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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Item From Adolescence to Young Adulthood: Racial/Ethnic Disparities in Smoking(2004) Ellickson, Phyllis L; Orlando, Maria; Tucker, Joan S; Klein, David JObjectives. We used data gathered from 6259 youths between the ages of 13 and 23 years to compare trends in smoking among 4 racial/ethnic groups. Methods. We weighted trend data to represnet baseline respondent characteristics and evaluated these data with linear contrasts derived from multiple regression analyses. Results. Although African Americans exhibited higher initiation rates than Whites, they exhibited consistently lower rates of regular smoking than both Whites and Hispanics. This seeming anomaly was explained by African Americans' lower rates of transition to regular smoking and greater tendency to quit. Racial/ethnic disparities were accounted for by differences in pro-smoking influences. Conclusions. Reducing racial/ethnic disparities in smoking may require reducing differences in the psychosocial factors that encourage smoking.Item Primary Care Physicians Who Treat Blacks and Whites(2004) Bach, Peter B; Pham, Hoangmai H; Schrag, Deborah; Tate, Ramsey C; Hargraves, J LeeBackground In the United States, black patients generally receive lower-quality health care than white patients. Black patients may receive their care from a subgroup of physicians whose qualifications or resources are inferior to those of the physicians who treat white patients. Methods We performed a cross-sectional analysis of 150,391 visits by black Medicare beneficiaries and white Medicare beneficiaries 65 years of age or older for medical “evaluation and management” who were seen by 4355 primary care physicians who participated in a biannual telephone survey, the 2000–2001 Community Tracking Study Physician Survey. Results Most visits by black patients were with a small group of physicians (80 percent of visits were accounted for by 22 percent of physicians) who provided only a small percentage of care to white patients. In a comparison of visits by white patients and black patients, we found that the physicians whom the black patients visited were less likely to be board certified (77.4 percent) than were the physicians visited by the white patients (86.1 percent, P=0.02) and also more likely to report that they were unable to provide high-quality care to all their patients (27.8 percent vs. 19.3 percent, P=0.005). The physicians treating black patients also reported facing greater difficulties in obtaining access for their patients to high-quality subspecialists, high-quality diagnostic imaging, and nonemergency admission to the hospital. Conclusions Black patients and white patients are to a large extent treated by different physicians. The physicians treating black patients may be less well trained clinically and may have less access to important clinical resources than physicians treating white patients. Further research should be conducted to address the extent to which these differences may be responsible for disparities in health care.Item Patient–Physician Relationships and Racial Disparities in the Quality of Health Care(2003) Saha, Somnath; Arbelaez, Jose J; Cooper, Lisa AObjectives. This study explored whether racial differences in patient–physician relationships contribute to disparities in the quality of health care. Methods. We analyzed data from The Commonwealth Fund’s 2001 Health Care Quality Survey to determine whether racial differences in patients’ satisfaction with health care and use of basic health services were explained by differences in quality of patient–physician interactions, physicians’ cultural sensitivity, or patient–physician racial concordance. Results. Both satisfaction with and use of health services were lower for Hispanics and Asians than for Blacks and Whites. Racial differences in the quality of patient–physician interactions helped explain the observed disparities in satisfaction, but not in the use of health services. Conclusions. Barriers in the patient–physician relationship contribute to racial disparities in the experience of health care.Item Disparities in Occupational Low Back Injuries: Predicting Pain-Related Disability from Satisfaction with Case Management in African Americans and Caucasians(2005) Chibnall, John T; Tait, Raymond CObjective. To predict postsettlement pain-related disability from claimant race and satisfaction with Workers’ Compensation case management. Design. Population-based survey with telephone interviewing. Setting. St. Louis City, St. Louis County, and Jackson County, Missouri. Participants. African American and Caucasian Workers’ Compensation claimants (1,475) with single incident low back injuries whose claims were settled between January 1, 2001 and June 1, 2002. Measures. Workers’ Compensation variables were obtained from the State of Missouri comprising treatment cost, temporary disability payment, disability rating, and settlement award. Satisfaction with Workers’ Compensation case management was evaluated across five Likert-type rating scales. Pain-related disability was measured using the Pain Disability Index. Injury variables included diagnosis of disc injury or regional backache. Socioeconomic status included education and income. Demographic variables were race, age, and gender. Results. Path analysis indicated direct negative associations between satisfaction and disability. Race had a direct association with disability but was also mediated through other variables: African Americans received less treatment/compensation across the Workers’ Compensation variables (relative to Caucasians), which predicted lower satisfaction. This pattern also held true for lower socioeconomic status claimants and those with regional backache. Conclusions. For African Americans and lower socioeconomic status persons in the Workers’ Compensation system, less treatment/compensation was associated with lower satisfaction with the process, which in turn predicted higher levels of postsettlement disability. Given that the function of Workers’ Compensation is to reduce disability from work-related injuries, the current results suggest that the system produces inequitable outcomes for these groups.Item Coronary artery calcification in black women and white women(2003) Khurana, Charanjit; Rosenbaum, Christina G; Howard, Barbara V; Adams-Campbell, Lucile L; Detrano, Robert C; Klouj, Afifa; Hsia, JudithBackground Coronary calcification is a potent independent predictor of coronary risk. Sex-specific risk categories based on calcium scores have been established, but ethnic differences in coronary calcification have been little studied. This prospective cohort study compares coronary calcification, assessed by computed tomography, in postmenopausal black women and white women. Methods and Results Computed tomographic scans were performed on 128 black women and 733 white women without known coronary artery disease (mean age 63 +/- 8 years). Although coronary risk factors were more prevalent among black women (P < .0001), total calcium scores were similar to those in white women. By use of the Framingham algorithm, higher calcium scores were associated with higher 10-year risk of myocardial infarction or coronary death. In multiple regression analysis, age was independently associated with higher calcium scores in both ethnic groups (P = .002 for black women, P < .0001 for white women). Diabetes mellitus and not exercising at least 3 times per week were independently associated with higher calcium scores in white women but not black women. Educational level, body mass index, current hormone replacement therapy, hysterectomy, dietary fat consumption, family history of premature coronary disease, hypertension, self-reported high cholesterol, and current smoking were not independently associated with coronary calcium score in black women, white women, or the combined cohort; neither was ethnicity an independent predictor of coronary calcification. Conclusions Despite higher dietary fat consumption, higher body mass index, and greater prevalence of hypertension, diabetes, and smoking, black women had coronary calcium scores similar to those of white women. Ethnicity was not an independent predictor of coronary calcification.Item Consistent Cytotoxic-T-Lymphocyte Targeting of Immunodominant Regions in Human Immunodeficiency Virus across Multiple Ethnicities(2004) Frahm, Nicole; Korber, BT; Adams, CM; Szinger, JJ; Draenert, R; Addo, MM; Feeney, ME; Yusim, K; Sango, K; Brown, NV; SenGupta, D; Piechocka-Trocha, A; Simonis, T; Marincola, FM; Wurcel, AG; Stone, DR; Russell, CJ; Adolf, P; Cohen, D; Roach, T; StJohn, A; Khatri, A; Davis, K; Mullins, J; Goulder, PJR; Walker, BD; Brander, CAlthough there is increasing evidence that virus-specific cytotoxic-T-lymphocyte (CTL) responses play an important role in the control of human immunodeficiency virus (HIV) replication in vivo, only scarce CTL data are available for the ethnic populations currently most affected by the epidemic. In this study, we examined the CD8+-T-cell responses in African-American, Caucasian, Hispanic, and Caribbean populations in which clade B virus dominates and analyzed the potential factors influencing immune recognition. Total HIV-specific CD8+-T-cell responses were determined by enzyme-linked immunospot assays in 150 HIV-infected individuals by using a clade B consensus sequence peptide set spanning all HIV proteins. A total of 88% of the 410 tested peptides were recognized, and Nef- and Gag-specific responses dominated the total response for each ethnicity in terms of both breadth and magnitude. Three dominantly targeted regions within these proteins that were recognized by >90% of individuals in each ethnicity were identified. Overall, the total breadth and magnitude of CD8+-T-cell responses correlated with individuals’ CD4 counts but not with viral loads. The frequency of recognition for each peptide was highly correlated with the relative conservation of the peptide sequence, the presence of predicted immunoproteasomal cleavage sites within the C-terminal half of the peptide, and a reduced frequency of amino acids that impair binding of optimal epitopes to the restricting class I molecules. The present study thus identifies factors that contribute to the immunogenicity of these highly targeted and relatively conserved sequences in HIV that may represent promising vaccine candidates for ethnically heterogeneous populations.Item Foundation Confronts the Disparities in Both the Disease Burden and Death Rates for African Americans Suffering From Heart Failure; Landmark Trial Signals Improved Quality of Care for African Americans with Heart Failure(2004) PR, NewswireBetween the ages of 45 and 64, African American males have a 70% higher risk for heart failure than Caucasian males. African American females between the ages of 45 and 54 have a 50% greater risk of developing heart failure than Caucasian females. The earlier onset of disease means higher rates of hospitalization, earlier disability, and higher rates of premature death (death before the age of 65)(1). This dramatic difference in health status and health outcomes can be attributed to a variety of factors, including lack of access to quality medical care. The National Minority Health Month Foundation (the Foundation) is pleased to recognize the potential advancements in treatment for heart failure in African Americans represented by the recently completed African American Heart Failure Trial (A- HeFT).Item MINORITY HEALTH: Latino/Hispanic diabetes media awareness campaign described(2004) Health and, Medicine WeekA Latino/Hispanic diabetes media awareness campaign is described in a recent issue of Family and Community Health. According to recent research from the United States, "The prevalence rates of diabetes in communities of color are higher than in Caucasian populations. Social marketing can be an effective approach to educating communities and encouraging visits to health care providers. This article describes Thunder and Lightning and Rain, a diabetes media awareness campaign implemented in a five-county area in central Washington State with a large Latino/Hispanic population.