Minority Health and Health Equity Archive

Permanent URI for this collectionhttp://hdl.handle.net/1903/21769

Welcome to the Minority Health and Health Equity Archive (MHHEA), an electronic archive for digital resource materials in the fields of minority health and health disparities research and policy. It is offered as a no-charge resource to the public, academic scholars and health science researchers interested in the elimination of racial and ethnic health disparities.

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Author: search.filters.author.Thomas, Stephen BSubject: search.filters.subject.Research

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    Beyond the cathedral: building trust to engage the African American community in health promotion and disease prevention.
    (2009) Ford, Angela F; Reddick, Karen; Browne, Mario C; Robins, Anthony; Thomas, Stephen B; Crouse Quinn, Sandra
    Effective efforts to eliminate health disparities must be grounded in strong community partnerships and trusting relationships between academic institutions and minority communities. However, there are often barriers to such efforts, including the frequent need to rely on time-limited funding mechanisms that take categorical approaches. This article provides an overview of health promotion and disease prevention projects implemented through the Community Outreach and Information Dissemination Core (COID) of the Center for Minority Health, within the Graduate School of Public Health at the University of Pittsburgh. The COID is one of five Cores that comprised the University of Pittsburgh's NIH Excellence in Partnerships for Community Outreach, and Research on Disparities in Health and Training (EXPORT Health) funded from 2002 to 2007 by the National Center on Minority Health and Health Disparities. Based in large part on the success of the community engagement activities, in 2007, the National Center on Minority Health and Health Disparities, National Institutes of Health, designated the CMH as a Research Center of Excellence on Minority Health Disparities. COID major initiatives included the Community Research Advisory Board, Health Disparity Working Groups, Health Advocates in Reach, Healthy Class of 2010, and the Healthy Black Family Project. Lessons learned may provide guidance to other academic institutions, community-based organizations, and health departments who seek to engage minority communities in changing social norms to support health promotion and disease prevention.
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    The impact of race/ethnicity on baseline characteristics and the burden of coronary atherosclerosis in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial.
    (2011) Beohar, Nirat; Davidson, Charles J; Massaro, Elaine M; Srinivas, V S; Sansing, Veronica V; Zonszein, Joel; Davis, Andrew M; Helmy, Tarek; Lopes, Neuza H; Thomas, Stephen B; Brooks, Maria M
    OBJECTIVES: We aimed to test the impact of race/ethnicity on coronary artery disease (CAD) after adjusting for baseline risk factors. BACKGROUND: Whether race/ethnicity remains an important determinant of the burden of CAD even among patients with long-standing type 2 diabetes (diabetes mellitus) and established CAD is unknown. METHODS: Analysis of baseline data from the BARI 2D trial (January 1, 2001, to March 31, 2005) was performed. Myocardial jeopardy index (MJI) was evaluated by a blinded core angiographic laboratory. Multivariate regression analysis was performed to determine the independent association of race/ethnicity on the burden of CAD after adjusting for baseline risk factors. Data were collected from US and Canadian academic and community hospitals. The baseline analysis was performed on patients with long-standing diabetes and documented CAD with no prior revascularization at study entry (n = 1,331). The main outcome measure was MJI, which represents the percentage of myocardium jeopardized by significant lesions (≥50%). The secondary outcome measure was ≥2 lesions with ≥50% stenosis. RESULTS: Risk factors varied significantly among racial/ethnic groups. Blacks were significantly more likely to be women, have no health insurance, be current smokers, have higher body mass index, have hypertension, have a longer duration of diabetes, a higher hemoglobin A(1c) level, and were more likely to be taking insulin. Their mean total, low-density lipid, and high-density lipid cholesterol levels were higher, whereas their triglycerides were lower than others. After controlling for baseline risk factors, blacks had a significantly lower burden of CAD; the adjusted MJI was 5.43 U lower (95% CI -9.13 to -1.72), and the adjusted number of lesions was 0.53 fewer (95% CI -0.88 to -0.18) in blacks compared to whites. CONCLUSIONS: In the BARI 2D trial, self-reported race/ethnicity is associated with important differences in baseline risk factors and is a powerful predictor of the burden of CAD adjusting for such baseline differences. These findings may help direct medical intervention and resources and further investigation into the basis of racial/ethnic differences in CAD burden.
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    Racial preferences for participation in a depression prevention trial involving problem-solving therapy.
    (2010) Kasckow, John; Brown, Charlotte; Morse, Jennifer Q; Karpov, Irina; Bensasi, Salem; Thomas, Stephen B; Ford, Angela; Reynolds, Charles
    OBJECTIVES: This study compared African Americans' and Caucasians' willingness to participate in an indicated intervention to prevent depression with problem-solving therapy. It also examined participants' problem-solving skills. Hypotheses stated that there would be no racial differences in consent rates and that social problem-solving coping skills would be lower among African Americans than Caucasians. METHODS: Proportions of African Americans and Caucasians who consented were compared, as were Social Problem Solving Inventory scores between the groups. RESULTS: Of 2,788 individuals approached, 82 (4%) of 1,970 Caucasians and 46 (6%) of 818 African Americans signed consent, and the difference was not significant (p=.09). Racial differences were observed in neither Social Problem Solving Inventory scores nor in the relationship between problem-solving skills and depressive symptoms. CONCLUSIONS: African Americans with depression demonstrated a willingness to participate in an indicated trial of depression prevention. Furthermore, both groups would appear to benefit from the problem-solving process.
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    BCHS 2524- Overview of Minority Health and Health Disparities in the US
    (2006) Thomas, Stephen B; Gilbert, Keon L
    Understanding health disparities involves a critical analysis of historical, political, economic, social, cultural, and environmental conditions that have produced an inequitable health status for racial and ethnic minorities in the United States. While we also recognize that disparities exist along socio-economic status, gender, sexual orientation and other factors, this class will focus on disparities in racial and ethnic minority communities. Issues of gender, SES and other factors will be examined as they intersect race and ethnicity, and further influence disparities in health. Minority health and health disparities have gained considerable attention from the recent publication of Healthy People 2010 Report, which lists as its two goals: 1) improve the quality of life for all citizens, and 2) eliminate health disparities. The purpose of this class is to introduce basic issues that underlie health disparities. We will gain a better understanding of the relationships of social and environmental phenomena and the health of minority communities. This course will include current literature and foster discussions that will examine health disparities, explore social and environmental determinants of those disparities, critically review measurement issues, and determine public health’s response to these disparities. Students should seek to critically reflect on their personal and professional roles in eliminating health disparities. By the end of the course, students will be able to:
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    Overview of Minority Health and Health Disparities in the US
    (2006) Thomas, Stephen B; Gilbert, Keon L
    Understanding health disparities involves a critical analysis of historical, political, economic, social, cultural, and environmental conditions that have produced an inequitable health status for racial and ethnic minorities in the United States. While we also recognize that disparities exist along socio-economic status, gender, sexual orientation and other factors, this class will focus on disparities in racial and ethnic minority communities. Issues of gender, SES and other factors will be examined as they intersect race and ethnicity, and further influence disparities in health. Minority health and health disparities have gained considerable attention from the recent publication of Healthy People 2010 Report, which lists as its two goals: 1) improve the quality of life for all citizens, and 2) eliminate health disparities. The purpose of this class is to introduce basic issues that underlie health disparities. We will gain a better understanding of the relationships of social and environmental phenomena and the health of minority communities. This course will include current literature and foster discussions that will examine health disparities, explore social and environmental determinants of those disparities, critically review measurement issues, and determine public health’s response to these disparities. Students should seek to critically reflect on their personal and professional roles in eliminating health disparities. By the end of the course, students will be able to:
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    Tuskegee: From Science to Conspiracy to Metaphor [Editorial]
    (1999) Thomas, Stephen B; Curran, James W
    On May 16, 1997, in the East Room of the White House, President Bill Clinton issued a formal apology for the Tuskegee Study of Untreated Syphilis in the Negro Male. Directing his words to the survivors, several of whom were over 90 years old, the President said, "...what was done cannot be undone, but we can end the silence. What the United States government did was shameful, and I am sorry." The President placed the burden of responsibility for the abuse on the medical research establishment when he stated, "the people who ran the study at Tuskegee diminished the stature of man by abandoning the most basic ethical precepts. They forgot their pledge to heal and repair."1 Almost 70 years after the study began in 1932, 26 years after it was stopped in 1972, and 1 year after the Presidential apology, there remains a legacy of mistrust among African Americans toward the medical research establishment.2-7 In this issue of The American Journal of the Medical Sciences, Giselle Corbie-Smith's essay argues that this mistrust is legitimate and she illustrates how the long shadow of Tuskegee is a barrier to increasing the participation of African Americans in clinical research. The Presidential apology and the Corbie-Smith essay both demonstrate the danger and the opportunity inherent in any attempt to draw lessons from the Tuskegee Study.
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    Attitudes and Beliefs of African Americans Toward Participation in Medical Research
    (1999) Corble-Smith, Giselle; Thomas, Stephen B; Williams, Mark V; Moody-Ayers, Sandra
    OBJECTIVE: To describe barriers to participation of African Americans in research. DESIGN: Focus group interviews conducted in 1997. PATIENTS: Thirty-three African-American adults presenting to an urban public hospital for outpatient medical care participated in one of five focus groups. MEASUREMENTS AND MAIN RESULTS: African-American patients' attitudes toward medical research were measured. Mistrust of doctors, scientists, and the government was reported consistently by the participants. Many participants described concerns about the ethical conduct of clinicians and investigators when poor or minority patients are involved and cited examples of exploitation as supporting evidence for their mistrust of the medical establishment. While participants were clear about the violation of human rights in the Tuskegee Syphilis Study, all were misinformed of the historical facts of the study. Few participants understood the concept of informed consent. Participants saw signing the document as relinquishing their autonomy and as a legal protection for physicians. Despite these concerns, participants gave recommendations to improve minority participation in research. CONCLUSIONS: African-American participants in this study described distrust of the medical community as a prominent barrier to participation in clinical research. Participants described real and perceived examples of exploitation to support their distrust of researchers. The goal of the consent process, to inform patients of risks and benefits so as to facilitate self-determination, was misinterpreted by these participants. Understanding the importance of interpersonal trust within the clinical relationship may prove to be a significant factor in enhancing participation in clinical trials.