Explain Health Disparities Research Articles

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.

Introduction to a special section: Racial disparities in health care.

Papers in the Special Section on Racial Disparities in Health Care stemmed from. the 60th Anniversary of Family Process Conference, The Heart of the Matter: Systemic Imperatives to Address Health Disparities and Racism in the Time of COVID, which took place in Washington, DC in September 2021. Of the 12 presenters at the conference, these four were asked to recreate their talks into articles. They address key issues that help to explain health disparities in people of color, particularly African Americans, in the United States, as well as suggest innovations to clinical interventions and health care delivery systems to better serve people who have suffered adversity from the racial inequities in the American system.

Food Swamp Versus Food Desert: Analysis of Geographic Disparities in Obesity and Diabetes in North Carolina Using GIS and Spatial Regression

This study examined how two different types of food environments—food deserts and food swamps—were associated with geographic disparities in obesity and diabetes in North Carolina using geographic information systems and spatial regression. To better identify the association between food swamps and health disparities, this study incorporated socioeconomic dimensions into the food swamp measure and considered dollar stores and gas stations with convenience stores as unhealthy food retailers, which were often overlooked in previous studies. It found that food deserts were concentrated in eastern North Carolina (ENC) and western North Carolina and food swamps in ENC, while obesity and diabetes hot spots were clustered in ENC. The results indicated that obesity and diabetes remained associated with food swamps even after spatial autocorrelation was controlled for, but the associations with food deserts—statistically significant in a nonspatial regression—became no longer significant when food swamps and spatial autocorrelation were controlled for. These results demonstrate that a food swamp might better explain health disparities in North Carolina than a food desert. Identifying ENC as a region containing both food deserts and food swamps illustrates the need for state and local governments to focus their efforts in this region to mitigate food insecurity and health disparities.

Association and Significance of Allostatic Load with Outcomes of Patients with Chronic Myeloid Leukemia (CML)

Introduction: Chronic psychosocial stress has been linked to cancer development and progression. Allostatic load (AL) has been proposed as a novel approach to measure the biological consequence of cumulative stress seeking to explain health disparities. As a multidimensional framework, AL delineates functioning across several physiologic networks including neuroendocrine, cardiovascular, metabolic, and inflammatory systems. Emerging evidence highlights the association between AL and cancer risk, yet little is known about its relevance in hematologic malignancies and its impact on treatment outcomes. Aim: To assess the influence of AL on the outcomes of CML patients (pts). Methods: We performed a retrospective analysis of a cohort of CML pts assessing sociodemographic, clinical, laboratory, and molecular data from 2003 to 2023. The AL was obtained from 23 biomarkers (peripheral pulse, systolic & diastolic blood pressure, hemoglobin, red & white blood cells, platelets, Na, K, Cl, CO2, Ca, urea, creatinine, glucose, total protein, albumin, AST, ALT, ALk, total bilirubin, body mass index, and estimated glomerular filtration rate). We calculated an AL index by summing the number of biomarkers that were out of normal range and categorizing the AL score as low (˂3) or high (≥3). The outcomes of interest were molecular response (MMR, MR 4, MR 4.5) and survival endpoints (freedom-free [FFS], event-free [EFS], transformation-free [TFS], and overall [OS]). Results: We included 132 CML pts; median age at diagnosis was 62 years (IQR, 46-72.5 years). Most pts were women (61.4%), more likely to identify as white (69.2%), then black (23.3%), and had multiple comorbidities (Median, Charlson Comorbidity Index 4, IQR 2-6). Reported healthy behaviors included regular exercise (76.8%), never smoking (64.8%), and not having history of substance abuse (85.4%). The mean AL index was 5.11 with 84.8% of pts allocated to high AL score (15.2% low). High AL was correlated with black race (OR= 3.527, CI 0.77-16.17), men (OR=1.73, CI 0.66-4.51), alcohol consumption (OR=0.55, CI 0.18-1.64), tobacco use (OR=0.48, CI 0.17-1.32), and substance abuse (OR=0.33, CI 0.093-1.17). AL was also associated with Social Determinants of Health, including living in metropolitan areas (OR=0.37, CI 0.10-1.318) or alone (OR=1.67, CI .46-6.23), and employment (OR=0.4, CI 0.1-1.3). Notably, pts with high AL presented a statistically significant lower probability of MMR (HR= 0.56, CI 0.31-0.98), and worse FFS (HR=2.76, CI 1.17-6.50). There was also a for pts with high AL not achieving MR4 (OR= 0.44, CI 0.17-1.15) or MR4.5 (OR=0.48, CI 0.18-1.28), having TKI failure (OR= 2.39, CI 0.90-6.34), transformation to accelerated or blast phase (OR=3.13, CI 0.39-25.06), and worse EFS (HR 1.15, CI 0.59-2.26) (illustrated in the figure). Conclusion: Pts with CML who have a high AL index showed an association with unfavorable treatment outcomes and deep molecular responses. AL, as a measurement of chronic stress, shows a potential ability to elucidate racial and socioeconomic disparities and predict molecular and clinical responses. Assessing AL through multiple time points could uncover help identify modifiable risk factors that could potential help improve outcomes.

Explaining Health Disparities in the Sexual Minority Population: The Role of Neighborhood Effects.

Individual health is affected not only by characteristics and behaviors of the individual, but also by the environment in which the individual lives. Although neighborhood effects are well-established in the health literature, whether these effects are different for sexual minority populations is unknown. There is evidence that the neighborhoods in which sexual minorities reside are distinct from those in which heterosexuals reside, which could give rise to differential neighborhood effects. This research uses restricted data from the National Center for Health Statistics Research Data Center-which include neighborhood identifiers-to investigate health-relevant differences between the neighborhoods in which heterosexuals and sexual minorities reside. We also provide preliminary evidence on whether neighborhood effects explain any or all the disparities in health behaviors or health outcomes between sexual minority and heterosexual populations or mediate or moderate the effects of other covariates in explaining these disparities.

Social Determinants of Health, Prenatal Maternal Stress, and Earlier Birth During the COVID-19 Pandemic.

During the COVID-19 pandemic, pregnant women, especially those from socioeconomically disadvantaged and marginalized groups, experienced unprecedented stress. Prenatal stress and social determinants of health (SDoH) such as lower education and lack of a relationship partner are known to contribute to earlier birth. However, whether SDoH and stress independently contribute or whether the harmful impact of SDoH is mediated by stress is unknown. Moreover, the contributions of these factors has not been investigated in the context of a communal health crisis such as the COVID-19 pandemic. To examine these processes, we used a longitudinal cohort of 2,473 women pregnant during the COVID-19 pandemic who reported a live birth. We compared structural equation models predicting gestational age at birth from SDoH (race/ethnicity, education, financial security, health insurance, relationship status, and lifetime abuse) and from prenatal maternal stress related and unrelated to the COVID-19 pandemic. Results indicate that the association of SDoH with earlier birth was partially mediated by prenatal stress. These findings help uncover mechanisms explaining health disparities in the U.S. and highlight the need to address both SDoH and the stress that these factors produce in under-resourced and marginalized communities.

Geographical pattern of minerals and its association with health disparities in the USA.

This study aimed to determine the common latent patterns of geographical distribution of health-related minerals across the USA and to evaluate the real-world cumulative effects of these patterns on overall population health. It was an ecological study using county-level data (3080 contiguous counties) on the concentrations of 14 minerals (i.e., aluminum, arsenic, calcium, copper, iron, lead, magnesium, manganese, mercury, phosphorus, selenium, sodium, titanium, zinc) in stream sediments (or surface soils), and the measurements of overall health including life expectancy at birth, age-specific mortality risks and cause-specific (summarized by 21 mutually exclusive groups) mortality rates. Latent class analysis (LCA) was employed to identify the common clusters of life expectancy-related minerals based on their concentration characteristics. Multivariate linear regression analyses were then conducted to examine the relationship between the LCA-derived clusters and the health measurements, with adjustment for potential confounding factors. Five minerals (i.e., arsenic, calcium, selenium, sodium and zinc) were associated with life expectancy and were analyzed in LCA. Three clusters were determined across the USA, the 'common' (n = 2056, 66.8%), 'infertile' (n = 739, 24.0%) and 'plentiful' (n = 285, 9.3%) clusters. Residents in counties with the 'infertile' profile were associated with the shortest life expectancy, highest mortality risks at all ages, and highest mortality rates for many reasons including the top five leading causes of death: cardiovascular diseases, neoplasms, neurological disorders, chronic respiratory conditions, and diabetes, urogenital, blood and endocrine diseases. Results remained statistically significant after confounding adjustment. Our study brings novel perspectives regarding environmental geochemistry to explain health disparities in the USA.

225-LB: Impaired Microvascular Responses May Explain Health Disparities and Impaired Metabolic Flexibility in Hispanic Residents of the Rio Grande Valley

Purpose: Impaired skeletal muscle microvascular blood flow (MBF) is one of the earliest pathophysiologies of type 2 diabetes (T2D) . People with a family history of T2D (FH+ are at greater risk for developing T2D than those with no family history (FH-) . Further, we have shown that normoglycemic Caucasian FH+ individuals have impaired skeletal muscle microvascular responses and metabolic flexibility (MF - ability to switch substrate oxidation upon stimulation) to a mixed meal challenge (MMC) when compared with matched FH- (p<0.01) , suggesting early vascular insulin resistance. Mexican Hispanic individuals have the highest prevalence of T2D in the US and make up ∼95% of Hispanic residents of the Rio Grande Valley (HRGV) where T2D diagnosis rates are ∼3x the national average. Therefore, we sought to determine if impaired MBF responses are present in healthy HRGV. Methods: 15 FH- and 13 FH+ HRGV were recruited to assess MF and MBF responses to a MMC. MF was measured via indirect calorimetry and MBF via contrast-enhanced ultrasound while fasting and again 60-min post MMC. Results: No changes in skeletal MBF were noted in FH- (1.21 ± 0.53 SEM and 0.86 ± 0.23 SEM fasting and postprandial MBF respectively) or FH+ (2.17 ± 0.98 SEM and 1.49 ± 0.66 SEM fasting and postprandial MBF respectively) groups. Abdominal adipose MBF responses increased in FH+ (-2.3 ± 0.71 SEM, p=0.004) , but not in FH- (-0.49 ± 0.39 SEM p=0.39) . FH+ display impaired postprandial metabolic flexibility (MF) responses during 60-min of testing post-MMC. Neither blood glucose responses (99.3 ± 1.3 SEM and 102.27 ± 2.1 SEM fasting and post-prandial respectively, p=0.2) nor body composition differed between FH groups. Conclusions: HRGV display impaired skeletal muscle MBF responses, indicating early vascular insulin resistance. Further, the impairment in MF in FH+ may be partially explained by increased adipose MBF responses, as adipose is less metabolically active than skeletal muscle. Disclosure R. D. Russell: None. Y. Tai: None. S. Marupudi: None.

“Our feelings are valid” – reviewing the lesbian, gay, and bisexual affirmative approaches in a mental health setting

In recent years, although research into support mechanisms for managing distress experienced by Lesbian Gay and Bisexual (LGB) communities has increased. Stigma-related discrimination related to sexual minority status remains. This is further compounded by stigma against mental illnesses thus creating double jeopardy. This review will outline recent discoveries by exploring existing theories highlighting factors that explain health disparities for cisgender LGB people. It appears that the experience of the LGB population and the use of psychological therapies is varied across the spectrum. Some focus upon symptom reduction as part of the experience, but others talk about not being validated. Some mention minority stress constructs, alongside the psychological mediation framework, which offers a potential theoretical understanding of the experiences of the LGB population who receive psychological therapies.

Cultural and social capitals as factors in self-rated health

The present-day epidemiological situation has once again drawn attention of the scientific community and policy makers to the importance of understanding of the social sources of biological risks. During the past few decades the empirical research into heath disparities has revealed the complex links existing between the socioeconomic status of an individual and his or her health. There are several theoretical models that explain health disparities chiefly focusing on various facets of the socioeconomic status and their effects on health. Those models point to the unequal distribution of health across different groups within a population, but they remain rather limited in terms of accounting for the mechanisms of its maintenance. Although the idea of the effects of socioeconomic status on health is not new and dates back at least as far as 19th c. social medicine, the body of knowledge regarding the social patterns of health, disease and mortality has increased considerably since then. Burgeoning new approaches to health disparities as well as incorporation of data from the epidemiological, medical, genetic and similar connected disciplines have enriched the sociological knowledge and changed the very conceptualization of health. The methodological means of assessing the social factors in health should be enhanced accordingly. The present study contributes to this empirical literature. The aim of the present study was to explore the factor of the cultural and social capitals in self-rated health status among the adult Ukrainians. During 2020–2021 the authors have conducted a two-phase mixed methods study employing the results of semi-structured interviews (n = 10) to develop a survey instrument (n = 156). The results pointed to the gradual data structure in self-rated health based on the cultural capital criterion. Individuals who were more knowledgeable in terms of healthy lifestyle habits and capable of translating this knowledge into practice adhering to it in their lifestyle, also had higher scores on all other forms of capital. This finding supports the notion that health is linked to the cultural taste which forms the status distinctions. As for the mechanisms of the interaction of capitals, it was found that cultural capital in the domain of health is connected to the variables of the cultural capital in the domain of diet and healthy habits, as well as with the social support aspect of the social capital. Cultural capital variables are intercorrelated among themselves, as well as with such aspects of social capital as social support and useful contact networks. Social capital emerged as a multidimensional construct with multiple interrelated compounds. The relationship between social and cultural capitals was mediated via social support availability.

The Importance of Psychosocial Factors in Aging: The Minority Aging Research Study

Psychosocial factors can provide crucial insight into lived experiences that influence healthy aging. Though psychosocial factors are often used to explain health disparities seen between different racial/ethnic groups, within-group investigations can be particularly powerful for identifying culturally specific psychosocial factors that impact heterogeneity in aging among minority populations. The Minority Aging Research Study (MARS) is an ongoing, longitudinal epidemiologic cohort of 797 older African Americans from the Chicago, IL metropolitan area. Participants are on average 73.4 (standard deviation [SD]=6.6) years of age, 78.2% are women, and mean years of education is 14.8 (SD=3.7). At baseline, 75.3% of participants were without cognitive impairment, 20.8% had mild cognitive impairment, and 3.9% had mild dementia. Participants were recruited starting in 2004 and complete annual visits including a clinical evaluation, cognitive and motor testing, and assessment of risk factors related to Alzheimer’s Disease risk, including those hypothesized to be associated with a higher burden of cognitive impairment among older African Americans. This symposium will discuss the longitudinal association between John Henryism and cognitive function and decline (McSorley), participation in social activities and risk of all-cause mortality (Lamar), and the predictive relationship between experiences of everyday discrimination and incident disability (Lange-Maia). Finally, we will examine multilevel correlates—including environmental, sociocultural, behavioral, and biological factors—related to perceived stress (Glover). Mendes de Leon will critically consider what appear to be the most potent psychosocial factors for minority aging and possible implications of integrating these factors into interventions focused on promoting healthy aging among older African Americans.

Health Disparities and Health Omissions: Pushing Medical Anthropology Forward in the United States

AbstractRacialized diagnosis of the fatal neurodegenerative disease ALS illustrates the limitations of medical anthropological knowledge that focuses only on “ethnic differences” to explain health disparities at the population level. I argue that a central focus on racism in our analysis of biomedical US spaces, and explicitly anti‐Black racism, will better equip anthropologists to understand how racialized forms of knowledge production in medicine and science have deleterious effects on people’s lives and bodies. The aggregate effects of racial science (the belief that human beings can be separated into biologically distinct groups) in slavery’s afterlife impact how clinicians and researchers see and treat Black people. I elaborate the concept of “health omissions” to equip anthropologists, clinical researchers, and biomedical clinicians with an analytical and truth‐telling lens that can attend to the ways that systemic marginalization in slavery’s afterlife omits Black people’s health problems and care.

Multilevel Analysis of Individual and Neighborhood Characteristics Associated with Viral Suppression Among Adults with HIV in Rio de Janeiro, Brazil.

Understanding the impact of neighborhood context on viral suppression outcomes may help explain health disparities and identify future interventions. We assessed the relationship between individual characteristics, neighborhood socioeconomic context, and viral suppression using multilevel logistic regression models. Adults with HIV initiating antiretroviral therapy (ART) between 2000 and 2017, who resided in Rio de Janeiro and had an HIV-1 RNA level (viral load) measured 90-270 days after ART initiation were included. Overall, 83.9% achieved viral suppression. Participants who were older, had a higher level of education, and identified as heterosexual cisgender men and cisgender men-who-have-sex-with-men had increased odds of viral suppression. Later calendar year of ART initiation carried the strongest association with viral suppression, reflecting the increased effectiveness and tolerability of ART over time. Neighborhood socioeconomic indicators did not predict viral suppression in unadjusted or adjusted analyses, which may result from the integrated care provided in our health care facility together with Brazil's universal treatment.

Abstract #1000316: Social Determinants of Health Training in US Endocrinology Fellowship Program Curricula: A Comprehensive Review of Program Websites

In 2019, the Accreditation Council for Graduate Medical Education revised the common program requirements of residencies and fellowships to incorporate an understanding of “the social determinants of health (SDH) of the populations they serve and incorporate them in the design and implementation of the program curriculum, with the ultimate goal of addressing these needs and health disparities.” Trainees must recognize that understanding SDH is central in explaining health disparities that exist in the communities they serve and diseases they treat. However, SDH curriculum is informal. Here we seek to evaluate how programs distinguish their SDH curriculum to endocrinology fellowship applicant.

Acculturation strategies, age at migration, and self-rated health: An empirical study on internal migrants in China

Berry's bidimensional acculturation model categorizes acculturation status (integration, assimilation, separation, marginalization) by preference toward host and origin cultures. According to Berry's theory, different acculturation strategies yield different health outcomes, and age at migration moderates the relationship between acculturation and health outcome. Previous research has applied this model to understand acculturation's influence on international migrants' health outcomes, but rarely for internal migrants. This research examines these relationships using a national survey on Chinese internal migrants. Using propensity score weighting, the results align with previous findings that integration strategy-using migrants reported optimal health status, separation/assimilation strategy-using migrants reported suboptimal health, and marginalization strategy-using migrants reported the worst health, suggesting the model can explain health disparities among internal migrants. Moreover, older age at migration deteriorates health outcomes and moderates health disparities among migrants employing different acculturation strategies. However, age at migration's moderating effect is significant only among inter-provincial migrants. Embracing the host society inhibits health deterioration among inter-provincial migrants with older age at migration, whereas rejecting or embracing both societies facilitates health deterioration among intra-provincial migrants.

The southern rural health and mortality penalty: A review of regional health inequities in the United States.

Rural-urban differences in morbidity and mortality across the United States have been well documented and termed the "rural mortality penalty". However, research studies frequently treat rural areas as homogeneous and often do not account for geospatial variability in rural health risks by both county, state, region, race, and sex within the United States. Additionally, people living in the rural South of the US have higher rates of morbidity and mortality compared to both their urban counterparts and other rural areas. Of those living in southern rural communities, people of color experience higher rates of death and disease compared to white populations. Although there is a wealth of research that uses individual-level behaviors to explain rural-urban health disparities, there is less focus on how community and structural factors influence these differences. This review focuses on the "southern rural health penalty", a term coined by the authors, which refers to the high rate of mortality and morbidity in southern rural areas in the USA compared to both urban areas and non-southern rural places. We use macrosocial determinants of health to explain possible reasons for the "southern rural health penalty". This review can guide future research on rural health between southern and non-southern populations in the US and examine if macrosocial determinants of health can explain health disparities within southern rural populations.

LGBTQ cultural competence for pharmacists

LGBTQ cultural competence for pharmacists

Gendered tri-racial stratification and health disparities

Despite extensive evidence confirming racial and gender health disparities, little research considers how race theory might aid in understanding these patterns. Using the Collaborative Psychiatric Epidemiology Surveys (CPES), this study fills this void by integrating two research areas—sociology of race and medical sociology—to assess the utility of Bonilla-Silva's tri-racial stratification perspective in predicting health patterns. More specifically, I address the following questions: is the tri-racial stratification thesis aligned with the health profiles of racial groups in the U.S.? Does the applicability of this perspective differ for women and men? Last, do the health patterns suggested by tri-racial stratification persist after adjusting for social factors (socioeconomic status and social support) often invoked to explain health disparities? Results indicate that the racial patterning of life-threatening conditions lend partial support for tri-racial stratification for women and men. Self-rated health findings yield counterintuitive patterns. Furthermore, social factors do not explain the majority of ethnic differences in health. Research and theoretical implications of these findings are discussed.

Potentials of School Nursing for Strengthening the Health Literacy of Children, Parents and Teachers.

Health literacy (HL) plays a key role in explaining health disparities. School nurses (SN) provide health related expertise within the school setting. A positive effect on the HL of children but also their teachers and parents has been suggested by some research, but gaps persist in the available information. As a pilot project, SN, which are not common in German schools, were placed in 28 public elementary and secondary schools in two German states. Children (11+ years, n = 2773), parents (n = 3978) and teachers (n = 420) participated in a 2017 baseline (T0) survey. Data collection was repeated in 2018 (T1). HL was measured using the Health Literacy for School-Aged Children scale (HLSAC) (children) and the European Health Literacy Short Scale (HLS-EU-Q16) (adults). Descriptive and multivariate data analyses were carried out. The HL of all groups increased between T0 and T1. Low child HL decreased from 17.9% to 14.9%. Problematic and inadequate HL dropped from 43.8% to 38.8% among parents and from 49.9% to 45.8% among teachers. Improvements were significant for children and parents but not for the teachers. Despite the relatively short intervention period and a relatively non-specific spectrum of interventions, there is some evidence that SN may contribute to strengthening HL within the school setting. The longer-term effects of SN on health literacy and child health should be further examined. For this, a clearer conceptualization of the scope of work of the SN in Germany including their educational interventions is imperative.

Minority stress and health: A grounded theory exploration among men who have sex with men in China and implications for health research and interventions.

Men who have sex with men (MSM) in China are disproportionately affected by HIV and mental health issues. Although predominately western-based research suggests a minority stress perspective to explain health disparities, how Chinese MSM experience stress related to being a sexual minority and how such experiences affect their health have not been carefully examined. This study was a qualitative investigation of how stress related to sexuality (e.g., stigma, discrimination, and oppression) are experienced among MSM in China and how these experiences affect their psychological and behavioral health. In-depth, semi-structured interviews were conducted with 24MSM in China. Grounded theory was employed to guide data analysis. Six categories emerged, which included: A Family-Oriented, Heteronormative Culture, Interpersonal Rejections and Marginalization, Internalization of Stigma, the Psychological Impact of Minority Stress, Impact on HIV-related Behavioral Health, and Coping. A conceptual model was developed, which illustrated relationships among categories and described sources, processes, and impact of minority stress among MSM in China. Cultural, social, and internalized sources of minority stress were shown to have detrimental effects on participants' psychological health and HIV-related behavioral health. Various coping strategies shared the purpose of navigating well-being in one's direct environment and in the larger culture. Findings demonstrate the relevance of minority stress in behavioral health among Chinese MSM as well as the need to conceptualize minority stress within MSM's sociocultural context. HIV prevention efforts may benefit from a contextualized understanding of minority stress and addressing minority stress in a culturally congruent, community-centered fashion.