Factor In Health Disparities Research Articles

ASSOCIATION BETWEEN NEIGHBORHOOD DEPRIVATION AND PLACE OF DEATH: A POPULATION STUDY

Abstract While recent decades have witnessed an overall trend away from deaths in hospitals and facilities and towards deaths at home, socioeconomic disparities persist. Minoritized individuals while less likely to die in a nursing facility are more likely to die in hospital and (except for dementia) less likely to die at home; more educated individuals are also less likely to die in a nursing facility but conversely less likely to die in hospital and more likely to die at home. Despite growing interest in the role of neighborhood-level factors in health disparities, no studies have examined the impact of neighborhood deprivation on place of death. Using a representative sample of Medicare beneficiaries (n = 3043) drawn from the National Health and Aging Trends Study, we examined the association between census-tract level social deprivation index (quartiles) and place of death (home vs all else, hospital vs all else, nursing facility vs all else, hospice residence vs all else) in a series of multivariable regression models, adjusting for relevant sociodemographic (age, sex, race, education, income) and clinical covariates (dementia, heart disease, lung disease, cancer). Compared with residence in the least deprived quartile, residence in a neighborhood in the most deprived quartile was associated with reduced odds of home death (aOR: 0.66 (0.45, 0.99)) and increased odds of death in a nursing facility (aOR: 1.68 (1.00, 2.80)). Future studies should confirm these findings and examine mechanisms through which neighborhood deprivation impacts place of death (including availability and quality of home-based clinical care.

Health literacy: What lessons can be learned from the experiences and policies of different countries?

Adequate levels of health literacy (HL) are crucial to ensure good quality of health, social life and wellbeing. HL is a mediating factor in health disparities. Low HL hampers interaction with healthcare. HL is a shared responsibility of individuals and the healthcare system. Multi-dimensional programs and policies should be set up. To learn from current HL policies and action plans and to identify elements to consider for the development of national HL plans. Transversal analysis of HL policies in six countries, based on a preliminary scoping review. A combination of document analysis and key informant approach. Local experts validated and completed information for their country. A transversal comparison was performed. Several approaches were identified, often influenced by contextual factors, healthcare reforms and existence of centers of expertise. Some governments developed full-fledged, standalone plans, while others developed broader plans covering the entire health and care sector. Some took a conceptually driven, high level approach. Others took a pragmatic approach. And some did not have a governmental plan at all. Policy makers should analyse their state structure and health system, and search for local 'pockets of excellence', to develop a well-planned, substantiated HL approach for their country.

Integrating Cultural Humility into the Medical Education Curriculum: Strategies for Educators

Issue: The framework of cultural humility, which emphasizes curiosity and self-reflection over mastery, was identified over 20 years ago as a way to address implicit bias in health care, an important factor in health disparities. Despite growing interest from researchers and educators, as well as the urgent call to adopt these values, the foundational elements of cultural humility remain challenging to teach in medical education and have not yet been widely adopted. Evidence: Health disparities persist throughout the United States among a growing population of diverse patients. The cultural humility framework undermines power imbalances by encouraging the clinician to view their patient as an expert of their own experience. This approach strengthens relationships within the community, illuminates racial and historical injustices, and contributes to equitable care. However, recent reviews have shown that humility-based principles have yet to be widely integrated into cultural curricula. Based on available evidence, this article introduces the foundational concepts of cultural humility with the aim of helping medical educators better understand and implement the principles of cultural humility into undergraduate medical education. Implications: Cultural humility is a powerful and feasible adjunct to help student physicians cultivate effective tools to provide the best patient care possible to an increasingly diverse patient population. However, there is little known about how best to implement the principles of cultural humility into existing undergraduate medical education curricula. The analyses and strategies presented provide educators with the background, instructional and curricular methods to enable learners to cultivate cultural humility. Future systematic research will need to focus on investigating design, implementation and impact.

Should Electronic Health Record-Derived Social and Behavioral Data Be Used in Precision Medicine Research?

Precision medicine research initiatives aim to use participants' electronic health records (EHRs) to obtain rich longitudinal data for large-scale precision medicine studies. Although EHRs vary widely in their inclusion and formatting of social and behavioral data, these data are essential to investigating genetic and social factors in health disparities. We explore possible biases in collecting, using, and interpreting EHR-based social and behavioral data in precision medicine research and their consequences for health equity.

Developing a Health Policy-Ready Practice Workforce: Violence and Health Disparities in Interprofessional Education

s / Journal of Interprofessional Education & Practice 1 (2015) 48e77 52 DEVELOPING A HEALTH POLICY-READY PRACTICE WORKFORCE: VIOLENCE AND HEALTH DISPARITIES IN INTERPROFESSIONAL EDUCATION Candace W. Burton PhD, RN, AFN-BC. Robert Wood Johnson Nurse Faculty Scholar Research Scientist for Intimate Partner Violence & Sexual Assault, VCU Institute for Women's Health Assistant Professor, Department of Family and Community Health Nursing Virginia Commonwealth University School of Nursing Background/Introduction Violence is a significant cause of and factor in health disparities, particularly among vulnerable populations. Developing a health care workforce that is prepared to address violence from a health policy standpoint necessitates integration of educational perspectives on both health disparities and violence.

Research Challenges and Bioethics Responsibilities in the Aftermath of the Presidential Apology to the Survivors of the U. S. Public Health Services Syphilis Study at Tuskegee

In 1997 President Clinton apologized to the survivors of the U.S. Public Health Service Syphilis Study. Since then, two of his recommendations have received little attention. First, he emphasized the need to remember the shameful past so we can build a better future for racial'ethnic minority populations. Second, he directed the creation in partnership with higher education to prepare training materials that would instruct biomedical researchers on the application of ethical principles to research with racial/ethnic minority populations. This article proposes the inclusion of these issues in the implementation of the Affordable Care Act. It asks, What is the right or good thing to do? What are our obligations to one another? Two challenges are examined: (a) Conducting research with African Americans without knowledge of bioethics specific to this population, and (b) the ethical dilemma of conducting research that does not adequately take into account the diversity within the Black population that is a contributing factor in health disparities. Training and policy recommendations responsive to President Clinton's Apology are presented.

Relationship between oral health literacy and oral health behaviors and clinical status in Japanese adults

Background/purposeHealth literacy is recognized as an important determinant of health as well as a causal factor in health disparities among different population groups. However, the paucity of information on oral health literacy makes urgent the need for more research on this important topic. The objective of this study was to investigate how oral health literacy relates to oral health behaviors, as well as clinical dental and periodontal condition. Materials and methodsA self-administered questionnaire and dental examination collected information on demographics of 589 adult residents of Akita prefecture, Japan, including: oral health behaviors; oral hygiene status; oral health literacy; number of natural teeth, decayed teeth, and functional tooth units (FTUs); and community periodontal index. ResultsLess than half of the participants knew the Japanese words such as “dental plaque,” “scaling,” “gingivitis,” “fluoride mouth rinsing,” “8020 campaign,” “mouthwash,” and “denture plaque,” or answered “true” in response to the statement: “Scaling is related to periodontal disease.” The higher a participant’s oral health literacy, the more often they brushed their teeth or dentures, self-checked oral condition with a mirror, had regular dental checkups, and the better their oral hygiene status. Furthermore, individuals with higher oral health literacy had higher mean numbers of natural teeth, n-FTUs, and nif-FTUs. Participants with higher oral health literacy also had fewer decayed teeth. Participants with low oral health literacy were more likely to fall into a higher category of the community periodontal index code compared to those with high oral health literacy. ConclusionOur findings indicate that oral health literacy is associated with differences in oral health behaviors and clinical oral health status. An understanding of participants’ oral health literacy levels is crucial for designing effective health educational materials and creating intervention programs to promote oral health.

Role of Acculturation Research in Advancing Science and Practice in Reducing Health Care Disparities Among Latinos

An impressive body of public health knowledge on health care disparities among Latinos has been produced. However, inconclusive and conflicting results on predictors of health care disparities remain. We examined the theoretical assumptions and methodological limitations of acculturation research in understanding Latino health care disparities, the evidence for socioeconomic position as a predictor of health care disparities, and the effectiveness of cultural competency practice. Persistent use of culture-driven acculturation models decenters social determinants of health as key factors in health disparities and diminishes the effectiveness of cultural competency practice. Social and economic determinants are more important predictors than is culture in understanding health care disparities. Improvements in the material conditions of low-income Latinos can effectively reduce health care disparities.

The Reserve Capacity Model as a Framework for Understanding Psychosocial Factors in Health Disparities

Substantial research has identified a robust, linear association between socioeconomic status (SES) and health, across many different populations and outcomes. Among myriad influences, psychosocial factors may contribute to SES‐related gradients in health. In the current manuscript, we describe the Reserve Capacity Model (Gallo & Matthews, 2003) as a potential framework through which to examine psychosocial pathways in health disparities. The model posits that SES is connected to health, in part through associations with stress and concomitant negative emotions, and their subsequent links with bio‐behavioral functioning. In addition, low SES may predict enhanced emotional and physiological reactivity to stress due to a deficiency in resilient psychosocial resources (i.e. “reserve capacity”) and limited opportunities to replenish resource reserves. In addition, resources might represent a direct mediational pathway from SES to health. We describe several studies in which we have examined various tenets of the Reserve Capacity Model, and comment on future research directions to better understand the roles of psychosocial variables in health disparities.

Psychology and Medical Education: Collaborations for Culturally Responsive Care

Recent years have witnessed an increasing attention to the vast and alarming health disparities in the United States. This paper explores provider factors in health disparities, considering the role of medical education in training health care providers to practice culturally responsive health care toward a diminution of health inequalities. The paper begins with a description of culturally responsive care along with an overview of the key elements of a comprehensive curriculum for health care providers in this arena. Next, the paper explores the key contributions from the field of psychology to collaborative instruction of health care providers in the areas of attitudes/awareness, knowledge and skills components of culturally responsive care. Finally, the paper concludes with a description of collaborative teaching from a family medicine residency program where a 33-h 'cultural medicine curriculum within the curriculum' is delivered over the course of 3 years.

Perceived Medical Discrimination and Cancer Screening Behaviors of Racial and Ethnic Minority Adults

Discrimination has been shown as a major causal factor in health disparities, yet little is known about the relationship between perceived medical discrimination (versus general discrimination outside of medical settings) and cancer screening behaviors. We examined whether perceived medical discrimination is associated with lower screening rates for colorectal and breast cancers among racial and ethnic minority adult Californians. Pooled cross-sectional data from 2003 and 2005 California Health Interview Survey were examined for cancer screening trends among African American, American Indian/Alaskan Native, Asian, and Latino adult respondents reporting perceived medical discrimination compared with those not reporting discrimination (n = 11,245). Outcome measures were dichotomous screening variables for colorectal cancer among respondents ages 50 to 75 years and breast cancer among women ages 40 to 75 years. Women perceiving medical discrimination were less likely to be screened for colorectal [odds ratio (OR), 0.66; 95% confidence interval (95% CI), 0.64-0.69] or breast cancer (OR, 0.52; 95% CI, 0.51-0.54) compared with women not perceiving discrimination. Although men who perceived medical discrimination were no less likely to be screened for colorectal cancer than those who did not (OR, 1.02; 95% CI, 0.97-1.07), significantly lower screening rates were found among men who perceived discrimination and reported having a usual source of health care (OR, 0.30; 95% CI, 0.28-0.32). These findings of a significant association between perceived racial or ethnic-based medical discrimination and cancer screening behaviors have serious implications for cancer health disparities. Gender differences in patterns for screening and perceived medical discrimination warrant further investigation.

Importance of adult literacy in understanding health disparities

In several recent studies, the importance of education and race in explaining health-related disparities has diminished when literacy was considered. This relationship has not been tested in a nationally representative sample of U.S. adults. To understand the effect of adult literacy on the explanatory power of education and race in predicting health status among U.S. adults. Using the 1992 National Adult Literacy Survey, logistic regression models predicting health status were estimated with and without literacy to test the effect of literacy inclusion on race and education. A nationally representative sample of 23,889 noninstitutionalized U.S. adults. Poor health status was measured by having a work-impairing condition or a long-term illness. Literacy was measured by an extensive functional skills test. When literacy was not considered, African Americans were 1.54 (95% confidence interval, 1.29 to 1.84) times more likely to have a work-impairing condition than whites, and completion of an additional level of education made one 0.75 (0.69 to 0.82) times as likely to have a work-impairing condition. When literacy was considered, the effect estimates of both African-American race and education diminished 32% to the point that they were no longer significantly associated with having a work-impairing condition. Similar results were seen with long-term illness. The inclusion of adult literacy reduces the explanatory power of crucial variables in health disparities research. Literacy inequity may be an important factor in health disparities, and a powerful avenue for alleviation efforts, which has been mistakenly attributed to other factors.

Genetic research and health disparities.

Alleviating health disparities in the United States is a goal with broad support. Medical research undertaken to achieve this goal typically adopts the well-established perspective that racial discrimination and poverty are the major contributors to unequal health status. However, the suggestion is increasingly made that genetic research also has a significant role to play in alleviating this problem, which likely overstates the importance of genetics as a factor in health disparities. Overemphasis on genetics as a major explanatory factor in health disparities could lead researchers to miss factors that contribute to disparities more substantially and may also reinforce racial stereotyping, which may contribute to disparities in the first place. Arguments that promote genetics research as a way to help alleviate health disparities are augmented by several factors, including research funding initiatives and the distinct demographic patterns of health disparities in the United States.

Addressing Health Disparities Through Dental‐Medical Collaborations, Part III: Leadership for the Public Good

This is the third in a series of articles featuring dental-medical collaborations to reduce oral health disparities. Previous articles have targeted disparities among children, the elderly, and those with mental retardation and developmental disabilities and the importance of cultural factors in health disparities. Articles in this third group describe projects that originated in the public health sector or utilize public health approaches. They include training of non-dental providers and Head Start/Early Head Start workers in children's oral health promotion; case management to ensure early preventive medical, dental, and developmental services for children; and a dental school-led outreach, training, and research effort to address oral cancer disparities. In this introductory article, we review lessons learned from the entire series of projects reported in these articles. The primary take-home message is that educational changes are needed in dental and medical training to better address oral health disparities. Other important lessons include the value of local or state-specific data, the need for partnerships with key stakeholders, and the role of financial incentives in leveraging change. We recommend more attention to outcome assessments in educational initiatives, greater partnering with families and patients, and utilization of change-management methodologies with systems, providers, and patients. We also advocate increased collaboration with the public health sector and bold leadership in dental education.