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Overweight in childhood: the role of resilient parenting in African-American households.
No full textBACKGROUND: Some low-income minority children in the U.S. remain at normal weight throughout their childhood despite high risk of obesity.
PURPOSE: This study examined whether resilient caregiving accounted for children's healthy weight maintenance and dietary compliance over a 4-year period among poverty-stricken African-American families.
METHODS: A representative sample of 317 African-American caregiver-children (aged 3-5 years) pairs from low-income areas of Detroit MI was examined in 2002-2003 with a follow-up assessment in 2007. Capacity for resilience among caregivers was defined using five individual and environmental protective factors. A BMI score for the children was computed from recorded height and weight, and converted into one of three categories (normal weight, overweight, obese) using age- and gender-specific national references. Dietary information was collected using the Block Food Frequency Questionnaire (FFQ) and Block Kids FFQ. Data were analyzed in 2010 to test whether children's weight transition and dietary compliance varied according to their caregivers' capacity for resilience.
RESULTS: In all, 95 caregivers (29%) were identified as having capacity for resilience. They were younger, had higher levels of educational attainment, and had lower levels of daily soda consumption. The children of these caregivers had a lower likelihood of remaining overweight or obese than being of normal weight (relative risk ratio=0.5, 95% CI=0.2, 0.9) and had persistently lower soda consumption over 4 years compared with other children.
CONCLUSIONS: This finding demonstrates that some caregivers positively influence children's health weight management and dietary compliance despite material deprivation. Interventions to initiate and promote resilient caregiving could benefit the health and health-related behaviors of low-income African-American children
Effectiveness of a Community Health Worker Intervention Among African American and Latino Adults With Type 2 Diabetes: A Randomized Controlled Trial
No full textObjectives. We tested the effectiveness of a culturally tailored, behavioral theory-based community health worker intervention for improving glycemic control. Methods. We used a randomized, 6-month delayed control group design among 164 African American and Latino adult participants recruited from 2 health systems in Detroit, Michigan. Our study was guided by the principles of community-based participatory research. Hemoglobin A1c (HbA1c) level was the primary outcome measure. Using an empowerment-based approach, community health workers provided participants with diabetes self-management education and regular home visits, and accompanied them to a clinic visit during the 6-month intervention period. Results. Participants in the intervention group had a mean HbA1c value of 8.6% at baseline, which improved to a value of 7.8% at 6 months, for an adjusted change of -0.8 percentage points (P<.01). There was no change in mean HbA1c among the control group (8.5%). Intervention participants also had significantly greater improvements in self-reported diabetes understanding compared with the control group. Conclusions. This study contributes to the growing evidence for the effectiveness of community health workers and their role in multidisciplinary teams engaged in culturally appropriate health care delivery. (Am J Public Health. Published online ahead of print June 16, 2011: e1-e8. doi:10.2105/AJPH.2010.300106)
Addressing Race and Genetics Health Disparities in the Age of Personalized Medicine
No full textThe human genome sequence has been fully completed for a decade now and the price of full genome sequencing is dropping precipitously. Many believe that with these developments, a new era of personalized medicine is about to hit full speed. Personalized medicine is essentially “the use of genetic susceptibility or pharmacogenetic testing to tailor an individual’s preventive care or drug therapy,” although some definitions also include the development of patient outcomes research, health information technology, and care delivery models. Put more simply, it means the development of medicines and therapies tailored to patients’ unique genetic traits and risks.
The field is evolving rapidly but many hurdles still remain. Individually tailored drugs based on a patient’s genetic makeup are far off, and the cost of developing drugs for genetic subpopulations with largely similar genetic traits for one or more diseases hinders developments in this arena. Similarly, the lack of standards surrounding direct-to-consumer genetic tests and the lack of robust, large-scale genomic data for many diseases and conditions are additional hurdles
Visiting nurse program aims to prevent Native American infant deaths
No full textSISSETON, S.D. - Toshina Oneroad’s infant daughter has sparkling eyes and a sunny disposition, but her tiny cough caught the nurse’s attention. Jodi Lutjens, a visiting nurse with the Indian Health Service clinic near here, 90 miles south of Fargo, took the infant’s temperature.
Normal. A good sign.
At the tender age of 1 month, the baby is vulnerable to infection – just the sort of pitfall Lutjens is trying to avoid through prevention and education, the front line of defense against infant mortality
Black Salt: Should the government single out African-Americans for low-sodium diets?
No full textThe salt debate is certainly heated. But the government doesn't hedge any bets in making a "key recommendation" that Americans reduce their daily intake of sodium to 2,300 milligrams—about a teaspoon, or roughly the amount in 10 dill pickles. This alone poses a remarkable challenge; less than 15 percent of the population currently meets this target. But the Dietary Guidelines don't stop there. They also recommend reducing salt intake to 1,500 mg for people who are 51 and older or have hypertension, diabetes, or chronic kidney disease. And they set the same, more stringent goal for anyone—anyone at all—who happens to be African-American
Dimensions of Perceived Racism and Self-Reported Health: Examination of Racial/Ethnic Differences and Potential Mediators
No full textBACKGROUND: Many details of the negative relationship between perceived racial/ethnic discrimination and health are poorly understood.
PURPOSE: The purpose of this study was to examine racial/ethnic differences in the relationship between perceived discrimination and self-reported health, identify dimensions of discrimination that drive this relationship, and explore psychological mediators.
METHODS: Asian, Black, and Latino(a) adults (N = 734) completed measures of perceived racial/ethnic discrimination, self-reported health, depression, anxiety, and cynical hostility.
RESULTS: The association between perceived discrimination and poor self-reported health was significant and did not differ across racial/ethnic subgroups. Race-related social exclusion and threat/harassment uniquely contributed to poor health for all groups. Depression, anxiety, and cynical hostility fully mediated the effect of social exclusion on health, but did not fully explain the effect of threat.
CONCLUSIONS: Our results suggest that noxious effects of race-related exclusion and threat transcend between-group differences in discriminatory experiences. The effects of race-related exclusion and threat on health, however, may operate through different mechanisms
A Review of Tobacco Use Treatments in U.S. Ethnic Minority Populations
No full textBackground. Tobacco use is the leading preventable cause of disease and death in the United States. Among racial and ethnic minorities, disparities in tobacco use, knowledge of health risks and treatment resources, and access to and utilization of treatment contribute to a disproportionate disease burden from tobacco use. Furthermore, racial and ethnic minorities have been underrepresented within tobacco treatment studies.
Purpose/Objective. This paper provides a review of published studies examining tobacco treatment interventions among ethnic and minority populations in the United States.
Study Design/Methods. Literature searches were used to identify smoking cessation interventions involving racial/ethnic minority populations. Identified studies were published between 1985 and 2009 involving African-American, Latino, Native American, and Asian or Pacific Islander smokers. Studies included in the review (1) targeted one or more ethnic minority group or had at least 10% of study participants from ethnic minority groups and (2) reported abstinence outcomes.
Results. Sixty-four studies were included in this review. Of studies meeting inclusion criteria, 28 included a primary focus on African-Americans, 10 focused on Latinos, 4 focused on Native Americans, and 3 focused on Asian-American smokers. An additional 19 studies reported samples including participants from more than one minority group. Sample inclusion criteria, intervention content and duration, follow-up, abstinence assessment, and limitations of these studies were reviewed.
Conclusions. Individuals from racial and ethnic minority populations are interested in stopping smoking and willing to participate in treatment research. Variations in the content of treatment intervention and study design produced a range of abstinence outcomes across studies. Additional research is needed for all groups, including African-American smokers, and special attention is warranted for Latino, Native American, and Asian groups given the paucity of published studies. Although there were limited evaluations of pharmacotherapy, the existing data support use of pharmacotherapy in addition to counseling for enhancing abstinence outcomes. Further attention to level of individual smoking, variability in smoking patterns, and use of other tobacco products is needed, given known variation within and between racial and ethnic groups. Overall, findings are consistent with recommendations from the 2008 Clinical Practice Guidelines calling for increased research devoted to evaluating and enhancing tobacco use treatment interventions among racial and ethnic minority populations
Rates and Reasons: Disparities in Low Intentions to Use a State Smoking Cessation Quitline
No full textPurpose. Little is known about population-level rates and reasons for low intentions to call the quitline, a widely available evidence-based smoking cessation treatment.
Design. This study is a secondary analysis of the 2008 Colorado Adult Tobacco Attitudes and Behavior Survey.
Setting. This is a population-based telephone survey of adults in Colorado.
Subjects. Study respondents (N = 1662) included current adult smokers who had heard of the Colorado QuitLine (QL) and did not report that they never intend to quit.
Measures. Outcome measures included intent to call the QL, self-reported reasons for not intending to call the QL, and knowledge of QL services.
Analysis. Descriptive and multivariate logistic regression analyses were used for each outcome variable. All analyses were weighted for complex survey design to represent the population of Colorado.
Results. Overall 45.6% of smokers intend never to call the QL. In multivariate analysis, Latinos (odds ratio [OR] = 2.5; 95% confidence intervals [CI], 1.4, 4.7), gay/lesbian/bisexuals (OR = 5.2; 95% CI, 2.4, 11.4), and those with no insurance compared with Medicaid (OR = 3.8; 95% CI, 1.1, 13.0) were most likely to intend never to call the QL. Perceiving no need for assistance (34.8%) was the most common reason for not calling.
Conclusions. A majority of smokers have no or weak intentions of ever calling the QL, with variation by subgroup. Reasons for not intending to call can inform targeted media campaigns to increase QL reach
Brazil: towards sustainability and equity in health
No full textWith a new government in place since January and a woman, Dilma Rousseff, at the helm, together with an economic growth rate of 7·5% last year and a newly discovered oil field off its coast, Brazil is a country in demand as a political and economic partner. Brazil now has an important and timely opportunity to cement its formidable health achievements towards its ultimate goal of universal, equitable, and sustainable health care to fulfil the right to health enshrined in its 1988 constitution. To highlight this opportunity, The Lancet is publishing a Series of six papers that critically examine what the country's policies have achieved and where future challenges might lie
Racial variation in breast cancer treatment among department of defense beneficiaries
No full textBACKGROUND:
Although the overall age-adjusted incidence rates for female breast cancer are higher among whites than blacks, mortality rates are higher among blacks. Many attribute this discrepancy to disparities in health care access and to blacks presenting with later stage disease. Within the Department of Defense (DoD) Military Health System, all beneficiaries have equal access to health care. The aim of this study was to determine whether female breast cancer treatment varied between white and black patients in the DoD system.
METHODS:
The study data were drawn from the DoD cancer registry and medical claims databases. Study subjects included 2308 white and 391 black women diagnosed with breast cancer between 1998 and 2000. Multivariate logistic regression analyses that controlled for demographic factors, tumor characteristics, and comorbidities were used to assess racial differences in the receipt of surgery, chemotherapy, and hormonal therapy.
RESULTS:
There was no significant difference in surgery type, particularly when mastectomy was compared with breast-conserving surgery plus radiation (blacks vs whites: odds ratio [OR], 1.1; 95% confidence interval [CI], 0.8-1.5). Among those with local stage tumors, blacks were as likely as whites to receive chemotherapy (OR, 1.2; 95% CI, 0.9-1.7) and hormonal therapy (OR, 1.0; 95% CI, 0.6-1.4). Among those with regional stage tumors, blacks were significantly less likely than whites to receive chemotherapy (OR, 0.4; 95% CI, 0.2-0.7) and hormonal therapy (OR, 0.5; 95% CI, 0.3-0.8).
CONCLUSIONS:
Even within an equal access health care system, stage-related racial variations in breast cancer treatment are evident. Studies that identify driving factors behind these within-stage racial disparities are warranted. Cancer 2011;. © 2011 American Cancer Society