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 Overweight and Depressive Symptoms among African-American Women(2000) Siegel, Judith M; Yancey, Antronette K; McCarthy, William JAbstract available at publisher's web site.Item Reconsidering the role of social disadvantage in physical and mental health: stressful life events, health behaviors, race, and depression.(2010) Mezuk, Briana; Rafferty, Jane A; Kershaw, Kiarri N; Hudson, Darrell; Abdou, Cleopatra M; Lee, Hedwig; Eaton, William W; Jackson, James SPrevalence of depression is associated inversely with some indicators of socioeconomic position, and the stress of social disadvantage is hypothesized to mediate this relation. Relative to whites, blacks have a higher burden of most physical health conditions but, unexpectedly, a lower burden of depression. This study evaluated an etiologic model that integrates mental and physical health to account for this counterintuitive patterning. The Baltimore Epidemiologic Catchment Area Study (Maryland, 1993-2004) was used to evaluate the interaction between stress and poor health behaviors (smoking, alcohol use, poor diet, and obesity) and risk of depression 12 years later for 341 blacks and 601 whites. At baseline, blacks engaged in more poor health behaviors and had a lower prevalence of depression compared with whites (5.9% vs. 9.2%). The interaction between health behaviors and stress was nonsignificant for whites (odds ratio (OR = 1.04, 95% confidence interval: 0.98, 1.11); for blacks, the interaction term was significant and negative (β: -0.18, P < 0.014). For blacks, the association between median stress and depression was stronger for those who engaged in zero (OR = 1.34) relative to 1 (OR = 1.12) and ≥2 (OR = 0.94) poor health behaviors. Findings are consistent with the proposed model of mental and physical health disparities.Item HIV/AIDS: a minority health issue.(2005) Cargill, Victoria A; Stone, Valerie EHIV infection among racial and ethnic minorities is an ongoing health crisis. The disproportionate impact of HIV infection on racial and ethnic minorities has affected communities already struggling with many social and economic challenges, such as poverty, substance abuse, homelessness,unequal access to health care, and unequal treatment once in the health care system. Superimposed on these challenges is HIV infection, the transmission of which is facilitated by many of these factors. Although the epidemic is disproportionately affecting all racial and ethnic minorities, within these minority populations women are particularly affected. The care and management of racial and ethnic minorities who have HIV infection has been complicated by the unequal access to health care and the unequal treatment once enrolled in health care. Health insurance status, lack of concordance between the race of the patient and the provider, and satisfaction with the quality of their care all impact on treatment outcomes in this population. In addition, the provider must be aware of the many comorbid conditions that may affect the delivery of care to minority patients living with HIV infection: depression, substance and alcohol abuse, and posttraumatic stress disorders. The impact of these comorbid conditions on the therapeutic relationship, including treatment and adherence, warrants screening for these disorders and treating them when identified. Because the patient provider relationship has been repeatedly identified as a predictor of higher adherence, developing and maintaining a strong therapeutic alliance is critical. Participation of racial and ethnic minorities in HIV clinical trials, as in other disease states, has been very poor. Racial and ethnic minorities have been chronically underrepresented in HIV clinical trials, despite their overrepresentation in the HIV epidemiology. This underrepresentation seems to be the result of a combination of factors including (1) provider bias in referring to clinical trials, (2) mistrust of clinical research, (3) past poor experience with the health care system, and (4) the conspiracy theories of HIV disease. The paucity of minority health care professionals and minority investigators in HIV research further affects minority participation in clinical research. To improve racial and ethnic minority participation in clinical trials a sustained effort is necessary at multiple levels. Increased recruitment and retention is an ongoing need, and one that will not be satisfactorily addressed until there are better community-academic and research partner-ships, and the research questions posed also address issues of concern and significance to the affected community. Reduction in barriers to participation in clinical trials, especially given the many competing needs of racial and ethnic minority patients, is also needed. Multidisciplinary HIV care teams and research staff with training in cultural competency and cultural sensitivity may also be helpful. Prevention of HIV infection remains essential, especially among those seeking care for HIV infection. Despite several published recommendations for the inclusion of HIV prevention in the clinical care setting, studies have documented how few providers actually achieve this goal, especially those who care for disadvantaged patients. Although there are many barriers to discussing HIV risk behaviors and prevention strategies in an office visit,including time constraints and potential provider discomfort in discussing these matters, clinical visits represent an important opportunity to reinforce HIV prevention and possibly decrease further HIV transmission.Item Patient–Physician Communication in the Primary Care Visits of African Americans and Whites with Depression(2008) Ghods, Bri K.; Roter, Debra L.; Ford, Daniel E.; Larson, Susan; Arbelaez, Jose J.; Cooper, Lisa A.Background Little research investigates the role of patient–physician communication in understanding racial disparities in depression treatment. Objective The objective of this study was to compare patient–physician communication patterns for African-American and white patients who have high levels of depressive symptoms. Design, Setting, and Participants This is a cross-sectional study of primary care visits of 108 adult patients (46 white, 62 African American) who had depressive symptoms measured by the Medical Outcomes Study–Short Form (SF-12) Mental Component Summary Score and were receiving care from one of 54 physicians in urban community-based practices. Main Outcomes Communication behaviors, obtained from coding of audiotapes, and physician perceptions of patients’ physical and emotional health status and stress levels were measured by post-visit surveys. Results African-American patients had fewer years of education and reported poorer physical health than whites. There were no racial differences in the level of depressive symptoms. Depression communication occurred in only 34% of visits. The average number of depression-related statements was much lower in the visits of African-American than white patients (10.8 vs. 38.4 statements, p = .02). African-American patients also experienced visits with less rapport building (20.7 vs. 29.7 statements, p = .009). Physicians rated a higher percentage of African-American than white patients as being in poor or fair physical health (69% vs. 40%, p = .006), and even in visits where depression communication occurred, a lower percentage of African-American than white patients were considered by their physicians to have significant emotional distress (67% vs. 93%, p = .07). Conclusions This study reveals racial disparities in communication among primary care patients with high levels of depressive symptoms. Physician communication skills training programs that emphasize recognition and rapport building may help reduce racial disparities in depression care.Item Relationship between depression and specific health indicators among hypertensive African American parents and grandparents.(2008) Taylor, Jacquelyn Y; Washington, Olivia G M; Artinian, Nancy T; Lichtenberg, PeterAfrican Americans are at greater risk for hypertension than are other ethnic groups. This study examined relationships among hypertension, stress, and depression among 120 urban African American parents and grandparents. This study is a secondary analysis of a larger nurse-managed randomized clinical trial testing the effectiveness of a telemonitoring intervention. Baseline data used in analyses, with the exception of medication compliance, were collected at 3 months' follow-up. Health indicators, perceived stress, and social support were examined to determine their relationship with depressive symptoms. A total of 48% of the variance in depressive symptomology was explained by perceived stress and support. Health indicators including average systolic blood pressure explained 21% of the variance in depressive symptomology The regression analysis using average diastolic blood pressure explained 26% of the variance in depressive symptomology Based on study results, African Americans should be assessed for perceived stress and social support to alleviate depressive symptomology.Item The role of stress and social support in predicting depression among a hypertensive African American sample.(2008) Dennis, John P; Markey, Megan A; Johnston, Karen A; Vander Wal, Jillon S; Artinian, Nancy TOBJECTIVE: We examined social support, stress, and selected demographic variables as predictors of depression among African Americans with hypertension. METHODS: Archival data collected on 194 hypertensive African Americans ranging in age from 30 to 88 years (mean age = 58.3 years, standard deviation = 12.2; 63% were female) were analyzed in the present study. Hierarchic regression analyses were conducted using two models of depression. The first model included basic demographic characteristics of the sample, including age, sex, educational attainment, income, and employment status. In the second model, the psychosocial variables of stress and social support were added to determine their predictive value. RESULTS: The first model accounted for 14% of the variance in depression and identified sex and age as significant predictors. The second model, in which two psychosocial variables were added, accounted for 45.2% of the total variance, with age, stress, and social support as significant predictors. CONCLUSIONS: Stress and social support are significant predictors of depression in a hypertensive African American population, beyond the influence of various demographic variables. These results have implications for prevention and intervention strategies with the target population.Item A comparison of the frequencies of risk factors for depression in older black and white participants in a study of indicated prevention(2010) Sriwattanakomen, Roy; McPherron, Jesse; Chatman, Jamie; Morse, Jennifer Q.; Martire, Lynn M.; Karp, Jordan F.; Houck, Patricia R.; Bensasi, Salem; Houle, Jill; Stack, Jacqueline A.; Woods, Mattie; Block, Bruce; Thomas, Stephen B.; Quinn, Sandra; Reynolds, Charles F.BACKGROUND: To compare the frequencies of risk factors, we describe risks for depression as a function of race among consecutively admitted participants in a randomized clinical trial of indicated depression prevention in later life. METHODS: Seventy-two black and 143 white participants were screened for risk factors for depression. RESULTS: Black participants were more likely to have fewer years of education and lower household income. They were more likely to be obese, live alone, experience functional disability, have a history of alcohol and drug abuse, and have lower scores on the Mini-mental State Examination and the Executive Interview (EXIT). White participants were not found to have greater prevalence or higher mean score on any risk factor. On average, black participants experienced approximately one more risk factor than white participants (t(213) = 3.32, p = 0.0011). CONCLUSIONS: In our sample, black participants had higher frequencies of eight risk factors for depression and a greater mean number of risk factors compared to white participants.Item 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, CharlesOBJECTIVES: 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.Item SICKLE CELL DISEASE: A STIGMATIZING CONDITION THAT MAY LEAD TO DEPRESSION(2005) Jenerette, Coretta; Funk, Marjorie; Murdaugh, CarolynIndividuals with a chronic illness such as sickle cell disease are at risk for depression. Moreover, they are at risk for untreated depression. Depression may go untreated because of the stigma and high rates of disability associated with this chronic illness that most often affects African Americans in the United States. The purpose of this cross-sectional study was to describe depressive symptoms using the Beck Depression Inventory Fast Screen in a sample of 232 African American adults with sickle cell disease. Respondents reported higher levels of depression (26%) and depressive symptoms (32%) than did the overall United States population (9.5%). All adults with chronic illnesses need to be screened for depression in primary care practice sites where the diagnosis and treatment of depression needs to be coordinated.Item Primary Care Attributes and Care for Depression Among Low-Income African American Women(2003) O’Malley, Ann S.; Forrest, Christopher B.; Miranda, JeanneObjectives. We examined the association between attributes of primary care providers and care for depression, from a patients’ perspective, among a sample of predominantly low-income African American women. Methods. Computer-assisted telephone interviews were conducted among a populationbased sample of 1202 women residing in Washington, DC. Results. Respondents whose primary care physicians provided more comprehensive medical services were more likely to be asked about and treated for depressive symptoms than women whose providers were less medically comprehensive. Women who rated their providers as having more respect for them also were more likely to be asked about and treated for depression. Conclusions. More comprehensive primary care delivery and a physician–patient relationship focused on mutual respect are associated with greater rates of physician inquiry about and treatment for depression among vulnerable women.