Journal of health disparities research and practice最新文献

This study attempts to clarify the associations between macro-social and social network factors and the continuing racial disparities in breast cancer survival. The study improves on prior methodologies by using a neighborhood disadvantage measure that assesses both economic and social disadvantage and an ego-network measurement tool that assesses key social network characteristics. Our population-based sample included 786 breast cancer patients (nHWhite=388; nHBlack=398) diagnosed during 2005-2008 in Chicago, IL. The data included census-derived macro-social context, self-reported social network, self-reported demographic and medically abstracted health measures. Mortality data from the National Death Index (NDI) were used to determine 5-year survival. Based on our findings, neighborhood concentrated disadvantage was negatively associated with survival among nHBlack and nHWhite breast cancer patients. In unadjusted models, social network size, network density, practical support, and financial support were positively associated with 5-year survival. However, in adjusted models only practical support was associated with 5-year survival. Our findings suggested that the association between network size and breast cancer survival is sensitive to scaling of the network measure, which helps to explain inconsistencies in past findings. Social networks of nHWhites and nHBlacks differed in size, social support dimensions, network density, and geographic proximity. Among social factors, residence in disadvantaged neighborhoods and unmet practical support explained some of the racial disparity in survival. Differences in late stage diagnosis and comorbidities between nHWhites and nHBlacks also explained some of the racial disparity in survival. Our findings highlight the relevance of social factors, both macro and inter-personal in the racial disparity in breast cancer survival. Findings suggest that reduced survival of nHBlack women is in part due to low social network resources and residence in socially and economically deprived neighborhoods. To improve survival among breast cancer patients social policies need to continue improving health care access as well as racially patterned social and economic disadvantage.

This study explored potential gender and racial/ethnic disparities in overall health risk related to 24 health risk indicators selected across six domains: socioeconomic, health status and health care, lifestyle, nutritional, clinical, and environmental. Using the 2003-2006 National Health and Nutrition Examination Surveys (NHANES), it evaluated cross-sectional data for 5,024 adults in the United States. Logistic regression models were developed to estimate prevalence odds ratios (PORs) adjusted for smoking, health insurance status, and age. Analyses evaluated disparities associated with 24 indicator variables of health risk, comparing females to males and four racial/ethnic groups to non-Hispanic Whites. Non-Hispanic Blacks and Mexican Americans were at greater risk for at least 50% of the 24 health risk indicators, including measures of socioeconomic status, health risk behaviors, poor/fair self-reported health status, multiple nutritional and clinical indicators, and blood lead levels. This demonstrates that cumulative health risk is unevenly distributed across racial/ethnic groups. A similarly high percentage (46%) of the risk factors was observed in females. Females as compared to males were more likely to have lower income, lower blood calcium, poor/fair self-reported health, more poor mental health days/month, higher medication usage and hospitalizations, and higher serum levels of some clinical indicators and blood cadmium. This analysis of cumulative health risk is responsive to calls for broader-based, more integrated assessment of health disparities that can help inform community assessments and public health policy.

This study investigated the association of race, age, and census tract area poverty level on breast cancer stage at diagnosis. The study was limited to women residing in Missouri, aged 18 years and older, diagnosed with breast cancer, and whose cases were reported to the Cancer Registry between 2003 and 2008. The risk, relative risk, and increased risk of late-stage at diagnosis by race, age, and census tract area poverty level were computed. We found that the odds of late-stage breast cancer among African-American women were higher when compared with their white counterpart (OR 1.433; 95% CI, 1.316, 1.560). In addition, the odds of advanced stage disease for women residing in high-poverty areas were greater than those living in low-poverty areas (OR 1.319; 95% CI 1.08; 1.201). To close the widening cancer disparities gap in Missouri, there is the need for effective and programmatic strategies to enable interventions to reach areas and populations most vulnerable to advanced stage breast cancer diagnosis.

Background: In 2015, only 42% of Puerto Rican (PR) girls aged 13-17 and 44% of U.S. Hispanic girls aged 13-17 were vaccinated with all three Human Papillomavirus (HPV) vaccine doses; These percentages were far lower than the Healthy People 2020 goal of 80% of girls aged 13-15 the Healthy People 2020 goal of 80%. The purpose of this study was to examine potential differences in HPV awareness and knowledge and HPV vaccine awareness and acceptability between a population-based sample of U.S. Hispanic and island Puerto Rican women.

Methods: We restricted our analyses to female respondents from the Health Information National Trends Survey (HINTS) 2007 (n=375; U.S. Hispanic) and HINTS Puerto Rico 2009 (n=417; PR). Using the Wald chi-square test, we assessed if there were significant differences in HPV awareness and knowledge and HPV vaccine awareness and acceptability between U.S. Hispanic and island PR women. We then utilized logistic or multinomial regression to control for covariates on significant outcomes.

Results: Both groups of Hispanic women were highly knowledgeable that HPV causes cancer (89.2% in both samples) and that HPV is a sexually transmitted infection (78.1% [U.S. Hispanics] and 84.7% [PR]). Less than 10% of both groups recognized that HPV can clear on its own without treatment. Island PR women had significantly higher HPV vaccine awareness (66.9% vs. 61.0%; Wald X² F(1, 97) = 16.03, p < .001) and were more accepting of the HPV vaccine for a real or hypothetical daughter, compared to U.S. Hispanic women (74.8% vs. 56.1%; Wald X² F(2, 96) = 7.18, p < .001). However, after controlling for sociodemographic variables and survey group, there was no longer a difference between the two groups of women and HPV vaccine awareness (AOR = .53; 95% CI = .23, 1.24). Moreover, after controlled analysis, island PR women were significantly less likely to have their hypothetical daughter get the HPV vaccine, compared to U.S. Hispanic women (AOR = 0.26; 95% CI = .08, .81).

Conclusions: Future research focused on factors contributing to differences and similarities in HPV knowledge and awareness and HPV vaccine awareness and acceptability between these two groups of Hispanic women is warranted. Findings may assist in developing health education programs and media to promote HPV vaccination among both groups.

Photovoice was used as a participatory research method to document perceived local environmental hazards, pollution sources, and potential impact on health among community members to address environmental health disparities. A convenience sample of 16 adults in Orangeburg, South Carolina participated in Photovoice. Photos depicted positive and negative implications of the environment across seven themes: recreation and leisure; food access; hazards and pollution; health, human, and social services; economic issues; beautification; and accommodation and accessibility. Positive and negative photos demonstrated a high level of interest among community members in considering how the environment influences health and health disparities.

Asian immigrants to the U.S. are settling in "new destinations," but there has been little research on their health care and social service needs. Our analysis of Census data to identify cities with the fastest Asian immigrant population growth (1990-2000) yielded 33 smaller cities in 13 states. The cities ranged in population from 7,677 to 86,660; were spread across 13 states in the Northeast, South, and Midwest regions of the US; and varied widely demographically. Pilot surveys conducted in 2009 indicated that, although many residents had positive attitudes towards immigrants, many were also concerned about job competition and dilution of American culture. Respondents reported a number of immigrant-targeted services but also service gaps and intergroup violence. We characterize smaller new destination cities' mixed response to their fast-growing immigrant populations as an "ambivalent embrace." Service gaps may be related to small city size and relatively small Asian immigrant population size, despite rapid population growth. Funding shortages were also cited as obstacles to cities' responsiveness, suggesting the importance of state and federal government aid.

Research has documented that African Americans suffer disproportionately from chronic diseases when compared to the general population. Yet, limited research examines older African Americans' perceptions about having chronic diseases. Accordingly, the first aim of the study provided insight into this disparity with the intent of revealing how older African Americans feel about their overall health, and how much they understand about their individual chronic disease(s). The second aim was to gather information about strategies and coping mechanisms older African Americans use to manage their chronic diseases. The purpose of this aim was to determine if any of the strategies they employed were related to the positive health outcomes. Two focus groups were conducted with African American older adults who live in community settings. The results from the focus groups indicate that older African Americans are aware of the conditions they have and have developed strong coping methods to help them manage. Recommendations are provided for future research studies and chronic disease management programs.

Mexican Americans (MAs) have been shown to have worse outcomes after stroke than non-Hispanic Whites (NHWs), but it is unknown if ethnic differences in stroke quality of care may contribute to these worse outcomes. We investigated ethnic differences in the quality of inpatient stroke care between MAs and NHWs within the population-based prospective Brain Attack Surveillance in Corpus Christi (BASIC) Project (February 2009- June 2012). Quality measures for inpatient stroke care, based on the 2008 Joint Commission Primary Stroke Center definitions were assessed from the medical record by a trained abstractor. Two summary measure of overall quality were also created (binary measure of defect-free care and the proportion of measures achieved for which the patient was eligible). 757 individuals were included (480 MAs and 277 NHWs). MAs were younger, more likely to have hypertension and diabetes, and less likely to have atrial fibrillation than NHWs. MAs were less likely than NHWs to receive tPA (RR: 0.72, 95% confidence interval (CI) 0.52, 0.98), and MAs with atrial fibrillation were less likely to receive anticoagulant medications at discharge than NHWs (RR 0.73, 95% CI 0.58, 0.94). There were no ethnic differences in the other individual quality measures, or in the two summary measures assessing overall quality. In conclusion, there were no ethnic differences in the overall quality of stroke care between MAs and NHWs, though ethnic differences were seen in the proportion of patients who received tPA and anticoagulant at discharge for atrial fibrillation.

Greater propensity to seek care is critical for improving health of elderly individuals with multimorbidity. We used the Medicare Current Beneficiary Survey (2012) to assess propensity to seek care among community-dwelling elderly Medicare beneficiaries (≥ 65 yrs.; N=11,270) having (1) no physical or mental illness; (2) single physical or mental condition; (3) multimorbidity with physical conditions only; and (4) multimorbidity with both physical and mental conditions. As compared to multimorbidity with physical conditions, elderly with no multimorbidity were less likely (Adjusted Odds Ratio [95% CI]: 0.50 [0.36, 0.68]) and elderly with both physical and mental conditions were more likely (1.57 [1.28, 1.93]) to have a health problem for which they should have seen a doctor but did not. Further, elderly having a usual source of care were less likely (0.53 [0.37, 0.75]) to have a health problem for which they should have seen a doctor but did not. Multimorbidity is negatively associated with propensity to seek care. The presence of both chronic mental and physical conditions worsened propensity to seek care among elderly individuals. Future efforts to increase the awareness of receiving timely care and improve the access to care can enhance propensity to seek care among elderly individuals with multimorbidity.

This article examines conceptualizations of the relationship between food insecurity and place. We use an ethnographically inspired and community-engaged approach to situate our analysis of fluid dynamics at work in a community with high levels of food insecurity. We propose that the relationship between place and people's experience of food insecurity is recursive, dialectical, and "whorled." This relationship reflects complex, interconnected, and multidimensional processes with consequences for the health of residents. Our research demonstrates the key nature of the health-place nexus by exploring how food insecurity articulates with place in unexpected ways that go beyond discussions of food, food environments, food access, food practices or food systems that have become common in the literature.