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 A review of the efficacy of smoking-cessation pharmacotherapies in nonwhite populations.(2008) Robles, Gisela I; Singh-Franco, Devada; Ghin, Hoytin LeeBACKGROUND: Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States. Research suggests that behavioral support strategies and pharmacotherapy can improve abstinence rates. However, both approaches, especially pharmacotherapy, have been understudied in nonwhite US populations. OBJECTIVE: The aim of this review was to evaluate the efficacy of smoking-cessation pharmacotherapy in nonwhite US populations. METHODS: Using search terms smoking cessation, nicotine replacement therapy, bupropion SR, varenicline, minority, ethnicity, African American, black, Hispanic, American Indian, and Alaska Native, a literature search was conducted to identify English-language studies that evaluated the use of smoking-cessation pharmacotherapies in nonwhite patients in MEDLINE (1966\2-December 2007), International Pharmaceutical Abstracts (1980\2-January 2008), Database of Abstracts of Reviews of Effectiveness (1990\2-December 2007), and EMBASE Drugs & Pharmacology (1991\2-third quarter 2007). RESULTS: Nine studies were identified and assessed. Six studies looked at smoking-cessation pharmacotherapy in black smokers, 1 in Hispanic smokers, 1 in Native American smokers, and 1 in white and nonwhite smokers. In black smokers (N = 410; mean cigarettes per day [cpd], 20.4) who received the nicotine patch versus placebo, the 30-day self-reported abstinence rates were 21.5% versus 13.7% (P = 0.03) at 10 weeks and 17.1% versus 11.7% (P = NS) at 6 months. In black smokers (N = 600; mean [SD] cpd, 16.1 [7.5]) who received sustained-release (SR) bupropion 150 mg BID versus placebo for 7 weeks, the 7-day biochemically verified abstinence rates at weeks 6 and 26 were 36.0% versus 19.0% (Delta, 17%; 95% CI, 9.7\2-24.4; P < 0.001) and 21.0% versus 13.7% (Delta, 7.3%; 95% CI, 1.0\2-13.7; P = 0.02). Predictors of smoking cessation included use of bupropion SR (abstinence rate, 41.5% vs 21.1%; P<0.001); smoking nonmentholated cigarettes (abstinence rate, 28.3% in mentholated smokers [n = 417] vs 41.5% in nonmentholated smokers [n = 118]; P = 0.006); not smoking within 30 minutes of awakening (abstinence rate, 26.4% [n = 420] in those who did vs 48.7% [n = 115] in those who did not; P < 0.001); and lower baseline salivary cotinine levels (256.8 [137.0] ng/mL in those who became abstinent vs 305.6 [143.4] ng/mL in those who remained smokers; P < 0.001). In black light (or=7 consecutive days (odds ratio, 0.20; 95% CI, 0.05-0.77; P = 0.02). CONCLUSIONS: Data from the studies in this review support the use of smoking-cessation pharmacotherapy (nicotine patch and bupropion SR) in nonwhite patients. Black patients, who smoked within 30 minutes of awakening, smoked mentholated cigarettes, and had high salivary cotinine levels may have difficulty quitting regardless of the number of cigarettes smoked per day; therefore, determining the type of cigarettes smoked (mentholated vs nonmentholated) and salivary cotinine levels may be helpful in assessing the severity of smoking addiction and guide pharmacotherapy (eg, starting at higher doses of nicotine-replacement therapy in a light smoker). Other than smoking-cessation behavioral studies, there is a lack of congruent smoking-cessation pharmacotherapy studies in American Indian/Alaska Native, Hispanic, and other ethnic populations.Item Racial/Ethnic Discrimination and Health: Findings From Community Studies(2003) Williams, David R.; Neighbors, Harold W.; Jackson, James S.The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health. (Am J Public Health. 2003;93:200-208)Item Racial and Ethnic Differences in Access to Medical Care(2000) Mayberry, Robert M; Mili, Fatima; Ofili, ElizabethThe authors’ review of the health services literature since the release of the landmark Report of the Secretary’s Task Force Report of Black and Minority Health in 1985 revealed significant differences in access to medical care by race and ethnicity within certain disease categories and types of health services. The differences are not explained by such factors as socioeconomic status (SES), insurance coverage, stage or severity of disease, comorbidities, type and availability of health care services, and patient preferences. Under certain circumstances when important variables are controlled, racial and ethnic disparities in access are reduced and may disappear. Nonetheless, the literature shows that racial and ethnic disparities persist in significant measure for several disease categories and service types. The complex challenge facing current and future researchers is to understand the basis for such disparities and to determine why disparities are apparent in some but not other disease categories and service types.Item Barriers to Buying Healthy Foods for People With Diabetes: Evidence of Environmental Disparities(2004) Horowitz, Carol A; Colson, Kathryn A; Hebert, Paul L; Lancaster, KristieObjectives. A community coalition compared the availability and cost of diabetes-healthy foods in a racial/ethnic minority neighborhood in East Harlem, with those in the adjacent, largely White and affluent Upper East Side in New York City. Methods. We documented which of the 173 East Harlem and 152 Upper East Side grocery stores stocked 5 recommended foods. Results. Overall, 18% of East Harlem stores stocked recommended foods, compared with 58% of stores in the Upper East Side (P<.0001). Only 9% of East Harlem bodegas (neighborhood stores) carried all items (vs 48% of Upper East Side bodegas), through East Harlem had more bodegas. East Harlem residents were more likely than Upper East Side residents (50% vs 24%) to have stores on their black that did not stock recommended foods and less likely (26% vs 30%) to have stores on their block that stocked recommended foods. Conclusions. A greater effort needs to be made to make available stores that carry diabetes-healthy foods.Item Racism in Medicine: Health Parity for African Americans(2002) UNSPECIFIEDThere are many false race-based myths concerning the history of man’s culture, civilization and modern medicine that are believed and taught even today. Today, these myths are being perpetuated, intentionally or unintentionally, in our universities and lower educational systems — and are therefore fostering misunderstandings that hinder resolving the issue of race and racism that is pervasive in American society. You will hear a provocative yet historic and evidenced-based presentation designed to further your understanding on the impact that racism had and still has in medicine.Item DISPARITIES IN PATIENT EXPERIENCES, HEALTH CARE PROCESSES, AND OUTCOMES: THE ROLE OF PATIENT–PROVIDER RACIAL, ETHNIC, AND LANGUAGE CONCORDANCE(The Commonwealth Fund, 2004) Cooper, Lisa A; Powe, Neil REthnic minorities are poorly represented among physicians and other health professionals. In what is called “race-discordant” relationships, patients from ethnic groups frequently are treated by professionals from a different ethnic background. The research reviewed here documents ongoing racial and ethnic disparities in health care and links patient–physician race and ethnic concordance with higher patient satisfaction and better health care processes. Based on this research, the authors issue the following recommendations: 1) health policy should be revised to encourage workforce diversity by funding programs that support the recruitment of minority students and medical faculty; 2) health systems should optimize their providers’ ability to establish rapport with minority patients to improve clinical practice and health care delivery; 3) cultural competency training should be incorporated into the education of health professionals; and 4) future research should provide additional insight into the mechanisms by which concordance of patient and physician race, ethnicity, and language influences processes and outcomes of care.Item Creating A State Minority Health Policy Report Card: An evaluation of states’ capacity to address racial and ethnic health disparities.(2005) Trivedi, Amal N; Gibbs, Brian; Nsiah-Jefferson, Laurie; Ayanian, John Z; Prothrow-Stith, DeborahA state minority health policy report card may provide an important tool for evaluating and promoting state policies to reduce health disparities. This study develops criteria that can form the basis of such a state report card and assesses the performance of all fifty states on these measures. The results indicate wide variation among states, with geographic region being a significant predictor of performance on all four measures. Future research should be conducted on other predictors of state variation in minority health policy and connections between state policy and health outcomes for minorities.Item Collaborative Research as an Essential Component for Addressing Cancer Disparities Among Southeast Asian and Pacific Islander Women(2002) Tanjasiri, Sora Park; Kagawa-Singer, Marjorie; Nguyen, Tu-Uyen; Foo, Mary AnneA fundamental component of community-based health promotion efforts to eliminate disparities is the mobilization of community involvement to address not only individual but also systemic and political causes of inequalities in health. The participatory action research (PAR) paradigm is well suited to address these multilevel inequalities in research and evaluation experienced by many ethnic and racial communities. In this article, a case study of a project to reduce health disparities in breast and cervical cancer among seven Southeast Asian and Pacific Islander communities in Southern California is presented. The authors applied a PAR framework to the process of needs assessment and program planning to understand and address the complex and multilevel factors that contribute to the problem of disparate breast and cervical cancer screening rates in these communities. Finally, the authors describe the lessons that were learned about how to promote collaborative research as an essential element in the design of projects and studies to address ethnic disparities in health outcomes for breast and cervical cancer.Item California plots strategy to end health disparities(2004) Krisberg, KimAfter years of work, public health advocates in California recently presented a strategic plan aimed at eliminating racial and ethnic health disparities in one of the nation's largest and most diverse states.Item Actions urged to increase numbers of US minority health workers(American Public Health Association, 2004) Late, MicheleUnless current US trends in medical and health education are reversed, the lack of minorities in the nation's health work force will continue to be an ongoing contributor to the nation's racial and ethnic health disparities, a prestigious health commission has predicted.