Members Of Minority Populations Research Articles

Evaluating the Impact of Race and Gender on Environmental Risk Perceptions in the Houston Neighborhood of Manchester.

Previous research has shown that white males tend to perceive risks from environmental exposures as lower than women and members of minority populations, often referred to as the white male effect. However, this effect was mostly demonstrated without regard to the actual lived environment experienced by the study participants. There is growing evidence that differences in risk perceptions cannot be adequately explained through race or gender. This cross-sectional study collected survey data from residents of Manchester, a small neighborhood in Houston, Texas, characterized by industrial sites, unimproved infrastructure, nuisance flooding, and poor air quality. Trained community members attempted a complete census within the geographically compact neighborhood. Logistic regression was used to estimate the relative effect of race on environmental health perceptions adjusted for generational age. In contrast to previous research, our study (N = 109) showed that nonwhite individuals perceived a lower environmental health risk compared with their white counterparts. Comparing female and minority racial groups with white males showed that on most issues, white males had the highest perception of risk. For example, adjusted for age, nonwhite respondents perceived the risk of contact with standing water as significantly lower than white respondents (odds ratio = 0.34; 95% confidence interval = 0.12-0.93). This study supports the hypothesis that when environmental conditions experienced by individuals are the same, minority groups tend to underestimate their risk compared with white males. One possible explanation put forth is that communal norms are created within minority populations through generations of exposure to negative environmental conditions compared with white populations.

The importance of assessing out-of-pocket payments when the financing of antiretroviral therapy is transitioned to domestic funding: findings from Vietnam.

To assess out-of-pocket payments and catastrophic health expenditures among antiretroviral therapy (ART) patients in Vietnam, and to model catastrophic payments under different copayment scenarios when the primary financing of ART changes to social health insurance. Cross-sectional facility-based survey of 843 patients at 42 health facilities representative of 87% of ART patients in 2015. Because of donor and government funding, no payments were made for antiretroviral drugs. Other health expenditures were about $66 per person per year (95% CI: $30-$102), of which $15 ($7-$22) were directly for HIV-related health services, largely laboratory tests. These payments resulted in a 4.9% (95% CI: 3.1-6.8%) catastrophic payment rate and 2.5% (95% CI: 0.9-4.1%) catastrophic payment rate for HIV-related health services. About 32% of respondents reported, they were eligible for SHI without copayments. If patients had to pay 20% of costs of ART under social health insurance, the catastrophic payment rate would increase to 8% (95% CI: 5.5-10.0%), and if patients without health insurance had to pay the full costs of ART, the catastrophic payment rate among all patients would be 24% (95% CI: 21.1-27.4%). Health and catastrophic expenditures were substantially lower than in previous studies, although different methods may explain some of the discrepancy. The 20% copayments required by social health insurance would present a financial burden to an additional 0.6% to 5.1% of ART patients. Ensuring access to health insurance for all ART patients will prevent an even higher level of financial hardship.

Renato Alarcón: Long-Time Advocate for Cultural Awareness in Psychiatry

Renato Alarcón: Long-Time Advocate for Cultural Awareness in Psychiatry

Delivering colonoscopy screening for low‐income populations in Suffolk County

Current and pending legislation provides colorectal cancer screening reimbursement for previously uninsured populations. Colonoscopy is currently the screening method most frequently recommended by physicians for insured patients. The experience of the SCOPE (Suffolk County Preventive Endoscopy) demonstration project (Project SCOPE) at Stony Brook University Medical Center provides a model for delivering colonoscopy screening to low-income populations to meet anticipated increasing demands. Project SCOPE, based in the Department of Preventive Medicine, featured internal collaboration with the academic medical center's large gastroenterology practice and external collaboration with the Suffolk County Department of Health Services' network of community health centers. Colonoscopies were performed by faculty gastroenterologists or supervised fellows. Measures of colonoscopy performance were compared with quality indicators and differences between faculty and supervised fellows were identified. During a 40-month screening period, 800 initial colonoscopies were performed. Approximately 21% of women screened were found to have adenomatous polyps compared with 36% of men. Five cancers were detected. The majority of the population screened (70%) were members of minority populations. African American individuals had a higher percentage of proximally located adenomas (78%) compared with white individuals (65%) and Hispanics (49%), based on the location of the most advanced lesion. Hispanic individuals had a 36% lower risk of adenomas compared with white individuals. Performance measures including the percentage of procedures with adequate bowel preparation, cecum reached, scope withdrawal time, and adenoma detection rate met quality benchmarks when performed by either faculty or supervised fellows. Project SCOPE's operational strategies demonstrated a feasible method for an academic medical center to provide high-quality screening colonoscopy for low-income populations.

Colorectal Cancer Screening Disparities for Rural Minorities in the United States

Despite the existence of effective screening, colorectal cancer remains the second leading cause of cancer death in the United States. Adults living in rural areas and members of minority populations both experience disparities in colorectal cancer screening. Cross-sectional prevalence study of Behavioral Risk Factor Surveillance System from the Centers for Disease Control from 1998 to 2005. Predicted probability of reporting timely colorectal cancer screening. rural residence, race/ethnicity. We adjusted for demographic and socioeconomic characteristics of respondents. After adjustment rural non-Hispanic whites (44.3%), rural African American/blacks (44.8%), urban and rural Hispanic/Latinos (43.7% and 40.8%, respectively), urban and rural American Indian/Alaska Natives (45.8% and 46.8%), and urban and rural Asians (35.4% and 39.6%) had lower compared with urban non-Hispanic whites (49.5%; P < .05% for all comparisons). Urban Asians were least likely to report use of fecal occult blood testing (8.6%, 95% confidence interval = 6.3% to 10.9%) and rural Asians were least likely to report use of endoscopy screening (21.2%, 95% confidence interval = 16.2% to 26.2%). Rural minorities may face different barriers to colorectal cancer screening than urban minorities or rural non-Hispanic whites. Further research to develop interventions to improve screening in these populations is warranted.

The role of the bilingual/bicultural worker in dementia education, support and care

Members of minority populations often have difficulty knowing about and accessing dementia services. One of the strategies used to promote access is the employment of bilingual/bicultural workers (sometimes referred to as multicultural, link or outreach workers). This study involved interviews with 24 bilingual/bicultural workers in south western Sydney, Australia to gain a better understanding of their role within the dementia field. Seven themes emerged: importance of working with family; process of building trust when moving between two cultures; importance of understanding the culture; self-care and culture; flexibility of their role; linking community members; and linking communities to mainstream services. Bilingual/bicultural workers play a significant and complex role in supporting individuals and families within their community who are affected by dementia. The significance of their role needs to be more clearly acknowledged in the development of policy, further research and service provision within the dementia field.

Families Are Key in Improving Quality

From Family Voices, Inc, Lexington, MA (Ms Wells); and National Partnership for Women and Families Washington, DC (Ms Partridge) The opinions expressed herein are those of the authors and do not necessarily represent the views of the US Department of Health and Human Services, the Agency for Healthcare Research and Quality, or the Centers for Medicare & Medicaid Services. The authors have no conflicts of interest to disclose. Publication of this article was supported by the US Department of Health and Human Services or the Agency for Healthcare Research and Quality. Address correspondence to NoraWells, MSEd, Family Voices, Inc, c/o ERG, 110, Hartwell Avenue, Lexington,Massachusetts 02421 (e-mail: nwells@familyvoices.org).

The painful face of poverty

The painful face of poverty

A Test of Gottfredson and Hirschi’S General Theory of Crime in African American Adolescents

Considerable empirical support exists for The General Theory of Crime. However, little work has been completed on members of minority populations in the United States. The current investigation examined whether low self-control predicted deviance in a sample of African American adolescents (n = 661; 55.1 percent female; mean age = 15.7 years). Confirmatory Factor Analyses provided evidence that the low self-control measure was a valid and reliable multidimensional scale in this sample, for both males and females. In addition, low self-control explained between 8.4 percent and 13.0 percent of the variance in male deviance measures and between 4.0 percent and 8.4 percent in female deviance. Follow-up z-tests by sex indicated fewdifferences in the relationships between low self-control and deviance. In addition, comparative analyses by race between African American and Caucasian adolescent males provided evidence of similarity in the importance of self-control. Findings support the cross-cultural validity of the General Theory of Crime, particularly for male adolescents and to a lesser extent for female youth.

Onset of Substance use among Transnational and Domestic Agricultural Workers: Social Relations and Place of Initiation

Farm workers differ from both urban and rural populations by their short-term, irregular employment and, for those who migrate, frequent travel. Overall, they enjoy few of the work benefits of other occupations, and they generally include members of minority populations that experience high levels of drug use. As such, they comprise an ideal population for the study of initiation of substance use. Although most farm workers have rural backgrounds as children, adolescents or adults, there are growing numbers of workers from small urban cities as well as metropolitan areas. Based on a series of 173 interviews in the American South with 119 men and women with a range of experience in agriculture, the present analysis examines locales where initiation of substance use takes place and identifies social relationships that figure in the context of first and subsequent use among transnational and U.S.-born workers in agriculture.

Veterans aging cohort three-site study (VACS 3): overview and description

Outcomes for middle-aged and older individuals with HIV infection are poor, and are likely to be mediated by age-related differences in risks and resources (access to care, relationship with the provider, comorbid conditions, health habits, and changes brought about by aging). The goal of the Veterans Aging Cohort Three-Site Study (VACS 3) is to study the influence of age and mediating factors on outcomes with HIV in order to identify mutable mediators of poorer outcomes. VACS 3 is an observational, longitudinal study. Data sources include patient and provider surveys and electronic medical data collected at baseline and 12-month follow-up from the Infections Disease Clinics at three Veterans Affairs Medical Centers (Cleveland, OH, Houston, TX, and Manhattan, NY). Trained Survey Coordinators at each site determined which patients are HIV infected, obtained consent, and asked the patient to complete a questionnaire. The primary provider also completed a questionnaire. Twelve-month follow-up will be completed July 2001. Of all veterans with HIV seen in these clinics 85% (881) have consented and enrolled. Of the 881 corresponding provider surveys, 92% were completed. Mean age is 49; 55% are African-American; 38% of the sample were men who have sex with men; and less than 2% are women. Almost a third (32%) have been without a permanent address. Complimentary or alternative therapies are common as are the use of cigarettes, alcohol, and illicit drugs. The majority (87%) of the patients are taking multiple antiretroviral medications. The median CD4 count is 331 mm 3, and the median viral load was 714 copies/ml. There is substantial variation by site. Veterans with HIV infection have characteristics that will likely become more prevalent among HIV-infected persons in the United States: they are older, commonly suffer comorbid disease, and are members of minority populations. VACS 3 may help inform the design of future clinical interventions to improve outcomes for people aging with HIV.

Perceived barriers to careers involving math and science: The perspective of medical school admissions officials

The medical community has become increasingly sensitive to the need to expand minority representation in the health professions, given that members of minority populations have poorer health status and use fewer health‐care resources relative to their needs. It has been argued that increased minority representation in the health professions may result in improved access to health care or increased willingness to seek needed care. Recent views suggest that such efforts must begin early in the students’ academic lives. This study solicited perceptions of medical school admissions officials regarding the preparation of students across four ethnic groups. Results suggest two distinct patterns of perceptions distinguishing different combinations of ethnic groups. The predominant discriminant function reflected a generalized perception that Blacks and Hispanics are receiving differentially poorer advisement, assessment, academic preparation, and access to educational resources relative to nonminority students. ...

Cultural sensitivity in AIDS education: A misunderstood concept

Because of the importance of educational programs for HIV and AIDS prevention, and the concommitant over-representation among AIDS cases by members of minority populations, there is growing concern regarding the culturalizing of AIDS educational materials. The current study examined some of the issues related to culturalizing AIDS educational materials and the content of educational programs. Data were collected independently from six focus groups-white, black, and Hispanic teachers, and white, black, and Hispanic youths. The growing literature on minority issues, and the data collected in the current study suggest an important distinction to be made between culturalizing materials, and making programs and materials culturally sensitive. Based on the data collected from six focus group interviews, the following conclusions were reached: (a) Accurate facts related to AIDS appear to be more important than the cultural milieu within which the material is presented; (b) the teachers interviewed were unanymous in suggesting that training is the most effective factor related to the implementation of new curricula, particularly curricular materials in sensitive areas; (c) strategies directed at sexual abstinance or “Just Say No” appear less effective than those that involve decision-making skills; and (d) all participants felt that curricular materials, and particularly student guides, need visual materials to enhance their effectiveness.