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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Now showing 1 - 10 of 22
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    Reducing hypertensive cardiovascular disease risk of African Americans with diet: focus on the facts.
    (2006) Reusser, Molly E; McCarron, David A
    Hypertension is more common and more severe in African Americans than in other population groups in the United States, placing them at increased risk of cardiovascular disease, stroke, and end-stage renal disease. Whereas past efforts to reduce blood pressure (BP) via the diet centered on manipulating isolated nutrients, there are now conclusive data demonstrating that it is not single dietary components but the overall dietary pattern that has the greatest influence on BP. A nutritionally complete diet rich in fruits, vegetables, and low-fat dairy foods has been clearly proven to significantly lower BP in all population groups. This diet, commonly referred to as the Dietary Approaches to Stop Hypertension (DASH) diet, has been tested in randomized, controlled trials emphasizing African American populations and documented the greatest beneficial effects in hypertensive African Americans. Improving diet quality has been shown to be simply implemented without adverse effects such as symptoms of lactose maldigestion. It is also known to beneficially affect other cardiovascular risk factors and is in keeping with dietary recommendations for prevention of some cancers and osteoporosis. This paper reviews the current data relating dietary patterns to BP control, and advocates dietary recommendations that can accomplish their intended objective of enhancing the health of Americans by promoting safe, feasible, and proven-effective means of doing so. In the case of hypertension prevention and treatment, and thus the reduction of cardiovascular disease risk, overall diet quality should be the primary focus of nutritional recommendations.
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    Data needed for improving the health of minorities
    (1993) Feinleib, Manning
    Abstract available at publisher's web site.
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    Sustained-Release Bupropion for Smoking Cessation in African Americans: A Randomized Controlled Trial
    (2002) Ahluwalia, J. S.
    Abstract available at publisher's web site.
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    Patient Preferences and Health Disparities
    (2001) Katz, J. N.
    Preference-based care is transforming the patient-clinician relationship. In a traditional management model physicians make treatment decisions, while in the preference-based paradigm patients choose the treatments that best conform to their values. The preference model fulfills a fundamental tenet of high-quality care—that the patient should be involved in decisions concerning the care process. In addition to respecting patient preferences, another key health care priority is the elimination of well-documented racial, ethnic, and sex disparities in use of health care resources. While preference-based care and health care disparities have received considerable attention over the last decade, there has been limited inquiry into how these issues relate to each other. Moreover, it is possible that preference-based care may reinforce the very inequities and disparities that health care policy makers have pledged to remedy.
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    Black communities' belief in “AIDS as genocide”☆A barrier to overcome for HIV prevention
    (1993) Guinan, Mary E.
    The belief that acquired immunodeficiency syndrome (AIDS) is a form of genocide targeted at the black population is prevalent in black communities in the United States. Public health authorities are distrusted, in part because of the legacy of the Tuskegee Study of untreated syphilis, a perceived racist experiment. For effective interventions to prevent the transmission of human immunodeficiency virus in black communities, genocidal fears and beliefs must be addressed and black community leaders should be involved in planning and implementation.
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    Trends in the Black-White Life Expectancy Gap in the United States, 1983-2003
    (2007) Harper, S.; Lynch, J.; Burris, S.; Davey Smith, G.
    CONTEXT: Since the early 1980s, the black-white gap in life expectancy at birth increased sharply and subsequently declined, but the causes of these changes have not been investigated. OBJECTIVE: To determine the contribution of specific age groups and causes of death contributing to the changes in the black-white life expectancy gap from 1983-2003. DESIGN AND SETTING: US vital statistics data from the US National Vital Statistics System, maintained by the National Center for Health Statistics. Standard life table techniques were used to decompose the change in the black-white life expectancy gap by combining absolute changes in age-specific mortality with relative changes in the distribution of causes of death. MAIN OUTCOME MEASURE: The gap in life expectancy at birth between blacks and whites. RESULTS: Among females, the black-white life expectancy gap increased 0.5 years in the period 1983-1993, primarily due to increased mortality from human immunodeficiency virus (HIV) (0.4 years) and slower declines in heart disease (0.1 years), which were somewhat offset by relative improvements in stroke (-0.1 years). The gap among males increased by 2 years in the period 1983-1993, principally because of adverse changes in HIV (1.1 years), homicide (0.5 years), and heart disease (0.3 years). Between 1993 and 2003, the female gap decreased by 1 year (from 5.59 to 4.54 years). Half of the total narrowing of the gap among females was due to relative mortality improvement among blacks in heart disease (-0.2 years), homicide (-0.2 years), and unintentional injuries (-0.1 years). The decline in the life expectancy gap was larger among males, declining by 25% (from 8.44 to 6.33 years). Nearly all of the 2.1-year decline among males was due to relative mortality improvement among blacks at ages 15 to 49 years (-2.0 years). Three causes of death accounted for 71% of the narrowing of the gap among males (homicide [-0.6 years], HIV [-0.6 years], and unintentional injuries [-0.3 years]), and lack of improvement in heart disease at older ages kept the gap from narrowing further. CONCLUSIONS: After widening during the late 1980s, the black-white life expectancy gap has declined because of relative mortality improvements in homicide, HIV, unintentional injuries, and, among females, heart disease. Further narrowing of the gap will require concerted efforts in public health and health care to address the major causes of the remaining gap from cardiovascular diseases, homicide, HIV, and infant mortality.
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    African American Physicians and Organized Medicine, 1846-1968: Origins of a Racial Divide
    (2008) Baker, R. B.; Washington, H. A.; Olakanmi, O.; Savitt, T. L.; Jacobs, E. A.; Hoover, E.; Wynia, M. K.
    Like the nation as a whole, organized medicine in the United States carries a legacy of racial bias and segregation that should be understood and acknowledged. For more than 100 years, many state and local medical societies openly discriminated against black physicians, barring them from membership and from professional support and advancement. The American Medical Association was early and persistent in countenancing this racial segregation. Several key historical episodes demonstrate that many of the decisions and practices that established and maintained medical professional segregation were challenged by black and white physicians, both within and outside organized medicine. The effects of this history have been far reaching for the medical profession and, in particular, the legacy of segregation, bias, and exclusion continues to adversely affect African American physicians and the patients they serve.
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    Participation in Cancer Clinical Trials: Race-, Sex-, and Age-Based Disparities
    (2004) Murthy, Vivek H.; Krumholz, Harlan M.; Gross, Cary P.
    Context Despite the importance of diversity of cancer trial participants with regard to race, ethnicity, age, and sex, there is little recent information about the representation of these groups in clinical trials. Objective To characterize the representation of racial and ethnic minorities, the elderly, and women in cancer trials sponsored by the National Cancer Institute. Design, Setting, and Patients Cross-sectional population-based analysis of all participants in therapeutic nonsurgical National Cancer Institute Clinical Trial Cooperative Group breast, colorectal, lung, and prostate cancer clinical trials in 2000 through 2002. In a separate analysis, the ethnic distribution of patients enrolled in 2000 through 2002 was compared with those enrolled in 1996 through 1998, using logistic regression models to estimate the relative risk ratio of enrollment for racial and ethnic minorities to that of white patients during these time periods. Main Outcome Measure Enrollment fraction, defined as the number of trial enrollees divided by the estimated US cancer cases in each race and age subgroup. Results Cancer research participation varied significantly across racial/ethnic and age groups. Compared with a 1.8% enrollment fraction among white patients, lower enrollment fractions were noted in Hispanic (1.3%; odds ratio [OR] vs whites, 0.72; 95% confidence interval [CI], 0.68-0.77; P<.001) and black (1.3%; OR, 0.71; 95% CI, 0.68-0.74; P<.001) patients. There was a strong relationship between age and enrollment fraction, with trial participants 30 to 64 years of age representing 3.0% of incident cancer patients in that age group, in comparison to 1.3% of 65- to 74-year-old patients and 0.5% of patients 75 years of age and older. This inverse relationship between age and trial enrollment fraction was consistent across racial and ethnic groups. Although the total number of trial participants increased during our study period, the representation of racial and ethnic minorities decreased. In comparison to whites, after adjusting for age, cancer type, and sex, patients enrolled in 2000 through 2002 were 24% less likely to be black (adjusted relative risk ratio, 0.76; 95% CI, 0.65-0.89; P<.001). Men were more likely than women to enroll in colorectal cancer trials (enrollment fractions: 2.1% vs 1.6%, respectively; OR, 1.30; 95% CI, 1.24-1.35; P<.001) and lung cancer trials (enrollment fractions: 0.9% vs 0.7%, respectively; OR, 1.23; 95% CI, 1.16-1.31; P<.001). Conclusions Enrollment in cancer trials is low for all patient groups. Racial and ethnic minorities, women, and the elderly were less likely to enroll in cooperative group cancer trials than were whites, men, and younger patients, respectively. The proportion of trial participants who are black has declined in recent years.
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    HIV/AIDS Case Profile of African Americans--Guidelines for Ethnic-Specific Health Promotion, Education, and Risk Reduction Activities for African Americans
    (2003) Williams, P Bassey
    There are discrepancies in health care services for the poor and ethnic minorities in the United States. Within the past decade widespread concerns regarding the need to reform the nation's health care services, including the problem of human immunodeficiency virus/acquired immune syndrome (HIV/AIDS) among African Americans has continued. These inequalities have been the cornerstone of the U.S. Healthy People 2010 national priority objectives.1 The objectives focus on health and social outcomes such as low quality of life and mortality rates, poverty, lak of accessibility to and appropriateness of care, and the prevalence of certain degenerative conditions and infectious diseases. The dearth of preventive health services for the high-risk groups, particularly children, adolescents, young adults, and older African American adults undermines early intervention efforts, including prompt HIV/AIDS identification and diagnosis, prevention education, health promotion, effective substance abuse treatment, and counseling services. This work reviews the magnitude of HIV/AIDS among African Americans between 1996 and 1999 by race/ethnicity, gender, and age groups. It also addresses the major factors responsible for the continued upward trend in the distribution and rate of infectiousness of HIV/AIDS among African Americans. The study recommends and discusses culturally sensitive and ethnic-specific intervention strategies for the prevention and control of HIV/AIDS among African Americans.
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    HIV Infections and Associated Costs Attributable to Syphilis Coinfection Among African Americans
    (2003) Chesson, Harrell W; Pinkerton, Steven D; Voigt, Richard; Counts, George W
    Objectives. We estimated the number and cost of syphilis-attributable HIV cases among African Americans. Methods. A mathematical model of HIV transmission was used to estimate the number of partnerships consisting of HIV-discordant African Americans in which infectious syphilis was present and the number of new HIV cases attributable to syphilis in these partnerships. Results. In 2000, an estimated 545 new cases of HIV infection among African Americans could be attributed to the facilitative effects of infectious syphilis, at a cost about $113 million. Conclusions. Syphilis prevention could reduce HIV incidence rates and the disproportionate burden of HIV/AIDS on the African American community, resulting in substantial reductions in future HIV/AIDS medical costs.