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Project GRACE: A Staged Approach to Development of a Community--Academic Partnership to Address HIV in Rural African American Communities
No full textThe HIV epidemic is a health crisis in rural African American communities in the Southeast United States; however, to date little attention has been paid to community-academic collaborations to address HIV in these communities. Interventions that use a community-based participatory research (CBPR) approach to address individual, social, and physical environmental factors have great potential for improving community health. Project GRACE (Growing, Reaching, Advocating for Change and Empowerment) uses a CBPR approach to develop culturally sensitive, feasible, and sustainable interventions to prevent the spread of HIV in rural African American communities. This article describes a staged approach to community-academic partnership: initial mobilization, establishment of organizational structure, capacity building for action, and planning for action. Strategies for engaging rural community members at each stage are discussed; challenges faced and lessons learned are also described. Careful attention to partnership development has resulted in a collaborative approach that has mutually benefited both the academic and community partners
Racial-Ethnic Disparities in Stroke Care: The American Experience: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association
No full textPurpose- Our goal is to describe the effect of race and ethnicity on stroke epidemiology, personal beliefs, access to care, response to treatment, and participation in clinical research. In addition, we seek to determine the state of knowledge on the main factors that may explain disparities in stroke care, with the goal of identifying gaps in knowledge to guide future research. The intended audience includes physicians, nurses, other healthcare professionals, and policy makers.
METHODS: Members of the writing group were appointed by the American Heart Association Stroke Council Scientific Statement Oversight Committee and represent different areas of expertise in relation to racial-ethnic disparities in stroke care. The writing group reviewed the relevant literature, with an emphasis on reports published since 1972. The statement was approved by the writing group; the statement underwent peer review, then was approved by the American Heart Association Science Advisory and Coordinating Committee.
RESULTS: There are limitations in the definitions of racial and ethnic categories currently in use. For the purpose of this statement, we used the racial categories defined by the US federal government: white, black or African American, Asian, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander. There are 2 ethnic categories: people of Hispanic/Latino origin or not of Hispanic/Latino origin. There are differences in the distribution of the burden of risk factors, stroke incidence and prevalence, and stroke mortality among different racial and ethnic groups. In addition, there are disparities in stroke care between minority groups compared with whites. These disparities include lack of awareness of stroke symptoms and signs and lack of knowledge about the need for urgent treatment and the causal role of risk factors. There are also differences in attitudes, beliefs, and compliance among minorities compared with whites. Differences in socioeconomic status and insurance coverage, mistrust of the healthcare system, the relatively limited number of providers who are members of minority groups, and system limitations may contribute to disparities in access to or quality of care, which in turn might result in different rates of stroke morbidity and mortality. Cultural and language barriers probably also contribute to some of these disparities. Minorities use emergency medical services systems less, are often delayed in arriving at the emergency department, have longer waiting times in the emergency department, and are less likely to receive thrombolysis for acute ischemic stroke. Although unmeasured factors may play a role in these delays, the presence of bias in the delivery of care cannot be excluded. Minorities have equal access to rehabilitation services, although they experience longer stays and have poorer functional status than whites. Minorities are inadequately treated with both primary and secondary stroke prevention strategies compared with whites. Sparse data exist on racial-ethnic disparities in access to surgical care after intracerebral hemorrhage and subarachnoid hemorrhage. Participation of minorities in clinical research is limited. Barriers to participation in clinical research include beliefs, lack of trust, and limited awareness. Race is a contentious topic in biomedical research because race is not proven to be a surrogate for genetic constitution.
CONCLUSIONS: There are limitations in the current definitions of race and ethnicity. Nevertheless, racial and ethnic disparities in stroke exist and include differences in the biological determinants of disease and disparities throughout the continuum of care, including access to and quality of care. Access to and participation in research is also limited among minority groups. Acknowledging the presence of disparities and understanding the factors that contribute to them are necessary first steps. More research is required to understand these differences and find solutio
Blood Pressure and the Risk of Developing Diabetes in African Americans and Whites: ARIC, CARDIA, and the Framingham Heart Study
No full textOBJECTIVE: We examined the association between high blood pressure and incident type 2 diabetes in African Americans and whites aged 35-54 years at baseline.
RESEARCH DESIGN AND METHODS: We combined data from the Atherosclerosis Risk in Communities (ARIC) study, the Coronary Artery Risk Development in Young Adults (CARDIA) study, and the Framingham Heart Study offspring cohort. Overall, 10,893 participants (57% women; 23% African American) were categorized by baseline blood pressure (normal, prehypertension, hypertension) and examined for incident diabetes (median follow-up 8.9 years).
RESULTS: Overall, 14.6% of African Americans and 7.9% of whites developed diabetes. Age-adjusted incidence was increasingly higher across increasing blood pressure groups (P values for trend: <0.05 for African American men; <0.001 for other race-sex groups). After adjustment for age, sex, BMI, fasting glucose, HDL cholesterol, and triglycerides, prehypertension or hypertension (compared with normal blood pressure) was associated with greater risks of diabetes in whites (hazard ratio [HR] for prehypertension: 1.32 [95% CI 1.09-1.61]; for hypertension: 1.25 [1.03-1.53]), but not African Americans (HR for prehypertension: 0.86 [0.63-1.17]; for hypertension: 0.92 [0.70-1.21]). HRs for developing diabetes among normotensive, prehypertensive, and hypertensive African Americans versus normotensive whites were: 2.75, 2.28, and 2.36, respectively (P values <0.001).
CONCLUSIONS: In African Americans, higher diabetes incidence among hypertensive individuals may be explained by BMI, fasting glucose, triglyceride, and HDL cholesterol. In whites, prehypertension and hypertension are associated with greater risk of diabetes, beyond that explained by other risk factors. African Americans, regardless of blood pressure, have greater risks of developing diabetes than whites
From Politics to Parity: Using a Health Disparities Index to Guide Legislative Efforts for Health Equity
No full textObjectives. We created an index quantifying the longitudinal burden of racial health disparities by state and compared this index to variables to guide the construction of, and validate support for, legislative efforts aimed at eliminating health disparities.
Methods. We evaluated 5 focus areas of greatest racial disparities in health from 1999 to 2005 and compiled state health disparities index (HDI) scores. We compared these scores with variables representing the purported social determinants of health.
Results. Massachusetts (0.35), Oklahoma (0.35), and Washington (0.39) averaged the fewest disparities. Michigan (1.22), Wisconsin (1.32), and Illinois (1.50) averaged the greatest disparities. The statistical reference point for nationwide average racial disparities was 1.00. The longitudinal mixed model procedure yielded statistically significant correlations between HDI scores and Black state population percentage as well as with the racial gap in uninsured percentages. We noted a trend for HDI correlations with median household income ratios.
Conclusions. On the basis of the HDI-established trends in the extent and distribution of racial health disparities, and their correlated social determinants of health, policymakers should consider incorporating this tool to advise future efforts in minority health legislation
Racial and Ethnic Disparities in Hospitalizations and Deaths Associated with 2009 Pandemic Influenza A (H1N1) Virus Infections in the United States
No full textPURPOSE: Concerns have been raised regarding possible racial-ethnic disparities in 2009 pandemic influenza A (H1N1) (pH1N1) illness severity and health consequences for U.S. minority populations.
METHODS: Using data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, Emerging Infections Program Influenza-Associated Hospitalization Surveillance, and Influenza-Associated Pediatric Mortality Surveillance, we calculated race-ethnicity-specific, age-adjusted rates of self-reported influenza-like illness (ILI) and pH1N1-associated hospitalizations. We used χ(2) tests to evaluate racial-ethnic disparities in ILI-associated health care-seeking behavior and pH1N1 hospitalization. To evaluate pediatric deaths, we compared racial-ethnic proportions of deaths against U.S. population distributions.
RESULTS: Prevalence of self-reported ILI was lower among Hispanics (6.5%), higher among American Indians/Alaska Natives (16.2%), and similar among non-Hispanic blacks (7.7%) compared with non-Hispanic whites (8.5%). No racial-ethnic differences were identified in ILI-associated health care-seeking behavior. Age-adjusted pH1N1-associated Emerging Infections Program hospitalization rates were higher among all minority populations (range: 8.1-10.9/100,000 population) compared with non-Hispanic whites (3.0/100,000). The proportion of pH1N1-associated pediatric deaths was higher than expected among Hispanics (31%) and lower than expected among non-Hispanic whites (45%) given the proportions of the U.S. population they comprise (22% and 58%, respectively).
CONCLUSIONS: Racial-ethnic disparities in pH1N1-associated hospitalizations and pediatric deaths were identified. Vaccination remains the primary intervention for preventing influenza
Addressing the Social Determinants of Health of Children and Youth: A Role for SOPHE Members
No full textThe determinants of youth health disparities include poverty, unequal access to health care, poor environmental conditions, and educational inequities. Poor and minority children have more health problems and less access to health care than their higher socioeconomic status cohorts. Having more health problems leads to more absenteeism in school, which, in turn, can affect achievement. The educational level that one attains is a significant determinant of one's earning potential and health. Those who learn more earn more money and have a better health status. Those who do not attain a high school diploma on average live 6 to 9 years less than those who do graduate from high school. Furthermore, their children also experience poorer health and the cycle is repeated. Achieving a high school diploma and a college degree is an acknowledged route out of poverty. However, that route is blocked for many poor and minority students. SOPHE is in a prime position to be the organization linking the health care, public health and education sectors in addressing the reduction of both health disparities and educational inequities. This article describes what SOPHE members can do both individually and collectively to reduce the health and educational inequities facing our most vulnerable children
Culturally tailored intervention for African Americans with type 2 diabetes administered by a nurse case manager and community health worker reduces emergency room visits
No full textType 2 diabetes mellitus (T2DM) is a major cause of morbidity and mortality for African Americans, who suffer disproportionately from its complications. The need for culturally appropriate, tailored interventions to improve metabolic outcomes and quality of life for African Americans with T2DM has been addressed in the literature;1 2 our task now is to develop, test and evaluate these interventions and to disseminate them to the healthcare community. The approach used in this intervention is innovative in that it creates a team of nurse case manager (NCM), community health worker (CHW) and primary care providers, providing for continuity of care (“supplement ongoing clinical care”) outside of regularly scheduled clinic visits
Health is power: An ecological theory-based health intervention for women of color
No full textObjective
Physical inactivity and poor dietary habits plague Americans as health challenges, with women of color most vulnerable to their detrimental effects. Individually focused interventions have not demonstrated lasting success, possibly due to the lack of focus on sustainable social and physical environment factors. This manuscript describes the rationale, design and methodology of Health Is Power (HIP), a transcultural, community based, randomized controlled trial that investigated the effectiveness of a group cohesion intervention to increase physical activity and improve dietary habits in African American and Hispanic or Latina women in Houston and Austin, Texas.
Methods
The intervention development was guided by group dynamics principles anchored within an ecologic model.
Results
Women participated in three health assessments and a six month face to face intervention that included evidence-based behavioral methods – integrated into strategies to promote group cohesion – framed to account for environmental factors contributing to health disparities. Women participated in team building activities, environmental mapping exercises, and supervised walks or taste tests.
Conclusions
Neighborhood contextual and environmental measures are described to test ecologic factors that may contribute to behavioral maintenance. Theoretically guided interventions that account for multiple levels of influence in behavior initiation and maintenance stand to improve health outcomes in vulnerable populations
Mortality Trends and Disparities Among Racial/Ethnic and Sex Subgroups in New York City, 1990 to 2000
No full textNew York City census data for 1990 and 2000 for all-cause and disease-specific mortality adjusted by age were examined by race/ethnicity. Primary cause of death was coded as HIV/AIDS, cardiovascular disease, coronary heart disease, acute myocardial infarction, stroke, diabetes, or cancer. For White, Black, Hispanic and Asian groups, relative mortality ratios (RMR) were derived for 2000 relative to 1990. Ratios of RMR’s for minority groups were derived relative to Whites. From 1990 to 2000, HIV, cancer, CVD, CHD, AMI, and stroke-related mortality decreased. Decreases in HIV-related mortality were notably less for minority males. Diabetes mortality rates rose dramatically, with Hispanic and Asian males having notably greater increases than White males. Increases in mortality among Asians exceeded those of other groups, and appear to correspond with increased immigration/acculturation. Mortality shifts among different diseases and racial groups should alert public health officials to consider immigration patterns in designing, implementing, and evaluating interventions to prevent disease-related mortality, with a goal to eliminate disparitie
Integrated connection to neighborhood storytelling network, education, and chronic disease knowledge among African Americans and Latinos in Los Angeles.
No full textCombining key ideas from the knowledge-gap hypothesis and communication infrastructure theory, the present study aimed to explain the relations among individuals' education, access to community-based communication resources, and knowledge of chronic diseases (diabetes, hypertension, breast cancer, and prostate cancer) among African Americans and Latinos in Los Angeles. Rather than explore the effect of isolated communication resources, this study explored the effect of an integrated connection to community-based storytellers on chronic disease knowledge. The authors hypothesized that individuals' access to a community-based communication infrastructure for obtaining and sharing information functions as an intervening step in the process where social inequality factors such as education lead to chronic disease knowledge gaps in a local community context. With random samples of African Americans and Latinos in Los Angeles, the authors found that access to community-based communication resources plays a mediating role in the case of breast cancer and diabetes knowledge, but not in hypertension and prostate cancer knowledge. The authors discussed these findings on the basis of communication infrastructure theory and knowledge-gap hypothesis