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 The three leading causes of death in African Americans: barriers to reducing excess disparity and to improving health behaviors.(1999) Feldman, R H; Fulwood, RAfrican Americans suffer disproportionately from several major health problems associated with high morbidity and mortality. The 1985 DHHS Secretary's Task Force Report on Blacks and Other Minorities identified six major disease categories of excess deaths for African Americans compared with whites by applying the lower death rate for whites to the American population. The report provided a stimulus for public and private action to begin to address the health disparities between minority and nonminority populations. This article examines three of the leading causes of death for African Americans and assesses the extent to which the health disparity between African Americans and whites has been reduced. The three leading causes of death for African American males are diseases of the heart, cancer, and HIV infection/AIDS. The conditions are the same for African American females except stroke replaces HIV infection. Three health outcomes measures are discussed: life expectancy, excess death rates, and years of potential life lost. A widening of the gap between the races was found for diseases of the heart and HIV infection for males and for cancer for females. An extensive list of barriers to reducing the disparity are presented from the scientific literature and strategies for reducing the three health problems are recommended.Item Race-ethnic disparities in the impact of stroke risk factors: the northern Manhattan stroke study.(2001) Sacco, R L; Boden-Albala, B; Abel, G; Lin, I F; Elkind, M; Hauser, W A; Paik, M C; Shea, SBACKGROUND AND PURPOSE: Stroke risk factors have been determined in large part through epidemiological studies in white cohorts; as a result, race-ethnic disparities in stroke incidence and mortality rates remained unexplained. The aim in the present study was to compare the prevalence, OR, and etiological fraction (EF) of stroke risk factors among white, blacks, and Caribbean Hispanics living in the same urban community of northern Manhattan. METHODS: In this population-based incident case-control study, cases (n=688) of first ischemic stroke were prospectively matched 1:2 by age, sex, and race-ethnicity with community controls (n=1156). Risk factors were determined through in-person assessment. Conditional logistic regression was used to calculate adjusted ORs in each race-ethnic group. Prevalence and multivariate EFs were determined in each race-ethnic group. RESULTS: Hypertension was an independent risk factor for whites (OR 1.8, EF 25%), blacks (OR 2.0, EF 37%), and Caribbean Hispanics (OR 2.1, EF 32%), but greater prevalence led to elevated EFs among blacks and Caribbean Hispanics. Greater prevalence rates of diabetes increased stroke risk in blacks (OR 1.8, EF 14%) and Caribbean Hispanics (OR 2.1 P<0.05, EF 10%) compared with whites (OR 1.0, EF 0%), whereas atrial fibrillation had a greater prevalence and EF for whites (OR 4.4, EF 20%) compared with blacks (OR 1.7, EF 3%) and Caribbean Hispanics (OR 3.0, EF 2%). Coronary artery disease was most important for whites (OR 1.3, EF 16%), followed by Caribbean Hispanics (OR 1.5, EF 6%) and then blacks (OR 1.1, EF 2%). Prevalence of physical inactivity was greater in Caribbean Hispanics, but an elevated EF was found in all groups. CONCLUSIONS: The prevalence, OR, and EF for stroke risk factors vary by race-ethnicity. These differences are crucial to the etiology of stroke, as well as to the design and implementation of stroke prevention programs.Item Promoting Functional Health in Midlife and Old Age: Long-Term Protective Effects of Control Beliefs, Social Support, and Physical Exercise(2010) Baune, Bernhard T.; Lachman, Margie E.; Agrigoroaei, StefanBACKGROUND: Previous studies have examined physical risk factors in relation to functional health, but less work has focused on the protective role of psychological and social factors. We examined the individual and joint protective contribution of control beliefs, social support and physical exercise to changes in functional health, beyond the influence of health status and physical risk factors in middle-aged and older adults. Given that functional health typically declines throughout adulthood, it is important to identify modifiable factors that can be implemented to maintain functioning, improve quality of life, and reduce disability. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a national longitudinal study, Midlife in the United States (MIDUS), with assessments in 1995-1996 and 2004-2006, and 3,626 community-residing adults, aged 32 to 84, were included in the analyses. Functional health (Physical Functioning subscale of the SF-36) and protective factors were measured at both occasions. While controlling for socio-demographic, health status, and physical risk factors (large waist circumference, smoking, and alcohol or drug problems), a composite of the three protective variables (control beliefs, social support, and physical exercise) at Time 1 was significantly related to functional health change. The more of these factors at Time 1, the better the health maintenance over 10 years. Among middle-aged and older adults, declines in health were significantly reduced with an increased number of protective factors. CONCLUSION/SIGNIFICANCE: Age-related declines in health were reduced among those with more protective factors up to a decade earlier in life. Modifiable psychological, social, and physical protective factors, individually and in the aggregate, are associated with maintenance of functional health, beyond the damaging effects of physical risk factors. The results are encouraging for the prospect of developing interventions to promote functional health and for reducing public health expenditures for physical disability in later life.Item Strategies for recruiting Hispanic women into a prospective cohort study of modifiable risk factors for gestational diabetes mellitus(2009) Chasan-Taber, Lisa; Fortner, Renée T; Hastings, Valerie; Markenson, GlennBACKGROUND: The purpose of this article was to describe effective strategies for recruitment of Hispanic women into a prospective cohort study of modifiable risk factors for gestational diabetes mellitus (GDM). Although Hispanic women have two to four times the risk of developing GDM compared with non-Hispanic white women, few GDM prevention studies have included Hispanic women. METHODS: The study was conducted in the ambulatory obstetrical practices of Baystate Medical Center located in a socioeconomically and ethnically diverse city in Massachusetts. The study employed a range of strategies to recruit Hispanic women based on a review of the literature as well as prior experience with the study population. RESULTS: Over a period of 32 months, a total of 851 Hispanic prenatal care patients were recruited. Among eligible women, 52.4% agreed to participate. Participants were young (70% <25 years), with low levels of education, and on public health insurance (81.5%); 88% were unmarried. Study design features such as use of bilingual recruiters, a flexible recruitment process, training recruiters to be culturally sensitive, use of culturally tailored materials, prescreening participants, participant compensation, seeking the cooperation of clinic staff, and continuous monitoring of recruitment goals emerged as important issues influencing recruitment. CONCLUSIONS: Findings suggest that investigators can successfully recruit pregnant women from ethnic minority groups of low socioeconomic status into observational studies. The study provides culturally appropriate recruitment strategies useful for practice-based settings recruiting Hispanic research participation.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 Ethnic differences in birthweight: the role of lifestyle and other factors(1997) Shiono, P H; Rauh, V A; Park, M; Lederman, S A; Zuskar, DOBJECTIVES: The purpose of this study was to expand the search for risk factors for low birthweight and to find new explanations for the ethnic-group disparities in birth outcomes. METHODS: The subjects were 1150 pregnant women from six ethnic groups (African American, Chinese, Dominican, Puerto Rican, Mexican, and White) who received prenatal care at clinics in New York and Chicago between December 1987 and December 1989. Two interviews were conducted during the second and third trimesters of pregnancy. RESULTS: The study, after controlling for poverty and other birthweight correlates, showed that living in public housing and believing that chance plays a major role in determining one's health status were negatively associated with birthweight. Having a stable residence was positively related to birthweight. Material hardship, social adversity, perceived racial discrimination, physical abuse, anxiety, and depression were not associated with birthweight. CONCLUSIONS: The negative role of an impoverished living environment and feelings of helplessness, as well as the positive role of having a stable form of social support, suggest new directions for research on the causes of low birthweight and the ethnic disparities in US birth outcomes.Item Socioeconomic Position, Race/Ethnicity, and Inflammation in the Multi-Ethnic Study of Atherosclerosis(2007) Ranjit, Nalini; Diez-Roux, Ana V.; Shea, Steven; Cushman, Mary; Ni, Hanyu; Seeman, TeresaBackground—Low socioeconomic position is known to be associated with cardiovascular events and atherosclerosis. Reasons for these associations remain a topic of research. Inflammation could be an important mediating mechanism linking socioeconomic position to cardiovascular risk. Methods and Results—This cross-sectional study used data from the baseline examination of the Multi-Ethnic Study of Atherosclerosis (MESA), a study of 6814 men and women 45 to 84 years of age. Race- and ethnicity-stratified regression analyses were used to estimate associations of household income and education with C-reactive protein and interleukin-6 before and after adjustment for infection and medication use, psychosocial factors, behaviors, adiposity, and diabetes mellitus. Low income was associated with higher concentrations of interleukin-6 in all race/ethnic groups. Percent differences associated with 1-SD–lower income were 9% (95% confidence interval [CI], 7 to 11), 6% (95% CI, 1 to 10), 8% (95% CI, 4 to 11), and 8% (95% CI, 3 to 13) for whites, Chinese, blacks, and Hispanics. Low levels of education were associated with higher levels of interleukin-6 only among whites and blacks (percent difference in interleukin-6 associated with 1-SD–lower education: 9% [95% CI, 6 to 12] among Whites, and 7% [95% CI, 3 to 10] among blacks). Similar patterns were observed for C-reactive protein. Adiposity was the single most important factor explaining socioeconomic position associations, especially among blacks and whites. A smaller effect was seen for psychosocial factors and behaviors in all race groups. Conclusions—Both household income and education are associated with inflammation, but associations vary across race/ethnic groups. Associations likely result from socioeconomic position patterning of adiposity and other factors.Item Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin(2002) Knowler, William C.; Barrett-Connor, Elizabeth; Fowler, Sarah E.; Hamman, Richard F.; Lachin, John M.; Walker, Elizabeth A.; Nathan, David M.Background Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors — elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle — are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. Methods We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups. Results The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin. Conclusions Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.Item Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update(2007) Mosca, Lori; Banka, Carole L.; Benjamin, Emelia J.; Berra, Kathy; Bushnell, Cheryl; Dolor, Rowena J.; Ganiats, Theodore G.; Gomes, Antoinette S.; Gornik, Heather L.; Gracia, Clarissa; Gulati, Martha; Haan, Constance K.; Judelson, Debra R.; Keenan, Nora; Kelepouris, Ellie; Michos, Erin D.; Newby, L. Kristin; Oparil, Suzanne; Ouyang, Pamela; Oz, Mehmet C; Diana Petitti, Diana; Pinn, Vivian W.; Redberg, Rita F.; Scott, Rosalyn; Sherif, Katherine; Smith, Sidney C.; Sopko, George; Steinhorn, Robin H.; Stone, Neil J.; Taubert, Kathryn A..; Todd, Barbara A.; Urbina, Elaine; Wenger, Nanette K.Worldwide, cardiovascular disease (CVD) is the largest single cause of death among women, accounting for one third of all deaths. In many countries, including the United States, more women than men die every year of CVD, a fact largely unknown by physicians. The public health impact of CVD in women is not related solely to the mortality rate, given that advances in science and medicine allow many women to survive heart disease. For example, in the United States, 38.2 million women (34%) are living with CVD, and the population at risk is even larger. In China, a country with a population of approximately 1.3 billion, the age-standardized prevalence rates of dyslipidemia and hypertension in women 35 to 74 years of age are 53% and 25%, respectively, which underscores the enormity of CVD as a global health issue and the need for prevention of risk factors in the first place. As life expectancy continues to increase and economies become more industrialized, the burden of CVD on women and the global economy will continue to increase.Item African Americans at Greater Risk for Stroke than Other Ethnic Groups(2004) Dawson, GeorgeAccording to the American Stroke Association, a division of the American Heart Association, African Americans are at greater risk of death from cardiovascular disease and stroke than any other ethnic group. Cardiovascular disease, including stroke, is the leading cause of death for African-American men and women—claiming the lives of over 100,000 annually. In 2000, cardiovascular disease accounted for 37% of all African-American deaths. It's estimated that 40% of African-American women and 41% of African- American men have cardiovascular disease, according to the Centers for Disease Control and Prevention of the National Center for Health Statistics. Stroke is the third leading cause of death in America today and a leading cause of severe long-term disability. The American Stroke Association is reminding African Americans this May—American Stroke Month—to learn their risk for stroke and take action to lower their risk.