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 Race/ethnic disparities in risk factor control and survival in the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D) trial.(2013) Beohar, Nirat; Sansing, Veronica V.; Davis, Andrew M.; Srinivas, V. S.; Helmy, Tarek; Althouse, Andrew D.; Thomas, Stephen B.; Brooks, Maria MoriThis study sought to evaluate the impact of race/ethnicity on cardiovascular risk factor control and on clinical outcomes in a setting of comparable access to medical care. The BARI 2D trial enrolled 1,750 participants from the United States and Canada that self-reported either White non-Hispanic (n [ 1,189), Black non-Hispanic (n =349), or Hispanic (n =212) race/ethnicity. Participants had type 2 diabetes and coronary artery disease and were randomized to cardiac and glycemic treatment strategies. All patients received intensive target-based medical treatment for cardiac risk factors. Average follow-up was 5.3 years. Kaplan-Meier survival curves and Cox proportional hazards regression models were constructed to assess potential differences in mortality and cardiovascular outcomes across racial/ethnic groups. Long-term risk of death and death/myocardial infarction/stroke did not vary significantly by race/ethnicity (5-year death: 11.0% Whites, 13.7% Blacks, 8.7% Hispanics, p =0.19; adjusted hazard ratio 1.18 Black versus White, 95% confidence interval 0.84 to 1.67, p = 0.33 and 0.82 Hispanic versus White, 95% confidence interval 0.51 to 1.34, p =0.43). Among the 1,168 patients with suboptimal risk factor control at baseline, the ability to attain better risk factor control during the trial was associated with higher 5-year survival (71%, 86% and 95% for patients with 0 or 1, 2, and 3 factors in control, respectively, p <0.001); this pattern was observed within each race/ethnic group. In conclusion, significant race/ethnic differences in cardiac risk profiles that persisted during follow-up did not translate into significant differences in 5-year death or death/MI/stroke.Item How Did Cause of Death Contribute to Racial Differences in Life Expectancy in the United States in 2010?(2013) Kochanek, Kenneth D.; Arias, Elizabeth; Anderson, Robert N.Item The Leap of Faith from Disease Treatment to Lifestyle Prevention: The Genealogy of a Policy Idea(2012) Larsen, Lars ThorupSince the 1970s public health policy has attempted to counter the rise of chronic diseases by getting individuals to make healthy choices about smoking, alcohol, diet, and physical exercise. Inspired by the so-called new perspective of the 1974 Lalonde report, this shift from disease treatment to prevention has been a key focus of public health policy to this day. Every generation of public health reports presents prevention as the answer to past failures, but the continuous experience of failure is strangely coexistent with a fundamental belief in the ability of lifestyle prevention to produce large health improvements. The article tracks the genealogy of lifestyle prevention as policy idea across three generations of U.S. and Danish public health reports and finds a systematic interpretation of lifestyle prevention as being more successful and promising than acute medical treatment.Item Chronic Disease and the Shifting Focus of Public Health: Is Prevention Still a Political Lightweight?(2012) Mayes, Rick; Oliver, Thomas R.Why is it so politically difficult to obtain government investment in public health initiatives that are aimed at addressing chronic disease? This article examines the structural disadvantage faced by those who advocate for public health policies and practices to reduce chronic disease related to people's unhealthy lifestyles and physical environments. It identifies common features that make it difficult to establish and maintain initiatives to prevent or reduce costly illness and physical suffering: (1) public health benefits are generally dispersed and delayed; (2) benefactors of public health are generally unknown and taken for granted; (3) the costs of many public health initiatives are concentrated and generate opposition from those who would pay them; and (4) public health often clashes with moral values or social norms. The article concludes by discussing the importance of a new paradigm, “health in all policies,” that targets the enormous health and economic burdens associated with chronic conditions and asserts a need for new policies, practices, and participation beyond the confines of traditional public health agencies and services.Item Making the Connection Between Zoning and Health Disparities(2012) Rossen, Lauren M.; Pollack, Keshia M.Abstract available at publisher's website.Item THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND KIDNEY FUNCTION/CHRONIC KIDNEY DISEASE(2010) Hawkins, MarquisINTRODUCTION: Chronic kidney disease is a serious public health concern because of the large physical and economic burden on society. Because of this large burden, it is important to determine what factors are associated with the development and progression of the disease, especially in early stages. Physical activity has been shown to be related to many risk factors for CKD; however, few studies have assessed its direct relationship with kidney function. METHODS: Using data from NHANES, a nationally representative U.S., we described physical activity by various intensities, gender and race/ethnicity (paper 1). We then investigated the cross-sectional relationship between varying intensities of objectively assessed physical activity and kidney function in the same population (paper 2). Using data from the Strong Heart Study, an American Indian cohort at high risk for CKD, we investigated the relationship between subjectively assessed physical activity with kidney function prospectively (paper 3). RESULTS: We showed that Mexican Americans were more physically active than whites and blacks at all levels of intensity, in contrast to findings using questionnaires. We also confirmed that light intensity activity made the largest contribution to total movement. In paper 2, we showed that objectively assessed light intensity physical activity was independently associated with kidney function while objectively and subjectively assessed moderate to vigorous physical activity was not. In paper 3 we showed that physical inactivity was associated with rapid declines and kidney THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND KIDNEY FUNCTION/CHRONIC KIDNEY DISEASE Marquis Hawkins, PhD University of Pittsburgh, 2010 vi function over a five year period. Physical inactivity was also associated with development of kidney damage over a ten year period. PUBLIC HEALTH SIGNIFICANCE: The results of these three papers show that physical activity of various intensities are related to kidney function and that physical activity may also preserve kidney function over time in a high risk population. Previous recommendations for physical activity and health were unable to discuss the benefits of physical activity on kidney function because the paucity of evidence. This study is of public health significance because it adds to the growing body of evidence for which we can base our future recommendations.Item Health Disparities Beginning in Childhood: A Life-Course Perspective(2009) Braveman, P.; Barclay, C.Abstract available at publisher's website.Item Promoting Prevention through the Affordable Care Act(2010) Koh, Howard K.; Sebelius, Kathleen G.No abstract available.Item Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States(2006) Murray, Christopher J. L.; Kulkarni, Sandeep C.; Michaud, Catherine; Tomijima, Niels; Bulzacchelli, Maria T.; Iandiorio, Terrell J.; Ezzati, MajidAbstract available at publisher's website.Item Early Life Adversity and Inflammation in African Americans and Whites in the Midlife in the United States Survey(2010) Slopen, N.; Lewis, T. T.; Gruenewald, T. L.; Mujahid, M. S.; Ryff, C. D.; Albert, M. A.; Williams, D. R.Abstract available at publisher's website.