Eliminate Health Disparities Research Articles

A Shift in Approach to Addressing Public Health Inequities and the Effect of Societal Structural and Systemic Drivers on Social Determinants of Health.

Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age that influence health outcomes, and structural and systemic drivers of health (SSD) are the social, cultural, political, and economic contexts that create and shape SDOH. With the integration of constructs from previous examples, we propose an SSD model that broadens the contextual effect of these driving forces or factors rooted in the Centers for Disease Control and Prevention's SDOH framework. Our SSD model (1) presents systems and structures as multidimensional, (2) considers 10 dimensions as discrete and intersectional, and (3) acknowledges health-related effects over time at different life stages and across generations. We also present an application of this SSD model to the housing domain and describe how SSD affect SDOH through multiple mechanisms that may lead to unequal resources, opportunities, and consequences contributing to a disproportionate burden of disease, illness, and death in the US population. Our enhanced SDOH framework offers an innovative and promising model for multidimensional, collaborative public health approaches toward achieving health equity and eliminating health disparities.

Abstract B169: Diversifying cancer patient advocate voices to eliminate health disparities

Abstract Cancer patient advocates have become key members in clinical research teams and participating in decision committees at FDA, NCI, ASCO, among others. There is a low number of Latino patient advocates actively participating in the above roles lacking opportunities to share lived experiences and challenges of their communities. Being able to sit at the table where advocates can share key issues and possible solutions can help eliminate health disparities. Based on the need to increase Latinos participation as research advocates, a training program was developed. The Latino cancer patient advocate training program was design to increase knowledge and develop a community of diverse individuals who can seek opportunities to participate in research teams and decision-making committees. The training program included 15 individuals and 4 mentors who were cancer patients, survivors and caregivers and were Latinos or from Latino descent. The training included four virtual sessions, one in-person session, and attending the conference advancing the science of cancer in Latinos. Those chosen to participate received a full scholarship. The dissemination process through emails and social media included a flyer with the requirements, inclusion criteria, and a link to the application form. A total of 34 people applied, 20 were interviewed, and 15 were selected. The participants were from eleven different states and represented different types of cancer. A based questionnaire before the training, one after the training was completed by the participants. A questionnaire comparing their knowledge before and after two virtual sessions and the in-person training was completed by 93.3% participants. Self-rated knowledge scores ranged from 1 (not knowledgeable at all) to 5 (extremely knowledgeable). The average knowledge score across all questions was 2.9 (somewhat knowledgeable) before the training and 4.0 (moderately knowledgeable) after participating in the training. Participants indicated having the most knowledge about “Resources for your cancer type” (average score: 3.6 before and 4.2 after) and “Patient Advocates” (average score: 3.4 before and 4.1 after) and the least knowledge about “Opportunities and Scholarships available for Advocates” (average score: 2.1 before and 3.8 after), which had the largest increase in knowledge. In terms of satisfaction with the overall training program, all participants were very satisfied (85.7%) or satisfied (14.3%). Further, 71.4% of participants strongly agreed and 28.6% of participants agreed that they were interested in becoming a scientific/research advocate because of their participation in the training. Other outcomes after the training include participants being invited to be DoD reviewers, panelists in conferences, participation in important committees. Furthermore, participants communicate weekly with each other sharing opportunities and information. This training provided knowledge and the opportunity to feel represented as Latino patient advocate diversifying the voices of advocates. Citation Format: Barbara Segarra-Vazquez, Sandi Stanford, Susanne Schmidt. Diversifying cancer patient advocate voices to eliminate health disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B169.

Enhancing undergraduate education and research in aging to eliminate health disparities (ENGAGED) – A pipeline program to advance diversity in aging research

ABSTRACT The Enhancing Undergraduate Education and Research in Aging to Eliminate Health Disparities (ENGAGED) program takes advantage of the broad, multidisciplinary research established in the area of aging at Wake Forest University School of Medicine and its partner institutions, Wake Forest University and Winston-Salem State University. The ENGAGED program is designed to provide undergraduate students who are underrepresented in the biomedical sciences an opportunity to participate in educational and research training in aging and health disparities. Funded since August 2019, ENGAGED has provided 73 academic year internships and 46 summer internships, with another 8 internships starting in Fall 2023. A total of 61 students (67% female, 64% African American, 21% Hispanic) have participated in the ENGAGED program, reflecting the fact that 49% participate in more than one session or program offering. To date, 38 of the ENGAGED trainees have graduated (100% with a science, technology, engineering, or math degree), 84% of whom are working or pursuing advanced degrees in the biomedical sciences. Given the unique strengths, existing infrastructure, and long-standing collaborations among the partner institutions, the ENGAGED program is helping advance diversity in aging and health disparities research by creating a pipeline for well-trained underrepresented students interested in biomedical research careers.

Bridging Health Disparities in the Data-Driven World of Artificial Intelligence: A Narrative Review.

Artificial intelligence (AI) holds exciting potential to revolutionize healthcare delivery in the United States. However, there are concerns about its potential to perpetuate disparities among historically marginalized populations. Following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we conducted a narrative review of current literature on AI and health disparities in the United States. We aimed to answer the question, Does AI have the potential to reduce or eliminate health disparities, or will its use further exacerbate these disparities? We searched the Ovid MEDLINE electronic database to identify and retrieve publications discussing AI and its impact on racial/ethnic health disparities. Articles were included if they discussed AI as a tool to mitigate racial health disparities with or without bias in developing and using AI. This review included 65 articles. We identified six themes of limitations in AI that impact health equity: (1) biases in AI can perpetuate and exacerbate racial and ethnic inequities; (2) equity in algorithms should be a priority; (3) lack of diversity in the field of AI is concerning; (4) the need for regulation and testing algorithms for accuracy; (5) ethical standards for AI in health care are needed; and (6) the importance of promoting transparency and accountability. While AI promises to enhance healthcare outcomes and address equity concerns, risks and challenges are associated with its implementation. To maximize the use of AI, it must be approached with an equity lens during all phases of development.

Rural Health Disparities during the COVID-19 Pandemic in the United States: A Scoping Review

COVID-19 has proven to be detrimental across the globe, most notably affecting the United States at an alarming rate compared to comparable countries. The pandemic has had multifactorial implications on the way communities in the United States prevent, prepare for, and address the virus; however, the impact of the pandemic on rural health is less well understood. Historically, rural communities have faced a unique set of challenges regarding accessing and receiving adequate healthcare, addressing chronic illness, and eliminating health disparities closely associated with the population’s socioeconomic status; the pandemic has exacerbated these challenges. The objective of the scoping review was to review peer-reviewed literature and identify gaps to evaluate the effect of the COVID-19 pandemic on rural populations both at the individual and community level. Articles for review were included if published between the 1st of January 1998 and to the 30th of December 2022. Keys words and phrases such as “COVID-19”, “Rural”, “Preventative Measures”, “heart disease”, “Diabetes”, “Substance Use”, “Access to Healthcare”, “Telehealth”, “Mental Health” and “Vaccines”. Articles that did not match and/or were published outside of history range were excluded. Databases utilized to generate results included PubMed, Web of Science, Scopus, USDA, Economic Research Service, Johns Hopkins University Center for system Science and Engineering, U.S. Department of Commerce, Bureau of Census, Current Population Survey, and annual American Community Survey estimates. Seventy-six articles or resources were generated between July 2022 and February 2023 and deemed appropriate for reference in this review. Pertinent results and findings were thoroughly discussed within the paper alongside figures. Limitations of evidence within this review were due to a lack of studies conducted on the impact of COVID- 19 in rural America specifically. Key findings were that rural health disparities increased both at the individual and system-wide levels as a direct result of the pandemic. The lack of infectious disease specialists, access to larger medical centers with substantial numbers of ICU beds and ventilators, and an overall lack of preparedness overwhelmed rural communities. Although comorbidities such as diabetes and heart disease were associated with poorer health outcomes for a multitude of reasons, the lack of clinic and physician availability for routine care during the pandemic further exacerbated the clinical link from COVID-19 positivity to comorbidities. Important lessons include that health comorbidities, mental health, substance use, health literacy, access to healthcare, among others can serve as key indicators for evaluating healthcare in rural communities’ Future studies should seek to identify gaps in the availability of rural health resources that can improve the lives of millions of Americans now and during the next pandemic.

Existing knowledge, myths, and perceptions about hepatitis B and liver cancer within highly impacted immigrant communities

BackgroundImmigrant groups from Southeast Asia, the Pacific Islands, sub-Saharan Africa, and the Caribbean bear the heaviest burden of chronic hepatitis B and primary liver cancer in the United States. Educational campaigns to increase knowledge about these diseases and their connection are necessary to promote protective health behaviors within these communities, to ultimately reduce the burden of disease, lessen stigma, and eliminate health disparities. ObjectivesThis project sought to engage groups within highly impacted communities to identify existing gaps in hepatitis B- and liver cancer-related knowledge, in order to inform future health education programming that will aim to reduce stigma and promote liver cancer prevention and early detection behaviors within and across groups. MethodsFifteen focus groups and two key informant interviews were conducted virtually with participants from Micronesian, Chinese, Hmong, Nigerian, Ghanaian, Vietnamese, Korean, Somali, Ethiopian, Filipino, Haitian, and Francophone West African communities. Qualitative data were analyzed using thematic coding. ResultsThere are large gaps in knowledge and awareness of hepatitis B and liver cancer, and the link between these two diseases among Asian, Pacific Islander, African and Haitian immigrant communities. This limited knowledge and misinformation, exacerbated by stigma, hinder these groups’ utilization of hepatitis B and liver cancer diagnostic and preventative healthcare services. ConclusionTo reduce hepatitis B and liver cancer health disparities within heavily burdened groups, health education needs to be community-informed, culturally sensitive, and actionable. Study results can guide the development of culturally and linguistically appropriate education programs that focus on the link between hepatitis B and liver cancer and the need for vaccination and routine screening, and that are responsive to the knowledge gaps and misperceptions of diverse communities. The results also provide valuable insights for healthcare providers to improve the knowledge gaps of the diverse patient populations that they serve.

Diabetes control in public assistance recipients and free/low-cost medical care program beneficiaries in Japan: a retrospective cross-sectional study

IntroductionPrevious research has highlighted the association between socioeconomic factors and diabetes management. This study aimed to elucidate the blood glucose control status among individuals with low income (ie, recipients of...

Clustering of Social Determinants of Health as an Indicator of Meaningful Subgroups within an African American Population: Application of Latent Class Analysis.

Health disparities between people who are African American (AA) versus their White counterparts have been well established, but disparities among AA people have not. The current study introduces a systematic method to determine subgroups within a sample of AA people based on their social determinants of health. Health screening data collected in the West Side of Chicago, an underserved predominantly AA area, in 2018 were used. Exploratory latent class analysis was used to determine subgroups of participants based on their responses to 16 variables, each pertaining to a specific social determinant of health. Four unique clusters of participants were found, corresponding to those with "many unmet needs", "basic unmet needs", "unmet healthcare needs", and "few unmet needs". The findings support the utility of analytically determining meaningful subgroups among a sample of AA people and their social determinants of health. Understanding the differences within an underserved population may contribute to future interventions to eliminate health disparities.

California's COVID-19 Vaccine Equity Policy: Cases, Hospitalizations, And Deaths Averted In Affected Communities.

In March2021, California implemented a vaccine equity policy that prioritized COVID-19 vaccine allocation to communities identified as least advantaged by an area-based socioeconomic measure, the Healthy Places Index. We conducted quasi-experimental and counterfactual analyses to estimate the effect of this policy on COVID-19 vaccination, case, hospitalization, and death rates. Among prioritized communities, vaccination rates increased 28.4percent after policy implementation. Furthermore, an estimated 160,892 COVID-19 cases, 10,248 hospitalizations, and 679 deaths in the least-advantaged communities were averted by the policy. Despite these improvements, the share of COVID-19 cases, hospitalizations, and deaths in prioritized communities remained elevated. These estimates were robust in sensitivity analyses that tested exchangeability between prioritized communities and those not prioritized by the policy; model specifications; and potential temporal confounders, including prior infections. Correcting for disparities by strategically allocating limited resources to the least-advantaged or most-affected communities can reduce the impacts of COVID-19 and other diseases but might not eliminate health disparities.

Can Artificial Intelligence Help Eliminate Health Disparities?

Can Artificial Intelligence Help Eliminate Health Disparities?

Implications of Physical Activity in Reducing Alcohol Use for Women Veterans: A Narrative Review.

Women veterans (WV) are a fast-growing population in the United States with concerning health disparities. Reports of increased risks of cardiovascular disease (CVD) and poorer health are evident in WV compared with their civilian counterparts. The transition from active duty to veteran poses additional life stressors, causing changes in health behaviors such as unhealthy alcohol consumption and decreased physical activity, which may explain health disparities in WV. The changes in these two health risk behaviors may be influenced by each other, and emerging evidence suggests that physical activity aids in managing alcohol consumption during alcohol use treatment. In this general narrative review, we summarized findings from studies involving WV on (1) the associations between alcohol consumption and physical activity and (2) the effect of physical activity on reducing alcohol use. We also discussed the clinical consideration of adding physical activity to alcohol use interventions for WV. Most of the literature included in this review has been based on predominantly veteran men populations. This knowledge gap highlights the importance of continued efforts and research studies targeting WV to eliminate health disparities among them.

68 Visiting endowed chair: a new model to support Hispanics junior investigators

OBJECTIVES/GOALS: Analyze how the Endowment HIREC ‘s Mentoring and Career Coach Model A productive mentoring relationship is essential to advance researchers into being independent and bring extramural funds. METHODS/STUDY POPULATION: Provide Hispanic researchers mentoring and career coaching to strengthen their pathway as researcher. The HiREC’s Career Coach and Mentoring Component (CCMC) is an innovated approach to support long-lasting research mentoring relationships in our institution. This approach was developed to advance research to eliminate health disparities, promote multidisciplinary translational research in a Minority Institution and sustain research infrastructure and services, career, and workforce development initiatives. Promising Faculty are target and early and mid-career investigators interested in pursuing a research career. To implement the CCMC with the Visiting Endowed Chair a HiREC Advisory Leadership Group in Mentoring will be established, with researchers from Puerto Rico, and US mainland. RESULTS/ANTICIPATED RESULTS: Three Hispanic mid-career women from the School of Medicine and one from the School of Health Professions from the University of Puerto Rico received a HiREC Advanced Research Award of $50,000. The awardees achieved their goals; completed their research plan, research infrastructure needs, peer-reviewed publications, and submission of a competitive grant. They also provided successful perspectives on mentoring relationships in a Minority institution. Each one showed the mentor’s and mentee’s experiences as fundamental for their research advancements, productivity, leadership, and successful results. HiIREC’s mentoring component with the Visiting Endowed Chairs improves a healthy work environment and expands the research agenda for each awardee sustaining the institutional research culture. DISCUSSION/SIGNIFICANCE: A productive mentoring relationship is essential to advance researchers into being independent and bring extramural funds. Four mentees received formal, long-term guidance and endowment funds for their research infrastructure requirements with successful outcomes. HiREC contributes to building up an institutional mentoring program.

Exploring Environmental Injustice in Exposure to Airborne Lead Released from Industrial Facilities in Kentucky, United States

ABSTRACT Exposure to lead remains a critical public health concern due to its toxic nature and widespread distribution in the environment. Limited research has investigated the risks of lead emissions to the environment by many operating industrial facilities. Using geospatial analysis and multiple regression methods, this article examines racial and class inequalities in proximity to industrial facilities and the concomitant lead exposure. We observe significant positive associations between the proportion of Black residents in census tracts and proximity to lead-emitting facilities and lead exposure after adjusting for other socioeconomic factors. Likewise, median household income was negatively associated with proximity to lead-emitting facilities. Moreover, Black residents and the below-poverty group had larger mean population-weighted lead exposures than white and the above-poverty group respectively. The findings of this study provided further evidence supporting the environmental injustice literature and can inform policies to reduce ambient lead releases from industrial facilities and eliminate health disparities.

Physician Workforce Diversity Is Still Necessary and Achievable if It Is Intentionally Prioritized.

The 2023 Supreme Court Decision from Students for Fair Admissions v. Harvard and Students for Fair Admissions v. University of North Carolina threatens the current progress in achieving diversity within undergraduate and graduate medical education. This is necessary to achieve a diverse healthcare workforce, which is a key to healing historical healthcare trauma, eliminating health disparities, and providing equitable healthcare access for all communities. Although the Supreme Court decision seems obstructionist, viable opportunities exist to enhance recruitment further and solidify diversity efforts in undergraduate and graduate medical education to achieve these goals.

Historical Trauma, Health Care Distrust, and the Legacy of Tuskegee: Implications for Nurse Practitioner Practice and Research

Nurse practitioners (NPs) represent a strong cadre of healers and researchers active in a global quest to eliminate health disparities and create health equity. Barriers to health care result in a disproportionate burden of disease/disability on marginalized groups. Historical trauma results in or contributes to health care distrust manifested as a unique type of barrier with implications for nurse practitioners in research and practice. The legacy of Tuskegee is a reminder and a sentinel exemplar of how Black American male participants in “The Tuskegee Study of Untreated Syphilis in the Negro Male” (the United States Public Health Services Study at Tuskegee) experienced historical trauma and how intergenerational trauma is linked to negative health care outcomes.

Radical Healing Community-Based Participatory Research to Eliminate Health Disparities

The health disparities experienced by Black older adults are associated with social determinants of health, all of which are inextricably linked to anti-Black racism. Research led by counseling psychologists has implications for promoting mental and physical health equity. We describe a new model, based on the integration of the radical healing framework and the community-based participatory research (CBPR) approach, for promoting mental and physical health and wellness among Black older adults. This model is called the radical healing CBPR model. Finally, we provide an example of a program informed by this model that helped improve the health outcomes and quality of life of Black older adults living in the low-income area of a city in the southeastern part of the United States. Notably, Black adults similar to the program participants, participated in the development and implementation of this program in ways that are consistent with the radical healing CBPR model.

Social Determinants of Health in Family Medicine Residency: A National Survey of Program Directors.

Social factors account for most health outcomes, underscoring the need to address social determinants of health (SDH) to eliminate health disparities. Our objectives are (1) to describe the scope of formal SDH curricula in family medicine residency, (2) to identify residency program characteristics associated with integrated core curriculum components to teach SDH, and (3) to identify barriers to addressing SDH in residency. We distributed a cross-sectional survey to all family medicine residency program directors (PDs) accredited by the Accreditation Council for Graduate Medical Education as identified by the Association of Family Medicine Residency Directors. Of 624 eligible program directors, 279 completed the survey (45% response rate). Overall, 41.2% of respondents reported significant formal SDH training in their program. Though a majority (93.9%) agreed that screening for social needs should be a standard of care, most (58.9%) did not use standardized screening tools. The most common barriers to addressing SDH were lack of clinical resources (eg, social workers, legal advocates), lack of community resources (eg, food banks, substance use disorder treatment), and inadequate screening instruments or integration into the electronic medical record system. Availability of referral resources was associated with PDs' increased perception of resident SDH competency. Nearly all respondents agreed that screening for social needs should be a standard part of care; however, this vision is not yet realized. To better train the next generation of physicians to identify and meaningfully address social needs, additional research is needed. This research might include mixed-methods approaches that incorporate qualitative assessments to define best practices and patient-centered outcomes related to identifying and responding to SDH.

The Day Disparities Died.

For many, many years, the public health community has grappled with health disparities. Reducing and/or eliminating health disparities are well-established goals, and have become a fixture in the public health space. The focus on health disparity elimination has permeated policy, resources, institutions of higher learning, and research agendas, to name a few. As a Black female public health professional, I believe that we play a central role in moving the country from a place of disparity to equity. Not only are our professional experiences critical for advancing public health, but our lived experiences can also contribute to the transformation that we all seek. This piece, titled "The Day Disparities Died," reflects this belief. To view the original version of this poem, see the supplemental material section of this article online.

The Heartbeat of Equity: The Crucial Contributions of Nurses in Health Equity

Background: The pursuit of health equity has gained significant attention in recent years, with a focus on eliminating health disparities and addressing social determinants of health. Health equity is crucial in ensuring that everyone has an equal opportunity to attain his/her full potential for well-being and health. Purpose: This paper aimed to conduct a comprehensive analysis of health equity and healthcare disparities, specifically from the perspective of nursing. It also emphasizes the importance of nursing professionals in promoting health equity, addressing health disparities, and advocating for fair and equitable access to healthcare services. Methods: A scoping review was performed to determine applicable international reports and literature published in English. The search was conducted across various electronic databases, including Google Scholar, CINAHL, EBSCO, MEDLINE, and PubMed. Results: The findings revealed that achieving health equity involves addressing the root causes that hinder individuals from attaining optimal health. Social determinants of health play a significant role in shaping health outcomes, and addressing these factors is essential to achieve health equity. Furthermore, the study underscores the need for a community-oriented approach that involves collaboration with community and government sectors to improve social care resources and healthcare delivery. Conclusion: Nurses play multi-faceted roles in promoting health equity through technology, policy, education, research, philosophy and theory context, and disaster response. They have the opportunity to address health disparities and promote health, particularly in underserved communities. Implications for Nursing: Nurses need to be actively involved in advocating for policies and practices that address social determinants of health and promote equity in healthcare delivery. By recognizing the impacts of social, economic, and environmental factors on health outcomes, nurses can play a key role in addressing health disparities and promoting health equity. This involves collaboration with various stakeholders, advocating for resource allocation, and implementing communityoriented approaches to address health inequities Keywords: Health equity, Health disparities, Social determinants, Nursing research, Nursing theories, Nursing policy, Nursing education, Health technology, Disaster response, Jordan.

Achieving Health Equity and Eliminating Health Disparities Based on Nursing Philosophical, Theoretical and Ethical Perspectives

Background: Nowadays, there has been a growing emphasis on the topic of health equity, which refers to the fundamental principle of addressing and resolving disparities in health outcomes and the factors that influence them, such as social determinants. The pursuit of health equity entails a dedicated effort towards achieving the utmost level of health and wellbeing for every individual, while also paying particular attention to those who are most vulnerable to experiencing poor health due to their social circumstances. Purpose: This paper aimed to delve deeply into the concepts of health equity and disparities in healthcare from nursing perspectives, exploring various philosophies, theories, and ethical principles. Furthermore, it aimed to highlight the crucial role that nursing professionals play in promoting health equity and eradicating health disparities. Methods: A scoping review was conducted to identify relevant international reports and literature published in English, multiple electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, MEDLINE, Google Scholar, SAGE Journals, and PubMed were searched. Results: Nursing professionals have a significant role in achieving health equity and eliminating health disparities. Therefore, there has been a growing emphasis on the importance of achieving health equity, enhancing caring and healing connections as the core of professional nursing, alongside the use of theory-guided practice approaches, and nursing philosophies. Consequently, professionals in the field are actively seeking more practical methods that incorporate a sense of purpose and significance into their work to achieve equity based on essential nursing philosophies and theories. Conclusion: Nurses have a unique and advantageous role in the healthcare system, as they have the ability to make a substantial impact on addressing the underlying factors that contribute to health disparities. Furthermore, nurses work closely with interdisciplinary teams, harnessing the power of collaboration and teamwork to effectively implement a range of strategies aimed at promoting fair and equal access to healthcare for all individuals. Implications for Nursing: Nursing professionals have a crucial role in promoting and maintaining health equity, which has been increasingly recognized and emphasized. In addition, they are in a unique position to lead the way in patient care and can make a significant impact in addressing the underlying causes of health disparities by understanding and acknowledging the various factors that influence a person's health and overall well-being. Keywords: Nursing philosophy, Nursing theories, Ethic principles, Health equity, Health disparities.