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Collecting Race, Ethnicity, and Language Data to Identify and Reduce Health Disparities: Perceptions of Health Plan Enrollees
Get PDFGaining and Maintaining Access: Exploring the Mechanisms that Support and Challenge the Relationship between Gatekeepers and Researchers
No full textMaking Ends Meet: Community Networks and Health Promotion Among Blacks in the City of Brotherly Love
No full textThis historical inquiry illustrates the power of social networks by examining the Starr Centre and the Whittier Centre, two civic associations that operated in Philadelphia during the early 20th century, a time when Black Americans faced numerous public health threats. Efforts to address those threats included health initiatives forged through collaborative social networks involving civic associations, health professionals, and members of Black communities. Such networks provided access to important resources and served as cornerstones of health promotion activities in many large cities. I trace the origins of these two centers, the development of their programs, their establishment of ties with Black community residents, and the relationship between strong community ties and the development of community health initiatives. Clinicians, researchers, and community health activists can draw on these historical precedents to address contemporary public health concerns by identifying community strengths, leveraging social networks, mobilizing community members, training community leaders, and building partnerships with indigenous community organizations. (Am J Public Health. 2011;Published Online Ahead of Print on June 16, 2011. doi:10.2105/AJPH.2011.300125)
The Effect of Peer-Driven Intervention on Rates of Screening for AIDS Clinical Trials Among African Americans and Hispanics
No full textOBJECTIVES:
We examined the efficacy of a peer-driven intervention to increase rates of screening for AIDS clinical trials among African Americans and Hispanics living with HIV/AIDS.
METHODS:
We used a randomized controlled trial design to examine the efficacy of peer-driven intervention (6 hours of structured sessions and the opportunity to educate 3 peers) compared with a time-matched control intervention. Participants were recruited using respondent-driven sampling (n = 342; 43.9% female; 64.9% African American, 26.6% Hispanic). Most participants (93.3%) completed intervention sessions and 64.9% recruited or educated peers. Baseline and post-baseline interviews (94.4% completed) were computer-assisted. A mixed model was used to examine intervention effects on screening.
RESULTS:
Screening was much more likely in the peer-driven intervention than in the control arm (adjusted odds ratio [AOR] = 55.0; z = 5.49, P < .001); about half of the participants in the intervention arm (46.0%) were screened compared with 1.6% of controls. The experience of recruiting and educating each peer also increased screening odds among those who were themselves recruited and educated by peers (AOR = 1.4; z = 2.06, P < .05).
CONCLUSIONS:
Peer-driven intervention was highly efficacious in increasing AIDS clinical trial screening rates among African Americans and Hispanics living with HIV/AIDS
Meaningful Disparities Reduction Through Research and Translation Programs
No full textHealth care disparities are unacceptable, but progress toward reducing them has been painfully slow. Each year the Agency for Healthcare Research and Quality's (AHRQ’s) National Healthcare Disparities Report documents persistent differences in care by factors such as race, ethnicity, and insurance status. 1 Public awareness of these disparities is growing, and the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010 will hasten transparency by encouraging collection of race, ethnicity, and language data. However, recognizing the existence of disparities is not sufficient to catalyze meaningful action. Even the most motivated clinicians and health care organizations may not know how to proceed because information on which interventions work in specific contexts or at scale is limited. 2
There is broad agreement that meaningful efforts to reduce disparities are linked inextricably to quality improvement. In its 2001 report Crossing the Quality Chasm, the Institute of
Acculturation, nutrition, and health disparities in Latinos
No full textBACKGROUND: Latinos have become the largest minority group in the United States and will represent 25% of the US population by 2050. Latinos experience a disproportionate burden of poverty and poor health outcomes.
OBJECTIVES: We critically examined the evidence for a link between acculturation and health disparities in Latinos with a focus on type 2 diabetes (T2D) and nutrition-related risk factors and illustrated how acculturation principles can help design a culturally appropriate T2D self-management intervention in Latinos.
DESIGN: Evidence presented in this article was drawn from 1) systematic reviews identified through PubMed searches, 2) backward searches that were based on articles cited, 3) experts in the field, and 4) the author's personal files.
RESULTS: The preponderance of the evidence supported an association of acculturation with poor dietary quality and obesity. These associations appeared to be modified by several socioeconomic and demographic factors and were not always linear. The association between acculturation and T2D is unclear.
CONCLUSIONS: Longitudinal studies and more sophisticated analytic approaches are needed to better understand if and how acculturation affects health-disparity outcomes in Latinos. Tailoring interventions to the acculturation level of individuals is likely to help reduce health disparities in Latinos
Racial and Ethnic Group Variations in Service Use in a National Sample of Medicare Home Health Care Patients with Type 2 Diabetes Mellitus
No full textType 2 diabetes mellitus is known to affect adults in racial and ethnic minority groups disproportionately. When diabetes mellitus-related symptoms lead to the need for skilled care in the community-dwelling Medicare population, physicians can order the Medicare home health care (HHC) benefit, and Medicare-certified home health agencies can deliver it. Little is known about the extent to which racial and ethnic disparities exist in types and patterns of HHC services delivered to Medicare beneficiaries with diabetes mellitus when they are approved for the Medicare HHC benefit. This was examined by comparing racial and ethnic groups in terms of measures of HHC service use in a nationally representative sample of Medicare HHC beneficiaries with a primary diagnosis of type 2 diabetes mellitus. Uniform clinical data from the Outcome and Assessment Information Set were linked with Medicare HHC claims for beneficiaries who received a complete episode of HHC in 2002. In the study sample (n=9,838), 62% of participants self-identified as white, 22% African American, 12% Hispanic, and 3% Asian. Nearly all (99%) participants in all racial and ethnic groups received skilled nursing services. Controlling for numerous sociodemographic and health-related covariates and geographic region of the country, African-American participants received fewer nurse visits per week and fewer visits per week from all clinical disciplines combined than whites (both P<.001), and Hispanic participants were less likely than whites to receive physical therapy (adjusted odds ratio (AOR)=0.640, 95% confidence interval (CI)=0.543-0.754, P<.001) or home health aide (AOR=0.716, 95% CI=0.582-0.880, P=.002) services. Lower use of skilled nursing and rehabilitation services by African Americans and of rehabilitation services by Hispanics warrant further clinical and research attention
Health care reform and equity: promise, pitfalls, and prescriptions.
No full textThe United States has made little progress during the past decade in addressing health care disparities. Recent health care reforms offer an historic opportunity to create a more equitable health care system. Key elements of health care reform relevant to promoting equity include access, support for primary care, enhanced health information technology, new payment models, a national quality strategy informed by research, and federal requirements for health care disparity monitoring. With effective implementation, improved alignment of resources with patient needs, and most importantly, revitalization of primary care, these reforms could measurably improve equity
Support and influence in the context of diabetes management: Do racial/ethnic differences exist?
No full textThis study examined the sources and frequency of, and dietary behavioral responses to, health-related social support and control in a racially/ethnically diverse sample of 1,361 adults with type 2 diabetes. Spouses were the most frequently reported sources of support/control for all racial/ethnic groups examined. Mexican Americans and Vietnamese Americans received more support/control compared to non-Hispanic whites. All types of social involvement were associated with good dietary behavior for Mexican Americans, whereas only support was associated with good dietary behavior for non-Hispanic whites. The findings underscore the importance of considering racial/ethnic differences in examining social network members’ involvement in chronic disease management
Preventing diabetes and obesity in American Indian communities: the potential of environmental interventions
No full textObesity, diabetes, and other diet-related chronic diseases persist in American Indians at rates that are significantly higher than those in other ethnic minority populations. Environmental interventions to improve diet and increase physical activity have the potential to improve these health outcomes, but relatively little work has taken place in American Indian communities. We reviewed the experiences and findings of the following 3 case studies of intervention trials in American Indian communities: the Pathways trial, which was a school-based trial that focused on children; the Apache Healthy Stores program, which was a food-store program that focused on food preparers and shoppers; and the Zhiwaapenewin Akino'maagewin trial, which was a multiinstitutional trial for First Nations adults that worked with food stores, elementary schools, and health and social services agencies. All 3 trials showed mixed success. Important lessons were learned, including the need to focus on supply and demand, institutional and multilevel approaches, and the identification of institutional bases to sustain programs