Causes Of Health Disparities Research Articles

Decreased Health Related Quality of Life among Hispanic Breast Cancer Survivors

Introduction: The breast cancer survivors’ population is growing due to the increased rate of early diagnosis and appropriate management. Hispanics (Latinos) constitute a rapidly growing population. Hispanic cancer survivors are often left without appropriate follow up care after completion of therapy, partly because of the lack of financial support and resources, and limited awareness of possible subsequent physical and mental health problems among those survivors. We sought to evaluate the quality of life (QoL) of the Hispanic breast cancer survivors in El Paso, TX, a large American-Mexican border city, using a validated Health related-Quality of life survey (HRQOL SF-36). Materials and Methods: After IRB approval, we recruited Hispanic women within their first 5 years post-diagnosis with Stages I, II, or III breast cancer, and who have completed their active chemotherapy and/or radiation therapy. They were provided with a written SF-36 questionnaire. We analyzed the two main components of the SF-36, the physical health through a Physical Component Summary (PCS), and the mental health, through a Mental Component Summary (MCS). Results were compared with the US healthy population (mean 50) using a one sample t-test. SF-36 scores were also compared with similar studies using a two sample t-test. Results:The study suggests that both the physical and mental components of QoL were low. PCS was significantly lower than one standard deviation below the US norm whereas MCS was approximately one third of a standard deviation below the US norm; 47% of all survivors reported that physical or emotional problems interfere with their normal social activities; 39% of all patients reported having emotional problems like depression and anxiety; and 77% indicated difficulty performing their work. The mean PCS and MCS scores of our Hispanic population were inferior to similar non-Hispanic breast cancer survivors’ population in other studies. Conclusion: Hispanic breast cancer survivors in El Paso, TX have decreased mental and physical health related QoL compared to healthy U.Swomen and possibly other breast cancer survivors in the U.S. Further investigation is needed to determine the possible underlying causes of health disparities in breast cancer survivors and identify strategies to improve these outcomes.

Evaluating the Measurement Structure of the Abbreviated HIV Stigma Scale in a Sample of African Americans Living With HIV/AIDS

Purpose: The purpose of this study was to validate the 10-item version of the HIV Stigma Scale (HSS-10) in a sample of African Americans with HIV/AIDS.Method: One hundred and ten African Americans living with HIV/AIDS were recruited from 3 case management agencies in Baton Rouge, Louisiana. Measurement structure of the HSS-10 was evaluated using exploratory and confirmatory factor analysis.Results: Factor analysis results support a 2-factor factorial structure for the HSS-10 (social stigma and self-stigma). The HSS-10 demonstrates good reliability and factorial validity, and it correlates moderately with related constructs in the expected directions.Conclusion: HSS-10 is a brief, reliable, and valid instrument for assessing HIV stigma and can be used as a clinical rehabilitation and research tool to assess the contribution of stigma as a major cause of health disparities and outcomes in African Americans living with HIV/AIDS.

A Greater Mission: Understanding Military Culture as a Tool for Serving Those Who Have Served.

The number of veterans who have served in Iraq and Afghanistan has grown over the past decade, and it is important to provide high-quality health care for this population. Unlike previous generations of veterans, contemporary veterans often have been deployed in multiple conflicts, have been exposed to close proximity explosions, and have had longer tours of duty, making their military histories and medical needs more complex. 1 To address this issue at the national level, the White House’s Joining Forces initiative pledged its commitment to meet the needs of veterans and their families. Shortly after the announcement of this initiative, the Association of American Medical Colleges (AAMC) initiated a nationwide survey of more than 100 medical schools and health systems to determine the extent to which future physicians were being trained to care for military personnel. 2 Nearly all medical schools indicated that their curriculum included training in posttraumatic stress disorder (PTSD) and traumatic brain injury; however, only 31% indicated that their curriculum provided training in military cultural competency. 2

Racial and Ethnic Disparities in Health and Health Care: an Assessment and Analysis of the Awareness and Perceptions of Public Health Workers Implementing a Statewide Community Transformation Grant in Texas.

Little is known about the awareness of public health professionals regarding racial and ethnic disparities in health in the United States of America (USA). Our study objective was to assess the awareness and perceptions of a group of public health workers in Texas regarding racial health disparities and their chief contributing causes. We surveyed public health professionals working on a statewide grant in Texas, who were participants at health disparities' training workshops. Multivariable logistic regression was employed in examining the association between the participants' characteristics and their perceptions of the social determinants of health as principal causes of health disparities. There were 106 respondents, of whom 38 and 35 % worked in health departments and non-profit organizations, respectively. The racial/ethnic groups with the highest incidence of HIV/AIDS and hypertension were correctly identified by 63 and 50 % of respondents, respectively, but only 17, and 32 % were knowledgeable regarding diabetes and cancer, respectively. Seventy-one percent of respondents perceived that health disparities are driven by the major axes of the social determinants of health. Exposure to information about racial/ethnic health disparities within the prior year was associated with a higher odds of perceiving that social determinants of health were causes of health disparities (OR 9.62; 95 % CI 2.77, 33.41). Among public health workers, recent exposure to information regarding health disparities may be associated with their perceptions of health disparities. Further research is needed to investigate the impact of such exposure on their long-term perception of disparities, as well as the equity of services and programs they administer.

Self-reported race/ethnicity in the age of genomic research: its potential impact on understanding health disparities.

This review explores the limitations of self-reported race, ethnicity, and genetic ancestry in biomedical research. Various terminologies are used to classify human differences in genomic research including race, ethnicity, and ancestry. Although race and ethnicity are related, race refers to a person’s physical appearance, such as skin color and eye color. Ethnicity, on the other hand, refers to communality in cultural heritage, language, social practice, traditions, and geopolitical factors. Genetic ancestry inferred using ancestry informative markers (AIMs) is based on genetic/genomic data. Phenotype-based race/ethnicity information and data computed using AIMs often disagree. For example, self-reporting African Americans can have drastically different levels of African or European ancestry. Genetic analysis of individual ancestry shows that some self-identified African Americans have up to 99% of European ancestry, whereas some self-identified European Americans have substantial admixture from African ancestry. Similarly, African ancestry in the Latino population varies between 3% in Mexican Americans to 16% in Puerto Ricans. The implication of this is that, in African American or Latino populations, self-reported ancestry may not be as accurate as direct assessment of individual genomic information in predicting treatment outcomes. To better understand human genetic variation in the context of health disparities, we suggest using “ancestry” (or biogeographical ancestry) to describe actual genetic variation, “race” to describe health disparity in societies characterized by racial categories, and “ethnicity” to describe traditions, lifestyle, diet, and values. We also suggest using ancestry informative markers for precise characterization of individuals’ biological ancestry. Understanding the sources of human genetic variation and the causes of health disparities could lead to interventions that would improve the health of all individuals.

Universal state newborn screening programs can reduce health disparities.

Universal state newborn screening programs can reduce health disparities.

"You get what you pay for": resources for training and practice in community pediatrics matter.

US children continue to live in communities where failing schools are common, food desserts exacerbate obesity, and violence is endemic, giving rise to the expression that when it comes to health, your zip code dominates your genetic code. The health outcomes of US children and youth are troubling: our infant mortality rate ranks 56th among world countries,1 homicide is the leading cause of death for African American youth,2 and, despite a recent decline, our teen birth rate remains the highest in the developed world.3 Today nearly half of US children live in low-income families and 22% live under the poverty line.4 Although 4 of 5 physicians acknowledge a need to write prescriptions for their patient’s unmet social needs, they simultaneously lament their ability to do so.5 Addressing these “Millennial Morbidities” in training and in practice remains the context of community pediatrics.6 The field of pediatrics is leading in addressing the mismatch between what physicians need to do and currently do. Required training in community health and advocacy7 to address the root cause of health disparities began in 1999. Reshaping pediatrics to extend beyond the bedside and clinic to incorporate community engagement was prescient, and it was Dr Anne E. Dyson’s … Address correspondence to Lisa J. Chamberlain, MP, MPH, Department of Pediatrics, Stanford University School of Medicine, 770 Welch Road, #100, Palo Alto, CA 94304. E-mail: lchamberlain{at}stanford.edu

"When nothing matters, things just happen": young parenting women's reflections on caring, health, and justice.

The field of public health frequently issues calls for social justice, but it is not clear that everyone agrees on what this means or how to achieve it. To assess lay citizens' views on the relationship between justice and health, we conducted individual interviews with 19 young parenting women to hear and discuss their thoughts about the causes of health disparities, ways to reduce them, and the nature of the just society. A salient theme to emerge in these interviews was the topic of "caring." This article reports on four categories identified under the theme of caring: 1) observations of apathy and indifference; 2) the effects of not caring; 3) models of caring; and 4) the pull of caring. Based on these results, the article outlines a grounded theory on the role of caring in conceptualizing health motivation.

Spatial cluster detection of air pollution exposure inequities across the United States.

Air quality is known to be a key factor in affecting the wellbeing and quality of life of the general populous and there is a large body of knowledge indicating that certain underrepresented groups may be overexposed to air pollution. Therefore, a more precise understanding of air pollution exposure as a driving cause of health disparities between and among ethnic and racial groups is necessary. Utilizing 52,613 urban census tracts across the United States, this study investigates age, racial, educational attainment and income differences in exposure to benzene pollution in 1999 as a case. The study examines spatial clustering patterns of these inequities using logistic regression modeling and spatial autocorrelation methods such as the Global Moran's I index and the Anselin Local Moran's I index. Results show that the age groups of 0 to 14 and those over 60 years old, individuals with less than 12 years of education, racial minorities including Blacks, American Indians, Asians, some other races, and those with low income were exposed to higher levels of benzene pollution in some census tracts. Clustering analyses stratified by age, education, and race revealed a clear case of disparities in spatial distribution of exposure to benzene pollution across the entire United States. For example, people aged less than 4 years from the western south and the Pacific coastal areas exhibit statistically significant clusters. The findings confirmed that there are geographical-location based disproportionate pattern of exposures to benzene air pollution by various socio-demographic factors across the United States and this type of disproportionate exposure pattern can be effectively detected by a spatial autocorrelation based cluster analysis method. It is suggested that there is a clear and present need for programs and services that will reduce inequities and ultimately improve environmental conditions for all underrepresented groups in the United States.

Research on Multiple Chronic Conditions

Research on Multiple Chronic Conditions

The Modified-Fetzer Multidimensional Measure of Religiousness and Spirituality: Examination of Construct Validity in Older Black Adults

Sociocultural explanatory frameworks are increasingly being considered to address causes of health disparities, and attention has been focused on religion among Black Americans and its subsequent influence on health. The purpose of this study was to examine a multidimensional measure of religiousness and spirituality (Modified-Fetzer Multidimensional Measure of Religiousness and Spirituality [M-FMMRS]) in a sample of Black older adults. The M-FMMRS was administered to 130 study participants, and confirmatory factor analysis was conducted. Findings did not support the hypothesized factor structure. Overall, the M-FMMRS is a reliable survey, but the validity needs to be further addressed. Historical documentation, review of data, and participant feedback are used to examine findings.

The Modified-Fetzer Multidimensional Measure of Religiousness and Spirituality: Examination of Construct Validity in Older Black Adults

Background and Purpose: Sociocultural explanatory frameworks are increasingly being considered to address causes of health disparities, and attention has been focused on religion among Black Americans and its subsequent influence on health. The purpose of this study was to examine a multidimensional measure of religiousness and spirituality (Modified-Fetzer Multidimensional Measure of Religiousness and Spirituality [M-FMMRS]) in a sample of Black older adults. Methods: The M-FMMRS was administered to 130 study participants, and confirmatory factor analysis was conducted. Results: Findings did not support the hypothesized factor structure. Conclusions: Overall, the M-FMMRS is a reliable survey, but the validity needs to be further addressed. Historical documentation, review of data, and participant feedback are used to examine findings.

An Analysis of Health Care Disparities and Subsequent Public Policy Initiatives

Racial and ethnic health disparities are a major clinical, public health, and societal problem in the United States. This article provides a historical analysis of the identification and progression of health disparities between Whites and minorities from 1989 to 2011. Key causes of health disparities are addressed, including the lack of culturally competent care, health insurance, and medical homes. Federal legislation that mandated federal health agencies to implement a plan to eliminate disparities is discussed.

Responses to a Theoretically Adapted Clinical Trial Education Session: Faith-Based Sites Versus Rural Work Site Dissemination

The process for advancing biomedical knowledge depends upon recruiting an adequate and representative sample of individuals to voluntarily participate in research studies. A consistent personal barrier to cancer clinical trial participation is the lack of awareness and understanding related to trial availability, and the prevention and treatment roles participation represents. In particular, comprehensive community-based approaches to recruit and educate rural residents are needed. Moreover, consistent under representation of priority populations should be addressed with innovative outreach to collaborate in identifying culturally meaningful approaches. A theoretically adapted version of a component of the National Cancer Institute's "Clinical Trial Education Series" was assessed via educational sessions delivered through work sites and churches. From eight focus groups with 90 participants, we found that church leaders, congregants, and community members were receptive to education on cancer research, increased their short-term knowledge about it, and intent to participate in cancer studies, decreased their current anxiety about clinical trials participation, and provided specific suggestions for further adapting the educational session to be even more culturally relevant. These outcomes provide evidence to support the effectiveness of future customized recruitment strategies embedded within a community or faith-based environment that may increase knowledge, decrease anxiety and intent to actual participation in cancer studies, as well as impact study representativeness and address causes of health disparities.

Differences in Beliefs About the Causes of Health Disparities in Black and White Nurses

To determine whether Black and White nurses' beliefs about causes of health disparities differ. Analyses reveal that overall Black nurses perceived external factors to contribute significantly more to health disparities than White nurses. Black nurses considered four specific causes dealing with physician and societal factors, such as "discrimination in society," to be more significant contributors to health disparities than White nurses, whereas White nurses considered genetic factors to be a greater contributor. Different views of the causes of health disparities are discussed, particularly in light of cultural competency training and other efforts to ameliorate health disparities.

Abstract 59: Prevalence of Major Cardiovascular Risk Factors and Cardiovascular Diseases Among Vulnerable Population of a Safety Net Hospital

Cardiovascular disease (CVD) is the leading cause of death and remains a major cause of health disparities. The underuse of prevention strategies and suboptimal control of risk factors could partially explain the increased CVD burden. We conducted a study to assess the prevalence of major cardiovascular risk factors and cardiovascular disease among vulnerable population in a general medical clinic (GMC) of a safety net hospital. A retrospective chart review of patients was conducted in GMC at John Stroger Hospital. Patients were selected using a random sampling method over two weeks and demographic, clinical and laboratory data was collected. Major CVD risk factors were defined based on current national guidelines. Hypercholesterolemia and dyslipidemia were defined as total cholesterol ≥240mg/dl, or LDL ≥160mg/dl, or HDL <40mg/dl (for persons with and without diabetes) or receiving cholesterol-lowering medication. Hypertension was a blood pressure (BP) ≥140/90 mmHg, or receiving antihypertensive medication. Obesity was defined as a BMI of 30 or greater. Diabetes mellitus was a fasting plasma glucose ≥126mg/dl, 2-hour-postload plasma glucose ≥200mg/dl, an HgbA1c ≥6.5%, or use of antihyperglycemic medications. Smoking was defined as currently smoking cigarettes. Prevalence of CHD and stroke was ascertained based upon the physician’s problem list. Of 255 charts, 5 were excluded from analysis because of missing data. The mean age was 61; 57% were women, 59% were African American. The overall prevalence of hypercholesterolemia was 57 % among men (62 of 108) and 56% (80 of 142) among women; with the highest among African American. Overall, 92 out of 108 (85%) of men and 116 out of 142 (82%) of women had hypertension; prevalence was respectively 60% (55 of 92) and 68% (79 of 116) for African American men and women. About 48 out of 108 (44%) of men were obese and among women overall prevalence of obesity was 52% (74 of 142). Overall, 50 out of 108 (49%) of men and 73 out of 142 (51%) of women had diabetes. The overall prevalence of smoking was 11% (27 of 250) and ranged from 10% (14 of 142) among women to 12% (13 of 108) among men. Overall, 10% (11 of 108) of men had an adverse level of any 1 major risk factor only; 26% (28 of 108) and 59% (64 of 108) had any 2 only or 3 or more risk factors. Among women, 16% (23 of 142) had 1 risk factor only; 25% (36 of 142) and 54% (76 of 142) had 2 or 3 or more risk factors. The overall prevalence of CHD and stroke was, respectively, 18% (19 of 108) and 1% (1 of 108) for men and 9% (13 of 142) and 10% (14 of 142) for women. In conclusion, findings from the study demonstrate the pervasive burden of CVD risk factors in vulnerable groups compared with the national trends. These data may enhance the impetus to implement interventions to lower burden of CVD risk factors among overall and targeted at-risk groups, as well as develop strategies to prevent future development of adverse CVD risk factors starting at the youngest age.

Managing uncertainty: A grounded theory of stigma in transgender health care encounters

A growing body of literature supports stigma and discrimination as fundamental causes of health disparities. Stigma and discrimination experienced by transgender people have been associated with increased risk for depression, suicide, and HIV. Transgender stigma and discrimination experienced in health care influence transgender people's health care access and utilization. Thus, understanding how stigma and discrimination manifest and function in health care encounters is critical to addressing health disparities for transgender people. A qualitative, grounded theory approach was taken to this study of stigma in health care interactions. Between January and July 2011, fifty-five transgender people and twelve medical providers participated in one-time in-depth interviews about stigma, discrimination, and health care interactions between providers and transgender patients. Due to the social and institutional stigma against transgender people, their care is excluded from medical training. Therefore, providers approach medical encounters with transgender patients with ambivalence and uncertainty. Transgender people anticipate that providers will not know how to meet their needs. This uncertainty and ambivalence in the medical encounter upsets the normal balance of power in provider–patient relationships. Interpersonal stigma functions to reinforce the power and authority of the medical provider during these interactions. Functional theories of stigma posit that we hold stigmatizing attitudes because they serve specific psychological functions. However, these theories ignore how hierarchies of power in social relationships serve to maintain and reinforce inequalities. The findings of this study suggest that interpersonal stigma also functions to reinforce medical power and authority in the face of provider uncertainty. Within functional theories of stigma, it is important to acknowledge the role of power and to understand how stigmatizing attitudes function to maintain systems of inequality that contribute to health disparities.

Advances in adult asthma diagnosis and treatment in 2012: Potential therapeutics and gene-environment interactions

In the Journal of Allergy and Clinical Immunology in 2012, research reports related to asthma in adults clustered around mechanisms of disease, with a special focus on their potential for informing new therapies. There was also consideration of the effect of the environment on health from pollution, climate change, and epigenetic influences, underlining the importance of understanding gene-environment interactions in the pathogenesis of asthma and response to treatment.

Genetic research and aboriginal and Torres Strait Islander Australians.

While human genetic research promises to deliver a range of health benefits to the population, genetic research that takes place in Indigenous communities has proven controversial. Indigenous peoples have raised concerns, including a lack of benefit to their communities, a diversion of attention and resources from non-genetic causes of health disparities and racism in health care, a reinforcement of "victim-blaming" approaches to health inequalities, and possible misuse of blood and tissue samples. Drawing on the international literature, this article reviews the ethical issues relevant to genetic research in Indigenous populations and considers how some of these have been negotiated in a genomic research project currently under way in a remote Aboriginal community. We consider how the different levels of Indigenous research governance operating in Australia impacted on the research project and discuss whether specific guidelines for the conduct of genetic research in Aboriginal and Torres Strait Islander communities are warranted.

Rigor, vigor, and the study of health disparities

Health disparities research spans multiple fields and methods and documents strong links between social disadvantage and poor health. Associations between socioeconomic status (SES) and health are often taken as evidence for the causal impact of SES on health, but alternative explanations, including the impact of health on SES, are plausible. Studies showing the influence of parents' SES on their children's health provide evidence for a causal pathway from SES to health, but have limitations. Health disparities researchers face tradeoffs between "rigor" and "vigor" in designing studies that demonstrate how social disadvantage becomes biologically embedded and results in poorer health. Rigorous designs aim to maximize precision in the measurement of SES and health outcomes through methods that provide the greatest control over temporal ordering and causal direction. To achieve precision, many studies use a single SES predictor and single disease. However, doing so oversimplifies the multifaceted, entwined nature of social disadvantage and may overestimate the impact of that one variable and underestimate the true impact of social disadvantage on health. In addition, SES effects on overall health and functioning are likely to be greater than effects on any one disease. Vigorous designs aim to capture this complexity and maximize ecological validity through more complete assessment of social disadvantage and health status, but may provide less-compelling evidence of causality. Newer approaches to both measurement and analysis may enable enhanced vigor as well as rigor. Incorporating both rigor and vigor into studies will provide a fuller understanding of the causes of health disparities.