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Sample records for multilevel health disparities

  1. Addressing Asthma Health Disparities: A Multilevel Challenge

    PubMed Central

    Canino, Glorisa; McQuaid, Elizabeth L.; Rand, Cynthia S.

    2009-01-01

    Substantial research has documented pervasive disparities in the prevalence, severity, and morbidity of asthma among minority populations compared to non-Latino whites. The underlying causes of these disparities are not well understood, and as a result, the leverage points to address them remain unclear. A multilevel framework for integrating research in asthma health disparities is proposed in order to advance both future research and clinical practice. The components of the proposed model include health care policies and regulations, operation of the health care system, provider/clinician-level factors, social/environmental factors, and individual/family attitudes and behaviors. The body of research suggests that asthma disparities have multiple, complex and inter-related sources. Disparities occur when individual, environmental, health system, and provider factors interact with one another over time. Given that the causes of asthma disparities are complex and multilevel, clinical strategies to address these disparities must therefore be comparably multilevel and target many aspects of asthma care. Clinical Implications: Several strategies that could be applied in clinical settings to reduce asthma disparities are described including the need for routine assessment of the patient’s beliefs, financial barriers to disease management, and health literacy, and the provision of cultural competence training and communication skills to health care provider groups. PMID:19447484

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

    PubMed Central

    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

  3. Multilevel Interventions and Racial/Ethnic Health Disparities

    PubMed Central

    Badr, Hoda; Krebs, Paul; Das, Irene Prabhu

    2012-01-01

    To examine the impact of multilevel interventions (with three or more levels of influence) designed to reduce health disparities, we conducted a systematic review and meta-analysis of interventions for ethnic/racial minorities (all except non-Hispanic whites) that were published between January 2000 and July 2011. The primary aims were to synthesize the findings of studies evaluating multilevel interventions (three or more levels of influence) targeted at ethnic and racial minorities to reduce disparities in their health care and obtain a quantitative estimate of the effect of multilevel interventions on health outcomes among these subgroups. The electronic database PubMed was searched using Medical Subject Heading terms and key words. After initial review of abstracts, 26 published studies were systematically reviewed by at least two independent coders. Those with sufficient data (n = 12) were assessed by meta-analysis and examined for quality using a modified nine-item Physiotherapy Evidence Database coding scheme. The findings from this descriptive review suggest that multilevel interventions have positive effects on several health behavior outcomes, including cancer prevention and screening, as well improving the quality of health-care system processes. The weighted average effect size across studies for all health behavior outcomes reported at the individual participant level (k = 17) was odds ratio (OR) = 1.27 (95% confidence interval [CI] = 1.11 to 1.44); for the outcomes reported by providers or organizations, the weighted average effect size (k = 3) was OR = 2.53 (95% CI = 0.82 to 7.81). Enhanced application of theories to multiple levels of change, novel design approaches, and use of cultural leveraging in intervention design and implementation are proposed for this nascent field. PMID:22623602

  4. Multilevel Interventions To Address Health Disparities Show Promise In Improving Population Health

    PubMed Central

    Paskett, Electra; Thompson, Beti; Ammerman, Alice S.; Ortega, Alexander N.; Marsteller, Jill; Richardson, DeJuran

    2017-01-01

    Multilevel interventions are those that affect at least two levels of influence—for example, the patient and the health care provider. They can be experimental designs or natural experiments caused by changes in policy, such as the implementation of the Affordable Care Act or local policies. Measuring the effects of multilevel interventions is challenging, because they allow for interaction among levels, and the impact of each intervention must be assessed and translated into practice. We discuss how two projects from the National Institutes of Health’s Centers for Population Health and Health Disparities used multilevel interventions to reduce health disparities. The interventions, which focused on the uptake of the human papillomavirus vaccine and community-level dietary change, had mixed results. The design and implementation of multilevel interventions are facilitated by input from the community, and more advanced methods and measures are needed to evaluate the impact of the various levels and components of such interventions. PMID:27503968

  5. Prevalence and framing of health disparities in local print news: Implications for multilevel interventions to address cancer inequalities

    PubMed Central

    Nagler, Rebekah H.; Bigman, Cabral A.; Ramanadhan, Shoba; Ramamurthi, Divya; Viswanath, K.

    2016-01-01

    Background Americans remain under-informed about cancer and other health disparities and the social determinants of health (SDH). The news media may be contributing to this knowledge deficit, whether by discussing these issues narrowly or ignoring them altogether. Because local media are particularly important in influencing public opinion and support for public policies, this study examines the prevalence and framing of disparities/SDH in local mainstream and ethnic print news. Methods We conducted a multi-method content analysis of local mainstream (English-language) and ethnic (Spanish-language) print news in two lower-income cities in New England with substantial racial/ethnic minority populations. After establishing inter-coder reliability (kappa=0.63–0.88), coders reviewed the primary English- and Spanish-language newspaper in each city, identifying both disparities and non-disparities health stories published between February 2010 and January 2011. Results Local print news coverage of cancer and other health disparities was rare. Of 650 health stories published across four newspapers during the one-year study period, only 21 (3.2%) discussed disparities/SDH. Although some stories identified causes of and solutions for disparities, these were often framed in individual (e.g., poor dietary habits) rather than social contextual terms (e.g., lack of food availability/affordability). Cancer and other health stories routinely missed opportunities to discuss disparities/SDH. Conclusion Local mainstream and ethnic media may be ideal targets for multilevel interventions designed to address cancer and other health inequalities. Impact By increasing media attention to and framing of health disparities, we may observe important downstream effects on public opinion and support for structural solutions to disparities, particularly at the local level. PMID:27196094

  6. Approaching Health Disparities from a Population Perspective: The NIH Centers for Population Health and Health Disparities

    USDA-ARS?s Scientific Manuscript database

    Addressing health disparities has been a national challenge for decades. The NIH-sponsored Centers for Population Health and Health Disparities (CPHHDs) represent the first federal initiative to support transdisciplinary multilevel research on the determinants of health disparities. Using preliminar...

  7. Reducing Alaska Native paediatric oral health disparities: a systematic review of oral health interventions and a case study on multilevel strategies to reduce sugar-sweetened beverage intake.

    PubMed

    Chi, Donald L

    2013-01-01

    children. Future investigators should evaluate the feasibility of implementing multilevel interventions and policies within Alaska Native communities as a way to reduce children's health disparities.

  8. Reducing Alaska Native paediatric oral health disparities: a systematic review of oral health interventions and a case study on multilevel strategies to reduce sugar-sweetened beverage intake

    PubMed Central

    Chi, Donald L.

    2013-01-01

    approaches to improve the oral and systemic health of Alaska Native children. Future investigators should evaluate the feasibility of implementing multilevel interventions and policies within Alaska Native communities as a way to reduce children's health disparities. PMID:24377091

  9. Rural Health Disparities

    MedlinePlus

    ... Health Gateway Evidence-based Toolkits Rural Health Models & Innovations Supporting Rural Community Health Tools for Success Am ... Update of the Rural-Urban Chartbook Highlights current trends and disparities across different levels of metro- and ...

  10. Literacy and Health Disparities

    ERIC Educational Resources Information Center

    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.

  11. Literacy and Health Disparities

    ERIC Educational Resources Information Center

    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.

  12. Disparities in Oral Health

    MedlinePlus

    ... Tips Disparities in Oral Health Oral Health Conditions Periodontal Disease Community Water Fluoridation Water Fluoridation Basics Over 70 ... 2% of U.S. adults have some form of periodontal disease. In adults aged 65 and older, 70.1% ...

  13. Engendering health disparities.

    PubMed

    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.

  14. Diabetes Health Disparities

    PubMed Central

    Peek, Monica E.; Cargill, Algernon; Huang, Elbert S.

    2008-01-01

    Racial and ethnic minorities bear a disproportionate burden of the diabetes epidemic; they have higher prevalence rates, worse diabetes control, and higher rates of complications. This article reviews the effectiveness of health care interventions at improving health outcomes and/or reducing diabetes health disparities among racial/ethnic minorities with diabetes. Forty-two studies met inclusion criteria. On average, these health care interventions improved the quality of care for racial/ethnic minorities, improved health outcomes (such as diabetes control and reduced diabetes complications), and possibly reduced health disparities in quality of care. There is evidence supporting the use of interventions that target patients (primarily through culturally tailored programs), providers (especially through one-on-one feedback and education), and health systems (particularly with nurse case managers and nurse clinicians). More research is needed in the areas of racial/ethnic minorities other than African Americans and Latinos, health disparity reductions, long-term diabetes-related outcomes, and the sustainability of health care interventions over time. PMID:17881626

  15. Summarizing Social Disparities in Health

    PubMed Central

    Asada, Yukiko; Yoshida, Yoko; Whipp, Alyce M

    2013-01-01

    Context Reporting on health disparities is fundamental for meeting the goal of reducing health disparities. One often overlooked challenge is determining the best way to report those disparities associated with multiple attributes such as income, education, sex, and race/ethnicity. This article proposes an analytical approach to summarizing social disparities in health, and we demonstrate its empirical application by comparing the degrees and patterns of health disparities in all fifty states and the District of Columbia (DC). Methods We used the 2009 American Community Survey, and our measure of health was functional limitation. For each state and DC, we calculated the overall disparity and attribute-specific disparities for income, education, sex, and race/ethnicity in functional limitation. Along with the state rankings of these health disparities, we developed health disparity profiles according to the attribute making the largest contribution to overall disparity in each state. Findings Our results show a general lack of consistency in the rankings of overall and attribute-specific disparities in functional limitation across the states. Wyoming has the smallest overall disparity and West Virginia the largest. In each of the four attribute-specific health disparity rankings, however, most of the best- and worst-performing states in regard to overall health disparity are not consistently good or bad. Our analysis suggests the following three disparity profiles across states: (1) the largest contribution from race/ethnicity (thirty-four states), (2) roughly equal contributions of race/ethnicity and socioeconomic factor(s) (ten states), and (3) the largest contribution from socioeconomic factor(s) (seven states). Conclusions Our proposed approach offers policy-relevant health disparity information in a comparable and interpretable manner, and currently publicly available data support its application. We hope this approach will spark discussion regarding how best

  16. Transdisciplinary cardiovascular and cancer health disparities training: experiences of the centers for population health and health disparities.

    PubMed

    Golden, Sherita Hill; Ferketich, Amy; Boyington, Josephine; Dugan, Sheila; Garroutte, Eva; Kaufmann, Peter G; Krok, Jessica; Kuo, Alice; Ortega, Alexander N; Purnell, Tanjala; Srinivasan, Shobha

    2015-07-01

    The Centers for Population Health and Health Disparities program promotes multilevel and multifactorial health equity research and the building of research teams that are transdisciplinary. We summarized 5 areas of scientific training for empowering the next generation of health disparities investigators with research methods and skills that are needed to solve disparities and inequalities in cancer and cardiovascular disease. These areas include social epidemiology, multilevel modeling, health care systems or health care delivery, community-based participatory research, and implementation science. We reviewed the acquisition of the skill sets described in the training components; these skill sets will position trainees to become leaders capable of effecting significant change because they provide tools that can be used to address the complexities of issues that promote health disparities.

  17. Transdisciplinary Cardiovascular and Cancer Health Disparities Training: Experiences of the Centers for Population Health and Health Disparities

    PubMed Central

    Ferketich, Amy; Boyington, Josephine; Dugan, Sheila; Garroutte, Eva; Kaufmann, Peter G.; Krok, Jessica; Kuo, Alice; Ortega, Alexander N.; Purnell, Tanjala; Srinivasan, Shobha

    2015-01-01

    The Centers for Population Health and Health Disparities program promotes multilevel and multifactorial health equity research and the building of research teams that are transdisciplinary. We summarized 5 areas of scientific training for empowering the next generation of health disparities investigators with research methods and skills that are needed to solve disparities and inequalities in cancer and cardiovascular disease. These areas include social epidemiology, multilevel modeling, health care systems or health care delivery, community-based participatory research, and implementation science. We reviewed the acquisition of the skill sets described in the training components; these skill sets will position trainees to become leaders capable of effecting significant change because they provide tools that can be used to address the complexities of issues that promote health disparities. PMID:25905828

  18. Genetic Research and Health Disparities

    PubMed Central

    Sankar, Pamela; Cho, Mildred K.; Condit, Celeste M.; Hunt, Linda M.; Koenig, Barbara; Marshall, Patricia; Lee, Sandra Soo-Jin; Spicer, Paul

    2008-01-01

    Alleviating health disparities in the United States is a goal with broad support. Medical research undertaken to achieve this goal typically adopts the well-established perspective that racial discrimination and poverty are the major contributors to unequal health status. However, the suggestion is increasingly made that genetic research also has a significant role to play in alleviating this problem, which likely overstates the importance of genetics as a factor in health disparities. Overemphasis on genetics as a major explanatory factor in health disparities could lead researchers to miss factors that contribute to disparities more substantially and may also reinforce racial stereotyping, which may contribute to disparities in the first place. Arguments that promote genetics research as a way to help alleviate health disparities are augmented by several factors, including research funding initiatives and the distinct demographic patterns of health disparities in the United States. PMID:15213210

  19. The Preconception Stress and Resiliency Pathways Model: a multi-level framework on maternal, paternal, and child health disparities derived by community-based participatory research.

    PubMed

    Ramey, Sharon Landesman; Schafer, Peter; DeClerque, Julia L; Lanzi, Robin G; Hobel, Calvin; Shalowitz, Madeleine; Chinchilli, Vern; Raju, Tonse N K

    2015-04-01

    Emerging evidence supports the theoretical and clinical importance of the preconception period in influencing pregnancy outcomes and child health. Collectively, this evidence affirms the need for a novel, integrative theoretical framework to design future investigations, integrate new findings, and identify promising, evidence-informed interventions to improve intergenerational health and reduce disparities. This article presents a transdisciplinary framework developed by the NIH Community Child Health Network (CCHN) through community-based participatory research processes. CCHN developed a Preconception Stress and Resiliency Pathways (PSRP) model by building local and multi-site community-academic participatory partnerships that established guidelines for research planning and decision-making; reviewed relevant findings diverse disciplinary and community perspectives; and identified the major themes of stress and resilience within the context of families and communities. The PSRP model focuses on inter-relating the multiple, complex, and dynamic biosocial influences theoretically linked to family health disparities. The PSRP model borrowed from and then added original constructs relating to developmental origins of lifelong health, epigenetics, and neighborhood and community influences on pregnancy outcome and family functioning (cf. MCHJ 2014). Novel elements include centrality of the preconception/inter-conception period, role of fathers and the parental relationship, maternal allostatic load (a composite biomarker index of cumulative wear-and-tear of stress), resilience resources of parents, and local neighborhood and community level influences (e.g., employment, housing, education, health care, and stability of basic necessities). CCHN's integrative framework embraces new ways of thinking about how to improve outcomes for future generations, by starting before conception, by including all family members, and by engaging the community vigorously at multiple

  20. Health Disparities in Women

    PubMed Central

    Hornbuckle, Lyndsey M; Amutah-Onukagha, Ndidiamaka; Bryan, Alicia; Skidmore Edwards, Elizabeth; Madzima, Takudzwa; Massey, Kelly; May, Linda; Robinson, Leah E

    2017-01-01

    AIMS AND SCOPE Clinical Medicine Insights: Women’s Health is an international, open-access, peer-reviewed journal which considers manuscripts on all aspects of the diagnosis, management, and prevention of disorders specific to women, in addition to related genetic, pathophysiological, and epidemiological topics. Clinical Medicine Insights: Women’s Health aims to provide researchers working in this complex, quickly developing field with online, open access to highly relevant scholarly articles by leading international researchers. In a field where the literature is ever-expanding, researchers increasingly need access to up-to-date, high-quality scholarly articles on areas of specific contemporary interest. This supplement is on Health Disparities in Women. This supplement aims to address this by presenting high-quality articles that allow readers to distinguish the signal from the noise. The editor in chief hopes that through this effort, practitioners and researchers will be aided in finding answers to some of the most complex and pressing issues of our time. PMID:28579867

  1. Racial and Ethnic Disparities in the Quality of Health Care.

    PubMed

    Fiscella, Kevin; Sanders, Mechelle R

    2016-01-01

    The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.

  2. Socioeconomic Disparities in Health Behaviors

    PubMed Central

    Pampel, Fred C.; Krueger, Patrick M.; Denney, Justin T.

    2011-01-01

    The inverse relationships between socioeconomic status (SES) and unhealthy behaviors such as tobacco use, physical inactivity, and poor nutrition have been well demonstrated empirically but encompass diverse underlying causal mechanisms. These mechanisms have special theoretical importance because disparities in health behaviors, unlike disparities in many other components of health, involve something more than the ability to use income to purchase good health. Based on a review of broad literatures in sociology, economics, and public health, we classify explanations of higher smoking, lower exercise, poorer diet, and excess weight among low-SES persons into nine broad groups that specify related but conceptually distinct mechanisms. The lack of clear support for any one explanation suggests that the literature on SES disparities in health and health behaviors can do more to design studies that better test for the importance of the varied mechanisms. PMID:21909182

  3. Environmental Health Disparities in Housing

    PubMed Central

    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

  4. Indian Health Disparities

    MedlinePlus

    ... Providers Best & Promising Practices Clinical Resources Committees Continuing Education Health & Wellness Programs Health Information Technology LISTSERV Email Groups National Combined Councils Patient Education ...

  5. Toward Explaining Mental Health Disparities

    ERIC Educational Resources Information Center

    Aneshensel, Carol S.

    2009-01-01

    Mental health disparities refer to the disproportionate amount of psychopathology found among persons of disadvantageous social standing, such as persons of low socioeconomic status (SES). Although social and self selection cannot entirely be ruled out as explanations for these differences, the accumulation of evidence supports a social causation…

  6. Global ovarian cancer health disparities

    PubMed Central

    Chornokur, Ganna; Amankwah, Ernest K.; Schildkraut, Joellen M.; Phelan, Catherine M.

    2013-01-01

    Objective The objective of this article is to broadly review the scientific literature and summarize the most up-to-date findings on ovarian cancer health disparities worldwide and in the United States (U.S.). Methods The present literature on disparities in ovarian cancer was reviewed. Original research and relevant review articles were included. Results Ovarian cancer health disparities exist worldwide and in the U.S. Ovarian cancer disproportionately affect African American women at all stages of the disease, from presentation through treatment, and ultimately increased mortality and decreased survival, compared to non-Hispanic White women. Increased mortality is likely to be explained by unequal access to care and non-standard treatment regimens frequently administered to African American women, but may also be attributed to genetic susceptibility, acquired co-morbid conditions and increased frequency of modifiable risk factors, albeit to substantially lesser extent. Unequal access to care is, in turn, largely a consequence of lower socioeconomic status and lack of private health insurance coverage among the African American population. Conclusions Our findings suggest the need for policy changes aimed at facilitating equal access to quality medical care. At the same time, further research is necessary to fully resolve racial disparities in ovarian cancer. PMID:23266352

  7. Health Disparities: Research

    MedlinePlus

    ... Native peoples were thought to be protected from cardiovascular disease, data now show that this is not the case, despite traditional lifestyles and high omega-3 fatty acid intake. Hispanic Community Health Study of Americans of ...

  8. Health Disparity and Cancer Health Disparity in China.

    PubMed

    Wang, Qi; Jiao, Jie

    2016-01-01

    China is one of the largest and most populated countries in the world. It has undergone rapid economic growth in recent years. However, the development is not equitable, and the distribution of wealth significantly varies among the regions in China. Geographical and socioeconomic inequalities, together with the lack of an equitable national social support system, cause the high variance of health outcomes among the regions. Furthermore, the fast growth of the economy has evoked many environmental challenges and puts much pressure on the population. The severe environmental deterioration, especially of the atmosphere and water bodies, has affected the health of the people living in China. As a result, cancer has become a major public health issue, and an alarming increase in incidence and mortality has been reported. However, cancer incidence and mortality vary in different areas in China. Cancer and cancer treatment disparities have existed for years. This article will discuss the existing health and cancer disparities associated with the risk factors and how these disparities are managed in China.

  9. Health Disparity and Cancer Health Disparity in China

    PubMed Central

    Wang, Qi; Jiao, Jie

    2016-01-01

    China is one of the largest and most populated countries in the world. It has undergone rapid economic growth in recent years. However, the development is not equitable, and the distribution of wealth significantly varies among the regions in China. Geographical and socioeconomic inequalities, together with the lack of an equitable national social support system, cause the high variance of health outcomes among the regions. Furthermore, the fast growth of the economy has evoked many environmental challenges and puts much pressure on the population. The severe environmental deterioration, especially of the atmosphere and water bodies, has affected the health of the people living in China. As a result, cancer has become a major public health issue, and an alarming increase in incidence and mortality has been reported. However, cancer incidence and mortality vary in different areas in China. Cancer and cancer treatment disparities have existed for years. This article will discuss the existing health and cancer disparities associated with the risk factors and how these disparities are managed in China. PMID:28083550

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

    PubMed Central

    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

  11. Food Systems and Public Health Disparities

    PubMed Central

    Neff, Roni A.; Palmer, Anne M.; Mckenzie, Shawn E.; Lawrence, Robert S.

    2009-01-01

    The United States has set a national goal to eliminate health disparities. This article emphasizes the importance of food systems in generating and exacerbating health disparities in the United States and suggests avenues for reducing them. It presents a conceptual model showing how broad food system conditions interplay with community food environments—and how these relationships are filtered and refracted through prisms of social disparities to generate and exacerbate health disparities. Interactions with demand factors in the social environment are described. The article also highlights the separate food systems pathway to health disparities via environmental and occupational health effects of agriculture. PMID:23173027

  12. Empowerment to reduce health disparities.

    PubMed

    Wallerstein, Nina

    2002-01-01

    This article articulates the theoretical construct of empowerment and its importance for health-enhancing strategies to reduce health disparities. Powerlessness is explored as a risk factor in the context of social determinants, such as poverty, discrimination, workplace hazards, and income inequities. Empowerment is presented and compared with social capital and community capacity as strategies to strengthen social protective factors. A case study of a youth empowerment and policy project in New Mexico illustrates the usefulness of empowerment strategies in both targeting social determinants, such as public policies which are detrimental to youth, and improving community capacities of youth to be advocates for social change. Challenges for future practice and research are articulated.

  13. The Moral Problem of Health Disparities

    PubMed Central

    2010-01-01

    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. PMID:20147677

  14. Race, racism and health: disparities, mechanisms, and interventions.

    PubMed

    Brondolo, Elizabeth; Gallo, Linda C; Myers, Hector F

    2009-02-01

    The goals of this special section are to examine the state-of-the-science regarding race/ethnicity and racism as they contribute to health disparities and to articulate a research agenda to guide future research. In the first paper, Myers presents an integrative theoretical framework for understanding how racism, poverty, and other major stressors relate to health through inter-related psychosocial and bio-behavioral pathways. Williams and Mohammed review the evidence concerning associations between racism and health, addressing the multiple levels at which racism can operate and commenting on important methodological issues. Klonoff provides a review and update of the literature concerning ethnicity-related disparities in healthcare, and addresses factors that may contribute to these disparities. Brondolo and colleagues consider racism from a stress and coping perspective, and review the literature concerning racial identity, anger coping, and social support as potential moderators of the racism-health association. Finally, Castro and colleagues describe an ecodevelopmental model that can serve as an integrative framework to examine multi-level social-cultural influences on health and health behavior. In aggregate, the special section papers address theoretical and methodological issues central to understanding the determinants of health disparities, with the aim of providing direction for future research critical to developing effective interventions to reduce these disparities.

  15. Clinical care and health disparities.

    PubMed

    Starfield, B; Gérvas, J; Mangin, D

    2012-04-01

    Health disparities, also known as health inequities, are systematic and potentially remediable differences in one or more aspects of health across population groups defined socially, economically, demographically, or geographically. This topic has been the subject of research stretching back at least decades. Reports and studies have delved into how inequities develop in different societies and, with particular regard to health services, in access to and financing of health systems. In this review, we consider empirical studies from the United States and elsewhere, and we focus on how one aspect of health systems, clinical care, contributes to maintaining systematic differences in health across population groups characterized by social disadvantage. We consider inequities in clinical care and the policies that influence them. We develop a framework for considering the structural and behavioral components of clinical care and review the existing literature for evidence that is likely to be generalizable across health systems over time. Starting with the assumption that health services, as one aspect of social services, ought to enhance equity in health care, we conclude with a discussion of threats to that role and what might be done about them.

  16. Sleep as a Potential Fundamental Contributor to Cardiovascular Health Disparities

    PubMed Central

    Jackson, Chandra L.; Redline, Susan; Emmons, Karen M.

    2016-01-01

    Optimal sleep is integral to health but is commonly not obtained. Despite its wide ranging public health impact, sleep health is under-appreciated by the general public and is only rarely considered by policy makers, employers, schools, and others whose policies and structures can adversely affect sleep. Inadequate sleep duration and quality are prevalent in minority and low-income populations and may play a fundamental role in racial and socioeconomic status (SES) inequities for a wide range of health conditions including cardiovascular disease (CVD).The goal of this review is to examine the relationship between sleep and CVD health disparities. To this end, we describe the overall public health importance of sleep and the role of sleep duration as well as the two most common disorders (sleep apnea and insomnia) as risk factors for a number of chronic diseases. We then focus on the potential link between sleep and CVD disparities. A multilevel model developed for the analysis of population health and health disparities as a part of the National Cancer Institute’s Centers on Population Health and Health Disparities served as our conceptual framework. It is based on the notion that individual behaviors, like sleep, are influenced by complex and dynamic interrelations among the individual and his or her physical and social environments across the lifespan. Using this model, we describe modifiable factors that contribute to insufficient sleep and circadian misalignment, propose potential interventions in various sectors (e.g. neighborhoods, schools, workplaces) that address social structures that contribute to disparities, and conclude by recommending critical areas for future sleep research. We ultimately suggest that integrating sleep into public health research will identify novel approaches for closing the gap in health disparities, such as CVD. PMID:25785893

  17. Training the Next Generation of Latino Health Researchers: A Multilevel, Transdisciplinary, Community-Engaged Approach.

    PubMed

    Kuo, Alice A; Sharif, Mienah Z; Prelip, Michael L; Glik, Deborah C; Albert, Stephanie L; Belin, Thomas; McCarthy, William J; Roberts, Christian K; Garcia, Rosa Elena; Ortega, Alexander N

    2016-09-08

    Reducing health disparities is a national public health priority. Latinos represent the largest racial/ethnic minority group in the United States and suffer disproportionately from poor health outcomes, including cardiovascular disease risk. Academic training programs are an opportunity for reducing health disparities, in part by increasing the diversity of the public health workforce and by incorporating training designed to develop a skill set to address health disparities. This article describes the Training and Career Development Program at the UCLA Center for Population Health and Health Disparities: a multilevel, transdisciplinary training program that uses a community-engaged approach to reduce cardiovascular disease risk in two urban Mexican American communities. Results suggest that this program is effective in enhancing the skill sets of traditionally underrepresented students to become health disparities researchers and practitioners.

  18. The Persistence of American Indian Health Disparities

    PubMed Central

    Jones, David S.

    2006-01-01

    Disparities in health status between American Indians and other groups in the United States have persisted throughout the 500 years since Europeans arrived in the Americas. Colonists, traders, missionaries, soldiers, physicians, and government officials have struggled to explain these disparities, invoking a wide range of possible causes. American Indians joined these debates, often suggesting different explanations. Europeans and Americans also struggled to respond to the disparities, sometimes working to relieve them, sometimes taking advantage of the ill health of American Indians. Economic and political interests have always affected both explanations of health disparities and responses to them, influencing which explanations were emphasized and which interventions were pursued. Tensions also appear in ongoing debates about the contributions of genetic and socioeconomic forces to the pervasive health disparities. Understanding how these economic and political forces have operated historically can explain both the persistence of the health disparities and the controversies that surround them. PMID:17077399

  19. Global health disparities: crisis in the diaspora.

    PubMed

    Cox, Raymond L

    2004-04-01

    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.

  20. Role of genomics in eliminating health disparities

    PubMed Central

    Kashyap, Meghana V; Nolan, Michael; Sprouse, Marc; Chakraborty, Ranajit; Cross, Deanna; Roby, Rhonda; Vishwanatha, Jamboor K

    2015-01-01

    The Texas Center for Health Disparities, a National Institute on Minority Health and Health Disparities Center of Excellence, presents an annual conference to discuss prevention, awareness education, and ongoing research about health disparities both in Texas and among the national population. The 2014 Annual Texas Conference on Health Disparities brought together experts in research, patient care, and community outreach on the “Role of Genomics in Eliminating Health Disparities.” Rapid advances in genomics and pharmacogenomics are leading the field of medicine to use genetics and genetic risk to build personalized or individualized medicine strategies. We are at a critical juncture of ensuring such rapid advances benefit diverse populations. Relatively few forums have been organized around the theme of the role of genomics in eliminating health disparities. The conference consisted of three sessions addressing “Gene-Environment Interactions and Health Disparities,” “Personalized Medicine and Elimination of Health Disparities,” and “Ethics and Public Policy in the Genomic Era.” This article summarizes the basic science, clinical correlates, and public health data presented by the speakers. PMID:26435701

  1. Addressing Health Care Disparities Among Sexual Minorities.

    PubMed

    Baptiste-Roberts, Kesha; Oranuba, Ebele; Werts, Niya; Edwards, Lorece V

    2017-03-01

    There is evidence of health disparities between sexual minority and heterosexual populations. Although the focus of lesbian, gay, bisexual, and transgender health research has been human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infection among men who have sex with men, there are health disparities among sexual minority women. Using the minority stress framework, these disparities may in part be caused by individual prejudice, social stigma, and discrimination. To ensure equitable health for all, there is urgent need for targeted culturally sensitive health promotion, cultural sensitivity training for health care providers, and intervention-focused research.

  2. Health Disparities and Gaps in School Readiness

    ERIC Educational Resources Information Center

    Currie, Janet

    2005-01-01

    The author documents pervasive racial disparities in the health of American children and analyzes how and how much those disparities contribute to racial gaps in school readiness. She explores a broad sample of health problems common to U.S. children, such as attention deficit hyperactivity disorder, asthma, and lead poisoning, as well as maternal…

  3. Health Disparities and Discrimination: Three Perspectives

    PubMed Central

    Ndiaye, Khadidiatou; Krieger, Janice R.; Warren, Jennifer R.; Hecht, Michael L.; Okuyemi, Kola

    2010-01-01

    This article presents three perspectives on health discrimination and disparities, organized around different conceptualizations of the way “space” perpetuates health disparities. The first two perspectives are grounded in conceptualizing space in a physical sense by exploring the manifestation of discrimination as a problem both among and within nations. The third perspective juxtaposes geographical space with cyberspace. The internet, with its ability to blur sense of place, social demarcations, and behavior is often considered a panacea that can eliminate the health disparities. The internet, however, may not be fulfilling its promise as an equal source of health information for all and disparities related to international and rural geography remain problematic. Solutions are proposed for reducing health disparities based on The Principle of Cultural Grounding (Hecht & Krieger, 2006; Hecht & Miller-Day, in press). PMID:20694161

  4. EGRP-Supported Health Disparities Research

    Cancer.gov

    The National Cancer Institute has targeted the reduction of cancer-related health disparities, differences in the incidence, prevalence, mortality, and burden of cancer and related adverse health conditions, as an important challenge.

  5. Multilevel modelling and public health policy.

    PubMed

    Leyland, Alastair H; Groenewegen, Peter P

    2003-01-01

    Multilevel modelling is a statistical technique that extends ordinary regression analysis to the situation where the data are hierarchical. Such data form an increasingly common evidence base for public health policy, and as such it is important that policy makers should be aware of this methodology. This paper therefore lays out the a basic description of multilevel modelling, discusses the problems of alternative approaches, and details the relevance for public health policy before describing which levels are relevant and illustrating the different kinds of hypotheses that can be tested using multilevel modelling. A series of examples is used throughout the paper. These relate to regional variations in the incidence of heart disease, the allocation of health resources, the relationship between neighbourhood disorder and mental health, the demand-control model in occupational health, and a school intervention to prevent cardiovascular disease.

  6. The 2014 Minority Health and Health Disparities Grantees’ Conference

    PubMed Central

    Edberg, Mark; Hayes, Barbara E.; Montgomery-Rice, Valerie; Tchounwou, Paul B.

    2015-01-01

    Health disparities have been defined as a particular type of health difference closely linked with social, economic and/or environmental disadvantage. The National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health, has a comprehensive portfolio of grants that fund scientific research to improve racial/ethnic minority health and eliminate health disparities. The 2014 Minority Health and Health Disparities Grantees’ Conference highlighted excellence and innovation in biological, environmental, sociocultural, clinical and behavioral research supported by NIMHD. This special issue of the International Journal of Environmental Research and Public Health includes peer-reviewed publications from investigators who participated in this conference.

  7. Health disparities and the cancer survivor.

    PubMed

    Blinder, Victoria S; Griggs, Jennifer J

    2013-12-01

    Disparities on the basis of race and ethnicity have been described in a variety of survivorship outcomes, including late and long-term effects of treatment, surveillance and health maintenance, and psychosocial outcomes. However, the current body of literature is limited in scope and additional research is needed to better define and address disparities among cancer survivors. © 2013 Elsevier Inc. All rights reserved.

  8. Approaches to Eliminating Sociocultural Disparities in Health

    PubMed Central

    Horowitz, Carol R.; Davis, Margaret H.; Palermo, Ann-Gel S.; Vladeck, Bruce C.

    2000-01-01

    The recent flurry of studies documenting the presence of racial, ethnic, and socioeconomic disparities in health care and health have outpaced articles that describe effective strategies to eliminate disparities. Through literature review and informal interviews with research, policy, and program experts, we developed a framework of programs that address disparities through targeting clinicians, patients and communities, and health systems. We found that the lack of technical expertise, resources, and sensitive tools are all common barriers to evaluating programs. To stimulate more effective programs and rigorous evaluations, we describe specialized implementation and evaluation techniques programs can use, and make recommendations for future efforts. PMID:11481745

  9. Transdisciplinary approaches to understanding and eliminating ethnic health disparities: are we on the right track?

    PubMed

    Knerr, Sarah; Fullerton, Stephanie M

    2012-01-01

    The public health community's struggle to combat domestic health disparities has occurred in a context of increasing implementation of transdisciplinary research approaches. While conceptually appealing, the focus on the multilevel framing of the causes of ethnic health disparities by large-scale transdisciplinary initiatives has, to date, resulted in few tangible products. Moreover, intervention and community engagement outcomes have received less attention than more process-oriented research outcomes, namely assessing levels of transdisciplinarity achieved during the research process. We argue that a renewed focus on the ultimate products of transdisciplinary approaches, namely effective multilevel interventions, specific health outcome improvements, and greater community involvement, will aid this promising research paradigm in carrying out its philosophical commitment to ending population health disparities.

  10. Transdisciplinary Approaches to Understanding and Eliminating Ethnic Health Disparities: Are We on the Right Track?

    PubMed Central

    Knerr, Sarah; Fullerton, Stephanie M.

    2012-01-01

    The public health community’s struggle to combat domestic health disparities has occurred in a context of increasing implementation of transdisciplinary research approaches. While conceptually appealing, the focus on the multilevel framing of the causes of ethnic health disparities by large-scale transdisciplinary initiatives has, to date, resulted in few tangible products. Moreover, intervention and community engagement outcomes have received less attention than more process-oriented research outcomes, namely assessing levels of transdisciplinarity achieved during the research process. We argue that a renewed focus on the ultimate products of transdisciplinary approaches, namely effective multilevel interventions, specific health outcome improvements, and greater community involvement, will aid this promising research paradigm in carrying out its philosophical commitment to ending population health disparities. PMID:23140084

  11. Empowerment Praxis: Community Organizing to Redress Systemic Health Disparities.

    PubMed

    Douglas, Jason A; Grills, Cheryl T; Villanueva, Sandra; Subica, Andrew M

    2016-12-01

    Social and environmental determinants of childhood obesity present a public health dilemma, particularly in low-income communities of color. Case studies of two community-based organizations participating in the Robert Wood Johnson Foundation's Communities Creating Healthy Environments (CCHE) childhood obesity initiative demonstrate multilevel, culturally situated community organizing strategies to address the root causes of this public health disparity. Informed by a 3-lens prescription-Social Justice, Culture-Place, and Organizational Capacity-contained in the CCHE Change Model and Evaluation Frame, we present examples of individual, organizational, and community empowerment to redress systemic inequities that manifest in poor health outcomes for people of color. These case studies offer compelling evidence that public health disparities in these communities may effectively be abated through strategies that employ bottom-up, community-level approaches for (a) identifying proximal and distal determinants of public health disparities, and (b) empowering communities to directly redress these inequities. Guided by this ecological framework, application of the CCHE evaluation approach demonstrated the necessity to document the granularity of community organizing for community health, adding to the community psychology literature on empowering processes and outcomes. © Society for Community Research and Action 2016.

  12. Racial and Ethnic Disparities in Health and Health Care.

    PubMed

    Wheeler, Sarahn M; Bryant, Allison S

    2017-03-01

    A health disparity is defined as an increased burden of an adverse health outcome or health determinant within a specific subset of the population. There are well-documented racial and ethnic disparities throughout health care at the patient, provider, and health care system levels. As the minority populations within the United States grow to record numbers, it is increasingly important to invest in efforts to characterize, understand, and end racial and ethnic disparities in health care. Inequities in health outcomes and care pose real threats to the entire nation's well-being. Eliminating health disparities is fundamental to the well-being, productivity, and viability of the entire nation.

  13. Health disparities among health care workers.

    PubMed

    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.

  14. Basic Information about Health Disparities in Cancer

    MedlinePlus

    ... Causes of Death Among American Indians and Alaska Natives African American Women and Mass Media Campaign Partners Related Links Stay Informed Cancer Home Basic Information About Health Disparities in Cancer Language: English Español (Spanish) Recommend ...

  15. The Public Health Approach to Eliminating Disparities in Health

    PubMed Central

    Satcher, David; Higginbotham, Eve J.

    2008-01-01

    Reducing and eliminating disparities in health is a matter of life and death. Each year in the United States, thousands of individuals die unnecessarily from easily preventable diseases and conditions. It is critical that we approach this problem from a broad public health perspective, attacking all of the determinants of health: access to care, behavior, social and physical environments, and overriding policies of universal access to care, physical education in schools, and restricted exposure to toxic substances. We describe the historical background for recognizing and addressing disparities in health, various factors that contribute to disparities, how the public health approach addresses such challenges, and two successful programs that apply the public health approach to reducing disparities in health. Public health leaders must advocate for public health solutions to eliminate disparities in health. PMID:18235057

  16. The Public Health Approach to Eliminating Disparities in Health

    PubMed Central

    Satcher, David; Higginbotham, Eve J.

    2008-01-01

    Reducing and eliminating disparities in health is a matter of life and death. Each year in the United States, thousands of individuals die unnecessarily from easily preventable diseases and conditions. It is critical that we approach this problem from a broad public health perspective, attacking all of the determinants of health: access to care, behavior, social and physical environments, and overriding policies of universal access to care, physical education in schools, and restricted exposure to toxic substances. We describe the historical background for recognizing and addressing disparities in health, various factors that contribute to disparities, how the public health approach addresses such challenges, and two successful programs that apply the public health approach to reducing disparities in health. Public health leaders must advocate for public health solutions to eliminate disparities in health. PMID:18687626

  17. Promoting health literacy research to reduce health disparities.

    PubMed

    Paasche-Orlow, Michael K; Wolf, Michael S

    2010-01-01

    Limited health literacy has been linked to worse health outcomes for a range of medical conditions. In addition, limited health literacy is more prevalent among specific racial and ethnic minorities. Although these findings have been widely acknowledged, little systematic research has been conducted to elucidate the role of health literacy in the creation of health disparities or to evaluate the possibility that interventions relating to health literacy may help eliminate health disparities. This paper presents recommendations for a research agenda that is focused on advancing the science for how health literacy research can promote the effort to eliminate health disparities.

  18. Health disparities in Milwaukee by socioeconomic status.

    PubMed

    Vila, Peter M; Swain, Geoffrey R; Baumgardner, Dennis J; Halsmer, Sarah E; Remington, Patrick L; Cisler, Ron A

    2007-10-01

    In 2006, the city of Milwaukee ranked worse than any Wisconsin county for health outcomes and worse than all but 1 county for health determinants. To further examine disparities in health, Milwaukee city ZIP codes were stratified into 3 groups (lower, middle, and upper) by socioeconomic status (SES). Health determinants (15 measures) and health outcomes (2 measures) were compared across these ZIP code groups, and to the rest of Wisconsin. The risk ratio for the lower SES group in comparison to the upper SES group was at least 2.0 for 5 of the 17 measures examined, and was at least 1.5 for 13 of the 17 measures. The upper SES group in Milwaukee, while the healthiest in the city, was worse than the state average in 6 measures. Large health disparities within the city of Milwaukee are associated with geographic regions of differing socioeconomic status. As the state's largest urban center, Milwaukee's relatively poor health and significant health disparities have a considerable impact on the overall health of the state. To improve population health in Wisconsin, substantial efforts and resources are needed to address these disparities, and their related upstream factors.

  19. Socioeconomic Disparities and Health: Impacts and Pathways

    PubMed Central

    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

  20. Socioeconomic disparities and health: impacts and pathways.

    PubMed

    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.

  1. Addressing health disparities: Brown University School of Public Health.

    PubMed

    Wetle, Terrie Fox; Scanlan, Karen

    2014-09-02

    Health disparities are a public health concern in Rhode Island and around the world. Faculty members and students in the Brown University School of Public Health are working to understand, address, and ultimately eliminate disparities in health and health care affecting diverse populations. Our educational offerings and research efforts are directed toward understanding and addressing the social, cultural, and environmental factors that contribute to these health disparities. Research methods to carry out this work include implementing interdisciplinary, community-based, quantitative and qualitative research with the goal of preventing, reducing, and eliminating health disparities. This article focuses on some of the School's work with vulnerable communities confronting issues around the following: HIV/AIDS, obesity, nutrition, physical activity and delivery of health services.

  2. The human face of health disparities.

    PubMed

    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.

  3. Institutional Disparities in the Cost Effectiveness of GCE A-Level Provision: A Multi-Level Approach.

    ERIC Educational Resources Information Center

    Fielding, A.

    1995-01-01

    Reanalyzes H. Thomas's 1980s data, which used teaching group as the unit of analysis and illuminated some institutional disparities in provision of General Certificate of Education (GCE) A-levels. Uses multilevel analysis to focus on individual students in a hierarchical framework. Among the study institutions, school sixth forms appear less…

  4. Racial and Ethnic Health Disparities in Incarcerated Populations.

    PubMed

    Borysova, Meghan E; Mitchell, Ojmarrh; Sultan, Dawood H; Williams, Arthur R

    2012-01-01

    Alarming disparities in population health and wellness in the United States have led to multidisciplinary research efforts to create health equity. Identifying disparities, elucidating the etiological bases of disparities, and implementing solutions to eliminate disparities are part of the U.S. national health agenda. Racial and ethnic disparities have been identified throughout the cancer control continuum, in cardiovascular disease, diabetes and a multitude of other conditions. The causes of disparities are complex, condition specific, and conjectured to result from combinations of biological and socio-behavioral factors. Racial and ethnic health disparities within the vast incarcerated communities have been excluded from most studies, yet are of significant ethical and fiscal concern to inmates, governing bodies, and non-incarcerated communities into which inmates return. Importantly, research on racial and ethnic disparities in this unique population may shed light on the relative etiologies of health disparities and solutions for creating health equity throughout the general population in the United States.

  5. Health disparities and gaps in school readiness.

    PubMed

    Currie, Janet

    2005-01-01

    The author documents pervasive racial disparities in the health of American children and analyzes how and how much those disparities contribute to racial gaps in school readiness. She explores a broad sample of health problems common to U.S. children, such as attention deficit hyperactivity disorder, asthma, and lead poisoning, as well as maternal health problems and health-related behaviors that affect children's behavioral and cognitive readiness for school. If a health problem is to affect the readiness gap, it must affect many children, it must be linked to academic performance or behavior problems, and it must show a racial disparity either in its prevalence or in its effects. The author focuses not only on the black-white gap in health status but also on the poor-nonpoor gap because black children tend to be poorer than white children. The health conditions Currie considers seriously impair cognitive skills and behavior in individual children. But most explain little of the overall racial gap in school readiness. Still, the cumulative effect of health differentials summed over all conditions is significant. Currie's rough calculation is that racial differences in health conditions and in maternal health and behaviors together may account for as much as a quarter of the racial gap in school readiness. Currie scrutinizes several policy steps to lessen racial and socioeconomic disparities in children's health and to begin to close the readiness gap. Increasing poor children's eligibility for Medicaid and state child health insurance is unlikely to be effective because most poor children are already eligible for public insurance. The problem is that many are not enrolled. Even increasing enrollment may not work: socioeconomic disparities in health persist in Canada and the United Kingdom despite universal public health insurance. The author finds more promise in strengthening early childhood programs with a built-in health component, like Head Start; family

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

    MedlinePlus

    ... Approaches to Community Health Tribal Support Women's Health Health Literacy Health Equity CDC Health Disparities & Inequalities Report (CHDIR) ... Approaches to Community Health Tribal Support Women's Health Health Literacy File Formats Help: How do I view different ...

  7. Scalable Combinatorial Tools for Health Disparities Research

    PubMed Central

    Langston, Michael A.; Levine, Robert S.; Kilbourne, Barbara J.; Rogers, Gary L.; Kershenbaum, Anne D.; Baktash, Suzanne H.; Coughlin, Steven S.; Saxton, Arnold M.; Agboto, Vincent K.; Hood, Darryl B.; Litchveld, Maureen Y.; Oyana, Tonny J.; Matthews-Juarez, Patricia; Juarez, Paul D.

    2014-01-01

    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. PMID:25310540

  8. Scalable combinatorial tools for health disparities research.

    PubMed

    Langston, Michael A; Levine, Robert S; Kilbourne, Barbara J; Rogers, Gary L; Kershenbaum, Anne D; Baktash, Suzanne H; Coughlin, Steven S; Saxton, Arnold M; Agboto, Vincent K; Hood, Darryl B; Litchveld, Maureen Y; Oyana, Tonny J; Matthews-Juarez, Patricia; Juarez, Paul D

    2014-10-10

    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.

  9. Addressing Health Disparities through Multi-institutional, Multidisciplinary Collaboratories

    PubMed Central

    Fleming, Erik S.; Perkins, James; Easa, David; Conde, José G.; Baker, Richard S.; Southerland, William M.; Dottin, Robert; Benabe, Julio E.; Ofili, Elizabeth O.; Bond, Vincent C.; McClure, Shelia A.; Sayre, Michael H.; Beanan, Maureen J.; Norris, Keith C.

    2009-01-01

    The national research leadership has recently become aware of the tremendous potential of translational research as an approach to address health disparities. The Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN) is a research network that supports multi-institutional, multidisciplinary collaboration with a focus on key diseases and conditions for which disproportionately adverse racial and ethnic health disparities exist. The RTRN is designed to facilitate the movement of scientific advances across the translational research spectrum by providing researchers at different institutions with the infrastructure and tools necessary to collaborate on interdisciplinary and transdisciplinary research projects relating to specific health outcomes for which major racial/ethnic disparities exist. In the past, the difficulty of overcoming the restrictions imposed by time and space have made it difficult to carry out this type of large-scale, multilevel collaboration efficiently. To address this formidable challenge, the RTRN will deploy a translational research cluster system that uses “cyber workspaces” to bring researchers with similar interests together by using online collaboratory technology. These virtual meeting environments will provide a number of tools, including videoconferences (seminars, works in progress, meetings); project management tools (WebCT, Microsoft Share Point); and posting areas for projects, concepts, and other research and educational activities. This technology will help enhance access to resources across institutions with a common mission, minimize many of the logistical hurdles that impede intellectual exchange, streamline the planning and implementation of innovative interdisciplinary research, and assess the use of protocols and practices to assist researchers in interacting across and within cyber workspaces. PMID:18646341

  10. Multilevel analysis of the role of human factors in regional disparities in crash outcomes.

    PubMed

    Adanu, Emmanuel Kofi; Smith, Randy; Powell, Lars; Jones, Steven

    2017-10-06

    A growing body of research has examined the disparities in road traffic safety among population groups and geographic regions. These studies reveal disparities in crash outcomes between people and regions with different socioeconomic characteristics. A critical aspect of the road traffic crash epidemic that has received limited attention is the influence of local characteristics on human elements that increase the risk of getting into a crash. This paper applies multilevel logistic regression modeling techniques to investigate the influence of driver residential factors on driver behaviors in an attempt to explain the area-based differences in the severity of road crashes across the State of Alabama. Specifically, the paper reports the effects of characteristics attributable to drivers and the geographic regions they reside on the likelihood of a crash resulting in serious injuries. Model estimation revealed that driver residence (postal code or region) accounted for about 7.3% of the variability in the probability of a driver getting into a serious injury crash, regardless of driver characteristics. The results also reveal disparities in serious injury crash rate as well as significant proportions of serious injury crashes involving no seatbelt usage, driving under influence (DUI), unemployed drivers, young drivers, distracted driving, and African American drivers among some regions. The average credit scores, average commute times, and populations of driver postal codes are shown to be significant predictors for risk of severe injury crashes. This approach to traffic crash analysis presented can serve as the foundation for evidence-based policies and also guide the implementation of targeted countermeasures. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: study protocol

    PubMed Central

    2013-01-01

    Background Racial disparities in blood pressure control have been well documented in the United States. Research suggests that many factors contribute to this disparity, including barriers to care at patient, clinician, healthcare system, and community levels. To date, few interventions aimed at reducing hypertension disparities have addressed factors at all of these levels. This paper describes the design of Project ReD CHiP (Reducing Disparities and Controlling Hypertension in Primary Care), a multi-level system quality improvement project. By intervening on multiple levels, this project aims to reduce disparities in blood pressure control and improve guideline concordant hypertension care. Methods Using a pragmatic trial design, we are implementing three complementary multi-level interventions designed to improve blood pressure measurement, provide patient care management services and offer expanded provider education resources in six primary care clinics in Baltimore, Maryland. We are staggering the introduction of the interventions and will use Statistical Process Control (SPC) charting to determine if there are changes in outcomes at each clinic after implementation of each intervention. The main hypothesis is that each intervention will have an additive effect on improvements in guideline concordant care and reductions in hypertension disparities, but the combination of all three interventions will result in the greatest impact, followed by blood pressure measurement with care management support, blood pressure measurement with provider education, and blood pressure measurement only. This study also examines how organizational functioning and cultural competence affect the success of the interventions. Discussion As a quality improvement project, Project ReD CHiP employs a novel study design that specifically targets multi-level factors known to contribute to hypertension disparities. To facilitate its implementation and improve its sustainability, we have

  12. National newspaper coverage of minority health disparities.

    PubMed Central

    Amzel, Anouk; Ghosh, Chandak

    2007-01-01

    OBJECTIVES: To assess American newspaper coverage regarding racial and ethnic minority health disparities (MHDs). METHODS: LexisNexis was queried with specific word combinations to elicit all MHD articles printed in 257 newspapers from 2000-2004. The full texts were read and articles categorized by racial/ethnic group and specific MHD topics mentioned. RESULTS: In the five years from 2000-2004, 1188 MHD articles were published, representing 0.09% of all articles about health. Newspapers gave much attention to MHD when discussed in conferences and meetings and speeches by senior health officials and politicians. Cancer, cardiovascular disease and HIV/AIDS were most frequent among disease-specific mentions. Articles about African Americans comprised 60.4% of all race/ethnicity-mentioning articles. CONCLUSIONS: Despite the release of major organizational reports and the publication of many studies confirming the prevalence of MHD, few newspaper articles have been published explaining MHD to the public. Because of the general public's low rate of health literacy, the health world should collaborate with the media to present a consistent, simple message concerning gaps in care experienced by all racial/ethnic minority groups. In a time of consumer-directed healthcare, if Americans understand that MHDs exist, they may galvanize to advocate for disparity elimination and quality improvement. PMID:17987915

  13. A multilevel decomposition approach to estimate the role of program location and neighborhood disadvantage in racial disparities in alcohol treatment completion.

    PubMed

    Jacobson, Jerry Owen; Robinson, Paul; Bluthenthal, Ricky N

    2007-01-01

    Large racial disparities in completion rates from substance abuse treatment programs in urban settings remain largely unexplained, although evidence is accumulating that neighborhood conditions may influence individual substance abuse patterns and consequences. Understanding racial disparities in alcohol treatment completion, in particular, is crucial to resolving health disparities because racial/ethnic minorities bear a disproportionate burden of alcohol-related health consequences. Patient records for all non-homeless African American (N=1677), Hispanic (N=1635), and white (N=1216) alcohol outpatients, ages 18 or older, discharged during 1998-2000 from publicly funded treatment programs in Los Angeles County, the second largest system of publicly funded substance abuse treatment in the United States, were combined with census data. We tested the hypothesis that racial differences in treatment completion are related to differences in neighborhood context, particularly neighborhood-level disadvantage. Estimates from multilevel statistical models indicate that treatment neighborhood disadvantage is independently associated with treatment completion after controlling for patient characteristics and facility- and zip code-level random effects. Results of a Oaxaca decomposition of the regression estimates indicate that racial differences in treatment neighborhood disadvantage account for 32.3% of African American-white differences in treatment completion. Hispanic-white differences in completion, and the effect of home neighborhood disadvantage on completion, were non-significant. We conclude that the location of publicly funded alcohol treatment programs is related to racial disparities in treatment completion, but additional research is necessary to understand the mechanism behind this association.

  14. Measurement Issues in Health Disparities Research

    PubMed Central

    Ramírez, Mildred; Ford, Marvella E; Stewart, Anita L; A Teresi, Jeanne

    2005-01-01

    Background Racial and ethnic disparities in health and health care have been documented; the elimination of such disparities is currently part of a national agenda. In order to meet this national objective, it is necessary that measures identify accurately the true prevalence of the construct of interest across diverse groups. Measurement error might lead to biased results, e.g., estimates of prevalence, magnitude of risks, and differences in mean scores. Addressing measurement issues in the assessment of health status may contribute to a better understanding of health issues in cross-cultural research. Objective To provide a brief overview of issues regarding measurement in diverse populations. Findings Approaches used to assess the magnitude and nature of bias in measures when applied to diverse groups include qualitative analyses, classic psychometric studies, as well as more modern psychometric methods. These approaches should be applied sequentially, and/or iteratively during the development of measures. Conclusions Investigators performing comparative studies face the challenge of addressing measurement equivalence, crucial for obtaining accurate results in cross-cultural comparisons. PMID:16179000

  15. Opportunities and challenges of using technology to address health disparities.

    PubMed

    Rivers, Brian M; Bernhardt, Jay M; Fleisher, Linda; Green, Bernard Lee

    2014-03-01

    During a panel presentation at the American Association for Cancer Research Cancer Health Disparities Conference titled 'Opportunities and challenges of using technology to address health disparities', the latest scientific advances in the application and utilization of mobile technology and/or mobile-health (mHealth) interventions to address cancer health disparities were discussed. The session included: an examination of overall population trends in the uptake of technology and the potential of addressing health disparities through such media; an exploration of the conceptual issues and challenges in the construction of mHealth interventions to address disparate and underserved populations; and a presentation of pilot study findings on the acceptability and feasibility of using mHealth interventions to address prostate cancer disparities among African-American men.

  16. Mental Health Disparities Among Canadian Transgender Youth.

    PubMed

    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.

  17. Increasing the capacity of health sciences to address health disparities.

    PubMed

    Daley, Sandra P; Broyles, Shelia L; Rivera, Lourdes M; Reznik, Vivian M

    2009-09-01

    In order to create a cohort of investigators who are engaged in health disparities research, scholarship, and practice, and to increase the amount of funding in the university that is invested in research focused on reducing health disparities, the San Diego EXPORT Center implemented 2 major initiatives: (1) the support of underrepresented minority (URM) junior faculty development and (2) the funding for pilot research grants in health disparities. This paper describes the activities employed by the center and summarizes the outcomes of these two initiatives. Ninety-five percent (18 of 19) URM junior faculty completed the faculty development program, and 83.3% (15 of 18) of the completers are advancing in their academic careers at University of California San Diego (UCSD) and are teaching, working with populations at risk and/or conducting research in health disparities. EXPORT awarded 7 investigators a total of $429186 to conduct pilot research, and 71.4% (5/7) have now obtained $4.7 million in independent extramural funding. The San Diego EXPORT Center has increased the research capacity, strengthened the infrastructure for health disparities research, and created a cohort of successful URM junior faculty who are advancing in their academic careers. These investigators are already changing the climate at UCSD by their leadership activities, research focus, peer-networking, and mentoring of students.

  18. Untangling the health disparities of teen pregnancy.

    PubMed

    Talashek, Marie L; Alba, Melinda L; Patel, Angira

    2006-01-01

    The purpose of this secondary analysis is to determine whether a developmental maturity model differentially predicts pregnancy for African American, Puerto Rican, and Mexican inner-city teens. This is a secondary analysis of data from a case control study that tested a model of developmental maturity and teen pregnancy with 183 pregnant and never-pregnant pairs of inner-city teens matched on age, ethnicity, and freshman cohort. The models differentially predict pregnancy for the separate ethnic groups, with sexual behaviors being the most important factors regardless of ethnicity. The health disparities of teen pregnancies may not decrease unless patterns of dating/sexual behaviors are reversed.

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

    PubMed

    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. Reducing and eliminating health disparities: a targeted approach.

    PubMed Central

    Green, B. Lee; Lewis, Rhonda K.; Bediako, Shawn M.

    2005-01-01

    Health disparities have dominated recent discourse among public health and medical researchers. Ever since the United States began to compile health statistics, differences in health status have been noted between majority and non-majority populations. Myriad approaches have been undertaken in an attempt to reduce or eliminate racial and ethnic disparities in health. However, the disparities continue to persist. We are at a point in our history where innovative strategies must be explored that will be more effective in addressing racial and ethnic disparities in health. In large part, health disparities exist as a result of inequitable distribution of goods, resources, services and power in America. We have learned that improvements in health cannot come about solely through primary and secondary interventions but rather through an examination of the availability of resources that would allow individuals to improve their health. The goal of this paper is to provide an overview of the contextual factors that affect health disparities, to integrate theory to address disparities and to provide recommendations to encourage systematic changes to eliminate health disparities. It is hoped that this paper will bring about a national discussion relating to addressing the real issues we face in reducing and ultimately eliminating health disparities. PMID:15719868

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

    PubMed

    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.

  2. Policy challenges in addressing racial disparities and improving population health.

    PubMed

    Mechanic, David

    2005-01-01

    Socioeconomic status fundamentally affects most health and disease outcomes, but black Americans are doubly disadvantaged by low status, discrimination, and residential segregation. Improving health and removing disparities are essential goals, but some efforts that improve the health of blacks in important ways also increase black-white disparity ratios. People with more information, influence, resources, and social networks may be better able to take advantage of new technologies and scientific developments, initially increasing disparities. Better health and reduced mortality should be the key policy criteria, but these criteria should be linked with consideration of careful targeting to level the playing field and close disparities.

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

    PubMed

    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.

  4. 77 FR 61611 - National Institute on Minority Health and Health Disparities; Notice of Closed Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-10

    ... Disparities Special Emphasis Panel; NIMHD Social, Behavioral, Health Services, and Policy Research on Minority... Minority Health and Health ] Disparities, National Institutes of Health, 6707 Democracy Blvd., Suite 800... Institute on Minority Health, and Health Disparities, National Institutes of Health, 6707 Democracy...

  5. How Resource Dynamics Explain Accumulating Developmental and Health Disparities for Teen Parents’ Children

    PubMed Central

    Mollborn, Stefanie; Lawrence, Elizabeth; James-Hawkins, Laurie; Fomby, Paula

    2014-01-01

    This study examines the puzzle of disparities experienced by U.S. teen parents’ young children, whose health and development increasingly lag behind those of peers while their parents are simultaneously experiencing socioeconomic improvements. Using the nationally representative Early Childhood Longitudinal Study-Birth Cohort (2001–2007; N ≈ 8,600), we assess four dynamic patterns in socioeconomic resources that might account for these growing developmental and health disparities throughout early childhood and then test them in multilevel growth curve models. Persistently low socioeconomic resources constituted the strongest explanation, given that consistently low income, maternal education, and assets fully or partially account for growth in cognitive, behavioral, and health disparities experienced by teen parents’ children from infancy through kindergarten. That is, although teen parents gained socioeconomic resources over time, those resources remained relatively low, and the duration of exposure to limited resources explains observed growing disparities. Results suggest that policy interventions addressing the time dynamics of low socioeconomic resources in a household, in terms of both duration and developmental timing, are promising for reducing disparities experienced by teen parents’ children. PMID:24802282

  6. How resource dynamics explain accumulating developmental and health disparities for teen parents' children.

    PubMed

    Mollborn, Stefanie; Lawrence, Elizabeth; James-Hawkins, Laurie; Fomby, Paula

    2014-08-01

    This study examines the puzzle of disparities experienced by U.S. teen parents' young children, whose health and development increasingly lag behind those of peers while their parents are simultaneously experiencing socioeconomic improvements. Using the nationally representative Early Childhood Longitudinal Study-Birth Cohort (2001-2007; N ≈ 8,600), we assess four dynamic patterns in socioeconomic resources that might account for these growing developmental and health disparities throughout early childhood and then test them in multilevel growth curve models. Persistently low socioeconomic resources constituted the strongest explanation, given that consistently low income, maternal education, and assets fully or partially account for growth in cognitive, behavioral, and health disparities experienced by teen parents' children from infancy through kindergarten. That is, although teen parents gained socioeconomic resources over time, those resources remained relatively low, and the duration of exposure to limited resources explains observed growing disparities. Results suggest that policy interventions addressing the time dynamics of low socioeconomic resources in a household, in terms of both duration and developmental timing, are promising for reducing disparities experienced by teen parents' children.

  7. The Sociobiologic Integrative Model (SBIM): Enhancing the Integration of Sociobehavioral, Environmental, and Biomolecular Knowledge in Urban Health and Disparities Research

    PubMed Central

    Brock, Malcolm; Alberg, Anthony J.; Glass, Thomas; LaVeist, Thomas A.; Baylin, Stephen; Levine, David; Fox, C. Earl

    2007-01-01

    Disentangling the myriad determinants of disease, within the context of urban health or health disparities, requires a transdisciplinary approach. Transdisciplinary approaches draw on concepts from multiple scientific disciplines to develop a novel, integrated perspective from which to conduct scientific investigation. Most historic and contemporary conceptual models of health were derived either from the sociobehavioral sciences or the biomolecular sciences. Those models deriving from the sociobehavioral sciences generally lack detail on involved biological mechanisms whereas those derived from the biomolecular sciences largely do not consider socioenvironmental determinants. As such, advances in transdisciplinary characterizations of health in complex systems like the urban environment or health disparities may be impeded. This paper suggests a sociobiologic organizing model that encourages a multilevel, integrative perspective in the study of urban health and health disparities. PMID:17216571

  8. The sociobiologic integrative model (SBIM): enhancing the integration of sociobehavioral, environmental, and biomolecular knowledge in urban health and disparities research.

    PubMed

    Gibbons, M Chris; Brock, Malcolm; Alberg, Anthony J; Glass, Thomas; LaVeist, Thomas A; Baylin, Stephen; Levine, David; Fox, C Earl

    2007-03-01

    Disentangling the myriad determinants of disease, within the context of urban health or health disparities, requires a transdisciplinary approach. Transdisciplinary approaches draw on concepts from multiple scientific disciplines to develop a novel, integrated perspective from which to conduct scientific investigation. Most historic and contemporary conceptual models of health were derived either from the sociobehavioral sciences or the biomolecular sciences. Those models deriving from the sociobehavioral sciences generally lack detail on involved biological mechanisms whereas those derived from the biomolecular sciences largely do not consider socioenvironmental determinants. As such, advances in transdisciplinary characterizations of health in complex systems like the urban environment or health disparities may be impeded. This paper suggests a sociobiologic organizing model that encourages a multilevel, integrative perspective in the study of urban health and health disparities.

  9. Health Disparities Among Sexual Minority Women Veterans

    PubMed Central

    Foynes, Melissa Ming; Shipherd, Jillian C.

    2013-01-01

    Abstract Background Lesbian and bisexual (i.e., sexual minority) identity is more common among women veterans than among male veterans. Unique health issues have been identified among women veterans and among sexual minority women, but little is known about women who are both sexual minorities and veterans. This study aimed to compare demographic and health information from sexual minority women veterans with sexual minority women non-veterans and heterosexual women veterans. Methods Behavioral Risk Factor Surveillance Survey data were pooled from ten U.S. states that elected to ask sexual identity during 2010. The analytic sample was comprised of women who identified both their sexual identity and veteran status (n=1,908). Mental health indicators were frequent mental distress, sleep problems, low social/emotional support, and low satisfaction with life. Health risk indicators included current smoking, overweight, and obesity. Physical health status was defined by three components: disability requiring assistive equipment, >14 days of poor physical health in the past 30 days, and activity limitations. Results Compared with heterosexual women veterans, sexual minority women veterans had higher odds of mental distress (odds ratio [OR]=3.03, 95% confidence interval [CI]: 1.61–5.70) and smoking (OR=2.31, 95%CI: 1.19–4.48). After adjusting for demographic correlates, sexual minority women veterans had three times the odds of poor physical health (OR=3.01, 95%CI: 1.51–5.99) than their sexual minority non-veteran peers. Conclusions Results suggest sexual minority women veterans may experience unique health disparities relevant to provision of care in both Veterans Affairs (VA) and non-VA healthcare systems. Future research requires availability of data that include sexual minority status. PMID:23746281

  10. Strategies To Empower Communities To Reduce Health Disparities.

    PubMed

    Thompson, Beti; Molina, Yamile; Viswanath, Kasisomayajula; Warnecke, Richard; Prelip, Michael L

    2016-08-01

    Community-based participatory research is a promising approach to reducing health disparities. It empowers individuals and communities to become the major players in solving their own health problems. We discuss the use of community-based participatory research and other strategies to enhance empowerment. We also discuss projects from the Centers for Population Health and Health Disparities that have empowered communities to achieve positive health outcomes aimed at reducing disparities. We offer recommendations to policy makers for involving residents in efforts to achieve health equity.

  11. Reducing Health Disparities: The Perfect Fit for Counseling Psychology

    ERIC Educational Resources Information Center

    Buki, Lydia P.

    2007-01-01

    This reaction to the Major Contribution presents a conceptualization of health disparities as another form of oppression of marginalized populations in our society. Consistent with this view, health disparities are then situated within a larger, national context, showing that counseling psychologists' involvement is an integral part of a…

  12. Understanding and addressing health disparities in North Carolina.

    PubMed

    Bell, Ronny A

    2012-01-01

    Health disparities--differences in the provision and outcomes of health care in 2 distinct populations--are pervasive and long-standing in North Carolina. Although some strategies for closing these gaps have been effective, many disparities have resisted attempts to eliminate them. Future efforts should focus on policy implementation and the translation of research findings into effective interventions.

  13. Social disparities in Disease Management Programmes for coronary heart disease in Germany: a cross-classified multilevel analysis.

    PubMed

    Bozorgmehr, Kayvan; Maier, Werner; Brenner, Hermann; Saum, Kai-Uwe; Stock, Christian; Miksch, Antje; Holleczek, Bernd; Szecsenyi, Joachim; Razum, Oliver

    2015-11-01

    Disease Management Programmes (DMPs) aim to improve effectiveness and equity of care but may suffer from selective enrolment. We analysed social disparities in DMP enrolment among elderly patients with coronary heart disease (CHD) in Germany, taking into account contextual effects at municipality and primary care practice levels. Cross-sectional analysis of effects of educational attainment and regional deprivation on physician-reported DMP enrolment in a subsample of a large population-based cohort study in Germany, adjusting for individual-level, practice-level and area-level variables. We calculated OR and their 95% CIs (95% CI) in cross-classified, multilevel logistic regression models. Among N=1280 individuals with CHD (37.3% women), DMP enrolment rates were 22.2% (women) and 35% (men). The odds of DMP enrolment were significantly higher for male patients (OR=1.98 (1.50 to 2.62)), even after adjustment for potential confounding by individual-level, practice-level and area-level variables (range: OR=1.60 (1.08 to 2.36) to 2.16 (1.57 to 2.98)). Educational attainment was not significantly associated with DMP enrolment. Compared to patients living in least-deprived municipalities, the adjusted propensity of DMP enrolment was statistically significantly lower for patients living in medium-deprived municipalities (OR=0.41 (0.24 to 0.71)), and it also tended to be lower for patients living in the most-deprived municipalities (OR=0.70 (0.40 to 1.21)). Models controlling for the social situation (instead of health-related behaviour) yielded comparable effect estimates (medium-deprived/most-deprived vs least-deprived areas: OR=0.45 (0.26 to 0.78)/OR=0.68 (0.33 to 1.19)). Controlling for differences in comorbidity attenuated the deprivation effect estimates. We found evidence for marked gender, but not educational disparities in DMP enrolment among patients with CHD. Small-area deprivation was associated with DMP enrolment, but the effects were partly explained by

  14. Social disparities in Disease Management Programmes for coronary heart disease in Germany: a cross-classified multilevel analysis

    PubMed Central

    Bozorgmehr, Kayvan; Maier, Werner; Brenner, Hermann; Saum, Kai-Uwe; Stock, Christian; Miksch, Antje; Holleczek, Bernd; Szecsenyi, Joachim; Razum, Oliver

    2015-01-01

    Background Disease Management Programmes (DMPs) aim to improve effectiveness and equity of care but may suffer from selective enrolment. We analysed social disparities in DMP enrolment among elderly patients with coronary heart disease (CHD) in Germany, taking into account contextual effects at municipality and primary care practice levels. Methods Cross-sectional analysis of effects of educational attainment and regional deprivation on physician-reported DMP enrolment in a subsample of a large population-based cohort study in Germany, adjusting for individual-level, practice-level and area-level variables. We calculated OR and their 95% CIs (95% CI) in cross-classified, multilevel logistic regression models. Results Among N=1280 individuals with CHD (37.3% women), DMP enrolment rates were 22.2% (women) and 35% (men). The odds of DMP enrolment were significantly higher for male patients (OR=1.98 (1.50 to 2.62)), even after adjustment for potential confounding by individual-level, practice-level and area-level variables (range: OR=1.60 (1.08 to 2.36) to 2.16 (1.57 to 2.98)). Educational attainment was not significantly associated with DMP enrolment. Compared to patients living in least-deprived municipalities, the adjusted propensity of DMP enrolment was statistically significantly lower for patients living in medium-deprived municipalities (OR=0.41 (0.24 to 0.71)), and it also tended to be lower for patients living in the most-deprived municipalities (OR=0.70 (0.40 to 1.21)). Models controlling for the social situation (instead of health-related behaviour) yielded comparable effect estimates (medium-deprived/most-deprived vs least-deprived areas: OR=0.45 (0.26 to 0.78)/OR=0.68 (0.33 to 1.19)). Controlling for differences in comorbidity attenuated the deprivation effect estimates. Conclusions We found evidence for marked gender, but not educational disparities in DMP enrolment among patients with CHD. Small-area deprivation was associated with DMP enrolment, but the

  15. Transformation for health: a framework for health disparities research.

    PubMed

    Esperat, M Christina R; Feng, Du; Owen, Donna C; Green, Alexia E

    2005-01-01

    The task of generating knowledge addressing disparities in health among vulnerable populations in American society is explored. The community-based participatory approach as an alternate paradigm to traditional research is mentioned as a process for understanding the realities of the populations of interest. Identification and testing of mediating and moderating variables is suggested to guide the process of increasing knowledge regarding health disparities. Transformation for Health is proposed as a conceptual framework to study how these third variables influence the relationship between the primary variables of interest. A theoretical example is offered describing the application of the framework to study the mediators and moderators in an investigation of childhood obesity. Analytical challenges in the exploration of "third variables" are described, and the authors recommend that salient methodological issues should be addressed when conducting these types of investigations.

  16. Explaining Racial/Ethnic Disparities in Children’s Dental Health: A Decomposition Analysis

    PubMed Central

    Guarnizo-Herreño, Carol Cristina

    2012-01-01

    Objectives. We measured racial/ethnic inequalities in US children’s dental health and quantified the contribution of conceptually relevant factors. Methods. Using data from the 2007 National Survey of Children’s Health, we investigated racial/ethnic disparities in selected child dental health and preventive care outcomes. We employed a decomposition model to quantify demographic, socioeconomic, maternal health, health insurance, neighborhood, and geographic effects. Results. Hispanic children had the poorest dental health and lowest preventive dental care utilization, followed by Black then White children. The model explanatory variables accounted for 58% to 77% of the disparities in dental health and 89% to 100% of the disparities in preventive dental care. Socioeconomic status accounted for 71% of the gap in preventive dental care between Black children and White children and 55% of that between Hispanic children and White children. Maternal health, age, and marital status; neighborhood safety and social capital; and state of residence were relevant factors. Conclusions. Reducing US children’s racial/ethnic dental health disparities—which are mostly socioeconomically driven—requires policies that recognize the multilevel pathways underlying them and the need for household- and neighborhood-level interventions. PMID:22420801

  17. Awareness of racial and socioeconomic health disparities in the United States: the national opinion survey on health and health disparities, 2008-2009.

    PubMed

    Booske, Bridget C; Robert, Stephanie A; Rohan, Angela M K

    2011-07-01

    Recent initiatives aim to improve public awareness of health disparities. However, little research has actually documented the US public's awareness of racial/ethnic and socioeconomic health disparities. We sought to determine 1) whether the US public is aware of racial, educational, and income disparities in health, 2) whether awareness differs across these disparity domains, and 3) what respondent characteristics are associated with awareness of racial, educational, and income disparities in health. We conducted the National Opinion Survey on Health and Health Disparities with 2,791 US adults. We asked respondents to answer questions about disparities in health between 1 of several pairs of population subgroups: African Americans versus whites, non-high school graduates versus high school graduates, high school graduates versus college graduates, the poor versus the middle class, or the middle class versus the rich. We used χ(2) tests and logistic regression to compare correlates of respondents' awareness of disparities across the different pairs of population subgroups. Most respondents were aware of health disparities between the poor and middle class (73%); fewer were aware of health disparities between African Americans and whites (46%). Although respondents recognized that education is associated with many positive life outcomes, they were less aware of the link between education and health. Respondents who were younger, less educated, lower-income, healthier, or politically conservative were less likely to be aware of health disparities. Public awareness of disparities in health differs depending on both the type of disparity and the characteristics of the individual respondent.

  18. Overcoming the Triad of Rural Health Disparities: How Local Culture, Lack of Economic Opportunity, and Geographic Location Instigate Health Disparities

    ERIC Educational Resources Information Center

    Thomas, Tami L.; DiClemente, Ralph; Snell, Samuel

    2014-01-01

    Objective: To discuss how the effects of culture, economy, and geographical location intersect to form a gestalt triad determining health-related disparities in rural areas. Methods: We critically profile each component of the deterministic triad in shaping current health-related disparities in rural areas; evaluate the uniquely composed…

  19. Overcoming the Triad of Rural Health Disparities: How Local Culture, Lack of Economic Opportunity, and Geographic Location Instigate Health Disparities

    ERIC Educational Resources Information Center

    Thomas, Tami L.; DiClemente, Ralph; Snell, Samuel

    2014-01-01

    Objective: To discuss how the effects of culture, economy, and geographical location intersect to form a gestalt triad determining health-related disparities in rural areas. Methods: We critically profile each component of the deterministic triad in shaping current health-related disparities in rural areas; evaluate the uniquely composed…

  20. Leveraging Health Informatics to a Foster Smart Systems Response to Health Disparities and Health Equity Challenges.

    PubMed

    Jay Carney, Timothy; Kong, Amanda Y

    2017-02-15

    Informaticians are challenged to design health IT solutions for complex problems like health disparities but are only achieving mixed results in demonstrating a direct impact on health outcomes. This presentation of collective intelligence and the corresponding terms of smart health, knowledge ecosystem, enhanced health disparities informatics capacities, knowledge exchange, big-data, and situational awareness are means of demonstrating the complex challenges informatics professional face in trying to model, measure, and manage an intelligence and a smart systems response to health disparities. A critical piece in our understanding of collective intelligence for public and population health rests in our understanding of any public and population health as a living and evolving network of individuals, organizations, and resources. This discussion represents a step in advancing the conversation of what a smart response to health disparities should represent and how informatics can drive the design of intelligent systems to assist in eliminating health disparities and achieving health equity.

  1. Occupational health disparities: a state public health-based approach.

    PubMed

    Stanbury, Martha; Rosenman, Kenneth D

    2014-05-01

    This report used employment and public health surveillance data in Michigan to characterize work-related race/ethnic health disparities. U.S. Census data were used to calculate the percent by race/Hispanic ethnicity in occupational groups ranked by three measures for potential work-related health risks. Disparities by race/ethnicity were generated from occupational health surveillance data. Blacks and Hispanics were over-represented in lower wage-higher manual-labor occupations and in highest risk occupations. Blacks were at greater risk of silicosis, work-related asthma, and work-related burns than whites, and Hispanics had higher rates of work-related acute fatal injuries and pesticide injury than non-Hispanics. Michigan employment data indicated that blacks and Hispanics were overly represented in lower paid and more hazardous jobs. Occupational health surveillance data confirmed disparate risks for some illnesses and injuries. This approach can be used in other states to bring awareness to policy makers and direct interventions. © 2013 Wiley Periodicals, Inc.

  2. Conceptual Approaches to the Study of Health Disparities

    PubMed Central

    Diez Roux, Ana V.

    2013-01-01

    Scientific and policy interest in health disparities, defined as systematic, plausibly avoidable health differences adversely affecting socially disadvantaged groups, has increased markedly over the past few decades. Like other research, research in health disparities is strongly influenced by the underlying conceptual model of the hypothetical causes of disparities. Conceptual models are important and a major source of debate because multiple types of factors and processes may be involved in generating disparities, because different disciplines emphasize different types of factors, and because the conceptual model often drives what is studied, how results are interpreted, and which interventions are identified as most promising. This article reviews common conceptual approaches to health disparities including the genetic model, the fundamental cause model, the pathways model, and the interaction model. Strengths and limitations of the approaches are highlighted. The article concludes by outlining key elements and implications of an integrative systems-based conceptual model. PMID:22224879

  3. Sex disparities in ideal cardiovascular health.

    PubMed

    Simon, Marie; Boutouyrie, Pierre; Narayanan, Kumar; Gaye, Bamba; Tafflet, Muriel; Thomas, Frédérique; Guibout, Catherine; Périer, Marie-Cécile; Pannier, Bruno; Jouven, Xavier; Empana, Jean-Philippe

    2017-10-01

    To quantify the gap in the distribution of ideal cardiovascular health (CVH) between men and women accounting for comorbidities, socioeconomic and psychological confounding factors. A cross-sectional analysis was conducted among 9012 French men and women aged 50-75 years who were participants of the Paris Prospective Study 3. Each of the seven metrics was defined according to the American Heart Association criteria, and the CVH was considered as poor (0 or 1 ideal health metric), intermediate (2, 3 or 4 ideal health metrics) and ideal (5-7 ideal health metrics). The odds of intermediate and ideal CVH in women compared with men were estimated by multivariate polytomous logistic regression analysis using poor CVH as the reference category. The mean age was 59.49 year (SD 6.25) and there were 38.54% of women. Though women were slightly older, less educated, more deprived, more often depressed, they were twice more often in ideal CVH than men (14.77% vs 6.84%, p<0.0001). After adjustment for age, deprivation score, education and depression, women were four times more often in ideal CVH (OR 4.01, 95% CI 3.42 to 4.69) and two times more often in intermediate CVH (OR 2.07, 95% CI 1.88 to 2.28) than men. The sex disparities in the prevalence of ideal CVH have the potential to guide sex-specific strategies for improving CVH status in the general population. NCT00741728;Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Challenges to using a business case for addressing health disparities.

    PubMed

    Lurie, Nicole; Somers, Stephen A; Fremont, Allen; Angeles, January; Murphy, Erin K; Hamblin, Allison

    2008-01-01

    The authors consider the challenges to quantifying both the business case and the social case for addressing disparities, which is central to achieving equity in the U.S. health care system. They describe the practical and methodological challenges faced by health plans exploring the business and social cases for undertaking disparity-reducing interventions. Despite these challenges, sound business and quality improvement principles can guide health care organizations seeking to reduce disparities. Place-based interventions may help focus resources and engage health care and community partners who can share in the costs of-and gains from-such efforts.

  5. Overcoming disparities in U.S. health care.

    PubMed

    Frist, William H

    2005-01-01

    Disparities in U.S. health care result from a complex mixture of systemic quality and access problems intertwined with historic injury. The many dimensions of health disparities include race, ethnicity, socioeconomic status, and geography. It is critically important for policymakers to define the problem correctly so that our solutions address their intended goal-health security for all regardless of socioeconomic characteristics. Further, U.S. efforts to eliminate disparities must also be part of a broader effort to transform health care and thus must focus, first and foremost, on improving the quality of care delivered to the individual patient.

  6. Health disparities in chronic diseases: where the money is.

    PubMed

    Crook, Errol D; Peters, Mosha

    2008-04-01

    Chronic diseases account for three-quarters of the U.S. health care expenditures and a majority of early deaths and lost of productive years of life. Health disparities exist among the common chronic diseases, such as hypertension, diabetes mellitus, HIV/AIDS, cancer, cardiovascular disease, and obesity, with ethnic minorities and the poor having higher incidence or worse outcomes. Strategies to eliminate these disparities in chronic diseases need to be multidisciplinary and focus on increasing access to all aspects of health care, including prevention. This article discusses the impact of health disparities on chronic diseases and offers some factors to consider for solutions to the problem.

  7. Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities.

    PubMed

    Chen, Jie; Mullins, C Daniel; Novak, Priscilla; Thomas, Stephen B

    2016-02-01

    Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making. © 2015 Society for Public Health Education.

  8. Health Reforms as Examples of Multilevel Interventions in Cancer Care

    PubMed Central

    Fennell, Mary L.; Devers, Kelly J.

    2012-01-01

    To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation’s health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform. PMID:22623600

  9. Health reforms as examples of multilevel interventions in cancer care.

    PubMed

    Flood, Ann B; Fennell, Mary L; Devers, Kelly J

    2012-05-01

    To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation's health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.

  10. Interventions to reduce racial and ethnic disparities in health care.

    PubMed

    Chin, Marshall H; Walters, Amy E; Cook, Scott C; Huang, Elbert S

    2007-10-01

    In 2005, the Robert Wood Johnson Foundation created Finding Answers: Disparities Research for Change, a program to identify, evaluate, and disseminate interventions to reduce racial and ethnic disparities in the care and outcomes of patients with cardiovascular disease, depression, and diabetes. In this introductory paper, we present a conceptual model for interventions that aim to reduce disparities. With this model as a framework, we summarize the key findings from the six other papers in this supplement on cardiovascular disease, diabetes, depression, breast cancer, interventions using cultural leverage, and pay-for-performance and public reporting of performance measures. Based on these findings, we present global conclusions regarding the current state of health disparities interventions and make recommendations for future interventions to reduce disparities. Multifactorial, culturally tailored interventions that target different causes of disparities hold the most promise, but much more research is needed to investigate potential solutions and their implementation.

  11. Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities

    PubMed Central

    Chen, Jie; Mullins, C. Daniel; Novak, Priscilla; Thomas, Stephen B.

    2015-01-01

    Designing culturally-sensitive personalized interventions is essential to sustain patients’ involvement in their treatment, and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multi-level activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health, and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms, and how they impact patient activation and empowerment. Such policies include Accountable Care Organizations and Value Based Purchasing, Patient Centered Medical Homes, and the Community Health Benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable, and will be critical to engaging patients in their treatment, developing patients’ abilities to manage their health, helping patients to express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making. PMID:25845376

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

    PubMed

    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.

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

    PubMed Central

    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. PMID:28366981

  14. Measuring Disparities across the Distribution of Mental Health Care Expenditures

    PubMed Central

    Cook, Benjamin Lê; Manning, Willard; Alegría, Margarita

    2013-01-01

    Background Previous mental health care disparities studies predominantly compare mean mental health care use across racial/ethnic groups, leaving policymakers with little information on disparities among those with a higher level of expenditures. Aims of the Study To identify racial/ethnic disparities among individuals at varying quantiles of mental health care expenditures. To assess whether disparities in the upper quantiles of expenditure differ by insurance status, income and education. Methods Data were analyzed from a nationally representative sample of white, black and Latino adults 18 years and older (n=83,878). Our dependent variable was total mental health care expenditure. We measured disparities in any mental health care expenditures, disparities in mental health care expenditure at the 95th, 97.5th, and 99th expenditure quantiles of the full population using quantile regression, and at the 50th, 75th, and 95th quantiles for positive users. In the full population, we tested interaction coefficients between race/ethnicity and income, insurance, and education levels to determine whether racial/ethnic disparities in the upper quantiles differed by income, insurance and education. Results Significant Black-white and Latino-white disparities were identified in any mental health care expenditures. In the full population, moving up the quantiles of mental health care expenditures, Black-White and Latino-White disparities were reduced but remained statistically significant. No statistically significant disparities were found in analyses of positive users only. The magnitude of black-white disparities was smaller among those enrolled in public insurance programs compared to the privately insured and uninsured in the 97.5th and 99th quantiles. Disparities persist in the upper quantiles among those in higher income categories and after excluding psychiatric inpatient and emergency department (ED) visits. Discussion Disparities exist in any mental health care and

  15. Racial/Ethnic Disparities in Men's Health: Examining Psychosocial Mechanisms

    PubMed Central

    Brown, Tyson; Hargrove, Taylor W.; Griffith, Derek M.

    2015-01-01

    This study uses data from the Health and Retirement Study and an approach informed by the Biopsychosocial Model of Racism as a Stressor to examine the extent to which SES, stressors, discrimination and neighborhood conditions are mechanisms underlying racial/ethnic disparities in functional limitations among men. Results reveal that racial/ethnic differences in SES, stressors, discrimination and neighborhood conditions—individually and collectively—account for a substantial proportion of racial/ethnic disparities in functional limitations. Findings suggest that the social determinants of health for men of color need to be more seriously considered in investigations of and efforts to address health disparities. PMID:26291191

  16. Social disparities among youth and the impact on their health

    PubMed Central

    Kreatsoulas, Catherine; Hassan, Areej; Subramanian, SV; Fleegler, Eric W

    2015-01-01

    Purpose Social disparities among youth have been recognized as an important influence on disease risk later in the life cycle. Despite this, social problems are seldom assessed in a clinical setting. The primary objective of our study was to evaluate the impact of social disparities on the health of youth. Methods A self-directed, web-based screening system was used to identify social disparities along seven social domains. Participants included youth, aged 15–24 years, recruited from an urban hospital clinic. The main outcome variable, self-rated health, was captured on a 5-point Likert scale. Univariable and multivariable regression models adjusted for sex, age, and race/ethnicity were implemented to assess the association between social problems and self-rated health. Correlation between social disparity problems was estimated using phi coefficient. Results Among 383 participants, 297 (78%) reported at least one social problem. The correlation among social disparity problems was low. Social disparities had an independent effect on self-rated health, and, in a fully adjusted model, disparities in health care access and food insecurity remained significant. The presence of even one social problem was associated with a decrease in overall health (β=0.68, P<0.01). Conclusion There is a high burden of social disparities among our youth urban hospital population. The presence of even one social problem increases the risk of worsening self-rated health. Evaluating the social disparities among youth in the medical setting can help elucidate factors that negatively affect patients’ health. PMID:25870520

  17. Cancer Disparities: Unmet Challenges in the Elimination of Disparities

    PubMed Central

    Gehlert, Sarah; Colditz, Graham A.

    2012-01-01

    Background The first 20 years of publication of Cancer Epidemiology, Biomarkers & Prevention occurred during a period of increased attention to health disparities and advances in knowledge about their determinants. Yet, despite clear documentation of disparities and advanced understanding of determinants, we have made little headway in reducing disparities at the population level. Multilevel models, such as one produced by the Centers for Population Health and Health Disparities (CPHHD), hold promise for understanding the complex determinants of cancer disparities and their interactions as well as translating scientific discoveries into solutions. The CPHHD model maps across a range of scientific disciplines, from the biological to the social, each with its own disciplinary language and methods. The ability to work effectively across disciplinary boundaries is essential to framing comprehensive solutions. Methods After briefly characterizing the current state of knowledge about health disparities, we outline three major challenges faced by disparities researchers and practitioners and offer suggestions for addressing these challenges. Results These challenges are how to consider race and ethnicity in disparities research, how best to translate discoveries into public health solutions to cancer disparities, and how to create a research environment that supports the successful execution of multilevel research. Conclusions Attention to all three of the challenges outlined above is urgently needed to advance our efforts to eliminate cancer disparities. Impact Addressing the challenges outlined above will help to eliminate disparities in the future. PMID:21784956

  18. Centers of Excellence on Environmental Health Disparities Research

    EPA Pesticide Factsheets

    collaborative effort that encourages basic, biological, clinical, epidemiological, behavioral, and/or social scientific investigations of disease conditions that are known to be a significant burden in low socioeconomic and health disparate populations

  19. Asthma and Health Disparities | NIH MedlinePlus the Magazine

    MedlinePlus

    ... 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- ...

  20. Using genetic technologies to reduce, rather than widen, health disparities

    USDA-ARS?s Scientific Manuscript database

    Evidence shows that both biological and nonbiological factors contribute to health disparities. Genetics, in particular, plays a part in how common diseases manifest themselves. Today, unprecedented advances in genetically based diagnoses and treatments provide opportunities for personalized medicin...

  1. Teaching About Health Care Disparities in the Clinical Setting

    PubMed Central

    Fernandez, Leonor; Irby, David M.; Harleman, Elizabeth; Fernandez, Alicia

    2010-01-01

    Clinical teachers often observe interactions that may contribute to health care disparities, yet may hesitate to teach about them. A pedagogical model could help faculty structure teaching about health care disparities in the clinical setting, but to our knowledge, none have been adapted for this purpose. In this paper, we adapt an established model, Time-Effective Strategies for Teaching (TEST), to the teaching of health care disparities. We use several case scenarios to illustrate the core components of the model: diagnose the learner, teach rapidly to the learner’s need, and provide feedback. The TEST model is straightforward, easy to use, and enables the incorporation of teaching about health care disparities into routine clinical teaching. PMID:20352501

  2. Partnering Health Disparities Research With Quality Improvement Science in Pediatrics

    PubMed Central

    Lion, K. Casey

    2015-01-01

    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. PMID:25560436

  3. One country, two worlds - the health disparity in China.

    PubMed

    Meng, Qingyue; Zhang, Jian; Yan, Fei; Hoekstra, Edward J; Zhuo, Jiatong

    2012-01-01

    As result of its spectacular economic growth, millions of Chinese have been lifted out of poverty, making China a model for impoverished countries. Although, for many, economic growth has led to prosperity, ever-growing disparities exist between those who have benefited from the economic advancement and those left behind. Massive gaps in development exist between: regions, urban and rural and social groups. This contribution is to develop a detailed understanding of the health disparity in China by examining the discrepancies in major health indicators. Current efforts to reduce the disparities, and its challenges, opportunities and global implications are also assessed.

  4. Immigrant-based Disparities in Mental Health Care Utilization

    PubMed Central

    Bauldry, Shawn; Szaflarski, Magdalena

    2017-01-01

    Studies of immigrant-based disparities in mental health care have been limited by small sample sizes and a lack of measures of different dimensions of acculturation. This study draws on the National Epidemiological Survey on Alcohol and Related Conditions to address these limitations. Results indicate first-generation immigrants have lower rates of utilization for both mood and anxiety disorders. Nativity-based disparities in treatment are particularly notable among people from African and Hispanic origins, while there is little evidence of disparities among people from European origins. Of three dimensions of acculturation, only the identity dimension has a positive association with mental health care utilization. PMID:28845455

  5. Racial and Ethnic Disparities in the Use of Health Services

    PubMed Central

    Ashton, Carol M; Haidet, Paul; Paterniti, Debora A; Collins, Tracie C; Gordon, Howard S; O'Malley, Kimberly; Petersen, Laura A; Sharf, Barbara F; Suarez-Almazor, Maria E; Wray, Nelda P; Street, Richard L

    2003-01-01

    African Americans and Latinos use services that require a doctor's order at lower rates than do whites. Racial bias and patient preferences contribute to disparities, but their effects appear small. Communication during the medical interaction plays a central role in decision making about subsequent interventions and health behaviors. Research has shown that doctors have poorer communication with minority patients than with others, but problems in doctor-patient communication have received little attention as a potential cause, a remediable one, of health disparities. We evaluate the evidence that poor communication is a cause of disparities and propose some remedies drawn from the communication sciences. PMID:12542590

  6. Health disparities and children in immigrant families: a research agenda.

    PubMed

    Mendoza, Fernando S

    2009-11-01

    Children in immigrant families now comprise 1 in 5 children in the United States. Eighty percent of them are US citizens, and 53% live in mixed-citizenship families. Their families are among the poorest, least educated, least insured, and least able to access health care. Nonetheless, these children demonstrate better-than-expected health status, a finding termed "the immigrant paradox" and one suggesting that cultural health behaviors among immigrant families might be protective in some areas of health. In this article the strength of the immigrant paradox, the effect of acculturation on health, and the relationships of acculturation, enculturation, language, and literacy skills to health disparities are reviewed. The current public policy issues that affect the health disparities of children of immigrant families are presented, and a research agenda for improving our knowledge about children in immigrant families to develop effective interventions and public policies that will reduce their health disparities is set forth.

  7. Social Capital and Health: A Review of Prospective Multilevel Studies

    PubMed Central

    Murayama, Hiroshi; Fujiwara, Yoshinori; Kawachi, Ichiro

    2012-01-01

    Background This article presents an overview of the concept of social capital, reviews prospective multilevel analytic studies of the association between social capital and health, and discusses intervention strategies that enhance social capital. Methods We conducted a systematic search of published peer-reviewed literature on the PubMed database and categorized studies according to health outcome. Results We identified 13 articles that satisfied the inclusion criteria for the review. In general, both individual social capital and area/workplace social capital had positive effects on health outcomes, regardless of study design, setting, follow-up period, or type of health outcome. Prospective studies that used a multilevel approach were mainly conducted in Western countries. Although we identified some cross-sectional multilevel studies that were conducted in Asian countries, including Japan, no prospective studies have been conducted in Asia. Conclusions Prospective evidence from multilevel analytic studies of the effect of social capital on health is very limited at present. If epidemiologic findings on the association between social capital and health are to be put to practical use, we must gather additional evidence and explore the feasibility of interventions that build social capital as a means of promoting health. PMID:22447212

  8. Are socioeconomic disparities in tobacco consumption increasing in India? A repeated cross-sectional multilevel analysis

    PubMed Central

    Bhan, Nandita; Srivastava, Swati; Agrawal, Sutapa; Subramanyam, Malavika; Millett, Christopher; Selvaraj, Sakthivel; Subramanian, S V

    2012-01-01

    Objectives India bears a significant portion of the global tobacco burden with high prevalence of tobacco use. This study examines the socioeconomic patterning of tobacco use and identifies the changing gender and socioeconomic dynamics in light of the Cigarette Epidemic Model. Design Secondary analyses of second and third National Family Health Survey (NFHS) data. Setting and participants Data were analysed from 201 219 men and 255 028 women over two survey rounds. Outcomes and methods Outcomes included smoking (cigarettes, bidis and pipes/cigar), chewed tobacco (paan masala, gutkha and others) and dual use, examined by education, wealth, living environment and caste. Standardised prevalence and percentage change were estimated. Pooled multilevel models estimated the effect of socioeconomic covariates on the log odds of tobacco use by gender, along with fixed and random parameters. Findings Among men (2005−2006), gradients in smoking by education (illiterates: 44% vs postgraduates: 15%) and chewing (illiterates: 47% vs postgraduates: 19%) were observed. Inverse gradients were also observed by wealth, living environment and caste. Chewed tobacco use by women showed inverse socioeconomic status (SES) gradients comparing the illiterates (7.4%) versus postgraduates (0.33%), and poorest (17%) versus richest (2%) quintiles. However, proportional increases in smoking were higher among more educated (postgraduates (98%) vs high schooling only (17%)) and chewing among richer (richest quintile (49%) vs poorest quintile (35%)). Among women, higher educated showed larger declines for smoking—90% (postgraduates) versus 12% (illiterates). Younger men (15–24 years) showed increasing tobacco use (smoking: 123% and chewing: 112%). Older women (35–49 years) show higher prevalence of smoking (3.2%) compared to younger women (0.3%). Conclusions Indian tobacco use patterns show significant diversions from the Cigarette Epidemic Model—from gender and socioeconomic

  9. Gynecologic Cancer Disparities: a Report from the Health Disparities Taskforce of the Society of Gynecologic Oncology

    PubMed Central

    Collins, Yvonne; Holcomb, Kevin; Chapman-Davis, Eloise; Khabele, Dineo; Farley, John H.

    2014-01-01

    Objectives To review the extent of health disparities in gynecologic cancer care and outcomes and to propose recommendations to help counteract the disparities. Methods We searched the electronic databases PubMed and the Cochrane Library. We included studies demonstrating quantifiable differences by race and ethnicity in the incidence, treatment, and survival of gynecologic cancers in the United States (US). Most studies relied on retrospective data. We focused on differences between Black and White women, because of the limited number of studies on non-Black women. Results White women have a higher incidence of ovarian cancer compared to Black women. However, the all-cause ovarian cancer mortality in Black women is 1.3 times higher than that of White women. Endometrial and cervical cancer mortality in Black women is twice that of White women. The etiology of these disparities is multifaceted. However, much of the evidence suggests that equal care leads to equal outcomes for Black women diagnosed with gynecologic cancers. Underlying molecular factors may play an additional role in aggressive tumor biology and endometrial cancer disparities. Conclusion Gynecologic cancer disparities exist between Black and White women. The literature is limited by the lack of large prospective trials and adequate numbers of non-Black racial and ethnic groups. We conclude with recommendations for continued research and a multifaceted approach to eliminate gynecologic cancer disparities. PMID:24406291

  10. Introduction: CDC Health Disparities and Inequalities Report - United States, 2013.

    PubMed

    Meyer, Pamela A; Yoon, Paula W; Kaufmann, Rachel B

    2013-11-22

    This supplement is the second CDC Health Disparities and Inequalities Report (CHDIR). The 2011 CHDIR was the first CDC report to assess disparities across a wide range of diseases, behavioral risk factors, environmental exposures, social determinants, and health-care access (CDC. CDC Health Disparities and Inequalities Report-United States, 2011. MMWR 2011;60[Suppl; January 14, 2011]). The 2013 CHDIR provides new data for 19 of the topics published in 2011 and 10 new topics. When data were available and suitable analyses were possible for the topic area, disparities were examined for population characteristics that included race and ethnicity, sex, sexual orientation, age, disability, socioeconomic status, and geographic location. The purpose of this supplement is to raise awareness of differences among groups regarding selected health outcomes and health determinants and to prompt actions to reduce disparities. The findings in this supplement can be used by practitioners in public health, academia and clinical medicine; the media; the general public; policymakers; program managers; and researchers to address disparities and help all persons in the United States live longer, healthier, and more productive lives.

  11. MODELING BLACK-WHITE PRETERM BIRTH DISPARITY: ECOLOGIC AND MULTILEVEL MODELS

    EPA Science Inventory

    INTRODUCTION. The disparity between black and white women's adverse birth outcomes has been subject to much investigation, yet the factors underlying its persistence remain elusive, which has encouraged research on neighborhood-level influences. This work considers two main que...

  12. MODELING BLACK-WHITE PRETERM BIRTH DISPARITY: ECOLOGIC AND MULTILEVEL MODELS

    EPA Science Inventory

    INTRODUCTION. The disparity between black and white women's adverse birth outcomes has been subject to much investigation, yet the factors underlying its persistence remain elusive, which has encouraged research on neighborhood-level influences. This work considers two main que...

  13. Explaining Racial Disparities in Infant Health in Brazil

    PubMed Central

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

    2013-01-01

    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 (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities. Results. The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone. Conclusions. 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:23409894

  14. Explaining racial disparities in infant health in Brazil.

    PubMed

    Nyarko, Kwame A; Lopez-Camelo, Jorge; Castilla, Eduardo E; Wehby, George L

    2015-10-01

    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. 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 (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities. The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone. 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.

  15. [Explaining racial disparities in infant health in Brazil].

    PubMed

    A Nyarko, Kwame; López-Camelo, Jorge; E Castilla, Eduardo; L Wehby, George

    2014-04-01

    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. We employed a sample of 8 949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (< 2 500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities. The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone. 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.

  16. Explaining Racial Disparities in Infant Health in Brazil

    PubMed Central

    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 (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities. Results. The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone. Conclusions. 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

  17. 78 FR 62638 - National Institute on Minority Health and Health Disparities; Notice of Closed Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-22

    ... HUMAN SERVICES National Institutes of Health National Institute on Minority Health and Health... unwarranted invasion of personal privacy. Name of Committee: National Institute on Minority Health and Health Disparities Special Emphasis Panel; NIMHD Technologies for Improving Minority Health and Eliminating...

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

    PubMed Central

    Malhotra, Chetna; Do, Young Kyung

    2013-01-01

    Objective 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). Methods 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. Results 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. Conclusion 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. PMID:22709921

  19. The Ethical Imperative of Addressing Oral Health Disparities

    PubMed Central

    Lee, J.Y.; Divaris, K.

    2014-01-01

    Health disparities are preventable differences in the burden of disease or opportunities to achieve optimal health that are experienced by socially disadvantaged population groups. Reducing health disparities has been identified as an ethical imperative by the World Health Organization’s Commission on Social Determinants of Health and numerous other national and international bodies. Significant progress has been made over the past years in identifying vulnerable groups, and ‘distal’ factors including political, economic, social, and community characteristics are now considered pivotal. It is thus unsurprising that the remarkable advances in the science and practice of dentistry have not led to notable reductions in oral health disparities. In this review, we summarize recent work and emphasize the need for a solid theoretical framing to guide oral health disparities research. We provide a theoretical framework outlining pathways that operate across the continuum of oral health determinants during the lifecourse and highlight potential areas for intervention. Because oral health disparities emanate from the unequal distribution of social, political, economic, and environmental resources, tangible progress is likely to be realized only by a global movement and concerted efforts by all stakeholders, including policymakers, the civil society, and academic, professional, and scientific bodies. PMID:24189268

  20. Health disparities in chickenpox or shingles in Alberta?

    PubMed

    Russell, M L; Schopflocher, D P; Svenson, L W

    2008-01-01

    Exploring for evidence of socio-economic health disparities in chickenpox and shingles in Alberta, Canada. Chickenpox and shingles cases were identified from administrative data from Alberta's universal health care insurance system for 1994-2002. Incident cases were those with the earliest dated utilization of a health service (chickenpox: ICD9-CM 052/ICD10-CA B01; shingles: ICD9-CM 053/ ICD10-CA B02). Crude and age-specific rates were estimated for each year by an indicator of socio-demographic status based upon the nature of the payer and eligibility for health care premium subsidy (SES-proxy) for the provincial health care insurance system. Among young children there is a gradient of disparity in chickenpox rates prior to the year in which publicly funded vaccination programs were implemented. After this point, disparities decline but less so for First Nations children than for others. There was no evidence of disparity by SES-proxy for shingles. Publicly funded vaccination programs may effectively contribute to reduction in disease disparities for vaccine-preventable diseases. Further study is required to ascertain why disparities continue for First Nations children.

  1. 75 FR 9421 - National Center on Minority Health and Health Disparities; Notice of Closed Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Center on Minority Health and Health Disparities... personal privacy. Name of Committee: National Center on Minority Health and Health Disparities Special...

  2. Health disparities beginning in childhood: a life-course perspective.

    PubMed

    Braveman, Paula; Barclay, Colleen

    2009-11-01

    In this article we argue for the utility of the life-course perspective as a tool for understanding and addressing health disparities across socioeconomic and racial or ethnic groups, particularly disparities that originate in childhood. Key concepts and terms used in life-course research are briefly defined; as resources, examples of existing literature and the outcomes covered are provided along with examples of longitudinal databases that have often been used for life-course research. The life-course perspective focuses on understanding how early-life experiences can shape health across an entire lifetime and potentially across generations; it systematically directs attention to the role of context, including social and physical context along with biological factors, over time. This approach is particularly relevant to understanding and addressing health disparities, because social and physical contextual factors underlie socioeconomic and racial/ethnic disparities in health. A major focus of life-course epidemiology has been to understand how early-life experiences (particularly experiences related to economic adversity and the social disadvantages that often accompany it) shape adult health, particularly adult chronic disease and its risk factors and consequences. The strong life-course influences on adult health could provide a powerful rationale for policies at all levels--federal, state, and local--to give more priority to investment in improving the living conditions of children as a strategy for improving health and reducing health disparities across the entire life course.

  3. Addressing cancer health disparities using a global biopsychosocial approach.

    PubMed

    King, Denae; Miranda, Patricia; Gor, Beverly; Fuchs-Young, Robin; Chilton, Janice; Hajek, Richard; Torres-Vigil, Isabel; Hernández-Valero, Mariá A; Snipes, S Amy; Jones, Lovell

    2010-01-15

    The Center for Research on Minority Health has translated the biopsychosocial framework to address global cancer health disparities through the integration of biological (eg, endogenous steroids, genetic susceptibility, and pesticide levels) and behavioral (eg, dietary interventions) determinants, along with community-based research (eg, comprehensive involvement of community advisory boards) and educational approaches (eg, kindergarten through postgraduate training). Evidence of successful implementation of this framework includes health disparities training for >2000 individuals ranging from elementary to the postgraduate level, and conducting transdisciplinary projects that incorporate traditional and nontraditional health professionals to examine associations between biological and nonbiological determinants of health. Examples and recommendations for implementation of the biopsychosocial approach as it applies to cancer health disparities research are described.

  4. The Nursing Research Center on HIV/AIDS Health Disparities.

    PubMed

    Holzemer, William L; Méndez, Marta Rivero; Portillo, Carmen; Padilla, Geraldine; Cuca, Yvette; Vargas-Molina, Ricardo L

    2004-01-01

    This report describes the partnership between the schools of nursing at the University of California San Francisco and the University of Puerto Rico to address the need for nursing research on HIV/AIDS health disparities. The partnership led to the creation of the Nursing Research Center on HIV/AIDS Health Disparities with funding from the National Institutes of Health/National Institute of Nursing Research. We provide background information on the disproportionate impact of the HIV/AIDS epidemic on racial and ethnic minorities, describe the major predictors of health disparities in persons at risk for or diagnosed with HIV/AIDS using the Outcomes Model for Health Care Research, and outline the major components of the Nursing Research Center. The center's goal is to improve health outcomes for people living with and affected by HIV/AIDS by enhancing the knowledge base for HIV/AIDS care.

  5. Understanding Racial/Ethnic Disparities in Youth Mental Health Services: Do Disparities Vary by Problem Type?

    ERIC Educational Resources Information Center

    Gudino, Omar G.; Lau, Anna S.; Yeh, May; McCabe, Kristen M.; Hough, Richard L.

    2009-01-01

    The authors examined racial/ethnic disparities in mental health service use based on problem type (internalizing/externalizing). A diverse sample of youth in contact with public sectors of care and their families provided reports of youth's symptoms and functional impairment during an initial interview. Specialty and school-based mental health…

  6. Understanding Racial/Ethnic Disparities in Youth Mental Health Services: Do Disparities Vary by Problem Type?

    ERIC Educational Resources Information Center

    Gudino, Omar G.; Lau, Anna S.; Yeh, May; McCabe, Kristen M.; Hough, Richard L.

    2009-01-01

    The authors examined racial/ethnic disparities in mental health service use based on problem type (internalizing/externalizing). A diverse sample of youth in contact with public sectors of care and their families provided reports of youth's symptoms and functional impairment during an initial interview. Specialty and school-based mental health…

  7. When identifying health disparities as a problem is a problem: pedagogical strategies for examining racialized contexts.

    PubMed

    Browne, Teri; Pitner, Ronald; Freedman, Darcy A

    2013-01-01

    The current study presents a critical discussion on community responses to health disparity research and the need for utilizing pedagogical strategies to prepare students to understand and address health disparities in racialized contexts. Qualitative research methods were used to examine community responses to media stories on two health disparity research projects, and four themes emerged: naming health disparities is a tool for dividing, structural racism does not exist, naming of health disparities is a political act, and health disparities exist because of individual-level deficiencies. The implications for teaching students about racial health disparities are presented and discussed.

  8. School Climate and Psychosomatic Health: A Multilevel Analysis

    ERIC Educational Resources Information Center

    Modin, Bitte; Ostberg, Viveca

    2009-01-01

    This study examined the importance of aspects of the school climate for adolescents' psychosomatic health using multilevel modelling. Analyses were based on 18,571 ninth-grade students distributed over 1,026 classes and 284 schools in the greater Stockholm area in 2004 and 2006. Both individual- and contextual-level associations between aspects of…

  9. The Relationship between Health Literacy and Health Disparities: A Systematic Review

    PubMed Central

    Mantwill, Sarah; Monestel-Umaña, Silvia; Schulz, Peter J.

    2015-01-01

    Objectives Health literacy is commonly associated with many of the antecedents of health disparities. Yet the precise nature of the relationship between health literacy and disparities remains unclear. A systematic review was conducted to better understand in how far the relationship between health literacy and health disparities has been systematically studied and which potential relationships and pathways have been identified. Methods Five databases, including PubMed/MEDLINE and CINAHL, were searched for peer-reviewed studies. Publications were included in the review when they (1) included a valid measure of health literacy, (2) explicitly conceived a health disparity as related to a social disparity, such as race/ethnicity or education and (3) when results were presented by comparing two or more groups afflicted by a social disparity investigating the effect of health literacy on health outcomes. Two reviewers evaluated each study for inclusion and abstracted relevant information. Findings were ordered according to the disparities identified and the role of health literacy in explaining them. Results 36 studies were included in the final synthesis. Most of the studies investigated racial/ethnic disparities, followed by some few studies that systematically investigated educational disparities. Some evidence was found on the mediating function of health literacy on self-rated health status across racial/ethnic and educational disparities, as well as on the potential effect of health literacy and numeracy on reducing racial/ethnic disparities in medication adherence and understanding of medication intake. Conclusion Overall the evidence on the relationship between health literacy and disparities is still mixed and fairly limited. Studies largely varied with regard to health(-related) outcomes under investigation and the health literacy assessments used. Further, many studies lacked a specific description of the nature of the disparity that was explored and a clear

  10. AAHD's Health Promotion and Wellness, Part 3: Health Disparities and People with Disabilities

    ERIC Educational Resources Information Center

    Exceptional Parent, 2011

    2011-01-01

    This article is the third of a 4-part series on "Health Promotion and Wellness" from the American Association on Health and Disability (AAHD). It focuses on health disparities and people with disabilities. Health disparities are differences in health outcomes between groups that reflect social inequalities. Disability rates vary by ethnicity, age,…

  11. AAHD's Health Promotion and Wellness, Part 3: Health Disparities and People with Disabilities

    ERIC Educational Resources Information Center

    Exceptional Parent, 2011

    2011-01-01

    This article is the third of a 4-part series on "Health Promotion and Wellness" from the American Association on Health and Disability (AAHD). It focuses on health disparities and people with disabilities. Health disparities are differences in health outcomes between groups that reflect social inequalities. Disability rates vary by ethnicity, age,…

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

    PubMed Central

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

    2013-01-01

    Background 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. Methods 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, was 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. Results Except among the younger Hispanic population, net worth was significantly associated with poor/fair health status within each racial/ethnic group in both datasets. 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). Conclusions The results add to 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. PMID:23427209

  13. A flexible urban health index for small area disparities.

    PubMed

    Rothenberg, Richard; Weaver, Scott R; Dai, Dajun; Stauber, Christine; Prasad, Amit; Kano, Megumi

    2014-10-01

    Available urban health metrics focus primarily on large area rankings. Less has been done to develop an index that provides information about level of health and health disparities for small geographic areas. Adopting a method used by the Human Development Index, we standardized indicators for small area units on a (0, 1) interval and combined them using their geometric mean to form an Urban Health Index (UHI). Disparities were assessed using the ratio of the highest to lowest decile and measurement of the slope of the eight middle deciles (middle; 80 %) of the data. We examined the sensitivity of the measure to weighting, to changes in the method, to correlation among indicators, and to substitution of indicators. Using seven health determinants and applying these methods to the 128 census tracts in the city of Atlanta, USA, we found a disparity ratio of 5.92 and a disparity slope of 0.54, suggesting substantial inequality and heterogeneity of risk. The component indicators were highly correlated; their systematic removal had a small effect on the results. Except in extreme cases, weighting had a little effect on the rankings. A map of Atlanta census tracts exposed a swath of high disparity. UHI rankings, ratio, and slope were resistant to alteration in composition and to non-extreme weighting schemes. This empirical evaluation was limited to a single realization, but suggests that a flexible tool, whose method rather than content is standardized, may be of use for local evaluation, for decision making, and for area comparison.

  14. Eliminating Tobacco-Related Health Disparities: Directions for Future Research

    PubMed Central

    Fagan, Pebbles; King, Gary; Lawrence, Deirdre; Petrucci, Sallie Anne; Robinson, Robert G.; Banks, David; Marable, Sharon; Grana, Rachel

    2004-01-01

    Certain groups in the United States remain at high risk and suffer disproportionately from tobacco-related illness and death despite progress made in reducing tobacco use. To address gaps in research on tobacco-related disparities and develop a comprehensive agenda aimed at reducing such disparities, representatives from funding agencies, community-based organizations, and academic institutions convened at the National Conference on Tobacco and Health Disparities in 2002. Conference participants reviewed the current research, identified existing gaps, and prioritized scientific recommendations. Panel discussions were organized to address research areas affecting underserved and understudied populations. We report major research recommendations made by the conference participants in several scientific domains. These recommendations will ultimately help guide the field in reducing and eliminating tobacco-related disparities in the United States. PMID:14759929

  15. Community-based teaching about health disparities: combining education, scholarship, and community service.

    PubMed

    Cené, Crystal W; Peek, Monica E; Jacobs, Elizabeth; Horowitz, Carol R

    2010-05-01

    The Institute of Medicine recommends that clinicians receive training to better understand and address disparities. While disparities in health status are primarily due to inequities in social determinants of health, current curricula largely focus on how to teach about disparities within the health care setting. Learners may more fully understand and appreciate how social contextual factors contribute to disparities through instruction about disparities in community settings. Community-based teaching about health disparities may be advantageous for learners, medical institutions, and participating communities. This manuscript aims to guide medical educators in teaching students and residents about health disparities through community-based activities, including service learning and research.

  16. African Americans: Disparities in Health Care Access and Utilization

    ERIC Educational Resources Information Center

    Copeland, Valire Carr

    2005-01-01

    Despite remarkable improvements in the overall health of the nation during the past two decades, compelling evidence suggests that the nation's racial and ethnic minority Americans suffer increasing disparities in the incidence, prevalence, mortality, and burden of diseases and adverse health outcomes compared with white Americans. The 1998…

  17. Health Disparities: Bridging the Gap. From Cells to Selves.

    ERIC Educational Resources Information Center

    National Inst. of Child Health and Human Development (NIH), Bethesda, MD.

    This document details the strategic plan of the National Institute of Child Health and Human Development to address disparities in health and developmental outcomes among Americans, particularly between and among racial and ethnic groups. Following a description of the plan's development, scientific areas of interest, and important themes, the…

  18. African Americans: Disparities in Health Care Access and Utilization

    ERIC Educational Resources Information Center

    Copeland, Valire Carr

    2005-01-01

    Despite remarkable improvements in the overall health of the nation during the past two decades, compelling evidence suggests that the nation's racial and ethnic minority Americans suffer increasing disparities in the incidence, prevalence, mortality, and burden of diseases and adverse health outcomes compared with white Americans. The 1998…

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

    PubMed

    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.

  20. Prioritizing health disparities in medical education to improve care

    PubMed Central

    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

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

    PubMed

    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.

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

    PubMed

    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.

  3. Understanding public resistance to messages about health disparities.

    PubMed

    Gollust, Sarah E; Cappella, Joseph N

    2014-04-01

    Advocates and policymakers strategically communicate about health disparities in an effort to raise public awareness, often by emphasizing the social and economic factors that influence these disparities. Previous research suggests that predisposing political orientation and values related to self-reliance and personal responsibility may produce resistance to such messages. In this study, the authors culled 4 messages about the causes of disparities in life expectancy from public discourse and randomly presented them to a nationally representative sample of 732 Americans. Three indicators of message resistance were measured: belief that messages are weak, elicitation of anger, and production of counterarguments. Expected political differences in message resistance were identified, with Republicans perceiving messages to be weaker, arousing less anger, and eliciting more counterarguing than for Democrats. Among 3 messages that described the social determinants of health disparities, a message that identified the role of personal choices (explicitly acknowledging personal responsibility) produced the least anger and counterarguing among Republicans. Political differences in anger arousal and counterarguing can be explained, in part, by predisposing values toward personal responsibility. These findings have relevance for policy advocates seeking to bridge public divides surrounding health disparities and for scholars advancing theories of reactance to policy-relevant health messaging.

  4. Behavior change, health, and health disparities: An introduction

    PubMed Central

    Higgins, Stephen T.

    2015-01-01

    This Special Issue of Preventive Medicine (PM) focuses on behavior change, health, and health disparities, topics of fundamental importance to improving population health in the U.S. and other industrialized countries. While the U.S. health care system and those of other industrialized countries were developed to manage infectious disease and acute illnesses, it is chronic health conditions that most need to be understood and managed in the 21st century. The evidence is clear that personal behavior patterns like cigarette smoking and physical inactivity/obesity are critically important proximal causes of chronic disease (cardiovascular disease, site-specific cancers, type-2 diabetes) and as such behavior change will need to be a key component of their management. As the outstanding contributions to this Special Issue illustrate, substantial headway is being made in advancing knowledge including developing effective prevention and treatment strategies, with cigarette smoking being an excellent example that change is possible. That said, cigarette smoking continues to be responsible for approximately 480,000 premature deaths annually in the U.S. alone and 5 million globally. So more needs to be done, especially in economically disadvantaged populations. The same certainly applies to the challenges of the obesity epidemic, which of course is a more recent problem and understandably efforts to curtail it are in earlier stages of development. PMID:25456804

  5. Behavior change, health, and health disparities: an introduction.

    PubMed

    Higgins, Stephen T

    2014-11-01

    This Special Issue of Preventive Medicine (PM) focuses on behavior change, health, and health disparities, topics of fundamental importance to improving population health in the U.S. and other industrialized countries. While the U.S. health care system and those of other industrialized countries were developed to manage infectious disease and acute illnesses, it is chronic health conditions that most need to be understood and managed in the 21st century. The evidence is clear that personal behavior patterns like cigarette smoking and physical inactivity/obesity are critically important proximal causes of chronic disease (cardiovascular disease, site-specific cancers, type-2 diabetes) and as such behavior change will need to be a key component of their management. As the outstanding contributions to this Special Issue illustrate, substantial headway is being made in advancing knowledge including developing effective prevention and treatment strategies, with cigarette smoking being an excellent example that change is possible. That said, cigarette smoking continues to be responsible for approximately 480,000 premature deaths annually in the U.S. alone and 5 million globally. So more needs to be done, especially in economically disadvantaged populations. The same certainly applies to the challenges of the obesity epidemic, which of course is a more recent problem and understandably efforts to curtail it are in earlier stages of development.

  6. Racial and Ethnic Disparities in Pediatric Mental Health

    PubMed Central

    Alegria, Margarita; Vallas, Melissa; Pumariega, Andres

    2010-01-01

    Disparities remain in mental health status and care for racial and ethnic minority youth, despite national attention to disparity reduction. This paper offers a comprehensive picture of the status of pediatric disparities, by addressing the major areas affecting minority youth mental health, including: prevention of problems, need for services, access to care, mental health treatment types and treatment outcomes. It addresses relevant factors in the family, community and socioeconomic context, and describes various local and national programs that aim to tackle the obstacles and fill the gaps in high quality care for racial/ethnic minority youth. It concludes by offering recommendations for improvement which acknowledge the importance of understanding preferences and attitudes towards treatment, ensuring that screening and diagnosis is appropriate to minority youth, and ensuring that evidence-based programs are available at multiple levels to best service children and succeed in addressing their needs. PMID:21056345

  7. Allostatic load and health disparities: a theoretical orientation.

    PubMed

    Carlson, E D; Chamberlain, R M

    2005-08-01

    Eliminating racial and ethnic health disparities requires restructuring the biomedical models that have focused on the individual as the level of analysis and emphasized the parts rather than the whole. A recently developed understanding of human physiology and adaptive regulation, constructs of allostasis and allostatic load, provides a theoretical orientation that needs to be explored. Thus, the purpose of this article is to present an orientation of allostasis and allostatic load as a theoretical framework for exploring health disparities. This article will (a) present a general background on the evolution of relevant physiologic theories, (b) offer the general theoretical definitions and explanations of allostasis, allostatic load, and mediation processes, (c) examine empirical evidence for the constructs, and (d) discuss the implications of this orientation for health disparities research. (c) 2005 Wiley Periodicals, Inc.

  8. Future research directions for understanding neighborhood contributions to health disparities.

    PubMed

    Osypuk, T L

    2013-06-01

    This paper proposes several promising future directions for neighborhood research to address health inequalities. First, there is a need to apply a Geography of Opportunity framework to understand how vast spatial (neighborhood, regional) inequality translates into health inequality. Such a framework highlights inequality that unfolds across an entire region, as well as the continuing significance of race/ethnicity for producing disparities in health and in the social determinants of health. The Geography of Opportunity framework also points to some of the methodological limitations of current neighborhood-health studies, given the structure of neighborhood racial inequality in the US for estimating how important neighborhoods are for producing racial health disparities. Second, there is a need to incorporate life-course concepts, data, and methods, including to model residential histories, neighborhood temporal change and residential mobility, starting early in life. A life-course focus would help inform when in life neighborhoods matter most for health and health inequalities, as well as improve exposure assessment of residential contexts. Third, we must model mechanisms linking neighborhoods and health, including the role of individual and household socioeconomic status. Lastly, we need to more meaningfully integrate social determinants of health, including drawing on policy evaluations that aim to improve neighborhood environments or that aim to expand household neighborhood choice. Doing so would inform how specific modifiable neighborhood exposures stimulated by policy may influence health and health disparities. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  9. Persons With Disabilities as an Unrecognized Health Disparity Population

    PubMed Central

    Walker, Deborah Klein; Correa-De-Araujo, Rosaly

    2015-01-01

    Disability is an emerging field within public health; people with significant disabilities account for more than 12% of the US population. Disparity status for this group would allow federal and state governments to actively work to reduce inequities. We summarize the evidence and recommend that observed differences are sufficient to meet the criteria for health disparities: population-level differences in health outcomes that are related to a history of wide-ranging disadvantages, which are avoidable and not primarily caused by the underlying disability. We recommend future research and policy directions to address health inequities for individuals with disabilities; these include improved access to health care and human services, increased data to support decision-making, strengthened health and human services workforce capacity, explicit inclusion of disability in public health programs, and increased emergency preparedness. PMID:25689212

  10. Persons with disabilities as an unrecognized health disparity population.

    PubMed

    Krahn, Gloria L; Walker, Deborah Klein; Correa-De-Araujo, Rosaly

    2015-04-01

    Disability is an emerging field within public health; people with significant disabilities account for more than 12% of the US population. Disparity status for this group would allow federal and state governments to actively work to reduce inequities. We summarize the evidence and recommend that observed differences are sufficient to meet the criteria for health disparities: population-level differences in health outcomes that are related to a history of wide-ranging disadvantages, which are avoidable and not primarily caused by the underlying disability. We recommend future research and policy directions to address health inequities for individuals with disabilities; these include improved access to health care and human services, increased data to support decision-making, strengthened health and human services workforce capacity, explicit inclusion of disability in public health programs, and increased emergency preparedness.

  11. The health disparities industry: is it an ethical conundrum?

    PubMed

    Shaw-Ridley, Mary; Ridley, Charles R

    2010-07-01

    Reducing health disparities is the purported mission of a huge network of professionals representing many specialties and organizations offering a variety of products and services. Given its elaborate infrastructure and specialized set of activities, we identity the network as the health disparities industry. In this article, we question the ethics of this industry. Specifically, we ask whether the public mission is trumped by questionable industry leadership, ethics, and quality assurances. Drawing on general principles of ethics and differentiating ethical concerns from ethical problems, we conclude that the collective behaviors within the industry may represent an ethical conundrum. The article concludes with a call for the cross-examination of the industry practices.

  12. A Human Capital Approach to Reduce Health Disparities

    PubMed Central

    Glover, Saundra H.; Xirasagar, Sudha; Jeon, Yunho; Elder, Keith T.; Piper, Crystal N.; Pastides, Harris

    2010-01-01

    Objective To introduce a human capital approach to reduce health disparities in South Carolina by increasing the number and quality of trained minority professionals in public health practice and research. Methods The conceptual basis and elements of Project EXPORT in South Carolina are described. Project EXPORT is a community based participatory research (CBPR) translational project designed to build human capital in public health practice and research. This project involves Claflin University (CU), a Historically Black College University (HBCU) and the African American community of Orangeburg, South Carolina to reduce health disparities, utilizing resources from the University of South Carolina (USC), a level 1 research institution to build expertise at a minority serving institution. The elements of Project EXPORT were created to advance the science base of disparities reduction, increase trained minority researchers, and engage the African American community at all stages of research. Conclusion Building upon past collaborations between HBCU’s in South Carolina and USC, this project holds promise for a public health human capital approach to reduce health disparities. PMID:21814634

  13. Metropolitan Fragmentation and Health Disparities: Is There a Link?

    PubMed Central

    Hutson, Malo André; Kaplan, George A; Ranjit, Nalini; Mujahid, Mahasin S

    2012-01-01

    Context This article explores the relationship between metropolitan fragmentation, as defined by the total number of governmental units within a metropolitan statistical area (local municipalities, special service districts, and school districts), and racial disparities in mortality among blacks and whites in the 1990s. The presence of numerous governmental jurisdictions in large metropolitan areas in the United States can shape the geography of opportunity, with adverse consequences for health. Methods We conducted a regression analysis using U.S. Census of Government data and Compressed Mortality File data for the country's largest 171 metropolitan statistical areas. Findings We found a link between increased metropolitan area fragmentation and greater racial differences in mortality between blacks and whites for both children and working-age adults. Although increasing fragmentation is associated with a higher mortality rate for blacks, it is not associated with a higher mortality rate for whites. These findings suggest that research is needed to understand how governance can positively or negatively influence a population's health and create conditions that generate or exacerbate health disparities. Conclusions We need to understand the extent to which metropolitan fragmentation contributes to racial segregation, whether racism contributes to both, and the role of poverty and antipoverty policies in reducing or exacerbating the consequences of metropolitan fragmentation. The exact pathways by which metropolitan fragmentation contributes to differences between blacks’ and whites’ mortality rates are unknown. Uncovering how institutions influence the social, economic, and environmental conditions, which in turn contribute to the current racial and ethnic health disparities in the largest metropolitan areas, is key. Understanding these “upstream” determinants of a population's health and the disparities in health between subgroups in the overall population

  14. Disparities in Abortion Rates: A Public Health Approach

    PubMed Central

    Harris, Lisa H.; Weitz, Tracy A.

    2013-01-01

    Women of lower socioeconomic status and women of color in the United States have higher rates of abortion than women of higher socioeconomic status and White women. Opponents of abortion use these statistics to argue that abortion providers are exploiting women of color and low socioeconomic status, and thus, regulations are needed to protect women. This argument ignores the underlying causes of the disparities. As efforts to restrict abortion will have no effect on these underlying factors, and instead will only result in more women experiencing later abortions or having an unintended childbirth, they are likely to result in worsening health disparities. We provide a review of the causes of abortion disparities and argue for a multifaceted public health approach to address them. PMID:23948010

  15. Vitamin D and cardiovascular disease: potential role in health disparities.

    PubMed

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

    2011-01-01

    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.

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

    PubMed Central

    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

  17. Approaching environmental health disparities and green spaces: An ecosystem services perspective

    Treesearch

    Viniece Jennings; Cassandra Johnson Gaither

    2015-01-01

    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...

  18. Educating Clinicians about Cultural Competence and Disparities in Health and Health Care

    ERIC Educational Resources Information Center

    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)…

  19. Participatory action research to understand and reduce health disparities.

    PubMed

    Olshansky, Ellen; Sacco, Diane; Braxter, Betty; Dodge, Pamela; Hughes, Ebony; Ondeck, Michele; Stubbs, Margaret L; Upvall, Michele J

    2005-01-01

    Participatory action research (PAR) is an excellent way to systematically learn about the conditions under which people experience health disparities, what it is like from the perspective of those experiencing such disparities and, even more importantly, how to ameliorate this major public health problem and create a more equitable and effective health care system. This article describes the method of PAR, supports the appropriateness of PAR to learn about and reduce health disparities, and then presents some specific examples of research projects that have employed or are planning to employ PAR. These examples are from the work of several authors of this article, who are members of an interdisciplinary working group that serves as a forum for discussion of issues related to qualitative research methods and facilitates the development of qualitative studies. All of the authors of this article are part of a task force of this working group that is focusing specifically on community outreach with the goal of reducing health disparities within specific communities.

  20. Cardiometabolic health disparities in native Hawaiians and other Pacific Islanders.

    PubMed

    Mau, Marjorie K; Sinclair, Ka'imi; Saito, Erin P; Baumhofer, Kau'i N; Kaholokula, Joseph Keawe'aimoku

    2009-01-01

    Elimination of health disparities in the United States is a national health priority. Cardiovascular disease, diabetes, and obesity are key features of what is now referred to as the "cardiometabolic syndrome," which disproportionately affects racial/ethnic minority populations, including Native Hawaiians and other Pacific Islanders (NHOPI). Few studies have adequately characterized the cardiometabolic syndrome in high-risk populations such as NHOPI. The authors systematically assessed the existing literature on cardiometabolic disorders among NHOPI to understand the best approaches to eliminating cardiometabolic health disparities in this population. Articles were identified from database searches performed in PubMed and MEDLINE from January 1998 to December 2008; 43 studies were included in the review. There is growing confirmatory evidence that NHOPI are one of the highest-risk populations for cardiometabolic diseases in the United States. Most studies found increased prevalences of diabetes, obesity, and cardiovascular risk factors among NHOPI. The few experimental intervention studies found positive results. Methodological issues included small sample sizes, sample bias, inappropriate racial/ethnic aggregation of NHOPI with Asians, and a limited number of intervention studies. Significant gaps remain in the understanding of cardiometabolic health disparities among NHOPI in the United States. More experimental intervention studies are needed to examine promising approaches to reversing the rising tide of cardiometabolic health disparities in NHOPI.

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

    PubMed Central

    Emmanuel, Mickey A.; 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 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. PMID:26459644

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

    PubMed

    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.

  3. Photonovels: an innovative approach to address health disparities and sustainability.

    PubMed

    McGinnis, Kara; Montiel-Ishino, F Alejandro; Standifer, Maisha Kambon; Wathington, Deanna; Goldsmith, Johnetta; Baldwin, Julie A

    2014-09-01

    Medically underserved and underrepresented communities have high rates of health disparities. In the greater Tampa Bay area, communities of color are disproportionately affected by chronic diseases such as cancer. In response to these concerns and as part of a lay health advisory program being implemented by the Center for Equal Health, a University of South Florida/H. Lee Moffitt Cancer Center & Research Institute partnership, our group created a photonovel, an educational tool which explains topics using a graphic novel style. The photonovel was designed to educate community members about prostate cancer and was compared to standard cancer educational materials currently used for cancer outreach. We found that our photonovel served as an effective health education tool to address cancer health disparities in medically underserved and underrepresented populations in Tampa Bay.

  4. Movement Advocacy, Personal Relationships, and Ending Health Care Disparities.

    PubMed

    Chin, Marshall H

    2017-01-01

    Deep-rooted structural problems drive health care disparities. Compounding the difficulty of attaining health equity, solutions in clinics and hospitals require the cooperation of clinicians, administrators, patients, and the community. Recent protests over police brutality and racism on campuses across America have opened fresh wounds over how best to end racism, with lessons for achieving health equity. Movement advocacy, the mobilizing of the people to raise awareness of an injustice and to advocate for reform, can break down ingrained structural barriers and policies that impede health equity. However, simultaneously advocates, clinicians, and health care organizations must build trusting relationships and resolve conflict with mutual respect and honesty. Tension is inherent in discussions about racial and ethnic disparities. Yet, tension can be constructive if it forces self-examination and spurs systems change and personal growth. We must simultaneously advocate for policy reform, build personal relationships across diverse groups, and honestly examine our biases.

  5. Health Disparities and Cancer: Racial Disparities in Cancer Mortality in the United States, 2000–2010

    PubMed Central

    O’Keefe, Eileen B.; Meltzer, Jeremy P.; Bethea, Traci N.

    2015-01-01

    Declining cancer incidence and mortality rates in the United States (U.S.) have continued through the first decade of the twenty-first century. Reductions in tobacco use, greater uptake of prevention measures, adoption of early detection methods, and improved treatments have resulted in improved outcomes for both men and women. However, Black Americans continue to have the higher cancer mortality rates and shorter survival times. This review discusses and compares the cancer mortality rates and mortality trends for Blacks and Whites. The complex relationship between socioeconomic status and race and its contribution to racial cancer disparities is discussed. Based on current trends and the potential and limitations of the patient protection and affordable care act with its mandate to reduce health care inequities, future trends, and challenges in cancer mortality disparities in the U.S. are explored. PMID:25932459

  6. Social disparities in children's respiratory health in El Paso, Texas.

    PubMed

    Grineski, Sara E; Collins, Timothy W; Chavez-Payan, Paola; Jimenez, Anthony M; Clark-Reyna, Stephanie; Gaines, Marie; Kim, Young-an

    2014-03-11

    The objectives of this study were to assess prevalence of children's respiratory health conditions and to measure and describe social disparities in children's respiratory problems and access to health resources for asthma/wheezing management. Data were collected through a cross-sectional, observational mail survey of all primary caretakers of 4th and 5th grade children in El Paso Independent School District (El Paso, TX, USA). 6295 primary caretakers received surveys at their home address and 1904 surveys were completed and returned for a 30% response rate. El Paso children have high rates of asthma (17%) and allergies (51%). In terms of social disparities, children that are male, not poor, obese, Hispanic, born in El Paso, have a US-born caretaker, and have a caretaker who has lower levels Spanish proficiency have increased odds of respiratory problems. Among children with asthma and wheezing, disparities exist in access to care; those that are poor, with a Spanish-speaking caretaker, or with a foreign-born caretaker had increased odds of seeking care in urgent care center, emergency rooms and hospitals. Results have scholarly and practical implications for broader trends in terms of increasing prevalence of respiratory health problems across multiple scales (from El Paso to the US context to worldwide) and health disparities experienced within the rapidly growing US Hispanic population.

  7. Measurement of socioeconomic status in health disparities research.

    PubMed Central

    Shavers, Vickie L.

    2007-01-01

    Socioeconomic status (SES) is frequently implicated as a contributor to the disparate health observed among racial/ ethnic minorities, women and elderly populations. Findings from studies that examine the role of SES and health disparities, however, have provided inconsistent results. This is due in part to the: 1) lack of precision and reliability of measures; 2) difficulty with the collection of individual SES data; 3) the dynamic nature of SES over a lifetime; 4) the classification of women, children, retired and unemployed persons; 5) lack of or poor correlation between individual SES measures; and 6) and inaccurate or misleading interpretation of study results. Choosing the best variable or approach for measuring SES is dependent in part on its relevance to the population and outcomes under study. Many of the commonly used compositional and contextual SES measures are limited in terms of their usefulness for examining the effect of SES on outcomes in analyses of data that include population subgroups known to experience health disparities. This article describes SES measures, strengths and limitations of specific approaches and methodological issues related to the analysis and interpretation of studies that examine SES and health disparities. PMID:17913111

  8. State of disparities in cardiovascular health in the United States.

    PubMed

    Mensah, George A; Mokdad, Ali H; Ford, Earl S; Greenlund, Kurt J; Croft, Janet B

    2005-03-15

    Reducing health disparities remains a major public health challenge in the United States. Having timely access to current data on disparities is important for policy and program development. Accordingly, we assessed the current magnitude of disparities in cardiovascular disease (CVD) and its risk factors in the United States. Using national surveys, we determined CVD and risk factor prevalence and indexes of morbidity, mortality, and overall quality of life in adults > or =18 years of age by race/ethnicity, sex, education level, socioeconomic status, and geographic location. Disparities were common in all risk factors examined. In men, the highest prevalence of obesity (29.2%) was found in Mexican Americans who had completed a high school education. Black women with or without a high school education had a high prevalence of obesity (47.3%). Hypertension prevalence was high among blacks (39.8%) regardless of sex or educational status. Hypercholesterolemia was high among white and Mexican American men and white women in both groups of educational status. Ischemic heart disease and stroke were inversely related to education, income, and poverty status. Hospitalization was greater in men for total heart disease and acute myocardial infarction but greater in women for congestive heart failure and stroke. Among Medicare enrollees, congestive heart failure hospitalization was higher in blacks, Hispanics, and American Indians/Alaska Natives than among whites, and stroke hospitalization was highest in blacks. Hospitalizations for congestive heart failure and stroke were highest in the southeastern United States. Life expectancy remains higher in women than men and higher in whites than blacks by approximately 5 years. CVD mortality at all ages tended to be highest in blacks. Disparities in CVD and related risk factors remain pervasive. The data presented here can be invaluable for policy development and in the planning, implementation, and evaluation of interventions

  9. New evidence regarding racial and ethnic disparities in mental health: policy implications.

    PubMed

    McGuire, Thomas G; Miranda, Jeanne

    2008-01-01

    Minorities have, in general, equal or better mental health than white Americans, yet they suffer from disparities in mental health care. This paper reviews the evidence for mental health and mental health care disparities, comparing them to patterns in health. Strategies for addressing disparities in health care, such as improving access to and quality of care, should also work to eliminate mental health care disparities. In addition, a diverse mental health workforce, as well as provider and patient education, are important to eliminating mental health care disparities.

  10. Intergroup Relations and Health Disparities: A Social Psychological Perspective

    PubMed Central

    Major, Brenda; Mendes, Wendy Berry; Dovidio, John F.

    2014-01-01

    Objective This article considers how the social psychology of intergroup processes helps to explain the presence and persistence of health disparities between members of socially advantaged and disadvantaged groups. Method Social psychological theory and research on intergroup relations, including prejudice, discrimination, stereotyping, stigma, prejudice concerns, social identity threat, and the dynamics of intergroup interactions, is reviewed and applied to understand group disparities in health and health care. Potential directions for future research are considered. Results Key features of group relations and dynamics, including social categorization, social hierarchy, and the structural positions of groups along dimensions of perceived warmth and competence, influence how members of high status groups perceive, feel about, and behave toward members of low status groups, how members of low status groups construe and cope with their situation, and how members of high and low status groups interact with each other. These intergroup processes, in turn, contribute to health disparities by leading to differential exposure to and experiences of chronic and acute stress, different health behaviors, and different quality of health care experienced by members of advantaged and disadvantaged groups. Within each of these pathways, social psychological theory and research identifies mediating mechanisms, moderating factors, and individual differences that can affect health. Conclusions A social psychological perspective illuminates the intergroup, interpersonal, and intrapersonal processes by which structural circumstances which differ between groups for historical, political, and economic reasons can lead to group differences in health. PMID:23646834

  11. Using Genetic Technologies To Reduce, Rather Than Widen, Health Disparities

    PubMed Central

    Smith, Caren E.; Fullerton, Stephanie M.; Dookeran, Keith A.; Hampel, Heather; Tin, Adrienne; Maruthur, Nisa M.; Schisler, Jonathan C.; Henderson, Jeffrey A.; Tucker, Katherine L.; Ordovás, José M.

    2016-01-01

    Evidence shows that both biological and nonbiological factors contribute to health disparities. Genetics, in particular, plays a part in how common diseases manifest themselves. Today, unprecedented advances in genetically based diagnoses and treatments provide opportunities for personalized medicine. However, disadvantaged groups may lack access to these advances, and treatments based on research on non-Hispanic whites might not be generalizable to members of minority groups. Unless genetic technologies become universally accessible, existing disparities could be widened. Addressing this issue will require integrated strategies, including expanding genetic research, improving genetic literacy, and enhancing access to genetic technologies among minority populations in a way that avoids harms such as stigmatization. PMID:27503959

  12. Using Genetic Technologies To Reduce, Rather Than Widen, Health Disparities.

    PubMed

    Smith, Caren E; Fullerton, Stephanie M; Dookeran, Keith A; Hampel, Heather; Tin, Adrienne; Maruthur, Nisa M; Schisler, Jonathan C; Henderson, Jeffrey A; Tucker, Katherine L; Ordovás, José M

    2016-08-01

    Evidence shows that both biological and nonbiological factors contribute to health disparities. Genetics, in particular, plays a part in how common diseases manifest themselves. Today, unprecedented advances in genetically based diagnoses and treatments provide opportunities for personalized medicine. However, disadvantaged groups may lack access to these advances, and treatments based on research on non-Hispanic whites might not be generalizable to members of minority groups. Unless genetic technologies become universally accessible, existing disparities could be widened. Addressing this issue will require integrated strategies, including expanding genetic research, improving genetic literacy, and enhancing access to genetic technologies among minority populations in a way that avoids harms such as stigmatization.

  13. Racial and Ethnic Health Disparities among People with Intellectual and Developmental Disabilities

    ERIC Educational Resources Information Center

    Magaña, Sandra; Parish, Susan; Morales, Miguel A.; Li, Henan; Fujiura, Glenn

    2016-01-01

    Racial and ethnic health disparities are a pervasive public health problem. Emerging research finds similar health disparities among people with intellectual and developmental disabilities (IDD) compared to nondisabled adults. However, few studies have examined racial and ethnic health disparities among adults with IDD. Using national data, we…

  14. Racial and Ethnic Health Disparities among People with Intellectual and Developmental Disabilities

    ERIC Educational Resources Information Center

    Magaña, Sandra; Parish, Susan; Morales, Miguel A.; Li, Henan; Fujiura, Glenn

    2016-01-01

    Racial and ethnic health disparities are a pervasive public health problem. Emerging research finds similar health disparities among people with intellectual and developmental disabilities (IDD) compared to nondisabled adults. However, few studies have examined racial and ethnic health disparities among adults with IDD. Using national data, we…

  15. Population Disparities in Mental Health: Insights From Cultural Neuroscience

    PubMed Central

    Blizinsky, Katherine D.

    2013-01-01

    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. PMID:23927543

  16. Complex Systems Thinking and Current Impasses in Health Disparities Research

    PubMed Central

    2011-01-01

    Complex systems approaches have received increasing attention in public health because reductionist approaches yield limited insights in the context of dynamic systems. Most discussions have been highly abstract. There is a need to consider the application of complex systems approaches to specific research questions. I review the features of population health problems for which complex systems approaches are most likely to yield new insights, and discuss possible applications of complex systems to health disparities research. I provide illustrative examples of how complex systems approaches may help address unanswered and persistent questions regarding genetic factors, life course processes, place effects, and the impact of upstream policies. The concepts and methods of complex systems may help researchers move beyond current impasse points in health disparities research. PMID:21778505

  17. Education and health disparities: a macro, not micro, phenomenon.

    PubMed

    Myers, Douglas J

    2010-01-01

    Numerous studies have identified associations between education and various health outcomes. Education and health are commonly measured at the individual level; proposed solutions are also often oriented toward altering the characteristics of persons. Better educating more individuals is frequently suggested. Here it is argued that macro-level processes produce the associations observed across these studies. The institutional context, it is proposed, is structured such that better health is among the rewards of higher education. Institutional changes that decouple this connection between education level and health chances may be better suited to reducing social disparities in health than approaches that promote changes in individuals.

  18. Reducing health disparities in underserved communities via interprofessional collaboration across health care professions

    PubMed Central

    Vanderbilt, Allison A; Dail, Michael D; Jaberi, Parham

    2015-01-01

    Health disparities can negatively impact subsets of the population who have systematically experienced greater socioeconomic obstacles to health. Health disparities are pervasive across the United States and no single health care profession can tackle this national crisis alone. It is essential that all health care providers work collaboratively toward the overarching goal of systematically closing the health disparities gap. Interprofessional collaboration is the foundation needed for health care providers to support patient needs and reduce health disparities in public health. Let us reach across the silos we work within and collaborate with our colleagues. Stand up and begin thinking about our communities, our patients, and the future overall health status of the population for the United States. PMID:25960659

  19. Strengthening Health Disparities Data Collection Act

    THOMAS, 113th Congress

    Sen. Schatz, Brian [D-HI

    2013-05-20

    Senate - 05/20/2013 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  20. Maryland's Special Populations Cancer Network: cancer health disparities reduction model.

    PubMed

    Baquet, Claudia R; Mack, Kelly M; Bramble, Joy; DeShields, Mary; Datcher, Delores; Savoy, Mervin; Hummel, Kery; Mishra, Shiraz I; Brooks, Sandra E; Boykin-Brown, Stephanie

    2005-05-01

    Cancer in Maryland is a serious health concern for minority and underserved populations in rural and urban areas. This report describes the National Cancer Institute (NCI) supported Maryland Special Populations Cancer Network (MSPN), a community-academic partnership. The MSPN's priority populations include African Americans, Native Americans, and other medically underserved residents of rural and urban areas. The MSPN has established a community infrastructure through formal collaborations with several community partners located in Baltimore City, the rural Eastern Shore, and Southern and Western Maryland, and among the Piscataway Conoy Tribe and the other 27 Native American Tribes in Maryland. Key partners also include the University of Maryland Eastern Shore and the University of Maryland Statewide Health Network. The MSPN has implemented innovative and successful programs in cancer health disparities research, outreach, and training; clinical trials education, health disparities policy, and resource leveraging. The MSPN addresses the goal of the NCI and the Department of Health and Human Services (DHHS) to reduce and eventually eliminate cancer health disparities. Community-academic partnerships are the foundation of this successful network.

  1. Finding a Place for Genomics in Health Disparities Research

    PubMed Central

    Fullerton, S.M.; Knerr, S.; Burke, W.

    2012-01-01

    The existence of pronounced differences in health outcomes between US populations is a problem of moral significance and public health urgency. Pursuing research on genetic contributors to such disparities, despite striking data on the fundamental role of social factors, has been controversial. Still, advances in genomic science are providing an understanding of disease biology at a level of precision not previously possible. The potential for genomic strategies to help in addressing population-level disparities therefore needs to be carefully evaluated. Using 3 examples from current research, we argue that the best way to maximize the benefits of population-based genomic investigations, and mitigate potential harms, is to direct research away from the identification of genetic causes of disparities and instead focus on applying genomic methodologies to the development of clinical and public health tools with the potential to ameliorate healthcare inequities, direct population-level health interventions or inform public policy. Such a transformation will require close collaboration between transdisciplinary teams and community members as well as a reorientation of current research objectives to better align genomic discovery efforts with public health priorities and well-recognized barriers to fair health care delivery. PMID:22488458

  2. Cultural context and a critical approach to eliminating health disparities.

    PubMed

    Griffith, Derek M; Johnson, Jonetta; Ellis, Katrina R; Schulz, Amy Jo

    2010-01-01

    The science of eliminating racial health disparities requires a clear understanding of the underlying social processes that drive persistent differences in health outcomes by self-identified race. Understanding these social processes requires analysis of cultural notions of race as these are instantiated in institutional policies and practices that ultimately contribute to health disparities. Racism provides a useful framework for understanding how social, political and economic factors directly and indirectly influence health outcomes. While it is important to capture how individuals are influenced by their psychological experience of prejudice and discrimination, racism is more than an intrapersonal or interpersonal variable. Considerable attention has focused on race-based residential segregation and other forms of institutional racism but less focus has been placed on how cultural values, frameworks and meanings shape institutional policies and practices. In this article, we highlight the intersection of cultural and institutional racism as a critical mechanism through which racial inequities in social determinants of health not only develop but persist. This distinction highlights and helps to explain processes and structures that contribute to racial disparities persisting across time and outcomes. Using two historical examples, the National Negro Health Movement and hospital desegregation during the Civil Rights Era, we identify key questions that an analysis of cultural racism might add to the more common focus on overt policy decisions and practices.

  3. Health Disparities and Intellectual Disabilities: Lessons from Individuals with down Syndrome

    ERIC Educational Resources Information Center

    Booth, Karin Vander Ploeg

    2011-01-01

    Individuals with intellectual disabilities experience health disparities and disparities in accessing health care services compared to individuals within the general population. In order to eliminate these disparities the contributors to them must be understood. In this article, we aim to describe a recent reconceptualization of health and…

  4. Health Disparities of Adults with Intellectual Disabilities: What Do We Know? What Do We Do?

    ERIC Educational Resources Information Center

    Krahn, Gloria L.; Fox, Michael H.

    2014-01-01

    Background: Recent attention to health of people with intellectual disabilities has used a health disparities framework. Building on historical context, the paper summarizes what is known about health disparities from reports and research and provides direction on what to do to reduce these disparities among adults with intellectual disabilities.…

  5. Health Disparities of Adults with Intellectual Disabilities: What Do We Know? What Do We Do?

    ERIC Educational Resources Information Center

    Krahn, Gloria L.; Fox, Michael H.

    2014-01-01

    Background: Recent attention to health of people with intellectual disabilities has used a health disparities framework. Building on historical context, the paper summarizes what is known about health disparities from reports and research and provides direction on what to do to reduce these disparities among adults with intellectual disabilities.…

  6. Technical report--racial and ethnic disparities in the health and health care of children.

    PubMed

    Flores, Glenn

    2010-04-01

    This technical report reviews and synthesizes the published literature on racial/ethnic disparities in children's health and health care. A systematic review of the literature was conducted for articles published between 1950 and March 2007. Inclusion criteria were peer-reviewed, original research articles in English on racial/ethnic disparities in the health and health care of US children. Search terms used included "child," "disparities," and the Index Medicus terms for each racial/ethnic minority group. Of 781 articles initially reviewed, 111 met inclusion criteria and constituted the final database. Review of the literature revealed that racial/ethnic disparities in children's health and health care are quite extensive, pervasive, and persistent. Disparities were noted across the spectrum of health and health care, including in mortality rates, access to care and use of services, prevention and population health, health status, adolescent health, chronic diseases, special health care needs, quality of care, and organ transplantation. Mortality-rate disparities were noted for children in all 4 major US racial/ethnic minority groups, including substantially greater risks than white children of all-cause mortality; death from drowning, from acute lymphoblastic leukemia, and after congenital heart defect surgery; and an earlier median age at death for those with Down syndrome and congenital heart defects. Certain methodologic flaws were commonly observed among excluded studies, including failure to evaluate children separately from adults (22%), combining all nonwhite children into 1 group (9%), and failure to provide a white comparison group (8%). Among studies in the final database, 22% did not perform multivariable or stratified analyses to ensure that disparities persisted after adjustment for potential confounders. Racial/ethnic disparities in children's health and health care are extensive, pervasive, and persistent, and occur across the spectrum of health

  7. The concept of culture: a core issue in health disparities.

    PubMed

    Page, J Bryan

    2005-06-01

    Contemporary discourse contains numerous examples of use of the concept of culture by social and behavioral scientists. Simple reification, where the speaker makes culture into a thing capable of action exemplifies one usage in public discourse. Some quantitative social scientists attempt to characterize people's cultural identities by means of a single categorical variable, which often "lumps" people into categories such as "Hispanic" or "Black" that in fact have numerous culturally bounded subcategories. Approaches that emphasize cultural process are preferable to those who attempt to categorize; more complex measures of acculturation help investigators to make convincing analyses of circumstances in which health disparities occur. Examples in which investigators make appropriate use of cultural characterizations demonstrate their utility in investigating health disparities in Haitian American women, injecting and noninjecting drug users, Hispanic youth, and adult Hispanics at risk of HIV infection. Focus on culture in the study of health disparities can identify entanglements between structural factors such as poverty and lack of education and cultural factors such as beliefs about health. Qualitative methods coupled with quantitative methods have great potential to improve investigators' grasp of cultural nuance while capturing the distribution of qualitatively derived behaviors.

  8. Health Disparities of Adults with Intellectual Disabilities: What Do We Know? What Do We Do?

    PubMed Central

    Krahn, Gloria L.; Fox, Michael H.

    2015-01-01

    Background Recent attention to health of people with intellectual disabilities has used a health disparities framework. Building on historical context, the paper summarizes what is known about health disparities from reports and research and provide direction on what to do to reduce these disparities among adults with intellectual disabilities. Methods The present authors examined literature from 2002 to 2011 on health disparities and people with disabilities looking for broad themes on documenting disparities and on research approaches and methods. Results Multiple countries published reports on health of people with intellectual disabilities. Researchers summarized existing research within a health disparities framework. A number of promising methodologies are identified such as health services research, health indicators, enhanced surveillance and mixed-methods. Conclusions Strategies to reduce health disparities include use of data to educate decision makers, attention to social determinants and a life-course model and emphasis on leveraging inclusion in mainstream services where possible. PMID:23913632

  9. Role of Acculturation Research in Advancing Science and Practice in Reducing Health Care Disparities Among Latinos

    PubMed Central

    Carter-Pokras, Olivia

    2010-01-01

    An impressive body of public health knowledge on health care disparities among Latinos has been produced. However, inconclusive and conflicting results on predictors of health care disparities remain. We examined the theoretical assumptions and methodological limitations of acculturation research in understanding Latino health care disparities, the evidence for socioeconomic position as a predictor of health care disparities, and the effectiveness of cultural competency practice. Persistent use of culture-driven acculturation models decenters social determinants of health as key factors in health disparities and diminishes the effectiveness of cultural competency practice. Social and economic determinants are more important predictors than is culture in understanding health care disparities. Improvements in the material conditions of low-income Latinos can effectively reduce health care disparities. PMID:19910358

  10. Discrimination and racial disparities in health: evidence and needed research

    PubMed Central

    Mohammed, Selina A.

    2010-01-01

    This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health. PMID:19030981

  11. Reducing disparity in behavioral health services: a report from the American College of Mental Health Administration.

    PubMed

    Dougherty, Richard H

    2004-01-01

    The 2003 AMCHA Summit was an initial step. It served to provide a broad outline of the socio-political context and key issues involved in reducing disparities, and it provided some momentum for change. However, much more work remains to be done. The summit clearly demonstrated that the reduction of disparities requires a multi-level approach and multi-disciplinary leaders. As a neutral convener, AMCHA is in a unique position to help advance the debate and lead the field. The membership includes researchers, administrators, clinicians, and policy makers from all levels of the behavioral health system. As noted, a change agenda needs to include efforts at national, state, and local levels involving consumers, providers, purchasers, oversight organizations, and researchers. ACMHA is committed to advancing the field and helping the national effort to reduce disparities. Examples of potential projects include the following: Training: Much has been done to develop effective cultural-competency training modules and to guide states in its implementation. No one should reinvent the wheel at this time. Funding should be targeted to provide incentives to states for dissemination of existing training curricula and the documentation of effectiveness to all providers and administrators. Nationally, the field will benefit from data standards for the collection of and reporting on system disparities. This will facilitate interstate comparisons and provide baseline data for change efforts. Conducting surveys of providers, health plans, and public behavioral health systems on the availability and current uses of data by race and ethnicity is one example of a useful first step in this process of setting data standards. Further research on the nature and causes of disparity is needed. There should be systematic research on factors influencing access, treatment, and outcomes for people of different cultures. Initially, because of the difficulties in deciding on standardized outcome

  12. Health disparities based on socioeconomic inequities: implications for urban health care.

    PubMed

    Fiscella, Kevin; Williams, David R

    2004-12-01

    Health is unevenly distributed across socioeconomic status. Persons of lower income, education, or occupational status experience worse health and die earlier than do their better-off counterparts. This article discusses these disparities in the context of urban medical practice. The article begins with a discussion of the complex relationship among socioeconomic status, race, and health in the United States. It highlights the effects of institutional, individual, and internalized racism on the health of African Americans, including the insidious consequences of residential segregation and concentrated poverty. Next, the article reviews health disparities based on socioeconomic status across the life cycle, beginning in fetal health and ending with disparities among the elderly. Potential explanations for these socioeconomic-based disparities are addressed, including reverse causality (e.g., being poor causes lower socioeconomic status) and confounding by genetic factors. The article underscores social causation as the primary explanation for health disparities and highlights the cumulative effects of social disadvantage across stages of the life cycle and across environments (e.g., fetal, family, educational, occupational, and neighborhood). The article concludes with a discussion of the implications of health disparities for the practice of urban medicine, including the role that concentration of disadvantage plays among patients and practice sites and the need for quality improvement to mitigate these disparities.

  13. The Impact of Disasters on Populations With Health and Health Care Disparities

    PubMed Central

    Davis, Jennifer R.; Wilson, Sacoby; Brock-Martin, Amy; Glover, Saundra; Svendsen, Erik R.

    2010-01-01

    Context A disaster is indiscriminate in whom it affects. Limited research has shown that the poor and medically underserved, especially in rural areas, bear an inequitable amount of the burden. Objective To review the literature on the combined effects of a disaster and living in an area with existing health or health care disparities on a community’s health, access to health resources, and quality of life. Methods We performed a systematic literature review using the following search terms: disaster, health disparities, health care disparities, medically underserved, and rural. Our inclusion criteria were peer-reviewed, US studies that discussed the delayed or persistent health effects of disasters in medically underserved areas. Results There has been extensive research published on disasters, health disparities, health care disparities, and medically underserved populations individually, but not collectively. Conclusions The current literature does not capture the strain of health and health care disparities before and after a disaster in medically underserved communities. Future disaster studies and policies should account for differences in health profiles and access to care before and after a disaster. PMID:20389193

  14. Cancer-Related Health Disparities in Women

    PubMed Central

    Glanz, Karen; Croyle, Robert T.; Chollette, Veronica Y.; Pinn, Vivian W.

    2003-01-01

    Objectives. This article synthesizes information about cancer in 9 populations of minority women: Mexican American, Puerto Rican, Cuban American, African American, Asian American, Native Hawaiian, American Samoan, American Indian, and Alaska Native. Methods. Cancer registry data, social indicators, government sources, and published articles were searched for information on the background and cancer experience of these 9 racial/ethnic groups. Results. Approximately 35 million women in these racial/ethnic groups live in the United States, and their numbers are increasing rapidly. Since 1992, incidence rates for major cancer sites have slowed or decreased among these groups, but declines in mortality have not occurred or have been smaller than for Whites. Gaps in early detection have narrowed, but minority women still lag behind Whites. Smoking and obesity remain common in these populations. Conclusions. More culturally appropriate interventions and research are needed, and these efforts must involve the community and raise the quality of health services. PMID:12554589

  15. Using community-based participatory research to address health disparities.

    PubMed

    Wallerstein, Nina B; Duran, Bonnie

    2006-07-01

    Community-based participatory research (CBPR) has emerged in the past decades as an alternative research paradigm, which integrates education and social action to improve health and reduce health disparities. More than a set of research methods, CBPR is an orientation to research that focuses on relationships between academic and community partners, with principles of colearning, mutual benefit, and long-term commitment and incorporates community theories, participation, and practices into the research efforts. As CBPR matures, tensions have become recognized that challenge the mutuality of the research relationship, including issues of power, privilege, participation, community consent, racial and/or ethnic discrimination, and the role of research in social change. This article focuses on these challenges as a dynamic and ever-changing context of the researcher-community relationship, provides examples of these paradoxes from work in tribal communities, discusses the evidence that CBPR reduces disparities, and recommends transforming the culture of academia to strengthen collaborative research relationships.

  16. Transitioning from Health Disparities to a Health Equity Research Agenda: The Time Is Now

    PubMed Central

    Williams, Shanita D.

    2014-01-01

    Health disparities are real. The evidence base is large and irrefutable. As such, the time is now to shift the research emphasis away from solely documenting the pervasiveness of the health disparities problem and begin focusing on health equity, the highest level of health possible. The focus on health equity research will require investigators to propose projects that develop and evaluate evidence-based solutions to health differences that are driven largely by social, economic, and environmental factors. This article highlights ongoing research and programmatic efforts underway at the National Institutes of Health that hold promise for advancing population health and improving health equity. PMID:24385668

  17. Transitioning from health disparities to a health equity research agenda: the time is now.

    PubMed

    Srinivasan, Shobha; Williams, Shanita D

    2014-01-01

    Health disparities are real. The evidence base is large and irrefutable. As such, the time is now to shift the research emphasis away from solely documenting the pervasiveness of the health disparities problem and begin focusing on health equity, the highest level of health possible. The focus on health equity research will require investigators to propose projects that develop and evaluate evidence-based solutions to health differences that are driven largely by social, economic, and environmental factors. This article highlights ongoing research and programmatic efforts underway at the National Institutes of Health that hold promise for advancing population health and improving health equity.

  18. 76 FR 31618 - National Center on Minority Health and Health Disparities; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-01

    ... HUMAN SERVICES National Institutes of Health National Center on Minority Health and Health Disparities.... App.), notice is hereby given of a meeting of the National Advisory Council on Minority Health and... personal privacy. Name of Committee: National Advisory Council on Minority Health and Health...

  19. 78 FR 9402 - National Institute on Minority Health and Health; Disparities Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-08

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute on Minority Health and Health... Health and Health Disparities. The meeting will be open to the public as indicated below, with attendance...

  20. Rationing mental health care: parity, disparity, and justice.

    PubMed

    Woolfolk, Robert L; Doris, John M

    2002-09-01

    Recent policy debates in the US over access to mental health care have raised several philosophically complex ethical and conceptual issues. The defeat of mental health parity legislation in the US Congress has brought new urgency and relevance to theoretical and empirical investigations into the nature of mental illness and its relation to other forms of sickness and disability. Manifold, nebulous, and often competing conceptions of mental illness make the creation of coherent public policy exceedingly difficult. Referencing a variety of approaches to ethical reflection on health care, and drawing from the empirical literature on therapeutic efficacy and economic efficiency, we argue that differential rationing, 'disparity,' is unjustifiable.

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

    PubMed

    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.

  2. Disparity and Convergence: Chinese Provincial Government Health Expenditures

    PubMed Central

    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. PMID:23977049

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

    PubMed

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

    2014-10-01

    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.

  4. Methods Matter: Tracking Health Disparities in Alternative High Schools.

    PubMed

    Johnson, Karen E; Goyal, Mohit; Simonton, Amanda J; Richardson, Rebecca; Morris, Marian; Rew, Lynn

    2017-02-09

    Alternative high school (AHS) students are at-risk for school dropout and engage in high levels of health-risk behaviors that should be monitored over time. They are excluded from most public health surveillance efforts (e.g., Youth Risk Behavior Survey; YRBS), hindering our ability to monitor health disparities and allocate scarce resources to the areas of greatest need. Using active parental consent, we recruited 515 students from 14 AHSs in Texas to take a modified YRBS. We calculated three different participation rates, tracked participation by age of legal consent (≥18 and <18 years), and identified other considerations for obtaining quality data. Being required to use active consent resulted in a much lower cooperation rate among students <18 years (32%) versus those who were ≥18 years and could provide their own consent (57%). Because chronic truancy is prevalent in AHS students, cooperation rates may be more accurate than participation rates based off of enrollment or attendance. Requiring active consent and not having accurate participation rates may result in surveillance data that are of disparate quality. This threatens to mask the needs of AHS students and perpetuate disparities because we are likely missing the highest-risk students within a high-risk sample and cannot generalize findings.

  5. Women and Lung Disease. Sex Differences and Global Health Disparities

    PubMed Central

    Harbaugh, Mary; Han, MeiLan K.; Jourdan Le Saux, Claude; Van Winkle, Laura S.; Martin, William J.; Kosgei, Rose J.; Carter, E. Jane; Sitkin, Nicole; Smiley-Jewell, Suzette M.; George, Maureen

    2015-01-01

    There is growing evidence that a number of pulmonary diseases affect women differently and with a greater degree of severity than men. The causes for such sex disparity is the focus of this Blue Conference Perspective review, which explores basic cellular and molecular mechanisms, life stages, and clinical outcomes based on environmental, sociocultural, occupational, and infectious scenarios, as well as medical health beliefs. Owing to the breadth of issues related to women and lung disease, we present examples of both basic and clinical concepts that may be the cause for pulmonary disease disparity in women. These examples include those diseases that predominantly affect women, as well as the rising incidence among women for diseases traditionally occurring in men, such as chronic obstructive pulmonary disease. Sociocultural implications of pulmonary disease attributable to biomass burning and infectious diseases among women in low- to middle-income countries are reviewed, as are disparities in respiratory health among sexual minority women in high-income countries. The implications of the use of complementary and alternative medicine by women to influence respiratory disease are examined, and future directions for research on women and respiratory health are provided. PMID:25945507

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

    PubMed Central

    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

  7. Women and Lung Disease. Sex Differences and Global Health Disparities.

    PubMed

    Pinkerton, Kent E; Harbaugh, Mary; Han, MeiLan K; Jourdan Le Saux, Claude; Van Winkle, Laura S; Martin, William J; Kosgei, Rose J; Carter, E Jane; Sitkin, Nicole; Smiley-Jewell, Suzette M; George, Maureen

    2015-07-01

    There is growing evidence that a number of pulmonary diseases affect women differently and with a greater degree of severity than men. The causes for such sex disparity is the focus of this Blue Conference Perspective review, which explores basic cellular and molecular mechanisms, life stages, and clinical outcomes based on environmental, sociocultural, occupational, and infectious scenarios, as well as medical health beliefs. Owing to the breadth of issues related to women and lung disease, we present examples of both basic and clinical concepts that may be the cause for pulmonary disease disparity in women. These examples include those diseases that predominantly affect women, as well as the rising incidence among women for diseases traditionally occurring in men, such as chronic obstructive pulmonary disease. Sociocultural implications of pulmonary disease attributable to biomass burning and infectious diseases among women in low- to middle-income countries are reviewed, as are disparities in respiratory health among sexual minority women in high-income countries. The implications of the use of complementary and alternative medicine by women to influence respiratory disease are examined, and future directions for research on women and respiratory health are provided.

  8. The Double Disparity Facing Rural Local Health Departments.

    PubMed

    Harris, Jenine K; Beatty, Kate; Leider, J P; Knudson, Alana; Anderson, Britta L; Meit, Michael

    2016-01-01

    Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.

  9. Reducing Oral Health Disparities: A Focus on Social and Cultural Determinants

    PubMed Central

    Patrick, Donald L; Lee, Rosanna Shuk Yin; Nucci, Michele; Grembowski, David; Jolles, Carol Zane; Milgrom, Peter

    2006-01-01

    Oral health is essential to the general health and well-being of individuals and the population. Yet significant oral health disparities persist in the U.S. population because of a web of influences that include complex cultural and social processes that affect both oral health and access to effective dental health care. This paper introduces an organizing framework for addressing oral health disparities. We present and discuss how the multiple influences on oral health and oral health disparities operate using this framework. Interventions targeted at different causal pathways bring new directions and implications for research and policy in reducing oral health disparities. PMID:16934121

  10. Bridging domains in efforts to reduce disparities in health and health care.

    PubMed

    Kumanyika, Shiriki K; Morssink, Christiaan B

    2006-08-01

    The concept of health disparities is a familiar one, but we must continually challenge our thinking on how disparities issues are framed. The 1985 Report of the Secretary's Task Force on Black and Minority Health established a disease-oriented focus on "excess deaths" as the primary targets of disparities initiatives. However, progress in reducing disparities has been limited. The disease focus, which emphasizes the individual-level and health care services, may be too narrow. A "population health" perspective can foster a more comprehensive and integrated approach. Both disease-oriented and population health perspectives have advantages and disadvantages, for both policy and practical purposes. The challenge is to effectively leverage both approaches to improve the health of ethnic minority and other disadvantaged populations. We need bridge builders who can articulate and hear diverse perspectives, work with systems, and maintain a long-term vision for affecting the social dynamics of society.

  11. 76 FR 18566 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-04

    ... HUMAN SERVICES National Institutes of Health National Center on Minority and Health Disparities; Notice... personal privacy. Name of Committee: National Center on Minority Health and Health Disparities Special...-Sharp, PhD, Scientific Review Officer, National Institute on Minority Health and Health...

  12. Eliminating oral health disparities: Ethics workshop reactor comments.

    PubMed

    Evans, Caswell A

    2006-11-01

    Oral health encompasses dentistry and is broader in concept. Dentistry alone appears insufficient to ensure oral health for the population at large. Troubling disparities in oral health status and access to care have been documented. The segment of the population that has little or no access to care is growing; aging baby-boomers are adding to this problem. As suggested in Oral Health in America: A Report of the Surgeon General, partnerships and collaboration are essential to improving oral health. The ethics of dental practice and the profession are being called into question. Who will provide the necessary leadership to address and resolve these issues, so that oral health is attainable by all?

  13. Understanding Racial/ethnic Disparities in Health: Sociological Contributions*

    PubMed Central

    Williams, David R.; Sternthal, Michelle

    2012-01-01

    This paper provides an overview of the contribution of sociologists to the study of racial and ethnic inequalities in health in the U.S. It argues that sociologists have made four principal contributions. First, they have challenged and problematized the biological understanding of race. Second, they have emphasized the primacy of social structure and context as determinants of racial differences in disease. Third, they have contributed to our understanding of the multiple ways in which racism affects health. Finally, sociologists have enhanced our understanding of the ways in which migration history and status can affect health. Sociological insights on racial disparities in health have important implications for the development of effective approaches to improve health and reduce health inequities. PMID:20943580

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

    PubMed

    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.

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

    PubMed Central

    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

  16. Racial/Ethnic Disparities in Health and Health Care among U.S. Adolescents

    PubMed Central

    Lau, May; Lin, Hua; Flores, Glenn

    2012-01-01

    Objective To examine racial/ethnic disparities in medical and oral health status, access to care, and use of services in U.S. adolescents. Data Source Secondary data analysis of the 2003 National Survey of Children's Health. The survey focus was children 0–17 years old. Study Design Bivariate and multivariable analyses were conducted for white, African American, Latino, Asian/Pacific Islander, American Indian/Alaskan Native, and multiracial adolescents 10–17 years old (n = 48,742) to identify disparities in 40 measures of health and health care. Principal Findings Certain disparities were especially marked for specific racial/ethnic groups and multiracial youth. These disparities included suboptimal health status and lack of a personal doctor or nurse for Latinos; suboptimal oral health and not receiving all needed medications in the past year for African Americans; no physician visit or mental health care in the past year for Asian/Pacific Islanders; overweight/obesity, uninsurance, problems getting specialty care, and no routine preventive visit in the past year for American Indian/Alaska Natives; and not receiving all needed dental care in multiracial youth. Conclusions U.S. adolescents experience many racial/ethnic disparities in health and health care. These findings indicate a need for ongoing identification and monitoring of and interventions for disparities for all five major racial/ethnic groups and multiracial adolescents. PMID:22417169

  17. What China's experiment in community building can tell us about tackling health disparities: community building and mental health in mid-life and older life: evidence from China.

    PubMed

    Muennig, Peter

    2014-04-01

    Disparities in physical and mental health between advantaged and disadvantaged communities are among the largest threats to population health worldwide. These disparities appear to be growing, probably in part because we do not understand how to address their underlying causes. Many believe the underlying causes are thought to arise directly or indirectly from the psychosocial problems underlying poverty, such as hunger, poor housing, drug use, or crime. One logical solution is therefore to provide more community services targeted at addressing these problems within the most disadvantaged communities. However, to date, data on the efficacy of this approach is lacking. China serves as a possible laboratory for studying the efficacy of community-based programs. This is because the extensive community-based programs present prior to economic reforms in 1978 were removed, and then later re-instated in a quasi-experimental manner. In this issue, Yuying Shen uses multi-level models to explore the impact of this experiment on community mental health in a multi-level associational study. She finds that the quantity (but not their length of time in the community) of such services is positively associated with mental health. This study opens the door to more rigorous analyses that might motivate formal social experiments at the community level worldwide. If successful, such experiments might not only transform what we currently know not just about improving health in disadvantaged communities, but also prove transformative for health policy as a discipline. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Federal investments to eliminate racial/ethnic health-care disparities.

    PubMed

    Moy, Ernest; Freeman, William

    2014-01-01

    Health care is an important lever for moderating the effects of social determinants on health. We present a model that describes the relationships among social disadvantage, health-care disparities, and health disparities. Improving access to health care and enhancing patient-provider interaction are critical pathways for reducing disparities. Increasing the diversity of the public health and health-care workforces is an efficient strategy for reducing disparities because it impacts both access to care and patient-provider communication. Federal policy makers should continue interest in workforce diversity to optimize the health of all Americans.

  19. Health Disparities Between Women With and Without Disabilities: A Review of the Research

    PubMed Central

    WISDOM, JENNIFER P.; McGEE, MARJORIE G.; HORNER-JOHNSON, WILLI; MICHAEL, YVONNE L.; ADAMS, ELIZABETH; BERLIN, MICHELLE

    2013-01-01

    As part of a women’s health center project, we reviewed 16 years of research to examine health disparities between women with and without disabilities. We reviewed MEDLINE-indexed articles between 1990 and 2005 with data on women with and without physical, sensory, intellectual, developmental, or psychiatric disabilities. Our review found few articles examining health disparities in chronic disease, cancer, mental health and substance abuse, preventive screening, health-promoting behaviors, and health services utilization. Results reflect apparent health disparities between women with and without disabilities. Challenges for the field exist in standardizing disability definitions and determining a future course for health disparity research and policy. PMID:20446182

  20. 78 FR 65345 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-31

    ... HUMAN SERVICES National Institutes of Health National Institute on Minority Health and Health... unwarranted invasion of personal privacy. Name of Committee: National Institute on Minority Health and Health Disparities Special Emphasis Panel; NIMHD Research Center in Minority Institution Program (G12)....

  1. Using Community Health Assessment to Teach and Explore Health Status Disparities

    ERIC Educational Resources Information Center

    Sullivan, Marianne; Levine, Jack

    2014-01-01

    Introduction: Community health assessment (CHA) is a useful tool for identifying health status disparities at the community level. Developing the skills of master's level public health students to conduct CHA addresses a number of the Association of Schools of Public Health Core competencies for graduate public health education. Teaching…

  2. 75 FR 53975 - National Center on Minority Health and Health Disparities; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Center on Minority Health and Health Disparities.... App.), notice is hereby given of a meeting of the National Advisory Council on Minority Health and...

  3. 75 FR 28262 - National Center on Minority Health and Health Disparities; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-20

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Center on Minority Health and Health Disparities.... App.), notice is hereby given of a meeting of the National Advisory Council on Minority Health and...

  4. 78 FR 35837 - National Institute on Minority Health and Health Disparities Research Endowments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-14

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health 42 CFR Part 52i RIN 0925-AA61 National Institute on Minority Health and Health Disparities Research Endowments AGENCY: National Institutes of Health...

  5. Health Insurance, Socio-Economic Position and Racial Disparities in Preventive Dental Visits in South Africa

    PubMed Central

    Ayo-Yusuf, Imade J.; Ayo-Yusuf, Olalekan A.; Olutola, Bukola G.

    2012-01-01

    This study sought to determine the contributions of socio-economic position and health insurance enrollment in explaining racial disparities in preventive dental visits (PDVs) among South Africans. Data on the dentate adult population participating in the last South African Demographic and Health Survey conducted during 2003–2004 (n = 6,312) was used. Main outcome measure: Reporting making routine yearly PDVs as a preventive measure. Education, material wealth index and nutritional status indicated socio-economic position. Multi-level logistic regression analysis was conducted to determine the predictors of PDVs. A variant of Blinder-Oaxaca decomposition analysis was also conducted. Health insurance coverage was most common among Whites (70%) and least common among black Africans (10.1%) in South Africa. Similarly, a yearly PDV was most frequently reported by Whites (27.8%) and least frequently reported among black Africans (3.1%). Lower education and lower material wealth were associated with lower odds of making PDVs. There was significant interaction between location (urban/rural) and education (p = 0.010). The racial and socio-economic differences in PDVs observed in urban areas were not observed in rural areas. In the general dentate population, having health insurance significantly increased the odds of making PDVs (OR = 4.32; 3.04–6.14) and accounted for 40.3% of the White/non-White gap in the probability of making PDVs. Overall, socio-economic position and health insurance enrollments together accounted for 55.9% (95% CI = 44.9–67.8) of the White/non-White gap in PDVs. Interventions directed at improving both socio-economic position and insurance coverage of non-White South Africans are likely to significantly reduce racial disparities in PDVs. PMID:23282482

  6. Churches, academic institutions, and public health: partnerships to eliminate health disparities.

    PubMed

    Goldmon, Moses V; Roberson, James T

    2004-01-01

    The four principles represent a framework for improving the process of establishing sustainable partnerships between research, public health, and faith-based institutions that seek to eliminate health disparities. To improve the efficacy of partnerships with churches identification of potential partner churches must be deliberate, trusting relationships must be built, divergent perspectives must be communicated and reconciled, and some tangible power should be transferred to church and community leaders where feasible. We applaud the National Institutes of Health, through the National Center on Minority Health and Health Disparities', efforts to "promote coordination and collaboration among the agencies conducting or supporting minority health or other health disparities research." We recommend that the North Carolina Office of Minority Health and Health Disparities be charged with and provided adequate resources to facilitate this type of coordination and collaboration among North Carolina Department of Health and Human Services agencies that are disparities conducting or supporting minority health and health research. A special emphasis should be placed on partnerships that seek to engage communities of faith.

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

    PubMed Central

    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

  8. Confronting Health Disparities: Latin American Social Medicine in Venezuela

    PubMed Central

    Mantini-Briggs, Clara

    2009-01-01

    Objectives. We explored the emergence and effectiveness of Venezuela's Misión Barrio Adentro, “Inside the Neighborhood Mission,” a program designed to improve access to health care among underserved residents of the country, hoping to draw lessons to apply to future attempts to address acute health disparities. Methods. We conducted our study in 3 capital-region neighborhoods, 2 small cities, and 2 rural areas, combining systematic observations with interviews of 221 residents, 41 health professionals, and 28 government officials. We surveyed 177 female and 91 male heads of household. Results. Interviews suggested that Misión Barrio Adentro emerged from creative interactions between policymakers, clinicians, community workers, and residents, adopting flexible, problem-solving strategies. In addition, data indicated that egalitarian physician–patient relationships and the direct involvement of local health committees overcame distrust and generated popular support for the program. Media and opposition antagonism complicated physicians’ lives and clinical practices but heightened the program's visibility. Conclusions. Top-down and bottom-up efforts are less effective than “horizontal” collaborations between professionals and residents in underserved communities. Direct, local involvement can generate creative and dynamic efforts to address acute health disparities in these areas. PMID:19150916

  9. Confronting health disparities: Latin American social medicine in Venezuela.

    PubMed

    Briggs, Charles L; Mantini-Briggs, Clara

    2009-03-01

    We explored the emergence and effectiveness of Venezuela's Misión Barrio Adentro, "Inside the Neighborhood Mission," a program designed to improve access to health care among underserved residents of the country, hoping to draw lessons to apply to future attempts to address acute health disparities. We conducted our study in 3 capital-region neighborhoods, 2 small cities, and 2 rural areas, combining systematic observations with interviews of 221 residents, 41 health professionals, and 28 government officials. We surveyed 177 female and 91 male heads of household. Interviews suggested that Misión Barrio Adentro emerged from creative interactions between policymakers, clinicians, community workers, and residents, adopting flexible, problem-solving strategies. In addition, data indicated that egalitarian physician-patient relationships and the direct involvement of local health committees overcame distrust and generated popular support for the program. Media and opposition antagonism complicated physicians' lives and clinical practices but heightened the program's visibility. Top-down and bottom-up efforts are less effective than "horizontal" collaborations between professionals and residents in underserved communities. Direct, local involvement can generate creative and dynamic efforts to address acute health disparities in these areas.

  10. Review: Increasing Awareness and Education on Health Disparities for Health Care Providers.

    PubMed

    Nesbitt, Shawna; Palomarez, Rigo Estevan

    2016-04-21

    The focus of this review is to highlight health care disparities and trends in several common diseases in selected populations while offering evidence-based approaches to mitigating health care disparities. Health care disparities cross many barriers and affect multiple populations and diseases. Ethnic minorities, the elderly, and those of lower socioeconomic status (SES) are more at-risk than others. However, many low SES Whites and higher SES racial minorities have poorer health than their racial or SES peers. Also, recent immigrant groups and Hispanics, in particular, maintain high health ratings. The so-called Hispanic Paradox provides an example of how culture and social background can be used to improve health outcomes. These groups have unique determinants of disparity that are based on a wide range of cultural and societal factors. Providing improved access to care and reducing the social determinants of disparity is crucial to improving public health. At the same time, for providers, increasing an understanding of the social determinants promotes better models of individualized care to encourage more equitable care. These approaches include increasing provider education on disparities encountered by different populations, practicing active listening skills, and utilizing a patient's cultural background to promote healthy behaviors.

  11. Review: Increasing Awareness and Education on Health Disparities for Health Care Providers

    PubMed Central

    Nesbitt, Shawna; Palomarez, Rigo Estevan

    2016-01-01

    The focus of this review is to highlight health care disparities and trends in several common diseases in selected populations while offering evidence-based approaches to mitigating health care disparities. Health care disparities cross many barriers and affect multiple populations and diseases. Ethnic minorities, the elderly, and those of lower socioeconomic status (SES) are more at-risk than others. However, many low SES Whites and higher SES racial minorities have poorer health than their racial or SES peers. Also, recent immigrant groups and Hispanics, in particular, maintain high health ratings. The so-called Hispanic Paradox provides an example of how culture and social background can be used to improve health outcomes. These groups have unique determinants of disparity that are based on a wide range of cultural and societal factors. Providing improved access to care and reducing the social determinants of disparity is crucial to improving public health. At the same time, for providers, increasing an understanding of the social determinants promotes better models of individualized care to encourage more equitable care. These approaches include increasing provider education on disparities encountered by different populations, practicing active listening skills, and utilizing a patient’s cultural background to promote healthy behaviors PMID:27103768

  12. 75 FR 71449 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-23

    ... HUMAN SERVICES National Institutes of Health National Center on Minority and Health Disparities; Notice... personal privacy. Name of Committee: National Center on Minority Health and Health Disparities Special...: Maryline Laude-Sharp, PhD, Scientific Review Officer, National Institute on Minority Health and...

  13. Tobacco-Related Health Disparities Across the Cancer Care Continuum.

    PubMed

    Simmons, Vani Nath; Pineiro, Barbara; Hooper, Monica Webb; Gray, Jhanelle E; Brandon, Thomas H

    2016-10-01

    Use of tobacco is the leading preventable cause of death in the United States. Racial/ethnic minorities and individuals of low socioeconomic status disproportionately experience tobacco-related disease and illness. Unique challenges and circumstances exist at each point in the cancer care continuum that may contribute to the greater cancer burden experienced by these groups. We reviewed tobacco-related disparities from cancer prevention to cancer survivorship. We also describe research that seeks to reduce tobacco-related disparities. Racial/ethnic minorities and low-income individuals experience unique social and environmental contextual challenges such as greater environmental cues to smoke and greater levels of perceived stress and social discrimination. Clinical practice guidelines support the effectiveness of pharmacotherapy and behavioral counseling for racial and ethnic minorities, yet smoking cessation rates are lower in this group when compared with non-Hispanic whites. Superior efficacy for culturally adapted interventions has not yet been established. To reduce health disparities in this population, a comprehensive strategy is needed with efforts directed at each point along the cancer care continuum. Strategies are needed to reduce the impact of contextual factors such as targeted tobacco marketing and social discrimination on smoking initiation and maintenance. Future efforts should focus on increasing the use of evidence-based cessation treatment methods and studying its effectiveness in these populations. Attention must also be focused on improving treatment outcomes by reducing smoking in diverse racial and ethnic patient populations.

  14. Health disparities in endocrine disorders: biological, clinical, and nonclinical factors--an Endocrine Society scientific statement.

    PubMed

    Golden, Sherita Hill; Brown, Arleen; Cauley, Jane A; Chin, Marshall H; Gary-Webb, Tiffany L; Kim, Catherine; Sosa, Julie Ann; Sumner, Anne E; Anton, Blair

    2012-09-01

    Outreach Core Committee; and 2) suggestions offered by the Council and members of The Endocrine Society. Several themes emerged in the statement, including a need for basic science, population-based, translational and health services studies to explore underlying mechanisms contributing to endocrine health disparities. Compared to non-Hispanic whites, non-Hispanic blacks have worse outcomes and higher mortality from certain disorders despite having a lower (e.g. macrovascular complications of diabetes mellitus and osteoporotic fractures) or similar (e.g. thyroid cancer) incidence of these disorders. Obesity is an important contributor to diabetes risk in minority populations and to sex disparities in thyroid cancer, suggesting that population interventions targeting weight loss may favorably impact a number of endocrine disorders. There are important implications regarding the definition of obesity in different race/ethnic groups, including potential underestimation of disease risk in Asian-Americans and overestimation in non-Hispanic black women. Ethnic-specific cut-points for central obesity should be determined so that clinicians can adequately assess metabolic risk. There is little evidence that genetic differences contribute significantly to race/ethnic disparities in the endocrine disorders examined. Multilevel interventions have reduced disparities in diabetes care, and these successes can be modeled to design similar interventions for other endocrine diseases.

  15. Health Disparities in Endocrine Disorders: Biological, Clinical, and Nonclinical Factors—An Endocrine Society Scientific Statement

    PubMed Central

    Brown, Arleen; Cauley, Jane A.; Chin, Marshall H.; Gary-Webb, Tiffany L.; Kim, Catherine; Sosa, Julie Ann; Sumner, Anne E.; Anton, Blair

    2012-01-01

    Advocacy and Public Outreach Core Committee; and 2) suggestions offered by the Council and members of The Endocrine Society. Conclusions: Several themes emerged in the statement, including a need for basic science, population-based, translational and health services studies to explore underlying mechanisms contributing to endocrine health disparities. Compared to non-Hispanic whites, non-Hispanic blacks have worse outcomes and higher mortality from certain disorders despite having a lower (e.g. macrovascular complications of diabetes mellitus and osteoporotic fractures) or similar (e.g. thyroid cancer) incidence of these disorders. Obesity is an important contributor to diabetes risk in minority populations and to sex disparities in thyroid cancer, suggesting that population interventions targeting weight loss may favorably impact a number of endocrine disorders. There are important implications regarding the definition of obesity in different race/ethnic groups, including potential underestimation of disease risk in Asian-Americans and overestimation in non-Hispanic black women. Ethnic-specific cut-points for central obesity should be determined so that clinicians can adequately assess metabolic risk. There is little evidence that genetic differences contribute significantly to race/ethnic disparities in the endocrine disorders examined. Multilevel interventions have reduced disparities in diabetes care, and these successes can be modeled to design similar interventions for other endocrine diseases. PMID:22730516

  16. Community-Driven Research Agenda to Reduce Health Disparities.

    PubMed

    McElfish, Pearl A; Kohler, Peter; Smith, Chris; Warmack, Scott; Buron, Bill; Hudson, Jonell; Bridges, Melissa; Purvis, Rachel; Rubon-Chutaro, Jellesen

    2015-12-01

    This paper describes how a new regional campus of an academic health center engaged in a community-based participatory research (CBPR) process to set a community-driven research agenda to address health disparities. The campus is situated among growing Marshallese and Hispanic populations that face significant health disparities. In 2013, with support from the Translational Research Institute, the University of Arkansas for Medical Sciences Northwest began building its research capacity in the region with the goal of developing a community-driven research agenda for the campus. While many researchers engage in some form of community-engaged research, using a CBPR process to set the research agenda for an entire campus is unique. Utilizing multiple levels of engagement, three research areas were chosen by the community: (1) chronic disease management and prevention; (2) obesity and physical activity; and (3) access to culturally appropriate healthcare. In only 18 months, the CBPR collaboration had dramatic results. Ten grants and five scholarly articles were collaboratively written and 25 community publications and presentations were disseminated. Nine research projects and health programs were initiated. In addition, many interprofessional educational and service learning objectives were aligned with the community-driven agenda resulting in practical action to address the needs identified. © 2015 Wiley Periodicals, Inc.

  17. Racial disparities in the cognition-health relationship.

    PubMed

    Thompson, Owen

    2011-03-01

    This paper investigates how the association between cognitive achievement and self-rated health in middle age differs by race, and attempts to explain these differences. The role of cognition in health determination has received only limited empirical attention, and even less is known about how race may affect this relationship. Using data from the NLSY, I find that while Whites with higher cognitive achievement scores tend to report substantially better general health, this relationship is far weaker or wholly absent among Blacks. Further tests suggest that about 35% of this racial difference can be explained by behavioral decisions during adulthood, and that another portion of the disparity may trace back to prenatal and early childhood experiences. The paper closes by noting that its results are broadly consistent with explanations of the racial health gap that emphasize entrenched forms of racial discrimination. Copyright © 2011 Elsevier B.V. All rights reserved.

  18. Quality improvement implementation and disparities: the case of the health disparities collaboratives.

    PubMed

    Chin, Marshall H

    2010-08-01

    The Health Disparities Collaboratives (HDCs), a quality improvement (QI) collaborative incorporating rapid QI, a chronic care model, and learning sessions, have been implemented in over 900 community health centers across the country. To determine the HDC's effect on clinical processes and outcomes, their financial impact, and factors important for successful implementation. Systematic review of the literature. The HDCs improve clinical processes of care over short-term period of 1 to 2 years, and clinical processes and outcomes over longer period of 2 to 4 years. Most participants perceive that the HDCs are successful and worth the effort. Analysis of the Diabetes Collaborative reveals that it is societally cost-effective, with an incremental cost-effectiveness ratio of $33,386 per quality-adjusted life year, but that consistent revenue streams for the initiative do not exist. Common barriers to improvement include lack of resources, time, and staff burnout. Highest ranked priorities for more funding are money for direct patient services, data entry, and staff time for QI. Other common requests for more assistance are help with patient self-management, information systems, and getting providers to follow guidelines. Relatively low-cost ways to increase staff morale and prevent burnout include personal recognition, skills development opportunities, and fair distribution of work. The HDCs have successfully improved quality of care, and the Diabetes Collaborative is societally cost-effective, but policy reforms are necessary to create a sustainable business case for these health centers that serve many uninsured and underinsured populations.

  19. Quality improvement implementation and disparities: the case of the health disparities collaboratives.

    PubMed

    Chin, Marshall H

    2011-12-01

    The Health Disparities Collaboratives (HDCs), a quality improvement (QI) collaborative incorporating rapid QI, a chronic care model, and learning sessions, have been implemented in over 900 community health centers across the country. To determine the HDC's effect on clinical processes and outcomes, their financial impact, and factors important for successful implementation. Systematic review of the literature. The HDCs improve clinical processes of care over short-term period of 1 to 2 years, and clinical processes and outcomes over longer period of 2 to 4 years. Most participants perceive that the HDCs are successful and worth the effort. Analysis of the Diabetes Collaborative reveals that it is societally cost-effective, with an incremental cost-effectiveness ratio of $33,386 per quality-adjusted life year, but that consistent revenue streams for the initiative do not exist. Common barriers to improvement include lack of resources, time, and staff burnout. Highest ranked priorities for more funding are money for direct patient services, data entry, and staff time for QI. Other common requests for more assistance are help with patient self-management, information systems, and getting providers to follow guidelines. Relatively low-cost ways to increase staff morale and prevent burnout include personal recognition, skills development opportunities, and fair distribution of work. The HDCs have successfully improved quality of care, and the Diabetes Collaborative is societally cost-effective, but policy reforms are necessary to create a sustainable business case for these health centers that serve many uninsured and underinsured populations.

  20. Increasing racial/ethnic diversity in nursing to reduce health disparities and achieve health equity.

    PubMed

    Phillips, Janice M; Malone, Beverly

    2014-01-01

    As nursing continues to advance health care in the 21st century, the current shift in demographics, coupled with the ongoing disparities in health care and health outcomes, will warrant our ongoing attention and action. As within all health professions, concerted efforts are needed to diversify the nation's health-care workforce. The nursing profession in particular will be challenged to recruit and retain a culturally diverse workforce that mirrors the nation's change in demographics. This increased need to enhance diversity in nursing is not new to the profession; however, the need to successfully address this issue has never been greater. This article discusses increasing the diversity in nursing and its importance in reducing health disparities. We highlight characteristics of successful recruitment and retention efforts targeting racial/ethnic minority nurses and conclude with recommendations to strengthen the development and evaluation of their contributions to eliminating health disparities.

  1. Increasing Racial/Ethnic Diversity in Nursing to Reduce Health Disparities and Achieve Health Equity

    PubMed Central

    Malone, Beverly

    2014-01-01

    As nursing continues to advance health care in the 21st century, the current shift in demographics, coupled with the ongoing disparities in health care and health outcomes, will warrant our ongoing attention and action. As within all health professions, concerted efforts are needed to diversify the nation's health-care workforce. The nursing profession in particular will be challenged to recruit and retain a culturally diverse workforce that mirrors the nation's change in demographics. This increased need to enhance diversity in nursing is not new to the profession; however, the need to successfully address this issue has never been greater. This article discusses increasing the diversity in nursing and its importance in reducing health disparities. We highlight characteristics of successful recruitment and retention efforts targeting racial/ethnic minority nurses and conclude with recommendations to strengthen the development and evaluation of their contributions to eliminating health disparities. PMID:24385664

  2. AJE invited commentary: Measuring social disparities in health - what was the question again?

    EPA Science Inventory

    Monitoring social disparities in health is not a straightforward project. Defining what constitutes a disparity is challenging, and multiple measures have been proposed to track changes in disparity over time. In this issue, Harper et al. (Am J Epidemiol 2008;167:889-899) present...

  3. AJE invited commentary: Measuring social disparities in health - what was the question again?

    EPA Science Inventory

    Monitoring social disparities in health is not a straightforward project. Defining what constitutes a disparity is challenging, and multiple measures have been proposed to track changes in disparity over time. In this issue, Harper et al. (Am J Epidemiol 2008;167:889-899) present...

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

    PubMed

    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.

  5. 76 FR 40384 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-08

    ... HUMAN SERVICES National Institutes of Health National Center on Minority and Health Disparities; Notice... personal privacy. Name of Committee: National Center on Minority Health and Health Disparities Special.... Contact Person: Robert Nettey, M.D., Chief, Scientific Review Officer, National Institute on...

  6. The Health Effects of Income Inequality: Averages and Disparities.

    PubMed

    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.

  7. Lessons Learned from Mississippi's Telehealth Approach to Health Disparities.

    PubMed

    deShazo, Richard D; Parker, Sara Bolen

    2017-04-01

    Many people see telemedicine as a solution to the nation's health disparities and in Mississippi as a solution to our last place in health. More than 13 years ago, the University of Mississippi Medical Center developed a successful TelEmergency program that saved rural Critical Access Hospitals and now provides telehealth services throughout the state. This occurred without acrimony because of partnerships that the University of Mississippi Medical Center developed with telecommunications companies, state government, health professions' licensure boards, and private donors. Today, the telemedicine market is exploding across the country with the entry of for-profit corporations into the medical market. These corporations often are more inclined to work with legislators rather than physicians, and some physician groups have attempted to limit their expansion. With the future of telemedicine now determined in part by the courts, rather than the providers, new pitfalls have arisen. The Mississippi experience may be helpful in navigating this new territory.

  8. Global disparities in health and human rights: a critical commentary.

    PubMed

    Benatar, S R

    1998-02-01

    Widening disparities in health and human rights at a global level represent the dark side of progress associated with escalation of economic and military exploitation and exponential population growth in the 20th century. Even the most basic universal human rights cannot be achieved for all under these circumstances. The goal of improved population health will be similarly elusive while medical care is commodified and exploited for commercial gain in the marketplace. Recognition of the powerful forces that polarize our world and commitment to reversing them are essential for the achievement of human rights for all, for the improvement of public health, and for the peaceful progress required to protect the "rational self-interest" of the most privileged people on earth against the escalation of war, disease, and other destructive forces arising from widespread poverty and ecological degradation.

  9. Global disparities in health and human rights: a critical commentary.

    PubMed Central

    Benatar, S R

    1998-01-01

    Widening disparities in health and human rights at a global level represent the dark side of progress associated with escalation of economic and military exploitation and exponential population growth in the 20th century. Even the most basic universal human rights cannot be achieved for all under these circumstances. The goal of improved population health will be similarly elusive while medical care is commodified and exploited for commercial gain in the marketplace. Recognition of the powerful forces that polarize our world and commitment to reversing them are essential for the achievement of human rights for all, for the improvement of public health, and for the peaceful progress required to protect the "rational self-interest" of the most privileged people on earth against the escalation of war, disease, and other destructive forces arising from widespread poverty and ecological degradation. PMID:9491027

  10. Multilevel survival analysis of health inequalities in life expectancy.

    PubMed

    Yang, Min; Eldridge, Sandra; Merlo, Juan

    2009-08-23

    The health status of individuals is determined by multiple factors operating at both micro and macro levels and the interactive effects of them. Measures of health inequalities should reflect such determinants explicitly through sources of levels and combining mean differences at group levels and the variation of individuals, for the benefits of decision making and intervention planning. Measures derived recently from marginal models such as beta-binomial and frailty survival, address this issue to some extent, but are limited in handling data with complex structures. Beta-binomial models were also limited in relation to measuring inequalities of life expectancy (LE) directly. We propose a multilevel survival model analysis that estimates life expectancy based on survival time with censored data. The model explicitly disentangles total health inequalities in terms of variance components of life expectancy compared to the source of variation at the level of individuals in households and parishes and so on, and estimates group differences of inequalities at the same time. Adjusted distributions of life expectancy by gender and by household socioeconomic level are calculated. Relative and absolute health inequality indices are derived based on model estimates. The model based analysis is illustrated on a large Swedish cohort of 22,680 men and 26,474 women aged 6569 in 1970 and followed up for 30 years. Model based inequality measures are compared to the conventional calculations. Much variation of life expectancy is observed at individual and household levels. Contextual effects at Parish and Municipality level are negligible. Women have longer life expectancy than men and lower inequality. There is marked inequality by the level of household socioeconomic status measured by the median life expectancy in each socio-economic group and the variation in life expectancy within each group. Multilevel survival models are flexible and efficient tools in studying health

  11. 76 FR 11499 - National Center on Minority and Health Disparities; Notice of Closed Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-02

    ... evaluate grant applications. Place: National Institutes of Health, Two Democracy Plaza, 6707 Democracy... Review Officer, National Institute on Minority Health and Health Disparities, 6707 Democracy Boulevard... Institutes of Health, 6706 Democracy Boulevard, Bethesda, MD 20892, (Virtual Meeting) Contact Person...

  12. A multilevel model of organizational health culture and the effectiveness of health promotion.

    PubMed

    Lin, Yea-Wen; Lin, Yueh-Ysen

    2014-01-01

    Organizational health culture is a health-oriented core characteristic of the organization that is shared by all members. It is effective in regulating health-related behavior for employees and could therefore influence the effectiveness of health promotion efforts among organizations and employees. This study applied a multilevel analysis to verify the effects of organizational health culture on the organizational and individual effectiveness of health promotion. At the organizational level, we investigated the effect of organizational health culture on the organizational effectiveness of health promotion. At the individual level, we adopted a cross-level analysis to determine if organizational health culture affects employee effectiveness through the mediating effect of employee health behavior. The study setting consisted of the workplaces of various enterprises. We selected 54 enterprises in Taiwan and surveyed 20 full-time employees from each organization, for a total sample of 1011 employees. We developed the Organizational Health Culture Scale to measure employee perceptions and aggregated the individual data to formulate organization-level data. Organizational effectiveness of health promotion included four dimensions: planning effectiveness, production, outcome, and quality, which were measured by scale or objective indicators. The Health Promotion Lifestyle Scale was adopted for the measurement of health behavior. Employee effectiveness was measured subjectively in three dimensions: self-evaluated performance, altruism, and happiness. Following the calculation of descriptive statistics, hierarchical linear modeling (HLM) was used to test the multilevel hypotheses. Organizational health culture had a significant effect on the planning effectiveness (β = .356, p < .05) and production (β = .359, p < .05) of health promotion. In addition, results of cross-level moderating effect analysis by HLM demonstrated that the effects of organizational health culture

  13. Facilitators, Challenges, and Collaborative Activities in Faith and Health Partnerships to Address Health Disparities

    ERIC Educational Resources Information Center

    Kegler, Michelle C.; Hall, Sarah M.; Kiser, Mimi

    2010-01-01

    Interest in partnering with faith-based organizations (FBOs) to address health disparities has grown in recent years. Yet relatively little is known about these types of partnerships. As part of an evaluation of the Institute for Faith and Public Health Collaborations, representatives of 34 faith--health teams (n = 61) completed semi-structured…

  14. Overcoming health care disparities via better cross-cultural communication and health literacy.

    PubMed

    Misra-Hebert, Anita D; Isaacson, J Harry

    2012-02-01

    Health care disparities have multiple causes; the dynamics of the physician-patient encounter is one of the causes that can be modified. Here, we discuss specific recommendations related to cross-cultural communication and health literacy as practical steps to providing more equitable health care to all patients.

  15. The Office of Minority Health Resource Center: Impacting on Health Related Disparities among Minority Populations.

    ERIC Educational Resources Information Center

    Payne, Karen W.; Ugarte, Carlos A.

    1989-01-01

    Describes the Office of Minority Health Resource Center, designed to disseminate minority health-related information and increase public awareness of the gravity and magnitude of the health disparity that persists between minority and nonminority populations. Technical support, assistance, and information referral services are provided to…

  16. Health literacy explains racial disparities in diabetes medication adherence.

    PubMed

    Osborn, Chandra Y; Cavanaugh, Kerri; Wallston, Kenneth A; Kripalani, Sunil; Elasy, Tom A; Rothman, Russell L; White, Richard O

    2011-01-01

    Although low health literacy and suboptimal medication adherence are more prevalent in racial/ethnic minority groups than Whites, little is known about the relationship between these factors in adults with diabetes, and whether health literacy or numeracy might explain racial/ethnic disparities in diabetes medication adherence. Previous work in HIV suggests health literacy mediates racial differences in adherence to antiretroviral treatment, but no study to date has explored numeracy as a mediator of the relationship between race/ethnicity and medication adherence. This study tested whether health literacy and/or numeracy were related to diabetes medication adherence, and whether either factor explained racial differences in adherence. Using path analytic models, we explored the predicted pathways between racial status, health literacy, diabetes-related numeracy, general numeracy, and adherence to diabetes medications. After adjustment for covariates, African American race was associated with poor medication adherence (r = -0.10, p < .05). Health literacy was associated with adherence (r = .12, p < .02), but diabetes-related numeracy and general numeracy were not related to adherence. Furthermore, health literacy reduced the effect of race on adherence to nonsignificance, such that African American race was no longer directly associated with lower medication adherence (r = -0.09, p = .14). Diabetes medication adherence promotion interventions should address patient health literacy limitations.

  17. Health Literacy Explains Racial Disparities in Diabetes Medication Adherence

    PubMed Central

    Osborn, Chandra Y.; Cavanaugh, Kerri; Wallston, Kenneth A.; Kripalani, Sunil; White, Richard O.; Elasy, Tom A.; Rothman, Russell L.

    2013-01-01

    While low health literacy and suboptimal medication adherence are more prevalent in racial/ethnic minority groups than Whites, little is known about the relationship between these factors in adults with diabetes, and whether health literacy or numeracy might explain racial/ethnic disparities in diabetes medication adherence. Previous work in HIV suggests health literacy mediates racial differences in adherence to anti-retroviral treatment, but no study to date has explored numeracy as a mediator of the relationship between race/ethnicity and medication adherence. This study tested whether health literacy and/or numeracy were related to diabetes medication adherence, and whether either factor explained racial differences in adherence. Using path analytic models, we explored the predicted pathways between racial status, health literacy, diabetes-related numeracy, general numeracy and adherence to diabetes medications. After adjustment for covariates, African American race was associated with poor medication adherence (r=−0.10, p<0.05). Health literacy was associated with adherence (r=.12, p<0.02), but diabetes-related numeracy and general numeracy were not related to adherence. Furthermore, health literacy reduced the effect of race on adherence to non-significance, such that African American race was no longer directly associated with less medication adherence (r=−0.09, p=.14). Diabetes medication adherence promotion interventions should address patient health literacy limitations. PMID:21951257

  18. Biomarkers of Psychological Stress in Health Disparities Research

    PubMed Central

    Djuric, Zora; Bird, Chloe E.; Furumoto-Dawson, Alice; Rauscher, Garth H.; Ruffin, Mack T.; Stowe, Raymond P.; Tucker, Katherine L.; Masi, Christopher M.

    2009-01-01

    Psychological stress can contribute to health disparities in populations that are confronted with the recurring stress of everyday life. A number of biomarkers have been shown to be affected by psychological stress. These biomarkers include allostatic load, which is a summary measure of the cumulative biological burden of the repeated attempts to adapt to daily stress. Allostatic load includes effects on the hypothalamic-pituitary axis, the sympathetic nervous system and the cardiovascular system. These in turn affect the immune system via bidirectional signaling pathways. Evidence is also building that psychological stress, perhaps via heightened inflammatory states, can increase oxidative stress levels and DNA damage. The inter-relationships of ethnicity, genotype, gene expression and ability to adequately mitigate stress response are just starting to be appreciated. The need to conduct these studies in disadvantaged populations is clear and requires methods to address potential logistical barriers. Biomarkers can help characterize and quantify the biological impact of psychological stress on the etiology of health disparities. PMID:20305736

  19. Sexual orientation disparities in physical health: age and gender effects in a population-based study.

    PubMed

    Bränström, Richard; Hatzenbuehler, Mark L; Pachankis, John E

    2016-02-01

    Recent studies have identified substantial health disparities between lesbian, gay, and bisexual (LGB) individuals compared to heterosexuals. However, possible variation in sexual orientation health disparities by age and according to gender remains largely unexplored. To examine physical health disparities between LGB and heterosexual individuals in a general population sample in Sweden, to explore potential age and gender differences in these disparities, and to test potential mechanisms underlying any observed disparities. Between 2008 and 2013, 60,922 individuals (16-84 years of age) responded to nationwide population-based health surveys. In the sample, 430 (0.7%) individuals self-identified as gay/lesbian and 757 (1.3%) self-identified as bisexual. Logistic and negative binomial regression analyses were used to explore health disparities based on sexual orientation. Overall, LGB individuals were more likely to report worse self-rated health as well as more physical health symptoms (e.g., pain, insomnia, dermatitis, tinnitus, intestinal problems) and conditions (e.g., diabetes, asthma, high blood pressure) compared to heterosexuals. However, these physical health disparities differed by age. Disparities were largest among adolescents and young adults and generally smallest in older age groups. Health behaviors and elevated reports of exposure to perceived discrimination, victimization, and threats of violence among sexual minorities partially explained the sexual orientation disparities in physical health. Age emerged as an important effect modifier of physical health disparities based on sexual orientation. Gender-specific findings suggest that sexual orientation disparities persist into adulthood for women but are gradually attenuated for older age groups; in contrast, for men, these disparities disappear starting with young adults. These results support a developmental model of minority stress and physical health among LGB individuals.

  20. Lesbian, gay, bisexual, and transgender health issues, disparities, and information resources.

    PubMed

    McKay, Becky

    2011-01-01

    Lesbian, gay, bisexual, and transgender (LGBT) persons, while widely diverse in many ways, share health disparities related to the stigma and discrimination they experience, including disproportionate rates of psychiatric disorders, substance abuse, and suicide. Lesbians, gay men, bisexuals, and the transgender communities have additional health concerns and disparities unique to each population. This paper highlights the national recognition of these health issues and disparities and presents web-based information resources about them and their mitigation.

  1. Understanding health literacy for strategic health marketing: eHealth literacy, health disparities, and the digital divide.

    PubMed

    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.

  2. Can States Simultaneously Improve Health Outcomes and Reduce Health Outcome Disparities?

    PubMed

    Kindig, David; Lardinois, Nicholas; Chatterjee, Debanjana

    2016-08-25

    Reducing racial health disparities is often stated as a population health goal, but specific targets for such improvement are seldom set. It is often assumed that improving overall health outcomes will be linked to disparity reduction, but this is not necessarily the case. We compared the annual change from 1999 through 2013 in combined-race (black and white) mortality with the annual change in absolute and relative racial mortality disparities for US states. Median annual improvement in combined-race mortality was 1.08% per year. Annual overall mortality rate reductions ranged from 0.24% per year in Oklahoma to 1.83% per year in Maryland. For disparities, the median for the black-white absolute gap was 3.60% per year, and the median for the relative black-to-white ratio was 1.19% per year. There was no significant correlation between the combined-race measure and either the absolute (0.03) or relative disparity measure reductions (-0.17). For mortality in US states over a recent period, improvement in the population mean and disparity reduction do not usually occur together. The disparity reduction rates observed may provide realistic guidance for public and private policy makers in setting goals for reducing population health disparity and creating investment priorities. As a starting point for discussion, the observed national median annual percentage improvement of 1.1 per year combined, 3.6% per year absolute gap reduction, and 1.2% per year relative gap reduction would be modest and reasonable goals.

  3. National Institute on Minority Health and Health Disparities

    MedlinePlus

    ... both baby and mom. More Minorities and Mental Health: Moving Beyond the Stigma Mental illness is one ... devastating effects on daily functioning. More Improving the Health Status of African American Males While the health ...

  4. Bad Jobs, Bad Health? How Work and Working Conditions Contribute to Health Disparities.

    PubMed

    Burgard, Sarah A; Lin, Katherine Y

    2013-08-01

    In this review, we touch on a broad array of ways that work is linked to health and health disparities for individuals and societies. First focusing on the health of individuals, we discuss the health differences between those who do and do not work for pay, and review key positive and negative exposures that can generate health disparities among the employed. These include both psychosocial factors like the benefits of a high status job or the burden of perceived job insecurity, as well as physical exposures to dangerous working conditions like asbestos or rotating shift work. We also provide a discussion of the ways differential exposure to these aspects of work contributes to social disparities in health within and across generations. Analytic complexities in assessing the link between work and health for individuals, such as health selection, are also discussed. We then touch on several contextual level associations between work and the health of populations, discussing the importance of the occupational structure in a given society, the policy environment that prevails there, and the oscillations of the macroeconomy for generating societal disparities in health. We close with a discussion of four areas and associated recommendations that draw on this corpus of knowledge but would push the research on work, health and inequality toward even greater scholarly and policy relevance.

  5. Bad Jobs, Bad Health? How Work and Working Conditions Contribute to Health Disparities

    PubMed Central

    Burgard, Sarah A.; Lin, Katherine Y.

    2013-01-01

    In this review, we touch on a broad array of ways that work is linked to health and health disparities for individuals and societies. First focusing on the health of individuals, we discuss the health differences between those who do and do not work for pay, and review key positive and negative exposures that can generate health disparities among the employed. These include both psychosocial factors like the benefits of a high status job or the burden of perceived job insecurity, as well as physical exposures to dangerous working conditions like asbestos or rotating shift work. We also provide a discussion of the ways differential exposure to these aspects of work contributes to social disparities in health within and across generations. Analytic complexities in assessing the link between work and health for individuals, such as health selection, are also discussed. We then touch on several contextual level associations between work and the health of populations, discussing the importance of the occupational structure in a given society, the policy environment that prevails there, and the oscillations of the macroeconomy for generating societal disparities in health. We close with a discussion of four areas and associated recommendations that draw on this corpus of knowledge but would push the research on work, health and inequality toward even greater scholarly and policy relevance. PMID:24187340

  6. Long-Term Development of a “Whole Community” Best Practice Model to Address Health Disparities in the Cambodian Refugee and Immigrant Community of Lowell, Massachusetts

    PubMed Central

    Toof, Robin; Silka, Linda; Liang, Sidney; Sou, Linda; Najarian, Lisa; Peou, Sonith; Och, Sheila

    2010-01-01

    Cambodians in Lowell, Massachusetts, experience significant health disparities. Understanding the trauma they have experienced in Cambodia and as refugees has been the starting point for Lowell Community Health Center's whole community approach to developing community-based interventions. This approach places physical-psychosocial-spiritual needs at the center of focus and is attentive to individual and institutional barriers to care. Interventions are multilevel. The effect of the overall program comes from the results of each smaller program, the collaborations and coordination with the Cambodian community and community-based organizations, and the range and levels of services available through the health center. PMID:20864723

  7. A media advocacy intervention linking health disparities and food insecurity

    PubMed Central

    Rock, Melanie J.; McIntyre, Lynn; Persaud, Steven A.; Thomas, Karen L.

    2011-01-01

    Media advocacy is a well-established strategy for transmitting health messages to the public. This paper discusses a media advocacy intervention that raised issues about how the public interprets messages about the negative effects of poverty on population health. In conjunction with the publication of a manuscript illustrating how income-related food insecurity leads to disparities related to the consumption of a popular food product across Canada (namely, Kraft Dinner®), we launched a media intervention intended to appeal to radio, television, print and Internet journalists. All the media coverage conveyed our intended message that food insecurity is a serious population health problem, confirming that message framing, personal narratives and visual imagery are important in persuading media outlets to carry stories about poverty as a determinant of population health. Among politicians and members of the public (through on-line discussions), the coverage provoked on-message as well as off-message reactions. Population health researchers and health promotion practitioners should anticipate mixed reactions to media advocacy interventions, particularly in light of new Internet technologies. Opposition to media stories regarding the socio-economic determinants of population health can provide new insights into how we might overcome challenges in translating evidence into preventive interventions. PMID:21685402

  8. A media advocacy intervention linking health disparities and food insecurity.

    PubMed

    Rock, Melanie J; McIntyre, Lynn; Persaud, Steven A; Thomas, Karen L

    2011-12-01

    Media advocacy is a well-established strategy for transmitting health messages to the public. This paper discusses a media advocacy intervention that raised issues about how the public interprets messages about the negative effects of poverty on population health. In conjunction with the publication of a manuscript illustrating how income-related food insecurity leads to disparities related to the consumption of a popular food product across Canada (namely, Kraft Dinner®), we launched a media intervention intended to appeal to radio, television, print and Internet journalists. All the media coverage conveyed our intended message that food insecurity is a serious population health problem, confirming that message framing, personal narratives and visual imagery are important in persuading media outlets to carry stories about poverty as a determinant of population health. Among politicians and members of the public (through on-line discussions), the coverage provoked on-message as well as off-message reactions. Population health researchers and health promotion practitioners should anticipate mixed reactions to media advocacy interventions, particularly in light of new Internet technologies. Opposition to media stories regarding the socio-economic determinants of population health can provide new insights into how we might overcome challenges in translating evidence into preventive interventions.

  9. Quality Improvement Implementation and Disparities: The Case of the Health Disparities Collaboratives

    PubMed Central

    Chin, Marshall H.

    2011-01-01

    Background The Health Disparities Collaboratives (HDC), a quality improvement collaborative incorporating rapid quality improvement (QI), a chronic care model, and learning sessions, have been implemented in over 900 community health centers across the country. Objectives To determine the HDC’s effect on clinical processes and outcomes, their financial impact, and factors important for successful implementation. Research Design Systematic review of the literature. Results The HDC improve clinical processes of care over short-term 1–2 year periods, and clinical processes and outcomes over longer 2–4 year periods. Most participants perceive that the HDC are successful and worth the effort. Analysis of the Diabetes Collaborative reveals that it is societally cost-effective with an incremental cost-effectiveness ratio of $33,386/quality-adjusted life year (QALY), but that consistent revenue streams for the initiative do not exist. Common barriers to improvement include lack of resources, time, and staff burnout. Highest ranked priorities for more funding are money for direct patient services, data entry, and staff time for QI. Other common requests for more assistance are help with patient self-management, information systems, and getting providers to follow guidelines. Relatively low-cost ways to increase staff morale and prevent burnout include personal recognition, skills development opportunities, and fair distribution of work. Conclusions The HDC have successfully improved quality of care and the Diabetes Collaborative is societally cost-effective, but policy reforms are necessary to create a sustainable business case for these health centers that serve many uninsured and underinsured populations. PMID:20613665

  10. Message Design Strategies to Raise Public Awareness of Social Determinants of Health and Population Health Disparities

    PubMed Central

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

    2008-01-01

    Context Raising public awareness of the importance of social determinants of health (SDH) and health disparities presents formidable communication challenges. Methods This article reviews three message strategies that could be used to raise awareness of SDH and health disparities: message framing, narratives, and visual imagery. Findings 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. Conclusions 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. PMID:18798887

  11. Implementing the Institute of Medicine definition of disparities: an application to mental health care.

    PubMed

    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.

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

    PubMed

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

    2017-08-28

    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.

  13. Applying Anthropology to Eliminate Tobacco-Related Health Disparities

    PubMed Central

    Burgess, Diana; Olayinka, Abimbola; Whembolua, Guy Lucien S.; Okuyemi, Kolawole S.

    2012-01-01

    Introduction: 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. Methods: 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? Results: 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. Conclusions: 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. PMID:22271609

  14. Identifying Health Consumers' eHealth Literacy to Decrease Disparities in Accessing eHealth Information.

    PubMed

    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.

  15. 76 FR 21748 - Health Disparities Subcommittee (HDS), Advisory Committee to the Director, Centers for Disease...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-18

    ... update including the CDC Health Disparities and Inequalities Report, U.S. 2011; the National Prevention... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Health Disparities Subcommittee (HDS...

  16. Disparities in the Geography of Mental Health: Implications for Social Work

    ERIC Educational Resources Information Center

    Hudson, Christopher G.

    2012-01-01

    This article reviews recent theory and research on geographic disparities in mental health and their implications for social work. It focuses on work emerging from the fields of mental health geography, psychiatric epidemiology, and social work, arguing that a wide range of spatial disparities in mental health are important to understand but that…

  17. Disparities in the Geography of Mental Health: Implications for Social Work

    ERIC Educational Resources Information Center

    Hudson, Christopher G.

    2012-01-01

    This article reviews recent theory and research on geographic disparities in mental health and their implications for social work. It focuses on work emerging from the fields of mental health geography, psychiatric epidemiology, and social work, arguing that a wide range of spatial disparities in mental health are important to understand but that…

  18. Health Care Disparities in the Post–Affordable Care Act Era

    PubMed Central

    Preston, Michael A.; Gonzales, Gilbert

    2015-01-01

    Disparities in health care have been targeted for elimination by federal agencies and professional organizations, including the American Public Health Association. Although the Affordable Care Act (ACA) provides a valuable first step in reducing the disparities gap, progress is contingent upon whether opportunities in the ACA help or hinder populations at risk for impaired health and limited access to medical care. PMID:25879149

  19. Disparities and Chronic Health Care Needs for Elderly American Indians Living on or Near a Reservation

    ERIC Educational Resources Information Center

    Wright, Kynna N.

    2009-01-01

    The American Indian tribal nations and communities have long experienced health status worse than that of other Americans. Although major gains in reducing health disparities were made during the last half of the 20th century, most gains stopped by the mid-1980s. Consequently, health disparities continue to exist with marked variation across…

  20. Disparities and Chronic Health Care Needs for Elderly American Indians Living on or Near a Reservation

    ERIC Educational Resources Information Center

    Wright, Kynna N.

    2009-01-01

    The American Indian tribal nations and communities have long experienced health status worse than that of other Americans. Although major gains in reducing health disparities were made during the last half of the 20th century, most gains stopped by the mid-1980s. Consequently, health disparities continue to exist with marked variation across…

  1. American health improvement depends upon addressing class disparities.

    PubMed

    Schroeder, Steven A

    2016-11-01

    The gap in health status between the United States and other (OECD) developed countries not only persists but has widened over the past decade. This has occurred despite major declines in smoking prevalence. But as with other health problems, such as obesity, gun violence, and teenage pregnancy, progress against smoking has disproportionately benefitted the better off segments of the American population. Thus smoking, as well as other problems, is now concentrated among the vulnerable members of our society: the poor and less educated, as well as disadvantaged groups such as those with mental illness and substance use disorders, the homeless, those who are incarcerated, and the LGBT community. Although this is a national issue, these problems, as well as overall poverty, are especially concentrated in the Southeastern part of the country. Compared with the other OECD countries, the U.S. has much greater inequality of income and wealth. Furthermore, we are unique in leaving substantial portions of our population not covered by health insurance, again most prominently in the southeastern region. This national health disparity is not simply a factor of the multicultural nature of American society, because it persists when the health of the whites only is compared with the more racially homogeneous OECD nations. The complexity of our poor health performance rules out a single intervention. But it is clear that without focusing on the less fortunate members of our society, especially those in the Southeast, our performance will continue to lag, and possibly deteriorate further.

  2. Addressing Health Disparities in the Undergraduate Curriculum: An Approach to Develop a Knowledgeable Biomedical Workforce

    PubMed Central

    Benabentos, Rocio; Ray, Payal

    2014-01-01

    Disparities in health and healthcare are a major concern in the United States and worldwide. Approaches to alleviate these disparities must be multifaceted and should include initiatives that touch upon the diverse areas that influence the healthcare system. Developing a strong biomedical workforce with an awareness of the issues concerning health disparities is crucial for addressing this issue. Establishing undergraduate health disparities courses that are accessible to undergraduate students in the life sciences is necessary to increase students’ understanding and awareness of these issues and motivate them to address these disparities during their careers. The majority of universities do not include courses related to health disparities in their curricula, and only a few universities manage them from their life sciences departments. The figures are especially low for minority-serving institutions, which serve students from communities disproportionally affected by health disparities. Universities should consider several possible approaches to infuse their undergraduate curricula with health disparities courses or activities. Eliminating health disparities will require efforts from diverse stakeholders. Undergraduate institutions can play an important role in developing an aware biomedical workforce and helping to close the gap in health outcomes. PMID:25452486

  3. Directions for unraveling the issue of alcohol and health disparities: findings from the Postmenopausal Health Disparities study.

    PubMed

    Gavaler, Judith S; Deal, Stephen R; Rosenblum, Elaine R

    2004-01-01

    The Postmenopausal Health Disparities Study (PHD Study) is a model for unraveling the underlying factors that may play a role in the health status and life expectancy disparities among racial and ethnic groups, with particular attention to effects of alcoholic beverage consumption. The study is bioepidemiologic; underlying mechanisms, rather than end points per se, are evaluated. The design is cross-sectional with historical prospective elements. Data were collected from responses to three questionnaires and examination findings from a clinic visit. There were significant differences among racial and ethnic groups in patterns of alcoholic beverage consumption and selected demographic factors, body mass index, measures of physical activity and fitness, and nutritional factors. Predictors of body mass index included both moderate drinking and hormonal factors. To address the current controversy about risks and benefits of hormone replacement therapy (HRT) we examined the predictors of control-based categories of estradiol among treated women; predictors included drinking of alcohol, hormonal variables, and being Caucasian. In addition, a substantial proportion of the variables examined differed significantly between alcohol drinkers and abstainers. The significant differences between alcohol drinkers and abstainers, and among racial and ethnic groups, demonstrate the value of studying multiple racial and ethnic groups simultaneously. The PHD Study provides a unique and productive model that can be used in other populations.

  4. The “Long Tail” and Public Health: New Thinking for Addressing Health Disparities

    PubMed Central

    Hovmand, Peter; Pfeiffer, Debbie J.; Fairchild, Maggie; Rath, Suchitra; Golla, Balaji; Casey, Chris

    2014-01-01

    The prevailing approach to improving population health focuses on shifting population means through a few targeted and universal interventions. The success of this approach for eliminating health disparities depends on an assumption about the distribution of demand for such interventions. We explored whether long tail thinking from business might yield greater progress in eliminating disparities. We examined 2011 to 2013 data from 513 state and local health agency representatives in 47 states who used an online system to create 4351 small media and client reminder products promoting colorectal cancer screening. Products in the long tail were more likely to target minority groups with higher rates of colorectal cancer and lower rates of screening than Whites. Long tail thinking could help improve the public's health and eliminate disparities. PMID:25322308

  5. The men's health forum: an initiative to address health disparities in the community.

    PubMed

    Grant, Cathy G; Davis, Jenna L; Rivers, Brian M; Rivera-Colón, Venessa; Ramos, Roberto; Antolino, Prado; Harris, Erika; Green, B Lee

    2012-08-01

    Racial/ethnic, socioeconomic, and gender disparities in health and access to and use of health care services currently exist. Health professionals are continually striving to reduce and eliminate health disparities within their own community. One such effort in the area of Tampa Bay, Florida was the creation of the African American Men's Health Forum, currently referred to as the Men's Health Forum. The African American Men's Health Forum was the result of the community's desire to reduce the gap in health outcomes for African American men. Later, it was recognized that the gap in health outcomes impacts other communities; therefore, it was broadened to include all men considered medically underserved (those who are uninsured, underinsured, or without a regular health care provider). The Men's Health Forum empowers men with the resources, knowledge, and information to effectively manage their health by providing health education and screenings to the community. This article provides an explanation of the key components that have contributed to the success of the Men's Health Forum, including challenges and lessons learned. It is intended that this information be replicated in other communities in an effort to eliminate health disparities.

  6. Health disparities of coal miners and coal mining communities: the role of occupational health nurses.

    PubMed

    Apostle, Elisa P; O'Connell, Marykate E; Vezeau, Toni M

    2011-07-01

    This article investigates how the health disparities of Appalachian coal miners and coal mining communities could be decreased through a partnership with occupational health nurses. On-site health clinics managed by occupational health nurses working in the coal mining industry are proposed as a means to improve health care outcomes. Health effects, economic considerations, environmental impacts, and U.S. coal mining legislation and regulation are examined. An epidemiological approach is presented to the unique health effects experienced by Appalachian coal miners and coal mining communities within the context of existent socioeconomic disparities. The long-standing health crisis in Appalachian coal mining communities requires a multidisciplinary approach led by occupational health nurses. Copyright 2011, SLACK Incorporated.

  7. Program Capacity to Eliminate Outcome Disparities in Addiction Health Services.

    PubMed

    Guerrero, Erick G; Aarons, Gregory A; Grella, Christine E; Garner, Bryan R; Cook, Benjamin; Vega, William A

    2016-01-01

    We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010 to 2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed.

  8. Program Capacity to Eliminate Outcome Disparities in Addiction Health Services

    PubMed Central

    Guerrero, Erick G.; Aarons, Gregory; Grella, Christine; Garner, Bryan R.; Cook, Benjamin; Vega, William A.

    2014-01-01

    We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010–2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed. PMID:25450596

  9. Translating Research Evidence Into Practice to Reduce Health Disparities: A Social Determinants Approach

    PubMed Central

    Koh, Howard K.; Massin-Short, Sarah B.; Emmons, Karen M.; Geller, Alan C.; Viswanath, K.

    2010-01-01

    Translating research evidence to reduce health disparities has emerged as a global priority. The 2008 World Health Organization Commission on Social Determinants of Health recently urged that gaps in health attributable to political, social, and economic factors should be closed in a generation. Achieving this goal requires a social determinants approach to create public health systems that translate efficacy documented by research into effectiveness in the community. We review the scope, definitions, and framing of health disparities and explore local, national, and global programs that address specific health disparities. Such efforts translate research evidence into real-world settings and harness collaborative social action for broad-scale, sustainable change. PMID:20147686

  10. Reducing health disparities: the role of sleep deficiency and sleep disorders.

    PubMed

    Laposky, Aaron D; Van Cauter, Eve; Diez-Roux, Ana V

    2016-02-01

    Decrements in sleep health, including insufficient sleep duration, irregular timing of sleep, poor sleep quality, and sleep/circadian disorders, are widespread in modern society and are associated with an array of disease risks and outcomes, including those contributing to health disparities (eg, cardiovascular disease, obesity and diabetes, psychiatric illness, and cancer). Recent findings have uncovered racial/ethnic and socioeconomic position differences in sleep health; however, the contribution of sleep deficiency to health disparities remains largely unexplored, and understanding the underlying causes of disparities in sleep health is only beginning to emerge. In 2011, the National Heart, Lung, and Blood Institute (NHLBI) convened a workshop, bringing together sleep and health disparities investigators, to identify research gaps and opportunities to advance sleep and health disparities science. This article provides a brief background and rationale for the workshop, and it disseminates the research recommendations and priorities resulting from the working group discussions. Published by Elsevier B.V.

  11. The Contribution of Urban Foodways to Health Disparities

    PubMed Central

    Weiss, Eve E.; Asch, David A.

    2010-01-01

    How do urban food environments produce health disparities? The literature currently emphasizes the etiologic relevance of urban food deserts and their nutritional shortcomings. This paper instead examines the health relevance of foodways—the social dynamics surrounding the production, purchase, and consumption of food. We report on data from 32 photo-elicitation interviews conducted with adult residents of Philadelphia, examining distinct foodways and health concerns that play out in the most commonly discussed retail establishments: corner stores, “Stop and Go’s” (delis that also sell beer), and Chinese takeout restaurants. Corner store visits, described as a routinized element of children’s school day, were implicated in early life patterning of unsound nutritional choices. Stop and Go’s were described as a health threat because of their alcohol sales and tacit promotion of public drunkenness, coupled with accessibility to youth. Stop and Go’s and Chinese takeouts both were perceived as generators of violence in part because of on-site sales of alcohol, drug paraphernalia, and illicit drugs. Chinese takeouts also were described as symbolic reminders of African Americans’ economic exclusion and as places infused with race/ethnic tension and hostile merchant–customer interactions. Instead of viewing the food environment simply as a source of calories and nutrients, participants discussed the complex social dynamics that play out therein, raising a range of important considerations for (especially disadvantaged) urban residents’ safety, physical well-being, and mental health. PMID:20354910

  12. Defining and targeting health disparities in chronic obstructive pulmonary disease.

    PubMed

    Pleasants, Roy A; Riley, Isaretta L; Mannino, David M

    2016-01-01

    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.

  13. Defining and targeting health disparities in chronic obstructive pulmonary disease

    PubMed Central

    Pleasants, Roy A; Riley, Isaretta L; Mannino, David M

    2016-01-01

    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. PMID:27785005

  14. The contribution of urban foodways to health disparities.

    PubMed

    Cannuscio, Carolyn C; Weiss, Eve E; Asch, David A

    2010-05-01

    How do urban food environments produce health disparities? The literature currently emphasizes the etiologic relevance of urban food deserts and their nutritional shortcomings. This paper instead examines the health relevance of foodways--the social dynamics surrounding the production, purchase, and consumption of food. We report on data from 32 photo-elicitation interviews conducted with adult residents of Philadelphia, examining distinct foodways and health concerns that play out in the most commonly discussed retail establishments: corner stores, "Stop and Go's" (delis that also sell beer), and Chinese takeout restaurants. Corner store visits, described as a routinized element of children's school day, were implicated in early life patterning of unsound nutritional choices. Stop and Go's were described as a health threat because of their alcohol sales and tacit promotion of public drunkenness, coupled with accessibility to youth. Stop and Go's and Chinese takeouts both were perceived as generators of violence in part because of on-site sales of alcohol, drug paraphernalia, and illicit drugs. Chinese takeouts also were described as symbolic reminders of African Americans' economic exclusion and as places infused with race/ethnic tension and hostile merchant-customer interactions. Instead of viewing the food environment simply as a source of calories and nutrients, participants discussed the complex social dynamics that play out therein, raising a range of important considerations for (especially disadvantaged) urban residents' safety, physical well-being, and mental health.

  15. Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care

    ERIC Educational Resources Information Center

    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.…

  16. A Cascade of Disparities: Health and Health Care Access for People with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Krahn, Gloria L.; Hammond, Laura; Turner, Anne

    2006-01-01

    People with ID represent approximately 2% of the population and, as a group, experience poorer health than the general population. This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and…

  17. Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care

    ERIC Educational Resources Information Center

    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.…

  18. Facilitators, challenges, and collaborative activities in faith and health partnerships to address health disparities.

    PubMed

    Kegler, Michelle C; Hall, Sarah M; Kiser, Mimi

    2010-10-01

    Interest in partnering with faith-based organizations (FBOs) to address health disparities has grown in recent years. Yet relatively little is known about these types of partnerships. As part of an evaluation of the Institute for Faith and Public Health Collaborations, representatives of 34 faith-health teams (n = 61) completed semi-structured interviews. Interviews were tape recorded, transcribed, and coded by two members of the evaluation team to identify themes. Major facilitators to faith-health collaborative work were passion and commitment, importance of FBOs in communities, favorable political climate, support from community and faith leaders, diversity of teams, and mutual trust and respect. Barriers unique to faith and health collaboration included discomfort with FBOs, distrust of either health agencies or FBOs, diversity within faith communities, different agendas, separation of church and state, and the lack of a common language. Findings suggest that faith-health partnerships face unique challenges but are capable of aligning resources to address health disparities.

  19. A 10-year experience with universal health insurance in Taiwan: measuring changes in health and health disparity.

    PubMed

    Wen, Chi Pang; Tsai, Shan Pou; Chung, Wen-Shen Isabella

    2008-02-19

    Universal national health insurance, financed jointly by payroll taxes, subsidies, and individual premiums, commenced in Taiwan in 1995. Coverage expanded from 57% of the population (before the introduction of national health insurance) to 98%. To assess the role of national health insurance in improving life expectancy and reducing health disparities in Taiwan. A before-and-after comparison of the decade before the introduction of national health insurance (1982-1984 to 1992-1994) with the decade after (1992-1994 to 2002-2004). Taiwan. All townships (n = 358) in Taiwan were ranked according to overall mortality rates before the introduction of national health insurance and then ranked into 10 health class groups in descending order of health (groups 1 [healthiest] to 10 [least healthy]). Health improvement (change in life expectancy after the introduction of national health insurance) and health disparity (reduction in the difference in life expectancy between the highest- and lowest-ranked health class groups). After the introduction of national health insurance, life expectancy increased more in health class groups that had higher mortality rates before the introduction of national health insurance and health disparity narrowed, reversing an earlier trend toward widening disparity. The major contributors to the reduction in disparity were relatively larger reductions in death from cardiovascular diseases, ill-defined conditions, infectious diseases, and accidents in the lower-ranked health class groups. However, death from cancer increased more in the lower-ranked health class groups. Utilization of medical services increased, whereas cost remained at 5% to 6% of the gross domestic product. The per capita average annual number of visits to the physician's office was 14. The interpretation of comparisons before and after the introduction of national health insurance assumes that the changes were entirely due to the effect of national health insurance rather than

  20. Reducing Health Disparities and Improving Health Equity in Saint Lucia

    PubMed Central

    Holden, Kisha; Charles, Lisa; King, Stephen; McGregor, Brian; Satcher, David; Belton, Allyson

    2015-01-01

    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. PMID:26703647

  1. Reducing Health Disparities and Improving Health Equity in Saint Lucia.

    PubMed

    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.

  2. Addressing health disparities in middle school students' nutrition and exercise.

    PubMed

    Frenn, Marilyn; Malin, Shelly; Bansal, Naveen; Delgado, Mary; Greer, Yvonne; Havice, Michael; Ho, Mary; Schweizer, Heidi

    2003-01-01

    Those with low income, especially women of African American and Hispanic heritage have the greatest risk of inactivity and obesity. A 4-session (Internet and video) intervention with healthy snack and gym labs was tested in 2 (gym lab in 1) urban low-middle-income middle schools to improve low fat diet and moderate and vigorous physical activity.1 The gym lab was particularly beneficial (p =.002). Fat in diet decreased with each Internet session in which students participated. Percentage of fat in food was reduced significantly p =.018 for Black, White, and Black/Native American girls in the intervention group. Interventions delivered through Internet and video may enable reduction of health disparities in students by encouraging those most at risk to consume 30% or less calories from fat and to engage in moderate and vigorous physical activity.

  3. The role of ophthalmology departments in overcoming health care disparities

    PubMed Central

    Salowe, Rebecca J.; Sankar, Prithvi; Miller-Ellis, Eydie; Pistilli, Maxwell; Ying, Gui-shuang; O'Brien, Joan M.

    2015-01-01

    Ophthalmology departments can play a unique role in providing care for at-risk patients. This study analyzed the age, gender, and socioeconomic measures for 267,286 unique African American patients seen at University of Pennsylvania Health System (UPHS). Patients seen by the Ophthalmology Department (n=33,801) were older and more likely to be from impoverished zip codes than those seen by other UPHS specialists. These results hint at several inherent advantages of ophthalmology departments in recruiting older, disadvantaged patients to their clinics. We found that supplementing this advantage with strong patient relationships, involvement of community leaders, and customized outreach efforts was key to overcoming access-to-care issues and to reaching these patients. This provides ophthalmologists with a unique opportunity to capture and refer systemic conditions with ocular manifestations and to possibly reduce disparities such as post-hospitalization readmission and mortality observed disproportionately in impoverished populations. PMID:26819970

  4. The role of ophthalmology departments in overcoming health care disparities.

    PubMed

    Salowe, Rebecca J; Sankar, Prithvi; Miller-Ellis, Eydie; Pistilli, Maxwell; Ying, Gui-Shuang; O'Brien, Joan M

    Ophthalmology departments can play a unique role in providing care for at-risk patients. This study analyzed the age, gender, and socioeconomic measures for 267,286 unique African American patients seen at University of Pennsylvania Health System (UPHS). Patients seen by the Ophthalmology Department (n=33,801) were older and more likely to be from impoverished zip codes than those seen by other UPHS specialists. These results hint at several inherent advantages of ophthalmology departments in recruiting older, disadvantaged patients to their clinics. We found that supplementing this advantage with strong patient relationships, involvement of community leaders, and customized outreach efforts was key to overcoming access-to-care issues and to reaching these patients. This provides ophthalmologists with a unique opportunity to capture and refer systemic conditions with ocular manifestations and to possibly reduce disparities such as post-hospitalization readmission and mortality observed disproportionately in impoverished populations.

  5. Race, ethnicity, and health: can genetics explain disparities?

    PubMed

    Braun, Lundy

    2002-01-01

    Over the past decade, numerous studies have documented profound racial and ethnic disparities in disease in the United States. This essay examines how popular and scientific concepts of race and ethnicity converge with dominant understandings of genetics to inform the design and interpretation of research, public health policy, and medical practice. Although there is some acknowledgment in the biomedical community that racial and ethnic categories are social and not genetic, ideas about race and ethnicity that circulate in biomedicine are contradictory. Thus, in practice genetic explanations for observed differences are common both in the scientific literature and in popular media accounts of biomedical research. Such explanations naturalize racial and ethnic difference and create a conceptual barrier to developing a research program that explores the complex ways in which social inequality and experiences of racial discrimination interact with human biology to influence patterns of disease. Importantly, genetically based ideas lead to disease prevention policies that are bound to be ineffective.

  6. Oral health disparities in Appalachia: orthodontic treatment need and demand.

    PubMed

    Martin, Chris A; McNeil, Daniel W; Crout, Richard J; Ngan, Peter W; Weyant, Robert J; Heady, Hilda R; Marazita, Mary L

    2008-05-01

    Significant oral health disparities affect people in West Virginia and elsewhere in Appalachia. Although oral diseases such as caries are a major problem, little is known about the occlusal status of this under-served group. Fifty-eight adolescents (ages 12-17 years) and 78 of their parents underwent an orthodontic examination as part of a larger study on oral health in two rural West Virginia counties. Two orthodontists used a standardized index to rate their need for orthodontic care. Participants were interviewed regarding their demand for and history of orthodontic care. The study results show that parents had a high rate of complete or partial edentulism, an infrequent history of orthodontic treatment, great unmet orthodontic need and less demand for orthodontic care than was suggested by their clinically determined need. The adolescents were similar to national norms with regard to orthodontic treatment history and need, but lower with regard to demand. The adolescents' similarity to general population norms with regard to previous orthodontic care and level of occlusal status is promising. Nevertheless, their lower recognition of a need for treatment suggests possible future oral health problems and a lower oral health quality of life. Their parents, however, were considerably worse off, in comparison with their adolescent children and adult comparison samples, with regard to orthodontic care and other oral health status measures. Culturally sensitive psychoeducational methods to promote recognition of oral health needs may be required among adolescents in Appalachia to have an impact on oral health values and to prevent oral health problems. Issues of orthodontic care utilization and, perhaps, access to care need to be addressed among adults in Appalachia.

  7. The Untapped Potential of the Nurse Practitioner Workforce in Reducing Health Disparities.

    PubMed

    Poghosyan, Lusine; Carthon, J Margo Brooks

    2017-01-01

    The growing nurse practitioner (NP) workforce represents a significant supply of primary care providers, who if optimally utilized, are well-positioned to improve access to health care for racial and ethnic minorities. However, many barriers affect the optimal utilization of NPs in primary care delivery. These barriers may also prevent NPs from maximally contributing to efforts to reduce racial and ethnic health disparities. Our review of the empirical and health policy literature sought to elucidate factors that affect NPs' potential and ability to narrow or eliminate health disparities. We found that restrictive state scope of practice regulations, disparate reimbursement policies, lack of NP workforce diversity, and poor organizational structures in NP practices may limit NPs' contributions to current efforts to reduce disparities. Our results led to the development of the nurse practitioner health disparities model which identifies barriers to and opportunities for optimal use of NPs in reducing racial and ethnic disparities. State and federal policymakers and administrators in health-care settings should take actions to remove legislative and organizational barriers to enable NPs to deliver high-quality care to racial and ethnic minorities. Researchers can use the nurse practitioner health disparities model to produce empirical evidence to reduce health disparities and improve population health.

  8. Disparities in precarious workers' health care access in South Korea.

    PubMed

    Min, Jin-Young; Park, Shin-Goo; Hwang, Sang Hee; Min, Kyoung-Bok

    2016-12-01

    This study explored whether precarious workers have difficulties in health care access as compared with non-precarious workers. The 2008 Korean Community Health Survey data were used for this study. Information was obtained on 51,322 participants (40,514 non-precarious workers and 10,808 precarious workers). Precarious workers were defined as part-time or contingent workers. Precarious workers had significantly higher risk of limited access to hospitals (OR = 1.14; 95% CI: 1.06-1.22) and dentists (OR = 1.28; 95% CI: 1.21-1.36) than non-precarious workers; disparities in doctor contacts among precarious workers were mostly linked to not having enough money. The risk of not receiving preventive care-medical checkups (OR = 0.52; 95% CI: 0.49-0.55) or cancer screenings (OR = 0.82; 95% CI: 0.77-0.86)-was also significantly elevated among precarious workers. We found that precarious workers had more difficulty accessing health care or receiving health checkups or cancer screenings than their non-precarious counterparts. Am. J. Ind. Med. 59:1136-1144, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  9. A participatory action research pilot study of urban health disparities using rapid assessment response and evaluation.

    PubMed

    Brown, David Richard; Hernández, Agueda; Saint-Jean, Gilbert; Evans, Siân; Tafari, Ida; Brewster, Luther G; Celestin, Michel J; Gómez-Estefan, Carlos; Regalado, Fernando; Akal, Siri; Nierenberg, Barry; Kauschinger, Elaine D; Schwartz, Robert; Page, J Bryan

    2008-01-01

    Healthy People 2010 made it a priority to eliminate health disparities. We used a rapid assessment response and evaluation (RARE) to launch a program of participatory action research focused on health disparities in an urban, disadvantaged Black community serviced by a major south Florida health center. We formed partnerships with community members, identified local health disparities, and guided interventions targeting health disparities. We describe the RARE structure used to triangulate data sources and guide intervention plans as well as findings and conclusions drawn from scientific literature and epidemiological, historic, planning, clinical, and ethnographic data. Disenfranchisement and socioeconomic deprivation emerged as the principal determinants of local health disparities and the most appropriate targets for intervention.

  10. Awareness and action for eliminating health care disparities in pain care: Web-based resources.

    PubMed

    Fan, Ling; Thomas, Melissa; Deitrick, Ginna E; Polomano, Rosemary C

    2008-01-01

    Evidence shows that disparities in pain care exist, and this problem spans across all health care settings. Health care disparities are complex, and stem from the health system climate, limitations imposed by laws and regulations, and discriminatory practices that are deep seated in biases, stereotypes, and uncertainties surrounding communication and decision-making processes. A search of the Internet identified thousands of Web sites, documents, reports, and educational materials pertaining to health and pain disparities. Web sites for federal agencies, private foundations, and professional and consumer-oriented organizations provide useful information on disparities related to age, race, ethnicity, geography, socioeconomic status, and specific populations. The contents of 10 Web sites are examined for resources to assist health professionals and consumers in better understanding health and pain disparities and ways to overcome them in practice.

  11. Social justice, health disparities, and culture in the care of the elderly.

    PubMed

    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.

  12. A Participatory Action Research Pilot Study of Urban Health Disparities Using Rapid Assessment Response and Evaluation

    PubMed Central

    Brown, David Richard; Hernández, Agueda; Saint-Jean, Gilbert; Evans, Siân; Tafari, Ida; Brewster, Luther G.; Celestin, Michel J.; Gómez-Estefan, Carlos; Regalado, Fernando; Akal, Siri; Nierenberg, Barry; Kauschinger, Elaine D.; Schwartz, Robert; Page, J. Bryan

    2008-01-01

    Healthy People 2010 made it a priority to eliminate health disparities. We used a rapid assessment response and evaluation (RARE) to launch a program of participatory action research focused on health disparities in an urban, disadvantaged Black community serviced by a major south Florida health center. We formed partnerships with community members, identified local health disparities, and guided interventions targeting health disparities. We describe the RARE structure used to triangulate data sources and guide intervention plans as well as findings and conclusions drawn from scientific literature and epidemiological, historic, planning, clinical, and ethnographic data. Disenfranchisement and socioeconomic deprivation emerged as the principal determinants of local health disparities and the most appropriate targets for intervention. PMID:18048802

  13. The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults

    PubMed Central

    Bennett, Ian M.; Chen, Jing; Soroui, Jaleh S.; White, Sheida

    2009-01-01

    PURPOSE Health literacy is associated with a range of poor health-related outcomes. Evidence that health literacy contributes to disparities in health is minimal and based on brief screening instruments that have limited ability to assess health literacy. The purpose of this study was to assess whether health literacy contributes, through mediation, to racial/ethnic and education-related disparities in self-rated health status and preventive health behaviors among older adults. METHODS We undertook a cross-sectional study of a nationally representative sample of 2,668 US adults aged 65 years and older from the 2003 National Assessment of Adult Literacy. Multiple regression analysis was used to assess for evidence of mediation. RESULTS Of older adults in the United States, 29% reported fair or poor health status, and 27% to 39% reported not utilizing 3 recommended preventive health care services in the year preceding the assessment (influenza vaccination 27%, mammography 34%, dental checkup 39%). Health literacy and the 4 health outcomes (self-rated health status and utilization of the 3 preventive health care services) varied by race/ethnicity and educational attainment. Regression analyses indicated that, after controlling for potential confounders, health literacy significantly mediated both racial/ethnic and education-related disparities in self-rated health status and receipt of influenza vaccination, but only education-related disparities in receipt of mammography and dental care. CONCLUSIONS Health literacy contributes to disparities associated with race/ethnicity and educational attainment in self-rated health and some preventive health behaviors among older adults. Interventions addressing low health literacy may reduce these disparities. PMID:19433837

  14. Framing Health Equity: US Health Disparities in Comparative Perspective.

    PubMed

    Lynch, Julia F; Perera, Isabel M

    2017-10-01

    In this article we explore systematically the different conceptions of health equity in key national health policy documents in the United States, the United Kingdom, and France. We find substantial differences across the three countries in the characterization of group differences (by SES, race/ethnicity, or territory), and the theorized causes of health inequalities (socioeconomic structures versus health care system features). In all three countries, reports throughout the period alluded at least minimally to inequalities in social determinants as the underlying cause of health inequalities. However, even in the reports with the strongest attachment to this causal model, the authors stop well short of advocating the redistribution of power and resources that would likely be necessary to redress these inequalities. Copyright © 2017 by Duke University Press.

  15. Understanding Health Disparities and Inequities Faced by Individuals with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Ouellette-Kuntz, Helene

    2005-01-01

    Background: There is an increasing interest in the notion of health disparities, inequities and inequalities in Canada and elsewhere. In Canada, individuals with disabilities represent one of six groups identified as particularly vulnerable to health disparities. Method: This paper combines the literature related to the concepts of inequity and…

  16. Health Disparities Grants Funded by National Institute on Aging: Trends between 2000 and 2010

    ERIC Educational Resources Information Center

    Kim, Giyeon; DeCoster, Jamie; Huang, Chao-Hui; Parmelee, Patricia

    2012-01-01

    Purpose of the Study: The present study examined the characteristics of health disparities grants funded by National Institute on Aging (NIA) from 2000 to 2010. Objectives were (a) to examine longitudinal trends in health disparities-related grants funded by NIA and (b) to identify moderators of these trends. Design and Methods: Our primary data…

  17. Disparities in the Use of Preventive Health Care among Children with Disabilities in Taiwan

    ERIC Educational Resources Information Center

    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…

  18. Everyone Swims: A Community Partnership and Policy Approach to Address Health Disparities in Drowning and Obesity

    ERIC Educational Resources Information Center

    Stempski, Sarah; Liu, Lenna; Grow, H. Mollie; Pomietto, Maureen; Chung, Celeste; Shumann, Amy; Bennett, Elizabeth

    2015-01-01

    Well-known disparities exist in rates of obesity and drowning, two public health priorities. Addressing these disparities by increasing access to safe swimming and water recreation may yield benefits for both obesity and injury prevention. "Everyone Swims," a community partnership, brought community health clinics and water recreation…

  19. Oral health disparities and the workforce: a framework to guide innovation.

    PubMed

    Hilton, Irene V; Lester, Arlene M

    2010-06-01

    Oral health disparities currently exist in the United States, and workforce innovations have been proposed as one strategy to address these disparities. A framework is needed to logically assess the possible role of workforce as a contributor to and to analyze workforce strategies addressing the issue of oral health disparities. Using an existing framework, A Strategic Framework for Improving Racial/Ethnic Minority Health and Eliminating Racial/Ethnic Health Disparities, workforce was sequentially applied across individual, environmental/community, and system levels to identify long-term problems, contributing factors, strategies/innovation, measurable outcomes/impacts, and long-term goals. Examples of current workforce innovations were applied to the framework. Contributing factors to oral health disparities included lack of racial/ethnic diversity of the workforce, lack of appropriate training, provider distribution, and a nonuser-centered system. The framework was applied to selected workforce innovation models delineating the potential impact on contributing factors across the individual, environmental/community, and system levels. The framework helps to define expected outcomes from workforce models that would contribute to the goal of reducing oral health disparities and examine impacts across multiple levels. However, the contributing factors to oral health disparities cannot be addressed by workforce innovation alone. The Strategic Framework is a logical approach to guide workforce innovation, solutions, and identification of other aspects of the oral healthcare delivery system that need innovation in order to reduce oral health disparities.

  20. Health Disparities Grants Funded by National Institute on Aging: Trends between 2000 and 2010

    ERIC Educational Resources Information Center

    Kim, Giyeon; DeCoster, Jamie; Huang, Chao-Hui; Parmelee, Patricia

    2012-01-01

    Purpose of the Study: The present study examined the characteristics of health disparities grants funded by National Institute on Aging (NIA) from 2000 to 2010. Objectives were (a) to examine longitudinal trends in health disparities-related grants funded by NIA and (b) to identify moderators of these trends. Design and Methods: Our primary data…

  1. Everyone Swims: A Community Partnership and Policy Approach to Address Health Disparities in Drowning and Obesity

    ERIC Educational Resources Information Center

    Stempski, Sarah; Liu, Lenna; Grow, H. Mollie; Pomietto, Maureen; Chung, Celeste; Shumann, Amy; Bennett, Elizabeth

    2015-01-01

    Well-known disparities exist in rates of obesity and drowning, two public health priorities. Addressing these disparities by increasing access to safe swimming and water recreation may yield benefits for both obesity and injury prevention. "Everyone Swims," a community partnership, brought community health clinics and water recreation…

  2. Understanding Health Disparities and Inequities Faced by Individuals with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Ouellette-Kuntz, Helene

    2005-01-01

    Background: There is an increasing interest in the notion of health disparities, inequities and inequalities in Canada and elsewhere. In Canada, individuals with disabilities represent one of six groups identified as particularly vulnerable to health disparities. Method: This paper combines the literature related to the concepts of inequity and…

  3. Using Decision Support to Address Racial Disparities in Mental Health Service Utilization

    ERIC Educational Resources Information Center

    Rawal, Purva H.; Anderson, Tanya R.; Romansky, Jill R.; Lyons, John S.

    2008-01-01

    Unfortunately, racial disparities are well documented in the delivery of behavioral health services. This study examines the effects of implementing a decision support process, integrating clinical information into the administration of mental health services, on racial disparities in psychiatric hospital admissions for children in state custody.…

  4. Disparities in the Use of Preventive Health Care among Children with Disabilities in Taiwan

    ERIC Educational Resources Information Center

    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…

  5. The National Health Plan Collaborative to Reduce Disparities and Improve Quality.

    PubMed

    Lurie, Nicole; Fremont, Allen; Somers, Stephen A; Coltin, Kathryn; Gelzer, Andrea; Johnson, Rhonda; Rawlins, Wayne; Ting, Grace; Wong, Winston; Zimmerman, Donna

    2008-05-01

    Despite numerous reports and initiatives, progress in reducing racial/ethnic disparities in health care has been slow. The National Health Plan Collaborative (NHPC), a novel public-private partnership between nine health plans covering approximately 95 million lives, leading learning and research organizations, the Agency for Healthcare Research and Quality, and the Robert Wood Johnson Foundation, was established in December 2004 to address these disparities. The health plans were able to overcame initial challenges in obtaining information on race/ethnicity of their enrollees and examined their diabetes performance measure to assess disparities in care. By February 2006, the initial nine plans that had joined the NHPC progressed from focusing solely on data collection and management issues and were engaged in outreach activities to members, providers, or community or had completed capacity development for disparities work. Five plans had implemented one or more pilot interventions. Plans also addressed unanticipated challenges, such as sorting through large amounts of data to target disparities. Because many of the plans are complex national entities with varying regional and departmental structures, simply achieving coordination of disparities activities across the organization has been a major challenge and, in many cases, a major breakthrough. The NHPC represents a model of shared learning and innovation through which health plans are tackling racial/ethnic disparities. Now that most of the plans have some data on their enrollees with diabetes and have begun targeting disparities, they want to capitalize on their collective industry strength to influence policy on issues related to disparities.

  6. Local Health Departments’ Activities to Address Health Disparities and Inequities: Are We Moving in the Right Direction?

    PubMed Central

    Shah, Gulzar H.; Sheahan, John P.

    2015-01-01

    Context: Health disparities are among the critical public health challenges. Objectives: To analyze the extent to which local health departments (LHDs) perform activities for addressing health disparities, changes in proportion of LHDs’ performing those activities since 2005, and factors associated with variation in such engagement. Methods: We used the 2013 National Profile of LHDs Survey to perform Logistic Regression of activities LHDs performed to address health disparities. Results: About 20 percent of LHDs did not perform any activity to address health disparities. Significant decreases occurred since 2005 in the proportion of LHDs that performed health disparity reduction/elimination activities for four activities. LHD characteristics significantly associated (p≤0.05) with the increased likelihood of performing activities to address health disparities were: recent completion of community health assessment, community health improvement plan and agency wide strategic plan. Other significant positive impacts on such activities included per capita expenditures, local governance, having one or more local boards of health, larger population size and metropolitan status of the LHD jurisdiction. Conclusions: Reduced infrastructural capacity of LHDs has resulted in fewer LHDs addressing health disparities in their jurisdictions. LHD characteristics associated with higher performance of activities for health disparity reduction identified by this research have important policy implications. PMID:26703693

  7. National Institute on Minority Health and Health Disparities

    MedlinePlus

    ... American men. More NIH Launching Landmark Adolescent Brain Cognitive Development Study NIH researchers are learning about child health and brain development through the Adolescent Brain Cognitive Development Study. More Extramural Research Programs NIMHD Funding Opportunities ...

  8. Disparities in preventive health services among Somali immigrants and refugees.

    PubMed

    Morrison, T Ben; Wieland, Mark L; Cha, Stephen S; Rahman, Ahmed S; Chaudhry, Rajeev

    2012-12-01

    African immigrants and refugees-almost half of them from Somalia-account for one of the fastest-growing groups in the United States. There is reason to suspect that Somali-Americans may be at risk for low completion of recommended preventive health services. This study's aim was to quantify disparities in preventive health services among Somali patients compared with non-Somali patients in an academic primary care practice in Rochester, Minn. It also examined the effect of medical interpreters, emergency department visits, and primary care visits on the completion of preventive services. Rates of pap smears, vaccinations (influenza, pneumococcus, and tetanus), lipid screening, colorectal cancer screening, and mammography were assessed in Somali and non-Somali patients during the second quarter of 2008. Data were collected regarding the utilization of medical interpreters, emergency services, and primary care services among Somali patients. Results were reported using standard descriptive statistics. Of the 91,557 patients identified in the database, 810 were Somali. Somali patients had significantly lower completion rates of colorectal cancer screening, mammography, pap smears, and influenza vaccination than non-Somali patients. Use of medical interpreters and primary care services were generally associated with higher completion rates of preventive services. There are significant discrepancies in the provision of preventive health services to Somali patients compared with that of non-Somali patients. These findings suggest the need to identify the root causes of these discrepancies so that interventions may be crafted to close the gap.

  9. Moving Toward Paradigm-Shifting Research in Health Disparities Through Translational, Transformational, and Transdisciplinary Approaches

    PubMed Central

    Rhee, Kyu B.; Stoff, David M.; Pohlhaus, Jennifer Reineke; Sy, Francisco S.; Stinson, Nathaniel; Ruffin, John

    2010-01-01

    Translational, transdisciplinary, and transformational research stands to become a paradigm-shifting mantra for research in health disparities. A windfall of research discoveries using these 3 approaches has increased our understanding of the health disparities in racial, ethnic, and low socioeconomic status groups. These distinct but related research spheres possess unique environments, which, when integrated, can lead to innovation in health disparities science. In this article, we review these approaches and propose integrating them to advance health disparities research through a change in philosophical position and an increased emphasis on community engagement. We argue that a balanced combination of these research approaches is needed to inform evidence-based practice, social action, and effective policy change to improve health in disparity communities. PMID:20147662

  10. Eliminating health disparities through transdisciplinary research, cross-agency collaboration, and public participation.

    PubMed

    Rashid, Jamila R; Spengler, Robert F; Wagner, Robin M; Melanson, Cindi; Skillen, Elizabeth L; Mays, Robert A; Heurtin-Roberts, Suzanne; Long, Judith A

    2009-11-01

    Despite efforts to the contrary, disparities in health and health care persist in the United States. To solve this problem, federal agencies representing different disciplines and perspectives are collaborating on a variety of transdisciplinary research initiatives. The most recent of these initiatives was launched in 2006 when the Centers for Disease Control and Prevention's Office of Public Health Research and the Department of Health and Human Services' Office of Minority Health brought together federal partners representing a variety of disciplines to form the Federal Collaboration on Health Disparities Research (FCHDR). FCHDR collaborates with a wide variety of federal and nonfederal partners to support and disseminate research that aims to reduce or eliminate disparities in health and health care. Given the complexity involved in eliminating health disparities, there is a need for more transdisciplinary, collaborative research, and facilitating that research is FCHDR's mission.

  11. Eliminating Health Disparities Through Transdisciplinary Research, Cross-Agency Collaboration, and Public Participation

    PubMed Central

    Spengler, Robert F.; Wagner, Robin M.; Melanson, Cindi; Skillen, Elizabeth L.; Mays, Robert A.; Heurtin-Roberts, Suzanne; Long, Judith A.

    2009-01-01

    Despite efforts to the contrary, disparities in health and health care persist in the United States. To solve this problem, federal agencies representing different disciplines and perspectives are collaborating on a variety of transdisciplinary research initiatives. The most recent of these initiatives was launched in 2006 when the Centers for Disease Control and Prevention's Office of Public Health Research and the Department of Health and Human Services’ Office of Minority Health brought together federal partners representing a variety of disciplines to form the Federal Collaboration on Health Disparities Research (FCHDR). FCHDR collaborates with a wide variety of federal and nonfederal partners to support and disseminate research that aims to reduce or eliminate disparities in health and health care. Given the complexity involved in eliminating health disparities, there is a need for more transdisciplinary, collaborative research, and facilitating that research is FCHDR's mission. PMID:19762652

  12. The role of geographic scale in testing the income inequality hypothesis as an explanation of health disparities.

    PubMed

    Chen, Zhuo; Gotway Crawford, Carol A

    2012-09-01

    This study re-examined the role of geographic scale in measuring income inequality and testing the income inequality hypothesis (IIH) as an explanation of health disparities. We merged Behavioral Risk Factor Surveillance System (BRFSS) 2000 data with income inequality indices constructed at different geographic scales to test the association between income inequality and four different health indicators, i.e., self-assessed health status as a morbidity measure, vaccination against influenza as a measure of use of preventive healthcare, having any kind of health insurance as a measure of access, and obesity as a modifiable health risk factor measure. Multilevel models are used in our regression of the health indicators on measures of income inequalities and control variables. Our analysis suggests that because income inequality is a contextual variable, income inequalities measured at different geographic scales have different interpretations and relate to societal characteristics at different levels. Therefore, a rejection of the IIH at one level does not necessarily negate the possibility that income inequality affects health at another level. Assessment across a variety of scales is needed to have a comprehensive picture of the IIH in any given study. Empirical results also show that whether the IIH holds could depend on the sex group examined and the health indicator used, which implies different mechanisms of IIH exist for different sex groups and health indicators, in addition to the geographic scale. The role of geographic scale should be more rigorously considered in social determinants of health research. Published by Elsevier Ltd.

  13. Disparities in academic achievement and health: the intersection of child education and health policy.

    PubMed

    Fiscella, Kevin; Kitzman, Harriet

    2009-03-01

    Recent data suggest that that the United States is failing to make significant progress toward the Healthy People 2010 goal of eliminating health disparities. One missing element from the US strategy for achieving this goal is a focus on gaps in child development and achievement. Academic achievement and education seem to be critical determinants of health across the life span and disparities in one contribute to disparities in the other. Despite these linkages, national policy treats child education and health as separate. Landmark education legislation, the No Child Left Behind Act of 2001, is due for Congressional reauthorization. It seeks to eliminate gaps in academic child achievement by 2014. It does so by introducing accountability for states, school districts, and schools. In this special article, we review health disparities and contributors to child achievement gaps. We review changes in achievement gaps over time and potential contributors to the limited success of the No Child Left Behind Act of 2001, including its unfunded mandates and unfounded assumptions. We conclude with key reforms, which include addressing gaps in child school readiness through adequate investment in child health and early education and reductions in child poverty; closing the gap in child achievement by ensuring equity in school accountability standards; and, importantly, ensuring equity in school funding so that resources are allocated on the basis of the needs of the students. This will ensure that schools, particularly those serving large numbers of poor and minority children, have the resources necessary to promote optimal learning.

  14. Can subjective and objective socioeconomic status explain minority health disparities in Israel?

    PubMed

    Baron-Epel, Orna; Kaplan, Giora

    2009-11-01

    Disparities in health exist between the three main population groups in Israel, non-immigrant Jews, immigrants from the former Soviet Union (arriving in Israel since 1990) and Arabs. This study examines the relationship between health and socioeconomic status in this multicultural population and assesses to what extent subjective and objective socioeconomic measures may explain the disparities in health. A random cross sectional telephone survey of 1004 Israelis aged 35-65 was performed. The questionnaire measured physical and mental health-related quality of life using the Short Form 12. Information regarding subjective socioeconomic status (SSS) and objective socioeconomic status (SES) was collected. Arabs and immigrant women from the former Soviet Union had worse physical health compared to non-immigrant Jews. Immigrant and Arab men and women had worse mental health compared to non-immigrant Jews. Multivariable log-linear regression analysis adjusting for age, SSS or SES explained the disparities in physical health between Arab and non-immigrant Jewish men. However, SSS and SES did not explain the disparities in physical health between the three groups of women. The disparities in mental health between immigrants and non-immigrant Jews can be explained by SSS for both men and women, whereas the disparities between Arabs and Jews can be explained by objective SES only among women. Employed men reported better physical and mental health. Part of the disparities in mental health in Israel can be attributed to differences in SSS and SES in the different groups. However, there is a need to identify additional factors that may add to the disparities in both physical and mental health. The disparities due to socioeconomic status vary by health measure and population group.

  15. Measurement of Health Disparities, Health Inequities, and Social Determinants of Health to Support the Advancement of Health Equity.

    PubMed

    Penman-Aguilar, Ana; Talih, Makram; Huang, David; Moonesinghe, Ramal; Bouye, Karen; Beckles, Gloria

    2016-01-01

    Reduction of health disparities and advancement of health equity in the United States require high-quality data indicative of where the nation stands vis-à-vis health equity, as well as proper analytic tools to facilitate accurate interpretation of these data. This article opens with an overview of health equity and social determinants of health. It then proposes a set of recommended practices in measurement of health disparities, health inequities, and social determinants of health at the national level to support the advancement of health equity, highlighting that (1) differences in health and its determinants that are associated with social position are important to assess; (2) social and structural determinants of health should be assessed and multiple levels of measurement should be considered; (3) the rationale for methodological choices made and measures chosen should be made explicit; (4) groups to be compared should be simultaneously classified by multiple social statuses; and (5) stakeholders and their communication needs can often be considered in the selection of analytic methods. Although much is understood about the role of social determinants of health in shaping the health of populations, researchers should continue to advance understanding of the pathways through which they operate on particular health outcomes. There is still much to learn and implement about how to measure health disparities, health inequities, and social determinants of health at the national level, and the challenges of health equity persist. We anticipate that the present discussion will contribute to the laying of a foundation for standard practice in the monitoring of national progress toward achievement of health equity.

  16. Racial and Ethnic Disparities in Patients' Experience With Skilled Home Health Care Services.

    PubMed

    Smith, Laura M; Anderson, Wayne L; Kenyon, Anne; Kinyara, Elizabeth; With, Sarah K; Teichman, Lori; Dean-Whittaker, Debra; Goldstein, Elizabeth

    2015-12-01

    Racial and ethnic disparities are found in many health care settings; however, there is little prior research on such disparities among patients receiving home health care services. This study used 2012 Home Health Care CAHPS(®) data to identify any overall patient-level disparities in self-reported experience of care and to decompose these disparities according to whether they result from within-agency versus between-agency differences. Although patient experience of care ratings were high across all groups, the study identified consistently lower ratings for all minority groups on two of three Home Health Care CAHPS measures, with Asians reporting the greatest disparities. Three quarters of disparities were found to be within-agency disparities, which were primarily related to care processes and provider/patient communications rather than to specific health care services received. Despite high ratings in general, home health agencies may need to focus on cultural competency initiatives to address racial and ethnic disparities within their agencies. © The Author(s) 2015.

  17. What makes African American health disparities newsworthy? An experiment among journalists about story framing

    PubMed Central

    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

  18. Disparities in Health Insurance Coverage and Health Status Among Farmworkers, Sonoma County, California, 2013–2014

    PubMed Central

    Mercado, Jenny; Hill, Jana; Katz, Sarah C.

    2016-01-01

    Introduction The Sonoma County Farmworker Health Survey (FHS) was conducted to describe the health and well-being of adult farmworkers in Sonoma County, California, and to identify preventable health disparities for this population. Methods From September 2013 through January 2014, venue-based and convenience sampling were used to survey 293 farmworkers aged 18 years or older. The questions included self-rated general health, diabetes and hypertension, and body mass index. To identify disparities between surveyed farmworkers and Sonoma County residents overall, age-adjusted prevalence estimates were developed by using indirect standardization to the adult (≥18 years) Sonoma County sample from the California Health Interview Survey for 2011–2012. Results Surveyed farmworkers were mostly male (91%) and Latino or Hispanic (95%), and 54% had an educational attainment of 8th grade or less. Most (81%) farmworkers reported their families earned less than $30,000 in 2012. After adjusting for age, 30% of farmworkers had US-based health insurance as compared with the 86% of Sonoma County adults in 2011–2012 (P < .001), and 15% of farmworkers reported ever being diagnosed with diabetes after adjusting for age as compared with 5% of Sonoma County adults (P = .002). After adjusting for age, 44% of farmworkers reported poor or fair health in general as compared with 13% of Sonoma County adults (P < .001). Conclusion We identified significant health disparities between Sonoma County farmworkers and Sonoma County adults overall. Additional research and new health policies are necessary to eliminate these health disparities and to facilitate farmworker access to the health care system. PMID:27032988

  19. Race-Based Health Disparities and the Digital Divide: Implications for Nursing Practice.

    PubMed

    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.

  20. [Immigration and health: social inequalities in health disparities in the health system, in welfare and work].

    PubMed

    Pullini, A

    2011-01-01

    Within the analysis of the socio-economic context and the data from hospital discharges, the themes of social inequalities, health disparities, determinants of health care are discussed. Regular immigrants versus irregular, wealthy people versus those in poverty, they have access to and receive different health treatments, besides presenting risk conditions significantly different in relation to their social situation. Through the analysis of hospital discharge records as well as data from injuries at work, besides underestimations in foreign people and the greater risk of injuries for immigrants, it is evident how the aspects of inequalities connected to socioeconomic determinants and the different access to health services are pivotal for our health and welfare and that a profound change is required to tackle them properly, focusing on intervention on health care system, according to models which take into account not only evidence based medicine, but also narrative medicine, not only health protection, but also health promotion, so that equity and quality of health care is warranted for everyone.

  1. Biopsychosocial health disparities among young women enrolled in cardiac rehabilitation.

    PubMed

    Beckie, Theresa M; Fletcher, Gerald; Groer, Maureen W; Kip, Kevin E; Ji, Ming

    2015-01-01

    Our aim was to compare the biopsychosocial characteristics of young women with those of older women who were enrolled in cardiac rehabilitation (CR). The baseline characteristics of women who prematurely terminated CR participation were also explored. Baseline physiological and psychosocial indices of women ≤ 55 years compared with older women eligible for CR were evaluated 1 week before enrolling in either a traditional CR or a gender-specific, motivationally enhanced CR. A greater proportion of young women (n = 65) compared with their older counterparts (n = 187) were diagnosed with acute myocardial infarction during their index hospitalization. They demonstrated lower high-density lipoprotein cholesterol, higher total cholesterol/high-density lipoprotein cholesterol ratios, and greater body weight compared with older women and were more likely to be active smokers. Young women compared with older women reported significantly worse health perceptions, quality of life, optimism, hope, social support, and stress and significantly more symptoms of depression and anxiety. Women who prematurely terminated CR participation were younger, more obese, with worse quality of life, and greater symptoms of depression and anxiety compared with women completing CR. Notable differences in physiological and psychosocial profiles of young women compared with older women enrolled in CR were evident, placing them at high risk for nonadherence to secondary prevention interventions as well as increased risk for disease progression and subsequent cardiac adverse events. Continued existence of these health differentials represents an important public health problem and warrants further research to address these age-related and sex-specific health disparities among women with coronary heart disease.

  2. Undiagnosed Diabetes and Pre-Diabetes in Health Disparities

    PubMed Central

    Fisher-Hoch, Susan P.

    2015-01-01

    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. PMID:26186342

  3. Developing a pediatric oral health therapist to help address oral health disparities among children.

    PubMed

    Nash, David A

    2004-01-01

    Oral Health in America: A Report of the Surgeon General documented the profound and significant disparities that exist in the oral health of children in the United States. Recently, the country has been issued a National Call to Action to Promote Oral Health, under the leadership of the Office of the Surgeon General. Among the significant factors contributing to the disparities problem is the access to oral health care by disadvantaged populations. There are inadequate numbers of dentists able and willing to treat children, particularly poor and minority children. In the early part of the twentieth century, New Zealand faced a significant problem with oral disease among its children and introduced a School Dental Service staffed by allied dental professionals, known as "school dental nurses," who had received two years training in caring for the teeth of children. A number of other countries have since adopted this model. This article reviews attempts to develop a comparable approach in the United States. Furthermore, it justifies and advocates the development of pediatric oral health therapists in the United States as a means of addressing the disparities problem that exists in this nation. These pediatric oral health therapists would be trained in a two-year program to provide dental care services to children. The article concludes by asserting that such action is a practical and cost-effective way for dentistry to fulfill its professional obligation to care for the oral health of all children, thus ensuring justice in oral health for America's children.

  4. Intergenerational health disparities: socioeconomic status, women's health conditions, and child behavior problems.

    PubMed Central

    Kahn, Robert S.; Wilson, Kathryn; Wise, Paul H.

    2005-01-01

    OBJECTIVE: Relatively little is known about the intergenerational mechanisms that lead to social disparities in child health. We examined whether the association between low socioeconomic status (SES) and child behavior problems is mediated by maternal health conditions and behavior. METHODS: Prospective cohort data (1979-1998) on 2,677 children and their mothers were obtained from the National Longitudinal Survey of Youth. SES, the Child Behavior Problems Index (BPI), and maternal smoking, depressive symptoms, and alcohol use before, during, and after pregnancy were examined. RESULTS: Lower income and lower maternal education were associated with increased child BPI scores. Adjustment for maternal smoking, depressive symptoms, and alcohol use attenuated the associations between SES and child BPI by 26% to 49%. These maternal health conditions often occurred together, persisted over time, and were associated with the mother's own childhood SES and pre-pregnancy health. CONCLUSIONS: Social disparities in women's health conditions may help shape the likelihood of behavior problems in the subsequent generation. Improved public health programs and services for disadvantaged women across the lifecourse may not only address their own urgent health needs, but reduce social disparities in the health and well-being of their children. PMID:16025720

  5. Editorial: 3rd Special Issue on behavior change, health, and health disparities

    PubMed Central

    Higgins, Stephen T.

    2017-01-01

    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. PMID:27693562

  6. Disparities in Health Care Quality among Asian Children with Special Health Care Needs.

    PubMed

    Son, Esther; Parish, Susan L; Igdalsky, Leah

    2017-03-02

    There is a dearth of information on the quality of health care for Asian American children and particularly Asian children with special health care needs (CSHCN). The goal of this article was to determine whether there were disparities in quality of health care for Asian CSHCN, whose experiences have not been studied. Data were derived from the 2009-2010 National Survey of Children with Special Health Care Needs (ns = 355 non-Hispanic Asian children and 4,343 non-Hispanic white CSHCN). Bivariate and multivariate logistic regression analyses were conducted to examine the relationship between racial identity (that is, non-Hispanic white and non-Hispanic Asian) and quality of health care. Racial disparities in quality of health care were substantial between Asian and white CSHCN in 2009-2010. Asian parents were significantly less likely than white parents to report that their health care provider provided the specific information they needed, helped them feel like a partner in their child's care, and was sensitive to the family's values and customs. The development and testing of specific, targeted policy and practice interventions to reduce disparities in health care quality for these children are urgently needed.

  7. Social Determinants and Disparities in Health: Their Crucifixion, Resurrection, and Ultimate Triumph(?) in Health Policy.

    PubMed

    House, James S

    2016-08-01

    David Mechanic has been a principal founder of modern sociological and social science approaches to health, especially in relation to health policy. These approaches have since the 1950s and 1960s resurrected ideas that had currency in the mid-nineteenth century but seemed crucified, dead, and buried by the rise of modern biomedicine from the mid-nineteenth century through the mid-twentieth century. Problems and lacunae in purely biomedical approaches to health in the later twentieth century, along with developments of new biopsychosocial approaches to health, have spawned a return toward ideas of Rudolf Virchow and mid-nineteenth-century social medicine that social determinants and disparities are major drivers of population health. Since individual health and population health constitute the major determinants of health care utilization and expenditures, social determinants and disparities in health are arguably the foundation of a new "demand-side" health policy that can resolve America's paradoxical health policy crisis of spending increasingly more than any nation on health care and insurance yet achieving increasingly worsening health outcomes relative to virtually all developed countries and some developing ones as well, something that current "supply-side" health policy, including Obamacare, cannot do, important as it is for expanding access to health insurance and care.

  8. A Community-Engaged Cardiovascular Health Disparities Research Training Curriculum: Implementation and Preliminary Outcomes

    PubMed Central

    Golden, Sherita Hill; Purnell, Tanjala; Halbert, Jennifer P.; Matens, Richard; Miller, Edgar R. “Pete”; Levine, David M.; Nguyen, Tam H.; Gudzune, Kimberly A.; Crews, Deidra C.; Mahlangu-Ngcobo, Mankekolo; Cooper, Lisa A.

    2014-01-01

    To overcome cardiovascular disease (CVD) disparities impacting high-risk populations, it is critical to train researchers and leaders in conducting community-engaged CVD disparities research. The authors summarize the key elements, implementation, and preliminary outcomes of the CVD Disparities Fellowship and Summer Internship Programs at the Johns Hopkins University Schools of Medicine, Nursing, and Bloomberg School of Public Health. In 2010, program faculty and coordinators established a trans-disciplinary CVD disparities training and career development fellowship program for scientific investigators who desire to conduct community-engaged clinical and translational disparities research. The program was developed to enhance mentorship support and research training for faculty, post-doctoral fellows, and pre-doctoral students interested in conducting CVD disparities research. A CVD Disparities Summer Internship Program for undergraduate and pre-professional students was also created to provide a broad experience in public health and health disparities in Baltimore, Maryland, with a focus on CVD. Since 2010, 39 pre-doctoral, post-doctoral, and faculty fellows have completed the program. Participating fellows have published disparities-related research and given presentations both nationally and internationally. Five research grant awards have been received by faculty fellows. Eight undergraduates, 1 post-baccalaureate, and 2 medical professional students representing seven universities have participated in the summer undergraduate internship. Over half of the undergraduate students are applying to or have been accepted into medical or graduate school. The tailored CVD health disparities training curriculum has been successful at equipping varying levels of trainees (from undergraduate students to faculty) with clinical research and public health expertise to conducting community-engaged CVD disparities research. PMID:25054421

  9. A community-engaged cardiovascular health disparities research training curriculum: implementation and preliminary outcomes.

    PubMed

    Golden, Sherita Hill; Purnell, Tanjala; Halbert, Jennifer P; Matens, Richard; Miller, Edgar R Pete; Levine, David M; Nguyen, Tam H; Gudzune, Kimberly A; Crews, Deidra C; Mahlangu-Ngcobo, Mankekolo; Cooper, Lisa A

    2014-10-01

    To overcome cardiovascular disease (CVD) disparities impacting high-risk populations, it is critical to train researchers and leaders in conducting community-engaged CVD disparities research. The authors summarize the key elements, implementation, and preliminary outcomes of the CVD Disparities Fellowship and Summer Internship Programs at the Johns Hopkins University Schools of Medicine, Nursing, and Bloomberg School of Public Health. In 2010, program faculty and coordinators established a transdisciplinary CVD disparities training and career development fellowship program for scientific investigators who desire to conduct community-engaged clinical and translational disparities research. The program was developed to enhance mentorship support and research training for faculty, postdoctoral fellows, and predoctoral students interested in conducting CVD disparities research. A CVD Disparities Summer Internship Program for undergraduate and preprofessional students was also created to provide a broad experience in public health and health disparities in Baltimore, Maryland, with a focus on CVD. Since 2010, 39 predoctoral, postdoctoral, and faculty fellows have completed the program. Participating fellows have published disparities-related research and given presentations both nationally and internationally. Five research grant awards have been received by faculty fellows. Eight undergraduates, one postbaccalaureate, and two medical professional students representing seven universities have participated in the summer undergraduate internship. Over half of the undergraduate students are applying to or have been accepted into medical or graduate school. The tailored CVD health disparities training curriculum has been successful at equipping varying levels of trainees (from undergraduate students to faculty) with clinical research and public health expertise to conducting community-engaged CVD disparities research.

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

    PubMed

    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.

  11. Statistical methods to enhance reporting of Aboriginal Australians in routine hospital records using data linkage affect estimates of health disparities.

    PubMed

    Randall, Deborah A; Lujic, Sanja; Leyland, Alastair H; Jorm, Louisa R

    2013-10-01

    To investigate under-recording of Aboriginal people in hospital data from New South Wales (NSW), Australia, define algorithms for enhanced reporting, and examine the impact of these algorithms on estimated disparities in cardiovascular and injury outcomes. NSW Admitted Patient Data were linked with NSW mortality data (2001-2007). Associations with recording of Aboriginal status were investigated using multilevel logistic regression. The number of admissions reported as Aboriginal according to six algorithms was compared with the original (unenhanced) Aboriginal status variable. Age-standardised admission, and 30- and 365-day mortality ratios were estimated for cardiovascular disease and injury. Sixty per cent of the variation in recording of Aboriginal status was due to the hospital of admission, with poorer recording in private and major city hospitals. All enhancement algorithms increased the number of admissions reported as Aboriginal, from between 4.1% and 37.8%. Admission and mortality ratios varied markedly between algorithms, with less strict algorithms resulting in higher admission rate ratios, but generally lower mortality rate ratios, particularly for cardiovascular disease. The choice of enhancement algorithm has an impact on the number of people reported as Aboriginal and on estimated outcome ratios. The influence of the hospital on recording of Aboriginal status highlights the importance of continued efforts to improve data collection. Estimates of Aboriginal health disparity can change depending on how Aboriginal status is reported. Sensitivity analyses using a number of algorithms are recommended. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

  12. Exploring health disparities in integrated communities: overview of the EHDIC study.

    PubMed

    LaVeist, Thomas; Thorpe, Roland; Bowen-Reid, Terra; Jackson, John; Gary, Tiffany; Gaskin, Darrell; Browne, Dorothy

    2008-01-01

    Progress in understanding the nature of health disparities requires data that are race-comparative while overcoming confounding between race, socioeconomic status, and segregation. The Exploring Health Disparities in Integrated Communities (EHDIC) study is a multisite cohort study that will address these confounders by examining the nature of health disparities within racially integrated communities without racial disparities in socioeconomic status. Data consisted of a structured questionnaire and blood pressure measurements collected from a sample of the adult population (age 18 and older) of two racially integrated contiguous census tracts. This manuscript reports on baseline results from the first EHDIC site, a low-income urban community in southwest Baltimore, Maryland (EHDIC-SWB). In the adjusted models, African Americans had lower rates of smoking and fair or poor self-rated health than whites, but no race differences in obesity, drinking, or physical inactivity. Our findings indicate that accounting for race differences in exposure to social conditions reduces or eliminates some health-related disparities. Moreover, these findings suggest that solutions to the seemingly intractable health disparities problem that target social determinants may be effective, especially those factors that are confounded with racial segregation. Future research in the area of health disparities should seek ways to account for confounding from SES and segregation.

  13. What Makes African American Health Disparities Newsworthy? An Experiment among Journalists about Story Framing

    ERIC Educational Resources Information Center

    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…

  14. Health and Social Issues Associated with Racial, Ethnic, and Cultural Disparities.

    ERIC Educational Resources Information Center

    Johnson, Jerry C.; Smith, Nancy H.

    2002-01-01

    The evidence of racial and ethnic disparities in health outcomes is overwhelming. Excess rates of death, morbidity, and disability are prevalent among racial and ethnic minority elders. Effective collaboration with community organizations is a crucial component of efforts to reduce and eliminate disparities. (Contains 39 references.) (Author/JOW)

  15. Addressing Health Disparities in the Undergraduate Curriculum: An Approach to Develop a Knowledgeable Biomedical Workforce

    ERIC Educational Resources Information Center

    Benabentos, Rocio; Ray, Payal; Kumar, Deepak

    2014-01-01

    Disparities in health and healthcare are a major concern in the United States and worldwide. Approaches to alleviate these disparities must be multifaceted and should include initiatives that touch upon the diverse areas that influence the healthcare system. Developing a strong biomedical workforce with an awareness of the issues concerning health…

  16. What Makes African American Health Disparities Newsworthy? An Experiment among Journalists about Story Framing

    ERIC Educational Resources Information Center

    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…

  17. Addressing Health Disparities in the Undergraduate Curriculum: An Approach to Develop a Knowledgeable Biomedical Workforce

    ERIC Educational Resources Information Center

    Benabentos, Rocio; Ray, Payal; Kumar, Deepak

    2014-01-01

    Disparities in health and healthcare are a major concern in the United States and worldwide. Approaches to alleviate these disparities must be multifaceted and should include initiatives that touch upon the diverse areas that influence the healthcare system. Developing a strong biomedical workforce with an awareness of the issues concerning health…

  18. The Science of Eliminating Health Disparities: Summary and Analysis of the NIH Summit Recommendations

    PubMed Central

    Rhee, Kyu B.; Williams, Kester; Sanchez, Idalia; Sy, Francisco S.; Stinson, Nathaniel; Ruffin, John

    2010-01-01

    In December 2008, the National Institutes of Health (NIH) sponsored the first NIH Summit showcasing its investment and contribution to health disparities research and unveiling a framework for moving this important field forward. The Summit, titled “The Science of Eliminating Health Disparities,” drew on extensive experience of experts leading health disparities research transformation in diverse fields. The Summit also provided a historic educational opportunity to contribute to health care reform. The theme, addressing disparities through integration of science, practice, and policy, introduced a paradigm for advancing research through transformational, translational, and transdisciplinary research. Engaging active participation throughout the Summit generated recommendations bridging science, practice, and policy, including action on social determinants of health, community engagement, broad partnerships, capacity-building, and media outreach. PMID:20147660

  19. The science of eliminating health disparities: summary and analysis of the NIH summit recommendations.

    PubMed

    Dankwa-Mullan, Irene; Rhee, Kyu B; Williams, Kester; Sanchez, Idalia; Sy, Francisco S; Stinson, Nathaniel; Ruffin, John

    2010-04-01

    In December 2008, the National Institutes of Health (NIH) sponsored the first NIH Summit showcasing its investment and contribution to health disparities research and unveiling a framework for moving this important field forward. The Summit, titled "The Science of Eliminating Health Disparities," drew on extensive experience of experts leading health disparities research transformation in diverse fields. The Summit also provided a historic educational opportunity to contribute to health care reform. The theme, addressing disparities through integration of science, practice, and policy, introduced a paradigm for advancing research through transformational, translational, and transdisciplinary research. Engaging active participation throughout the Summit generated recommendations bridging science, practice, and policy, including action on social determinants of health, community engagement, broad partnerships, capacity-building, and media outreach.

  20. Environmental Health Disparities: A Framework Integrating Psychosocial and Environmental Concepts

    PubMed Central

    Gee, Gilbert C.; Payne-Sturges, Devon C.

    2004-01-01

    Although it is often acknowledged that social and environmental factors interact to produce racial and ethnic environmental health disparities, it is still unclear how this occurs. Despite continued controversy, the environmental justice movement has provided some insight by suggesting that disadvantaged communities face greater likelihood of exposure to ambient hazards. The exposure–disease paradigm has long suggested that differential “vulnerability” may modify the effects of toxicants on biological systems. However, relatively little work has been done to specify whether racial and ethnic minorities may have greater vulnerability than do majority populations and, further, what these vulnerabilities may be. We suggest that psychosocial stress may be the vulnerability factor that links social conditions with environmental hazards. Psychosocial stress can lead to acute and chronic changes in the functioning of body systems (e.g., immune) and also lead directly to illness. In this article we present a multidisciplinary framework integrating these ideas. We also argue that residential segregation leads to differential experiences of community stress, exposure to pollutants, and access to community resources. When not counterbalanced by resources, stressors may lead to heightened vulnerability to environmental hazards. PMID:15579407

  1. New Perspectives on Health Disparities and Obesity Interventions in Youth

    PubMed Central

    2009-01-01

    Objective This article reviews intervention studies that address health disparities and the increasing rate of obesity in minority youth. The review focuses on interventions that target obesity-related behaviors (diet, physical activity, sedentary behaviors) and adiposity outcomes (body mass index) in minority children and adolescents. Methods A conceptual framework is presented that integrates ecological, cultural, social, and cognitive approaches to reducing obesity in ethnically diverse youth. The review highlights effective interventions in minority youth and distinguishes between culturally targeted and culturally tailored components. Results A limited number of studies have been conducted that target obesity-related behaviors and adiposity outcomes in minority youth. The most successful interventions for minority youth have incorporated culturally targeted and culturally tailored intervention components using multi-systemic approaches. Conclusions Further research is needed that focuses on testing the efficacy of theoretically based approaches that integrate culturally appropriate program elements for improving obesity-related behaviors and adiposity outcomes in minority youth. PMID:19223277

  2. Tobacco Use among Foster Youth: Evidence of Health Disparities

    PubMed Central

    Braciszewski, Jordan M.; Colby, Suzanne M.

    2015-01-01

    Youth aging out of foster care face a challenging road to independence. Following exposure to myriad risk factors such as abuse, neglect, parental substance use, and severe housing mobility, supportive services decrease upon exit from care, often increasing risk for substance use, homelessness, and unemployment. Although tobacco use is also highly prevalent, little attention has been paid to screening, assessment, and treatment of tobacco use in this vulnerable group. The current study (N = 116) reports on tobacco use prevalence, consequences, and co-occurrence with other substances in a sample of youth (ages 18 to 19) exiting the foster care system. In the face of an overall decrease in tobacco use among general population adolescents and young adults, results suggest disproportionate levels of lifetime, recent, and daily use among foster youth. Prevalence of recent tobacco use (46%) is nearly triple national rates, while daily smoking (32%) is almost four times that of general population young adults. Tobacco users were more likely than non-users to drink (70% vs. 40%) and to smoke marijuana (72% vs. 25%). We strongly encourage researchers and practitioners to increase attention to this tobacco-related health disparity. PMID:26478645

  3. Environmental health disparities: a framework integrating psychosocial and environmental concepts.

    PubMed

    Gee, Gilbert C; Payne-Sturges, Devon C

    2004-12-01

    Although it is often acknowledged that social and environmental factors interact to produce racial and ethnic environmental health disparities, it is still unclear how this occurs. Despite continued controversy, the environmental justice movement has provided some insight by suggesting that disadvantaged communities face greater likelihood of exposure to ambient hazards. The exposure-disease paradigm has long suggested that differential "vulnerability" may modify the effects of toxicants on biological systems. However, relatively little work has been done to specify whether racial and ethnic minorities may have greater vulnerability than do majority populations and, further, what these vulnerabilities may be. We suggest that psychosocial stress may be the vulnerability factor that links social conditions with environmental hazards. Psychosocial stress can lead to acute and chronic changes in the functioning of body systems (e.g., immune) and also lead directly to illness. In this article we present a multidisciplinary framework integrating these ideas. We also argue that residential segregation leads to differential experiences of community stress, exposure to pollutants, and access to community resources. When not counterbalanced by resources, stressors may lead to heightened vulnerability to environmental hazards.

  4. Translating disparities research to policy: a qualitative study of state mental health policymakers' perceptions of mental health care disparities report cards.

    PubMed

    Valentine, Anne; DeAngelo, Darcie; Alegría, Margarita; Cook, Benjamin L

    2014-11-01

    Report cards have been used to increase accountability and quality of care in health care settings, and to improve state infrastructure for providing quality mental health care services. However, to date, report cards have not been used to compare states on racial/ethnic disparities in mental health care. This qualitative study examines reactions of mental health care policymakers to a proposed mental health care disparities report card generated from population-based survey data of mental health and mental health care utilization. We elicited feedback about the content, format, and salience of the report card. Interviews were conducted with 9 senior advisors to state policymakers and 1 policy director of a national nongovernmental organization from across the United States. Four primary themes emerged: fairness in state-by-state comparisons; disconnect between the goals and language of policymakers and researchers; concerns about data quality; and targeted suggestions from policymakers. Participant responses provide important information that can contribute to making evidence-based research more accessible to policymakers. Further, policymakers suggested ways to improve the structure and presentation of report cards to make them more accessible to policymakers, and to foster equity considerations during the implementation of new health care legislation. To reduce mental health care disparities, effort is required to facilitate understanding between researchers and relevant stakeholders about research methods, standards for interpretation of research-based evidence, and its use in evaluating policies aimed at ameliorating disparities. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  5. Translating Disparities Research to Policy: A Qualitative Study of State Mental Health Policymakers' Perceptions of Mental Health Care Disparities Report Cards

    PubMed Central

    Valentine, Anne; DeAngelo, Darcie; Alegría, Margarita; Cook, Benjamin L.

    2014-01-01

    Report cards have been used to increase accountability and quality of care in health care settings, and to improve state infrastructure for providing quality mental health care services. However, to date, report cards have not been used to compare states on racial/ethnic disparities in mental health care. This qualitative study examines reactions of mental health care policymakers to a proposed mental health care disparities report card generated from population-based survey data of mental health and mental health care utilization. We elicited feedback about the content, format, and salience of the report card. Interviews were conducted with nine senior advisors to state policymakers and one policy director of a national non-governmental organization from across the U.S. Four primary themes emerged: fairness in state-by-state comparisons; disconnect between the goals and language of policymakers and researchers; concerns about data quality and; targeted suggestions from policymakers. Participant responses provide important information that can contribute to making evidence-based research more accessible to policymakers. Further, policymakers suggested ways to improve the structure and presentation of report cards to make them more accessible to policymakers and to foster equity considerations during the implementation of new health care legislation. To reduce mental health care disparities, effort is required to facilitate understanding between researchers and relevant stakeholders about research methods, standards for interpretation of research-based evidence and its use in evaluating policies aimed at ameliorating disparities. PMID:25383993

  6. The public health exposome: a population-based, exposure science approach to health disparities research.

    PubMed

    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

    2014-12-01

    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.

  7. The Public Health Exposome: A Population-Based, Exposure Science Approach to Health Disparities Research

    PubMed Central

    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

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

    PubMed

    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.

  9. Challenges in Covering Health Disparities in Local News Media: An Exploratory Analysis Assessing Views of Journalists

    PubMed Central

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

    2011-01-01

    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 conduc 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. PMID:20041281

  10. Influence of Hormonal Contraceptive Use and Health Beliefs on Sexual Orientation Disparities in Papanicolaou Test Use

    PubMed Central

    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

  11. The role of public policies in reducing mental health status disparities for people of color.

    PubMed

    Alegría, Margarita; Pérez, Debra Joy; Williams, Sandra

    2003-01-01

    Ethnic and racial disparities in mental health are driven by social factors such as housing, education, and income. Many of these social factors are different for minorities than they are for whites. Policies that address gaps in these social factors therefore can address mental health status disparities. We analyze three policies and their impact on minorities: the Individuals with Disability Education Act, Section 8 housing vouchers, and the Earned Income Tax Credit. Two of the three policies appear to have been effective in reducing social inequalities between whites and minorities. Expansion of public policies can be the mechanism to eliminate mental health status disparities for minorities.

  12. Global Perspectives on Cancer Health Disparities: Impact, Utility, and Implications for Cancer Nursing

    PubMed Central

    So, Winnie K. W.; Chan, Raymond Javan; Truant, Tracy; Trevatt, Paul; Bialous, Stella Aguinaga; Barton-Burke, Margaret

    2016-01-01

    This paper examines cancer health disparities and contributing factors at national, regional, and international levels. The authors all live in different countries and regions with different health-care systems and practices. Despite the shared cancer nursing perspective, each country or global region approaches cancer disparities differently. With globalization the world is becoming smaller, and in turn becoming interconnected and interdependent. This article focuses on cancer health disparities and global cancer nursing, exemplifying these concepts about the impact and implications of person-centered care. PMID:28083548

  13. Addressing health disparities in the undergraduate curriculum: an approach to develop a knowledgeable biomedical workforce.

    PubMed

    Benabentos, Rocio; Ray, Payal; Kumar, Deepak

    2014-01-01

    Disparities in health and healthcare are a major concern in the United States and worldwide. Approaches to alleviate these disparities must be multifaceted and should include initiatives that touch upon the diverse areas that influence the healthcare system. Developing a strong biomedical workforce with an awareness of the issues concerning health disparities is crucial for addressing this issue. Establishing undergraduate health disparities courses that are accessible to undergraduate students in the life sciences is necessary to increase students' understanding and awareness of these issues and motivate them to address these disparities during their careers. The majority of universities do not include courses related to health disparities in their curricula, and only a few universities manage them from their life sciences departments. The figures are especially low for minority-serving institutions, which serve students from communities disproportionally affected by health disparities. Universities should consider several possible approaches to infuse their undergraduate curricula with health disparities courses or activities. Eliminating health disparities will require efforts from diverse stakeholders. Undergraduate institutions can play an important role in developing an aware biomedical workforce and helping to close the gap in health outcomes. © 2014 R. Benabentos et al. CBE—Life Sciences Education © 2014 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

  14. Physician clinical information technology and health care disparities.

    PubMed

    Ketcham, Jonathan D; Lutfey, Karen E; Gerstenberger, Eric; Link, Carol L; McKinlay, John B

    2009-12-01

    The authors develop a conceptual framework regarding how information technology (IT) can alter within-physician disparities, and they empirically test some of its implications in the context of coronary heart disease. Using a random experiment on 256 primary care physicians, the authors analyze the relationships between three IT functions (feedback and two types of clinical decision support) and five process-of-care measures. Endogeneity is addressed by eliminating unobserved patient characteristics with vignettes and by proxying for omitted physician characteristics. The results indicate that IT has no effects on physicians' diagnostic certainty and treatment of vignette patients overall. The authors find that treatment and certainty differ by patient age, gender, and race. Consistent with the framework, IT's effects on these disparities are complex. Feedback eliminated the gender disparities, but the relationships differed for other IT functions and process measures. Current policies to reduce disparities and increase IT adoption may be in discord.

  15. An exploratory multilevel analysis of income, income inequality and self-rated health of the elderly in China

    PubMed Central

    Feng, Zhixin; Wang, Wenfei Winnie; Jones, Kelvyn; Li, Yaqing

    2013-01-01

    In the last three decades, China has experienced rapid economic development and growing economic inequality, such that economic disparities between rural and urban areas, as well as coastal and interior areas have deepened. Since the late 1990s China has also experienced an ageing population which has attracted attention to the wellbeing of the rapidly growing number of elderly. This research aims to characterise province differences in health and to explore the effects of individual income and economic disparity in the form of income inequality on health outcomes of the elderly. The study is based on the Chinese Longitudinal Healthy Longevity Survey data collected in 2008 for 23 provinces. Multilevel logistic models are employed to investigate the relationship between income, income inequality and self-rated health for the elderly using both individual and province-level variables. Results are presented as relative odds ratios, and for province differentials as Median Odds Ratios. The analysis is deliberately exploratory so as to find evidence of income effects if they exist and particular attention is placed on how province-level inequality (contemporaneous and lagged) may moderate individual relationships. The results show that the health of the elderly is not only affected by individual income (the odds of poor health are 3 times greater for the elderly with the lowest income compared to those at the upper quartile) but also by a small main effect for province-level income inequality (odds ratio of 1.019). There are significant cross-level interactions such that where inequality is high there are greater differences between those with and without formal education, and between men and women with the latter experiencing poorer health. PMID:23063218

  16. From Documenting to Eliminating Disparities in Mental Health Care for Latinos

    ERIC Educational Resources Information Center

    Lopez, Steven R.; Barrio, Concepcion; Kopelowicz, Alex; Vega, William A.

    2012-01-01

    The U.S. Surgeon General's report "Mental Health: Culture, Race and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General" (U.S. Department of Health and Human Services, 2001) identified significant disparities in mental health care for Latinos and recommended directions for future research and mental health services. We update…

  17. From Documenting to Eliminating Disparities in Mental Health Care for Latinos

    ERIC Educational Resources Information Center

    Lopez, Steven R.; Barrio, Concepcion; Kopelowicz, Alex; Vega, William A.

    2012-01-01

    The U.S. Surgeon General's report "Mental Health: Culture, Race and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General" (U.S. Department of Health and Human Services, 2001) identified significant disparities in mental health care for Latinos and recommended directions for future research and mental health services. We update…

  18. Toward a Fourth Generation of Disparities Research to Achieve Health Equity

    PubMed Central

    Thomas, Stephen B.; Quinn, Sandra Crouse; Butler, James; Fryer, Craig S.; Garza, Mary A.

    2011-01-01

    Achieving health equity, driven by the elimination of health disparities, is a goal of Healthy People 2020. In recent decades, the improvement in health status has been remarkable for the U.S. population as a whole. However, racial and ethnic minority populations continue to lag behind whites with a quality of life diminished by illness from preventable chronic diseases and a life span cut short by premature death. We examine a conceptual framework of three generations of health disparities research to understand (a) data trends, (b) factors driving disparities, and (c) solutions for closing the gap. We propose a new, fourth generation of research grounded in public health critical race praxis, utilizing comprehensive interventions to address race, racism, and structural inequalities and advancing evaluation methods to foster our ability to eliminate disparities. This new generation demands that we address the researcher’s own biases as part of the research process. PMID:21219164

  19. Toward a fourth generation of disparities research to achieve health equity.

    PubMed

    Thomas, Stephen B; Quinn, Sandra Crouse; Butler, James; Fryer, Craig S; Garza, Mary A

    2011-01-01

    Achieving health equity, driven by the elimination of health disparities, is a goal of Healthy People 2020. In recent decades, the improvement in health status has been remarkable for the U.S. population as a whole. However, racial and ethnic minority populations continue to lag behind whites with a quality of life diminished by illness from preventable chronic diseases and a life span cut short by premature death. We examine a conceptual framework of three generations of health disparities research to understand (a) data trends, (b) factors driving disparities, and (c) solutions for closing the gap. We propose a new, fourth generation of research grounded in public health critical race praxis, utilizing comprehensive interventions to address race, racism, and structural inequalities and advancing evaluation methods to foster our ability to eliminate disparities. This new generation demands that we address the researcher's own biases as part of the research process.

  20. Review of State Legislative Approaches to Eliminating Racial and Ethnic Health Disparities, 2002–2011

    PubMed Central

    Pollack, Keshia; Rutkow, Lainie

    2015-01-01

    We conducted a legal mapping study of state bills related to racial/ethnic health disparities in all 50 states between 2002 and 2011. Forty-five states introduced at least 1 bill that specifically targeted racial/ethnic health disparities; we analyzed 607 total bills. Of these 607 bills, 330 were passed into law (54.4%). These bills approached eliminating racial/ethnic health disparities by developing governmental infrastructure, providing appropriations, and focusing on specific diseases and data collection. In addition, states tackled emerging topics that were previously lacking laws, particularly Hispanic health. Legislation is an important policy tool for states to advance the elimination of racial/ethnic health disparities. PMID:25905834

  1. Understanding observed and unobserved health care access and utilization disparities among US Latino adults.

    PubMed

    Vargas Bustamante, Arturo; Fang, Hai; Rizzo, John A; Ortega, Alexander N

    2009-10-01

    This study hypothesizes that differences in health care access and utilization exist across Latino adults (>18 years), with U.S. Latino adults of Mexican ancestry demonstrating the worst patterns of access and utilization. The analyses use the National Health Interview Survey (NHIS) data from 1999 to 2007 (N = 33,908). The authors first estimate the disparities in health care access and utilization among different categories of Latinos. They also implement Blinder-Oaxaca techniques to decompose disparities into observed and unobserved components, comparing Latinos of Mexican ancestry with non-Mexican Latinos. Latinos of Mexican ancestry consistently demonstrate lower health care access and utilization patterns than non-Mexican Latinos. Health insurance and region of residence were the most important factors that explained observable differences. In contrast, language and citizenship status were relatively unimportant. Although a significant share of these disparities may be explained by observed characteristics, disparities because of unobserved heterogeneity among the different Latino cohorts are also considerable.

  2. The contributing role of health-care communication to health disparities for minority patients with asthma.

    PubMed

    Diette, Gregory B; Rand, Cynthia

    2007-11-01

    Asthma is a common, chronic illness with substantial morbidity, especially for racial and ethnic minorities in the United States. The care of the patient with asthma is complex and depends ideally on excellent communication between patients and health-care providers. Communication is essential for the patient to communicate the severity of his or her illness, as well as for the health-care provider to instruct patients on pharmacologic and nonpharmacologic care. This article describes evidence for poor provider/patient communication as a contributor to health-care disparities for minority patients with asthma. Communication problems stem from issues with patients, health-care providers, and health-care systems. It is likely that asthma disparities can be improved, in part, by improving patient/provider communication. While much is known presently about the problem of patient/provider communication in asthma, there is a need to improve and extend the evidence base on the role of effective communication of asthma care and the links to outcomes for minorities. Additional studies are needed that document the extent to which problems with doctor/patient communication lead to inadequate care and poor outcomes for minorities with asthma, as well as mechanisms by which these disparities occur.

  3. Health journalism internships: a social marketing strategy to address health disparities.

    PubMed

    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.

  4. Health Journalism Internships: A Social Marketing Strategy to Address Health Disparities

    PubMed Central

    Nguyen, Duy H.; Shimasaki, Suzuho; Stafford, Helen Shi

    2010-01-01

    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. PMID:20186519

  5. Devising, implementing, and evaluating interventions to eliminate health care disparities in minority children.

    PubMed

    Flores, Glenn

    2009-11-01

    Despite an accumulating body of literature addressing racial/ethnic disparities in children's health and health care, there have been few published studies of interventions that have been successful in eliminating these disparities. The objectives of this article, therefore, are to (1) describe 3 interventions that have been successful in eliminating racial/ethnic disparities in children's health and health care, (2) highlight tips and pitfalls regarding devising, implementing, and evaluating pediatric disparities interventions, and (3) propose a research agenda for pediatric disparities interventions. Key characteristics of the 3 successful interventions include rigorous study designs; large sample sizes; appropriate comparison groups; community-based interventions that are culturally and linguistically sensitive and involve collaboration with participants; research staff from the same community as the participants; appropriate blinding of outcomes assessors; and statistical adjustment of outcomes for relevant covariates. On the basis of these characteristics, I propose tips, pitfalls, an approach, and a research agenda for devising, implementing, and evaluating successful pediatric disparities interventions. Examination of 3 successful interventions indicates that pediatric health care disparities can be eliminated. Achievement of this goal requires an intervention that is rigorous, evidence-based, and culturally and linguistically appropriate. The intervention must also include community collaboration, minimize attrition, adjust for potential confounders, and incorporate mechanisms for sustainability.

  6. Devising, Implementing, and Evaluating Interventions to Eliminate Health Care Disparities in Minority Children

    PubMed Central

    Flores, Glenn

    2010-01-01

    Despite an accumulating body of literature addressing racial/ethnic disparities in children’s health and health care, there have been few published studies of interventions that have been successful in eliminating these disparities. The objectives of this article, therefore, are to (1) describe 3 interventions that have been successful in eliminating racial/ethnic disparities in children’s health and health care, (2) high-light tips and pitfalls regarding devising, implementing, and evaluating pediatric disparities interventions, and (3) propose a research agenda for pediatric disparities interventions. Key characteristics of the 3 successful interventions include rigorous study designs; large sample sizes; appropriate comparison groups; community-based interventions that are culturally and linguistically sensitive and involve collaboration with participants; research staff from the same community as the participants; appropriate blinding of outcomes assessors; and statistical adjustment of outcomes for relevant covariates. On the basis of these characteristics, I propose tips, pitfalls, an approach, and a research agenda for devising, implementing, and evaluating successful pediatric disparities interventions. Examination of 3 successful interventions indicates that pediatric health care disparities can be eliminated. Achievement of this goal requires an intervention that is rigorous, evidence-based, and culturally and linguistically appropriate. The intervention must also include community collaboration, minimize attrition, adjust for potential confounders, and incorporate mechanisms for sustainability. PMID:19861473

  7. Mapping the Quebec dental workforce: ranking rural oral health disparities.

    PubMed

    Emami, Elham; Khiyani, Muhammad Faheem; Habra, Carl Patrick; Chassé, Véronique; Rompré, Pierre H

    2016-01-01

    Ensuring access to oral health services is crucial for improving the oral health of rural and remote populations. A logical step towards addressing oral health disparities and underutilization of services in rural areas is to ensure the availability of the dental workforce. Geographical information systems are valuable in examining workforce dispersion patterns and identifying priority areas requiring administrative and policy attention. The objective of this study was to examine and map the distribution patterns of the dental workforce in Quebec, Canada. Utilizing the membership directory of Quebec Professional Orders (2009-2010), data on practice locations, practice types and license issue date for all active members of the Quebec dental workforce were obtained. This was followed by reverse geocoding of the geographic coordinates using a global positioning system visualizer to reveal textual locations. These locations were classified according to various degrees of rurality as defined by the 2006 Census Metropolitan Area and Census Agglomeration Influenced Zone typology, developed by Statistics Canada. Cartography layers were extracted from a geospatial database provided by Canada Natural Resources using ArcGIS 9.3. Descriptive and bivariate analyses were performed using SPSS v17 for Windows. Data analysis revealed statistically significant differences in the distribution of dental professionals in rural and urban areas (urban 59.4±19.4/100 000 vs rural 39.9±17.6/100 000; p<0.001). Approximately 90.3% of the dental workforce was located in urban zones, 1.3% in the zones strongly influenced by metropolitan area, 4.9% in the moderately influenced zones, while only 0.3% of the dental workforce was located in non-metropolitan-influenced zones. Urban zones such as Montreal, Quebec and Sherbrooke had the highest workforce availability (4-6 dentists for every 5000 inhabitants). Of a total of 447 specialist dentists in Quebec, only five were located in rural areas

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

    PubMed Central

    Jennings, Viniece; Johnson Gaither, Cassandra

    2015-01-01

    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. PMID:25674782

  9. Approaching environmental health disparities and green spaces: an ecosystem services perspective.

    PubMed

    Jennings, Viniece; Gaither, Cassandra Johnson

    2015-02-10

    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.

  10. Aberrant DNA Methylation: Implications in Racial Health Disparity

    PubMed Central

    Wang, Xuefeng; Ji, Ping; Zhang, Yuanhao; LaComb, Joseph F.; Tian, Xinyu; Li, Ellen; Williams, Jennie L.

    2016-01-01

    Background 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. Materials and Methods 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. Results 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. Conclusion DNA methylation profile and/or products of its downstream targets could serve as biomarker(s) addressing racial health disparity. PMID:27111221

  11. Positive Parenting Practices, Health Disparities, and Developmental Progress

    PubMed Central

    Sobotka, Sarah A.; Chen, Yi-Fan; Msall, Michael E.

    2015-01-01

    OBJECTIVE: To describe interactive activities between parents and young children in a nationally representative sample. We hypothesized that the frequency of participation in interactive activities would be different across economic strata and would be associated with developmental delay. METHODS: Children 4 to 36 months of age were identified by using The National Survey of Children’s Health 2011–2012. Interactive caregiving practices were reported by poverty status. Developmental concerns were derived from caregiver responses and scoring of the Parents Evaluation of Developmental Status. Multivariable logistic regressions with weighting were used to explore the effect of interactive practices on risk for developmental delay across poverty levels. Covariates including age, gender, insurance type, maternal education, parenting stress, and ethnicity were adjusted in the models. RESULTS: In our sample (n = 12 642), caregivers with the lowest income versus highest income reported lower participation in reading (33% vs 64%; P < .0001), singing or telling stories (52% vs 77%, P < .0001), and taking their child on an outing (13% vs 22%, P < .0001). Less frequent participation in interactive activities during the week were associated with increased risk of developmental delay among low-income families (Reading odds ratio [OR] 1.57, 95% confidence interval [CI] 1.15–2.13; Singing songs/Telling Stories OR 1.66, 95% CI 1.15–2.40; Outings OR 1.48, 95% CI 1.11–1.97). CONCLUSIONS: Despite evidence emphasizing the protective effects of supportive parenting practices on early child development, our work demonstrates significant disparities in parenting practices that promote early child development between economically advantaged and disadvantaged parents. Innovative population-level strategies that enrich parenting practices for vulnerable children in early childhood are needed. PMID:26216325

  12. Genomic Basis of Prostate Cancer Health Disparity Among African-American Men

    DTIC Science & Technology

    2014-07-01

    Cancer Health Disparity Among African-American Men PRINCIPAL INVESTIGATOR: Harry Ostrer, M.D. RECIPIENT: Albert Einstein College of...ORGANIZATION REPORT NUMBER Albert Einstein College of Medicine Of Yeshiva University Bronx, NY 10461 9. SPONSORING

  13. Adaptation to study design challenges in rural health disparities community research

    USDA-ARS?s Scientific Manuscript database

    Intervention research in rural health disparities communities presents challenges for study design, implementation, and evaluation, thus threatening scientific rigor, reducing response rates, and confounding study results. A multisite nutrition intervention was conducted in the rural Lower Mississip...

  14. Effects of social, economic, and labor policies on occupational health disparities.

    PubMed

    Siqueira, Carlos Eduardo; Gaydos, Megan; Monforton, Celeste; Slatin, Craig; Borkowski, Liz; Dooley, Peter; Liebman, Amy; Rosenberg, Erica; Shor, Glenn; Keifer, Matthew

    2014-05-01

    This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States. 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. 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. 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. © 2013 Wiley Periodicals, Inc.

  15. Do in utero events contribute to current health disparities in reproductive medicine?

    PubMed

    Sauerbrun-Cutler, May-Tal; Segars, James H

    2013-09-01

    Health disparities exist in reproductive medicine as discussed in detail in the subsequent articles of this issue; however, in most cases, the exact cause of these differences is unknown. Some of these disparities can be linked to environmental exposures such as alcohol and other hazardous toxic exposures (polycarbonate, pesticides, nicotine) in adults. In addition, low socioeconomic status, behavioral risk factors, and lack of education have been linked to poor obstetric and reproductive outcomes in minority groups. Aside from these various environmental exposures later in life, there is evidence that adverse events in utero could contribute to poor reproductive outcome in specific minority groups. We will focus on the developmental origins of health and disease as a possible causal mechanism for health disparities in reproductive diseases, as this perspective may suggest tractable solutions of how to address and eliminate these health disparities.

  16. A Multifaceted Mentoring Model for Minority Researchers to Address HIV Health Disparities

    PubMed Central

    Santiago, Lydia E.; Zorrilla, Carmen D.

    2009-01-01

    In an era of significant biomedical advances in the treatment of HIV, health disparities still persist. The participation of minority researchers brings new perspectives to health-disparities research. Mentoring is key to this process. We present the multifaceted mentoring model that evolved in the Puerto Rico Comprehensive Center for the Study of HIV Disparities and the Mentoring Institute for HIV and Mental Health. The model includes (1) multi-institutional collaborations, (2) competency development, and (3) cross-disciplinary teams. These aspects of the model provide guidelines for institutions seeking to formalize mentoring programs while addressing the complexities of health disparities. The competency development component is a powerful tool in assessing and supporting the researchers. Further explorations on the applicability of the model are encouraged. PMID:19246663

  17. Clinical Cultural Competency and Knowledge of Health Disparities Among Pharmacy Students

    PubMed Central

    Odedina, Folakemi T.; Reams, Romonia R.; Smith, W. Thomas

    2012-01-01

    Objective. 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. Methods. A cross-sectional survey study design was used to collect data from participants. Results. 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. Conclusions. 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. PMID:22544957

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

    PubMed

    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.

  19. From documenting to eliminating disparities in mental health care for Latinos.

    PubMed

    López, Steven R; Barrio, Concepcion; Kopelowicz, Alex; Vega, William A

    2012-10-01

    The U.S. Surgeon General's report Mental Health: Culture, Race and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services, 2001) identified significant disparities in mental health care for Latinos and recommended directions for future research and mental health services. We update that report by reviewing five groundbreaking research projects on the mental health of Latinos that were published since 2001. National studies of adults and children, longitudinal designs, and analyses of Latino subgroups characterize these investigations. Despite the increasing sophistication of disparities research, these landmark studies, as well as the research in the supplemental report, can be characterized as documenting disparities in care. We argue that the next wave of research should give greater attention to reducing and eliminating disparities. Accordingly, we apply Rogler and Cortes's (1993) framework of pathways to care to the study of Latinos with schizophrenia. Specifically, we draw on research regarding the recognition of illness, social networks (families) and their association with the course of illness, and interventions. We illustrate examples at each pathway that have the potential to reduce disparities. We argue that implementing interventions synchronously across multiple pathways has considerable potential to reduce and eventually eliminate disparities in mental health care.

  20. Disparities in child health in the Arab region during the 1990s

    PubMed Central

    Khawaja, Marwan; Dawns, Jesse; Meyerson-Knox, Sonya; Yamout, Rouham

    2008-01-01

    Background While Arab countries showed an impressive decline in child mortality rates during the past few decades, gaps in mortality by gender and socioeconomic status persisted. However, large socioeconomic disparities in child health were evident in almost every country in the region. Methods Using available tabulations and reliable micro data from national household surveys, data for 18 Arab countries were available for analysis. In addition to infant and child mortality, child health was measured by nutritional status, vaccination, and Acute Respiratory Infection (ARI). Within-country disparities in child health by gender, residence (urban/rural) and maternal educational level were described. Child health was also analyzed by macro measures of development, including per capita GDP (PPP), female literacy rates, urban population and doctors per 100,000 people. Results Gender disparities in child health using the above indicators were less evident, with most showing clear female advantage. With the exception of infant and child survival, gender disparities demonstrated a female advantage, as well as a large urban advantage and an overall advantage for mothers with secondary education. Surprisingly, the countries' rankings with respect to disparities were not associated with various macro measures of development. Conclusion The tenacity of pervasive intra-country socioeconomic disparities in child health calls for attention by policy makers and health practitioners. PMID:19021903

  1. Racial and ethnic disparities in the use of health services: bias, preferences, or poor communication?

    PubMed

    Ashton, Carol M; Haidet, Paul; Paterniti, Debora A; Collins, Tracie C; Gordon, Howard S; O'Malley, Kimberly; Petersen, Laura A; Sharf, Barbara F; Suarez-Almazor, Maria E; Wray, Nelda P; Street, Richard L

    2003-02-01

    African Americans and Latinos use services that require a doctor's order at lower rates than do whites. Racial bias and patient preferences contribute to disparities, but their effects appear small. Communication during the medical interaction plays a central role in decision making about subsequent interventions and health behaviors. Research has shown that doctors have poorer communication with minority patients than with others, but problems in doctor-patient communication have received little attention as a potential cause, a remediable one, of health disparities. We evaluate the evidence that poor communication is a cause of disparities and propose some remedies drawn from the communication sciences.

  2. Racial and Ethnic Health Disparities and the Affordable Care Act: a Status Update.

    PubMed

    Sealy-Jefferson, Shawnita; Vickers, Jasmine; Elam, Angela; Wilson, M Roy

    2015-12-01

    Persistent racial and ethnic health disparities exist in the USA, despite decades of research and public health initiatives. Several factors contribute to health disparities, including (but not limited to) implicit provider bias, access to health care, social determinants, and biological factors. Disparities in health by race/ethnicity are unacceptable and correctable. The Patient Protection and Affordable Care Act is a comprehensive legislation that is focused on improving health care access, quality, and cost control. This health care reform includes specific provisions which focus on preventive care, the standardized collection of data on race, ethnicity, primary language and disability status, and health information technology. Although some provisions of the Patient Protection and Affordable Care Act have not been implemented, such as funding for the U.S. Public Health Sciences track, which would have addressed the shortage of medical professionals in the USA who are trained to use patient-centered, interdisciplinary, and care coordination approaches, this legislation is still poised to make great strides toward eliminating health disparities. The purpose of this manuscript is to highlight the unprecedented opportunities that exist for the Patient Protection and Affordable Care Act to reduce racial and ethnic disparities in health in the USA.

  3. Racial and Ethnic Health Disparities and the Affordable Care Act: a Status Update

    PubMed Central

    Sealy-Jefferson, Shawnita; Vickers, Jasmine; Elam, Angela; Wilson, M. Roy

    2015-01-01

    Persistent racial and ethnic health disparities exist in the USA, despite decades of research and public health initiatives. Several factors contribute to health disparities, including (but not limited to) implicit provider bias, access to health care, social determinants, and biological factors. Disparities in health by race/ethnicity are unacceptable and correctable. The Patient Protection and Affordable Care Act is a comprehensive legislation that is focused on improving health care access, quality, and cost control. This health care reform includes specific provisions which focus on preventive care, the standardized collection of data on race, ethnicity, primary language and disability status, and health information technology. Although some provisions of the Patient Protection and Affordable Care Act have not been implemented, such as funding for the U.S. Public Health Sciences track, which would have addressed the shortage of medical professionals in the USA who are trained to use patient-centered, interdisciplinary, and care coordination approaches, this legislation is still poised to make great strides toward eliminating health disparities. The purpose of this manuscript is to highlight the unprecedented opportunities that exist for the Patient Protection and Affordable Care Act to reduce racial and ethnic disparities in health in the USA. PMID:26668787

  4. DEFINING THE “COMMUNITY” FOR A COMMUNITY-BASED PUBLIC HEALTH INTERVENTION ADDRESSING LATINO IMMIGRANT HEALTH DISPARITIES: AN APPLICATION OF ETHNOGRAPHIC METHODS

    PubMed Central

    Edberg, Mark; Cleary, Sean; Simmons, Lauren B.; Cubilla-Batista, Idalina; Andrade, Elizabeth L.; Gudger, Glencora

    2015-01-01

    Although Latino and other immigrant populations are the driving force behind population increases in the U.S., there are significant gaps in knowledge and practice on addressing health disparities in these populations. The Avance Center for the Advancement of Immigrant/Refugee Health, a health disparities research center in the Washington, DC area, includes as part of its mission a multi-level, participatory community intervention (called Adelante) to address the co-occurrence of substance abuse, violence and sex risk among Latino immigrant youth and young adults. Research staff and community partners knew that the intervention community had grown beyond its Census-designated place (CDP) boundaries, and that connection and attachment to community were relevant to an intervention. Thus, in order to understand current geographic and social boundaries of the community for sampling, data collection, intervention design and implementation, the research team conducted an ethnographic study to identify self-defined community boundaries, both geographic and social. Beginning with preliminary data from a pilot intervention and the original CDP map, the research included: geo-mapping de-identified addresses of service clients from a major community organization; key informant interviews; and observation and intercept interviews in the community. The results provided an expanded community boundary profile and important information about community identity. PMID:25892743

  5. DEFINING THE "COMMUNITY" FOR A COMMUNITY-BASED PUBLIC HEALTH INTERVENTION ADDRESSING LATINO IMMIGRANT HEALTH DISPARITIES: AN APPLICATION OF ETHNOGRAPHIC METHODS.

    PubMed

    Edberg, Mark; Cleary, Sean; Simmons, Lauren B; Cubilla-Batista, Idalina; Andrade, Elizabeth L; Gudger, Glencora

    2015-01-01

    Although Latino and other immigrant populations are the driving force behind population increases in the U.S., there are significant gaps in knowledge and practice on addressing health disparities in these populations. The Avance Center for the Advancement of Immigrant/Refugee Health, a health disparities research center in the Washington, DC area, includes as part of its mission a multi-level, participatory community intervention (called Adelante) to address the co-occurrence of substance abuse, violence and sex risk among Latino immigrant youth and young adults. Research staff and community partners knew that the intervention community had grown beyond its Census-designated place (CDP) boundaries, and that connection and attachment to community were relevant to an intervention. Thus, in order to understand current geographic and social boundaries of the community for sampling, data collection, intervention design and implementation, the research team conducted an ethnographic study to identify self-defined community boundaries, both geographic and social. Beginning with preliminary data from a pilot intervention and the original CDP map, the research included: geo-mapping de-identified addresses of service clients from a major community organization; key informant interviews; and observation and intercept interviews in the community. The results provided an expanded community boundary profile and important information about community identity.

  6. Health Care Disparities of Ohioans With Developmental Disabilities Across the Lifespan.

    PubMed

    Prokup, Jessica A; Andridge, Rebecca; Havercamp, Susan M; Yang, Emily A

    2017-09-01

    We explored health care differences across the lifespan comparing people with developmental disabilities to people without developmental disabilities. Health care disparities are inequities occurring during the provision of and in access to health care that are experienced by socially disadvantaged populations. We discovered significant disparities between persons with and without developmental disabilities in health status, quality, utilization, access, and unmet health care needs. Our results highlight the need to educate health care clinicians on the care of patients with developmental disabilities of all ages. © 2017 Annals of Family Medicine, Inc.

  7. Envisioning and advancing marginalized men's health disparities scholarship: the marginality-cultural competence integrative framework (M-CCIF).

    PubMed

    Willis, Danny G; Porche, Demetrius J

    2006-05-01

    Given the current focus of the National Institutes of Health (NIH) on eliminating health disparities among minority populations, a substantive body of culturally competent scholarship about marginalized men's health disparities is needed to add knowledge about the complex features, processes, and relationships underlying health disparities, marginality, men's health, interventions, and clinical outcomes. Marginalized men in the United States suffer disproportionately from mental and chronic health problems. Historically disadvantaged, their voices have not been privileged in health care and clinical discourses. Utilizing the concepts of marginalization and culturally competent scholarship, an integrative framework has been created to facilitate clinicians and scholars in envisioning and advancing critical scholarship related to marginalized men's health disparities.

  8. Welfare state regimes, health and health inequalities in adolescence: a multilevel study in 32 countries.

    PubMed

    Richter, Matthias; Rathman, Katharina; Nic Gabhainn, Saoirse; Zambon, Alessio; Boyce, William; Hurrelmann, Klaus

    2012-07-01

    Comparative research on health and health inequalities has recently started to establish a welfare regime perspective. The objective of this study was to determine whether different welfare regimes are associated with health and health inequalities among adolescents. Data were collected from the 'Health Behaviour in School-aged Children' study in 2006, including 11- to 15-year-old students from 32 countries (N = 141,091). Prevalence rates and multilevel logistic regression models were calculated for self-rated health (SRH) and health complaints. The results show that between 4 per cent and 7 per cent of the variation in both health outcomes is attributable to differences between countries. Compared to the Scandinavian regime, the Southern regime had lower odds ratios for SRH, while for health complaints the Southern and Eastern regime showed high odds ratios. The association between subjective health and welfare regime was largely unaffected by adjusting for individual socioeconomic position. After adjustment for the welfare regime typology, the country-level variations were reduced to 4.6 per cent for SRH and to 2.9 per cent for health complaints. Regarding cross-level interaction effects between welfare regimes and socioeconomic position, no clear regime-specific pattern was found. Consistent with research on adults this study shows that welfare regimes are important in explaining variations in adolescent health across countries.

  9. Racial disparities in context: a multilevel analysis of neighborhood variations in poverty and excess mortality among black populations in Massachusetts.

    PubMed

    Subramanian, S V; Chen, Jarvis T; Rehkopf, David H; Waterman, Pamela D; Krieger, Nancy

    2005-02-01

    We analyzed neighborhood heterogeneity in associations among mortality, race/ethnicity, and area poverty. We performed a multilevel statistical analysis of Massachusetts all-cause mortality data for the period 1989 through 1991 (n=142836 deaths), modeled as 79813 cells (deaths and denominators cross-tabulated by age, gender, and race/ethnicity) at level 1 nested within 5532 block groups at level 2 within 1307 census tracts (CTs) at level 3. We also characterized CTs by percentage of the population living below poverty level. Neighborhood variation in mortality across CTs and block groups was not accounted for by these areas' age, gender, and racial/ethnic composition. Neighborhood variation in mortality was much greater for the Black population than for the White population, largely because of CT-level variation in poverty rates. Neighborhood heterogeneity in the relationship between mortality and race/ethnicity in Massachusetts is statistically significant and is closely related to CT-level variation in poverty.

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

    PubMed

    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

  11. Multidisciplinary design and analytic approaches to advance prospective research on the multilevel determinants of child health.

    PubMed

    Johnson, Sara B; Little, Todd D; Masyn, Katherine; Mehta, Paras D; Ghazarian, Sharon R

    2017-06-01

    Characterizing the determinants of child health and development over time, and identifying the mechanisms by which these determinants operate, is a research priority. The growth of precision medicine has increased awareness and refinement of conceptual frameworks, data management systems, and analytic methods for multilevel data. This article reviews key methodological challenges in cohort studies designed to investigate multilevel influences on child health and strategies to address them. We review and summarize methodological challenges that could undermine prospective studies of the multilevel determinants of child health and ways to address them, borrowing approaches from the social and behavioral sciences. Nested data, variation in intervals of data collection and assessment, missing data, construct measurement across development and reporters, and unobserved population heterogeneity pose challenges in prospective multilevel cohort studies with children. We discuss innovations in missing data, innovations in person-oriented analyses, and innovations in multilevel modeling to address these challenges. Study design and analytic approaches that facilitate the integration across multiple levels, and that account for changes in people and the multiple, dynamic, nested systems in which they participate over time, are crucial to fully realize the promise of precision medicine for children and adolescents. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. The Current Scope of Health Disparities in the U.S.: A Review of Literature

    ERIC Educational Resources Information Center

    Pettit, Michele L.; Nienhaus, Alyson R.

    2010-01-01

    This review of literature examines leading contributors and mediators of health disparities in the United States. Specifically, poverty, education, and health are addressed. Special emphasis is placed on implications of health risk behaviors and health education for select populations and settings. Existing and suggested strategies for addressing…

  13. 77 FR 15780 - New Proposed Collection; Comment Request: Child Health Disparities Measurement for the National...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-16

    ... used to assess and validate measures of health literacy, discrimination, parenting self-efficacy, and... interest to the NCS because studies have shown that health literacy, discrimination, parenting self-efficacy, health care (access, utilization, and quality) contribute to health disparities....

  14. Editorial: 2nd Special Issue on behavior change, health, and health disparities

    PubMed Central

    Higgins, Stephen T.

    2016-01-01

    This Special Issue of Preventive Medicine (PM) is the 2nd that we have organized on behavior change, health, and health disparities. This is a topic of fundamental importance to improving population health in the U.S. and other industrialized countries that are trying to more effectively manage chronic health conditions. There is broad scientific consensus that personal behavior patterns 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. As such behavior change needs to be a key component of improving population health. There is also broad agreement that while these problems extend across socioeconomic strata, they are overrepresented among more economically disadvantaged populations and contribute directly to the growing problem of health disparities. Hence, behavior change represents an essential step in curtailing that unsettling problem as well. In this 2nd Special Issue, we devote considerable space to the current U.S. prescription opioid addiction epidemic, a crisis that was not addressed in the prior Special Issue. We also continue to devote attention to the two largest contributors to preventable disease and premature death, cigarette smoking and physical inactivity/obesity as well as risks of co-occurrence of these unhealthy behavior patterns. Across each of these topics we included contributions from highly accomplished policymakers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges to effectively managing these important chronic health problems. PMID:26257372

  15. Editorial: 2nd Special Issue on behavior change, health, and health disparities.

    PubMed

    Higgins, Stephen T

    2015-11-01

    This Special Issue of Preventive Medicine (PM) is the 2nd that we have organized on behavior change, health, and health disparities. This is a topic of fundamental importance to improving population health in the U.S. and other industrialized countries that are trying to more effectively manage chronic health conditions. There is broad scientific consensus that personal behavior patterns 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. As such behavior change needs to be a key component of improving population health. There is also broad agreement that while these problems extend across socioeconomic strata, they are overrepresented among more economically disadvantaged populations and contribute directly to the growing problem of health disparities. Hence, behavior change represents an essential step in curtailing that unsettling problem as well. In this 2nd Special Issue, we devote considerable space to the current U.S. prescription opioid addiction epidemic, a crisis that was not addressed in the prior Special Issue. We also continue to devote attention to the two largest contributors to preventable disease and premature death, cigarette smoking and physical inactivity/obesity as well as risks of co-occurrence of these unhealthy behavior patterns. Across each of these topics we included contributions from highly accomplished policy makers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges to effectively managing these important chronic health problems.

  16. The impact of health information technology on disparity of process of care.

    PubMed

    Lee, Jinhyung

    2015-04-01

    Disparities in the quality of health care and treatment among racial or ethnic groups can result from unequal access to medical care, disparate treatments for similar severities of symptoms, and wide divergence in general health status among individuals. Such disparities may be eliminated through better use of health information technology (IT). Investment in health IT could foster better coordinated care, improve guideline compliance, and reduce the likelihood of redundant testing, thereby encouraging more equitable treatment for underprivileged populations. However, there is little research exploring the impact of health IT investment on disparities of process of care. This study examines the impact of health IT investment on waiting times - from admission to the date of first principle procedure - among different racial and ethnic groups, using patient and hospital data for the state of California collected from 2001 to 2007. The final sample includes 14,056,930 patients admitted with medical diseases to 316 unique, acute-care hospitals over a seven-year period. The linear random intercept and slope model was employed to examine the impacts of health IT investment on waiting time, while controlling for patient, disease, and hospital characteristics. Greater health IT investment was associated with shorter waiting times, and the reduction in waiting times was greater for non-White than for White patients. This indicates that minority populations could benefit from health IT investment with regard to process of care. Investments in health IT may reduce disparities in process of care.

  17. Racial and ethnic health disparities in reproductive medicine: an evidence-based overview.

    PubMed

    Owen, Carter M; Goldstein, Ellen H; Clayton, Janine A; Segars, James H

    2013-09-01

    Racial and ethnic health disparities in reproductive medicine exist across the life span and are costly and burdensome to our healthcare system. Reduction and ultimate elimination of health disparities is a priority of the National Institutes of Health who requires reporting of race and ethnicity for all clinical research it supports. Given the increasing rates of admixture in our population, the definition and subsequent genetic significance of self-reported race and ethnicity used in health disparity research is not straightforward. Some groups have advocated using self-reported ancestry or carefully selected single-nucleotide polymorphisms, also known as ancestry informative markers, to sort individuals into populations. Despite the limitations in our current definitions of race and ethnicity in research, there are several clear examples of health inequalities in reproductive medicine extending from puberty and infertility to obstetric outcomes. We acknowledge that socioeconomic status, education, insurance status, and overall access to care likely contribute to the differences, but these factors do not fully explain the disparities. Epigenetics may provide the biologic link between these environmental factors and the transgenerational disparities that are observed. We propose an integrated view of health disparities across the life span and generations focusing on the metabolic aspects of fetal programming and the effects of environmental exposures. Interventions aimed at improving nutrition and minimizing adverse environmental exposures may act synergistically to reverse the effects of these epigenetic marks and improve the outcome of our future generations.

  18. Health outcome disparities among subgroups of people with disabilities: a scoping review.

    PubMed

    Rowland, Maya; Peterson-Besse, Jana; Dobbertin, Konrad; Walsh, Emily S; Horner-Johnson, Willi

    2014-04-01

    A growing body of research has found that people with disabilities experience lower health status and an excess burden of disease relative to the general US population. However, the population of people with disabilities is quite diverse. Thus, it is important to understand health differences between subgroups of people with disabilities in order to most effectively target interventions to address disparities. An initial step in this process is reviewing and synthesizing available research addressing these subgroup differences. To conduct a scoping review of literature to describe recent research activity that has examined health outcome disparities within populations of people with disabilities. We searched for relevant articles in MEDLINE, PsycINFO, and CINAHL databases. Three staff independently reviewed abstracts according to inclusion criteria. Two authors then independently extracted data from each included article. For many of the health outcomes of interest, there was no published literature in relation to key disparity factors (e.g. race, income) within the population of people with disabilities. The health outcomes most frequently examined were diabetes and heart disease. The most frequently examined disparity factors were the type of disabling condition and gender. There are significant gaps in available research. Building a body of research that identifies disparities and potentially vulnerable subgroups may improve understanding of the causes of disparities and contribute to efforts to improve quality of life and health outcomes for individuals with disabilities. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Racial and Ethnic Disparities in the VA Health Care System: A Systematic Review

    PubMed Central

    Freeman, Michele; Toure, Joahd; Tippens, Kimberly M.; Weeks, Christine; Ibrahim, Said

    2008-01-01

    Objectives To better understand the causes of racial disparities in health care, we reviewed and synthesized existing evidence related to disparities in the “equal access” Veterans Affairs (VA) health care system. Methods We systematically reviewed and synthesized evidence from studies comparing health care utilization and quality by race within the VA. Results Racial disparities in the VA exist across a wide range of clinical areas and service types. Disparities appear most prevalent for medication adherence and surgery and other invasive procedures, processes that are likely to be affected by the quantity and quality of patient–provider communication, shared decision making, and patient participation. Studies indicate a variety of likely root causes of disparities including: racial differences in patients’ medical knowledge and information sources, trust and skepticism, levels of participation in health care interactions and decisions, and social support and resources; clinician judgment/bias; the racial/cultural milieu of health care settings; and differences in the quality of care at facilities attended by different racial groups. Conclusions Existing evidence from the VA indicates several promising targets for interventions to reduce racial disparities in the quality of health care. PMID:18301951

  20. Eight Americas: new perspectives on U.S. health disparities.

    PubMed

    Murray, Christopher J L; Kulkarni, Sandeep; Ezzati, Majid

    2005-12-01

    The Eight Americas Study divides the U.S. population into eight distinct groups with different epidemiologic patterns and mortality experience. The Eight Americas are Asians (America 1), below-median-income whites living in the Northland (America 2), middle America (America 3), poor whites living in Appalachia and the Mississippi Valley (America 4), Native Americans living on reservations in the West (America 5), black middle-America (America 6), poor blacks living in the rural South (America 7), and blacks living in high-risk urban environments (America 8). Life expectancy for males in America 8 is 21 years lower than life expectancy for females in America 1. For males, the gap between America 1 and America 8, 16.1 years, is as large as the gap between Iceland with the highest male life expectancy in the world and Bangladesh. Even in Americas 5, 6, 7, and 8, U.S. child mortality is in the middle of the range defined by the Organization of Economic Cooperation and Development (OECD) countries. For young and middle-aged males and females, however, mortality experience in the disadvantaged Americas is up to two times worse than the worst OECD country. The enormous excess of young and middle-aged mortality is largely due to chronic disease death. Based on the World Health Organization Comparative Risk Assessment project, we expect the major risks in the United States to be tobacco, alcohol, obesity, blood pressure, and cholesterol. Risk factor analysis using Behavioral Risk Factor Surveillance System data for the Eight Americas suggests that the pattern for tobacco, alcohol, and obesity is distinct for each America. Currently available data in the public domain do not provide an adequate basis to assess levels of blood pressure and cholesterol in the Eight Americas. To tackle disparities in the United States, public health will need to increase its focus on chronic diseases in young and middle-aged Americans. In particular, if blood pressure and cholesterol are

  1. Which environmental factors are associated with lived health when controlling for biological health? - a multilevel analysis.

    PubMed

    Bostan, Cristina; Oberhauser, Cornelia; Stucki, Gerold; Bickenbach, Jerome; Cieza, Alarcos

    2015-05-27

    Lived health and biological health are two different perspectives of health introduced by the International Classification of Functioning, Disability and Health (ICF). Since in the concept of lived health the impact of the environment on biological health is inherently included, it seems intuitive that when identifying the environmental determinants of health, lived health is the appropriate outcome. The Multilevel Item Response Theory (MLIRT) model has proven to be a successful method when dealing with the relation between a latent variable and observed variables. The objective of this study was to identify environmental factors associated with lived health when controlling for biological health by using the MLIRT framework. We performed a psychometric study using cross-sectional data from the Spanish Survey on Disability, Independence and Dependency Situation. Data were collected from 17,303 adults living in 15,263 dwellings. The MLIRT model was used for each of the two steps of the analysis to: (1) calculate people's biological health abilities and (2) estimate the association between lived health and environmental factors when controlling for biological health. The hierarchical structure of individuals in dwellings was considered in both models. Social support, being able to maintain one's job, the extent to which one's health needs are addressed and being discriminated against due to one's health problems were the environmental factors identified as associated with lived health. Biological health also had a strong positive association with lived health. This study identified environmental factors associated with people's lived health differences within and between dwellings according to the MLIRT-model approach. This study paves the way for the future implementation of the MLIRT model when analysing ICF-based data.

  2. Health Centers after Fifty Years: Lessons from the Health Disparities Collaboratives.

    PubMed

    Stevens, David M

    2016-01-01

    The fertile social movements of the 1960s in the United States gave birth to the community health center model. During the past 50 years, health centers have emerged as a national primary care institution serving over 20 million of the nation's most vulnerable people. Founded on the shared health center mission and commitment to collective action, the Health Disparities Collaboratives (HDC) provided a cultural and social milieu for accelerated learning as well as a homegrown system and infrastructure for collaborative learning and improvement. Although the HDC only existed during the years from 1999-2006, they generated positive health outcomes and strengthened the capacity of health centers for quality improvement. After a description of the history and the characteristics of the HDC, six recommendations are presented for the re-design and implementation of a second-generation health center learning and improvement system.

  3. Designing and Evaluating Interventions to Eliminate Racial and Ethnic Disparities in Health Care

    PubMed Central

    Cooper, Lisa A; Hill, Martha N; Powe, Neil R

    2002-01-01

    A large number of factors contribute to racial and ethnic disparities in health status. Health care professionals, researchers, and policymakers have believed for some time that access to care is the centerpiece in the elimination of these health disparities. The Institute of Medicine's (IOM) model of access to health services includes personal, financial, and structural barriers, health service utilization, and mediators of care. This model can be used to describe the interactions among these factors and their impact on health outcomes and equity of services among racial and ethnic groups. We present a modified version of the IOM model that incorporates the features of other access models and highlights barriers and mediators that are relevant for interventions designed to eliminate disparities in U.S. health care. We also suggest that interventions to eliminate disparities and achieve equity in health care services be considered within the broader context of improving quality of care. Some health service intervention studies have shown improvements in the health of disadvantaged groups. If properly designed and implemented, these interventions could be used to reduce health disparities. Successful features of interventions include the use of multifaceted, intense approaches, culturally and linguistically appropriate methods, improved access to care, tailoring, the establishment of partnerships with stakeholders, and community involvement. However, in order to be effective in reducing disparities in health care and health status, important limitations of previous studies need to be addressed, including the lack of control groups, nonrandom assignment of subjects to experimental interventions, and use of health outcome measures that are not validated. Interventions might be improved by targeting high-risk populations, focusing on the most important contributing factors, including measures of appropriateness and quality of care and health outcomes, and prioritizing

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

    PubMed

    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.

  5. SHAPING A NEW GENERATION OF HISPANIC CLINICAL AND TRANSLATIONAL RESEARCHERS ADDRESSING MINORITY HEALTH AND HEALTH DISPARITIES

    PubMed Central

    Estape, Estela S.; Segarra, Barbara; Baez, Adriana; Huertas, Aracelis; Diaz, Clemente; Frontera, Walter

    2012-01-01

    In 2011, research educators face significant challenges. Training programs in Clinical and Translational Research need to develop or enhance their curriculum to comply with new scientific trends and government policies. Curricula must impart the skills and competencies needed to help facilitate the dissemination and transfer of scientific advances at a faster pace than current health policy and practice. Clinical and translational researchers are facing also the need of new paradigms for effective collaboration, and resource sharing while using the best educational models. Both government and public policy makers emphasize addressing the goals of improving health quality and elimination of health disparities. To help achieve this goal, our academic institution is taking an active role and striving to develop an environment that fosters the career development of clinical and translational researchers. Consonant with this vision, in 2002 the University of Puerto Rico, Medical Sciences Campus School of Health Professions and School of Medicine initiated a multidisciplinary post-doctoral Master of Science in Clinical Research focused in training Hispanics who will address minority health and health disparities research. Recently, we proposed a curriculum revision to enhance this commitment in promoting competency-based curricula for clinician-scientists in clinical and translational sciences. The revised program will be a post-doctoral Master of Science in Clinical and Translational Research (MCTR), expanding its outreach by actively engaging in establishing new collaborations and partnerships that will increase our capability to diversify our educational efforts and make significant contributions to help reduce and eliminate the gap in health disparities. PMID:22263296

  6. A Multiinstitutional, Multidisciplinary Model for Developing and Teaching Translational Research in Health Disparities

    PubMed Central

    Estape, Estela; de Laurido, Lourdes E. Soto; Shaheen, Magda; Quarshie, Alexander; Frontera, Walter; Mays, Mary Helen; Harrigan, Rosanne; White, Richard

    2011-01-01

    Abstract Health disparities may affect any person in any community in the world, resulting from a multitude of factors including socioeconomic status, race, ethnicity, environment, and genetics. The impact of health disparities is felt by affected individuals, their families, communities, and the greater health care system. There is a critical need to increase health disparities research activities. This may be achieved by expanding and strengthening the training, education and career development of motivated clinicians, physicians and basic scientists, engaging them in clinical and translational research. Translational research relies on collaboration across disciplines, facilitating the dissemination and transfer of knowledge to populations for the overall improvement of health while decreasing the economic burden of health care. The University of Puerto Rico Medical Sciences Campus (UPR‐MSC), Schools of Health Professions and Medicine joint initiatives, Clinical Research Education and Career Development (CRECD) and Hispanics in Research Capability (HiREC) programs, convened health disparities experts, faculty and scholars from multiple disciplines, cultural backgrounds and institutions. Together, they created a model for teaching translational research in health disparities that spans disciplines without boundaries. This work was presented at the 2011 Clinical and Translational Research and Education Meeting, ACRT/AFMR/SCTS Joint Annual Meeting in Washington, DC. Clin Trans Sci 2011; Volume 4: 434–438. PMID:22212225

  7. Engaging multilevel stakeholders in an implementation trial of evidence-based quality improvement in VA women's health primary care.

    PubMed

    Hamilton, Alison B; Brunner, Julian; Cain, Cindy; Chuang, Emmeline; Luger, Tana M; Canelo, Ismelda; Rubenstein, Lisa; Yano, Elizabeth M

    2017-06-05

    The Veterans Health Administration (VHA) has undertaken primary care transformation based on patient-centered medical home (PCMH) tenets. VHA PCMH models are designed for the predominantly male Veteran population, and require tailoring to meet women Veterans' needs. We used evidence-based quality improvement (EBQI), a stakeholder-driven implementation strategy, in a cluster randomized controlled trial across 12 sites (eight EBQI, four control) that are members of a Practice-Based Research Network. EBQI involves engaging multilevel, inter-professional leaders and staff as stakeholders in reviewing evidence and setting QI priorities. The goal of this analysis was to examine processes of engaging stakeholders in early implementation of EBQI to tailor VHA's medical home for women. Four inter-professional regional stakeholder planning meetings were conducted; these meetings engaged stakeholders by providing regional data about gender disparities in Veterans' care experiences. Subsequent to each meeting, qualitative interviews were conducted with 87 key stakeholders (leaders and staff). Stakeholders were asked to describe QI efforts and the use of data to change aspects of care, including women's health care. Interview transcripts were summarized and coded using a hybrid deductive/inductive analytic approach. The presentation of regional-level data about gender disparities resulted in heightened awareness and stakeholder buy-in and decision-making related to women's health-focused QI. Interviews revealed that stakeholders were familiar with QI, with regional and facility leaders aware of inter-disciplinary committees and efforts to foster organizational change, including PCMH transformation. These efforts did not typically focus on women's health, though some informal efforts had been undertaken. Barriers to engaging in QI included lack of communication across clinical service lines, fluidity in staffing, and lack of protected time. Inter-professional, multilevel

  8. Contextualizing Disparities: The Case for Comparative Research on Social Inequalities in Health.

    PubMed

    Olafsdottir, Sigrun; Beckfield, Jason; Bakhtiari, Elyas

    2013-01-01

    Research on healthcare disparities is making important descriptive and analytical strides, and the issue of disparities has gained the attention of policymakers in the US, other nation-states, and international organizations. Still, disparities scholarship remains US-centric and too rarely takes a cross-national comparative approach to answering its questions. The US-centricity of disparities research has fostered a fixation on race and ethnicity that, although essential to understanding health disparities in the United States, has truncated the range of questions researchers investigate. In this article, we make a case for comparative research that highlights its ability to identify the institutional factors may affect disparities. We discuss the central methodological challenges to comparative research. After describing current solutions to such problems, we use data from the World Values Survey to show the impact of key social fault lines on self-assessed health in Europe and the U.S. The negative impact of SES on health is more generalizable across context, than the impact of race/ethnicity or gender. Our analysis includes a limited number of countries and relies on one measure of health. The paper represents a first step in a research agenda to understand health inequalities within and across societies.

  9. A robust method for the reconstruction of disparity maps based on multilevel processing of stereo color image pairs

    NASA Astrophysics Data System (ADS)

    Kravchenko, V. F.; Ponomaryov, V. I.; Pustovoit, V. I.; Sadovnychiy, S. N.

    2017-08-01

    A novel method for the reconstruction of disparity maps (DMs) with robust properties to nonideal registration conditions, reflections, and noise in stereo color image pairs has been substantiated for the first time. The novel approach proposes a scheme for image DM reconstruction where Jaccard distance metric is used as a proximity criterion in stereo image pair matching. A physical interpretation of the method that allows the quality of the formed DMs to be improved significantly is given. A processing block diagram has been developed in accordance with the novel approach. Simulations of the novel DM reconstruction method have shown an advantage of the proposed DM reconstruction scheme in terms of generally recognized criteria, such as the structural similarity index measure and the bad matching pixels, and when visually comparing the formed DMs.

  10. Disparities in Social Health by Sexual Orientation and the Etiologic Role of Self-Reported Discrimination

    PubMed Central

    Doyle, David Matthew; Molix, Lisa

    2015-01-01

    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. PMID:26566900

  11. Disparities in Social Health by Sexual Orientation and the Etiologic Role of Self-Reported Discrimination.

    PubMed

    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.

  12. Removing Obstacles To Eliminate Racial And Ethnic Disparities In Behavioral Health Care

    PubMed Central

    Alegría, Margarita; Alvarez, Kiara; Ishikawa, Rachel Zack; DiMarzio, Karissa; McPeck, Samantha

    2016-01-01

    Despite decades of research, racial and ethnic disparities in behavioral health care persist. The Affordable Care Act expanded access to behavioral health care, but many reform initiatives fail to consider research about racial/ethnic minorities. Mistaken assumptions that underlie the expansion of behavioral health care risk replicating existing service disparities. Based on a review of relevant literature and numerous observational and field studies with minority populations, we identified the following three mistaken assumptions: improvement in health care access alone will reduce disparities, current service planning addresses minority patients’ preferences, and evidence-based interventions are readily available for diverse populations. We propose tailoring the provision of care to remove obstacles that minority patients face in accessing treatment, promoting innovative services that respond to patient needs and preferences, and allowing flexibility in evidence-based practice and the expansion of the behavioral health workforce. These proposals should help meet the health care needs of a growing racial/ethnic minority population. PMID:27269014

  13. Reducing disparities through culturally competent health care: an analysis of the business case.

    PubMed

    Brach, Cindy; Fraser, Irene

    2002-01-01

    Finding ways to deliver high-quality health care to an increasingly diverse population is a major challenge for the American health care system. The persistence of racial and ethnic disparities in health care access, quality, and outcomes has prompted considerable interest in increasing the cultural competence of health care, both as an end in its own right and as a potential means to reduce disparities. This article reviews the potential role of cultural competence in reducing racial and ethnic health disparities, the strength of health care organizations' current incentives to adopt cultural competence techniques, and the limitations inherent in these incentives that will need to be overcome if cultural competence techniques are to become widely adopted.

  14. Applying Organizational Change to Promote Lesbian, Gay, Bisexual, and Transgender Inclusion and Reduce Health Disparities.

    PubMed

    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.

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

    PubMed

    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.

  16. Environmental health disparities in the Central Appalachian region of the United States.

    PubMed

    Krometis, Leigh-Anne; Gohlke, Julia; Kolivras, Korine; Satterwhite, Emily; Marmagas, Susan West; Marr, Linsey C

    2017-07-06

    Health disparities that cannot be fully explained by socio-behavioral factors persist in the Central Appalachian region of the United States. A review of available studies of environmental impacts on Appalachian health and analysis of recent public data indicates that while disparities exist, most studies of local environmental quality focus on the preservation of nonhuman biodiversity rather than on effects on human health. The limited public health studies available focus primarily on the impacts of coal mining and do not measure personal exposure, constraining the ability to identify causal relationships between environmental conditions and public health. Future efforts must engage community members in examining all potential sources of environmental health disparities to identify effective potential interventions.

  17. Photovoice with vulnerable populations: addressing disparities in health promotion among people with intellectual disabilities.

    PubMed

    Jurkowski, Janine M; Paul-Ward, Amy

    2007-10-01

    Eliminating health disparities is a national priority. People with intellectual disabilities (PWID) are a vulnerable group that experiences health disparities. However, their health disparities have largely been overlooked. Photovoice is an effective method for engaging PWID in health promotion planning and research. This article discusses the importance of including PWID as a priority group, presents a Photovoice project among Latinos with ID, and concludes with recommendations for employing Photovoice with PWID. The Photovoice project was a part of a larger pilot study that aimed to enable the voices of Latinos with ID and guide the development of health promotion programs at a community agency. The findings were presented in reports and at a town hall meeting during which attendees responded and developed actions steps for improving health promotion for PWID. Each Photovoice participant received a scrapbook of their photographs as a keepsake of their experiences participating in the project [corrected

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

    PubMed

    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.

  19. Reducing Disparities through Culturally Competent Health Care: An Analysis of the Business Case

    PubMed Central

    Brach, Cindy; Fraser, Irene

    2016-01-01

    Finding ways to deliver high-quality health care to an increasingly diverse population is a major challenge for the American health care system. The persistence of racial and ethnic disparities in health care access, quality, and outcomes has prompted considerable interest in increasing the cultural competence of health care, both as an end in its own right and as a potential means to reduce disparities. This article reviews the potential role of cultural competence in reducing racial and ethnic health disparities, the strength of health care organizations’ current incentives to adopt cultural competence techniques, and the limitations inherent in these incentives that will need to be overcome if cultural competence techniques are to become widely adopted. PMID:12938253

  20. Income, financial barriers to health care and public health expenditure: A multilevel analysis of 28 countries.

    PubMed

    Kim, Tae Jun; Vonneilich, Nico; Lüdecke, Daniel; von dem Knesebeck, Olaf

    2017-03-01

    International studies have repeatedly shown that people with lower income are more likely to experience difficulties to access medical services. Less is known on why these relations vary across countries. This study investigates whether the association between income and financial barriers to health care is influenced by national public health expenditures (PHE, in % of total health expenditure). Data from the International Social Survey Programme (2011) was used (28 countries, 23,669 respondents). Financial barriers were assessed by the individual experience of forgone care due to financial reasons. Monthly equivalent household income was included as the main predictor. Other individual-level control variables were age, gender, education, subjective health, insurance coverage and place of living. PHE was considered as a macro-level predictor, adjusted for total health expenditure. Statistically significant associations between income and forgone care were found in 21 of 28 examined countries. Multilevel analyses across countries revealed that people with lower income have a higher likelihood to forgo needed medical care (OR: 3.94, 95%-CI: 2.96-5.24). After adjustments for individual-level covariates, this association slightly decreased (OR: 2.94, 95%-CI: 2.16-3.99). PHE did not moderate the relation between income and forgone care. The linkage between health system financing and inequalities in access to health care seems to be more complex than initially assumed, pointing towards further research to explore how PHE affects the redistribution of health resources in different health care systems.

  1. Networking health: multi-level marketing of health products in Ghana.

    PubMed

    Droney, Damien

    2016-01-01

    Multi-level marketing (MLM0), a business model in which product distributors are compensated for enrolling further distributors as well as for selling products, has experienced dramatic growth in recent decades, especially in the so-called global South. This paper argues that the global success of MLM is due to its involvement in local health markets. While MLM has been subject to a number of critiques, few have analyzed the explicit health claims of MLM distributors. The majority of the products distributed through MLM are health products, which are presented as offering transformative health benefits. Based on interviews with MLM distributors in Ghana, but focusing on the experiences of one woman, this paper shows that MLM companies become intimately entwined with Ghanaian quests for health by providing their distributors with the materials to become informal health experts, allowing their distributors to present their products as medicines, and presenting MLM as an avenue to middle class cosmopolitanism. Ghanaian distributors promote MLM products as medically powerful, and the distribution of these products as an avenue to status and profit. As a result, individuals seeking health become a part of ethically questionable forms of medical provision based on the exploitation of personal relationships. The success of MLM therefore suggests that the health industry is at the forefront of transnational corporations' extraction of value from informal economies, drawing on features of health markets to monetize personal relationships.

  2. Musculoskeletal health disparities: health literacy, cultural competency, informed consent, and shared decision making.

    PubMed

    McClellan, Frank M; Wood, James E; Fahmy, Sherin M; Jones, Lynne C

    2014-01-01

    The factors that contribute to musculoskeletal healthcare disparities may influence the results of studies regarding the long-term outcome of orthopaedic implants. Patient decisions regarding their healthcare and their subsequent outcomes are influenced by health literacy. Providing patients with the information that they need to consent to treatment must be provided in a culturally competent manner. The influence of the physician or healthcare provider on the treatment choice varies depending on the type of decision-making process: patient-based, physician-based, or shared decision making. Respecting the patient's autonomy while acknowledging the knowledge and experience of the physician, we advocate for shared decision making. This may require modification of existing regulations regarding informed consent. Furthermore, federal and state directives have been put into place to address healthcare disparities, especially with respect to culturally competent care and access to proper healthcare.

  3. Building a funded research program in cancer health disparities: considerations for young investigators.

    PubMed

    Ochs-Balcom, Heather M; Phillips, Lynette S; Nichols, Hazel B; Martinez, Elena; Thompson, Beti; Ojeifo, John; Rebbeck, Timothy R

    2015-05-01

    A workshop entitled "Building a funded research program in cancer health disparities" was held at the 38th Annual American Society of Preventive Oncology (ASPO) Meeting. Organized by the Junior Members Interest Group, the session addressed topics relevant to career development for cancer disparities investigators. Such considerations include the development of research programs on a backdrop of existing multi- and transdisciplinary teams, recognizing opportunities for advancing their research, given the growth of consortia-related research, and development of effective community-based partnerships. Key strategies for developing a sustainable career in cancer health disparities in the current environment include the need to effectively engage with communities, appreciate the value of team science and develop cross-discipline collaborations, and navigate the use and utility of consortia for disparities research. Academic considerations related to earning tenure and promotion that may be faced by the junior investigator in cancer health disparities were also discussed. This report may serve to both educate and provide lessons for early-stage investigators who wish to tackle complex scientific questions while developing their careers in cancer health disparities.

  4. Black: White Health Disparities in the United States and Chicago: 1990-2010.

    PubMed

    Hunt, Bijou; Whitman, Steve

    2015-03-01

    In order to assess progress in eliminating health disparities, a Healthy People 2010 goal, both at the national level and in Chicago, Illinois, we examined whether disparities between non-Hispanic Black and non-Hispanic White persons widened, narrowed, or stayed the same between 1990 and 2010. We examined 17 health status indicators. In order to determine whether a disparity widened, narrowed, or remained unchanged between 1990 and 2010, we examined the relative percentage difference in rates at both time points and at each location. We calculated P values to determine whether changes in relative percentage difference over time were statistically significant. Disparities between non-Hispanic Black and non-Hispanic White populations widened for 8 of the 17 health status indicators examined for the USA (6 significantly), whereas in Chicago the majority of disparities widened (9 of 17, 4 significantly). The mortality gap is responsible for more than 60,000 excess Black deaths per year in the USA. Despite substantial effort and funds aimed at meeting the Healthy People 2010 goal of eliminating health disparities, minimal progress has been made.

  5. Public health national approach to reducing breast and cervical cancer disparities.

    PubMed

    Miller, Jacqueline W; Plescia, Marcus; Ekwueme, Donatus U

    2014-08-15

    Breast and cervical cancer have had disparate impact on the lives of women. The burden of breast and cervical cancer is more prominent among some racial and ethnic minority women. Providing comprehensive care to all medically underserved women is a critical element in continuing the battle to reduce cancer burden and eliminate disparities. The National Breast and Cervical Cancer Early Detection Program is the only nationally organized cancer screening program for underserved women in the United States. Its public health goal is to ensure access to high-quality screening, follow-up, and treatment services for diverse and vulnerable populations that, in turn, may reduce disparities.

  6. The State of the Union: Sexual Health Disparities in a National Sample of US College Students

    ERIC Educational Resources Information Center

    Buhi, Eric R.; Marhefka, Stephanie L.; Hoban, Mary T.

    2010-01-01

    Objective: To examine sexual health disparities between blacks and whites in a national sample of US college students. Participants and Method Summary: Analyses utilized secondary data from 44,165 nonmarried undergraduates (aged 18-24; M = 20.1) responding to the Spring 2007 American College Health Association-National College Health Assessment;…

  7. The potential of black radio to disseminate health messages and reduce disparities.

    PubMed

    Hall, Ingrid J; Johnson-Turbes, C Ashani; Williams, Kymber N

    2010-07-01

    Radio stations that target African American audiences ("black radio") reach a national African American audience daily, making black radio an ideal medium for health promotion and disparities reduction in the African American community. Black radio can be used to communicate public health messages and to recruit African Americans into public health research.

  8. The State of the Union: Sexual Health Disparities in a National Sample of US College Students

    ERIC Educational Resources Information Center

    Buhi, Eric R.; Marhefka, Stephanie L.; Hoban, Mary T.

    2010-01-01

    Objective: To examine sexual health disparities between blacks and whites in a national sample of US college students. Participants and Method Summary: Analyses utilized secondary data from 44,165 nonmarried undergraduates (aged 18-24; M = 20.1) responding to the Spring 2007 American College Health Association-National College Health Assessment;…

  9. Education, Knowledge and the Evolution of Disparities in Health. NBER Working Paper No. 15840

    ERIC Educational Resources Information Center

    Aizer, Anna; Stroud, Laura

    2010-01-01

    We study how advances in scientific knowledge affect the evolution of disparities in health. Our focus is the 1964 Surgeon General Report on Smoking and Health--the first widely publicized report of the negative effects of smoking on health. Using an historical dataset that includes the smoking habits of pregnant women 1959-1966, we find that…

  10. Leveraging Health IT to Reduce Disparities in Three Underserved Beacon Communities.

    PubMed

    Des Jardins, Terrisca; Drone, Shenetta A; Hashisaka, Susan; Hazzard, Jobyna; Hunt, Susan B; Massey, Kimberly; Rein, Alison; Schachter, Abigail; Turske, Scott

    2016-01-01

    Using health information technology (IT) can potentially address health disparities by increasing access to care, delivering higher-quality care, improving patient-provider communication, and enhancing patient safety. It describes challenges encountered by three underserved Beacon Communities that implemented health IT interventions, including inadequate connectivity infrastructure, technical support, expertise, and financial resources; provider shortages and staff turnover; and equipment theft.

  11. Integrating Education on Addressing Health Disparities into the Graduate Social Work Curriculum

    ERIC Educational Resources Information Center

    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…

  12. Education, Knowledge and the Evolution of Disparities in Health. NBER Working Paper No. 15840

    ERIC Educational Resources Information Center

    Aizer, Anna; Stroud, Laura

    2010-01-01

    We study how advances in scientific knowledge affect the evolution of disparities in health. Our focus is the 1964 Surgeon General Report on Smoking and Health--the first widely publicized report of the negative effects of smoking on health. Using an historical dataset that includes the smoking habits of pregnant women 1959-1966, we find that…

  13. Using social determinants of health to link health workforce diversity, care quality and access, and health disparities to achieve health equity in nursing.

    PubMed

    Williams, Shanita D; Hansen, Kristen; Smithey, Marian; Burnley, Josepha; Koplitz, Michelle; Koyama, Kirk; Young, Janice; Bakos, Alexis

    2014-01-01

    It is widely accepted that diversifying the nation's health-care workforce is a necessary strategy to increase access to quality health care for all populations, reduce health disparities, and achieve health equity. In this article, we present a conceptual model that utilizes the social determinants of health framework to link nursing workforce diversity and care quality and access to two critical population health indicators-health disparities and health equity. Our proposed model suggests that a diverse nursing workforce can provide increased access to quality health care and health resources for all populations, and is a necessary precursor to reduce health disparities and achieve health equity. With this conceptual model as a foundation, we aim to stimulate the conceptual and analytical work-both within and outside the nursing field-that is necessary to answer these important but largely unanswered questions.

  14. Using Social Determinants of Health to Link Health Workforce Diversity, Care Quality and Access, and Health Disparities to Achieve Health Equity in Nursing

    PubMed Central

    Hansen, Kristen; Smithey, Marian; Burnley, Josepha; Koplitz, Michelle; Koyama, Kirk; Young, Janice; Bakos, Alexis

    2014-01-01

    It is widely accepted that diversifying the nation's health-care workforce is a necessary strategy to increase access to quality health care for all populations, reduce health disparities, and achieve health equity. In this article, we present a conceptual model that utilizes the social determinants of health framework to link nursing workforce diversity and care quality and access to two critical population health indicators—health disparities and health equity. Our proposed model suggests that a diverse nursing workforce can provide increased access to quality health care and health resources for all populations, and is a necessary precursor to reduce health disparities and achieve health equity. With this conceptual model as a foundation, we aim to stimulate the conceptual and analytical work—both within and outside the nursing field—that is necessary to answer these important but largely unanswered questions. PMID:24385662

  15. Big Data Science: Opportunities and Challenges to Address Minority Health and Health Disparities in the 21st Century.

    PubMed

    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 geographical variables and social determinants of health for geographically defined populations to clinical data and health outcomes. Third and most importantly, Big Data science may lead to a better understanding of the etiology of health disparities and understanding of minority health in order to guide intervention development. However, the promise of Big Data needs to be considered in light of significant challenges that threaten to widen health disparities. Care must be taken to incorporate diverse populations to realize the potential benefits. Specific recommendations include investing in data collection on small sample populations, building a diverse workforce pipeline for data science, actively seeking to reduce digital divides, developing novel ways to assure digital data privacy for small populations, and promoting widespread data sharing to benefit under-resourced minority-serving institutions and minority researchers. With deliberate efforts, Big Data presents a dramatic opportunity for reducing health disparities but without active engagement, it risks further widening them.

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

    PubMed

    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.

  17. Creating a Transdisciplinary Research Center to Reduce Cardiovascular Health Disparities in Baltimore, Maryland: Lessons Learned

    PubMed Central

    Boulware, L. Ebony; Miller, Edgar R.; Golden, Sherita Hill; Carson, Kathryn A.; Noronha, Gary; Huizinga, Mary Margaret; Roter, Debra L.; Yeh, Hsin-Chieh; Bone, Lee R.; Levine, David M.; Hill-Briggs, Felicia; Charleston, Jeanne; Kim, Miyong; Wang, Nae-Yuh; Aboumatar, Hanan; Halbert, Jennifer P.; Ephraim, Patti L.; Brancati, Frederick L.

    2013-01-01

    Cardiovascular disease (CVD) disparities continue to have a negative impact on African Americans in the United States, largely because of uncontrolled hypertension. Despite the availability of evidence-based interventions, their use has not been translated into clinical and public health practice. The Johns Hopkins Center to Eliminate Cardiovascular Health Disparities is a new transdisciplinary research program with a stated goal to lower the impact of CVD disparities on vulnerable populations in Baltimore, Maryland. By targeting multiple levels of influence on the core problem of disparities in Baltimore, the center leverages academic, community, and national partnerships and a novel structure to support 3 research studies and to train the next generation of CVD researchers. We also share the early lessons learned in the center’s design. PMID:24028238

  18. Creating a transdisciplinary research center to reduce cardiovascular health disparities in Baltimore, Maryland: lessons learned.

    PubMed

    Cooper, Lisa A; Boulware, L Ebony; Miller, Edgar R; Golden, Sherita Hill; Carson, Kathryn A; Noronha, Gary; Huizinga, Mary Margaret; Roter, Debra L; Yeh, Hsin-Chieh; Bone, Lee R; Levine, David M; Hill-Briggs, Felicia; Charleston, Jeanne; Kim, Miyong; Wang, Nae-Yuh; Aboumatar, Hanan; Halbert, Jennifer P; Ephraim, Patti L; Brancati, Frederick L

    2013-11-01

    Cardiovascular disease (CVD) disparities continue to have a negative impact on African Americans in the United States, largely because of uncontrolled hypertension. Despite the availability of evidence-based interventions, their use has not been translated into clinical and public health practice. The Johns Hopkins Center to Eliminate Cardiovascular Health Disparities is a new transdisciplinary research program with a stated goal to lower the impact of CVD disparities on vulnerable populations in Baltimore, Maryland. By targeting multiple levels of influence on the core problem of disparities in Baltimore, the center leverages academic, community, and national partnerships and a novel structure to support 3 research studies and to train the next generation of CVD researchers. We also share the early lessons learned in the center's design.

  19. Service Learning: A Vehicle for Building Health Equity and Eliminating Health Disparities

    PubMed Central

    Sabo, Samantha; de Zapien, Jill; Teufel-Shone, Nicolette; Rosales, Cecilia; Bergsma, Lynda

    2015-01-01

    Service learning (SL) is a form of community-centered experiential education that places emerging health professionals in community-generated service projects and provides structured opportunities for reflection on the broader social, economic, and political contexts of health. We describe the elements and impact of five distinct week-long intensive SL courses focused on the context of urban, rural, border, and indigenous health contexts. Students involved in these SL courses demonstrated a commitment to community-engaged scholarship and practice in both their student and professional lives. SL is directly in line with the core public health value of social justice and serves as a venue to strengthen community–campus partnerships in addressing health disparities through sustained collaboration and action in vulnerable communities. PMID:25706014

  20. Service learning: a vehicle for building health equity and eliminating health disparities.

    PubMed

    Sabo, Samantha; de Zapien, Jill; Teufel-Shone, Nicolette; Rosales, Cecilia; Bergsma, Lynda; Taren, Douglas

    2015-03-01

    Service learning (SL) is a form of community-centered experiential education that places emerging health professionals in community-generated service projects and provides structured opportunities for reflection on the broader social, economic, and political contexts of health. We describe the elements and impact of five distinct week-long intensive SL courses focused on the context of urban, rural, border, and indigenous health contexts. Students involved in these SL courses demonstrated a commitment to community-engaged scholarship and practice in both their student and professional lives. SL is directly in line with the core public health value of social justice and serves as a venue to strengthen community-campus partnerships in addressing health disparities through sustained collaboration and action in vulnerable communities.

  1. Health information technology and quality of health care: strategies for reducing disparities in underresourced settings.

    PubMed

    Millery, Mari; Kukafka, Rita

    2010-10-01

    Health information technology (health IT) has potential for facilitating quality improvement and reducing quality disparities found in underresourced settings (URSs). With this systematic literature review, complemented by key informant interviews, the authors sought to identify evidence regarding health IT and quality outcomes in URSs. The review included 105 peer-reviewed studies (2004-2009) in all settings. Only 15 studies included URSs, and 8 focused on URSs. Based on literature across settings, most evidence was available for quality impact of order entry, clinical decision support systems, and computerized reminders. Study designs were predominantly quasi-experimental (37%) or descriptive (35%); 90% of the studies focused on the microsystem level of quality improvement, indicating a need for expanding research into patient experience and organizational and environmental levels. Key informants highlighted organizational partnerships and health IT champions and emphasized that for health IT to have an impact on quality, there must be an organizational culture of quality improvement.

  2. Narratives and images used by public communication campaigns addressing social determinants of health and health disparities.

    PubMed

    Clarke, Christopher E; Niederdeppe, Jeff; Lundell, Helen C

    2012-12-01

    Researchers have increasingly focused on how social determinants of health (SDH) influence health outcomes and disparities. They have also explored strategies for raising public awareness and mobilizing support for policies to address SDH, with particular attention to narrative and image-based information. These efforts will need to overcome low public awareness and concern about SDH; few organized campaigns; and limited descriptions of existing message content. To begin addressing these challenges, we analyzed characteristics of 58 narratives and 135 visual images disseminated by two national SDH awareness initiatives: The Robert Wood Johnson Foundation's Commission to Build a Healthier America and the PBS-produced documentary film Unnatural Causes. Certain types of SDH, including income/wealth and one's home and workplace environment, were emphasized more heavily than others. Solutions for addressing SDH often involved combinations of self-driven motivation (such as changes in personal health behaviors) along with externally-driven factors such as government policy related to urban revitilization. Images, especially graphs and charts, drew connections among SDH, health outcomes, and other variables, such as the relationship between mother's education and infant mortality as well as the link between heart disease and education levels within communities. We discuss implications of these findings for raising awareness of SDH and health disparities in the US through narrative and visual means.

  3. Narratives and Images Used by Public Communication Campaigns Addressing Social Determinants of Health and Health Disparities

    PubMed Central

    Clarke, Christopher E.; Niederdeppe, Jeff; Lundell, Helen C.

    2012-01-01

    Researchers have increasingly focused on how social determinants of health (SDH) influence health outcomes and disparities. They have also explored strategies for raising public awareness and mobilizing support for policies to address SDH, with particular attention to narrative and image-based information. These efforts will need to overcome low public awareness and concern about SDH; few organized campaigns; and limited descriptions of existing message content. To begin addressing these challenges, we analyzed characteristics of 58 narratives and 135 visual images disseminated by two national SDH awareness initiatives: The Robert Wood Johnson Foundation’s Commission to Build a Healthier America and the PBS-produced documentary film Unnatural Causes. Certain types of SDH, including income/wealth and one’s home and workplace environment, were emphasized more heavily than others. Solutions for addressing SDH often involved combinations of self-driven motivation (such as changes in personal health behaviors) along with externally-driven factors such as government policy related to urban revitilization. Images, especially graphs and charts, drew connections among SDH, health outcomes, and other variables, such as the relationship between mother’s education and infant mortality as well as the link between heart disease and education levels within communities. We discuss implications of these findings for raising awareness of SDH and health disparities in the US through narrative and visual means. PMID:23330220

  4. Multi-Level Partnerships Support a Comprehensive Faith-Based Health Promotion Program

    ERIC Educational Resources Information Center

    Hardison-Moody, Annie; Dunn, Carolyn; Hall, David; Jones, Lorelei; Newkirk, Jimmy; Thomas, Cathy

    2011-01-01

    This article examines the role of multi-level partnerships in implementing Faithful Families Eating Smart and Moving More, a faith-based health promotion program that works with low-resource faith communities in North Carolina. This program incorporates a nine-lesson individual behavior change program in concert with policy and environmental…

  5. Multi-Level Partnerships Support a Comprehensive Faith-Based Health Promotion Program

    ERIC Educational Resources Information Center

    Hardison-Moody, Annie; Dunn, Carolyn; Hall, David; Jones, Lorelei; Newkirk, Jimmy; Thomas, Cathy

    2011-01-01

    This article examines the role of multi-level partnerships in implementing Faithful Families Eating Smart and Moving More, a faith-based health promotion program that works with low-resource faith communities in North Carolina. This program incorporates a nine-lesson individual behavior change program in concert with policy and environmental…

  6. Subjective Health and Mental Well-Being of Adolescents and the Health Promoting School: A Cross-Sectional Multilevel Analysis

    ERIC Educational Resources Information Center

    Levin, Kate; Inchley, Jo; Currie, Dorothy; Currie, Candace

    2012-01-01

    Purpose: The aim of this paper is to examine the impact of the health promoting school (HPS) on adolescent well-being. Design/methodology/approach: Data from the 2006 Health Behaviour in School-aged Children: WHO-collaborative Study in Scotland were analysed using multilevel linear regression analyses for outcome measures: happiness, confidence,…

  7. Subjective Health and Mental Well-Being of Adolescents and the Health Promoting School: A Cross-Sectional Multilevel Analysis

    ERIC Educational Resources Information Center

    Levin, Kate; Inchley, Jo; Currie, Dorothy; Currie, Candace

    2012-01-01

    Purpose: The aim of this paper is to examine the impact of the health promoting school (HPS) on adolescent well-being. Design/methodology/approach: Data from the 2006 Health Behaviour in School-aged Children: WHO-collaborative Study in Scotland were analysed using multilevel linear regression analyses for outcome measures: happiness, confidence,…

  8. Can Cultural Competency Reduce Racial And Ethnic Health Disparities? A Review And Conceptual Model

    PubMed Central

    Brach, Cindy; Fraserirector, Irene

    2016-01-01

    This article develops a conceptual model of cultural competency’s potential to reduce racial and ethnic health disparities, using the cultural competency and disparities literature to lay the foundation for the model and inform assessments of its validity. The authors identify nine major cultural competency techniques: interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of community health workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations. The conceptual model shows how these techniques could theoretically improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations, thereby improving outcomes and reducing disparities. The authors conclude that while there is substantial research evidence to suggest that cultural competency should in fact work, health systems have little evidence about which cultural competency techniques are effective and less evidence on when and how to implement them properly. PMID:11092163

  9. Language and immigrant status effects on disparities in Hispanic children's health status and access to health care.

    PubMed

    Avila, Rosa M; Bramlett, Matthew D

    2013-04-01

    The objective of this study is to estimate Hispanic/non-Hispanic (nH)-white health disparities and assess the extent to which disparities can be explained by immigrant status and household primary language. The 2007 National Survey of Children's Health was funded by the Maternal and Child Health Bureau, and conducted by Centers for Disease Control and Prevention's National Center for Health Statistics as a module of the State and Local Area Integrated Telephone Survey. We calculated disparities for various health indicators between Hispanic and nH-white children, and used logistic regression to adjust them for socio-economic and demographic characteristics, primary language spoken in the household, and the child's immigrant status. Controlling for language and immigrant status greatly reduces health disparities, although it does not completely eliminate all disparities showing poorer outcomes for Hispanic children. English-speaking and nonimmigrant Hispanic children are more similar to nH-white children than are Hispanic children in non-English speaking households or immigrant children. Hispanic/nH-white health disparities among children are largely driven by that portion of the Hispanic population that is either newly-arrived to this country or does not speak primarily English in the household.

  10. Assessing a multilevel model of young children’s oral health with national survey data

    PubMed Central

    Bramlett, Matthew D.; Soobader, Mah-J; Fisher-Owens, Susan A.; Weintraub, Jane A.; Gansky, Stuart A.; Platt, Larry J.; Newacheck, Paul W.

    2010-01-01

    Objectives To empirically test a multilevel conceptual model of children’s oral health incorporating 22 domains of children’s oral health across four levels: child, family, neighborhood and state. Data source The 2003 National Survey of Children’s Health, a module of the State and Local Area Integrated Telephone Survey conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics, is a nationally representative telephone survey of caregivers of children. Study design We examined child-, family-, neighborhood-, and state-level factors influencing parent’s report of children’s oral health using a multilevel logistic regression model, estimated for 26 736 children ages 1–5 years. Principal findings Factors operating at all four levels were associated with the likelihood that parents rated their children’s oral health as fair or poor, although most significant correlates are represented at the child or family level. Of 22 domains identified in our conceptual model, 15 domains contained factors significantly associated with young children’s oral health. At the state level, access to fluoridated water was significantly associated with favorable oral health for children. Conclusions Our results suggest that efforts to understand or improve children’s oral health should consider a multilevel approach that goes beyond solely child-level factors. PMID:20370808

  11. The Health Equity Promotion Model: Reconceptualization of Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Disparities

    PubMed Central

    Fredriksen-Goldsen, Karen I.; Simoni, Jane M.; Kim, Hyun-Jun; Lehavot, Keren; Walters, Karina L.; Yang, Joyce; Hoy-Ellis, Charles P.

    2015-01-01

    National health initiatives emphasize the importance of eliminating health disparities among historically disadvantaged populations. Yet, few studies have examined the range of health outcomes among lesbian, gay, bisexual, and transgender (LGBT) people. To stimulate more inclusive research in the area, we present the Health Equity Promotion Model—a framework oriented toward LGBT people reaching their full mental and physical health potential that considers both positive and adverse health-related circumstances. The model highlights (a) heterogeneity and intersectionality within LGBT communities; (b) the influence of structural and environmental context; and (c) both health-promoting and adverse pathways that encompass behavioral, social, psychological, and biological processes. It also expands upon earlier conceptualizations of sexual minority health by integrating a life course development perspective within the health-promotion model. By explicating the important role of agency and resilience as well as the deleterious effect of social structures on health outcomes, it supports policy and social justice to advance health and well-being in these communities. Important directions for future research as well as implications for health-promotion interventions and policies are offered. PMID:25545433

  12. The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities.

    PubMed

    Fredriksen-Goldsen, Karen I; Simoni, Jane M; Kim, Hyun-Jun; Lehavot, Keren; Walters, Karina L; Yang, Joyce; Hoy-Ellis, Charles P; Muraco, Anna

    2014-11-01

    National health initiatives emphasize the importance of eliminating health disparities among historically disadvantaged populations. Yet, few studies have examined the range of health outcomes among lesbian, gay, bisexual, and transgender (LGBT) people. To stimulate more inclusive research in the area, we present the Health Equity Promotion Model-a framework oriented toward LGBT people reaching their full mental and physical health potential that considers both positive and adverse health-related circumstances. The model highlights (a) heterogeneity and intersectionality within LGBT communities; (b) the influence of structural and environmental context; and (c) both health-promoting and adverse pathways that encompass behavioral, social, psychological, and biological processes. It also expands upon earlier conceptualizations of sexual minority health by integrating a life course development perspective within the health-promotion model. By explicating the important role of agency and resilience as well as the deleterious effect of social structures on health outcomes, it supports policy and social justice to advance health and well-being in these communities. Important directions for future research as well as implications for health-promotion interventions and policies are offered.

  13. Advancing genomic research and reducing health disparities: what can nurse scholars do?

    PubMed

    Jaja, Cheedy; Gibson, Robert; Quarles, Shirley

    2013-06-01

    Advances in genomic research are improving our understanding of human diseases and evoking promise of an era of genomic medicine. It is unclear whether genomic medicine may exacerbate or attenuate extant racial group health disparities. We delineate how nurse scholars could engage in the configuration of an equitable genomic medicine paradigm. We identify as legitimate subjects for nursing scholarship the scientific relevance, ethical, and public policy implications for employing racial categories in genomic research in the context of reducing extant health disparities. Since genomic research is largely population specific, current classification of genomic data will center on racial and ethnic groups. Nurse scholars should be involved in clarifying how putative racial group differences should be elucidated in light of the current orthodoxy that genomic solutions may alleviate racial health disparities. Nurse scholars are capable of employing their expertise in concept analysis to elucidate how race is used as a variable in scientific research, and to use knowledge brokering to delineate how race variables that imply human ancestry could be utilized in genomic research pragmatically in the context of health disparities. In an era of genomic medicine, nurse scholars should recognize and understand the challenges and complexities of genomics and race and their relevance to health care and health disparities. © 2013 Sigma Theta Tau International.

  14. Advancing Genomic Research and Reducing Health Disparities: What Can Nurse Scholars Do?

    PubMed Central

    Jaja, Cheedy; Gibson, Robert; Quarles, Shirley