Disparities In Health Services Research Articles

Looking beneath and in-between the hidden surfaces: a critical review of defining, measuring and contextualizing mental health service disparities in the child welfare system

Efforts to understand and respond to racial and ethnic disparities in referrals to and use of mental health services among children involved in the child welfare system are constrained by the lack of consistency in defining and measuring disparities and the lack of clarity as to what causal mechanisms sustain patterns of disparate treatment. Recent developments in the field of public health offer some insight as to how our understanding of similar disparities in child welfare may be advanced. Despite advancements, there is still an insufficient knowledge base from which to offer an alternative definition of disparities that illuminates conceptual and methodological innovation in child welfare research. Based on a critical review of the literature, more exploratory and etiological research grounded in implementation of advanced metrics and multivariate methods is warranted to generate a clear definition. Recommendations are offered to address conceptual ambiguity. • There is lack of consistency in defining and measuring disparities. • Public health scholars offer insight on how to measure disparities. • Despite progress, prior definitions of disparities conceal more than they reveal. • More research is warranted to generate a clear definition of disparities. • Methodological advancements are needed to address determinants of disparities.

Influenza vaccination among cancer survivors: disparities in prevalence between blacks and whites

Cancer survivors are at increased risk for influenza-related complications. Racial disparities in preventive health services have not been extensively studied among cancer survivors. Our objective is to compare influenza vaccination prevalence among black and white cancer survivors We performed a secondary data analysis of 41,346 white and black cancer survivors (excluding non-melanoma skin cancer) from the 2009 Behavioral Risk Factor Surveillance System survey. Respondents were asked whether they had received an influenza vaccination in the previous year. Multivariable logistic regression was used to estimate the odds of having influenza vaccine by race. Sixty-five percent of whites reported receiving the vaccine in the last year compared to 50% of blacks. Blacks had significantly lower odds of vaccination after controlling for covariates significantly associated with the odds of influenza vaccination. Higher education, having health insurance, having a primary care provider, and having a routine check-up in the last year increased the odds of receiving an influenza vaccine. Our analysis supports that racial disparities in vaccine coverage persist among cancer survivors, a group strongly recommended to receive annual influenza vaccine, even when predictors significantly associated with increased vaccination are controlled for. As a nationally representative survey with a large sample size, our study provides a picture of self-reported vaccine coverage among cancer survivors in the USA and the disparity that exists between blacks and whites in this population. Care teams can use these findings to better target follow-up care for cancer survivors.

Role of Referrals in Mental Health Service Disparities for Racial and Ethnic Minority Youth

To investigate racial/ethnic differences in teachers' and other adults' identification and/or encouragement of parents to seek treatment for psychiatric problems in their children and to evaluate if and whether identification/encouragement is associated with service use. Data on identification/encouragement to seek treatment for externalizing disorders (i.e., attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and/or conduct disorder) and internalizing disorders (i.e., major depressive episode/dysthymia and/or separation anxiety disorder) and services used were obtained for 6,112 adolescents (13-17 years of age) in the National Comorbidity Survey Adolescent Supplement. Racial/ethnic differences were examined for Latinos, non-Latino blacks, and non-Latino whites. There were few racial/ethnic differences in rates of youth identification/encouragement and how identification/encouragement related to service use. Only non-Latino black youth with low severity internalizing disorders were less likely to be identified/encouraged to seek services compared with non-Latino white youth with the same characteristics (odds ratio [OR] = 0.4, 95% confidence interval [CI] = [0.2-0.7]). Identification/encouragement increased the likelihood of seeking services for externalizing and internalizing disorders for all youth. However, compared with their non-Latino white counterparts, non-Latino black youth who met criteria for internalizing disorders appeared less likely to have used any services (OR = 0.4, 95%, CI = 0.2-0.7), after adjusting for identification/encouragement, clinical, and sociodemographic characteristics. Non-Latino black youth with internalizing disorders and without identification/encouragement were less likely to use the specialty care sector than their non-Latino white counterparts. In this study of a nationally representative sample of adolescents, almost no ethnic/racial differences in identification/encouragement were found. However, identification/encouragement may increase service use for all youth.

Disparities in Preventive Health Services Among Somali Immigrants and Refugees

African immigrants and refugees-almost half of them from Somalia-account for one of the fastest-growing groups in the United States. There is reason to suspect that Somali-Americans may be at risk for low completion of recommended preventive health services. This study's aim was to quantify disparities in preventive health services among Somali patients compared with non-Somali patients in an academic primary care practice in Rochester, Minn. It also examined the effect of medical interpreters, emergency department visits, and primary care visits on the completion of preventive services. Rates of pap smears, vaccinations (influenza, pneumococcus, and tetanus), lipid screening, colorectal cancer screening, and mammography were assessed in Somali and non-Somali patients during the second quarter of 2008. Data were collected regarding the utilization of medical interpreters, emergency services, and primary care services among Somali patients. Results were reported using standard descriptive statistics. Of the 91,557 patients identified in the database, 810 were Somali. Somali patients had significantly lower completion rates of colorectal cancer screening, mammography, pap smears, and influenza vaccination than non-Somali patients. Use of medical interpreters and primary care services were generally associated with higher completion rates of preventive services. There are significant discrepancies in the provision of preventive health services to Somali patients compared with that of non-Somali patients. These findings suggest the need to identify the root causes of these discrepancies so that interventions may be crafted to close the gap.

The impact of insurance coverage in diminishing racial and ethnic disparities in behavioral health services.

To estimate whether racial/ethnic behavioral health service disparities are likely to be reduced through insurance expansion coverage expected through the Affordable Health Care Act. Pooled data from the nationally representative NIMH Collaborative Psychiatric Epidemiological Studies (2001-2003). We employ a novel reweighting method to estimate service disparities in the presence and absence of insurance coverage. Access to care was assessed by whether any behavioral health treatment was received in the past year. Need was determined by presence of prior year psychiatric disorder, psychiatric diagnoses, physical comorbidities, gender, and age. Improving patient education and availability of community clinics, combined with insurance coverage reduces service disparities across racial/ethnic groups.However, even with expanded insurance coverage, approximately 10 percent fewer African Americans with need for behavioral health services are likely to receive services compared to non-Latino whites while Latinos show no measurable disparity. Expansion of insurance coverage might have different effects for racial/ethnic groups, requiring additional interventions to reduce disparities for all groups.

Rural Mental Health: Implications for Telepsychiatry in Clinical Service, Workforce Development, and Organizational Capacity

In Hawai'i, rural residents suffer disproportionately from poor health and mental health outcomes. Hawai'i's island geography makes rural health service disparities especially compelling. Physician workforce shortages are projected to increase, despite 30 years of programs aimed at recruiting physicians to rural areas. Telepsychiatry has been shown to be a feasible way to provide a variety of health services to individuals living in rural areas with limited access to healthcare. The University of Hawai'i Rural Health Collaboration (UHRHC) was established by the Department of Psychiatry to address the need for workforce development and rural access to mental health services across the State of Hawai'i by using telepsychiatry. Partnerships with community health clinics have been formed to provide patient care and consultation-liaison services through telepsychiatry technology. In addition, UHRHC focuses on workforce development in its residency training curriculum by utilizing a service-learning approach to rural mental health. Evaluation of these efforts is currently underway, with preliminary evidence suggesting that UHRHC is a promising strategy to increase access to critical mental health services and reduce health disparities in rural Hawai'i.

Lessons from the use of vignettes in the study of mental health service disparities.

To examine the development, feasibility, and use of a vignette approach as an important tool in health services disparities research. Interviews with vignette developers and qualitative data from a novel mental health services disparities study that used vignettes in two samples: (1) predominantly low-income parents of children attending mental health specialty care who were Latino or non-Latino White and (2) Latino and non-Latino mental health clinicians who treat children in their practice. We conduct a content analysis of qualitative data from patients and providers in the Ethnic Differences Study to explore the feasibility of vignette methodology in health services disparities research, and we identify lessons learned that may guide future vignette development. Vignettes provide a valuable approach that is acceptable to participants, elicits important insight on participant experience and services, and sheds light on factors that can help optimize study design for exploring health disparities questions. Researchers, clinicians, and others should consider a set of factors that help determine when a vignette approach is warranted in research, training, or for other uses, including how best to address identified weaknesses.

Handicap et troubles mentaux de l’enfant chez les ruraux au Sénégal

BackgroundLike the other African developing countries, in Senegal, disparities in health services between towns and the rest of the country are very important in, particularly, the main town. Only some populations have opportunities to get enough quality of care health services. A lot of children and adolescents endure chronic diseases or handicap without correct assistance. Only one modern unit gives the children and their family adequate mental health cares. ObjectivesThe authors try to determine the sociodemographic characteristics of the children coming from rural areas and consulting in child-psychiatry unit of Fann Hospital (Ker Xaleyi). They examine the origins of their mental handicap and make also the analysis of the main elements. At the end, some tracks of solutions are proposed. MethodsRetrospectives data are used by consulting files of the children who have consulted at the years from 2000 to 2006 in the child-psychiatry unit “Kër Xaleyi”. Starting from the whole, those concerning the areas outside the main town (Dakar) are particularly analyzed. Data are treated by the freeware Epi Info 6 which is a series of programs for use by public health professionals, general database and statistics applications. In this work, the frequencies are mostly calculated concerning gender, age, repartition by region, kinds of disorders and diseases related to handicap. ResultsOnly one quarter of the patients comes from rural areas. Some regions are poorly represented like Tambacounda and Kolda. Repartition about gender is not so different whatever the region or the trouble considered. Intellectual deficiency is more frequent as handicap. Concerning the sources of the mental handicap presented by many children, a majority is related to organic affections. Analyze/DiscussionThe differences seem to be linked to geographic availability (more the region is far from main town, less the population is represented in the unit), traditional convictions (persons are more in contact with mystic and irrational considerations in rural areas unlike the metropolitan citizen who have more information and education) and the poverty level is a characteristic of our rural areas (health care services and the means of transport are more developed in the city). Malaria and purulent meningitis cause sequels, which are aggravated by deficiency of taking care and inefficiency of prevention. ConclusionDespite real difficulties in rural areas, a reduction of the gap in health services between the main town and the other cities can be realized by a better prevention policy, a better exchange of ideas between actors and new consideration of sociocultural realities.

Cultural Competence: A Literature Review and Conceptual Model for Mental Health Services

Cultural Competence: A Literature Review and Conceptual Model for Mental Health Services

Disparities in Health Services for HIV/AIDS, Hepatitis C Virus, and Sexually Transmitted Infections: Role of Substance Abuse Treatment Programs

This report focused upon the availability of infection-related health services in substance abuse treatment programs with and without addiction services tailored for special populations (women and non-white populations). In a cross-sectional, descriptive design, treatment program administrators across the United States within the National Drug Abuse Treatment Clinical Trials Network provided information on program characteristics, the availability of infection-related services (four medical services and three non-medical services for HIV, HCV, and STI), and barriers to providing infection-related services. Of 319 programs, 269 submitted surveys (84% response rate). Of these, 80% provided addiction services for special populations. Programs providing addiction services designed for at least one special population, were more likely to provide infection-related health services, especially HIV-related education (94% versus 85%, p = 0.05) and patient counseling (76% versus 60%, p = 0.03) and were more likely to include outpatient addiction services (86% versus 57%, p<0.001) and outreach and support services (92% versus 70%, p=0.01). Barriers to providing infection-related services included funding (cited by 48.3% to 74.7% of programs), health insurance (cited by 28.9% to 60.8% of programs), and patient acceptance (cited by 23.2% to 54.3% of programs). Despite many barriers, infection-related healthcare is available in programs with addiction treatment services tailored for special populations, especially for African Americans and Latino Americans. Tailoring substance abuse treatment along with reducing barriers to infection-related care represent public health interventions with potential to reduce the burdens and disparities associated with these infections.

Segregation and Disparities in Health Services Use

We compared race disparities in health services use in a national sample of adults from the 2002 Medical Expenditure Panel Survey and data from the Exploring Health Disparities in Integrated Communities Project, a 2003 survey of adult residents from a low-income integrated urban community in Maryland. In the Medical Expenditure Panel Survey data, African Americans were less likely to have a health care visit compared with Whites. However, in the Exploring Health Disparities in Integrated Communities Project, the integrated community, African Americans were more likely to have a health care visit than Whites. The race disparities in the incidence rate of health care use among persons who had at least one visit were similar in both samples. Our findings suggest that disparities in health care utilization may differ across communities and that residential segregation may be a confounding factor.

Understanding Racial/Ethnic Disparities in Youth Mental Health Services

The authors examined racial/ethnic disparities in mental health service use based on problem type (internalizing/externalizing). A diverse sample of youth in contact with public sectors of care and their families provided reports of youth's symptoms and functional impairment during an initial interview. Specialty and school-based mental health service use during the subsequent 2 years was assessed prospectively. Greater disparities in mental health service receipt were evident for internalizing problems, with non-Hispanic White youth more likely to receive services in response to internalizing symptoms than minority youth. Fewer disparities in rates of unmet need emerged for externalizing problems, but minority youth were more likely to have need for externalizing problems met and African American youth were particularly likely to receive services in response to such problems. Findings highlight the importance of considering problem type when examining racial disparities in mental health services and underscore concerns about the responsiveness of mental health services for minority youth with internalizing disorders.

Latino Disparities in Child Mental Health Services

Access and utilization of mental health services for Latino children. As Latino children may experience higher rates of unmet needs, this article examines the current literature for the reasons for the disparity and the barriers to the utilization of mental health services for Latino children. An integrative literature review was undertaken from child psychiatry and nursing. The literature confirmed a pattern of underutilization of mental health services by Latino children, but did not completely address the reasons for the disparity. Suggested barriers were language and cultural issues. Gaps in the literature include a lack of agreement for definition of a mental health problem and the tools to identify these, insufficient studies into the barriers for Latino children in the access and utilization of mental health services, and cultural and language issues related to Latino research.

Hospital-Based Emergency Nursing in Rural Settings

In 2006, the Institute of Medicine (IOM) released a series of reports that highlighted the urgent need for improvements in the nation's emergency health services. This news has provided new energy to a growing body of research about the development and implementation of best practices in emergency care. Despite evidence of geographical disparities in health services, relatively little attention has been focused on rural emergency services to identify environmental differences. The purpose of this chapter is to summarize the contributions of nursing research to the rural emergency services literature. The research resembles a so-called shotgun effect as the exploratory and interventional studies cover a wide range of topics without consistency or justification. Emergency nursing research has been conducted primarily in urban settings, with small samples and insufficient methodological rigor. This chapter will discuss the limitations of the research and set forth an agenda of critical topics that need to be explored related to emergency nursing in rural settings.

Race and Hospital Diagnoses of Schizophrenia and Mood Disorders

Overdiagnosis or misdiagnosis of schizophrenia among African American clients is a longstanding and critical disparity in mental health services. Overdiagnosis of schizophrenia is detrimental because it increases the potential for treatment with the wrong medications. Inadequate assessment of mood disorders, co-occurring substance abuse, and client characteristics are three factors believed to be associated with the overdiagnosis of schizophrenia. This article examines the relationships among demographic characteristics, co-occurring substance abuse, and admission diagnoses of schizophrenia and mood disorder for clients admitted to state psychiatric hospitals in Indiana. Data were obtained from the state management information system for a sample of 2,404 clients. The sample comprised white clients (80.5 percent) and African American clients (19.5 percent). All but a few of the clients were involuntarily hospitalized, and more than half of them had a diagnosis of schizophrenia. African American clients were less frequently diagnosed with bipolar and major depressive disorders and more frequently diagnosed with schizophrenia than were white clients. After controlling for the influence of other demographic variables, client race was the strongest predictor of admission diagnoses of schizophrenia. Implications for social work practice in the field of mental health and mental health services research are discussed.

Racial and Ethnic Disparities in SSRI Availability in Substance Abuse Treatment

Racial and Ethnic Disparities in SSRI Availability in Substance Abuse Treatment

An overview of ethnicity and assessment of family history in primary care settings

To discuss the importance of and the nurse practitioner's (NP's) role in the assessment of ethnicity/family of origin in conducting a multigenerational family history in primary care settings. A review of the literature on past research results addressing racial and ethnic disparities and current articles from scientific journals exploring the relationship between race and genetics. Web sites were from the National Institutes of Health, the Human Genome Research Institute, the National Cancer Institute, and the Health and Human Services Minority Health and Disparities report. The family history has received renewed interest due to the sequencing of the human genome. A multigenerational family history is an important first step in screening for a multitude of disorders impacted by genetic susceptibility, shared environments, and common behaviors. Assessment of the patient's ethnicity/family of origin is an integral part of the multigenerational family history, particularly in the diagnosis of chronic diseases and the assessment of risks for genetic disorders. The multigenerational family history is important in diagnosis, predictive genetic testing, disease prevention, and health promotion. Challenges facing NPs and the utilization of a multigenerational family history in the current U.S. health system include (a) training clinicians on the correct assessment and utilization of a multigenerational family history, (b) assessment of the subtleties of ethnicity and identifying multiple ethnic groups within a family, (c) collection of the family history in a manner that is sensitive to the cultural beliefs of individuals, and (d) avoidance of stereotyping. Significant advances in genetics and genetic testing requires that NPs be well versed in collecting and interpreting a multigenerational family history to include assessment of the patient/family's ethnicity/family of origin. The ability to effectively conduct and evaluate the individual's and family's health risk through a multigenerational family history will be important in diagnosis, health promotion, disease prevention, and the determination for genetic counseling referral and predictive testing when appropriate. Assessment of risk and prevention of disease is also important in reducing health disparities.

Global notes: the 10/90 gap disparities in global health research

Globally the total amount of money public and private invested in health research and development is estimated to be 73 billion US dollars a year. Although the poor represent 25% of world population they carry a disproportionate burden of disease and ill health. Currently however less than 10% of global funding for research is spent on diseases that afflict more than 90% of the worlds population. This disparity in spending the health research dollars on diseases that affect the rich rather than the poor countries is known as The 10/90 gap. In 1990 the Commission on Health Research and Development recognized the seriousness of the matter. This led to the formation of the Health Forum under the auspices of WHO. The Health Forum is an international organization managed by a 20-member council the members of which are drawn from a wide variety of partners: government policy-makers donors womens organizations and international NGOs. The Health Forums report Health Research: Essential Link to Equity in Development made several observations and recommendations. It identified four major challenges the world will face in the coming decades: (1) high burden of infectious diseases among the poor that can be addressed using the existing cost-effective drugs; (2) continually increasing threat of HIV/AIDS Tuberculosis and Malaria; (3) the increasing epidemics of noncommunicable diseases such as heart disease diabetes and injuries in the low- and middle-income countries; and (4) disparities in efficiency and equitable health services in different populations. (excerpt)

National Historically Black Colleges and Universities (HBCUs) Research Network for Health Services and Health Disparities 2004 Research Conference: Racial Disparities in Health Outcomes: Research and Intervention Perspectives

National Historically Black Colleges and Universities (HBCUs) Research Network for Health Services and Health Disparities 2004 Research Conference: Racial Disparities in Health Outcomes: Research and Intervention Perspectives

National Historically Black Colleges and Universities (HBCUs) Research Network for Health Services and Health Disparities 2004 Research Conference: Racial Disparities in Health Outcomes: Research and Intervention Perspectives

National Historically Black Colleges and Universities (HBCUs) Research Network for Health Services and Health Disparities 2004 Research Conference: Racial Disparities in Health Outcomes: Research and Intervention Perspectives