Address Health Disparities Research Articles

Scarcity of Women in Interventional Radiology in SubSaharan Africa: Survey and Insights

Purpose: Globally, women are underrepresented in Interventional Radiology (IR) and calls have been made to increase gender equity. In sub-Saharan Africa specifically, IR is a rapidly emerging field. However, concerns have been raised about the lack of women in IR in the region. The purpose of this study was to assess the state of women in IR in sub-Saharan Africa, with attention to their training experiences, and perceived barriers, to identify opportunities to increase gender equity. Methods: We distributed a survey to all identifiable female IR physicians and trainees in sub-Saharan Africa (SSA). The survey included questions on demographics, training experiences, barriers faced professionally, and suggestions for encouraging more women in Africa to pursue IR. Results: Eight women in IR in SSA were identified, six of whom responded to the survey (75% response rate). Commonly cited perceived barriers include lack of training opportunities, gender underrepresentation and societal expectations. Suggestions for increasing women's participation in IR can be increased by creating more training opportunities in Africa, including gender-specific opportunities, integrating IR into diagnostic radiology training programs, developing mentoring programs, and concerted efforts by professional societies to establish dedicated committees, scholarships and sponsorship of women. Conclusions: While interventional radiologists are few in SSA, gender disparities already exist. As increasing the number of IR physicians in low resource areas is essential to addressing health disparities, and women in IR frequently treat women's health conditions, including maternal mortality, building physician capacity in a gender-sensitive manner is essential.

Exploring the Intersection of Social Justice and Health through Art

This paper examines the role of art in advocating for social justice and addressing health disparities. It highlights how various artistic mediums such as photography, installations, performance, and visual arts serve as powerful tools to communicate the complexities of structural inequality and promote public health advocacy. The review discusses the intersection of art and politics, as well as the potential for art to shift perspectives, foster empathy, and influence policy. It delves into case studies where artistic initiatives have contributed to health advocacy, particularly in marginalized communities, and demonstrates how art can be an effective therapeutic tool for healing, empowerment, and mobilization for health equity. Keywords: Social Justice, Health Disparities, Art and Activism, Health Equity, Community Engagement.

Collecting sociodemographic data in primary care: Qualitative interviews in community health centers.

Many primary care organizations do not routinely collect sociodemographic data (SDD) such as race, gender, or income despite the importance of this data in addressing health disparities. To understand the experiences of primary care providers and staff in collecting SDD. A qualitative interview study with 33 primary care and interprofessional team members from eight Ontario Community Health Centres (CHCs). Semi-structured virtual interviews and content analysis of interview transcripts. Participants reported using both formal methods of SDD collection, and informal methods of SDD collection that were more organic, varied, and conducted over time. Participants discussed sometimes feeling uncomfortable collecting this data formally, as well as associated burden and limited resources to support collection. Client-provider rapport was noted as facilitating data collection and participants suggested more training, streamlined data collection, and better communication about purpose and use of data. SDD can be collected informally or formally but there are limitations to informally collected data and barriers to the adoption of formal processes.

Public health policy for temporary seasonal workers with chronic hepatitis B in high-income countries: A comparative analysis.

This study examines Australia's Hepatitis B public health policies with a focus on the Pacific Australia Labour Mobility scheme seasonal workers as a priority population. The aim is to evaluate if Australia's Hepatitis B public health policies adequately address health disparities and equitable access to health care for seasonal workers as a priority population. We draw comparisons with the public health policies of New Zealand and Canada, to understand how these nations approach similar health concerns among their temporary seasonal workers. A health policy analysis was conducted on the public health Hepatitis B policies in Australia and then compared with those in Canada and New Zealand. Due to the nature of the study question, the review had a major focus on grey literature. The search was undertaken in two stages, including (1) Google search engine and (2) targeted websites. Basic document data was produced in descriptive summaries. Any data either explicitly or inexplicitly relating to the elimination of hepatitis B or equity towards the inclusion of seasonal workers was produced as analytical summaries through multiple revisions. Nineteen documents were identified, predominantly from Australia. Although Hepatitis B public health policies emphasised testing and awareness in priority populations, specifically mentioning seasonal workers as a priority population was absent in all three countries. The study underscores the exclusion of temporary seasonal workers in public health policies and strategies as a human rights issue, conflicting with principles of equity and equitable access to health care. Despite acknowledging challenges for temporary visa holders, policies lack specific provisions for seasonal workers. Addressing this gap is crucial for health equity and inclusive health systems. SO WHAT?: Our findings highlight the need to prioritise equity for temporary seasonal workers to achieve hepatitis B elimination goals by 2030. Exclusion from public health policies is a human rights concern, impacting access to quality health care. This study advocates for inclusive policies explicitly recognising temporary seasonal workers as a priority population, aligning with international human rights commitments to health care for all.

Exploring the Importance of Cultural Sensitivity in Arts-Based Health Interventions

Arts-based health interventions have emerged as valuable tools for improving community health and well-being by integrating creative practices such as music, visual arts, and performance into healthcare settings. These interventions provide a unique way to address health disparities and engage communities. However, the success of such interventions hinges on cultural sensitivity, as they are implemented in diverse communities with different values, beliefs, and health practices. This paper examines the role of cultural sensitivity in the development and implementation of arts-based health interventions. It emphasizes the need for cultural competence to ensure that these interventions are relevant, respectful, and effective across various cultural contexts. Case studies of successful culturally sensitive arts-based initiatives are examined, highlighting best practices for collaboration with communities and the importance of adapting interventions to local needs. Keywords: Arts-based health interventions, Cultural sensitivity, Community health, Cultural competence, Public health.

Addressing health disparities in food allergy: APosition Statement of the AAAAI Prior Authorization Task Force.

Self-reported food allergies (FAs) affect approximately 8% of the US pediatric and approximately 10% of the adult population, which reflects potentially disproportionate increases among ethnically and racially minoritized groups. Multiple gaps and unmet needs exist regarding FA disparities. There is reported evidence of disparities in FA outcomes, and the FA burden may also be disproportionate in low-income families. Low family income has been associated with higher emergency care spending and insecure access to allergen-free food. Pharmacoinequity arises in part as a result of structural racism still experienced by historically marginalized populations today. Historically redlined communities continue to experience greater rates of neighborhood-level air pollution and indoor allergen exposure, lack of transportation to medical appointments, poverty, and lower prescription rates of necessary medications. Clinical research needs racially and ethnically diverse participation to ensure generalizability of research findings and equitable access to medical advances, but race reporting in clinical trials has been historically poor. Addressing health disparities in FA is a priority of clinical care, with professional organizations such as the American Academy of Allergy, Asthma & Immunology having a prominent role to play in mitigating the challenges faced by these individuals. In this position statement we recommend some key steps to address this important issue.

Impact of the Affordable Care Act on Revascularization Versus Amputation in Patients Presenting With Chronic Limb-Threatening Ischemia in Maryland.

The Affordable Care Act (ACA) aimed to expand Medicaid, enhance health care quality and efficiency, and address health disparities. These goals have potentially influenced medical care, notably revascularization rates in patients presenting with chronic limb-threatening ischemia (CLTI). This study examines the effect of the ACA on revascularization vs amputation rates in patients presenting with CTLI in Maryland. This was a retrospective analysis of the Maryland State Inpatient Database comparing the rate of revascularization to rate of major amputation in patients presenting with CLTI over 2 periods: pre-ACA (2007-2009) and post-ACA (2018-2020). In this study, we included patients presenting with CLTI and underwent a major amputation or revascularization during that same admission. Using regression analysis, we estimated the odds of revascularization vs amputation pre- and post-ACA implementation, adjusting for pertinent variables. During the study period, 12,131 CLTI patients were treated. Post-ACA, revascularization rate increased from 43.9% to 77.4% among patients presenting with CLTI. This was associated with a concomitant decrease in the proportion of CLTI patients undergoing major amputation from 56.1% to 22.6%. In the multivariate analysis, there was a 4-fold odds of revascularization among patients with CLTI compared to amputation (OR = 4.73, 95% CI 4.34-5.16) post-ACA. This pattern was seen across all insurance groups. The post-ACA period in Maryland was associated with an increased revascularization rate for patients presenting with CLTI with overall benefits across all insurance types.

Asking Why Is Necessary to Address Health Disparities: A Critical Approach for Solution-Oriented Environmental Epidemiological Research.

In environmental epidemiology, we use an array of tools from various, related disciplines to answer key questions about environmental exposures in relation to health outcomes. Typically, we ask questions related to what, who, where, when, and how. We value these questions because they contribute to novel scientific discovery and our understanding of disease etiology linked to environmental exposures. In addition, these questions help us better understand who might be at highest risk of exposure and subsequent risk of disease. Although necessary for the goals of environmental epidemiology, these questions are insufficient for addressing environmental health disparities. Specifically, these questions may be able to help us describe exposure-health outcome associations but are limited in their ability to move beyond identification to intervening on observed disparities to achieve environmental health equity. We sought to emphasize the need to value and routinely add the key question of "Why?" in environmental epidemiological studies. In asking this additional critical question, we can identify and incorporate the structural determinants and drivers of environmental exposure disparities and determine whether these factors are linked to existing and historically recalcitrant health disparities. Further, we can design effective studies that build on existing frameworks to address the fundamental causes of environmental health disparities. This commentary underscores the need to routinely incorporate "why" questions in the practice of environmental epidemiology. By asking and addressing "Why?" we can employ better, more solution-oriented study designs, improve data collection, and enhance our ability to collaborate with diverse study populations through trust-building and community-engaged research. Incorporating these approaches will move environmental epidemiology forward from mostly documenting to actively addressing environmental health disparities. https://doi.org/10.1289/EHP14513.

Initiatives to improve lung and sleep health in children: Delphi consensus from the pediatrics, pulmonary, and sleep conference.

The lung and sleep health of adults is heavily influenced by early factors, both genetic and environmental; therefore, optimizing respiratory health begins in childhood. Multiple barriers impede improvements in lung and sleep health for children. First, the traditional siloing between general pediatric care in the community, pediatric pulmonary and sleep subspecialty care, and the research community limits the translation of knowledge into practice. Additionally, identifying and addressing health disparities remains a challenge. The 2021 NHLBI-sponsored workshop "Defining and Promoting Pediatric Pulmonary Health (DAP3H)" was a first step in defining critical gaps in our current healthcare system in identifying and optimizing lung and sleep health in children. The workshop identified key opportunities including measuring pulmonary function in young children, sleep-focused outcomes, developing biomarkers, and longitudinal research cohorts. To expand on the work of DAP3H and continue initiatives to improve childhood lung and sleep health, the Pediatrics & Pulmonary Network: Improving Health Together conference was held in 2023. A modified Delphi process was applied to form consensus surrounding gaps, barriers, and action items, with the goal of identifying the most urgent opportnities for improving childhood lung and sleep health. Cross-cutting foundational principles were identified as: (1) Authentic Stakeholder Collaboration & Engagement, (2) Reach & Implementation in Real World Settings, (3) Understanding Current Landscape & Resources and (4) Purposeful Diversity, Equity, & Inclusion Initiatives. To improve lung and sleep health in children, these principles should be the foundation for research design, development, and implementation.

Advancing preventive health care for men across the lifespan.

Historically, cisgender men have been found to be reluctant to utilize healthcare services, particularly preventive care services. NPs can bridge this gap to address health disparities among men, who are more likely to develop life-threatening conditions and who generally face higher mortality at younger ages than women. Focusing on advancing preventive care among men strengthens family, community, and societal health, and the NP is crucial in fostering a culture of preventive care in this population. To help drive this change, use of a life-stage approach that incorporates a preventive care mindset is critical. The NP should tailor health strategies to each life phase to ensure that men receive the best preventive care possible across the lifespan.

Social Accountability at Southern Illinois University School of Medicine: A Focus on Admission Policy

Given the increasing health disparities across regions and populations, social accountability is not an option but an obligation for health professions schools, including medical schools. In this short communication, the authors report the case of Southern Illinois University School of Medicine (SIU SOM), which has been an exemplary medical school for social accountability, receiving the 2013 AMEE ASPIRE Award in social accountability and the 2018 Josiah Macy Jr. Foundation Award for Institutional Excellence in Social Mission in Health Professions Education. This paper focuses on the school’s admission policies in the discussion of its social accountability. It starts with the background of central and southern Illinois, where the school is located to address the shortage of healthcare professionals in the areas. It discusses the school’s holistic admission policies and two pipeline programs—namely, MEDPREP and McNeese Physician Preparatory Pipeline Program (P4)—that are strategically designed as a long-term physician workforce development plan to address health disparities in rural areas. As of January 30, 2024, 3,233 students have earned the MD (Doctor of Medicine) degree at SIU SOM. In total, 770 alumni (33%) are practicing in primary care. Among 901 graduates practicing in Illinois, 484 (54%) are practicing in SIU SOM service area counties (i.e., central and southern Illinois). Social accountability is the core value and organizational identity of SIU SOM and the guiding principle of the school’s innovation and excellence.

Home Mortgage Lending and Neighborhood Mental Health: A Spatial Econometric Analysis of 18 U.S. Metropolitan Statistical Areas.

This study investigates the relationship between home mortgages and neighborhood mental health across the 18 largest metropolitan statistical areas (MSAs) in the United States. Home mortgages, a primary avenue to homeownership, contribute to housing security and stability. Moreover, their issuance reflects local investment and potential improvements in the built environment, hypothesized to positively influence community mental well-being. Using census tract-level data from multiple sources, we employed a spatial econometric approach, specifically spatial error modeling, to account for spatial dependency and estimate the association between home mortgage lending (2011 to 2020) and the prevalence of self-reported poor mental health in 2020. Our findings indicate a statistically significant negative association between mortgage issuance and self-reported poor mental health across all 18 MSAs, suggesting that increased mortgage lending is associated with improved neighborhood mental health. Comparisons between standard linear models and spatial error models highlight the influence of unmeasured, spatially correlated factors on neighborhood mental health outcomes. This study underscores mortgage lending as a crucial factor in community well-being and emphasizes the necessity of addressing spatial dependency in neighborhood health studies for accurate estimations. The findings offer valuable insights for researchers and policymakers aiming to enhance community mental health and address health disparities through informed housing policies.

Implementing patient navigation for cancer prevention among individuals with mentally ill-health

Abstract Issue In Europe, over 80 million people experience mental ill-health and there are 4 million new cancer diagnoses each year. Individuals experiencing mental ill-health exhibit higher rates of cancer morbidity and mortality, with this excess attributed to risky health behaviors and obstacles encountered when accessing often fragmented healthcare systems. Description of the problem The aim of Co-CAPTAIN is the pilot implementation and evaluation of the Patient Navigation Model (PNM) for the improvement of primary cancer prevention in individuals with mental ill-health, adapted through participatory co-design in the European context. The project will adopt a cohort-based study design, commencing data collection at baseline and succeeded by three follow-ups (6 weeks, 9 months, 18 months). It will utilize a mixed-methods approach, combining quantitative and qualitative methodologies to assess diverse outcomes of PNM, facilitating both exploratory and confirmatory research. Qualitative data will be obtained through semi-structured interviews, while quantitative data will be collected using validated questionnaires and items developed ad hoc. The project will involve four pilot sites in Europe (Austria, Greece, Poland and Spain), where the PNM will be adapted to the specificities of national healthcare and support systems. The implementation phase is expected to begin in June 2024. Results During implementation, gathering both quantitative and qualitative data will offer valuable insights into feasibility and effectiveness, establishing a baseline for reshaping health and social care policies for individuals with mental ill-health across Europe. Lessons Co-CAPTAIN project aims to reduce health disparities for individuals with mental ill-health by improving overall health and reducing cancer burdens, leading to cost reductions in European health and social care systems. Key messages • The project aims to deliver an innovative solution based on the PNM, to address health disparities among individuals with mental ill-health by reducing cancer burden. • Combination of qualitative and quantitative methodologies to assess diverse outcomes.

Who is Willing to Learn About Inequality? Predictors of Choice Exposure to Messaging About Racial Disparities in Air Pollution Effects Among Black and White U.S. Residents

ABSTRACT Widespread public awareness is needed to address health disparities and push for effective and equitable solutions. However, in a high choice media environment, this can only be achieved to the extent that people opt to consume disparity messaging. Drawing on theories of selective exposure, the present research uses a pre-registered online study conducted with U.S. adult participants to examine identity-based predictors of choice exposure to a racial disparity message about the health consequences of air pollution. Findings indicate that racial identity and environmental justice awareness are key predictors of disparity message selection, likely motivated by information utility and a bias toward congenial information. Altogether, results underscore the difficulty of raising awareness of disparities beyond impacted or already well-informed groups and highlight the need to examine more creative messaging strategies in order to broaden public awareness.

Empowering Early Career Researchers: The Jackson Heart Study Smith Scholars Program.

The University of Mississippi Medical Center Graduate Training and Education Center houses the Robert E. Smith, MD, Scholars Program, a two-year certificate program that equips predoctoral trainees from five Mississippi universities with advanced research skills in cardiovascular epidemiology. Funded by the National Heart, Lung, and Blood Institute (NHLBI), the program focuses on addressing health disparities, minority health, and health inequities in underserved communities. Trainees receive mentorship, career coaching, and a $7,500 annual stipend, building a foundation for postdoctoral opportunities and expanding professional networks. The Smith Scholars Program emphasizes population health and provides interdisciplinary training in areas such as biostatistics, scientific communication, and cardiovascular health. It is uniquely positioned to address systemic challenges, particularly in Mississippi, a state with high cardiovascular disease prevalence and limited research funding. The program's regional advantage and its partnership with the Jackson Heart Study offer scholars exposure to health disparities in Black/African American communities, preparing them to contribute to innovative, community-based research. Additionally, it fosters collaborative science, enabling participants to overcome academic barriers and engage with large-scale health equity research efforts. The Smith Scholars Program has been instrumental in shaping the career trajectories of its participants, facilitating their transition to postdoctoral positions and independent research roles.

Teaching health disparities on the road: An experiential educational intervention for doctor of nursing practice students

AimThis analysis was conducted to understand the nuanced and underlying benefits and challenges of an experiential educational intervention for DNP students learning how neighborhoods and health disparities may be related. BackgroundPoor social and environmental conditions in many low-income urban neighborhoods are linked to deleterious health outcomes. Many of the structural and political influences are unknown to health providers, which can inhibit their understanding of the social effects on health. One aspect of a new DNP social determinants of health curriculum is a guided community bus tour in economically disadvantaged neighborhoods to enhance understanding of health disparities. DesignA concurrent mixed methods design, including comparison surveys and thematic analysis, was used to analyze student responses to the experiential educational intervention. MethodA community-based bus tour implemented in socially disadvantaged neighborhoods in an urban environment was the study focus. New DNP students (n=91) in a midwestern university introductory course agreed to provide feedback following an experiential learning activity. The analysis of responses to the educational intervention was completed using a systematic thematic analysis alongside descriptive statistics and paired t-tests in a convergent mixed methods analytical approach to answer the research aim. ResultsStudents expressed confidence in naming and addressing health disparities after the bus tour activity. Analysis showed: (a) A visual tour can impact new learning, (b) Policy can explain inequity and is new to students, (c) Students do not well articulate racial disparities and (d) Understanding racial history requires attention and conversation. ConclusionA community bus tour met our expectations for teaching DNP students concepts related to health disparities as it illustrated real-life situations in actual neighborhoods. However, there were unusual student responses that prompted us to reflect on the activity and consider improvements. More emphasis needs to be placed on cultural wealth and on discussion planning for such experiences. Our results lay the groundwork for curriculum development. Setting goals and targets in line with the 2022 CDC’s Core Health Equity Science and Implementation Strategy is essential.

Dementia risk scores, apolipoprotein E, and risk of Alzheimer's disease: One size does not fit all.

Evaluating the generalizability of dementia risk scores, primarily developed in non-Latinx White (NLW) participants, and interactions with genetic risk factors in diverse populations is crucial for addressing health disparities. We analyzed the association of the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) and modified CAIDE (mCAIDE) scores with dementia risk using logistic regression models stratified by race/ethnicity in National Alzheimer's Coordinating Center (NACC) and Alzheimer's Disease Neuroimaging Initiative (ADNI), and assessed their interaction with apolipoprotein E (APOE). Higher CAIDE scores were associated with an increased risk of dementia in Asian, Latinx, and NLW participants but not in Black participants. In contrast, higher mCAIDE scores were also associated with an increased risk of dementia in Black participants. Unfavorable mCAIDE risk profiles exacerbated the apolipoprotein E*ε4 (APOE*ε4) risk effect and attenuated the APOE*ε2 protective effect. Our findings underscore the importance of evaluating the validity of dementia risk scores in diverse populations for their use in personalized medicine approaches to promote brain health. Dementia risk scores demonstrate race/ethnic-specific effects on dementia risk. Unfavorable modifiable risk profiles moderate the effect of APOE on dementia risk. Dementia risk scores need to be validated in diverse populations.

A qualitative exploration of the implementation facilitators and challenges of a community health worker program to address health disparities for people recently released from incarceration using the consolidated framework for implementation research

BackgroundDespite the potential for community health worker (CHW)-led programs to improve the health of people with justice involvement (PWJI), little is known about the practical implementation of such models. We explored barriers and facilitators to implementation of a municipal CHW program, the Health Justice Network (NYC HJN), led by the New York City Department of Health and Mental Hygiene (DOHMH) in partnership with three reentry-focused community-based organizations (CBOs) and three federally qualified health centers (FQHCs) that was designed to serve the health and social service needs of PWJI.MethodsEighteen in-depth qualitative interviews were conducted with a purposive sample of CHWs, partner site supervisors, and DOHMH staff. Interviews were conducted virtually and transcribed verbatim. Codes and themes were developed using the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers to NYC HJN implementation.ResultsImportant facilitators to implementation included: lived experience of CHWs, as well as NYC HJN’s voluntary nature, lack of onerous eligibility criteria, and prioritization of participant needs. One barrier was the lack of a formal implementation protocol. Themes identified as facilitators in some instances and barriers in others were CHW integration into site partners, the expansive scope of work for CHWs, the integration of a trauma-informed approach, values alignment and existing infrastructure, leadership engagement, CHW training and support, and input, feedback, and communication.ConclusionsFindings will help inform how to successfully implement future CHW-led interventions for PWJI with municipal, health, and social service partners.

The Unique Perspective of an Expert Humanitarian Nurse: A Case Study.

Nurses perform a key role in national and international humanitarian efforts. This case study of a highly experienced Registered Nurse who has engaged in international humanitarian projects for more than 30 years provides unique insight into the way nurses care for underserved populations. This nurse constructed knowledge and derived meaning from her practice by utilizing Carper's Patterns of Knowing. Many previous studies have proposed that Aesthetic Knowing is the dominant form of knowledge most nurses use to synthesize their understanding. However, in her personal account, this nurse identified Ethical Knowing as the overarching framework she used to construct all her other forms of knowledge and to derive meaning from her experiences. Findings from this case study identify significant themes related to the role of nurses in humanitarian work, and provide new insight into prevailing Western theoretical frameworks and how nurses can address health disparities among marginalized populations.

Trends in gender and ethnic diversity among US psychiatry residents: A 5-year analysis.

This study aims to analyze trends in gender and ethnic diversity among incoming US psychiatry residents over the past 5 years. Physician diversity improves patient care as minority physicians often serve underserved communities and address health disparities. Increasing the representation of women and underrepresented minorities in medicine is essential for preparing a physician workforce that can effectively care for an increasingly diverse population. This study highlights the importance of efforts to enhance diversity within the field of psychiatry.