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Distinct Beliefs, Attitudes, and Experiences of Latino Smokers: Relevance for Cessation Interventions
No full textPurpose. Determine the extent to which Latino smokers are using effective interventions for smoking cessation, with particular focus on nicotine replacement therapy (NRT). Related aims were to explore cultural, attitudinal, knowledge, and socioeconomic variables associated with treatment use.
Design. Cross-sectional telephone survey of two groups of Colorado adult smokers: Latinos (n = 1010) and non-Latino whites (n = 519).
Setting. Colorado.
Methods. Computer-assisted telephone survey in either Spanish or English. Survey addressed sociodemographic variables; smoking and cessation history; knowledge, attitudes, and beliefs about smoking and quitting; and experiences in and attitudes toward the health care setting.
Participants. Latino and non-Latino white adult Colorado residents who reported being regular smokers.
Results. Colorado Latinos report using NRT substantially less often than do non-Latino whites residing in the state. This and other differences in the study were more pronounced in Latinos characterized as low acculturation on the basis of a language preference variable. Latinos smoke somewhat less than non-Latino whites and report lower levels of dependence. They appear to be motivated to quit but endorse attitudes and beliefs antithetical to NRT use. Health care access was lower among Latinos, and this was related to lower reports of lifetime NRT use. Receipt of recommended practitioner intervention (the “five As”) did not differ by ethnicity.
Conclusions. Results suggested that use of effective cessation interventions among Latinos may be enhanced by education about nicotine addiction and NRT. Policy change to increase health care access also showed promise
Different types of distrust in clinical research among whites and African Americans.
No full textBACKGROUND: African Americans are thought to be more distrustful of clinical research compared to elderly whites, but it is unknown whether specific types of distrust in clinical research, such as interpersonal or societal distrust, vary according to race. The primary objective was to identify racial differences in interpersonal or societal distrust in clinical research among African Americans and whites.
METHODS: Seven hundred seventy-six older African Americans and whites were surveyed about their interpersonal and societal distrust using a 7-item index of distrust in clinical research. We combined the 2 societal distrust items into a societal distrust subscale. We also assessed trust in primary care physicians, access to care, health/functional status, previous exposure to clinical research, awareness of the Tuskegee Syphilis Study, perceived discrimination in health care, and sociodemographic characteristics.
RESULTS: High societal distrust was more common among African Americans compared to whites (21% vs 7% in the top quartile of the societal distrust, p < .0001), but there were no racial differences in responses to the individual interpersonal distrust index items. In sequentially built multivariable analyses, the relationship between African American race and societal distrust (odds ratio, 2.2; 95% CI, 1.2-3.7) was not completely explained by other factors such as trust in one's physician, previous discrimination, or awareness of the Tuskegee Syphilis Study.
CONCLUSIONS: Racial differences according to the type of distrust in clinical research may warrant assessing specific types of distrust separately among racially diverse populations in future studies
HHS Announces Plan to Reduce Health Disparities
No full textThe U.S. Department of Health and Human Services today launched two strategic plans aimed at reducing health disparities.
The HHS Action Plan to Reduce Racial and Ethnic Health Disparities outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities.
HHS also released the National Stakeholder Strategy for Achieving Health Equity, a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities and other underserved groups reach their full health potential. The strategy, a product of the National Partnership for Action (NPA), incorporates ideas, suggestions and comments from thousands of individuals and organizations across the country. The NPA was coordinated by the HHS Office of Minority Health
Randomized Controlled Trial to Improve Adiposity, Inflammation, and Insulin Resistance in Obese African-American and Latino Youth
No full textThe purpose of this study was to examine ethnic differences in the metabolic responses to a 16-week intervention designed to improve insulin sensitivity (SI), adiposity, and inflammation in obese African-American and Latino adolescents. A total of 100 participants (African Americans: n = 48, Latino: n = 52; age: 15.4 ± 1.1 years, BMI percentile: 97.3 ± 3.3) were randomly assigned to interventions: control (C; n = 30), nutrition (N; n = 39, 1×/week focused on decreasing sugar and increasing fiber intake), or nutrition + strength training (N+ST; n = 31, 2×/week). The following were measured at pre- and postintervention: strength, dietary intake, body composition (dual-energy X-ray absorptiometry/magnetic resonance imaging) and glucose/insulin indexes (oral glucose tolerance test (OGTT)/intravenous glucose tolerance test (IVGTT)) and inflammatory markers. Overall, N compared to C and N+ST reported significant improvements in SI (+16.5% vs. -32.3% vs. -6.9% respectively, P < 0.01) and disposition index (DI: +15.5% vs. -14.2% vs. -13.7% respectively, P < 0.01). N+ST compared to C and N reported significant reductions in hepatic fat fraction (HFF: -27.3% vs. -4.3% vs. 0% respectively, P < 0.01). Compared to N, N+ST reported reductions in plasminogen activator inhibitor-1 (PAI-1) (-38.3% vs. +1.0%, P < 0.01) and resistin (-18.7% vs. +11.3%, P = 0.02). There were no intervention effects for all other measures of adiposity or inflammation. Significant intervention by ethnicity interactions were found for African Americans in the N group who reported increases in total fat mass, 2-h glucose and glucose incremental areas under the curve (IAUC) compared to Latinos (P's < 0.05). These interventions yielded differential effects with N reporting favorable improvements in SI and DI and N+ST reporting marked reductions in HFF and inflammation. Both ethnic groups had significant improvements in metabolic health; however some improvements were not seen in African Americans
Estimated Deaths Attributable to Social Factors in the United States
No full textObjectives. We estimated the number of deaths attributable to social factors in the United States. Methods. We conducted a MEDLINE search for all English-language articles published between 1980 and 2007 with estimates of the relation between social factors and adult all-cause mortality. We calculated summary relative risk estimates of mortality, and we obtained and used prevalence estimates for each social factor to calculate the population-attributable fraction for each factor. We then calculated the number of deaths attributable to each social factor in the United States in 2000. Results. Approximately 245000 deaths in the United States in 2000 were attributable to low education, 176000 to racial segregation, 162000 to low social support, 133000 to individual-level poverty, 119000 to income inequality, and 39000 to area-level poverty. Conclusions. The estimated number of deaths attributable to social factors in the United States is comparable to the number attributed to pathophysiological and behavioral causes. These findings argue for a broader public health conceptualization of the causes of mortality and an expansive policy approach that considers how social factors can be addressed to improve the health of populations. (Am J Public Health. Published online ahead of print June 16, 2011:e1-e10. doi:10.2105/AJPH.2010.300086)
Today's Topics In Health Disparities: HHS' Action Plan to Reduce Health Disparities
No full textOn Monday, April 25, 2011 Today's Topics in Health Disparities webcast examined the new Department of Health and Human Services’ Action Plan to Reduce Racial and Ethnic Health Disparities.
The program addressed the contents of the strategy and its timeline for implementation as well as its implications for providers. The panelists also discussed how the new strategy relates to other recently released HHS strategies including the National Strategy for Quality Improvement in Health Care, the National Prevention and Health Promotion Strategy, the Healthy People 2020 initiative and the National HIV/AIDS Strategy for the United States. Panelists also considered what the strategy’s role as it relates to health reform implementation
Association Between Perceived Interpersonal Everyday Discrimination and Waist Circumference Over a 9-Year Period in the Midlife Development in the United States Cohort Study
No full textThe relation between perceived interpersonal experiences of discrimination and measures of obesity is of great interest to many. This study examined the relation between changes in waist circumference and changes in perceived interpersonal everyday discrimination using the 1995-2004 Midlife Development in the United States cohort study (N = 1,452). After controlling for potential confounding variables that assessed behavioral and sociodemographic characteristics, sex-stratified ordinary least squares regression analyses suggested that the waist circumference of adult males who reported consistently high levels of interpersonal everyday discrimination increased 2.39 cm more than that of adult males who consistently reported low levels of interpersonal everyday discrimination (P < 0.05). Similarly, the waist circumference of adult females who reported an increase in interpersonal everyday discrimination increased 1.88 cm more than that of adult females who reported consistently low levels of interpersonal everyday discrimination (P < 0.05). These findings suggest that perceived interpersonal everyday discrimination may be associated with an increase in waist circumference over time among adults in the United States
A community based participatory approach to improving health in a Hispanic population
No full textABSTRACT: BACKGROUND: The Charlotte-Mecklenburg region has one of the fastest growing Hispanic communities in the country. This population has experienced disparities in health outcomes and diminished ability to access healthcare services. This city is home to an established practice-based research network (PBRN) that includes community representatives, health services researchers, and primary care providers. The aims of this project are: to use key principles of community-based participatory research (CBPR) within a practice-based research network (PBRN) to identify a single disease or condition that negatively affects the Charlotte Hispanic community; to develop a community-based intervention that positively impacts the chosen condition and improves overall community health; and to disseminate findings to all stakeholders. METHODS/DESIGN: This project is designed as CBPR. The CBPR process creates new social networks and connections between participants that can potentially alter patterns of healthcare utilization and other health-related behaviors. The first step is the development of equitable partnerships between community representatives, providers, and researchers. This process is central to the CBPR process and will occur at three levels -- community members trained as researchers and outreach workers, a community advisory board (CAB), and a community forum. Qualitative data on health issues facing the community -- and possible solutions -- will be collected at all three levels through focus groups, key informant interviews and surveys. The CAB will meet monthly to guide the project and oversee data collection, data analysis, participant recruitment, implementation of the community forum, and intervention deployment. The selection of the health condition and framework for the intervention will occur at the level of a community-wide forum. Outcomes of the study will be measured using indicators developed by the participants as well as geospatial modeling.On completion, this study will: determine the feasibility of the CBPR process to design interventions; demonstrate the feasibility of geographic models to monitor CBPR-derived interventions; and further establish mechanisms for implementation of the CBPR framework within a PBRN
Who Are America’s Poor Children? Examining Health Disparities Among Children in the United States
No full textGood health goes a long way, as research suggests that poor health in childhood not only impedes early child development, but can also have lasting consequences on children’s future health and wellbeing. Although many would agree that a health is a fundamental right, children born into low-income families are less likely to enjoy this right.
As part of NCCP’s Who are America’s Poor Children? series, this report draws on the National Health Interview Survey (NHIS) and the National Health and Nutrition Examination Survey (NHANES) to provide an overview of the health of America’s children by poverty status from 2007 to 2009. To assess health disparities