the association between race/ethnicity and cardiovascular disease risk factor control in a large cohort of insulin-treated veterans with type 2 diabetes. Methods We conducted a cross-sectional observational study at 3 Veterans Affairs Medical Centers in the American Southwest. Using electronic pharmacy databases, we randomly selected 338 veterans with insulin-treated type 2 diabetes. We collected medical record and patient survey data on diabetes control and management, cardiovascular disease risk factors, comorbidity, demographics, socioeconomic factors, psychological status, and health behaviors. We used analysis of variance and multivariate linear regression to determine the effect of race/ethnicity on glycemic control, insulin treatment intensity, lipid levels, and blood pressure control. Results The study cohort was comprised of 72 (21.3% Hispanic subjects (H, 35 (10.4% African Americans (AA, and 226 (67% non-Hispanic whites (NHW. The mean (SD hemoglobin A1c differed significantly by race/ethnicity: NHW 7.86 (1.4%, H 8.16 (1.6%, AA 8.84 (2.9%, p = 0.05. The multivariate-adjusted A1c was significantly higher for AA (+0.93%, p = 0.002 compared to NHW. Insulin doses (unit/day also differed significantly: NHW 70.6 (48.8, H 58.4 (32.6, and AA 53.1 (36.2, p Conclusion In our cohort, insulin-treated minority veterans, particularly AA, had poorer glycemic control and received lower doses of insulin than NHW. However, we found no differences for control of other cardiovascular disease risk factors. The diabetes treatment disparity could be due to provider behaviors and/or patient behaviors or preferences. Further research with larger sample sizes and more geographically diverse populations are needed to confirm our findings.

  18. Ethnic disparities in educational and occupational gradients of estimated cardiovascular disease risk: The Healthy Life in an Urban Setting study

    NARCIS (Netherlands)

    Perini, Wilco; Agyemang, Charles; Snijder, Marieke B.; Peters, Ron J. G.; Kunst, Anton E.

    2017-01-01

    European societies are becoming increasingly ethnically diverse. This may have important implications for socio-economic inequalities in health due to the often disadvantaged position of ethnic minority groups in both socio-economic status (SES) and disease, especially cardiovascular disease (CVD).

  19. Disparities in Depressive Symptoms and Antidepressant Treatment by Gender and Race/Ethnicity among People Living with HIV in the United States.

    Science.gov (United States)

    Bengtson, Angela M; Pence, Brian W; Crane, Heidi M; Christopoulos, Katerina; Fredericksen, Rob J; Gaynes, Bradley N; Heine, Amy; Mathews, W Christopher; Moore, Richard; Napravnik, Sonia; Safren, Steven; Mugavero, Michael J

    2016-01-01

    To describe disparities along the depression treatment cascade, from indication for antidepressant treatment to effective treatment, in HIV-infected individuals by gender and race/ethnicity. The Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) cohort includes 31,000 HIV-infected adults in routine clinical care at 8 sites. Individuals were included in the analysis if they had a depressive symptoms measure within one month of establishing HIV care at a CNICS site. Depressive symptoms were measured using the validated Patient Health Questionnaire-9 (PHQ-9). Indication for antidepressant treatment was defined as PHQ-9 ≥ 10 or a current antidepressant prescription. Antidepressant treatment was defined as a current antidepressant prescription. Evidence-based antidepressant treatment was considered treatment changes based on a person's most recent PHQ-9, in accordance with clinical guidelines. We calculated the cumulative probability of moving through the depression treatment cascade within 24 months of entering CNICS HIV care. We used multivariable Cox proportional hazards models to estimate associations between gender, race/ethnicity, and a range of depression outcomes. In our cohort of HIV-infected adults in routine care, 47% had an indication for antidepressant treatment. Significant drop-offs along the depression treatment cascade were seen for the entire study sample. However, important disparities existed. Women were more likely to have an indication for antidepressant treatment (HR 1.54; 95% CI 1.34, 1.78), receive antidepressant treatment (HR 2.03; 95% CI 1.53, 2.69) and receive evidence-based antidepressant treatment (HR 1.67; 95% CI 1.03, 2.74), even after accounting for race/ethnicity. Black non-Hispanics (HR 0.47, 95% CI 0.35, 0.65), Hispanics (HR 0.63, 95% CI 0.44, 0.89) and other race/ethnicities (HR 0.35, 95% CI 0.17, 0.73) were less likely to initiate antidepressant treatment, compared to white non-Hispanics. In our cohort

  20. Ethnic and social disparities in different types of examinations in undergraduate pre-clinical training

    NARCIS (Netherlands)

    K.M. Stegers-Jager (Karen); F.N. Brommet; A.P.N. Themmen (Axel)

    2016-01-01

    textabstractMedical schools are increasingly faced with a more diverse student population. Generally, ethnic minority students are reported to underperform compared with those from the ethnic majority. However, there are inconsistencies in findings in different types of examinations. Additionally,

  1. Cardiovascular health: associations with race-ethnicity, nativity, and education in a diverse, population-based sample of Californians.

    Science.gov (United States)

    Bostean, Georgiana; Roberts, Christian K; Crespi, Catherine M; Prelip, Michael; Peters, Anne; Belin, Thomas R; McCarthy, William J

    2013-07-01

    This study examined how race-ethnicity, nativity, and education interact to influence disparities in cardiovascular (CV) health, a new concept defined by the American Heart Association. We assessed whether race-ethnicity and nativity disparities in CV health vary by education and whether the foreign-born differ in CV health from their U.S.-born race-ethnic counterparts with comparable education. We used data from the 2009 California Health Interview Survey to determine the prevalence of optimal CV health metrics (based on selected American Heart Association guidelines) among adults ages 25 and older (n = 42,014). We examined the interaction between education and ethnicity-nativity, comparing predicted probabilities of each CV health measure between U.S.-born and foreign-born White, Asian, and Latino respondents. All groups were at high risk of suboptimal physical activity levels, fruit and vegetable and fast food consumption, and overweight/obesity. Those with greater education were generally better off except among Asian respondents. Ethnicity-nativity differences were more pronounced among those with less than a college degree. The foreign-born respondents exhibited both advantages and disadvantages in CV health compared with their U.S.-born counterparts that varied by ethnicity-nativity. Education influences ethnicity-nativity disparities in CV health, with most race-ethnic and nativity differences occurring among the less educated. Studies of nativity differences in CV health should stratify by education in order to adequately address SES differences. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Decreasing health disparities for people with disabilities through improved communication strategies and awareness.

    Science.gov (United States)

    Sharby, Nancy; Martire, Katharine; Iversen, Maura D

    2015-03-19

    Factors influencing access to health care among people with disabilities (PWD) include: attitudes of health care providers and the public, physical barriers, miscommunication, income level, ethnic/minority status, insurance coverage, and lack of information tailored to PWD. Reducing health care disparities in a population with complex needs requires implementation at the primary, secondary and tertiary levels. This review article discusses common barriers to health care access from the patient and provider perspective, particularly focusing on communication barriers and how to address and ameliorate them. Articles utilized in this review were published from 2005 to present in MEDLINE and CINAHL and written in English that focused on people with disabilities. Topics searched for in the literature include: disparities and health outcomes, health care dissatisfaction, patient-provider communication and access issues. Ineffective communication has significant impacts for PWD. They frequently believe that providers are not interested in, or sensitive to their particular needs and are less likely to seek care or to follow up with recommendations. Various strategies for successful improvement of health outcomes for PWD were identified including changing the way health care professionals are educated regarding disabilities, improving access to health care services, and enhancing the capacity for patient centered care.

  3. Geographic and racial-ethnic differences in satisfaction with and perceived benefits of mental health services.

    Science.gov (United States)

    Kim, Giyeon; Parton, Jason M; Ford, Katy-Lauren; Bryant, Ami N; Shim, Ruth S; Parmelee, Patricia

    2014-12-01

    This study examined whether racial-ethnic differences in satisfaction with and perceived benefits from mental health services vary by geographic region among U.S. adults. Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), selected samples consisted of 2,160 adults age 18 and older from diverse racial-ethnic groups (Asian, black, Hispanic/Latino, and white) who had used mental health services in the past 12 months. Generalized linear model analysis was conducted for the United States as a whole and separately by geographic region (Northeast, South, Midwest, and West) after adjustment for covariates. In the national sample, no significant main effects of race-ethnicity and geographic region were found in either satisfaction with or perceived benefits from mental health services. In the stratified analyses for geographic regions, however, significant racial-ethnic differences were observed in the West; blacks in the West were significantly more likely to report higher satisfaction and perceived benefits, whereas Hispanics/Latinos in the West were significantly less likely to do so. The findings suggest that there are regional variations of racial-ethnic differences in satisfaction with and perceived benefits from mental health services among U.S. adults and that addressing needs of Hispanics/Latinos in the West may help reduce racial-ethnic disparities in mental health care. Clinical and policy implications are discussed.

  4. Identity threat at work: how social identity threat and situational cues contribute to racial and ethnic disparities in the workplace.

    Science.gov (United States)

    Emerson, Katherine T U; Murphy, Mary C

    2014-10-01

    Significant disparities remain between racial and ethnic minorities' and Whites' experiences of American workplaces. Traditional prejudice and discrimination approaches explain these gaps in hiring, promotion, satisfaction, and well-being by pointing to the prejudice of people within organizations such as peers, managers, and executives. Grounded in social identity threat theory, this theoretical review instead argues that particular situational cues-often communicated by well-meaning, largely unprejudiced employees and managers-signal to stigmatized groups whether their identity is threatened and devalued or respected and affirmed. First, we provide an overview of how identity threat shapes the psychological processes of racial and ethnic minorities by heightening vigilance to certain situational cues in the workplace. Next, we outline several of these cues and their role in creating and sustaining perceptions of identity threat (or safety). Finally, we provide empirically grounded suggestions that organizations may use to increase identity safety among their employees of color. Taken together, the research demonstrates how situational cues contribute to disparate psychological experiences for racial and ethnic minorities at work, and suggests that by altering threatening cues, organizations may create more equitable, respectful, and inclusive environments where all people may thrive. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  5. The State of Research on Racial/Ethnic Discrimination in The Receipt of Health Care

    Science.gov (United States)

    Fagan, Pebbles; Jones, Dionne; Klein, William M. P.; Boyington, Josephine; Moten, Carmen; Rorie, Edward

    2012-01-01

    Objectives. We conducted a review to examine current literature on the effects of interpersonal and institutional racism and discrimination occurring within health care settings on the health care received by racial/ethnic minority patients. Methods. We searched the PsychNet, PubMed, and Scopus databases for articles on US populations published between January 1, 2008 and November 1, 2011. We used various combinations of the following search terms: discrimination, perceived discrimination, race, ethnicity, racism, institutional racism, stereotype, prejudice or bias, and health or health care. Fifty-eight articles were reviewed. Results. Patient perception of discriminatory treatment and implicit provider biases were the most frequently examined topics in health care settings. Few studies examined the overall prevalence of racial/ethnic discrimination and none examined temporal trends. In general, measures used were insufficient for examining the impact of interpersonal discrimination or institutional racism within health care settings on racial/ethnic disparities in health care. Conclusions. Better instrumentation, innovative methodology, and strategies are needed for identifying and tracking racial/ethnic discrimination in health care settings. PMID:22494002

  6. Workforce ethnic diversity and culturally competent health care: the case of Arab physicians in Israel.

    Science.gov (United States)

    Popper-Giveon, Ariela; Liberman, Ido; Keshet, Yael

    2014-01-01

    In recent years, a growing body of literature has been calling for ethnic diversity in health systems, especially in multicultural contexts. Ethnic diversity within the health care workforce is considered to play an important role in reducing health disparities among different ethnic groups. The present study explores the topic using quantitative data on participation of Arab employees in the Israeli health system and qualitative data collected through semi-structured interviews with Arab physicians working in the predominantly Jewish Israeli health system. We show that despite the underrepresentation of Arabs in the Israeli health system, Arab physicians who hold positions in Israeli hospitals do not perceive themselves as representatives of the Arab sector; moreover, they consider themselves as having broken through the 'glass ceiling' and reject stereotyping as Arab 'niche doctors.' We conclude that minority physicians may prefer to promote culturally competent health care through integration and advocacy of interaction with the different cultures represented in the population, rather than serving as representatives of their own ethnic minority population. These findings may concern various medical contexts in which issues of ethnic underrepresentation in the health system are relevant, as well as sociological contexts, especially those regarding minority populations and professions.

  7. Personal vis-a-vis social responsibility for disparities in health status: An issue of justice.

    Science.gov (United States)

    Jha, Ayan; Dobe, Madhumita

    2016-01-01

    Health inequities are disparities which can be avoided through rational actions on the part of policymakers. Such inequalities are unnecessary and unjust and may exist between and within nations, societies, and population groups. Social determinants such as wealth, income, occupation, education, gender, and racial/ethnic groups are the principal drivers of this inequality since they determine the health risks and preventive behaviors, access to, and affordability of health care. Within this framework, there is a debate on assigning a personal responsibility factor over and above societal responsibility to issues of ill health. One school of philosophy argues that when individuals are worse-off than others for no fault of their own, it is unjust, as opposed to health disparities that arise due to avoidable personal choices such as smoking and drug addiction for which there should (can) be a personal responsibility. Opposing thoughts have pointed out that the relative socioeconomic position of an individual dictates how his/her life may progress from education to working conditions and aging, susceptibility to diseases and infirmity, and the consequences thereof. The existence of a social gradient in health outcomes across populations throughout the world is a testimony to this truth. It has been emphasized that assuming personal responsibility for health in public policy-making can only have a peripheral place. Instead, the concept of individual responsibility should be promoted as a positive concept of enabling people to gain control over the determinants of health through conscious, informed, and healthy choices.

  8. 76 FR 40384 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2011-07-08

    ... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special, Emphasis Panel, U24 Grant Review. Date: July 11-12, 2011. Time: 8 a.m..., National Institute on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda...

  9. 76 FR 11500 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2011-03-02

    ... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; R01 grant review (03). Date: March 7, 2011. Time: 8 a.m... Health Disparities, National Institutes of Health, 6707 Democracy Boulevard, Suite 800, Bethesda, MD...

  10. 76 FR 28795 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2011-05-18

    ... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; R25 Grant Review. Date: May 23-24, 2011. Time: 8 a.m..., National Institute on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda...

  11. 75 FR 71449 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2010-11-23

    ... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel (R01). Date: December 15-16, 2010. Time: 7:45 a.m. to 3..., National Institute on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda...

  12. 76 FR 18566 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2011-04-04

    ... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel, NIMHD Conference Grant Application (R13) Review. Date... Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 451-9536...

  13. 75 FR 25273 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2010-05-07

    ... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel, Faith Based R21. Date: June 29-July 1, 2010. Time: 5 p..., Chief, Office of Scientific Review, National Center on Minority Health and Health Disparities, 6707...

  14. The relationship between race/ethnicity and the perceived experience of mental health care.

    Science.gov (United States)

    Cai, Angela; Robst, John

    2016-01-01

    Although there is a vast amount of literature on differences in the perceived experiences of general health care among different racial/ethnic groups, few studies have examined the relationship between race/ethnicity and perceptions of mental health care. The purpose of this study was to determine whether non-Hispanic African Americans and Hispanics had more negative (or less positive) perceptions of the mental health treatment they receive compared to non-Hispanic Whites. Data were from the 1998-2006 Florida Health Services Surveys. The findings indicated that African Americans and Hispanics were less likely than Whites to have favorable perceptions of the mental health care services they received, even after adjusting for demographic and health status variables. Interventions should be designed to address disparities in mental health treatment and the perceptions of such treatment. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  15. Population disparities in mental health: insights from cultural neuroscience.

    Science.gov (United States)

    Chiao, Joan Y; Blizinsky, Katherine D

    2013-10-01

    By 2050, nearly 1 in 5 Americans (19%) will be an immigrant, including Hispanics, Blacks, and Asians, compared to the 1 in 8 (12%) in 2005. They will vary in the extent to which they are at risk for mental health disorders. Given this increase in cultural diversity within the United States and costly population health disparities across cultural groups, it is essential to develop a more comprehensive understanding of how culture affects basic psychological and biological mechanisms. We examine these basic mechanisms that underlie population disparities in mental health through cultural neuroscience. We discuss the challenges to and opportunities for cultural neuroscience research to determine sociocultural and biological factors that confer risk for and resilience to mental health disorders across the globe.

  16. Race, Ethnicity, and Self-Rated Health Among Immigrants in the United States.

    Science.gov (United States)

    Alang, Sirry M; McCreedy, Ellen M; McAlpine, Donna D

    2015-12-01

    Previous work has not fully explored the role of race in the health of immigrants. We investigate race and ethnic differences in self-rated health (SRH) among immigrants, assess the degree to which socio-economic characteristics explain race and ethnic differences, and examine whether time in the USA affects racial and ethnic patterning of SRH among immigrants. Data came from the 2012 National Health Interview Survey (N = 16, 288). Using logistic regression, we examine race and ethnic differences in SRH controlling for socio-economic differences and length of time in the country. Hispanic and non-Hispanic Black immigrants were the most socio-economically disadvantaged. Asian immigrants were socio-economically similar to non-Hispanic White immigrants. Contrary to U.S. racial patterning, Black immigrants had lower odds of poor SRH than did non-Hispanic White immigrants when socio-demographic factors were controlled. When length of stay in the USA was included in the model, there were no racial or ethnic differences in SRH. However, living in the USA for 15 years and longer was associated with increased odds of poor SRH for all immigrants. Findings have implications for research on racial and ethnic disparities in health. Black-White disparities that have received much policy attention do not play out when we examine self-assessed health among immigrants. The reasons why non-Hispanic Black immigrants have similar self-rated health than non-Hispanic White immigrants even though they face greater socio-economic disadvantage warrant further attention.

  17. Basic Information about Health Disparities in Cancer

    Science.gov (United States)

    ... income, social class, disability, geographic location, or sexual orientation. 1 According to CDC’s Office of Minority Health ... YouTube Instagram Listen Watch RSS ABOUT About CDC Jobs Funding LEGAL Policies Privacy FOIA No Fear Act ...

  18. Assessing the contribution of the dental care delivery system to oral health care disparities.

    Science.gov (United States)

    Pourat, Nadereh; Andersen, Ronald M; Marcus, Marvin

    2015-01-01

    Existing studies of disparities in access to oral health care for underserved populations often focus on supply measures such as number of dentists. This approach overlooks the importance of other aspects of the dental care delivery system, such as personal and practice characteristics of dentists, that determine the capacity to provide care. This study aims to assess the role of such characteristics in access to care of underserved populations. We merged data from the 2003 California Health Interview Survey and a 2003 survey of California dentists in their Medical Study Service Areas (MSSAs). We examined the role of overall supply and other characteristics of dentists in income and racial/ethnic disparities in access, which was measured by annual dental visits and unmet need for dental care due to costs. We found that some characteristics of MSSAs, including higher proportions of dentists who were older, white, busy or overworked, and did not accept public insurance or discounted fees, inhibited access for low-income and minority populations. These findings highlight the importance of monitoring characteristics of dentists in addition to traditional measures of supply such as licensed-dentist-to-population ratios. The findings identify specific aspects of the delivery system such as dentists' participation in Medicaid, provision of discounted care, busyness, age, race/ethnicity, and gender that should be regularly monitored. These data will provide a better understanding of how the dental care delivery system is organized and how this knowledge can be used to develop more narrowly targeted policies to alleviate disparities. © 2014 American Association of Public Health Dentistry.

  19. Can universal coverage eliminate health disparities? Reversal of disparate injury outcomes in elderly insured minorities.

    Science.gov (United States)

    Ramirez, Michelle; Chang, David C; Rogers, Selwyn O; Yu, Peter T; Easterlin, Molly; Coimbra, Raul; Kobayashi, Leslie

    2013-06-15

    Health outcome disparities in racial minorities are well documented. However, it is unknown whether such disparities exist among elderly injured patients. We hypothesized that such disparities might be reduced in the elderly owing to insurance coverage under Medicare. We investigated this issue by comparing the trauma outcomes in young and elderly patients in California. A retrospective analysis of the California Office of Statewide Health Planning and Development hospital discharge database was performed for all publicly available years from 1995 to 2008. Trauma admissions were identified by International Classification of Disease, Ninth Revision, primary diagnosis codes from 800 to 959, with certain exclusions. Multivariate analysis examined the adjusted risk of in-hospital mortality in young (<65 y) and elderly (≥65 y) patients, controlling for age, gender, injury severity as measured by the survival risk ratio, Charlson comorbidity index, insurance status, calendar year, and teaching hospital status. A total of 1,577,323 trauma patients were identified. Among the young patients, the adjusted odds ratio of death relative to non-Hispanic whites for blacks, Hispanics, Asians, and Native Americans/others was 1.2, 1.2, 0.90, and 0.78, respectively. The corresponding adjusted odds ratios of death for elderly patients were 0.78, 0.87, 0.92, and 0.61. Young black and Hispanic trauma patients had greater mortality risks relative to non-Hispanic white patients. Interestingly, elderly black and Hispanic patients had lower mortality risks compared with non-Hispanic whites. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Social disparities in BMI trajectories across adulthood by gender, race/ethnicity and lifetime socio-economic position: 1986-2004.

    Science.gov (United States)

    Clarke, Philippa; O'Malley, Patrick M; Johnston, Lloyd D; Schulenberg, John E

    2009-04-01

    The prevalence of obesity and overweight is rapidly increasing in industrialized countries, with long-term health and social consequences. There is also a strong social patterning of obesity and overweight, with a higher prevalence among women, racial/ethnic minorities and those from a lower socio-economic position (SEP). Most of the existing work in this area, however, is based on cross-sectional data or single cohort studies. No national studies to date have examined how social disparities in obesity and overweight differ by age and historical period using longitudinal data with repeated measures. We used panel data from the nationally representative Monitoring the Future Study (1986-2004) to examine social disparities in trajectories of body mass index (BMI) over adulthood (age 18-45). Self-reported height and weight were collected in this annual US survey of high-school seniors, followed biennially since 1976. Using growth curve models, we analysed BMI trajectories over adulthood by gender, race/ethnicity and lifetime SEP (measured by parents' education and respondent's education). BMI trajectories exhibit a curvilinear rate of change from age 18 to 45, but there was a strong period effect, such that weight gain was more rapid for more recent cohorts. As a result, successive cohorts become overweight (BMI>25) at increasingly earlier points in the life course. BMI scores were also consistently higher for women, racial/ethnic minority groups and those from a lower SEP. However, BMI scores for socially advantaged groups in recent cohorts were actually higher than those for their socially disadvantaged counterparts who were born 10 years earlier. Results highlight the importance of social status and socio-economic resources for maintaining optimal weight. Yet, even those in advantaged social positions have experienced an increase in BMI in recent years.

  1. Racial, Ethnic, and Insurance Status Disparities in Use of Posthospitalization Care after Trauma

    Science.gov (United States)

    Englum, Brian R; Villegas, Cassandra; Bolorunduro, Oluwaseyi; Haut, Elliott R; Cornwell, Edward E; Efron, David T; Haider, Adil H

    2012-01-01

    BACKGROUND Posthospitalization care is important for recovery after trauma. Disadvantaged populations, like racial or ethnic minorities and the uninsured, make up substantial percentages of trauma patients, but their use of posthospitalization facilities is unknown. STUDY DESIGN This study analyzed National Trauma Data Bank admissions from 2007 for 18- to 64-year-olds and estimated relative risk ratios (RRR) of discharge to posthospitalization facilities—home, home health, rehabilitation, or nursing facility—by race, ethnicity, and insurance. Multinomial logistic regression adjusted for patient characteristics including age, sex, Injury Severity Score, mechanism of injury, and length of stay, among others. RESULTS There were 136,239 patients who met inclusion criteria with data for analysis. Most patients were discharged home (78.9%); fewer went to home health (3.3%), rehabilitation (5.0%), and nursing facilities (5.4%). When compared with white patients in adjusted analysis, relative risk ratios of discharge to rehabilitation were 0.61 (95% CI 0.56, 0.66) and 0.44 (95% CI 0.40, 0.49) for blacks and Hispanics, respectively. Compared with privately insured white patients, Hispanics had lower rates of discharge to rehabilitation whether privately insured (RRR 0.45, 95% CI 0.40, 0.52), publicly insured (RRR 0.51, 95% CI 0.42, 0.61), or uninsured (RRR 0.20, 95% CI 0.17, 0.24). Black patients had similarly low rates: private (RRR 0.63, 95% CI 0.56, 0.71), public (RRR 0.72, 95% CI 0.63, 0.82), or uninsured (RRR 0.27, 95% CI 0.23, 0.32). Relative risk ratios of discharge to home health or nursing facilities showed similar trends among blacks and Hispanics regardless of insurance, except for black patients with insurance whose discharge to nursing facilities was similar to their white counterparts. CONCLUSIONS Disadvantaged populations have more limited use of posthospitalization care such as rehabilitation after trauma, suggesting a potential improvement in trauma

  2. Measuring the effect of ethnic and non-ethnic discrimination on Europeans' self-rated health.

    Science.gov (United States)

    Alvarez-Galvez, Javier

    2016-04-01

    The study of perceived discrimination based on race and ethnic traits belongs to a long-held tradition in this field, but recent studies have found that non-ethnic discrimination based on factors such as gender, disability or age is also a crucial predictor of health outcomes. Using data from the European Social Survey (2010), and applying Boolean Factor Analysis and Ordered Logistic Regression models, this study is aimed to compare how ethnic and non-ethnic types of discrimination might affect self-rated health in the European context. We found that non-ethnic types of discrimination produce stronger differences on health outcomes. This result indicates that the probabilities of presenting a poor state of health are significantly higher when individuals feel they are being discriminated against for social or demographic conditions (gender, age, sexuality or disability) rather than for ethnic reasons (nationality, race, ethnicity, language or religiosity). This study offers a clear comparison of health inequalities based on ethnic and non-ethnic types of discrimination in the European context, overcoming analytical based on binary indicators and simple measures of discrimination.

  3. 76 FR 52959 - National Center on Minority and Health Disparities; Notice of Closed Meetings

    Science.gov (United States)

    2011-08-24

    ... and Health Disparities; Notice of Closed Meetings Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; NIMHD Revision Applications to Support Environmental Health Disparities Research P20. Date: August 29, 2011. Time: 8 a.m. to 12 p.m. Agenda: To review and...

  4. 76 FR 21748 - Health Disparities Subcommittee (HDS), Advisory Committee to the Director, Centers for Disease...

    Science.gov (United States)

    2011-04-18

    ... Disparities Subcommittee (HDS), Advisory Committee to the Director, Centers for Disease Control and Prevention... through the ACD on strategic and other health disparities and health equity issues and provide guidance on... update including the CDC Health Disparities and Inequalities Report, U.S. 2011; the National Prevention...

  5. 75 FR 42100 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2010-07-20

    ... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel, NCMHD Social Determinants of Health (R01) Panel. Date... Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 594-8696, [email protected

  6. Disparities in the use of screening magnetic resonance imaging of the breast in community practice by race, ethnicity, and socioeconomic status.

    Science.gov (United States)

    Haas, Jennifer S; Hill, Deirdre A; Wellman, Robert D; Hubbard, Rebecca A; Lee, Christoph I; Wernli, Karen J; Stout, Natasha K; Tosteson, Anna N A; Henderson, Louise M; Alford-Teaster, Jennifer A; Onega, Tracy L

    2016-02-15

    Uptake of breast magnetic resonance imaging (MRI) coupled with breast cancer risk assessment offers the opportunity to tailor the benefits and harms of screening strategies for women with differing cancer risks. Despite the potential benefits, there is also concern for worsening population-based health disparities. Among 316,172 women aged 35 to 69 years from 5 Breast Cancer Surveillance Consortium registries (2007-2012), the authors examined 617,723 negative screening mammograms and 1047 screening MRIs. They examined the relative risks (RRs) of MRI use by women with a college or technical school were 43% more likely and those who had at least a college degree were 132% more likely to receive an MRI compared with those with a high school education or less. Among women with a ≥20% lifetime risk, there was no statistically significant difference noted with regard to the use of screening MRI by race or ethnicity, but high-risk women with a high school education or less were less likely to undergo screening MRI than women who had graduated from college (RR, 0.40; 95% confidence interval, 0.25-0.63). Uptake of screening MRI of the breast into clinical practice has the potential to worsen population-based health disparities. Policies beyond health insurance coverage should ensure that the use of this screening modality reflects evidence-based guidelines. © 2015 American Cancer Society.

  7. Ethnic disparities in ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage incidence in the Netherlands

    NARCIS (Netherlands)

    Agyemang, Charles; van Oeffelen, Aloysia A. M.; Norredam, Marie; Kappelle, L. Jaap; Klijn, Catharina J. M.; Bots, Michiel L.; Stronks, Karien; Vaartjes, Ilonca

    2014-01-01

    Data on the incidence of stroke subtypes among ethnic minority groups are limited. We assessed ethnic differences in the incidence of stroke subtypes in the Netherlands. A Dutch nationwide register-based cohort study (n=7 423 174) was conducted between 1998 and 2010. We studied the following stroke

  8. Ethnic Disparities in Ischemic Stroke, Intracerebral Hemorrhage, and Subarachnoid Hemorrhage Incidence in The Netherlands

    DEFF Research Database (Denmark)

    Agyemang, Charles; van Oeffelen, Aloysia A M; Nørredam, Marie Louise

    2014-01-01

    BACKGROUND AND PURPOSE: Data on the incidence of stroke subtypes among ethnic minority groups are limited. We assessed ethnic differences in the incidence of stroke subtypes in the Netherlands. METHODS: A Dutch nationwide register-based cohort study (n=7 423 174) was conducted between 1998 and 2010....... We studied the following stroke subtypes: ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Cox proportional hazard models were used to estimate incidence differences between first-generation ethnic minorities and the Dutch majority population (ethnic Dutch). RESULTS: Compared.......16-0.72), and subarachnoid hemorrhage (0.42; 0.20-0.88 and 0.34; 0.17-0.68) compared with ethnic Dutch counterparts. The results varied by stroke subtype and sex for the other minority groups. For example, Turkish women had a reduced incidence of subarachnoid hemorrhage, whereas Turkish men had an increased incidence...

  9. Cultural Beliefs and Mental Health Treatment Preferences of Ethnically Diverse Older Adult Consumers in Primary Care

    Science.gov (United States)

    Jimenez, Daniel E.; Bartels, Stephen J.; Cardenas, Veronica; Daliwal, Sanam S.; Alegría, Margarita

    2011-01-01

    Background Beliefs concerning the causes of mental illness may help explain why there are significant disparities in the rates of formal mental health service use among racial/ethnic minority elderly as compared with their Caucasian counterparts. This study applies the Cultural Influences on Mental Health framework to identify the relationship between race/ethnicity and differences in: (1) beliefs on the cause of mental illness; (2) preferences for type of treatment; and (3) provider characteristics. Method Analyses were conducted using baseline data collected from participants who completed the Cultural Attitudes toward Healthcare and Mental Illness Questionnaire, developed for the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) study, a multi-site randomized trial for older adults (65+) with depression, anxiety, or at-risk alcohol consumption. The final sample consisted of 1257 non-Latino Whites, 536 African-Americans, 112 Asian-Americans, and 303 Latinos. Results African-Americans, Asian-Americans, and Latinos had differing beliefs regarding the causes of mental illness when compared to Non-Latino Whites. Race/ethnicity was also associated with determining who makes healthcare decisions, treatment preferences, and preferred characteristics of healthcare providers. Conclusions This study highlights the association between race/ethnicity and health beliefs, treatment preferences, healthcare decisions, and consumers' preferred characteristics of healthcare providers. Accommodating the values and preferences of individuals can be helpful in engaging racial/ethnic minority patients in mental health services. PMID:21992942

  10. Cultural beliefs and mental health treatment preferences of ethnically diverse older adult consumers in primary care.

    Science.gov (United States)

    Jimenez, Daniel E; Bartels, Stephen J; Cardenas, Veronica; Dhaliwal, Sanam S; Alegría, Margarita

    2012-06-01

    Beliefs concerning the causes of mental illness may help to explain why there are significant disparities in the rates of formal mental health service use among racial/ethnic minority elderly as compared with their white counterparts. This study applies the cultural influences on mental health framework to identify the relationship between race/ethnicity and differences in 1) beliefs on the cause of mental illness, 2) preferences for type of treatment, and 3) provider characteristics. Analyses were conducted using baseline data collected from participants who completed the cultural attitudes toward healthcare and mental illness questionnaire, developed for the Primary Care Research in Substance Abuse and Mental Health for the Elderly study, a multisite randomized trial for older adults (65+) with depression, anxiety, or at-risk alcohol consumption. The final sample consisted of 1,257 non-Latino whites, 536 African Americans, 112 Asian Americans, and 303 Latinos. African Americans, Asian Americans, and Latinos had differing beliefs regarding the causes of mental illness when compared with non-Latino whites. Race/ethnicity was also associated with determining who makes healthcare decisions, treatment preferences, and preferred characteristics of healthcare providers. This study highlights the association between race/ethnicity and health beliefs, treatment preferences, healthcare decisions, and consumers' preferred characteristics of healthcare providers. Accommodating the values and preferences of individuals can be helpful in engaging racial/ethnic minority patients in mental health services.

  11. Disparity and convergence: Chinese provincial government health expenditures.

    Science.gov (United States)

    Pan, Jay; Wang, Peng; Qin, Xuezheng; Zhang, Shufang

    2013-01-01

    The huge regional disparity in government health expenditures (GHE) is a major policy concern in China. This paper addresses whether provincial GHE converges in China from 1997 to 2009 using the economic convergence framework based on neoclassical economic growth theory. Our empirical investigation provides compelling evidence of long-term convergence in provincial GHE within China, but not in short-term. Policy implications of these empirical results are discussed.

  12. Disparity and convergence: Chinese provincial government health expenditures.

    Directory of Open Access Journals (Sweden)

    Jay Pan

    Full Text Available The huge regional disparity in government health expenditures (GHE is a major policy concern in China. This paper addresses whether provincial GHE converges in China from 1997 to 2009 using the economic convergence framework based on neoclassical economic growth theory. Our empirical investigation provides compelling evidence of long-term convergence in provincial GHE within China, but not in short-term. Policy implications of these empirical results are discussed.

  13. Ethnic/racial disparities in adolescents' home food environments and linkages to dietary intake and weight status

    OpenAIRE

    Larson, Nicole; Eisenberg, Marla E.; Berge, Jerica M.; Arcan, Chrisa; Neumark-Sztainer, Dianne

    2014-01-01

    Research is needed to confirm that public health recommendations for home/family food environments are equally relevant for diverse populations. This study examined ethnic/racial differences in the home/family environments of adolescents and associations with dietary intake and weight status. The sample included 2,382 ethnically/racially diverse adolescents and their parents enrolled in coordinated studies, EAT 2010 (Eating and Activity in Teens) and Project F-EAT (Families and Eating and Act...

  14. Gender and Race/Ethnicity Differences in Mental Health Care Use before and during the Great Recession.

    Science.gov (United States)

    Chen, Jie; Dagher, Rada

    2016-04-01

    This study examines the changes in health care utilization for mental health disorders among patients who were diagnosed with depressive and/or anxiety disorders during the Great Recession 2007-2009 in the USA. Negative binomial regressions are used to estimate the association of the economic recession and mental health care use for females and males separately. Results show that prescription drug utilization (e.g., antidepressants, psychotropic medications) increased significantly during the economic recession 2007-2009 for both females and males. Physician visits for mental health disorders decreased during the same period. Results show that racial disparities in mental health care might have increased, while ethnic disparities persisted during the Great Recession. Future research should separately examine mental health care utilization by gender and race/ethnicity.

  15. Implications of sleep and energy drink use for health disparities

    Science.gov (United States)

    Grandner, Michael A; Knutson, Kristen L; Troxel, Wendy; Hale, Lauren; Jean-Louis, Girardin; Miller, Kathleen E

    2014-01-01

    The popularity of energy drinks has increased rapidly in the past decade. One of the main reasons people use energy drinks is to counteract effects of insufficient sleep or sleepiness. Risks associated with energy drink use, including those related to sleep loss, may be disproportionately borne by racial minorities and those of lower socioeconomic status. In this review, a brief introduction to the issue of health disparities is provided, population-level disparities and inequalities in sleep are described, and the social-ecological model of sleep and health is presented. Social and demographic patterns of energy drink use are then presented, followed by discussion of the potential ways in which energy drink use may contribute to health disparities, including the following: 1) effects of excessive caffeine in energy drinks, 2) effects of energy drinks as sugar-sweetened beverages, 3) association between energy drinks and risk-taking behaviors when mixed with alcohol, 4) association between energy drink use and short sleep duration, and 5) role of energy drinks in cardiometabolic disease. The review concludes with a research agenda of critical unanswered questions. PMID:25293540

  16. 76 FR 55078 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2011-09-06

    ... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel, ZMD1 RN (02) NIMHD Comprehensive Center of Excellence... Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 496-3996, [email protected

  17. 76 FR 11499 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2011-03-02

    ... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; 2011 LRP Panel 1. Date: March 18, 2011. Time: 8 a.m. to... Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 451-9536, [email protected

  18. 76 FR 57068 - National Center on Minority and Health Disparities Notice of Closed Meeting

    Science.gov (United States)

    2011-09-15

    ... and Health Disparities Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; ZMD1 RN 01 NIMHD Exploratory Centers of Excellence (P20... Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 496-3996, [email protected

  19. 76 FR 14673 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2011-03-17

    ... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; 2011 LRP Panel 3. Date: April 13, 2011. Time: 8 a.m. to... Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 451-9536, [email protected

  20. Racial/Ethnic Disparities in Consistent Reporting of Smoking-Related Behaviors

    OpenAIRE

    Soulakova, Julia N; Huang, Huang; Crockett, Lisa J

    2015-01-01

    This study assessed the effect of race/ethnicity on the prevalence of inconsistent reports regarding ever smoking, time since smoking cessation, and age of initiating regular smoking. We used the Tobacco Use Supplement to the Current Population Survey data, which came from a test-retest reliability study, and considered three racial/ethnic subpopulations, Hispanics, Non-Hispanic (NH) Blacks and NH Whites. Initial exploration of highly disagreeing reports of time since smoking cessation and ag...

  1. New Century, Old Disparities: Gender and Ethnic Wage Gaps in Latin America

    OpenAIRE

    Atal, Juan Pablo; Nopo, Hugo; Winder, Natalia

    2009-01-01

    This paper surveys gender and ethnic wage gaps in 18 Latin American countries, decomposing differences using matching comparisons as a non-parametric alternative to the Blinder-Oaxaca (BO) decomposition. It is found that men earn 9-27 percent more than women, with high cross-country heterogeneity. The unexplained pay gap is higher among older, informal and self-employed workers and those in small firms. Ethnic wage differences are greater than gender differences, and educational attainment di...

  2. New century, old disparities: Gender and ethnic gaps in Latin America

    OpenAIRE

    Ñopo, Hugo; Atal, Juan Pablo; Winder, Natalia

    2010-01-01

    This paper surveys gender and ethnic wage gaps in 18 Latin American countries, decomposing differences using matching comparisons as a non-parametric alternative to the Blinder-Oaxaca (BO) decomposition. It is found that men earn 9-27 percent more than women, with high cross-country heterogeneity. The unexplained pay gap is higher among older, informal and self-employed workers and those in small firms. Ethnic wage differences are greater than gender differences, and educational attainment di...

  3. Racial and ethnic disparities in pediatric renal allograft survival in the United States

    OpenAIRE

    Patzer, Rachel E; Mohan, Sumit; Kutner, Nancy; McClellan, William M; Amaral, Sandra

    2014-01-01

    This study was undertaken to describe the association of patient race/ethnicity and renal allograft survival among the national cohort of pediatric renal allograft recipients. Additionally, we determined whether racial and ethnic differences in graft survival exist among individuals living in low or high poverty neighborhoods and those with private or public insurance. Among 6,216 incident, pediatric End Stage Renal Disease patients in the United States Renal Data System (kidney transplant fr...

  4. Assumptions about culture in discourse on ethnic minority health

    DEFF Research Database (Denmark)

    Jæger, Kirsten

    2014-01-01

    as contributing to low levels of knowledge about health and to adverse health behavior. Thus, the texts present cultural beliefs and practices as contributing to the high prevalence of lifestyle diseases among ethnic minority population groups. The analysis, however, demonstrates that a more nuanced discourse......This paper is interested in the way the concept of culture is deployed in documents aimed at investigating, informing on and promoting aspects of ethnic minority health. Within a health-political discourse focusing increasingly on individual lifestyles, ethnic minority health became subject...... to increased political and professional interest in the last decades of the twentieth and the first decade of the twenty-first century. Analysis of the discourse on ethnic minority health emerging in five texts addressing health professionals shows that the culture of ethnic minority citizens is primarily seen...

  5. Message design strategies to raise public awareness of social determinants of health and population health disparities.

    Science.gov (United States)

    Niederdeppe, Jeff; Bu, Q Lisa; Borah, Porismita; Kindig, David A; Robert, Stephanie A

    2008-09-01

    Raising public awareness of the importance of social determinants of health (SDH) and health disparities presents formidable communication challenges. This article reviews three message strategies that could be used to raise awareness of SDH and health disparities: message framing, narratives, and visual imagery. Although few studies have directly tested message strategies for raising awareness of SDH and health disparities, the accumulated evidence from other domains suggests that population health advocates should frame messages to acknowledge a role for individual decisions about behavior but emphasize SDH. These messages might use narratives to provide examples of individuals facing structural barriers (unsafe working conditions, neighborhood safety concerns, lack of civic opportunities) in efforts to avoid poverty, unemployment, racial discrimination, and other social determinants. Evocative visual images that invite generalizations, suggest causal interpretations, highlight contrasts, and create analogies could accompany these narratives. These narratives and images should not distract attention from SDH and population health disparities, activate negative stereotypes, or provoke counterproductive emotional responses directed at the source of the message. The field of communication science offers valuable insights into ways that population health advocates and researchers might develop better messages to shape public opinion and debate about the social conditions that shape the health and well-being of populations. The time has arrived to begin thinking systematically about issues in communicating about SDH and health disparities. This article offers a broad framework for these efforts and concludes with an agenda for future research to refine message strategies to raise awareness of SDH and health disparities.

  6. Choropleth map legend design for visualizing community health disparities

    Directory of Open Access Journals (Sweden)

    Cromley Ellen K

    2009-09-01

    Full Text Available Abstract Background Disparities in health outcomes across communities are a central concern in public health and epidemiology. Health disparities research often links differences in health outcomes to other social factors like income. Choropleth maps of health outcome rates show the geographical distribution of health outcomes. This paper illustrates the use of cumulative frequency map legends for visualizing how the health events are distributed in relation to social characteristics of community populations. The approach uses two graphs in the cumulative frequency legend to highlight the difference between the raw count of the health events and the raw count of the social characteristic like low income in the geographical areas of the map. The approach is applied to mapping publicly available data on low birth weight by town in Connecticut and Lyme disease incidence by town in Connecticut in relation to income. The steps involved in creating these legends are described in detail so that health analysts can adopt this approach. Results The different health problems, low birth weight and Lyme disease, have different cumulative frequency signatures. Graphing poverty population on the cumulative frequency legends revealed that the poverty population is distributed differently with respect to the two different health problems mapped here. Conclusion Cumulative frequency legends can be useful supplements for choropleth maps. These legends can be constructed using readily available software. They contain all of the information found in standard choropleth map legends, and they can be used with any choropleth map classification scheme. Cumulative frequency legends effectively communicate the proportion of areas, the proportion of health events, and/or the proportion of the denominator population in which the health events occurred that falls within each class interval. They illuminate the context of disease through graphing associations with other

  7. Missed Opportunity? Leveraging Mobile Technology to Reduce Racial Health Disparities.

    Science.gov (United States)

    Ray, Rashawn; Sewell, Abigail A; Gilbert, Keon L; Roberts, Jennifer D

    2017-10-01

    Blacks and Latinos are less likely than whites to access health insurance and utilize health care. One way to overcome some of these racial barriers to health equity may be through advances in technology that allow people to access and utilize health care in innovative ways. Yet, little research has focused on whether the racial gap that exists for health care utilization also exists for accessing health information online and through mobile technologies. Using data from the Health Information National Trends Survey (HINTS), we examine racial differences in obtaining health information online via mobile devices. We find that blacks and Latinos are more likely to trust online newspapers to get health information than whites. Minorities who have access to a mobile device are more likely to rely on the Internet for health information in a time of strong need. Federally insured individuals who are connected to mobile devices have the highest probability of reliance on the Internet as a go-to source of health information. We conclude by discussing the importance of mobile technologies for health policy, particularly related to developing health literacy, improving health outcomes, and contributing to reducing health disparities by race and health insurance status. Copyright © 2017 by Duke University Press.

  8. Racial and Ethnic Disparities in Parental Refusal of Consent in a Large, Multisite Pediatric Critical Care Clinical Trial.

    Science.gov (United States)

    Natale, Joanne E; Lebet, Ruth; Joseph, Jill G; Ulysse, Christine; Ascenzi, Judith; Wypij, David; Curley, Martha A Q

    2017-05-01

    To evaluate whether race or ethnicity was independently associated with parental refusal of consent for their child's participation in a multisite pediatric critical care clinical trial. We performed a secondary analyses of data from Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE), a 31-center cluster randomized trial of sedation management in critically ill children with acute respiratory failure supported on mechanical ventilation. Multivariable logistic regression modeling estimated associations between patient race and ethnicity and parental refusal of study consent. Among the 3438 children meeting enrollment criteria and approached for consent, 2954 had documented race/ethnicity of non-Hispanic White (White), non-Hispanic Black (Black), or Hispanic of any race. Inability to approach for consent was more common for parents of Black (19.5%) compared with White (11.7%) or Hispanic children (13.2%). Among those offered consent, parents of Black (29.5%) and Hispanic children (25.9%) more frequently refused consent than parents of White children (18.2%, P refuse consent. Parents of children offered participation in the intervention arm were more likely to refuse consent than parents in the control arm (OR 2.15, 95% CI 1.37-3.36, P care clinical trial. Ameliorating this racial disparity may improve the validity and generalizability of study findings. ClinicalTrials.gov: NCT00814099. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Disparities in Breast Cancer Survival Among Asian Women by Ethnicity and Immigrant Status: A Population-Based Study

    Science.gov (United States)

    Clarke, Christina A.; Shema, Sarah J.; Chang, Ellen T.; Keegan, Theresa H. M.; Glaser, Sally L.

    2010-01-01

    Objectives. We investigated heterogeneity in ethnic composition and immigrant status among US Asians as an explanation for disparities in breast cancer survival. Methods. We enhanced data from the California Cancer Registry and the Surveillance, Epidemiology, and End Results program through linkage and imputation to examine the effect of immigrant status, neighborhood socioeconomic status, and ethnic enclave on mortality among Chinese, Japanese, Filipino, Korean, South Asian, and Vietnamese women diagnosed with breast cancer from 1988 to 2005 and followed through 2007. Results. US-born women had similar mortality rates in all Asian ethnic groups except the Vietnamese, who had lower mortality risk (hazard ratio [HR] = 0.3; 95% confidence interval [CI] = 0.1, 0.9). Except for Japanese women, all foreign-born women had higher mortality than did US-born Japanese, the reference group. HRs ranged from 1.4 (95% CI = 1.2, 1.7) among Koreans to 1.8 (95% CI = 1.5, 2.2) among South Asians and Vietnamese. Little of this variation was explained by differences in disease characteristics. Conclusions. Survival after breast cancer is poorer among foreign- than US-born Asians. Research on underlying factors is needed, along with increased awareness and targeted cancer control. PMID:20299648

  10. Reducing Ex-offender Health Disparities through the Affordable Care Act: Fostering Improved Health Care Access and Linkages to Integrated Care

    Directory of Open Access Journals (Sweden)

    Lacreisha Ejike-King

    2014-04-01

    Full Text Available Despite steadily declining incarceration rates overall, racial and ethnic minorities, namely African Americans, Latinos, and American Indians and Alaska Natives, continue to be disproportionately represented in the justice system. Ex-offenders commonly reenter communities with pressing health conditions but encounter obstacles to accessing care and remaining in care. The lack of health insurance coverage and medical treatment emerge as the some of the most reported reentry health needs and may contribute to observed health disparities. Linking ex-offenders to care and services upon release increases the likelihood that they will remain in care and practice successful disease management. The Affordable Care Act (ACA offers opportunities to address health disparities experienced by the reentry population that places them at risk for negative health outcomes and recidivism. Coordinated efforts to link ex-offenders with these newly available opportunities may result in a trajectory for positive health and overall well-being as they reintegrate into society.

  11. Effects of ethnicity and gender on youth health

    OpenAIRE

    Komalsingh Rambaree; Igor Knez

    2016-01-01

    This study investigated the effects of ethnicity and gender on the health of young people (14–25 years old) living in Mauritius. Combinations of female and male by four ethnic groups—“Creole”, “Hindu”, “Muslim” and “Mixed”—were used for multivariate analysis of variances. “Mixed” ethnic group consumed most tobacco, alcohol and drugs compared to other ethnic groups. They were also the ones that mostly skipped breakfast and lunch and were found to eat most fast food. Moreover, “Mixed” ethnic gr...

  12. Controlling for race/ethnicity: a comparison of California commercial health plans CAHPS scores to NCBD benchmarks

    Directory of Open Access Journals (Sweden)

    Lopez Rebeca A

    2010-01-01

    Full Text Available Abstract Background Because California has higher managed care penetration and the race/ethnicity of Californians differs from the rest of the United States, we tested the hypothesis that California's lower health plan Consumer Assessment of Healthcare Providers and Systems (CAHPS® survey results are attributable to the state's racial/ethnic composition. Methods California CAHPS survey responses for commercial health plans were compared to national responses for five selected measures: three global ratings of doctor, health plan and health care, and two composite scores regarding doctor communication and staff courtesy, respect, and helpfulness. We used the 2005 National CAHPS 3.0 Benchmarking Database to assess patient experiences of care. Multiple stepwise logistic regression was used to see if patient experience ratings based on CAHPS responses in California commercial health plans differed from all other states combined. Results CAHPS patient experience responses in California were not significantly different than the rest of the nation after adjusting for age, general health rating, individual health plan, education, time in health plan, race/ethnicity, and gender. Both California and national patient experience scores varied by race/ethnicity. In both California and the rest of the nation Blacks tended to be more satisfied, while Asians were less satisfied. Conclusions California commercial health plan enrollees rate their experiences of care similarly to enrollees in the rest of the nation when seven different variables including race/ethnicity are considered. These findings support accounting for more than just age, gender and general health rating before comparing health plans from one state to another. Reporting on race/ethnicity disparities in member experiences of care could raise awareness and increase accountability for reducing these racial and ethnic disparities.

  13. Ethnic and social disparities in different types of examinations in undergraduate pre-clinical training.

    Science.gov (United States)

    Stegers-Jager, K M; Brommet, F N; Themmen, A P N

    2016-12-01

    Medical schools are increasingly faced with a more diverse student population. Generally, ethnic minority students are reported to underperform compared with those from the ethnic majority. However, there are inconsistencies in findings in different types of examinations. Additionally, little is known about the performance of first-generation university students and about performance differences across ethnic minority groups. This study aimed to investigate underperformance across ethnic minority groups and by first-generation university students in different types of written tests and clinical skills examinations during pre-clinical training. A longitudinal prospective cohort study of progress on a 3-year Dutch Bachelor of Medicine course was conducted. Participants included 2432 students who entered the course over a consecutive 6-year period (2008-2013). Compared with Dutch students, the three non-Western ethnic minority groups (Turkish/Moroccan/African, Surinamese/Antillean and Asian) underperformed in the clinical problem solving tests, the language test and the OSCEs. Findings on the theoretical end-of-block tests and writing skills tests, and results for Western minority students were less consistent. Age, gender, pre-university grade point average and additional socio-demographic variables (including first-generation university student, first language, and medical doctor parent) could explain the ethnicity-related differences in theoretical examinations, but not in language, clinical and writing skills examinations. First-generation university students only underperformed in the language test. Apparently, underperformance differs both across ethnic subgroups and between different types of written and clinical examinations. Medical schools should ensure their assessment strategies create a level playing field for all students and explore reasons for underperformance in the clinical and writing skills examinations.

  14. Investigating the relationship between socially-assigned ethnicity, racial discrimination and health advantage in New Zealand.

    Directory of Open Access Journals (Sweden)

    Donna M Cormack

    Full Text Available BACKGROUND: While evidence of the contribution of racial discrimination to ethnic health disparities has increased significantly, there has been less research examining relationships between ascribed racial/ethnic categories and health. It has been hypothesized that in racially-stratified societies being assigned as belonging to the dominant racial/ethnic group may be associated with health advantage. This study aimed to investigate associations between socially-assigned ethnicity, self-identified ethnicity, and health, and to consider the role of self-reported experience of racial discrimination in any relationships between socially-assigned ethnicity and health. METHODS: The study used data from the 2006/07 New Zealand Health Survey (n = 12,488, a nationally representative cross-sectional survey of adults 15 years and over. Racial discrimination was measured as reported individual-level experiences across five domains. Health outcome measures examined were self-reported general health and psychological distress. RESULTS: The study identified varying levels of agreement between participants' self-identified and socially-assigned ethnicities. Individuals who reported both self-identifying and being socially-assigned as always belonging to the dominant European grouping tended to have more socioeconomic advantage and experience less racial discrimination. This group also had the highest odds of reporting optimal self-rated health and lower mean levels of psychological distress. These differences were attenuated in models adjusting for socioeconomic measures and individual-level racial discrimination. CONCLUSIONS: The results suggest health advantage accrues to individuals who self-identify and are socially-assigned as belonging to the dominant European ethnic grouping in New Zealand, operating in part through socioeconomic advantage and lower exposure to individual-level racial discrimination. This is consistent with the broader evidence of the

  15. Current Status of Gender and Racial/Ethnic Disparities Among Academic Emergency Medicine Physicians.

    Science.gov (United States)

    Madsen, Tracy E; Linden, Judith A; Rounds, Kirsten; Hsieh, Yu-Hsiang; Lopez, Bernard L; Boatright, Dowin; Garg, Nidhi; Heron, Sheryl L; Jameson, Amy; Kass, Dara; Lall, Michelle D; Melendez, Ashley M; Scheulen, James J; Sethuraman, Kinjal N; Westafer, Lauren M; Safdar, Basmah

    2017-10-01

    A 2010 survey identified disparities in salaries by gender and underrepresented minorities (URM). With an increase in the emergency medicine (EM) workforce since, we aimed to 1) describe the current status of academic EM workforce by gender, race, and rank and 2) evaluate if disparities still exist in salary or rank by gender. Information on demographics, rank, clinical commitment, and base and total annual salary for full-time faculty members in U.S. academic emergency departments were collected in 2015 via the Academy of Administrators in Academic Emergency Medicine (AAAEM) Salary Survey. Multiple linear regression was used to compare salary by gender while controlling for confounders. Response rate was 47% (47/101), yielding data on 1,371 full-time faculty: 33% women, 78% white, 4% black, 5% Asian, 3% Asian Indian, 4% other, and 7% unknown race. Comparing white race to nonwhite, 62% versus 69% were instructor/assistant, 23% versus 20% were associate, and 15% versus 10% were full professors. Comparing women to men, 74% versus 59% were instructor/assistant, 19% versus 24% were associate, and 7% versus 17% were full professors. Of 113 chair/vice-chair positions, only 15% were women, and 18% were nonwhite. Women were more often fellowship trained (37% vs. 31%), less often core faculty (59% vs. 64%), with fewer administrative roles (47% vs. 57%; all p disparities in salary and rank persist among full-time U.S. academic EM faculty. There were gender and URM disparities in rank and leadership positions. Women earned less than men regardless of rank, clinical hours, or training. Future efforts should focus on evaluating salary data by race and developing systemwide practices to eliminate disparities. © 2017 by the Society for Academic Emergency Medicine.

  16. Tracking Biocultural Pathways to Health Disparities: The Value of Biomarkers

    Science.gov (United States)

    Worthman, Carol M.; Costello, E. Jane

    2009-01-01

    Background Cultural factors and biomarkers are emerging emphases in social epidemiology that readily ally with human biology and anthropology. Persistent health challenges and disparities have established biocultural roots, and environment plays an integral role in physical development and function that form the bases of population health. Biomarkers have proven to be valuable tools for investigating biocultural bases of health disparities. Aims We apply recent insights from biology to consider how culture gets under the skin and evaluate the construct of embodiment. We analyze contrasting biomarker models and applications, and propose an integrated model for biomarkers. Three examples from the Great Smoky Mountains Study (GSMS) illustrate these points. Subjects and methods The longitudinal developmental epidemiological GSMS comprises a population-based sample of 1420 children with repeated measures including mental and physical health, life events, household conditions, and biomarkers for pubertal development and allostatic load. Results Analyses using biomarkers resolved competing explanations for links between puberty and depression, identified gender differences in stress at puberty, and revealed interactive effects of birthweight and postnatal adversity on risk for depression at puberty in girls. Conclusion An integrated biomarker model can both enrich epidemiology and illuminate biocultural pathways in population health. PMID:19381986

  17. Disparities in young adolescent inhalant use by rurality, gender, and ethnicity.

    Science.gov (United States)

    Edwards, Ruth W; Stanley, Linda; Plested, Barbara Ann; Marquart, Beverly S; Chen, Julie; Thurman, Pamela Jumper

    2007-01-01

    Inhalant use is of increasing concern as rates appear to be rising among young adolescents and gender differences narrowing. Data from 20,684 Mexican American and White non-Hispanic seventh- and eighth-grade males and females from the Western United States and 15,659 African American and White non-Hispanic seventh- and eighth-grade males and females from states in the southeastern United States collected via in-school surveys from 1996 to 2000 were analyzed using a variety of statistical techniques including multilevel modeling. Questions addressed in the study included: Does inhalant use vary by level of rurality? What effect does the ethnic composition of the community have on inhalant use and does this effect differ by an individual's ethnicity? Do males use more inhalants than females and does the level of use by males and females differ by individual ethnicity, ethnicity of the community, or level of rurality? Do males and females of different ethnicities initiate inhalant use at different ages? Limitations of the study and implications of findings for prevention are discussed and areas of future research are suggested. This study was funded by the National Institute on Drug Abuse.

  18. Ethnic Variations in Psychosocial and Health Correlates of Eating Disorders.

    Science.gov (United States)

    Assari, Shervin; DeFreitas, Mariana R

    2018-04-25

    The aim of this study is to explore ethnic variations in psychosocial and health correlates of eating disorders in the United States, Specifically, we compared associations between gender, socioeconomic status (SES), body mass index (BMI), physical and mental self-rated health (SRH), and major depressive disorder (MDD) with eating disorders (EDs) across 10 different ethnic groups in the United States. Data was obtained from the Collaborative Psychiatric Epidemiology Surveys (CPES), a national household probability sample collected in 2001⁻2003. Data for this study included a sample of 17,729 individuals with the following ethnic profile: 520 Vietnamese, 508 Filipino, 600 Chinese, 656 Other Asian, 577 Cuban, 495 Puerto Rican, 1442 Mexican, 1106 Other Hispanic, 4746 African American, and 7587 Non-Latino Whites. Gender, SES (education and income), BMI, SRH, MDD, and presence of EDs were measured across different ethnic groups. Logistic regression analysis was conducted for each ethnic group with lifetime EDs as the main outcome. Ethnic group varied in psychosocial and health correlates of EDs. In most ethnic groups, gender and SES were not associated with EDs. In almost all ethnic groups, EDs were associated with MDD and BMI. EDs were found to be associated with SRH in half of the ethnic groups studied. The associations between gender, SES, BMI, SRH, MDD, and EDs vary across different ethnic groups. These differences must be considered in further studies and in clinical practice in order to improve our approach towards diagnosis and treatment of EDs.

  19. Ethnic Variations in Psychosocial and Health Correlates of Eating Disorders

    Directory of Open Access Journals (Sweden)

    Shervin Assari

    2018-04-01

    Full Text Available The aim of this study is to explore ethnic variations in psychosocial and health correlates of eating disorders in the United States, Specifically, we compared associations between gender, socioeconomic status (SES, body mass index (BMI, physical and mental self-rated health (SRH, and major depressive disorder (MDD with eating disorders (EDs across 10 different ethnic groups in the United States. Data was obtained from the Collaborative Psychiatric Epidemiology Surveys (CPES, a national household probability sample collected in 2001–2003. Data for this study included a sample of 17,729 individuals with the following ethnic profile: 520 Vietnamese, 508 Filipino, 600 Chinese, 656 Other Asian, 577 Cuban, 495 Puerto Rican, 1442 Mexican, 1106 Other Hispanic, 4746 African American, and 7587 Non-Latino Whites. Gender, SES (education and income, BMI, SRH, MDD, and presence of EDs were measured across different ethnic groups. Logistic regression analysis was conducted for each ethnic group with lifetime EDs as the main outcome. Ethnic group varied in psychosocial and health correlates of EDs. In most ethnic groups, gender and SES were not associated with EDs. In almost all ethnic groups, EDs were associated with MDD and BMI. EDs were found to be associated with SRH in half of the ethnic groups studied. The associations between gender, SES, BMI, SRH, MDD, and EDs vary across different ethnic groups. These differences must be considered in further studies and in clinical practice in order to improve our approach towards diagnosis and treatment of EDs.

  20. Targeting energy justice: Exploring spatial, racial/ethnic and socioeconomic disparities in urban residential heating energy efficiency

    International Nuclear Information System (INIS)

    Reames, Tony Gerard

    2016-01-01

    Fuel poverty, the inability of households to afford adequate energy services, such as heating, is a major energy justice concern. Increasing residential energy efficiency is a strategic fuel poverty intervention. However, the absence of easily accessible household energy data impedes effective targeting of energy efficiency programs. This paper uses publicly available data, bottom-up modeling and small-area estimation techniques to predict the mean census block group residential heating energy use intensity (EUI), an energy efficiency proxy, in Kansas City, Missouri. Results mapped using geographic information systems (GIS) and statistical analysis, show disparities in the relationship between heating EUI and spatial, racial/ethnic, and socioeconomic block group characteristics. Block groups with lower median incomes, a greater percentage of households below poverty, a greater percentage of racial/ethnic minority headed-households, and a larger percentage of adults with less than a high school education were, on average, less energy efficient (higher EUIs). Results also imply that racial segregation, which continues to influence urban housing choices, exposes Black and Hispanic households to increased fuel poverty vulnerability. Lastly, the spatial concentration and demographics of vulnerable block groups suggest proactive, area- and community-based targeting of energy efficiency assistance programs may be more effective than existing self-referral approaches. - Highlights: • Develops statistical model to predict block group (BG) residential heating energy use intensity (EUI), an energy efficiency proxy. • Bivariate and multivariate analyses explore racial/ethnic and socioeconomic relationships with heating EUI. • BGs with more racial/ethnic minority households had higher heating EUI. • BGs with lower socioeconomics had higher heating EUI. • Mapping heating EUI can facilitate effective energy efficiency intervention targeting.

  1. Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China.

    Science.gov (United States)

    Ren, Yan; Qian, Ping; Duan, Zhanqi; Zhao, Ziling; Pan, Jay; Yang, Min

    2017-09-29

    The maternal mortality rate (MMR) markedly decreased in China, but there has been a significant imbalance among different geographic regions (east, central and west regions), and the mortality in the western region remains high. This study aims to examine how much disparity in the health system and MMR between ethnic minority and non-minority counties exists in Sichuan province of western China and measures conceivable commitments of the health system determinants of the disparity in MMR. The MMR and health system data of 67 minority and 116 non-minority counties were taken from Sichuan provincial official sources. The 2-level Poisson regression model was used to identify health system determinants. A series of nested models with different health system factors were fitted to decide contribution of each factor to the disparity in MMR. The MMR decreased over the last decade, with the fastest declining rate from 2006 to 2010. The minority counties experienced higher raw MMR in 2002 than non-minority counties (94.4 VS. 58.2), which still remained higher in 2014 (35.7 VS. 14.3), but the disparity of raw MMR between minority and non-minority counties decreased from 36.2 to 21.4. The better socio-economic condition, more health human resources and higher maternal health care services rate were associated with lower MMR. Hospital delivery rate alone explained 74.5% of the difference in MMR between minority and non-minority counties. All health system indicators together explained 97.6% of the ethnic difference in MMR, 59.8% in the change trend, and 66.3% county level variation respectively. Hospital delivery rate mainly determined disparity in MMR between minority and non-minority counties in Sichuan province. Increasing hospital birth rates among ethnic minority counties may narrow the disparity in MMR by more than two-thirds of the current level.

  2. Race/Ethnicity and Health-Related Quality of Life Among LGBT Older Adults

    Science.gov (United States)

    Kim, Hyun-Jun; Jen, Sarah; Fredriksen-Goldsen, Karen I.

    2017-01-01

    Purpose of the Study: Few existing studies have addressed racial/ethnic differences in the health and quality of life of lesbian, gay, bisexual, and transgender (LGBT) older adults. Guided by the Health Equity Promotion Model, this study examines health-promoting and health risk factors that contribute to racial/ethnic health disparities among LGBT adults aged 50 and older. Design and Methods: We utilized weighted survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. By applying multiple mediator models, we analyzed the indirect effects of race/ethnicity on health-related quality of life (HRQOL) via demographics, lifetime LGBT-related discrimination, and victimization, and socioeconomic, identity-related, spiritual, and social resources. Results: Although African Americans and Hispanics, compared with non-Hispanic Whites, reported lower physical HRQOL and comparable psychological HRQOL, indirect pathways between race/ethnicity and HRQOL were observed. African Americans and Hispanics had lower income, educational attainment, identity affirmation, and social support, which were associated with a decrease in physical and psychological HRQOL. African Americans had higher lifetime LGBT-related discrimination, which was linked to a decrease in their physical and psychological HRQOL. African Americans and Hispanics had higher spirituality, which was associated with an increase in psychological HRQOL. Implications: Findings illustrate the importance of identifying both health-promoting and health risk factors to understand ways to maximize the health potential of racially and ethnically diverse LGBT older adults. Interventions aimed at health equity should be tailored to bolster identity affirmation and social networks of LGBT older adults of color and to support strengths, including spiritual resources. PMID:28087793

  3. Race/Ethnicity and Health-Related Quality of Life Among LGBT Older Adults.

    Science.gov (United States)

    Kim, Hyun-Jun; Jen, Sarah; Fredriksen-Goldsen, Karen I

    2017-02-01

    Few existing studies have addressed racial/ethnic differences in the health and quality of life of lesbian, gay, bisexual, and transgender (LGBT) older adults. Guided by the Health Equity Promotion Model, this study examines health-promoting and health risk factors that contribute to racial/ethnic health disparities among LGBT adults aged 50 and older. We utilized weighted survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. By applying multiple mediator models, we analyzed the indirect effects of race/ethnicity on health-related quality of life (HRQOL) via demographics, lifetime LGBT-related discrimination, and victimization, and socioeconomic, identity-related, spiritual, and social resources. Although African Americans and Hispanics, compared with non-Hispanic Whites, reported lower physical HRQOL and comparable psychological HRQOL, indirect pathways between race/ethnicity and HRQOL were observed. African Americans and Hispanics had lower income, educational attainment, identity affirmation, and social support, which were associated with a decrease in physical and psychological HRQOL. African Americans had higher lifetime LGBT-related discrimination, which was linked to a decrease in their physical and psychological HRQOL. African Americans and Hispanics had higher spirituality, which was associated with an increase in psychological HRQOL. Findings illustrate the importance of identifying both health-promoting and health risk factors to understand ways to maximize the health potential of racially and ethnically diverse LGBT older adults. Interventions aimed at health equity should be tailored to bolster identity affirmation and social networks of LGBT older adults of color and to support strengths, including spiritual resources. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. Racial and Ethnic Disparities in Preterm Birth Among American Indian and Alaska Native Women.

    Science.gov (United States)

    Raglan, Greta B; Lannon, Sophia M; Jones, Katherine M; Schulkin, Jay

    2016-01-01

    Preterm birth disproportionately affects American Indian/Alaska Native (AI/AN) women. This disparity in birth outcomes may stem from higher levels of exposure to psychosocial, sociodemographic, and medical risk factors. This paper reviews relevant research related to preterm birth in American Indian and Alaska Native women. This narrative review examines disparities in preterm birth rates between AI/AN and other American women, and addresses several maternal risk factors and barriers that contribute to elevated preterm birth rates among this racial minority group. Additionally, this paper focuses on recent evidence that geographical location can significantly impact preterm birth rates among AI/AN women. In particular, access to care among AI/AN women and differences between rural and urban areas are discussed.

  5. Oral health-related cultural beliefs for four racial/ethnic groups: Assessment of the literature.

    Science.gov (United States)

    Butani, Yogita; Weintraub, Jane A; Barker, Judith C

    2008-09-15

    The purpose of this study was to assess information available in the dental literature on oral health-related cultural beliefs. In the US, as elsewhere, many racial/ethnic minority groups shoulder a disproportionate burden of oral disease. Cultural beliefs, values and practices are often implicated as causes of oral health disparities, yet little is known about the breadth or adequacy of literature about cultural issues that could support these assertions. Hence, this rigorous assessment was conducted of work published in English on cultural beliefs and values in relation to oral health status and dental practice. Four racial/ethnic groups in the US (African-American, Chinese, Filipino and Hispanic/Latino) were chosen as exemplar populations. The dental literature published in English for the period 1980-2006 noted in the electronic database PUBMED was searched, using keywords and MeSH headings in different combinations for each racial/ethnic group to identify eligible articles. To be eligible the title and abstract when available had to describe the oral health-related cultural knowledge or orientation of the populations studied. Overall, the majority of the literature on racial/ethnic groups was epidemiologic in nature, mainly demonstrating disparities in oral health rather than the oral beliefs or practices of these groups. A total of 60 relevant articles were found: 16 for African-American, 30 for Chinese, 2 for Filipino and 12 for Hispanic/Latino populations. Data on beliefs and practices from these studies has been abstracted, compiled and assessed. Few research-based studies were located. Articles lacked adequate identification of groups studied, used limited methods and had poor conceptual base. The scant information available from the published dental and medical literature provides at best a rudimentary framework of oral health related ideas and beliefs for specific populations.

  6. Oral health-related cultural beliefs for four racial/ethnic groups: Assessment of the literature

    Directory of Open Access Journals (Sweden)

    Barker Judith C

    2008-09-01

    Full Text Available Abstract Background The purpose of this study was to assess information available in the dental literature on oral health-related cultural beliefs. In the US, as elsewhere, many racial/ethnic minority groups shoulder a disproportionate burden of oral disease. Cultural beliefs, values and practices are often implicated as causes of oral health disparities, yet little is known about the breadth or adequacy of literature about cultural issues that could support these assertions. Hence, this rigorous assessment was conducted of work published in English on cultural beliefs and values in relation to oral health status and dental practice. Four racial/ethnic groups in the US (African-American, Chinese, Filipino and Hispanic/Latino were chosen as exemplar populations. Methods The dental literature published in English for the period 1980–2006 noted in the electronic database PUBMED was searched, using keywords and MeSH headings in different combinations for each racial/ethnic group to identify eligible articles. To be eligible the title and abstract when available had to describe the oral health-related cultural knowledge or orientation of the populations studied. Results Overall, the majority of the literature on racial/ethnic groups was epidemiologic in nature, mainly demonstrating disparities in oral health rather than the oral beliefs or practices of these groups. A total of 60 relevant articles were found: 16 for African-American, 30 for Chinese, 2 for Filipino and 12 for Hispanic/Latino populations. Data on beliefs and practices from these studies has been abstracted, compiled and assessed. Few research-based studies were located. Articles lacked adequate identification of groups studied, used limited methods and had poor conceptual base. Conclusion The scant information available from the published dental and medical literature provides at best a rudimentary framework of oral health related ideas and beliefs for specific populations.

  7. Racial and Ethnic Disparities in Crime and Criminal Justice in the United States

    OpenAIRE

    Lauritsen, Janet L.; Sampson, Robert

    1997-01-01

    Although racial discrimination emerges some of the time at some stages of criminal justice processing-such as juvenile justice-there is little evidence that racial disparities result from systematic, overt bias. Discrimination appears to be indirect, stemming from the amplification of initial disadvantages over time, along with the social construction of "moral panics" and associated political responses. The "drug war" of the 1980s and 1990s exacerbated the disproportionate representation of ...

  8. Practitioner and client explanations for disparities in health care use between migrant and non-migrant groups in Sweden: a qualitative study.

    Science.gov (United States)

    Akhavan, Sharareh; Karlsen, Saffron

    2013-02-01

    To investigate variations in explanations given for disparities in health care use between migrant and non-migrant groups, by clients and care providers in Sweden. Qualitative evidence collected during in-depth interviews with five 'migrant' health service clients and five physicians. The interview data generated three categories which were perceived by respondents to produce ethnic differences in health service use: "Communication issues", "Cultural differences in approaches to medical consultations" and "Effects of perceptions of inequalities in care quality and discrimination". Explanations for disparities in health care use in Sweden can be categorized into those reflecting social/structural conditions and the presence/absence of power and those using cultural/behavioural explanations. The negative perceptions of 'migrant' clients held by some Swedish physicians place the onus for addressing their poor health with the clients themselves and risks perpetuating their health disadvantage. The power disparity between doctors and 'migrant' patients encourages a sense of powerlessness and mistreatment among patients.

  9. Facilitating Racial and Ethnic Diversity in the Health Workforce.

    Science.gov (United States)

    Snyder, Cyndy R; Frogner, Bianca K; Skillman, Susan M

    2018-01-01

    Racial and ethnic diversity in the health workforce can facilitate access to healthcare for underserved populations and meet the health needs of an increasingly diverse population. In this study, we explored 1) changes in the racial and ethnic diversity of the health workforce in the United States over the last decade, and 2) evidence on the effectiveness of programs designed to promote racial and ethnic diversity in the U.S. health workforce. Findings suggest that although the health workforce overall is becoming more diverse, people of color are most often represented among the entry-level, lower-skilled health occupations. Promising practices to help facilitate diversity in the health professions were identified in the literature, namely comprehensive programs that integrated multiple interventions and strategies. While some efforts have been found to be promising in increasing the interest, application, and enrollment of racial and ethnic minorities into health profession schools, there is still a missing link in understanding persistence, graduation, and careers.

  10. Toward a Demographic Understanding of Incarceration Disparities : Race, Ethnicity, and Age Structure

    NARCIS (Netherlands)

    Vogel, M.S.; Porter, L.C.

    2015-01-01

    Objectives Non-Hispanic blacks and Hispanics in the United States are more likely to be incarcerated than non-Hispanic whites. The risk of incarceration also varies with age, and there are striking differences in age distributions across racial/ethnic groups. Guided by these trends, the present

  11. Gender disparities in hypertension among different ethnic groups in Amsterdam, the Netherlands: The SUNSET study

    NARCIS (Netherlands)

    Agyemang, Charles; de Munter, Jeroen; van Valkengoed, Irene; van den Born, Bert-Jan; Stronks, Karien

    2008-01-01

    BACKGROUND Studies have consistently shown a lower prevalence of hypertension in women than in men. Obesity is an important risk factor for hypertension, and the rate of obesity is particularly high among ethnic minority women. It is therefore questionable whether the lower prevalence of

  12. Evidence and Implications of Racial and Ethnic Disparities in Emotional and Behavioral Disorders Identification and Treatment

    Science.gov (United States)

    Morgan, Paul L.; Farkas, George

    2016-01-01

    We summarize our recent findings that White children in the United States are more likely than otherwise similar racial or ethnic minority children to receive special education services, including for emotional and behavioral disorders. We show how the findings are robust. We explain why our findings conflict with prior reports in education that…

  13. Nonlinear Predictive Models for Multiple Mediation Analysis: With an Application to Explore Ethnic Disparities in Anxiety and Depression Among Cancer Survivors.

    Science.gov (United States)

    Yu, Qingzhao; Medeiros, Kaelen L; Wu, Xiaocheng; Jensen, Roxanne E

    2018-04-02

    Mediation analysis allows the examination of effects of a third variable (mediator/confounder) in the causal pathway between an exposure and an outcome. The general multiple mediation analysis method (MMA), proposed by Yu et al., improves traditional methods (e.g., estimation of natural and controlled direct effects) to enable consideration of multiple mediators/confounders simultaneously and the use of linear and nonlinear predictive models for estimating mediation/confounding effects. Previous studies find that compared with non-Hispanic cancer survivors, Hispanic survivors are more likely to endure anxiety and depression after cancer diagnoses. In this paper, we applied MMA on MY-Health study to identify mediators/confounders and quantify the indirect effect of each identified mediator/confounder in explaining ethnic disparities in anxiety and depression among cancer survivors who enrolled in the study. We considered a number of socio-demographic variables, tumor characteristics, and treatment factors as potential mediators/confounders and found that most of the ethnic differences in anxiety or depression between Hispanic and non-Hispanic white cancer survivors were explained by younger diagnosis age, lower education level, lower proportions of employment, less likely of being born in the USA, less insurance, and less social support among Hispanic patients.

  14. Racial and Ethnic Disparities in Nonalcoholic Fatty Liver Disease Prevalence, Severity, and Outcomes in the United States: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Rich, Nicole E; Oji, Stefany; Mufti, Arjmand R; Browning, Jeffrey D; Parikh, Neehar D; Odewole, Mobolaji; Mayo, Helen; Singal, Amit G

    2018-02-01

    Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States, affecting 75-100 million Americans. However, the disease burden may not be equally distributed among races or ethnicities. We conducted a systematic review and meta-analysis to characterize racial and ethnic disparities in NAFLD prevalence, severity, and prognosis. We searched MEDLINE, EMBASE, and Cochrane databases through August 2016 for studies that reported NAFLD prevalence in population-based or high-risk cohorts, NAFLD severity including presence of nonalcoholic steatohepatitis (NASH) and significant fibrosis, and NAFLD prognosis including development of cirrhosis complications and mortality. Pooled relative risks, according to race and ethnicity, were calculated for each outcome using the DerSimonian and Laird method for a random-effects model. We identified 34 studies comprising 368,569 unique patients that characterized disparities in NAFLD prevalence, severity, or prognosis. NAFLD prevalence was highest in Hispanics, intermediate in Whites, and lowest in Blacks, although differences between groups were smaller in high-risk cohorts (range 47.6%-55.5%) than population-based cohorts (range, 13.0%-22.9%). Among patients with NAFLD, risk of NASH was higher in Hispanics (relative risk, 1.09; 95% CI, 0.98-1.21) and lower in Blacks (relative risk, 0.72; 95% CI, 0.60-0.87) than Whites. However, the proportion of patients with significant fibrosis did not significantly differ among racial or ethnic groups. Data were limited and discordant on racial or ethnic disparities in outcomes of patients with NAFLD. In a systematic review and meta-analysis, we found significant racial and ethnic disparities in NAFLD prevalence and severity in the United States, with the highest burden in Hispanics and lowest burden in Blacks. However, data are discordant on racial or ethnic differences in outcomes of patients with NAFLD. Copyright © 2018 AGA Institute. Published by

  15. Solving Disparities Through Payment And Delivery System Reform: A Program To Achieve Health Equity.

    Science.gov (United States)

    DeMeester, Rachel H; Xu, Lucy J; Nocon, Robert S; Cook, Scott C; Ducas, Andrea M; Chin, Marshall H

    2017-06-01

    Payment systems generally do not directly encourage or support the reduction of health disparities. In 2013 the Finding Answers: Solving Disparities through Payment and Delivery System Reform program of the Robert Wood Johnson Foundation sought to understand how alternative payment models might intentionally incorporate a disparities-reduction component to promote health equity. A qualitative analysis of forty proposals to the program revealed that applicants generally did not link payment reform tightly to disparities reduction. Most proposed general pay-for-performance, global payment, or shared savings plans, combined with multicomponent system interventions. None of the applicants proposed making any financial payments contingent on having successfully reduced disparities. Most applicants did not address how they would optimize providers' intrinsic and extrinsic motivation to reduce disparities. A better understanding of how payment and care delivery models might be designed and implemented to reduce health disparities is essential. Project HOPE—The People-to-People Health Foundation, Inc.

  16. Localization and upregulation of survivin in cancer health disparities: a clinical perspective

    Directory of Open Access Journals (Sweden)

    Khan S

    2015-07-01

    Full Text Available Salma Khan,1,2 Heather Ferguson Bennit,1,2 Malyn May Asuncion Valenzuela,1,2 David Turay,1,3 Carlos J Diaz Osterman,1,2 Ron B Moyron,1,2 Grace E Esebanmen,1,2 Arjun Ashok,1,2 Nathan R Wall1,2 1Department of Biochemistry, 2Center for Health Disparities and Molecular Medicine, 3Department of Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, USA Abstract: Survivin is one of the most important members of the inhibitors of apoptosis protein family, as it is expressed in most human cancers but is absent in normal, differentiated tissues. Lending to its importance, survivin has proven associations with apoptosis and cell cycle control, and has more recently been shown to modulate the tumor microenvironment and immune evasion as a result of its extracellular localization. Upregulation of survivin has been found in many cancers including breast, prostate, pancreatic, and hematological malignancies, and it may prove to be associated with the advanced presentation, poorer prognosis, and lower survival rates observed in ethnically diverse populations. Keywords: survivin, cancer, exosomes, health disparity

  17. Cancer Health Disparities Research: Where have we been and where should we go?

    Science.gov (United States)

    Scarlett Lin Gomez, PhD, MPH, is Professor in the Department of Epidemiology and Biostatistics and a member of the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco. She is also Director of the Greater Bay Area Cancer Registry, a part of the California Cancer Registry and the NCI Surveillance Epidemiology End Results (SEER) Program. Her research focuses primarily on cancer health disparities and aims to understand the multilevel drivers of those disparities. She has contributed surveillance data regarding cancer incidence and outcome patterns and trends for distinct Asian American, Native Hawaiian, and Pacific Islander and Hispanic ethnic groups, as well as cancer patterns by nativity status and neighborhood characteristics. She developed the California Neighborhoods Data System, a compilation of small-area level data on social and built environment characteristics, and has used these data in more than a dozen funded studies to evaluate the impact of social and built neighborhood environment factors on disease outcomes. Since 1996, Dr. Lin Gomez has received many honors and awards, including being named Author of the Year in 2010 by the American Journal of Public Health, the Above and Beyond Excellence Award in 2012 and the Mentoring Award in 2014, both by the Cancer Prevention Institute of California. She completed her education in epidemiology with an MPH at the University of Michigan, Ann Arbor, and her PhD at Stanford.

  18. Determinants of health disparities: The perennial struggle against polio in Nigeria

    Directory of Open Access Journals (Sweden)

    Nosayaba Osazuwa-Peters

    2011-01-01

    Full Text Available Polio remains a global public health issue, and even though it has been eradicated from most countries of the world, countries like Nigeria, the largest black nation on earth, threatens the dream of total eradication of polio from the surface of the earth. Transmission of wild polio virus has never been eliminated in Nigeria, but even worse is the number of countries, both in Sub-Saharan Africa and all over the world that has become re-infected by polio virus strains from Northern Nigeria in recent past. Although a lot has been documented about the Nigerian polio struggle, one aspect that has received little attention on this issue is ethnic and geographic disparities between the Southern and the Northern parts of Nigeria. Understanding these disparities involved in polio virus transmission in Nigeria, as well as the social determinants of health prevalent in Northern Nigeria will help government and other stakeholders and policy makers to synergize their efforts in the fight against this perennial scourge.

  19. Disparities in Consumption of Sugar-Sweetened and Other Beverages by Race/Ethnicity and Obesity Status among United States Schoolchildren

    Science.gov (United States)

    Dodd, Allison Hedley; Briefel, Ronette; Cabili, Charlotte; Wilson, Ander; Crepinsek, Mary Kay

    2013-01-01

    Objective: Identify disparities by race/ethnicity and obesity status in the consumption of sugar-sweetened beverages (SSBs) and other beverages among United States schoolchildren to help tailor interventions to reduce childhood obesity. Design: Secondary data analysis using beverage intake data from 24-hour dietary recalls and measured height and…

  20. Ethnicity and health: key themes in a developing field \\ud

    OpenAIRE

    Ahmad, Waqar I. U.; Bradby, Hannah

    2008-01-01

    Ethnicity is a social division that is increasingly difficult to ignore. Ethnicity has to be considered alongside other social divisions including socioeconomic status which is crucial to explaining minority disadvantages in health. Identity is a key dimension of ethnicity, which encompasses self-ascribed and externally-imposed elements. The stigma associated with particular conditions, combined with the effects of racism and economic marginalization, can be central to some minority groups' a...

  1. Distance decay and persistent health care disparities in South Africa.

    Science.gov (United States)

    McLaren, Zoë M; Ardington, Cally; Leibbrandt, Murray

    2014-11-04

    Access to health care is a particular concern given the important role of poor access in perpetuating poverty and inequality. South Africa's apartheid history leaves large racial disparities in access despite post-apartheid health policy to increase the number of health facilities, even in remote rural areas. However, even when health services are provided free of charge, monetary and time costs of travel to a local clinic may pose a significant barrier for vulnerable segments of the population, leading to overall poorer health. Using newly available health care utilization data from the first nationally representative panel survey in South Africa, together with administrative geographic data from the Department of Health, we use graphical and multivariate regression analysis to investigate the role of distance to the nearest facility on the likelihood of having a health consultation or an attended birth. Ninety percent of South Africans live within 7 km of the nearest public clinic, and two-thirds live less than 2 km away. However, 14% of Black African adults live more than 5 km from the nearest facility, compared to only 4% of Whites, and they are 16 percentage points less likely to report a recent health consultation (p apartheid but progress is still needed to achieve equity in health care access.

  2. Assumptions about culture in discourse on ethnic minority health.

    Science.gov (United States)

    Jaeger, Kirsten

    2013-01-01

    This paper is interested in the way the concept of culture is deployed in documents aimed at investigating, informing on and promoting aspects of ethnic minority health. Within a health-political discourse focusing increasingly on individual lifestyles, ethnic minority health became subject to increased political and professional interest in the last decades of the twentieth and the first decade of the twenty-first century. Analysis of the discourse on ethnic minority health emerging in five texts addressing health professionals shows that the culture of ethnic minority citizens is primarily seen as contributing to low levels of knowledge about health and to adverse health behavior. Thus, the texts present cultural beliefs and practices as contributing to the high prevalence of lifestyle diseases among ethnic minority population groups. The analysis, however, demonstrates that a more nuanced discourse is evolving, taking the complexity of the culture concept into account. In accordance with Danish health-political priorities, the most recent text analyzed in this study promotes an individualistic approach to both ethnic minority and Danish ethnic majority citizens.

  3. Health disparities in liver disease in sub-Saharan Africa.

    Science.gov (United States)

    Spearman, C Wendy; Sonderup, Mark W

    2015-09-01

    Disparities in health reflect the differences in the incidence, prevalence, burden of disease and access to care determined by socio-economic and environmental factors. With liver disease, these disparities are exacerbated by a combination of limited awareness and preventable causes of morbidity and mortality in addition to the diagnostic and management costs. Sub-Saharan Africa, comprising 11% of the world's population, disproportionately has 24% of the global disease burden, yet allocates health. It has 3% of the global healthcare workforce with a mean of 0.8 healthcare workers per 1000 population. Barriers to healthcare access are many and compounded by limited civil registration data, socio-economic inequalities, discrepancies in private and public healthcare services and geopolitical strife. The UN 2014 report on the Millennium Development Goals suggest that sub-Saharan Africa will probably not meet several goals, however with HIV/AIDS and Malaria (goal 6), many successes have been achieved. A 2010 Global Burden of Disease study demonstrated that cirrhosis mortality in sub-Saharan Africa doubled between 1980 and 2010. Aetiologies included hepatitis B (34%), hepatitis C (17%), alcohol (18%) and unknown in 31%. Hepatitis B, C and alcohol accounted for 47, 23 and 20% of hepatocellular carcinoma respectively. In 10%, the underlying aetiology was not known. Liver disease reflects the broader disparities in healthcare in sub-Saharan Africa. However, many of these challenges are not insurmountable as vaccines and new therapies could comprehensively deal with the burden of viral hepatitis. Access to and affordability of therapeutics remains the major barrier. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities).

    Science.gov (United States)

    McPheeters, Melissa L; Kripalani, Sunil; Peterson, Neeraja B; Idowu, Rachel T; Jerome, Rebecca N; Potter, Shannon A; Andrews, Jeffrey C

    2012-08-01

    This review evaluates the effectiveness of quality improvement (QI) strategies in reducing disparities in health and health care. We identified papers published in English between 1983 and 2011 from the MEDLINE® database, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science Social Science Index, and PsycINFO. All abstracts and full-text articles were dually reviewed. Studies were eligible if they reported data on effectiveness of QI interventions on processes or health outcomes in the United States such that the impact on a health disparity could be measured. The review focused on the following clinical conditions: breast cancer, colorectal cancer, diabetes, heart failure, hypertension, coronary artery disease, asthma, major depressive disorder, cystic fibrosis, pneumonia, pregnancy, and end-stage renal disease. It assessed health disparities associated with race or ethnicity, socioeconomic status, insurance status, sexual orientation, health literacy/numeracy, and language barrier. We evaluated the risk of bias of individual studies and the overall strength of the body of evidence based on risk of bias, consistency, directness, and precision. Nineteen papers, representing 14 primary research studies, met criteria for inclusion. All but one of the studies incorporated multiple components into their QI approach. Patient education was part of most interventions (12 of 14), although the specific approach differed substantially across the studies. Ten of the studies incorporated self-management; this would include, for example, teaching individuals with diabetes to check their blood sugar regularly. Most (8 of 14) included some sort of provider education, which may have focused on the clinical issue or on raising awareness about disparities affecting the target population. Studies evaluated the effect of these strategies on disparities in the prevention or treatment of breast or colorectal cancer, cardiovascular disease, depression, or

  5. The Health Effects of Income Inequality: Averages and Disparities.

    Science.gov (United States)

    Truesdale, Beth C; Jencks, Christopher

    2016-01-01

    Much research has investigated the association of income inequality with average life expectancy, usually finding negative correlations that are not very robust. A smaller body of work has investigated socioeconomic disparities in life expectancy, which have widened in many countries since 1980. These two lines of work should be seen as complementary because changes in average life expectancy are unlikely to affect all socioeconomic groups equally. Although most theories imply long and variable lags between changes in income inequality and changes in health, empirical evidence is confined largely to short-term effects. Rising income inequality can affect individuals in two ways. Direct effects change individuals' own income. Indirect effects change other people's income, which can then change a society's politics, customs, and ideals, altering the behavior even of those whose own income remains unchanged. Indirect effects can thus change both average health and the slope of the relationship between individual income and health.

  6. Disparities in quality of cancer care: The role of health insurance and population demographics.

    Science.gov (United States)

    Parikh-Patel, Arti; Morris, Cyllene R; Kizer, Kenneth W

    2017-12-01

    Escalating costs and concerns about quality of cancer care have increased calls for quality measurement and performance accountability for providers and health plans. The purpose of the present cross-sectional study was to assess variability in the quality of cancer care by health insurance type in California.Persons with breast, ovary, endometrium, cervix, colon, lung, or gastric cancer during the period 2004 to 2014 were identified in the California Cancer Registry. Individuals were stratified into 5 health insurance categories: private insurance, Medicare, Medicaid, dual Medicare and Medicaid eligible, and uninsured. Quality of care was evaluated using Commission on Cancer quality measures. Logistic regression models were generated to assess the independent effect of health insurance type on stage at diagnosis, quality of care and survival after adjusting for age, sex, race/ethnicity, and socioeconomic status (SES).A total of 763,884 cancer cases were evaluated. Individuals with Medicaid or Medicare-Medicaid dual-eligible coverage and the uninsured had significantly lower odds of receiving recommended radiation and/or chemotherapy after diagnosis or surgery for breast, endometrial, and colon cancer, relative to those with private insurance. Dual eligible patients with gastric cancer had 21% lower odds of having the recommended number of lymph nodes removed and examined compared to privately insured patients.After adjusting for known demographic confounders, substantial and consistent disparities in quality of cancer care exist according to type of health insurance in California. Further study is needed to identify particular factors and mechanisms underlying the identified treatment disparities across sources of health insurance. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  7. Ethnic minority health in Vietnam: a review exposing horizontal inequity

    Directory of Open Access Journals (Sweden)

    Mats Målqvist

    2013-03-01

    Full Text Available Background: Equity in health is a pressing concern and reaching disadvantaged populations is necessary to close the inequity gap. To date, the discourse has predominately focussed on reaching the poor. At the same time and in addition to wealth, other structural determinants that influence health outcomes exist, one of which is ethnicity. Inequities based on group belongings are recognised as ‘horizontal’, as opposed to the more commonly used notion of ‘vertical’ inequity based on individual characteristics. Objective: The aim of the present review is to highlight ethnicity as a source of horizontal inequity in health and to expose mechanisms that cause and maintain this inequity in Vietnam. Design: Through a systematic search of available academic and grey literature, 49 publications were selected for review. Information was extracted on: a quantitative measures of health inequities based on ethnicity and b qualitative descriptions explaining potential reasons for ethnicity-based health inequities. Results: Five main areas were identified: health-care-seeking and utilization, maternal and child health, nutrition, infectious diseases, and oral health and hygiene. Evidence suggests the presence of severe health inequity in health along ethnic lines in all these areas. Research evidence also offers explanations derived from both external and internal group dynamics to this inequity. It is reported that government policies and programs appear to be lacking in culturally adaptation and sensitivity, and examples of bad attitudes and discrimination from health staff toward minority persons were identified. In addition, traditions and patriarchal structures within ethnic minority groups were seen to contribute to the maintenance of harmful health behaviors within these groups. Conclusion: Better understandings of the scope and pathways of horizontal inequities are required to address ethnic inequities in health. Awareness of ethnicity as a

  8. Ethnic minority health in Vietnam: a review exposing horizontal inequity

    Science.gov (United States)

    Målqvist, Mats; Hoa, Dinh Thi Phuong; Liem, Nguyen Thanh; Thorson, Anna; Thomsen, Sarah

    2013-01-01

    Background Equity in health is a pressing concern and reaching disadvantaged populations is necessary to close the inequity gap. To date, the discourse has predominately focussed on reaching the poor. At the same time and in addition to wealth, other structural determinants that influence health outcomes exist, one of which is ethnicity. Inequities based on group belongings are recognised as ‘horizontal’, as opposed to the more commonly used notion of ‘vertical’ inequity based on individual characteristics. Objective The aim of the present review is to highlight ethnicity as a source of horizontal inequity in health and to expose mechanisms that cause and maintain this inequity in Vietnam. Design Through a systematic search of available academic and grey literature, 49 publications were selected for review. Information was extracted on: a) quantitative measures of health inequities based on ethnicity and b) qualitative descriptions explaining potential reasons for ethnicity-based health inequities. Results Five main areas were identified: health-care-seeking and utilization, maternal and child health, nutrition, infectious diseases, and oral health and hygiene. Evidence suggests the presence of severe health inequity in health along ethnic lines in all these areas. Research evidence also offers explanations derived from both external and internal group dynamics to this inequity. It is reported that government policies and programs appear to be lacking in culturally adaptation and sensitivity, and examples of bad attitudes and discrimination from health staff toward minority persons were identified. In addition, traditions and patriarchal structures within ethnic minority groups were seen to contribute to the maintenance of harmful health behaviors within these groups. Conclusion Better understandings of the scope and pathways of horizontal inequities are required to address ethnic inequities in health. Awareness of ethnicity as a determinant of health, not

  9. Defining and targeting health disparities in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Pleasants RA

    2016-10-01

    Full Text Available Roy A Pleasants,1–3 Isaretta L Riley,1–3 David M Mannino4 1Duke Asthma, Allergy, and Airways Center, 2Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, 3Durham VA Medical Center, Durham, NC, 4Division of Pulmonary, Critical Care, and Sleep Medicine, Pulmonary Epidemiology Research Laboratory, University of Kentucky, Lexington, KY, USA Abstract: The global burden of chronic obstructive pulmonary disease (COPD continues to grow in part due to better outcomes in other major diseases and in part because a substantial portion of the worldwide population continues to be exposed to inhalant toxins. However, a disproportionate burden of COPD occurs in people of low socioeconomic status (SES due to differences in health behaviors, sociopolitical factors, and social and structural environmental exposures. Tobacco use, occupations with exposure to inhalant toxins, and indoor biomass fuel (BF exposure are more common in low SES populations. Not only does SES affect the risk of developing COPD and etiologies, it is also associated with worsened COPD health outcomes. Effective interventions in these people are needed to decrease these disparities. Efforts that may help lessen these health inequities in low SES include 1 better surveillance targeting diagnosed and undiagnosed COPD in disadvantaged people, 2 educating the public and those involved in health care provision about the disease, 3 improving access to cost-effective and affordable health care, and 4 markedly increasing the efforts to prevent disease through smoking cessation, minimizing use and exposure to BF, and decreasing occupational exposures. COPD is considered to be one the most preventable major causes of death from a chronic disease in the world; therefore, effective interventions could have a major impact on reducing the global burden of the disease, especially in socioeconomically disadvantaged populations. Keywords: health disparities

  10. Ethnic Disparities of Perceived Safety Climate Among Construction Workers in Georgia, 2015.

    Science.gov (United States)

    Welton, Michael; DeJoy, David; Castellanos, Maria Eugenia; Ebell, Mark; Shen, Ye; Robb, Sara

    2017-06-22

    Safety climate involves worker perception about the relative importance where they work and safety climate and has been shown to be a reliable predictor of safety-related outcomes. The primary objective of this study is to investigate ethnic differences in perceived safety climate among construction workers. Surveys (n = 179) that included a 10-item safety climate scale were administered in Athens, Georgia (GA), at local construction sites and home improvement stores during June-August, 2015. The majority of respondents were carpenters or roofers (39%), followed by laborers (22%), painters and dry wall workers (14%), other skilled trades (14%), and supervisors (11%); 32% were Hispanic. Hispanic ethnicity (p construction workers than non-Hispanics construction workers.

  11. Racial and ethnic disparities in functional, psychosocial, and neurobehavioral outcomes after brain injury.

    Science.gov (United States)

    Arango-Lasprilla, Juan Carlos; Kreutzer, Jeffrey S

    2010-01-01

    Because of the growing minority population in the past 3 decades in the United States and the increasing numbers of individuals who sustain a traumatic brain injury (TBI), researchers and clinicians have started to pay more attention to the role of race and ethnicity in outcomes after TBI, with the goal of better serving this population. The aim of this article is to review the literature on the influence of race/ethnicity on functional, psychosocial, and neurobehavioral outcomes after TBI. Specifically, the following 8 areas of outcomes will be examined: (1) treatment outcomes, (2) neuropsychological outcomes, (3) employment/productivity, (4) functional outcomes, (5) community integration, (6) marital status, (7) quality of life/life satisfaction, and (8) emotional/neurobehavioral outcomes. To conclude this review, suggestions for improvements in professional competency, research, systems of care, and training are proposed.

  12. Ethnic disparity in stillbirth and infant mortality in Denmark 1981-2003

    DEFF Research Database (Denmark)

    Villadsen, Sarah Fredsted; Mortensen, Laust Hvas; Andersen, Anne-Marie Nybo

    2009-01-01

    .60-2.77) for Somali women. The relative risks of infant mortality were 1.41 (1.22-1.63), 1.88 (1.53-2.30), 1.39 (1.03-1.89) for children born of Turkish, Pakistani, and Somali mothers, respectively. The fetal and infant mortality in offspring of Lebanese and Former Yugoslavian women was not different from...... the mortality in the Danish group. The differences found were, in general, not attributable to ethnic differences in socioeconomic position. Turkish, Pakistani, and Somali children had an excess relative risk of infant death due to congenital malformations and the risk of death of perinatal causes was increased...... among the Pakistani offspring. CONCLUSION: Among the five largest ethnic minorities, the Turkish. Pakistani, and Somali population had substantially higher fetal and infant mortality compared to the Danish majority population, while the Lebanese and Former Yugoslavian minorities were at the same level...

  13. Disparities in prognosis communication among parents of children with cancer: The impact of race and ethnicity.

    Science.gov (United States)

    Ilowite, Maya F; Cronin, Angel M; Kang, Tammy I; Mack, Jennifer W

    2017-10-15

    Most parents of children with cancer say they want detailed information about their child's prognosis. However, prior work has been conducted in populations of limited diversity. The authors sought to evaluate the impact of parental race/ethnicity on prognosis communication experiences among parents of children with cancer. In total, 357 parents of children with cancer and the children's physicians were surveyed at Dana-Farber Cancer Institute/Boston Children's Hospital and Children's Hospital of Philadelphia. Outcome measures were parental preferences for prognostic information, physician beliefs about parental preferences, prognosis communication processes, and communication outcomes. Associations were assessed by logistic regression with generalized estimating equations to correct for physician clustering. Two hundred eighty-one parents (79%) were white, 23 (6%) were black, 29 (8%) were Hispanic, and 24 (7%) were Asian/other. Eighty-seven percent of parents wanted as much detail as possible about their child's prognosis, with no significant differences by race/ethnicity (P = .75). However, physician beliefs about parental preferences for prognosis communication varied based on parent race/ethnicity, with physicians considering black and Hispanic parents less interested in details about prognosis than whites (P = .003). Accurate understanding of a less favorable prognosis was greater among white (49%) versus nonwhite parents (range, 20%-29%), although this difference was not statistically significant (P = .14). Most parents, regardless of racial and ethnic background, want detailed prognostic information about their child's cancer. However, physicians underestimate the information needs of black and Hispanic parents. To meet parents' information needs, physicians should ask about parents' information preferences before prognosis discussions. Cancer 2017;123:3995-4003. © 2017 American Cancer Society. © 2017 American Cancer Society.

  14. Ethnic disparity in 21-hydroxylase gene mutations identified in Pakistani congenital adrenal hyperplasia patients

    Directory of Open Access Journals (Sweden)

    Jabbar Abdul

    2011-02-01

    Full Text Available Abstract Background Congenital adrenal hyperplasia (CAH is a group of autosomal recessive disorders caused by defects in the steroid 21 hydroxylase gene (CYP21A2. We studied the spectrum of mutations in CYP21A2 gene in a multi-ethnic population in Pakistan to explore the genetics of CAH. Methods A cross sectional study was conducted for the identification of mutations CYP21A2 and their phenotypic associations in CAH using ARMS-PCR assay. Results Overall, 29 patients were analyzed for nine different mutations. The group consisted of two major forms of CAH including 17 salt wasters and 12 simple virilizers. There were 14 phenotypic males and 15 females representing all the major ethnic groups of Pakistan. Parental consanguinity was reported in 65% cases and was equally distributed in the major ethnic groups. Among 58 chromosomes analyzed, mutations were identified in 45 (78.6% chromosomes. The most frequent mutation was I2 splice (27% followed by Ile173Asn (26%, Arg 357 Trp (19%, Gln319stop, 16% and Leu308InsT (12%, whereas Val282Leu was not observed in this study. Homozygosity was seen in 44% and heterozygosity in 34% cases. I2 splice mutation was found to be associated with SW in the homozygous. The Ile173Asn mutation was identified in both SW and SV forms. Moreover, Arg357Trp manifested SW in compound heterozygous state. Conclusion Our study showed that CAH exists in our population with ethnic difference in the prevalence of mutations examined.

  15. Reducing Cancer Health Disparities through Community Engagement: Working with Faith-Based Organizations (Project CHURCH)

    Science.gov (United States)

    Lorna H. McNeill, PhD, MPH, is Chair and Associate Professor in the Department of Health Disparities at the University of Texas MD Anderson Cancer Center. Dr. McNeill's research is on the elimination of cancer-related health disparities in minority populations. Her research has particular emphasis on understanding the influence of social contextual determinants of cancer in minorities, with a special focus of the role of physical activity as a key preventive behavior and obesity as a major cancer determinant. Her research takes place in minority and underserved communities such as public housing developments, black churches, community-based clinics and low-income neighborhoods-communities with excess cancer death rates. She has been continuously funded, receiving grants from various funding agencies (i.e., National Institutes of Health, Robert Wood Johnson Foundation, etc.), to better understand and design innovative solutions to address obesity in racial/ethnic minority communities. Dr. McNeill is PI of several community-based studies, primarily working with African American churches. One is a called Project CHURCH, an academic-faith-based partnership established to: 1) identify underlying reasons for health disparities in cancer and cancer risk factors (e.g., screening, diet) among AAs using a cohort study (N=2400), 2) engage AAs as partners in the research process, and 3) to ultimately eliminate disparities among AAs. In 2014 Dr. McNeill furthered her partnership through the Faith, Health, and Family (FHF) Collaborative. The goals of FHF are to enhance the Project CHURCH partnership to address family obesity in African Americans, strengthen the partnership by developing a larger coalition of organizations and stakeholders to address the problem, assess church and community interest in family obesity and develop an agenda to address obesity in faith settings. To date we have 50 churches as members. Dr. McNeill is also director of the Center for Community

  16. Model-based analyses to compare health and economic outcomes of cancer control: inclusion of disparities.

    Science.gov (United States)

    Goldie, Sue J; Daniels, Norman

    2011-09-21

    Disease simulation models of the health and economic consequences of different prevention and treatment strategies can guide policy decisions about cancer control. However, models that also consider health disparities can identify strategies that improve both population health and its equitable distribution. We devised a typology of cancer disparities that considers types of inequalities among black, white, and Hispanic populations across different cancers and characteristics important for near-term policy discussions. We illustrated the typology in the specific example of cervical cancer using an existing disease simulation model calibrated to clinical, epidemiological, and cost data for the United States. We calculated average reduction in cancer incidence overall and for black, white, and Hispanic women under five different prevention strategies (Strategies A1, A2, A3, B, and C) and estimated average costs and life expectancy per woman, and the cost-effectiveness ratio for each strategy. Strategies that may provide greater aggregate health benefit than existing options may also exacerbate disparities. Combining human papillomavirus vaccination (Strategy A2) with current cervical cancer screening patterns (Strategy A1) resulted in an average reduction of 69% in cancer incidence overall but a 71.6% reduction for white women, 68.3% for black women, and 63.9% for Hispanic women. Other strategies targeting risk-based screening to racial and ethnic minorities reduced disparities among racial subgroups and resulted in more equitable distribution of benefits among subgroups (reduction in cervical cancer incidence, white vs. Hispanic women, 69.7% vs. 70.1%). Strategies that employ targeted risk-based screening and new screening algorithms, with or without vaccination (Strategies B and C), provide excellent value. The most effective strategy (Strategy C) had a cost-effectiveness ratio of $28,200 per year of life saved when compared with the same strategy without

  17. Racial and ethnic disparities in universal cervical length screening with transvaginal ultrasound

    Science.gov (United States)

    Haviland, Miriam J; Shainker, Scott A; Hacker, Michele R; Burris, Heather H

    2016-01-01

    Objective Determine if race or ethnicity is associated with missed or late transvaginal cervical length screening in a universal screening program. Methods Retrospective cohort study of nulliparous women with singleton gestations and a fetal anatomical ultrasound from 16-24 weeks' gestation from January, 2012 through November, 2013. We classified women into mutually exclusive racial and ethnic groups: non-Hispanic black (black), Hispanic, Asian, non-Hispanic white (white), and other or unknown race. We used log-binomial regression to calculate the risk ratio (RR) and 95% confidence interval (CI) of missed or late (≥ 20 weeks' gestation) screening vs. optimally-timed screening between the different racial and ethnic groups. Results Among the 2 967 women in our study population, 971 (32.7%) had either missed or late cervical length screening. Compared to white women, black (RR: 1.3; 95% CI:1.1-1.5) and Hispanic (RR:1.2; 95% CI:1.01-1.5) women were more likely to have missed or late screening. Among women screened, black (vs. white) women were more likely to be screened late (RR: 2.2; 95% CI: 1.6-3.1). Conclusions Black and Hispanic women may be more likely to have missed or late cervical length screenings. PMID:26987873

  18. Health disparities, social injustice, and the culture of nursing.

    Science.gov (United States)

    Giddings, Lynne S

    2005-01-01

    Nurses are well positioned to challenge institutionalized social injustices that lead to health disparities. The aim of this cross-cultural study was to collect stories of difference and fairness within nursing. The study used a life history methodology informed by feminist theory and critical social theory. Life story interviews were conducted with 26 women nurses of varying racial, cultural, sexual identity, and specialty backgrounds in the United States (n = 13) and Aotearoa New Zealand (n = 13). Participants reported having some understanding of social justice issues. They were asked to reflect on their experience of difference and fairness in their lives and specifically within nursing. Their stories were analyzed using a life history immersion method. Nursing remains attached to the ideological construction of the "White good nurse." Taken-for-granted ideals privilege those who fit in and marginalize those who do not. The nurses experienced discrimination and unfairness, survived by living in two worlds, learned to live in contradiction, and worked surreptitiously for social justice. For nurses to contribute to changing the systems and structures that maintain health disparities, the privilege of not seeing difference and the processes of mainstream violence that support the construction of the "White good nurse" must be challenged. Nurses need skills to deconstruct the marginalizing social processes that sustain inequalities in nursing and healthcare. These hidden realities--racism, sexism, heterosexism, and other forms of discrimination--will then be made visible and open to challenge.

  19. Ethnic density in school classes and adolescent mental health

    NARCIS (Netherlands)

    Gieling, M.; Vollebergh, W.A.M; Dorsselaer, S. van

    2009-01-01

    Objective The present study set out to examine the association between ethnic composition of school classes and prevalence of internalising and externalising problem behaviour among ethnic minority and majority students. Methods Data were derived from the Dutch 2002 Health Behaviour in School-aged

  20. Ethnic differences in utilization of youth mental health care

    NARCIS (Netherlands)

    de Haan, A.M.; Boon, A.E.; Vermeiren, R.R.J.M.; de Jong, J.T.V.M.

    2012-01-01

    Objectives. There is an overall underutilization of youth mental health care (YMHC). It is unknown whether underutilization differs per ethnic group. Therefore, this study is aimed at gaining insight into the effects of ethnicity, age and gender on this utilization. Design. The sample consisted of

  1. A Systematic Review of Interventions to Improve Initiation of Mental Health Care Among Racial-Ethnic Minority Groups.

    Science.gov (United States)

    Lee-Tauler, Su Yeon; Eun, John; Corbett, Dawn; Collins, Pamela Y

    2018-05-02

    The objective of this systematic review was to identify interventions to improve the initiation of mental health care among racial-ethnic minority groups. The authors searched three electronic databases in February 2016 and independently assessed eligibility of 2,065 titles and abstracts on the basis of three criteria: the study design included an intervention, the participants were members of racial-ethnic minority groups and lived in the United States, and the outcome measures included initial access to or attitudes toward mental health care. The qualitative synthesis involved 29 studies. Interventions identified included collaborative care (N=10), psychoeducation (N=7), case management (N=5), colocation of mental health services within existing services (N=4), screening and referral (N=2), and a change in Medicare medication reimbursement policy that served as a natural experiment (N=1). Reduction of disparities in the initiation of antidepressants or psychotherapy was noted in seven interventions (four involving collaborative care, two involving colocation of mental health services, and one involving screening and referral). Five of these disparities-reducing interventions were tested among older adults only. Most (N=23) interventions incorporated adaptations designed to address social or cultural barriers to care. Interventions that used a model of integrated care reduced racial-ethnic disparities in the initiation of mental health care.

  2. Applying anthropology to eliminate tobacco-related health disparities.

    Science.gov (United States)

    Goldade, Kate; Burgess, Diana; Olayinka, Abimbola; Whembolua, Guy Lucien S; Okuyemi, Kolawole S

    2012-06-01

    Disparities in tobacco's harm persist. Declines in smoking among the general population have not been experienced to the same extent by vulnerable populations. Innovative strategies are required to diminish disparities in tobacco's harm. As novel tools, anthropological concepts and methods may be applied to improve the design and outcomes of tobacco cessation interventions. We reviewed over 60 articles published in peer-reviewed journals since 1995 for content on anthropology and smoking cessation. The specific questions framing the review were: (a) "How can lessons learned from anthropological studies of smoking improve the design and effectiveness of smoking cessation interventions?" (b) How can anthropology be applied to diminish disparities in smoking cessation? and (c) How can qualitative methods be used most effectively in smoking cessation intervention research? Three specific disciplinary tools were identified and examined: (a) culture, (b) reflexivity, and (c) qualitative methods. Examining culture as a dynamic influence and understanding the utilities of smoking in a particular group is a precursor to promoting cessation. Reflexivity enables a deeper understanding of how smokers perceive quitting and smoking beyond addiction and individual health consequences. Qualitative methods may be used to elicit in-depth perspectives on quitting, insights to inform existing community-based strategies for making behavior changes, and detailed preferences for cessation treatment or programs. Anthropological tools can be used to improve the effectiveness of intervention research studies targeting individuals from vulnerable groups. Synthesized applications of anthropological concepts can be used to facilitate translation of findings into clinical practice for providers addressing tobacco cessation in vulnerable populations.

  3. Racializing drug design: implications of pharmacogenomics for health disparities.

    Science.gov (United States)

    Lee, Sandra Soo-Jin

    2005-12-01

    Current practices of using "race" in pharmacogenomics research demands consideration of the ethical and social implications for understandings of group difference and for efforts to eliminate health disparities. This discussion focuses on an "infrastructure of racialization" created by current trajectories of research on genetic differences among racially identified groups, the use of race as a proxy for risk in clinical practice, and increasing interest in new market niches by the pharmaceutical industry. The confluence of these factors has resulted in the conflation of genes, disease, and race. I argue that public investment in pharmacogenomics requires careful consideration of current inequities in health status and social and ethical concerns over reifying race and issues of distributive justice.

  4. Implementing the Institute of Medicine definition of disparities: an application to mental health care.

    Science.gov (United States)

    McGuire, Thomas G; Alegria, Margarita; Cook, Benjamin L; Wells, Kenneth B; Zaslavsky, Alan M

    2006-10-01

    In a recent report, the Institute of Medicine (IOM) defines a health service disparity between population groups to be the difference in treatment or access not justified by the differences in health status or preferences of the groups. This paper proposes an implementation of this definition, and applies it to disparities in outpatient mental health care. Health Care for Communities (HCC) reinterviewed 9,585 respondents from the Community Tracking Study in 1997-1998, oversampling individuals with psychological distress, alcohol abuse, drug abuse, or mental health treatment. The HCC is designed to make national estimates of service use. Expenditures are modeled using generalized linear models with a log link for quantity and a probit model for any utilization. We adjust for group differences in health status by transforming the entire distribution of health status for minority populations to approximate the white distribution. We compare disparities according to the IOM definition to other methods commonly used to assess health services disparities. Our method finds significant service disparities between whites and both blacks and Latinos. Estimated disparities from this method exceed those for competing approaches, because of the inclusion of effects of mediating factors (such as income) in the IOM approach. A rigorous definition of disparities is needed to monitor progress against disparities and to compare their magnitude across studies. With such a definition, disparities can be estimated by adjusting for group differences in models for expenditures and access to mental health services.

  5. Racial Disparities in Health Behaviors and Conditions Among Lesbian and Bisexual Women: The Role of Internalized Stigma

    Science.gov (United States)

    Molina, Yamile; Lehavot, Keren; Beadnell, Blair; Simoni, Jane

    2013-01-01

    There are documented disparities in physical health behaviors and conditions, such as physical activity and obesity, with regard to both race/ethnicity and sexual orientation. However, physical health disparities for lesbian and bisexual (LB) women who are also racial minorities are relatively unexplored. Minority stressors, such as internalized stigma, may account for disparities in such multiply marginalized populations. We sought to (1) characterize inequalities among non-Hispanic white and African American LB women and (2) examine the roles of internalized sexism and homophobia in disparities. Data on health behaviors (diet, physical activity); physical health (hypertension, diabetes, overweight/obesity); internalized sexism; and internalized homophobia were collected via a web-based survey. Recruitment ads were sent electronically to over 200 listservs, online groups, and organizations serving the lesbian, gay, and bisexual community in all 50 U.S. states. The analytic sample consisted of 954 white and 75 African American LB women. African American participants were more likely than white participants to report low fruit/vegetable intake and physical activity, a higher body mass index, and a history of diabetes and hypertension. There were no racial differences in internalized homophobia, but African American women reported higher levels of internalized sexism. Internalized sexism partially mediated racial disparities in physical activity and diabetes, but not in the other outcomes. Findings suggest that African American LB women may be at greater risk than their white counterparts for poor health and that internalized sexism may be a mediator of racial differences for certain behaviors and conditions. PMID:25364769

  6. Unintentional, non-fatal drowning of children: US trends and racial/ethnic disparities.

    Science.gov (United States)

    Felton, Heather; Myers, John; Liu, Gil; Davis, Deborah Winders

    2015-12-15

    The current study aimed to better understand trends and risk factors associated with non-fatal drowning of infants and children in the USA using two large, national databases. A secondary data analysis was conducted using the National Inpatient Sample and the Nationwide Emergency Department Sample databases. The analytic sample (n=19,403) included children near-drowning/non-fatal drowning. Descriptive, χ(2) and analysis of variance techniques were applied, and incidence rates were calculated per 100,000 population. Non-fatal drowning incidence has remained relatively stable from 2006 to 2011. In general, the highest rates of non-fatal drowning occurred in swimming pools and in children from racial/ethnic minorities. However, when compared with non-Hispanic Caucasian children, children from racial/ethnic minorities were more likely to drown in natural waterways than in swimming pools. Despite the overall lower rate of non-fatal drowning among non-Hispanic Caucasian children, the highest rate of all non-fatal drowning was for non-Hispanic Caucasian children aged 0-4 years in swimming pools. Children who were admitted to inpatient facilities were younger, male and came from families with lower incomes. Data from two large US national databases show lack of progress in preventing and reducing non-fatal drowning admissions from 2006 to 2011. Discrepancies are seen in the location of drowning events and demographic characteristics. New policies and interventions are needed, and tailoring approaches by age and race/ethnicity may improve their effectiveness. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Racial/ethnic disparities in prevalence and care of patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Ferdinand, Keith C; Nasser, Samar A

    2015-05-01

    As of 2012, nearly 10% of Americans had diabetes mellitus. People with diabetes are at approximately double the risk of premature death compared with those in the same age groups without the condition. While the prevalence of diabetes has risen across all racial/ethnic groups over the past 30 years, rates are higher in minority populations. The objective of this review article is to evaluate the prevalence of diabetes and disease-related comorbidities as well as the primary endpoints of clinical studies assessing glucose-lowering treatments in African Americans, Hispanics, and Asians. As part of our examination of this topic, we reviewed epidemiologic and outcome publications. Additionally, we performed a comprehensive literature search of clinical trials that evaluated glucose-lowering drugs in racial minority populations. For race/ethnicity, we used the terms African American, African, Hispanic, and Asian. We searched PubMed for clinical trial results from 1996 to 2015 using these terms by drug class and specific drug. Search results were filtered qualitatively. Overall, the majority of publications that fit our search criteria pertained to native Asian patient populations (i.e., Asian patients in Asian countries). Sulfonylureas; the α-glucosidase inhibitor, miglitol; the biguanide, metformin; and the thiazolidinedione, rosiglitazone have been evaluated in African American and Hispanic populations, as well as in Asians. The literature on other glucose-lowering drugs in non-white races/ethnicities is more limited. Clinical data are needed for guiding diabetes treatment among racial minority populations. A multi-faceted approach, including vigilant screening in at-risk populations, aggressive treatment, and culturally sensitive patient education, could help reduce the burden of diabetes on minority populations. To ensure optimal outcomes, educational programs that integrate culturally relevant approaches should highlight the importance of risk-factor control in

  8. Distress, race/ethnicity and smoking cessation in treatment-seekers: implications for disparity elimination.

    Science.gov (United States)

    Webb Hooper, Monica; Kolar, Stephanie K

    2015-09-01

    Distress is a modifiable risk factor for smoking maintenance. This study aimed to assess racial/ethnic differences in distress pre- and post-cognitive-behavioral therapy (CBT) for smoking cessation, and relations with abstinence. Analyses of variance and logistic regressions were conducted. University-based smoking cessation laboratory in South Florida, USA. The sample comprised 234 treatment-seekers recruited from the community (18% white, 60% African American and 22% Hispanic). All participants received eight sessions of group CBT plus 8 weeks of transdermal nicotine patches (TNP). Demographics and smoking history [baseline], perceived stress and depressive symptoms [baseline and end of therapy (EOT)], carbon monoxide-verified 7-day point prevalence abstinence (p.p.a.) at EOT, 3 months post-CBT (primary outcome) and 6 months (self-report). Compared with whites, African Americans reported greater baseline perceived stress (P = 0.03) and depressive symptoms (P = 0.06); no EOT differences were found. African Americans (P perceived stress reduction, and African Americans reported greater reductions in depressive symptoms (P perceived stress (adjusted odds ratio (AOR) = 0.93 (0.89-0.98)) and depressive symptoms [AOR = 0.96 (0.93-0.99)] were associated inversely with 7-day p.p.a. at 3 months. Reductions in perceived stress [AOR = 0.93 (0.89-0.98)] and depressive symptoms at the EOT [AOR = 0.96 (0.93-0.99)] were associated with cessation, such that reduced distress increased the odds of abstinence. The interactions between race/ethnicity and distress on 7-day p.p.a. were not significant at any assessment point. Among smokers in Florida, USA, racial/ethnic differences in distress before starting cognitive-behavioral therapy for smoking cessation were eliminated at the end of treatment, driven by improvements among African Americans and Hispanics. High levels of distress were associated with reduced odds of abstinence through 6

  9. Understanding health literacy for strategic health marketing: eHealth literacy, health disparities, and the digital divide.

    Science.gov (United States)

    Bodie, Graham D; Dutta, Mohan Jyoti

    2008-01-01

    Even despite policy efforts aimed at reducing health-related disparities, evidence mounts that population-level gaps in literacy and healthcare quality are increasing. This widening of disparities in American culture is likely to worsen over the coming years due, in part, to our increasing reliance on Internet-based technologies to disseminate health information and services. The purpose of the current article is to incorporate health literacy into an Integrative Model of eHealth Use. We argue for this theoretical understanding of eHealth literacy and propose that macro-level disparities in social structures are connected to health disparities through the micro-level conduits of eHealth literacy, motivation, and ability. In other words, structural inequities reinforce themselves and continue to contribute to healthcare disparities through the differential distribution of technologies that simultaneously enhance and impede literacy, motivation, and ability of different groups (and individuals) in the population. We conclude the article by suggesting pragmatic implications of our analysis.

  10. Unhealthy interactions: the role of stereotype threat in health disparities.

    Science.gov (United States)

    Aronson, Joshua; Burgess, Diana; Phelan, Sean M; Juarez, Lindsay

    2013-01-01

    Stereotype threat is the unpleasant psychological experience of confronting negative stereotypes about race, ethnicity, gender, sexual orientation, or social status. Hundreds of published studies show how the experience of stereotype threat can impair intellectual functioning and interfere with test and school performance. Numerous published interventions derived from this research have improved the performance and motivation of individuals targeted by low-ability stereotypes. Stereotype threat theory and research provide a useful lens for understanding and reducing the negative health consequences of interracial interactions for African Americans and members of similarly stigmatized minority groups. Here we summarize the educational outcomes of stereotype threat and examine the implications of stereotype threat for health and health-related behaviors.

  11. Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Cruz-Flores, Salvador; Rabinstein, Alejandro; Biller, Jose; Elkind, Mitchell S V; Griffith, Patrick; Gorelick, Philip B; Howard, George; Leira, Enrique C; Morgenstern, Lewis B; Ovbiagele, Bruce; Peterson, Eric; Rosamond, Wayne; Trimble, Brian; Valderrama, Amy L

    2011-07-01

    Our goal is to describe the effect of race and ethnicity on stroke epidemiology, personal beliefs, access to care, response to treatment, and participation in clinical research. In addition, we seek to determine the state of knowledge on the main factors that may explain disparities in stroke care, with the goal of identifying gaps in knowledge to guide future research. The intended audience includes physicians, nurses, other healthcare professionals, and policy makers. Members of the writing group were appointed by the American Heart Association Stroke Council Scientific Statement Oversight Committee and represent different areas of expertise in relation to racial-ethnic disparities in stroke care. The writing group reviewed the relevant literature, with an emphasis on reports published since 1972. The statement was approved by the writing group; the statement underwent peer review, then was approved by the American Heart Association Science Advisory and Coordinating Committee. There are limitations in the definitions of racial and ethnic categories currently in use. For the purpose of this statement, we used the racial categories defined by the US federal government: white, black or African American, Asian, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander. There are 2 ethnic categories: people of Hispanic/Latino origin or not of Hispanic/Latino origin. There are differences in the distribution of the burden of risk factors, stroke incidence and prevalence, and stroke mortality among different racial and ethnic groups. In addition, there are disparities in stroke care between minority groups compared with whites. These disparities include lack of awareness of stroke symptoms and signs and lack of knowledge about the need for urgent treatment and the causal role of risk factors. There are also differences in attitudes, beliefs, and compliance among minorities compared with whites. Differences in socioeconomic status and insurance coverage

  12. Improving Service Coordination and Reducing Mental Health Disparities Through Adoption of Electronic Health Records.

    Science.gov (United States)

    McGregor, Brian; Mack, Dominic; Wrenn, Glenda; Shim, Ruth S; Holden, Kisha; Satcher, David

    2015-09-01

    Despite widespread support for removing barriers to the use of electronic health records (EHRs) in behavioral health care, adoption of EHRs in behavioral health settings lags behind adoption in other areas of health care. The authors discuss barriers to use of EHRs among behavioral health care practitioners, suggest solutions to overcome these barriers, and describe the potential benefits of EHRs to reduce behavioral health care disparities. Thoughtful and comprehensive strategies will be needed to design EHR systems that address concerns about policy, practice, costs, and stigma and that protect patients' privacy and confidentiality. However, these goals must not detract from continuing to challenge the notion that behavioral health and general medical health should be treated as separate and distinct. Ultimately, utilization of EHRs among behavioral health care providers will improve the coordination of services and overall patient care, which is essential to reducing mental health disparities.

  13. Ethnic/racial disparities in adolescents' home food environments and linkages to dietary intake and weight status.

    Science.gov (United States)

    Larson, Nicole; Eisenberg, Marla E; Berge, Jerica M; Arcan, Chrisa; Neumark-Sztainer, Dianne

    2015-01-01

    Research is needed to confirm that public health recommendations for home/family food environments are equally relevant for diverse populations. This study examined ethnic/racial differences in the home/family environments of adolescents and associations with dietary intake and weight status. The sample included 2374 ethnically/racially diverse adolescents and their parents enrolled in coordinated studies, EAT 2010 (Eating and Activity in Teens) and Project F-EAT (Families and Eating and Activity in Teens), in the Minneapolis/St. Paul metropolitan area. Adolescents and parents completed surveys and adolescents completed anthropometric measurements in 2009-2010. Nearly all home/family environment variables (n=7 of 8 examined) were found to vary significantly across the ethnic/racial groups. Several of the home/family food environment variables were significantly associated with one or more adolescent outcome in expected directions. For example, parental modeling of healthy food choices was inversely associated with BMI z-score (p=0.03) and positively associated with fruit/vegetable consumption (peating was associated with lower intake of sugar-sweetened beverages only among youth representing the White, African American, Asian, and mixed/other ethnic/racial groups and was unrelated to intake among East African, Hispanic, and Native American youth. Food and nutrition professionals along with other providers of health programs and services for adolescents should encourage ethnically/racially diverse parents to follow existing recommendations to promote healthy eating such as modeling nutrient-dense food choices, but also recognize the need for cultural sensitivity in providing such guidance. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Ethnic variations in upper gastrointestinal hospitalizations and deaths: the Scottish Health and Ethnicity Linkage Study.

    Science.gov (United States)

    Cezard, Genevieve I; Bhopal, Raj S; Ward, Hester J T; Bansal, Narinder; Bhala, Neeraj

    2016-04-01

    Upper gastrointestinal (GI) diseases are common, but there is a paucity of data describing variations by ethnic group and so a lack of understanding of potential health inequalities. We studied the incidence of specific upper GI hospitalization and death by ethnicity in Scotland. Using the Scottish Health and Ethnicity Linkage Study, linking NHS hospitalizations and mortality to the Scottish Census 2001, we explored ethnic differences in incidence (2001-10) of oesophagitis, peptic ulcer disease, gallstone disease and pancreatitis. Relative Risks (RRs) and 95% confidence intervals were calculated using Poisson regression, multiplied by 100, stratified by sex and adjusted for age, country of birth (COB) and socio-economic position. The White Scottish population (100) was the reference population. Ethnic variations varied by outcome and sex, e.g. adjusted RRs (95% confidence intervals) for oesophagitis were comparatively higher in Bangladeshi women (209; 124-352) and lower in Chinese men (65; 51-84) and women (69; 55-88). For peptic ulcer disease, RRs were higher in Chinese men (171; 131-223). Pakistani women had higher RRs for gallstone disease (129; 112-148) and pancreatitis (147; 109-199). The risks of upper GI diseases were lower in Other White British and Other White [e.g. for peptic ulcer disease in men, respectively (74; 64-85) and (81; 69-94)]. Risks of common upper GI diseases were comparatively lower in most White ethnic groups in Scotland. In non-White groups, however, risk varied by disease and ethnic group. These results require consideration in health policy, service planning and future research. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  15. Identifying Health Consumers' eHealth Literacy to Decrease Disparities in Accessing eHealth Information.

    Science.gov (United States)

    Park, Hyejin; Cormier, Eileen; Gordon, Glenna; Baeg, Jung Hoon

    2016-02-01

    The increasing amount of health information available on the Internet highlights the importance of eHealth literacy skills for health consumers. Low eHealth literacy results in disparities in health consumers' ability to access and use eHealth information. The purpose of this study was to assess the perceived eHealth literacy of a general health consumer population so that healthcare professionals can effectively address skills gaps in health consumers' ability to access and use high-quality online health information. Participants were recruited from three public library branches in a Northeast Florida community. The eHealth Literacy Scale was used. The majority of participants (n = 108) reported they knew how and where to find health information and how to use it to make health decisions; knowledge of what health resources were available and confidence in the ability to distinguish high- from low-quality information were considerably less. The findings suggest the need for eHealth education and support to health consumers from healthcare professionals, in particular, how to access and evaluate the quality of health information.

  16. Total sulfane sulfur bioavailability reflects ethnic and gender disparities in cardiovascular disease

    Directory of Open Access Journals (Sweden)

    Saurabh Rajpal

    2018-05-01

    Full Text Available Hydrogen sulfide (H2S has emerged as an important physiological and pathophysiological signaling molecule in the cardiovascular system influencing vascular tone, cytoprotective responses, redox reactions, vascular adaptation, and mitochondrial respiration. However, bioavailable levels of H2S in its various biochemical metabolite forms during clinical cardiovascular disease remain poorly understood. We performed a case-controlled study to quantify and compare the bioavailability of various biochemical forms of H2S in patients with and without cardiovascular disease (CVD. In our study, we used the reverse-phase high performance liquid chromatography monobromobimane assay to analytically measure bioavailable pools of H2S. Single nucleotide polymorphisms (SNPs were also identified using DNA Pyrosequencing. We found that plasma acid labile sulfide levels were significantly reduced in Caucasian females with CVD compared with those without the disease. Conversely, plasma bound sulfane sulfur levels were significantly reduced in Caucasian males with CVD compared with those without the disease. Surprisingly, gender differences of H2S bioavailability were not observed in African Americans, although H2S bioavailability was significantly lower overall in this ethnic group compared to Caucasians. We also performed SNP analysis of H2S synthesizing enzymes and found a significant increase in cystathionine gamma-lyase (CTH 1364 G-T allele frequency in patients with CVD compared to controls. Lastly, plasma H2S bioavailability was found to be predictive for cardiovascular disease in Caucasian subjects as determined by receiver operator characteristic analysis. These findings reveal that plasma H2S bioavailability could be considered a biomarker for CVD in an ethnic and gender manner. Cystathionine gamma-lyase 1346 G-T SNP might also contribute to the risk of cardiovascular disease development.

  17. Total sulfane sulfur bioavailability reflects ethnic and gender disparities in cardiovascular disease.

    Science.gov (United States)

    Rajpal, Saurabh; Katikaneni, Pavan; Deshotels, Matthew; Pardue, Sibile; Glawe, John; Shen, Xinggui; Akkus, Nuri; Modi, Kalgi; Bhandari, Ruchi; Dominic, Paari; Reddy, Pratap; Kolluru, Gopi K; Kevil, Christopher G

    2018-05-01

    Hydrogen sulfide (H 2 S) has emerged as an important physiological and pathophysiological signaling molecule in the cardiovascular system influencing vascular tone, cytoprotective responses, redox reactions, vascular adaptation, and mitochondrial respiration. However, bioavailable levels of H 2 S in its various biochemical metabolite forms during clinical cardiovascular disease remain poorly understood. We performed a case-controlled study to quantify and compare the bioavailability of various biochemical forms of H 2 S in patients with and without cardiovascular disease (CVD). In our study, we used the reverse-phase high performance liquid chromatography monobromobimane assay to analytically measure bioavailable pools of H 2 S. Single nucleotide polymorphisms (SNPs) were also identified using DNA Pyrosequencing. We found that plasma acid labile sulfide levels were significantly reduced in Caucasian females with CVD compared with those without the disease. Conversely, plasma bound sulfane sulfur levels were significantly reduced in Caucasian males with CVD compared with those without the disease. Surprisingly, gender differences of H 2 S bioavailability were not observed in African Americans, although H 2 S bioavailability was significantly lower overall in this ethnic group compared to Caucasians. We also performed SNP analysis of H 2 S synthesizing enzymes and found a significant increase in cystathionine gamma-lyase (CTH) 1364 G-T allele frequency in patients with CVD compared to controls. Lastly, plasma H 2 S bioavailability was found to be predictive for cardiovascular disease in Caucasian subjects as determined by receiver operator characteristic analysis. These findings reveal that plasma H 2 S bioavailability could be considered a biomarker for CVD in an ethnic and gender manner. Cystathionine gamma-lyase 1346 G-T SNP might also contribute to the risk of cardiovascular disease development. Copyright © 2018 The Authors. Published by Elsevier B.V. All

  18. Reducing health disparities: the social role of medical schools.

    Science.gov (United States)

    Dopelt, Keren; Davidovitch, Nadav; Yahav, Zehava; Urkin, Jacob; Bachner, Yaacov G

    2014-06-01

    Medical education based on the principles of social medicine can contribute toward reducing health disparities through the "creation" of doctors who are more involved in community programs. This study compared the social medicine orientation of graduates from various medical schools in Israel. The authors conducted an online cross-sectional survey in May 2011 among physicians who are graduates of Israeli medical schools. The study included 1050 physicians practicing medicine in Israel: 36% who are graduates from the Hebrew University, 26% from Tel Aviv University, 22% from the Technion and 16% from Ben-Gurion University. A greater percentage of physicians who studied either at the Technion or Ben-Gurion are working or have worked in the periphery (∼50% vs. ∼30% at the Hebrew and Tel Aviv Universities). Among Ben-Gurion graduates, 47% are active in social medicine programs vs. 34-38% from other schools. Among physicians active in social medicine programs, 32% of Ben-Gurion alumni estimated that their medical education greatly influenced their social medicine involvement vs. 8-15% from other schools. Hebrew University alumni described their studies as more research-oriented. In contrast, Ben-Gurion graduates described their studies as more social medicine-oriented and they exhibited more positive attitudes about the role of physicians in reducing health disparities. Social medicine-oriented medical education induces a socialization process reinforcing human values regarding doctor-patient relationships and produces positive attitudes among future doctors about social involvement. Findings emphasize the need to develop educational programs with this orientation and to strengthen medical schools in the periphery.

  19. Rural-Urban Disparities in Health and Health Care in Africa: Cultural ...

    African Journals Online (AJOL)

    Rural-Urban Disparities in Health and Health Care in Africa: Cultural Competence, Lay-beliefs in Narratives of Diabetes among the Rural Poor in the Eastern Cape ... to exist in the utilization of cardiac diagnostic and therapeutic procedures, prescription of analgesia for pains, treatment of diabetes (e.g. gym exercise).

  20. 77 FR 66623 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2012-11-06

    ... and Health Disparities Special Emphasis Panel; NIMHD Community-Based Participatory Research (CBPR... Marriott Suites, 6711 Democracy Boulevard, Bethesda, MD 20817. Contact Person: Robert Nettey, M.D., Chief... of Health, 6707 Democracy Blvd., Suite 800, Bethesda, MD 20892, (301) 496-3996, [email protected

  1. Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care

    Science.gov (United States)

    Davitt, Joan K.

    2014-01-01

    Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…

  2. Race/Ethnic Differences in Adult Mortality: The Role of Perceived Stress and Health Behaviors*

    Science.gov (United States)

    Krueger, Patrick M.; Saint Onge, Jarron M.; Chang, Virginia W.

    2011-01-01

    We examine the role of perceived stress and health behaviors (i.e., cigarette smoking, alcohol consumption, physical inactivity, sleep duration) in shaping differential mortality among whites, blacks, and Hispanics. We use data from the 1990 National Health Interview Survey (N=38,891), a nationally representative sample of United States adults, to model prospective mortality through 2006. Our first aim examines whether unhealthy behaviors and perceived stress mediate race/ethnic disparities in mortality. The black disadvantage in mortality, relative to whites, closes after adjusting for socioeconomic status (SES), but re-emerges after adjusting for the lower smoking levels among blacks. After adjusting for SES, Hispanics have slightly lower mortality than whites; that advantage increases after adjusting for the greater physical inactivity among Hispanics, but closes after adjusting for their lower smoking levels. Perceived stress, sleep duration, and alcohol consumption do not mediate race/ethnic disparities in mortality. Our second aim tests competing hypotheses about race/ethnic differences in the relationships among unhealthy behaviors, perceived stress, and mortality. The social vulnerability hypothesis predicts that unhealthy behaviors and high stress levels will be more harmful for race/ethnic minorities. In contrast, the Blaxter (1990) hypothesis predicts that unhealthy lifestyles will be less harmful for disadvantaged groups. Consistent with the social vulnerability perspective, smoking is more harmful for blacks than for whites. But consistent with the Blaxter hypothesis, compared to whites, current smoking has a weaker relationship with mortality for Hispanics, and low or high levels of alcohol consumption, high levels of physical inactivity, and short or long sleep hours have weaker relationships with mortality for blacks. PMID:21920655

  3. Disparities in children's oral health and access to dental care.

    Science.gov (United States)

    Mouradian, W E; Wehr, E; Crall, J J

    Dental caries can be prevented by a combination of community, professional, and individual measures including water fluoridation, professionally applied topical fluorides and dental sealants, and use of fluoride toothpastes. Yet, tooth decay is the most common chronic disease of childhood. Dental care is the most prevalent unmet health need in US children with wide disparities existing in oral health and access to care. Only 1 in 5 children covered by Medicaid received preventive oral care for which they are eligible. Children from low income and minority families have poorer oral health outcomes, fewer dental visits, and fewer protective sealants. Water fluoridation is the most effective measure in preventing caries, but only 62% of water supplies are fluoridated, and lack of fluoridation may disproportionately affect poor and minority children. Childhood oral disease has significant medical and financial consequences that may not be appreciated because of the separation of medicine and dentistry. The infectious nature of dental caries, its early onset, and the potential of early interventions require an emphasis on preventive oral care in primary pediatric care to complement existing dental services. However, many pediatricians lack critical knowledge to promote oral health. We recommend financial incentives for prioritizing Medicaid Early and Periodic Screening, Diagnostic, and Treatment dental services; managed care accountability; integration of medical and dental professional training, clinical care, and research; and national leadership. JAMA. 2000;284:2625-2631.

  4. Gender disparities in health: attending to the particulars.

    Science.gov (United States)

    McGrath, Barbara Burns; Puzan, Elayne

    2004-03-01

    As we get a feel for this new century, collective creativity is called for while we confront the challenges presented. Globalization, with its flow of ideas, people, and materials is no longer a theoretical concept and its advantages and disadvantages are becoming clear. While the axiom that "all politics are local" remains relevant, world events touch all corners of the globe. In the world of science, there are exciting advances being made,but many of these are accompanied by concerns about unequal access to biomedicine and technology, and misplaced health care priorities. One of the effects of transnationalism is that multiculturalism becomes the norm so that the label "minority" begins to lose its meaning. In the field of women's health, the issues have not changed as much as the conceptualization of them. The fact that biology and society contribute to sex differences is well known, but understanding how these interact at all levels (from the molecular to the community level) requires innovative research strategies. Efforts to describe gender disparities in health status are inadequate unless they are linked with actions that will improve the well being of diverse populations. An approach suggested in this article is to direct research and policy attention to the lifestyles and needs of particular women living in a particular time and place in society. This is the first step before meaningful interventions can be implemented and the women's health paradigm expanded.

  5. Social justice, health disparities, and culture in the care of the elderly.

    Science.gov (United States)

    Dilworth-Anderson, Peggye; Pierre, Geraldine; Hilliard, Tandrea S

    2012-01-01

    Older minority Americans experience worse health outcomes than their white counterparts, exhibiting the need for social justice in all areas of their health care. Justice, fairness, and equity are crucial to minimizing conditions that adversely affect the health of individuals and communities. In this paper, Alzheimer's disease (AD) is used as an example of a health care disparity among elderly Americans that requires social justice interventions. Cultural factors play a crucial role in AD screening, diagnosis, and access to care, and are often a barrier to support and equality for minority communities. The "conundrum of health disparities" refers to the interplay between disparity, social justice, and cultural interpretation, and encourages researchers to understand both (1) disparity caused by economic and structural barriers to access, treatment, and diagnosis, and (2) disparity due to cultural interpretation of disease, in order to effectively address health care issues and concerns among elderly Americans. © 2012 American Society of Law, Medicine & Ethics, Inc.

  6. Reducing Health Disparities and Improving Health Equity in Saint Lucia

    Directory of Open Access Journals (Sweden)

    Kisha Holden

    2015-12-01

    Full Text Available St. Lucia is an island nation in the Eastern Caribbean, with a population of 179,000 people, where chronic health conditions, such as hypertension and diabetes, are significant. The purpose of this pilot study is to create a model for community health education, tracking, and monitoring of these health conditions, research training, and policy interventions in St. Lucia, which may apply to other Caribbean populations, including those in the U.S. This paper reports on phase one of the study, which utilized a mixed method analytic approach. Adult clients at risk for, or diagnosed with, diabetes (n = 157, and health care providers/clinic administrators (n = 42, were recruited from five healthcare facilities in St. Lucia to assess their views on health status, health services, and improving health equity. Preliminary content analyses indicated that patients and providers acknowledge the relatively high prevalence of diabetes and other chronic illnesses, recognize the impact that socioeconomic status has on health outcomes, and desire improved access to healthcare and improvements to healthcare infrastructures. These findings could inform strategies, such as community education and workforce development, which may help improve health outcomes among St. Lucians with chronic health conditions, and inform similar efforts among other selected populations.

  7. Reducing Health Disparities and Improving Health Equity in Saint Lucia.

    Science.gov (United States)

    Holden, Kisha; Charles, Lisa; King, Stephen; McGregor, Brian; Satcher, David; Belton, Allyson

    2015-12-22

    St. Lucia is an island nation in the Eastern Caribbean, with a population of 179,000 people, where chronic health conditions, such as hypertension and diabetes, are significant. The purpose of this pilot study is to create a model for community health education, tracking, and monitoring of these health conditions, research training, and policy interventions in St. Lucia, which may apply to other Caribbean populations, including those in the U.S. This paper reports on phase one of the study, which utilized a mixed method analytic approach. Adult clients at risk for, or diagnosed with, diabetes (n = 157), and health care providers/clinic administrators (n = 42), were recruited from five healthcare facilities in St. Lucia to assess their views on health status, health services, and improving health equity. Preliminary content analyses indicated that patients and providers acknowledge the relatively high prevalence of diabetes and other chronic illnesses, recognize the impact that socioeconomic status has on health outcomes, and desire improved access to healthcare and improvements to healthcare infrastructures. These findings could inform strategies, such as community education and workforce development, which may help improve health outcomes among St. Lucians with chronic health conditions, and inform similar efforts among other selected populations.

  8. Sex and Race Disparities in Health: Cohort Variations in Life Course Patterns

    Science.gov (United States)

    Yang, Yang; Lee, Linda C.

    2009-01-01

    This study assesses changes in sex and race disparities in health over the life course and across cohorts by conducting growth curve analyses of nationally representative longitudinal data that spans 15 years. It finds that changes in disparities in depressive symptoms, disability and self-assessments of health across the life course are…

  9. Disparities in the Use of Preventive Health Care among Children with Disabilities in Taiwan

    Science.gov (United States)

    Tsai, Wen-Chen; Kung, Pei-Tseng; Wang, Jong-Yi

    2012-01-01

    Children with disabilities face more barriers accessing preventive health services. Prior research has documented disparities in the receipt of these services. However, most are limited to specific types of disability or care. This study investigates disparities in the use of preventive health care among children with disabilities in Taiwan. Three…

  10. Ethnic Disparities in Endothelial Function and Its Cardiometabolic Correlates: The Pathobiology of Prediabetes in A Biracial Cohort Study

    Directory of Open Access Journals (Sweden)

    Ibiye Owei

    2018-03-01

    association between RHI and age, glucose and HDL cholesterol displayed marked ethnic disparities.ConclusionIn our biracial cohort comprising offspring of parents with T2D, prediabetes increased the risk of endothelial dysfunction. However, the association between EF and cardiometabolic risk factors was significantly modified by ethnicity and gender. Our findings support current understanding of endothelial dysfunction as an early sensitive indicator of cardiometabolic risk.

  11. Sex and race/ethnic disparities in the cross-sectional association between depressive symptoms and muscle mass: the Multi-ethnic Study of Atherosclerosis.

    Science.gov (United States)

    Remigio-Baker, Rosemay A; Allison, Matthew A; Schreiner, Pamela J; Carnethon, Mercedes R; Nettleton, Jennifer A; Mujahid, Mahasin S; Szklo, Moyses; Crum, Rosa M; Leuotsakos, Jeannie-Marie; Franco, Manuel; Jensky, Nicole; Golden, Sherita Hill

    2015-09-18

    The cross-sectional area of total muscle mass has been reported to decrease by about 40% for those 20-60 years of age. Depressive symptoms may discourage motivation to engage in physical activity such as strength training shown to negate muscle loss. Inflammation related to depressive symptoms may also contribute to muscle atrophy. Physiological differences by sex and race/ethnicity may also modify the association between depression and muscle mass. Evidence on the relationship between depression (or depressive symptoms) and adiposity has been mounting; however, little is known about the depressive symptoms-muscle mass association. We sought to determine the association between elevated depressive symptoms (EDS) and lean muscle mass and whether this varies by sex and race/ethnicity. Evaluating 1605 adults (45-84 years of age) from the Multi-ethnic Study of Atherosclerosis Abdominal Body Composition, Inflammation and Cardiovascular Disease Study, we examined the cross-sectional association between EDS (Center for Epidemiologic Studies for Depression Scale score≥16 and/or antidepressant use) and computed tomography-measured abdominal lean muscle mass using linear regression. Muscles were evaluated as a whole and by functionality (locomotion vs. stabilization/posture). Covariates included height, body mass index, sociodemographics, comorbidities, inflammatory markers and health behaviors (pack-years of smoking, alcohol locomotion compared to men, total intentional exercise, daily caloric intake). Sex and race/ethnicity were assessed as potential modifiers. Statistical significance was at a pdepressive symptoms had 5.9 cm2 lower lean muscle mass for locomotion compared to men without EDS, fully-adjusted (CI=-10.5, -1.4, p=0.011). This was statistically significantly different from the null finding among women (interaction p=0.05). Chinese participants with EDS had 10.2 cm2 lower abdominal lean muscle mass for locomotion compared to those without EDS (fully

  12. Ethnic and cultural diversity: challenges and opportunities for health law.

    Science.gov (United States)

    Hendriks, Aart

    2008-09-01

    Guaranteeing equal health care of appropriate quality implies taking ethnic and cultural diversity into account, without over- or underestimating the importance of these grounds. Besides awareness of its relevance, it is essential to have disaggregated data to better understand the relationship between ethnicity and culture on the one hand and health and health care on the other hand. From a health law perspective, it is a prerequisite to understand the conceptual and normative meaning of equality and non-discrimination, also in relation to the right to privacy, and to be aware of the need to collaborate with other legal and non-legal disciplines.

  13. Cultural competence and perceptions of community health workers' effectiveness for reducing health care disparities.

    Science.gov (United States)

    Mobula, Linda M; Okoye, Mekam T; Boulware, L Ebony; Carson, Kathryn A; Marsteller, Jill A; Cooper, Lisa A

    2015-01-01

    Community health worker (CHW) interventions improve health outcomes of patients from underserved communities, but health professionals' perceptions of their effectiveness may impede integration of CHWs into health care delivery systems. Whether health professionals' attitudes and skills, such as those related to cultural competence, influence perceptions of CHWs, is unknown. A questionnaire was administered to providers and clinical staff from 6 primary care practices in Maryland from April to December 2011. We quantified the associations of self-reported cultural competence and preparedness with attitudes toward the effectiveness of CHWs using logistic regression adjusting for respondent age, race, gender, provider/staff status, and years at the practice. We contacted 200 providers and staff, and 119 (60%) participated. Those reporting more cultural motivation had higher odds of perceiving CHWs as helpful for reducing health care disparities (odds ratio [OR] = 9.66, 95% confidence interval [CI] = 3.48-28.80). Those reporting more frequent culturally competent behaviors also had higher odds of believing CHWs would help reduce health disparities (OR = 3.58, 95% CI = 1.61-7.92). Attitudes toward power and assimilation were not associated with perceptions of CHWs. Cultural preparedness was associated with perceived utility of CHWs in reducing health care disparities (OR = 2.33, 95% CI = 1.21-4.51). Providers and staff with greater cultural competence and preparedness have more positive expectations of CHW interventions to reduce healthcare disparities. Cultural competency training may complement the use of CHWs and support their effective integration into primary care clinics that are seeking to reduce disparities. © The Author(s) 2014.

  14. Disparities in health in the United States: An overview of the social determinants of health for otolaryngologists.

    Science.gov (United States)

    Bergmark, Regan W; Sedaghat, Ahmad R

    2017-08-01

    Social determinants of health include social and demographic factors such as poverty, education status, race and ethnicity, gender, insurance status, and other factors that influence (1) development of illness, (2) ability to obtain and utilize healthcare, and (3) health and healthcare outcomes. In otolaryngology, as in other subspecialty surgical fields, we are constantly confronted by patients' social and demographic circumstances including poverty, language barriers, and lack of health insurance and yet there is limited research on how these factors impact health equity in our field, or how attention to these patient characteristics may improve health equity. This review provides the reader with a framework to understand the social determinants of health including how socioeconomic status, insurance status, race, gender, and other factors impact health. Foundational papers on the social determinants of health are reviewed, as well as otolaryngology publications focused on health and healthcare disparities. The social determinants of health have a major impact on patient health as well as healthcare utilization, but there is a relative lack of data on these factors and how they can be addressed within otolaryngology. Incorporating tools to measure social and demographic characteristics and actually report on these measures is a first simple step to increase the data on the social determinants of health as they pertain to otolaryngology. More research is needed on the social determinants of health, and how they impact otolaryngic disease. Medicare's Accountable Care Organization models will increasingly change the way in which physicians are reimbursed, making the social determinants of health central not only to our moral conscience but also the bottom line. 4.

  15. The state of racial/ethnic diversity in North Carolina's health workforce.

    Science.gov (United States)

    McGee, Victoria; Fraher, Erin

    2012-01-01

    Increasing the racial and ethnic diversity of the health care workforce is vital to achieving accessible, equitable health care. This study provides baseline data on the diversity of health care practitioners in North Carolina compared with the diversity of the state's population. We analyzed North Carolina health workforce diversity using licensure data from the respective state boards of selected professions from 1994-2009; the data are stored in the North Carolina Health Professions Data System. North Carolina's health care practitioners are less diverse than is the state's population as a whole; only 17% of the practitioners are nonwhite, compared with 33% of the state's population. Levels of diversity vary among the professions, which are diversifying slowly over time. Primary care physicians are diversifying more rapidly than are other types of practitioners; the percentage who are nonwhite increased by 14 percentage points between 1994 and 2009, a period during which 1,630 nonwhite practitioners were added to their ranks. The percentage of licensed practical nurses who are nonwhite increased by 7 percentage points over the same period with the addition of 1,542 nonwhite practitioners to their ranks. Nonwhite health professionals cluster regionally throughout the state, and 79% of them practice in metropolitan counties. This study reports on only a selected number of health professions and utilizes race/ethnicity data that were self-reported by practitioners. Tracking the diversity among North Carolina's health care practitioners provides baseline data that will facilitate future research on barriers to health workforce entry, allow assessment of diversity programs, and be useful in addressing racial and ethnic health disparities.

  16. What makes African American health disparities newsworthy? An experiment among journalists about story framing

    Science.gov (United States)

    Hinnant, Amanda; Oh, Hyun Jee; Caburnay, Charlene A.; Kreuter, Matthew W.

    2011-01-01

    News stories reporting race-specific health information commonly emphasize disparities between racial groups. But recent research suggests this focus on disparities has unintended effects on African American audiences, generating negative emotions and less interest in preventive behaviors (Nicholson RA, Kreuter MW, Lapka C et al. Unintended effects of emphasizing disparities in cancer communication to African-Americans. Cancer Epidemiol Biomarkers Prev 2008; 17: 2946–52). They found that black adults are more interested in cancer screening after reading about the progress African Americans have made in fighting cancer than after reading stories emphasizing disparities between blacks and whites. This study builds on past findings by (i) examining how health journalists judge the newsworthiness of stories that report race-specific health information by emphasizing disparities versus progress and (ii) determining whether these judgments can be changed by informing journalists of audience reactions to disparity versus progress framing. In a double-blind-randomized experiment, 175 health journalists read either a disparity- or progress-framed story on colon cancer, preceded by either an inoculation about audience effects of such framing or an unrelated (i.e. control) information stimuli. Journalists rated the disparity-frame story more favorably than the progress-frame story in every category of news values. However, the inoculation significantly increased positive reactions to the progress-frame story. Informing journalists of audience reactions to race-specific health information could influence how health news stories are framed. PMID:21911844

  17. Examining the impact of migrant status on ethnic differences in mental health service use preceding a first diagnosis of schizophrenia.

    Science.gov (United States)

    Anderson, Kelly K; McKenzie, Kwame J; Kurdyak, Paul

    2017-08-01

    Some ethnic groups have more negative contacts with health services for first-episode psychosis, likely arising from a complex interaction between ethnicity, socio-economic factors, and immigration status. Using population-based health administrative data, we sought to examine the effects of ethnic group and migrant status on patterns of health service use preceding a first diagnosis of schizophrenia or schizoaffective disorder among people aged 14-35 over a 10-year period. We compared access to care and intensity of service use for first-generation ethnic minority groups to the general population of Ontario. To control for migrant status, we restricted the sample to first-generation migrants and compared service use indicators for ethnic minority groups to the European migrant group. Our cohort included 18,080 people with a first diagnosis of schizophrenia or schizoaffective disorder, of whom 14.4% (n = 2607) were the first-generation migrants. Our findings suggest that the magnitude of ethnic differences in health service use is reduced and no longer statistically significant when the sample is restricted to first-generation migrants. Of exception, nearly, all migrant groups have lower intensity of primary care use, and Caribbean migrants are consistently less likely to use psychiatric services. We observed fewer ethnic differences in health service use preceding the first diagnosis of psychosis when patterns are compared among first-generation migrants, rather than to the general population, suggesting that the choice of reference group influences ethnic patterning of health service use. We need a comprehensive understanding of the mechanisms behind observed differences for minority groups to adequately address disparities in access to care.

  18. Health Disparities in Adolescent Bariatric Surgery: Nationwide Outcomes and Utilization.

    Science.gov (United States)

    Nunez Lopez, Omar; Jupiter, Daniel C; Bohanon, Fredrick J; Radhakrishnan, Ravi S; Bowen-Jallow, Kanika A

    2017-11-01

    Bariatric surgery represents an appropriate treatment for adolescent severe obesity, but its utilization remains low in this patient population. We studied the impact of race and sex on preoperative characteristics, outcomes, and utilization of adolescent bariatric surgery. Retrospective analysis (2007-2014) of adolescent bariatric surgery using the Bariatric Outcomes Longitudinal Database, a national database that collects bariatric surgical care data. We assessed the relationships between baseline characteristics and outcomes (weight loss and remission of obesity-related conditions [ORCs]). Using the National Health and Nutrition Examination Survey and U.S. census data, we calculated the ratio of severe obesity and bariatric procedures among races and determined the ratio of ratios to assess for disparities. About 1,539 adolescents underwent bariatric surgery. Males had higher preoperative body mass index (BMI; 51.8 ± 10.5 vs. 47.1 ± 8.7, p adolescents underwent bariatric surgery at a higher proportion than blacks and Hispanics (2.5 and 2.3 times higher, respectively). Preoperative characteristics vary according to race and sex. Race and sex do not impact 12-month weight loss or ORC's remission rates. Minority adolescents undergo bariatric surgery at lower-than-expected rates. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  19. Disparities in Quality of Park Play Spaces between Two Cities with Diverse Income and Race/Ethnicity Composition: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Gavin R. Jenkins

    2015-07-01

    Full Text Available This study investigated the differences in the quality of park play spaces between an affluent and a non-affluent community in a large US Southeastern metropolitan area. Two cities were purposefully selected to reflect differences in household income and race/ethnicity characteristics. Using the Playable Space Quality Assessment Tool (PSQAT, all parks (n = 11, with six in the affluent city, and five in the non-affluent city in these two cities were evaluated. The data were analyzed across three aspects of environmental features of the PSQAT: Location, Play Value and Care and Maintenance between parks in the two cities. The Mann-Whitney U test was used to test the study hypotheses. Results indicated significant differences between parks in the two cities in all three aspects of the PSQAT with p-values ≤ 0.03 and effect sizes of > 0.65, suggesting that the affluent city had parks of a higher quality than the non-affluent city. Significant disparity in Play Value (p = 0.009 in parks between these two communities suggests that children and young people are likely to have different experiences of the play spaces in their locality and therefore may experience different physical and psychological health benefits.

  20. Attitudes toward health care providers, collecting information about patients' race, ethnicity, and language.

    Science.gov (United States)

    Baker, David W; Hasnain-Wynia, Romana; Kandula, Namratha R; Thompson, Jason A; Brown, E Richard

    2007-11-01

    Experts recommend that health care providers (HCPs) collect patients' race/ethnicity and language, but we know little about public attitudes towards this. To determine attitudes towards HCPs collecting race/ethnicity and language data. A telephone survey was held with 563 Californians, including 105 whites, 97 blacks, 199 Hispanics (162 Spanish-speaking), 129 Asians (73 Chinese-speaking), and 33 multiracial individuals. Attitudes towards HCPs asking patients their race/ethnicity and preferred language, concerns about providing their own information, reactions to statements explaining the rationale for data collection, and attitudes towards possible policies. Most (87.8%) somewhat or strongly agreed that HCPs should collect race/ethnicity information and use this to monitor disparities, and 73.6% supported state legislation requiring this. Support for collection of patients' preferred language was even higher. However, 17.2% were uncomfortable (score 1-4 on 10-point scale) reporting their own race/ethnicity, and 46.3% of participants were somewhat or very worried that providing information could be used to discriminate against them. In addition, 35.9% of Hispanics were uncomfortable reporting their English proficiency. All statements explaining the rationale for data collection modestly increased participants' comfort level; the statement that this would be used for staff training increased comfort the most. Although most surveyed believe that HCPs should collect information about race/ethnicity and language, many feel uncomfortable giving this information and worry it could be misused. Statements explaining the rationale for collecting data may assuage concerns, but community engagement and legislation to prevent misuse may be needed to gain more widespread trust and comfort.

  1. Race-Based Health Disparities and the Digital Divide: Implications for Nursing Practice.

    Science.gov (United States)

    Price, Zula

    2015-12-01

    Knowledge of the sources of race-based health disparities could improve nursing practice and education in minority underserved communities. This purpose of this paper was to consider if Black-nonBlack health disparities were at least in part explained by Black-nonBlack disparities in access to Internet-based health information. With data on the U.S. adult population from the 2012 General Social Survey, the parameters of a health production function in which computer usage as an input was estimated. It was found that while there are Black-nonBlack disparities in health, once computer usage was accounted for, Black-nonBlack health disparities disappeared. This suggests nursing and health interventions that improve Internet access for Black patients in underserved communities could improve the health of Black Americans and close the racial health disparities gap. These findings complement recent nursing researchfindings that suggest closing Black-nonBlack disparities in computer access, the "digital divide," can render nursing practice more effective in providing care to minority and underserved communities.

  2. Undiagnosed Diabetes and Pre-Diabetes in Health Disparities.

    Directory of Open Access Journals (Sweden)

    Susan P Fisher-Hoch

    Full Text Available Globally half of all diabetes mellitus is undiagnosed. We sought to determine the extent and characteristics of undiagnosed type 2 diabetes mellitus and pre-diabetes in Mexican Americans residing in the United States. This disadvantaged population with 50% lifetime risk of diabetes is a microcosm of the current pandemic. We accessed baseline data between 2004 and 2014 from 2,838 adults recruited to our Cameron County Hispanic Cohort (CCHC; a two-stage randomly selected 'Framingham-like' cohort of Mexican Americans on the US Mexico border with severe health disparities. We examined prevalence, risk factors and metabolic health in diagnosed and undiagnosed diabetes and pre-diabetes. Two thirds of this Mexican American population has diabetes or pre-diabetes. Diabetes prevalence was 28.0%, nearly half undiagnosed, and pre-diabetes 31.6%. Mean BMI among those with diabetes was 33.5 kg/m2 compared with 29.0 kg/m2 for those without diabetes. Significant risk factors were low income and educational levels. Most with diabetes had increased waist/hip ratio. Lack of insurance and access to health services played a decisive role in failure to have diabetes diagnosed. Participants with undiagnosed diabetes and pre-diabetes had similar measures of poor metabolic health similar but generally not as severe as those with diagnosed diabetes. More than 50% of a minority Mexican American population in South Texas has diabetes or pre-diabetes and is metabolically unhealthy. Only a third of diabetes cases were diagnosed. Sustained efforts are imperative to identify, diagnose and treat individuals in underserved communities.

  3. The Relationship between Teacher Regard and College Attendance Expectations: Socioeconomic and Racial-Ethnic Disparities

    Science.gov (United States)

    Pinchak, Nicolo P.

    2018-01-01

    This study uses data from wave one of the National Longitudinal Survey of Adolescent to Adult Health to analyze the relationship between middle and secondary school students' perceptions of their teachers, or "teacher regard," and students' expectations for college attendance. Variation in this relationship is further examined by…

  4. Effects of ethnicity and gender on youth health

    Directory of Open Access Journals (Sweden)

    Komalsingh Rambaree

    2016-12-01

    Full Text Available This study investigated the effects of ethnicity and gender on the health of young people (14–25 years old living in Mauritius. Combinations of female and male by four ethnic groups—“Creole”, “Hindu”, “Muslim” and “Mixed”—were used for multivariate analysis of variances. “Mixed” ethnic group consumed most tobacco, alcohol and drugs compared to other ethnic groups. They were also the ones that mostly skipped breakfast and lunch and were found to eat most fast food. Moreover, “Mixed” ethnic group had heard most about HIV/AIDS programmes, but were least satisfied with such programmes and with public hospitals and health services. Females were shown to perceive more physical and mental health issues than did males; although males smoked more cigarettes and drunk more alcohol. However, females consumed more fast food and deep fries and rated public hospitals and sexual and reproductive health services as less good than did males. The findings call for further research on the health of young people living in Mauritius with respect to socio-economic variables in order to promote social justice in the Mauritian society. In addition, this article also emphasises on the need of having a new National Youth Policy for Mauritius, which is long overdue.

  5. Rural-Urban Disparities in Health and Health Care in Africa: Cultural ...

    African Journals Online (AJOL)

    medical health care system, rural-urban disparities would seem obvious. .... have led to the development and onset of the illness and cure/controllability, what the ..... and then went back for the result but the nurse that I saw said that I should ...

  6. Influence of Race, Ethnicity and Social Determinants of Health on Diabetes Outcomes.

    Science.gov (United States)

    Walker, Rebekah J; Strom Williams, Joni; Egede, Leonard E

    2016-04-01

    There is strong evidence that race, ethnicity and social determinants of health significantly influence outcomes for patients with diabetes. A better understanding of the mechanisms of these relationships or associations would improve development of cost-effective, culturally tailored programs for patients with diabetes. This article reviews the current state of the literature on the influence of race and ethnicity and social determinants of health on process of care, quality of care and outcomes for diabetes, with particular emphasis on the rural South to give an overview of the state of the literature. The literature review shows that racial or ethnic differences in the clinical outcomes for diabetes, including glycemic, blood pressure (BP) and lipid control, continue to persist. In addition, the literature review shows that the role of social determinants of health on outcomes, and the possible role these determinants play in disparities have largely been ignored. Psychosocial factors, such as self-efficacy, depression, social support and perceived stress, show consistent associations with self-care, quality of life and glycemic control. Neighborhood factors, such as food insecurity, social cohesion and neighborhood esthetics have been associated with glycemic control. Perceived discrimination has also been associated with self-care and the psychological component of quality of life. Healthcare professionals need to be skilled in assessing social determinants of health and taking them into consideration in clinical care. In addition, more research is needed to identify the separate and combined influence of race and ethnicity and social determinants of health on process of care, quality of care and outcomes in diabetes, especially in the South, where the burden of disease is particularly high. Copyright © 2016 Southern Society for Clinical Investigation. All rights reserved.

  7. Editorial: 3rd Special Issue on behavior change, health, and health disparities.

    Science.gov (United States)

    Higgins, Stephen T

    2016-11-01

    This Special Issue of Preventive Medicine (PM) is the 3rd that we have organized on behavior change, health, and health disparities. This is a topic of critical importance to improving U.S. population health. There is broad scientific consensus that personal behaviors such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. Hence, effectively promoting health-related behavior change needs to be a key component of health care research and policy. There is also broad recognition that while these problems extend throughout the population, they disproportionately impact economically disadvantaged populations and other vulnerable populations and represent a major contributor to health disparities. Thus, behavior change represents an essential step in curtailing health disparities, which receives special attention in this 3rd Special Issue. We also devote considerable space to the longstanding challenges of reducing cigarette smoking and use of other tobacco and nicotine delivery products in vulnerable populations, obesity, and for the first time food insecurity. Across each of these topics we include contributions from highly accomplished policymakers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. What Makes African American Health Disparities Newsworthy? An Experiment among Journalists about Story Framing

    Science.gov (United States)

    Hinnant, Amanda; Oh, Hyun Jee; Caburnay, Charlene A.; Kreuter, Matthew W.

    2011-01-01

    News stories reporting race-specific health information commonly emphasize disparities between racial groups. But recent research suggests this focus on disparities has unintended effects on African American audiences, generating negative emotions and less interest in preventive behaviors (Nicholson RA, Kreuter MW, Lapka C "et al." Unintended…

  9. Integrating Ethnicity and Migration As Determinants of Canadian Women's Health

    OpenAIRE

    Vissandjee, Bilkis; Desmeules, Marie; Cao, Zheynuan; Abdool, Shelly; Kazanjian, Arminée

    2004-01-01

    Abstract Health Issue This chapter investigates (1) the association between ethnicity and migration, as measured by length of residence in Canada, and two specific self-reported outcomes: (a) self-perceived health and (b) self-reports of chronic conditions; and (2) the extent to which these selected determinants provide an adequate portrait of the differential outcomes on Canadian women's self-perceived health and self-reports of chronic conditions. The 2000 Canadian Community Health Survey w...

  10. Differential mental health impact of cancer across racial/ethnic groups: findings from a population-based study in California.

    Science.gov (United States)

    Alcalá, Héctor E

    2014-09-08

    Little research has examined the interactive effect of cancer status and race/ethnicity on mental health. As such, the present study examined the mental health of adults, 18 and over, diagnosed with cancer. This study examined the extent to which a cancer diagnosis is related to poorer mental health because it erodes finances and the extent to which the mental health impact of cancer differs across racial/ethnic groups. Furthermore, this study aimed to test the stress process model, which posits that the proliferation of stress can lead to mental illness and this process can differ across racial/ethnic groups. Data from the 2005 Adult California Health Interview Survey was used (N = 42,879). The Kessler 6, a validated measure of psychological distress, was used to measure mental health, with higher scores suggesting poorer mental health. Scores on the Kessler 6 ranged from 0 to 24. Linear regression models estimating psychological distress tested each aim. The mediating effect of income and the race by cancer interaction were tested. After controlling for gender, age, insurance status, education and race/ethnicity, cancer was associated with higher Kessler 6 scores. About 6% of this effect was mediated by household income (t = 4.547; SE = 0.011; p groups. Future work should explore reasons for these disparities. Efforts to increase access to mental health services among minorities with cancer are needed.

  11. Racial/ethnic disparity in the associations of smoking status with uncontrolled hypertension subtypes among hypertensive subjects.

    Science.gov (United States)

    Liu, Xuefeng; Zhu, Tinghui; Manojlovich, Milisa; Cohen, Hillel W; Tsilimingras, Dennis

    2017-01-01

    Racial/ethnic differences in the associations of smoking with uncontrolled blood pressure (BP) and its subtypes (isolated uncontrolled systolic BP (SBP), uncontrolled systolic-diastolic BP, and isolated uncontrolled diastolic BP (DBP)) have not been investigated among diagnosed hypertensive subjects. A sample of 7,586 hypertensive patients aged ≥18 years were selected from the National Health and Nutrition Examination Survey 1999-2010. Race/ethnicity was classified into Hispanic, non-Hispanic white, and non-Hispanic black. Smoking was categorized as never smoking, ex-smoking, and current smoking. Uncontrolled BP was determined as SBP≥140 or DBP≥90 mm Hg. Isolated uncontrolled SBP was defined as SBP≥140 and DBPsmokers, current smokers were 29% less likely to have uncontrolled BP in non-Hispanic whites (OR = 0.71, 95% CI = 0.56-0.90), although the likelihood for uncontrolled BP is the same for smokers and never smokers in Hispanics and non-Hispanic blacks. Current smokers were 26% less likely than never smokers to have isolated uncontrolled SBP in non-Hispanic whites (OR = 0.74, 95% CI = 0.58-0.95). However, current smoking is associated with an increased likelihood of uncontrolled systolic-diastolic BP in non-Hispanic blacks, and current smokers in this group were 70% more likely to have uncontrolled systolic-diastolic BP than never smokers (OR = 1.70, 95% CI = 1.10-2.65). The associations between current smoking and uncontrolled BP differed over race/ethnicity. Health practitioners may need to be especially vigilant with non-Hispanic black smokers with diagnosed hypertension.

  12. Effect of Medicaid Managed Care on racial disparities in health care access.

    Science.gov (United States)

    Cook, Benjamin Lê

    2007-02-01

    To evaluate the impact of Medicaid Managed Care (MMC) on racial disparities in access to care consistent with the Institute of Medicine (IOM) definition of racial disparity, which excludes differences stemming from health status but includes socioeconomic status (SES)-mediated differences. Secondary data from the Adult Samples of the 1997-2001 National Health Interview Survey, metropolitan statistical area (MSA)-level Medicaid Health Maintenance Organization (MHMO) market share from the 1997 to 2001 InterStudy MSA Trend Dataset, and MSA characteristics from the 1997 to 2001 Area Resource File. I estimate multivariate regression models to compare racial disparities in doctor visits, emergency room (ER) use, and having a usual source of care between enrollees in MMC and Medicaid Fee-for-Service (FFS) plans. To contend with potential selection bias, I use a difference-in-difference analytical strategy and assess the impact of greater MHMO market share at the MSA level on Medicaid enrollees' access measures. To implement the IOM definition of racial disparity, I adjust for health status but not SES factors using a novel method to transform the distribution of health status for minority populations to approximate the white health status distribution. MMC enrollment is associated with lowered disparities in having any doctor visit in the last year for blacks, and in having any usual source of care for both blacks and Hispanics. Increasing Medicaid HMO market share lowered disparities in having any doctor visits in the last year for both blacks and Hispanics. Although disparities in most other measures were not much affected, black-white ER use disparities exist among MMC enrollees and in areas of high MHMO market share. MMC programs' reduction of some disparities suggests that recent shifts in Medicaid policy toward managed care plans have benefited minority enrollees. Future research should investigate whether black-white disparities in ER use within MMC groups

  13. Disparities in cigarette tax exposure by race, ethnicity, poverty status and sexual orientation, 2006-2014, USA.

    Science.gov (United States)

    Golden, Shelley D; Kong, Amanda Y; Lee, Joseph G L; Ribisl, Kurt M

    2018-03-01

    Cigarette excise taxes are an effective tobacco control strategy but they vary geographically due to differences in state and local taxation. There are also pronounced sociodemographic differences in community composition, suggesting that different population groups might face vastly different cigarette excise tax rates. In this study, we examine how cigarette excise tax rates differ for population groups defined by race, ethnicity, poverty status, and sexual orientation, and how these differences have evolved over time. We constructed annual cigarette tax rates in 109 mutually exclusive jurisdictions within the United States (U.S.) between 2006 and 2014. After merging with Census sociodemographic data, we calculated annual cigarette excise tax exposures for each population group as the average of each place-based tax, weighted by the proportion of the group living there. In 2014, the average U.S. resident was required to pay $2.68 in cigarette taxes, more than 60% of which was due to state and local taxation. On average, Asian/Native Hawaiian and Other Pacific Islander populations faced the highest average tax ($2.95), which was $0.44 more than American Indian populations. Local taxes disproportionately augmented state and federal taxes for non-White populations, same-sex couples, and people living in poverty. Geographic variation in cigarette excise taxes produces sociodemographic variation in cigarette tax exposure. Raising cigarette taxes specifically in those places where groups at risk for tobacco-related disease are more likely to live, or otherwise creating geographically uniform tax levels, could reduce important disparities in cigarette smoking. Copyright © 2017. Published by Elsevier Inc.

  14. Ethnicity and child health in northern Tanzania: Maasai pastoralists are disadvantaged compared to neighbouring ethnic groups.

    Directory of Open Access Journals (Sweden)

    David W Lawson

    Full Text Available The Maasai of northern Tanzania, a semi-nomadic ethnic group predominantly reliant on pastoralism, face a number of challenges anticipated to have negative impacts on child health, including marginalisation, vulnerabilities to drought, substandard service provision and on-going land grabbing conflicts. Yet, stemming from a lack of appropriate national survey data, no large-scale comparative study of Maasai child health has been conducted. Savannas Forever Tanzania surveyed the health of over 3500 children from 56 villages in northern Tanzania between 2009 and 2011. The major ethnic groups sampled were the Maasai, Sukuma, Rangi, and the Meru. Using multilevel regression we compare each ethnic group on the basis of (i measurements of child health, including anthropometric indicators of nutritional status and self-reported incidence of disease; and (ii important proximate determinants of child health, including food insecurity, diet, breastfeeding behaviour and vaccination coverage. We then (iii contrast households among the Maasai by the extent to which subsistence is reliant on livestock herding. Measures of both child nutritional status and disease confirm that the Maasai are substantially disadvantaged compared to neighbouring ethnic groups, Meru are relatively advantaged, and Rangi and Sukuma intermediate in most comparisons. However, Maasai children were less likely to report malaria and worm infections. Food insecurity was high throughout the study site, but particularly severe for the Maasai, and reflected in lower dietary intake of carbohydrate-rich staple foods, and fruits and vegetables. Breastfeeding was extended in the Maasai, despite higher reported consumption of cow's milk, a potential weaning food. Vaccination coverage was lowest in Maasai and Sukuma. Maasai who rely primarily on livestock herding showed signs of further disadvantage compared to Maasai relying primarily on agriculture. We discuss the potential ecological

  15. Influence of Hormonal Contraceptive Use and Health Beliefs on Sexual Orientation Disparities in Papanicolaou Test Use

    Science.gov (United States)

    Corliss, Heather L.; Missmer, Stacey A.; Frazier, A. Lindsay; Rosario, Margaret; Kahn, Jessica A.; Austin, S. Bryn

    2014-01-01

    Objectives. Reproductive health screenings are a necessary part of quality health care. However, sexual minorities underutilize Papanicolaou (Pap) tests more than heterosexuals do, and the reasons are not known. Our objective was to examine if less hormonal contraceptive use or less positive health beliefs about Pap tests explain sexual orientation disparities in Pap test intention and utilization. Methods. We used multivariable regression with prospective data gathered from 3821 females aged 18 to 25 years in the Growing Up Today Study (GUTS). Results. Among lesbians, less hormonal contraceptive use explained 8.6% of the disparities in Pap test intention and 36.1% of the disparities in Pap test utilization. Less positive health beliefs associated with Pap testing explained 19.1% of the disparities in Pap test intention. Together, less hormonal contraceptive use and less positive health beliefs explained 29.3% of the disparities in Pap test intention and 42.2% of the disparities in Pap test utilization. Conclusions. Hormonal contraceptive use and health beliefs, to a lesser extent, help to explain sexual orientation disparities in intention and receipt of a Pap test, especially among lesbians. PMID:23763393

  16. The Public Health Exposome: A Population-Based, Exposure Science Approach to Health Disparities Research

    Science.gov (United States)

    Juarez, Paul D.; Matthews-Juarez, Patricia; Hood, Darryl B.; Im, Wansoo; Levine, Robert S.; Kilbourne, Barbara J.; Langston, Michael A.; Al-Hamdan, Mohammad Z.; Crosson, William L.; Estes, Maurice G.; Estes, Sue M.; Agboto, Vincent K.; Robinson, Paul; Wilson, Sacoby; Lichtveld, Maureen Y.

    2014-01-01

    The lack of progress in reducing health disparities suggests that new approaches are needed if we are to achieve meaningful, equitable, and lasting reductions. Current scientific paradigms do not adequately capture the complexity of the relationships between environment, personal health and population level disparities. The public health exposome is presented as a universal exposure tracking framework for integrating complex relationships between exogenous and endogenous exposures across the lifespan from conception to death. It uses a social-ecological framework that builds on the exposome paradigm for conceptualizing how exogenous exposures “get under the skin”. The public health exposome approach has led our team to develop a taxonomy and bioinformatics infrastructure to integrate health outcomes data with thousands of sources of exogenous exposure, organized in four broad domains: natural, built, social, and policy environments. With the input of a transdisciplinary team, we have borrowed and applied the methods, tools and terms from various disciplines to measure the effects of environmental exposures on personal and population health outcomes and disparities, many of which may not manifest until many years later. As is customary with a paradigm shift, this approach has far reaching implications for research methods and design, analytics, community engagement strategies, and research training. PMID:25514145

  17. The Public Health Exposome: A Population-Based, Exposure Science Approach to Health Disparities Research

    Directory of Open Access Journals (Sweden)

    Paul D. Juarez

    2014-12-01

    Full Text Available The lack of progress in reducing health disparities suggests that new approaches are needed if we are to achieve meaningful, equitable, and lasting reductions. Current scientific paradigms do not adequately capture the complexity of the relationships between environment, personal health and population level disparities. The public health exposome is presented as a universal exposure tracking framework for integrating complex relationships between exogenous and endogenous exposures across the lifespan from conception to death. It uses a social-ecological framework that builds on the exposome paradigm for conceptualizing how exogenous exposures “get under the skin”. The public health exposome approach has led our team to develop a taxonomy and bioinformatics infrastructure to integrate health outcomes data with thousands of sources of exogenous exposure, organized in four broad domains: natural, built, social, and policy environments. With the input of a transdisciplinary team, we have borrowed and applied the methods, tools and terms from various disciplines to measure the effects of environmental exposures on personal and population health outcomes and disparities, many of which may not manifest until many years later. As is customary with a paradigm shift, this approach has far reaching implications for research methods and design, analytics, community engagement strategies, and research training.

  18. Depression recognition and capacity for self-report among ethnically diverse nursing homes residents: Evidence of disparities in screening.

    Science.gov (United States)

    Chun, Audrey; Reinhardt, Joann P; Ramirez, Mildred; Ellis, Julie M; Silver, Stephanie; Burack, Orah; Eimicke, Joseph P; Cimarolli, Verena; Teresi, Jeanne A

    2017-12-01

    To examine agreement between Minimum Data Set clinician ratings and researcher assessments of depression among ethnically diverse nursing home residents using the 9-item Patient Health Questionnaire. Although depression is common among nursing homes residents, its recognition remains a challenge. Observational baseline data from a longitudinal intervention study. Sample of 155 residents from 12 long-term care units in one US facility; 50 were interviewed in Spanish. Convergence between clinician and researcher ratings was examined for (i) self-report capacity, (ii) suicidal ideation, (iii) at least moderate depression, (iv) Patient Health Questionnaire severity scores. Experiences by clinical raters using the depression assessment were analysed. The intraclass correlation coefficient was used to examine concordance and Cohen's kappa to examine agreement between clinicians and researchers. Moderate agreement (κ = 0.52) was observed in determination of capacity and poor to fair agreement in reporting suicidal ideation (κ = 0.10-0.37) across time intervals. Poor agreement was observed in classification of at least moderate depression (κ = -0.02 to 0.24), lower than the maximum kappa obtainable (0.58-0.85). Eight assessors indicated problems assessing Spanish-speaking residents. Among Spanish speakers, researchers identified 16% with Patient Health Questionnaire scores of 10 or greater, and 14% with thoughts of self-harm whilst clinicians identified 6% and 0%, respectively. This study advances the field of depression recognition in long-term care by identification of possible challenges in assessing Spanish speakers. Use of the Patient Health Questionnaire requires further investigation, particularly among non-English speakers. Depression screening for ethnically diverse nursing home residents is required, as underreporting of depression and suicidal ideation among Spanish speakers may result in lack of depression recognition and referral for evaluation and

  19. The Linked CENTURY Study: linking three decades of clinical and public health data to examine disparities in childhood obesity.

    Science.gov (United States)

    Hawkins, Summer Sherburne; Gillman, Matthew W; Rifas-Shiman, Sheryl L; Kleinman, Ken P; Mariotti, Megan; Taveras, Elsie M

    2016-03-09

    Despite the need to identify the causes of disparities in childhood obesity, the existing epidemiologic studies of early life risk factors have several limitations. We report on the construction of the Linked CENTURY database, incorporating CENTURY (Collecting Electronic Nutrition Trajectory Data Using Records of Youth) Study data with birth certificates; and discuss the potential implications of combining clinical and public health data sources in examining the etiology of disparities in childhood obesity. We linked the existing CENTURY Study, a database of 269,959 singleton children from birth to age 18 years with measured heights and weights, with each child's Massachusetts birth certificate, which captures information on their mothers' pregnancy history and detailed socio-demographic information of both mothers and fathers. Overall, 74.2 % were matched, resulting in 200,343 children in the Linked CENTURY Study with 1,580,597 well child visits. Among this cohort, 94.0 % (188,334) of children have some father information available on the birth certificate and 60.9 % (121,917) of children have at least one other sibling in the dataset. Using maternal race/ethnicity from the birth certificate as an indicator of children's race/ethnicity, 75.7 % of children were white, 11.6 % black, 4.6 % Hispanic, and 5.7 % Asian. Based on socio-demographic information from the birth certificate, 20.0 % of mothers were non-US born, 5.9 % smoked during pregnancy, 76.3 % initiated breastfeeding, and 11.0 % of mothers had their delivery paid for by public health insurance. Using clinical data from the CENTURY Study, 22.7 % of children had a weight-for-length ≥ 95(th) percentile between 1 and 24 months and 12.0 % of children had a body mass index ≥ 95(th) percentile at ages 5 and 17 years. By linking routinely-collected data sources, it is possible to address research questions that could not be answered with either source alone. Linkage between a clinical

  20. Association between Self-Rated Health and the Ethnic Composition of the Residential Environment of Six Ethnic Groups in Amsterdam

    Science.gov (United States)

    Veldhuizen, Eleonore M.; Musterd, Sako; Dijkshoorn, Henriëtte; Kunst, Anton E.

    2015-01-01

    Background: Studies on the association between health and neighborhood ethnic composition yielded inconsistent results, possibly due to methodological limitations. We assessed these associations at different spatial scales and for different measures of ethnic composition. Methods: We obtained health survey data of 4673 respondents of Dutch, Surinamese, Moroccan, Turkish other non-Western and other Western origin. Neighborhood ethnic composition was measured for buffers varying from 50–1000 m. Associations with self-rated health were measured using logistic multilevel regression analysis, with control for socioeconomic position at the individual and area level. Results: Overall ethnic heterogeneity was not related to health for any ethnic group. The presence of other Surinamese was associated with poor self-rated health among Surinamese respondents. The presence of Moroccans or Turks was associated with poor health among some groups. The presence of Dutch was associated with better self-rated health among Surinamese and Turks. In most cases, these associations were stronger at lower spatial scales. We found no other associations. Conclusions: In Amsterdam, self-rated health was not associated with ethnic heterogeneity in general, but may be related to the presence of specific ethnic groups. Policies regarding social and ethnic mixing should pay special attention to the co-residence of groups with problematic interrelations. PMID:26569282

  1. Health literacy and primary health care use of ethnic minorities in the Netherlands.

    Science.gov (United States)

    van der Gaag, Marieke; van der Heide, Iris; Spreeuwenberg, Peter M M; Brabers, Anne E M; Rademakers, Jany J D J M

    2017-05-15

    In the Netherlands, ethnic minority populations visit their general practitioner (GP) more often than the indigenous population. An explanation for this association is lacking. Recently, health literacy is suggested as a possible explaining mechanism. Internationally, associations between health literacy and health care use, and between ethnicity and health literacy have been studied separately, but, so far, have not been linked to each other. In the Netherlands, some expectations have been expressed with regard to supposed low health literacy of ethnic minority groups, however, no empirical study has been done so far. The objectives of this study are therefore to acquire insight into the level of health literacy of ethnic minorities in the Netherlands and to examine whether the relationship between ethnicity and health care use can be (partly) explained by health literacy. A questionnaire was sent to a sample of 2.116 members of the Dutch Health Care Consumer Panel (response rate 46%, 89 respondents of non-western origin). Health literacy was measured with the Health Literacy Questionnaire (HLQ) which covers nine different domains. The health literacy levels of ethnic minority groups were compared to the indigenous population. A negative binomial regression model was used to estimate the association between ethnicity and GP visits. To examine whether health literacy is an explaining factor in this association, health literacy and interaction terms of health literacy and ethnicity were added into the model. Differences in levels of health literacy were only found between the Turkish population and the indigenous Dutch population. This study also found an association between ethnicity and GP visits. Ethnic minorities visit their GP 33% more often than the indigenous population. Three domains of the HLQ (the ability to navigate the health care system, the ability to find information and to read and understand health information) partly explained the association

  2. Health Promotion and Health Behaviors of Diverse Ethnic/Racial Women Cosmetologists: A Review

    Directory of Open Access Journals (Sweden)

    Naomi Thelusma

    2016-01-01

    Full Text Available Women from diverse ethnic/racial backgrounds have higher chronic disease mortality rates when compared to White non-Hispanic women. Community-based programs, such as beauty salons, have been used to reach diverse ethnic/racial women, yet little is known about diverse ethnic/racial women cosmetologists' involvement in health promotion and their health behaviors, which is the purpose of this review. The growing beauty salon health promotion literature indicates that their roles in these studies have been varied, not only as health promoters but also as recruiters, facilitators, and in general major catalysts for investigator-initiated studies. However, the review also identified a major void in the literature in that there were few studies on health behaviors of diverse ethnic/racial women cosmetologists, especially African American women cosmetologists. Recommendations include increasing the capacity of diverse ethnic/racial women cosmetologists as community health leaders and investigating their health status, knowledge, attitudes, and practices.

  3. Ethnicity, Migration and the 'Social Determinants of Health' Agenda

    Directory of Open Access Journals (Sweden)

    David Ingleby

    2012-12-01

    Full Text Available One of the most promising recent developments in health policy has been the emergence of a global 'health equity' movement concerned with the social determinants of health. In European research and policy-making, however, there is an strong tendency to reduce 'social determinants' to 'socioeconomic determinants' and to ignore the role of ethnicity, migration and other factors in the creation of inequities. This threatens to hold up the development of work on ethnicity and migration and thus to perpetuate inequities linked to these factors. The present article sets out to illustrate this tendency and to investigate the reasons which may underlie it. The justifications often put forward for neglecting ethnicity and migration are shown to be erroneous. An integrated approach, simultaneously taking account of socioeconomic status, migration and ethnicity as well as other determinants of inequity, is essential if work on the social determinants of health is to make progress. Equity is indivisible; researchers investigating different aspects of social stratification should not treat each other as rivals, but as indispensible allies. An integrated, intersectional, multivariate and multilevel approach will improve our understanding of health inequities and make available more resources for tackling them.

  4. Racial/Ethnic Disparities at the End of an HIV Epidemic: Persons Who Inject Drugs in New York City, 2011-2015.

    Science.gov (United States)

    Des Jarlais, Don C; Arasteh, Kamyar; McKnight, Courtney; Feelemyer, Jonathan; Tross, Susan; Perlman, David; Friedman, Samuel; Campbell, Aimee

    2017-07-01

    To examine whether racial/ethnic disparities persist at the "end of the HIV epidemic" (prevalence of untreated HIV infection New York City. We recruited 2404 PWID entering New York City substance use treatment in 2001 to 2005 and 2011 to 2015. We conducted a structured interview, and testing for HIV and herpes simplex virus 2 (HSV-2; a biomarker for high sexual risk). We estimated incidence by using newly diagnosed cases of HIV. Disparity analyses compared HIV, untreated HIV, HIV-HSV-2 coinfection, HIV monoinfection, and estimated HIV incidence among Whites, African Americans, and Latinos. By 2011 to 2015, Whites, African Americans, and Latino/as met both criteria of our operational "end-of-the-epidemic" definition. All comparisons that included HIV-HSV-2-coinfected persons had statistically significant higher rates of HIV among racial/ethnic minorities. No comparisons limited to HIV monoinfected persons were significant. "End-of-the-epidemic" criteria were met among White, African American, and Latino/a PWID in New York City, but elimination of disparities may require a greater focus on PWID with high sexual risk.

  5. Health journalism internships: a social marketing strategy to address health disparities.

    Science.gov (United States)

    Nguyen, Duy H; Shimasaki, Suzuho; Stafford, Helen Shi; Sadler, Georgia Robins

    2010-09-01

    The USA seeks to eliminate health disparities by stimulating the rapid uptake of health-promoting behaviors within disadvantaged communities. A health journalism internship incorporates social marketing strategies to increase communities' access to cancer information, while helping the interns who are recruited from underrepresented communities gain admission to top graduate schools. Interns are taught basic health journalism skills that enable them to create immediate streams of cancer-related press releases for submission to community newspapers. Interns are charged with the social responsibility of continuing this dissemination process throughout their careers. Intermediate outcomes are measured as mediators of distal behavioral change goals.

  6. Disparities in type 2 diabetes prevalence among ethnic minority groups resident in Europe: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Meeks, Karlijn A. C.; Freitas-Da-Silva, Deivisson; Adeyemo, Adebowale; Beune, Erik J. A. J.; Modesti, Pietro A.; Stronks, Karien; Zafarmand, Mohammad H.; Agyemang, Charles

    2016-01-01

    Many ethnic minorities in Europe have a higher type 2 diabetes (T2D) prevalence than their host European populations. The risk size differs between ethnic groups, but the extent of the differences in the various ethnic minority groups has not yet been systematically quantified. We conducted a

  7. Clinical cultural competency and knowledge of health disparities among pharmacy students.

    Science.gov (United States)

    Okoro, Olihe N; Odedina, Folakemi T; Reams, Romonia R; Smith, W Thomas

    2012-04-10

    To evaluate the level of competency and knowledge about health disparities among third-year doctor of pharmacy (PharmD) students at 2 Florida public colleges of pharmacy and to explore the demographic correlates of these variables. A cross-sectional survey study design was used to collect data from participants. The students had low health-disparities knowledge and moderate skills in dealing with sociocultural issues and cross-cultural encounters. Speaking a language(s) other than English and having exposure to cultural-competency instruction were the demographic variables found to be most significantly associated with clinical cultural competency and/or knowledge of health disparities. Clinical cultural competency and health-disparities instruction may not be adequately incorporated into the pharmacy school curricula in the institutions studied. Relevant education and training are necessary to enhance cultural competency among pharmacy students.

  8. Effects of Social, Economic, and Labor Policies on Occupational Health Disparities

    Science.gov (United States)

    Siqueira, Carlos Eduardo; Gaydos, Megan; Monforton, Celeste; Slatin, Craig; Borkowski, Liz; Dooley, Peter; Liebman, Amy; Rosenberg, Erica; Shor, Glenn; Keifer, Matthew

    2018-01-01

    Background This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States. Methods We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities. Results Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including worker’s compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities. Conclusions There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all. PMID:23606055

  9. Making sense of housing disparities research: a review of health and economic inequities.

    Science.gov (United States)

    Narine, Lutchmie; Shobe, Marcia A

    2014-01-01

    Despite the recent recession and accompanying housing crisis, important gains have occurred in U.S. homeownership over the past several decades; however, wide inequalities among minority and immigrant populations remain. Understanding the role of several under-studied factors on housing outcomes, including health status and disability, and differences in financial capital, such as savings, investments, and other assets, remains a major policy initiative. Although past research has examined African American-White housing disparities, it is also important to explore disparities among Hispanics, Asians, and immigrants. This article reviews health and financial capital disparities in homeownership and home values between Whites and minority populations and offers suggestions for future policy research.

  10. Differences in Receipt of Three Preventive Health Care Services by Race/Ethnicity in Medicare Advantage Plans: Tracking the Impact of Pay for Performance, 2010 and 2013

    Science.gov (United States)

    Palta, Mari; Smith, Maureen; Oliver, Thomas R.; DuGoff, Eva H.

    2016-01-01

    Introduction In 2012, the Centers for Medicare and Medicaid Services (CMS) introduced the Quality Bonus Payment Demonstration, a pay-for-performance (P4P) program, into Medicare Advantage plans. Previous studies documented racial/ethnic disparities in receipt of care among participants in these plans. The objective of this study was to determine whether P4P incentives have affected these disparities in Medicare Advantage plans. Methods We studied 411 Medicare Advantage health plans that participated in the Medicare Health Outcome Survey in 2010 and 2013. Preventive health care was defined as self-reported receipt of health care provider communication or treatment to reduce risk of falling, improve bladder control, and monitor physical activity among individuals reporting these problems. Logistic regression stratified by health care plan was used to examine racial/ethnic disparities in receipt of preventive health care before and after the introduction of the P4P program in 2012. Results We found similar racial/ethnic differences in receipt of preventive health care before and after the introduction of P4P. Blacks and Asians were less likely than whites to receive advice to improve bladder control and more likely to receive advice to reduce risk of falling and improve physical activity. Hispanics were more likely to report receiving advice about all 3 health issues than whites. After the introduction of P4P, the gap decreased between Hispanics and whites for improving bladder control and monitoring physical activity and increased between blacks and whites for monitoring physical activity. Conclusion Racial/ethnic differences in receipt of preventive health care are not always in the expected direction. CMS should consider developing a separate measure of equity in preventive health care services to encourage health plans to reduce gaps among racial/ethnic groups in receiving preventive care services. PMID:27609303

  11. Maternal health care utilization in Viet Nam: increasing ethnic inequity.

    Science.gov (United States)

    Målqvist, Mats; Lincetto, Ornella; Du, Nguyen Huy; Burgess, Craig; Hoa, Dinh Thi Phuong

    2013-04-01

    To investigate changes that took place between 2006 and 2010 in the inequity gap for antenatal care attendance and delivery at health facilities among women in Viet Nam. Demographic, socioeconomic and obstetric data for women aged 15-49 years were extracted from Viet Nam's Multiple Indicator Cluster Survey for 2006 (MICS3) and 2010-2011 (MICS4). Multivariate logistic regression was performed to determine if antenatal care attendance and place of delivery were significantly associated with maternal education, maternal ethnicity (Kinh/Hoa versus other), household wealth and place of residence (urban versus rural). These independent variables correspond to the analytical framework of the Commission on Social Determinants of Health. Large discrepancies between urban and rural populations were found in both MICS3 and MICS4. Although antenatal care attendance and health facility delivery rates improved substantially between surveys (from 86.3 to 92.1% and from 76.2 to 89.7%, respectively), inequities increased, especially along ethnic lines. The risk of not giving birth in a health facility increased significantly among ethnic minority women living in rural areas. In 2006 this risk was nearly five times higher than among women of Kinh/Hoa (majority) ethnicity (odds ratio, OR: 4.67; 95% confidence interval, CI: 2.94-7.43); in 2010-2011 it had become nearly 20 times higher (OR: 18.8; 95% CI: 8.96-39.2). Inequity in maternal health care utilization has increased progressively in Viet Nam, primarily along ethnic lines, and vulnerable groups in the country are at risk of being left behind. Health-care decision-makers should target these groups through affirmative action and culturally sensitive interventions.

  12. Socioeconomic and Racial/Ethnic Disparities in Cancer Mortality, Incidence, and Survival in the United States, 1950–2014: Over Six Decades of Changing Patterns and Widening Inequalities

    Directory of Open Access Journals (Sweden)

    Gopal K. Singh

    2017-01-01

    Full Text Available We analyzed socioeconomic and racial/ethnic disparities in US mortality, incidence, and survival rates from all-cancers combined and major cancers from 1950 to 2014. Census-based deprivation indices were linked to national mortality and cancer data for area-based socioeconomic patterns in mortality, incidence, and survival. The National Longitudinal Mortality Study was used to analyze individual-level socioeconomic and racial/ethnic patterns in mortality. Rates, risk-ratios, least squares, log-linear, and Cox regression were used to examine trends and differentials. Socioeconomic patterns in all-cancer, lung, and colorectal cancer mortality changed dramatically over time. Individuals in more deprived areas or lower education and income groups had higher mortality and incidence rates than their more affluent counterparts, with excess risk being particularly marked for lung, colorectal, cervical, stomach, and liver cancer. Education and income inequalities in mortality from all-cancers, lung, prostate, and cervical cancer increased during 1979–2011. Socioeconomic inequalities in cancer mortality widened as mortality in lower socioeconomic groups/areas declined more slowly. Mortality was higher among Blacks and lower among Asian/Pacific Islanders and Hispanics than Whites. Cancer patient survival was significantly lower in more deprived neighborhoods and among most ethnic-minority groups. Cancer mortality and incidence disparities may reflect inequalities in smoking, obesity, physical inactivity, diet, alcohol use, screening, and treatment.

  13. Racial/ethnic disparity in the associations of smoking status with uncontrolled hypertension subtypes among hypertensive subjects.

    Directory of Open Access Journals (Sweden)

    Xuefeng Liu

    Full Text Available Racial/ethnic differences in the associations of smoking with uncontrolled blood pressure (BP and its subtypes (isolated uncontrolled systolic BP (SBP, uncontrolled systolic-diastolic BP, and isolated uncontrolled diastolic BP (DBP have not been investigated among diagnosed hypertensive subjects.A sample of 7,586 hypertensive patients aged ≥18 years were selected from the National Health and Nutrition Examination Survey 1999-2010. Race/ethnicity was classified into Hispanic, non-Hispanic white, and non-Hispanic black. Smoking was categorized as never smoking, ex-smoking, and current smoking. Uncontrolled BP was determined as SBP≥140 or DBP≥90 mm Hg. Isolated uncontrolled SBP was defined as SBP≥140 and DBP<90 mm Hg, uncontrolled SDBP as SBP≥140 and DBP≥90 mm Hg, and isolated uncontrolled DBP as SBP<140 and DBP≥90 mm Hg. Adjusted odds ratios (ORs with 95% confidence intervals (CIs of uncontrolled BP and its subtypes were calculated using weighted logistic regression models.The interaction effect of race and smoking was significant after adjustment for the full potential confounding covariates (Adjusted p = 0.0412. Compared to never smokers, current smokers were 29% less likely to have uncontrolled BP in non-Hispanic whites (OR = 0.71, 95% CI = 0.56-0.90, although the likelihood for uncontrolled BP is the same for smokers and never smokers in Hispanics and non-Hispanic blacks. Current smokers were 26% less likely than never smokers to have isolated uncontrolled SBP in non-Hispanic whites (OR = 0.74, 95% CI = 0.58-0.95. However, current smoking is associated with an increased likelihood of uncontrolled systolic-diastolic BP in non-Hispanic blacks, and current smokers in this group were 70% more likely to have uncontrolled systolic-diastolic BP than never smokers (OR = 1.70, 95% CI = 1.10-2.65.The associations between current smoking and uncontrolled BP differed over race/ethnicity. Health practitioners may need to be especially

  14. Race/Ethnicity, Educational Attainment, and Foregone Health Care in the United States in the 2007–2009 Recession

    Science.gov (United States)

    Hawkins, Jaclynn M.

    2014-01-01

    Objectives. This study assessed possible associations between recessions and changes in the magnitude of social disparities in foregone health care, building on previous studies that have linked recessions to lowered health care use. Methods. Data from the 2006 to 2010 waves of the National Health Interview Study were used to examine levels of foregone medical, dental and mental health care and prescribed medications. Differences by race/ethnicity and education were compared before the Great Recession of 2007 to 2009, during the early recession, and later in the recession and in its immediate wake. Results. Foregone care rose for working-aged adults overall in the 2 recessionary periods compared with the pre-recession. For multiple types of pre-recession care, foregoing care was more common for African Americans and Hispanics and less common for Asian Americans than for Whites. Less-educated individuals were more likely to forego all types of care pre-recession. Most disparities in foregone care were stable during the recession, though the African American–White gap in foregone medical care increased, as did the Hispanic–White gap and education gap in foregone dental care. Conclusions. Our findings support the fundamental cause hypothesis, as even during a recession in which more advantaged groups may have had unusually high risk of losing financial assets and employer-provided health insurance, they maintained their relative advantage in access to health care. Attention to the macroeconomic context of social disparities in health care use is warranted. PMID:24328647

  15. Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students.

    Science.gov (United States)

    Sonneville, K R; Lipson, S K

    2018-03-02

    Eating disorders (EDs) present a significant threat to the health of adolescents and young adults, yet remain under-diagnosed and under-treated at a population-level. EDs have historically been thought to afflict "skinny, white, affluent girls" (the SWAG stereotype). As such, higher-weight individuals, racial/ethnic minorities, those from socioeconomically disadvantaged backgrounds, and males may not recognize their need for treatment, may not be properly screened for EDs, and/or may not be referred to treatment. Using large-scale survey data from the healthy bodies study, we examined variations in prevalence of perceived need for ED treatment, ED diagnosis, past-year ED treatment, and treatment barriers according to weight status, race, socioeconomic background, and sex among undergraduate and graduate students with symptoms of an ED (N = 1,747). Among students with symptoms of an ED, 30.7% perceived a need for treatment, 10.5% had received a diagnosis, and 13.6% had received treatment in the past year. Individual characteristics were highly associated with perceived need, diagnosis, and past-year treatment. Females were more likely than males to perceive a need for treatment (OR = 1.97), to be diagnosed (OR = 4.66), and to be treated (OR = 1.64) for their ED symptoms. Socioeconomic background was associated with perceived need for treatment and past-year treatment, with students from affluent backgrounds having higher odds of perceiving need (OR = 1.52) and of receiving treatment (OR = 1.89) compared with their non-affluent peers. At a population-level, the unmet need for ED treatment disproportionately affects certain groups. Stereotypes about who develops EDs could contribute to disparities in ED treatment and outcomes. © 2018 Wiley Periodicals, Inc.

  16. Limited english proficiency, primary language at home, and disparities in children's health care: how language barriers are measured matters.

    Science.gov (United States)

    Flores, Glenn; Abreu, Milagros; Tomany-Korman, Sandra C

    2005-01-01

    Approximately 3.5 million U.S. schoolchildren are limited in English proficiency (LEP). Disparities in children's health and health care are associated with both LEP and speaking a language other than English at home, but prior research has not examined which of these two measures of language barriers is most useful in examining health care disparities. Our objectives were to compare primary language spoken at home vs. parental LEP and their associations with health status, access to care, and use of health services in children. We surveyed parents at urban community sites in Boston, asking 74 questions on children's health status, access to health care, and use of health services. Some 98% of the 1,100 participating children and families were of non-white race/ethnicity, 72% of parents were LEP, and 13 different primary languages were spoken at home. "Dose-response" relationships were observed between parental English proficiency and several child and parental sociodemographic features, including children's insurance coverage, parental educational attainment, citizenship and employment, and family income. Similar "dose-response" relationships were noted between the primary language spoken at home and many but not all of the same sociodemographic features. In multivariate analyses, LEP parents were associated with triple the odds of a child having fair/poor health status, double the odds of the child spending at least one day in bed for illness in the past year, and significantly greater odds of children not being brought in for needed medical care for six of nine access barriers to care. None of these findings were observed in analyses of the primary language spoken at home. Individual parental LEP categories were associated with different risks of adverse health status and outcomes. Parental LEP is superior to the primary language spoken at home as a measure of the impact of language barriers on children's health and health care. Individual parental LEP

  17. Ethnicity and Health in Colombia: What Do Self-Perceived Health Indicators Tell Us?

    Science.gov (United States)

    Agudelo-Suárez, Andrés A; Martínez-Herrera, Eliana; Posada-López, Adriana; Rocha-Buelvas, Anderson

    2016-04-21

    To compare self-perceived health indicators between ethnic groups in Colombia. Cross-sectional study with data from the 2007 National Public Health Survey (ENSP-2007). Data from 57,617 people ≥18 years were used. Variables included: belonging to an ethnic group (exposure); self-rated health; mental health problems, injuries for accidents/violence (outcomes); sex, age, education level and occupation (explicative/control). A descriptive study was carried out of the explicative variables, and the prevalence of the outcomes was calculated according to ethnicity, education level and occupation. The association between the exposure variable and the outcomes was estimated by means of adjusted odds ratios (OR) with 95% CI using logistic regression. Analyses were conducted separately for men and women. The prevalence of outcomes was higher in people reporting to belong to an ethnic group and differences were found by sex, ethnic groups and health outcomes. Women from the Palenquero group were more likely to report poor self-rated health (aOR 7.04; 95%CI 2.50-19.88) and injuries from accidents/violence (aOR 7.99; 95%CI 2.89-22.07). Indigenous men were more likely to report mental health problems (aOR 1.75; 95%CI 1.41-2.17). Gradients according to ethnicity, education, occupation and sex were found. Minority ethnic groups are vulnerable to reporting poor health outcomes. Political actions are required to diminish health inequalities in these groups.

  18. Assessing the Relationship between Physical Illness and Mental Health Service Use and Expenditures among Older Adults from Racial/Ethnic Minority Groups

    Science.gov (United States)

    Jimenez, Daniel E; Cook, Benjamin; Kim, Giyeon; Reynolds, Charles F.; Alegria, Margarita; Coe-Odess, Sarah; Bartels, Stephen J.

    2015-01-01

    Objective The association of physical illness and mental health service use in older adults from racial/ethnic minority groups is an important area of study given the mental and physical health disparities and the low use of mental health services in this population. The purpose of this study is to describe the impact of comorbid physical illness on mental health service use and expenditures in older adults; and to evaluate disparities in mental health service use and expenditures among a racially/ethnically diverse sample of older adults with and without comorbid physical illness. Methods Data were obtained from the Medical Expenditure Panel Survey (years 2004–2011). The sample included 1563 whites, 519 African-Americans, and 642 Latinos and (N=2,724) aged 65+ with probable mental illness. Using two-part generalized linear models, we estimated and compared mental health service use among those with and without a comorbid physical illness. Results Mental health service use was greater for older adults with comorbid physical illness compared to those without a comorbid physical illness. Once mental health services were accessed, no differences in mental health expenditures were found. Comorbid physical illness increased the likelihood of mental health service use in older whites and Latinos. However, the presence of a comorbidity did not impact racial/ethnic disparities in mental health service use. Conclusions This study highlighted the important role of comorbid physical illness as a potential contributor to using mental health services and suggests intervention strategies to enhance engagement in mental health services by older adults from racial/ethnic minority groups. PMID:25772763

  19. Exploring ethnic inequalities in health: Evidence from the Health Survey for England, 1998-2011

    OpenAIRE

    Darlington, F; Norman, P; Ballas, D; Exeter, DJ

    2015-01-01

    Issues of social justice and social and spatial inequalities in health have long been researched, yet there is a relative paucity of research on ethnic inequalities in health. Given the increasing ethnic diversity of England's population and the persistence of unjust differences in health this research is timely. We used annual data from the Health Survey for England between 1998 and 2011, combined into a time-series dataset, to examine the influence of socioeconomic and spatial factors on et...

  20. Register-based studies on migration, ethnicity, and health

    DEFF Research Database (Denmark)

    Norredam, Marie; Kastrup, Marianne; Helweg-Larsen, Karin

    2011-01-01

    INTRODUCTION: Researchers in Denmark have unique possibilities of register-based research in relation to migration, ethnicity, and health. This review article outlines how these opportunities have been used, so far, by presenting a series of examples. RESEARCH TOPICS: We selected six registers...... it discriminatory. Although, we do not register ethnicity in relation to use of health care in Denmark, our possibilities of linkage between population registers and registers on diseases and healthcare utilisation appear to render the same potentials....... to highlight the process of how migrant study populations have been established and studied in relation to different registers: The Danish Cancer Registry, the Danish Central Psychiatric Research Register, the Danish National Patient Register, the Danish National Health Service Register, the Danish Injury...

  1. Disparities in Social Health by Sexual Orientation and the Etiologic Role of Self-Reported Discrimination.

    Science.gov (United States)

    Doyle, David Matthew; Molix, Lisa

    2016-08-01

    Some past work indicates that sexual minorities may experience impairments in social health, or the perceived and actual availability and quality of one's social relationships, relative to heterosexuals; however, research has been limited in many ways. Furthermore, it is important to investigate etiological factors that may be associated with these disparities, such as self-reported discrimination. The current work tested whether sexual minority adults in the United States reported less positive social health (i.e., loneliness, friendship strain, familial strain, and social capital) relative to heterosexuals and whether self-reported discrimination accounted for these disparities. Participants for the current study (N = 579) were recruited via Amazon's Mechanical Turk, including 365 self-identified heterosexuals (105 women) and 214 sexual minorities (103 women). Consistent with hypotheses, sexual minorities reported impaired social health relative to heterosexuals, with divergent patterns emerging by sexual orientation subgroup (which were generally consistent across sexes). Additionally, self-reported discrimination accounted for disparities across three of four indicators of social health. These findings suggest that sexual minorities may face obstacles related to prejudice and discrimination that impair the functioning of their relationships and overall social health. Moreover, because social health is closely related to psychological and physical health, remediating disparities in social relationships may be necessary to address other health disparities based upon sexual orientation. Expanding upon these results, implications for efforts to build resilience among sexual minorities are discussed.

  2. Applying Organizational Change to Promote Lesbian, Gay, Bisexual, and Transgender Inclusion and Reduce Health Disparities.

    Science.gov (United States)

    Eckstrand, Kristen L; Lunn, Mitchell R; Yehia, Baligh R

    2017-06-01

    Lesbian, gay, bisexual, and transgender (LGBT) populations face numerous barriers when accessing and receiving healthcare, which amplify specific LGBT health disparities. An effective strategic approach is necessary for academic health centers to meet the growing needs of LGBT populations. Although effective organizational change models have been proposed for other minority populations, the authors are not aware of any organizational change models that specifically promote LGBT inclusion and mitigate access barriers to reduce LGBT health disparities. With decades of combined experience, we identify elements and processes necessary to accelerate LGBT organizational change and reduce LGBT health disparities. This framework may assist health organizations in initiating and sustaining meaningful organizational change to improve the health and healthcare of the LGBT communities.

  3. Racial and Ethnic Disparities in the Incidence and Trends of Soft Tissue Sarcoma Among Adolescents and Young Adults in the United States, 1995-2008.

    Science.gov (United States)

    Hsieh, Mei-Chin; Wu, Xiao-Cheng; Andrews, Patricia A; Chen, Vivien W

    2013-09-01

    The aim of this study was to examine racial/ethnic disparities in the incidence rates and trends of soft tissue sarcoma (STS) by gender, age, and histological type among adolescents and young adults (AYAs) aged 15-29 years. The 1995-2008 incidence data from 25 population-based cancer registries, covering 64% of the United States population, were obtained from the North American Association of Central Cancer Registries. The Surveillance, Epidemiology and End Results AYA site recode and International Classification of Diseases for Oncology, 3rd Edition, were adopted to categorize STS histological types and anatomic groups. Age-adjusted incidence rates and average annual percent change (AAPC) were calculated. The incidence of all STSs combined was 34% higher in males than females (95% CI: 1.28, 1.39), 60% higher among blacks than whites (95% CI: 1.52, 1.68), and slightly higher among Hispanics than whites. Compared with whites, blacks had significantly higher incidence of fibromatous neoplasms, and Hispanics had significantly higher incidence of liposarcoma. Whites were more likely to be diagnosed with synovial sarcoma than blacks. Black and Hispanic males had significantly higher Kaposi sarcoma incidence than white males. The AAPC of all STSs combined showed a significant decrease from 1995 to 2008 (AAPC=-2.1%; 95% CI: -3.2%, -1.0%). However, after excluding Kaposi sarcoma, there was no significant trend. The incidence rates of STS histological types in AYAs vary among racial/ethnic groups. The declining trends of STS are due mainly to decreasing incidence of Kaposi sarcoma in all races/ethnicities. Research to identify factors associated with racial/ethnic disparities in AYA STS is necessary.

  4. Trends in racial/ethnic and income disparities in foods and beverages consumed and purchased from stores among US households with children, 2000–201312

    Science.gov (United States)

    Poti, Jennifer M; Popkin, Barry M

    2016-01-01

    Background: It is unclear whether racial/ethnic and income differences in foods and beverages obtained from stores contribute to disparities in caloric intake over time. Objective: We sought to determine whether there are disparities in calories obtained from store-bought consumer packaged goods (CPGs), whether brands (name brands compared with private labels) matter, and if disparities have changed over time. Design: We used NHANES individual dietary intake data among households with children along with the Nielsen Homescan data on CPG purchases among households with children. With NHANES, we compared survey-weighted energy intakes for 2003–2006 and 2009–2012 from store and nonstore sources by race/ethnicity [non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), and Hispanic Mexican-Americans) and income [≤185% federal poverty line (FPL), 186–400% FPL, and >400% FPL]. With the Nielsen data, we compared 2000–2013 trends in calories purchased from CPGs (obtained from stores) across brands by race/ethnicity (NHW, NHB, and Hispanic) and income. We conducted random-effect models to derive adjusted trends and differences in calories purchased (708,175 observations from 64,709 unique households) and tested whether trends were heterogeneous by race/ethnicity or income. Results: Store-bought foods and beverages represented the largest component of dietary intake, with greater decreases in energy intakes in nonstore sources for foods and in store sources for beverages. Beverages from stores consistently decreased in all subpopulations. However, in adjusted models, reductions in CPG calories purchased in 2009–2012 were slower for NHB and low-income households than for NHW and high-income households, respectively. The decline in calories from name-brand food purchases was slower among NHB, Hispanic, and lowest-income households. NHW and high-income households had the highest absolute calories purchased in 2000. Conclusions: Across 2 large data sources, we found

  5. Trends in racial/ethnic and income disparities in foods and beverages consumed and purchased from stores among US households with children, 2000-2013.

    Science.gov (United States)

    Ng, Shu Wen; Poti, Jennifer M; Popkin, Barry M

    2016-09-01

    It is unclear whether racial/ethnic and income differences in foods and beverages obtained from stores contribute to disparities in caloric intake over time. We sought to determine whether there are disparities in calories obtained from store-bought consumer packaged goods (CPGs), whether brands (name brands compared with private labels) matter, and if disparities have changed over time. We used NHANES individual dietary intake data among households with children along with the Nielsen Homescan data on CPG purchases among households with children. With NHANES, we compared survey-weighted energy intakes for 2003-2006 and 2009-2012 from store and nonstore sources by race/ethnicity [non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), and Hispanic Mexican-Americans) and income [≤185% federal poverty line (FPL), 186-400% FPL, and >400% FPL]. With the Nielsen data, we compared 2000-2013 trends in calories purchased from CPGs (obtained from stores) across brands by race/ethnicity (NHW, NHB, and Hispanic) and income. We conducted random-effect models to derive adjusted trends and differences in calories purchased (708,175 observations from 64,709 unique households) and tested whether trends were heterogeneous by race/ethnicity or income. Store-bought foods and beverages represented the largest component of dietary intake, with greater decreases in energy intakes in nonstore sources for foods and in store sources for beverages. Beverages from stores consistently decreased in all subpopulations. However, in adjusted models, reductions in CPG calories purchased in 2009-2012 were slower for NHB and low-income households than for NHW and high-income households, respectively. The decline in calories from name-brand food purchases was slower among NHB, Hispanic, and lowest-income households. NHW and high-income households had the highest absolute calories purchased in 2000. Across 2 large data sources, we found decreases in intake and purchases of beverages from stores

  6. Attending to Communication and Patterns of Interaction: Culturally Sensitive Mental Health Care for Groups of Urban, Ethnically Diverse, Impoverished, and Underserved Women.

    Science.gov (United States)

    Molewyk Doornbos, Mary; Zandee, Gail Landheer; DeGroot, Joleen

    2014-07-01

    The United States is ethnically diverse. This diversity presents challenges to nurses, who, without empirical evidence to design culturally congruent interventions, may contribute to mental health care disparities. Using Leininger's theory of culture care diversity and universality, this study documented communication and interaction patterns of ethnically diverse, urban, impoverished, and underserved women. Using a community-based participatory research framework, 61 Black, Hispanic, and White women participated in focus groups around their experiences with anxiety/depression. Researchers recorded verbal communication, nonverbal behavior, and patterns of interaction. The women's communication and interaction patterns gave evidence of three themes that were evident across all focus groups and five subthemes that emerged along ethnic lines. The results suggest cultural universalities and cultural uniquenesses relative to the communication and interaction patterns of urban, ethnically diverse, impoverished, and underserved women that may assist in the design of culturally sensitive mental health care. © The Author(s) 2014.

  7. Promoting Community Health and Eliminating Health Disparities Through Community-Based Participatory Research.

    Science.gov (United States)

    Xia, Ruiping; Stone, John R; Hoffman, Julie E; Klappa, Susan G

    2016-03-01

    In physical therapy, there is increasing focus on the need at the community level to promote health, eliminate disparities in health status, and ameliorate risk factors among underserved minorities. Community-based participatory research (CBPR) is the most promising paradigm for pursuing these goals. Community-based participatory research stresses equitable partnering of the community and investigators in light of local social, structural, and cultural elements. Throughout the research process, the CBPR model emphasizes coalition and team building that joins partners with diverse skills/expertise, knowledge, and sensitivities. This article presents core concepts and principles of CBPR and the rationale for its application in the management of health issues at the community level. Community-based participatory research is now commonly used to address public health issues. A literature review identified limited reports of its use in physical therapy research and services. A published study is used to illustrate features of CBPR for physical therapy. The purpose of this article is to promote an understanding of how physical therapists could use CBPR as a promising way to advance the profession's goals of community health and elimination of health care disparities, and social responsibility. Funding opportunities for the support of CBPR are noted. © 2016 American Physical Therapy Association.

  8. Integrating Education on Addressing Health Disparities into the Graduate Social Work Curriculum

    Science.gov (United States)

    Mitchell, Jamie Ann

    2012-01-01

    The purpose of this article is to propose an elective social work course as a means of better preparing social workers entering practice in healthcare to meet the challenges of promoting health and reducing health disparities in minority and underserved communities. Course offerings specifically targeting health or medical social work training…

  9. Take Action to Decrease Your Cancer Risk - Obesity and Its Role in Cancer Health Disparities

    Science.gov (United States)

    In support of this year’s National Minority Health Month theme “Prevention is Power: Taking Action for Health Equity!”, CRCHD is highlighting the role of obesity in cancer health disparities among diverse population groups in the U.S.

  10. Investigating the Relationship between Ethnic Consciousness, Racial Discrimination and Self-Rated Health in New Zealand

    Science.gov (United States)

    Harris, Ricci; Cormack, Donna; Stanley, James; Rameka, Ruruhira

    2015-01-01

    In this study, we examine race/ethnic consciousness and its associations with experiences of racial discrimination and health in New Zealand. Racism is an important determinant of health and cause of ethnic inequities. However, conceptualising the mechanisms by which racism impacts on health requires racism to be contextualised within the broader social environment. Race/ethnic consciousness (how often people think about their race or ethnicity) is understood as part of a broader assessment of the ‘racial climate’. Higher race/ethnic consciousness has been demonstrated among non-dominant racial/ethnic groups and linked to adverse health outcomes in a limited number of studies. We analysed data from the 2006/07 New Zealand Health Survey, a national population-based survey of New Zealand adults, to examine the distribution of ethnic consciousness by ethnicity, and its association with individual experiences of racial discrimination and self-rated health. Findings showed that European respondents were least likely to report thinking about their ethnicity, with people from non-European ethnic groupings all reporting relatively higher ethnic consciousness. Higher ethnic consciousness was associated with an increased likelihood of reporting experience of racial discrimination for all ethnic groupings and was also associated with fair/poor self-rated health after adjusting for age, sex and ethnicity. However, this difference in health was no longer evident after further adjustment for socioeconomic position and individual experience of racial discrimination. Our study suggests different experiences of racialised social environments by ethnicity in New Zealand and that, at an individual level, ethnic consciousness is related to experiences of racial discrimination. However, the relationship with health is less clear and needs further investigation with research to better understand the racialised social relations that create and maintain ethnic inequities in health in

  11. Unraveling Health Disparities Among Sexual and Gender Minorities: A Commentary on the Persistent Impact of Stigma.

    Science.gov (United States)

    Valdiserri, Ronald O; Holtgrave, David R; Poteat, Tonia C; Beyrer, Chris

    2018-01-03

    LGBT (lesbian, gay, bisexual, and transgender) populations experience disparities in health outcomes, both physical and mental, compared to their heterosexual and cisgender peers. This commentary confronts the view held by some researchers that the disparate rates of mental health problems reported among LGBT populations are the consequences of pursuing a particular life trajectory, rather than resulting from the corrosive and persistent impact of stigma. Suggesting that mental health disparities among LGBT populations arise internally, de novo, when individuals express non-heterosexual and non-conforming gender identities ignores the vast body of evidence documenting the destructive impact of socially mediated stigma and systemic discrimination on health outcomes for a number of minorities, including sexual and gender minorities. Furthermore, such thinking is antithetical to widely accepted standards of health and wellbeing because it implies that LGBT persons should adopt and live out identities that contradict or deny their innermost feelings of self.

  12. Ethnic and racial disparities in the risk of preterm birth: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Schaaf, Jelle M.; Liem, Sophie M. S.; Mol, Ben Willem J.; Abu-Hanna, Ameen; Ravelli, Anita C. J.

    2013-01-01

    The aim of this study is to present a systematic review of available literature on the effect of maternal ethnicity (Africans/blacks, Asians, Hispanics, others) on the risk of preterm birth (PTB). Studies investigating ethnicity (or race) as a risk factor for PTB were included if performing

  13. Disparities in Gynecological Malignancies

    Directory of Open Access Journals (Sweden)

    Sudeshna eChatterjee

    2016-02-01

    Full Text Available Objectives: Health disparities and inequalities in access to care among different socioeconomic, ethnic, and racial groups have been well documented in the U.S. healthcare system. In this review, we aimed to provide an overview of barriers to care contributing to health disparities in gynecological oncology management and to describe site-specific disparities in gynecologic care for endometrial, ovarian, and cervical cancer. Methods: We performed a literature review of peer-reviewed academic and governmental publications focusing on disparities in gynecological care in the United States by searching PubMed and Google Scholar electronic databases. Results: There are multiple important underlying issues that may contribute to the disparities in gynecological oncology management in the United States, namely geographic access and hospital based-discrepancies, research-based discrepancies, influence of socioeconomic and health insurance status, and finally the influence of race and biological factors. Despite the reduction in overall cancer-related deaths since the 1990s, the 5-year survival for Black women is significantly lower than for White women for each gynecologic cancer type and each stage of diagnosis. For ovarian and endometrial cancer, black patients are less likely to receive treatment consistent with evidence-based guidelines and have worse survival outcomes even after accounting for stage and comorbidities. For cervical and endometrial cancer, the mortality rate for black women remains twice that of White women. Conclusions: Health care disparities in the incidence and outcome of gynecologic cancers are complex and involve biologic factors as well as racial, socioeconomic and geographic barriers that influence treatment and survival. These barriers must be addressed to provide optimal care to women in the U.S. with gynecologic cancer.

  14. Healthcare disparities in critical illness.

    Science.gov (United States)

    Soto, Graciela J; Martin, Greg S; Gong, Michelle Ng

    2013-12-01

    To summarize the current literature on racial and gender disparities in critical care and the mechanisms underlying these disparities in the course of acute critical illness. MEDLINE search on the published literature addressing racial, ethnic, or gender disparities in acute critical illness, such as sepsis, acute lung injury, pneumonia, venous thromboembolism, and cardiac arrest. Clinical studies that evaluated general critically ill patient populations in the United States as well as specific critical care conditions were reviewed with a focus on studies evaluating factors and contributors to health disparities. Study findings are presented according to their association with the prevalence, clinical presentation, management, and outcomes in acute critical illness. This review presents potential contributors for racial and gender disparities related to genetic susceptibility, comorbidities, preventive health services, socioeconomic factors, cultural differences, and access to care. The data are organized along the course of acute critical illness. The literature to date shows that disparities in critical care are most likely multifactorial involving individual, community, and hospital-level factors at several points in the continuum of acute critical illness. The data presented identify potential targets as interventions to reduce disparities in critical care and future avenues for research.

  15. Big Data Science: Opportunities and Challenges to Address Minority Health and Health Disparities in the 21st Century

    Science.gov (United States)

    Zhang, Xinzhi; Pérez-Stable, Eliseo J.; Bourne, Philip E.; Peprah, Emmanuel; Duru, O. Kenrik; Breen, Nancy; Berrigan, David; Wood, Fred; Jackson, James S.; Wong, David W.S.; Denny, Joshua

    2017-01-01

    Addressing minority health and health disparities has been a missing piece of the puzzle in Big Data science. This article focuses on three priority opportunities that Big Data science may offer to the reduction of health and health care disparities. One opportunity is to incorporate standardized information on demographic and social determinants in electronic health records in order to target ways to improve quality of care for the most disadvantaged populations over time. A second opportunity is to enhance public health surveillance by linking