Behavioral & Community Health

Permanent URI for this communityhttp://hdl.handle.net/1903/2271

Prior to January 24, 2011, this unit was named the Department of Public & Community Health.

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Subject: search.filters.subject.Health Disparities

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Now showing 1 - 7 of 7
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    DISPARITIES IN PRE-EXPOSURE PROPHYLAXIS AWARENESS AMONG WOMEN: A SYSTEMATIC REVIEW OF THE LITERATURE AND LATENT CLASS ANALYSIS OF SYNDEMIC RISK FACTORS
    (2020) Stubbs, Leandra Nicole; Curbow, Barbara; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    While rates of HIV infection have declined among women in recent years, women still account for 19% of all new infections each year in the United States (US). Sociodemographic disparities remain with much of the burden falling on Black adult women aged 25-44. Ongoing transmission of HIV in this population has mostly resulted from heterosexual contact and prior studies have identified interpersonal and sociocultural factors that impede a woman’s choice to engage in safe sex and prevent HIV acquisition. With the debut of pre-exposure prophylaxis (PrEP), an FDA-approved once-daily pill to prevent HIV transmission, researchers believed that this user-controlled method would be an innovative method in reducing HIV in this subpopulation. However, since its release in 2012, there has been insufficient knowledge of PrEP among women in the U.S, resulting in slow and disproportionate uptake of PrEP in this population. While we know the clinical efficacy of PrEP, more understanding of the behavioral, social, and structural factors that impede PrEP awareness among women is important in the dissemination of PrEP-related information and subsequent use.In this dissertation, I took an exploratory approach to: a) identify awareness, knowledge, barriers and facilitators of PrEP use among US-based women through a systematic review; b) identify factors associated with PrEP awareness among female participants in the 2018 Community Health Survey; and c) explore how the presence of multiple deleterious factors can create distinct subgroups of women and further exacerbate disparities in PrEP awareness. In Paper 1, the systematic review of PrEP knowledge among Black/African American women identified 12 articles with findings disaggregated by both race and gender. Primary findings included gaps in PrEP knowledge; acceptability and willingness to use once informed of PrEP; perceived disadvantages as a result of exclusion in clinical trials and early dissemination; and social, structural, and institutional barriers to engagement in the PrEP care continuum. Papers 2 and 3 leveraged data from the 2018 Community Health Survey, a cross-sectional telephone survey of randomly selected adults aged 18 and older from all five boroughs of New York City. In Paper 2, 36% of a female subsample (N=2,295) were aware of PrEP at time of survey. As a result of multinomial linear regression, nine variables were significantly associated with PrEP awareness: nativity, education level, recent HIV test, number of sex partners, IPV, age, race/ethnicity, general health, and prior incarceration. In Paper 3, latent class analysis was used to identify distinct classes of women with varied responses to behavioral and structural variables. The adjusted item-response probabilities resulted in three distinct profiles of women: high resource and low risk group (39%), low resource and moderate risk group (33%), and moderate resource and high-risk group (28%). Key differences between groups include PrEP awareness, perceived health, count of sexual partners, and neighborhood poverty level. These findings have key implications for the way in which PrEP is marketed to women. Future studies should consider the importance of intersectionality and the social and structural context through which women engage with HIV prevention materials and promotional campaigns.
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    INVESTIGATING CARDIOVASCULAR RISK AT THE INTERSECTION OF RACE, GENDER, AND EDUCATION
    (2019) Taiwo, Omolola Tanya; Boekeloo, Bradley O; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    As a risk factor of cardiovascular disease (CVD), systemic inflammation is differentially distributed by race, with black populations disproportionately impacted. Additionally, inflammation, as measured by the inflammatory marker C-reactive protein (CRP), is documented to be higher among women when compared to men and varies by educational level. Despite evidence suggesting that various chronic stress domains may contribute to the relationship between race and inflammation, there is limited data exploring the possible mediating role of chronic stress. Furthermore, to date, no study has examined if the potential indirect effect of race on CRP through chronic stress domains are moderated by gender and education. This secondary data analysis stems from the Midlife Development in the United States (MIDUS II) study, and the sample consisted of 193 black and 582 white adults. Study 1: Examined the association between CRP and seven racial/gender/education subgroups. With educated white men as the reference group, findings revealed that educated black and white women had the highest significant risk for elevated CRP. Study 2: Assessed the psychometric properties of a Chronic Stress Scale (CSS) comprised of nine chronic stress subscales. Analyses revealed CSS to be a three-dimensional scale with questionable validity and reliability. Study 3: First, tested for significant correlations between nine chronic stress domains, race, and CRP. Everyday discrimination and financial strain were found to be the only two domains significantly correlated to race and CRP. Second, two mediation analyses assessed the mediating effect of financial strain and discrimination, finding that they both respectively mediated the relationship between race and CRP. Third, two moderated mediation analyses examined if the indirect effect of financial strain and discrimination were moderated by gender and education. Results indicated that the indirect effect of race on CRP through discrimination was significant only among educated black men. Additionally, findings revealed that the indirect effect of race on CRP through financial strain was significant among black men and women regardless of educational attainment. Combined, these studies characterized the social patterning of CRP, illustrated validity and reliability concerns when developing a multidimensional chronic stress scale, and revealed that discrimination and financial strain did have mediating roles and these mediators were moderated by gender and education.
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    Reducing Liver Cancer Disparities: A Community-Based Hepatitis-B Prevention Program for Asian-American Communities
    (The National Medical Association, 2007-08-01) Hsu, Chiehwen Ed
    Objectives: Several Asian-American groups are at a higher risk of dying of liver diseases attributable to hepatitis B infection. This culturally diverse community should be well informed of and protected against liver diseases. The present study assesses the knowledge of hepatitis B before and after a hepatitis-B educational program and determines the infection status of an Asian community. Methods: Nine Asian communities of Montgomery County, MD, enrolled in the hepatitis-B prevention rogram between 2005 and 2006. They attended culturally tailored lectures on prevention, completed self-administered pre- and posttests, and received blood screening for the disease. Results: More than 800 Asian Americans participated in the study. Knowledge of prevention was improved after educational delivery. The average infection rate was 4.5%, with Cambodian, Thai, Vietnamese, Chinese and Korean groups having higher infection rates. The age group of 36–45 had the highest percentage of carriers (9.1%). Conclusion: Many Asian groups, particularly those of a southeast Asian decent, were subject to a higher probability of hepatitis-B infection. At an increased risk are first-generation Asian immigrants, groups with low immunization rates and those aged 36–45. The findings provide potential directions for focusing preventive interventions on at-risk Asian communities to reduce liver cancer disparities.
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    A Spatial-Temporal Approach to Surveillance of Prostate Cancer Disparities in Population Subgroups
    (National Medical Association, 2007-01-10) Hsu, Chiehwen Ed; Soto Mas, Francisco; Nkhoma, Ella; Miller, Jerry
    Background: Prostate cancer mortality disparities exist among racial/ethnic groups in the United States, yet few studies have explored the spatiotemporal trend of the disease burden. To better understand mortality disparities by geographic regions over time, the present study analyzed the geographic variations of prostate cancer mortality by three Texas racial/ethnic groups over a 22-year period. Methods: The Spatial Scan Statistic developed by Kulldorff et al was used. Excess mortality was detected using scan windows of 50% and 90% of the study period and a spatial cluster size of 50% of the population at risk. Time trend was analyzed to examine the potential temporal effects of clustering. Spatial queries were used to identify regions with multiple racial/ethnic groups having excess mortality. Results: The most likely area of excess mortality for blacks occurred in Dallas-Metroplex and upper east Texas areas between 1990 and 1999; for Hispanics, in central Texas between 1992 and 1996; and for non-Hispanic whites, in the upper south and west to central Texas areas between 1990 and 1996. Excess mortality persisted among all racial/ethnic groups in the identified counties. The second scan revealed that three counties in west Texas presented an excess mortality for Hispanics from 1980–2001. Many counties bore an excess mortality burden for multiple groups. There is no time trend decline in prostate cancer mortality for blacks and non-Hispanic whites in Texas. Conclusion: Disparities in prostate cancer mortality among racial/ethnic groups existed in Texas. Central Texas counties with excess mortality in multiple subgroups warrant further investigation.
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    Public Health Preparedness of Health Providers: Meeting the Needs of Diverse, Rural Communities
    (2006-11) Hsu, Chiehwen Ed; Soto Mas, Francisco; Jacobson, Holly; Harris, Ann Marie; Nkhoma, Ella; Hunt, Victoria
    Meeting the needs of public health emergency and response presents a unique challenge for health practitioners with primary responsibilities for rural communities that are often very diverse. The present study assessed the language capabilities, confidence and training needs of Texas rural physicians in responding to public health emergencies. In the first half of year 2004, a cross-sectional, semistructured survey questionnaire was administered in northern, rural Texas. The study population consisted of 841 practicing or retired physicians in the targeted area. One-hundred-sixty-six physicians (30%) responded to the survey. The responses were geographically referenced in maps. Respondents reported seeing patients with diverse cultural backgrounds. They communicated in 16 different languages other than English in clinical practice or at home, with 40% speaking Spanish at work. Most were not confident in the diagnosis or treatment of public health emergency cases. Geographic information systems were found useful in identifying those jurisdictions with expressed training and cultural needs. Additional efforts should be extended to involve African-American/Hispanic physicians in preparedness plans for providing culturally and linguistically appropriate care in emergencies.
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    Surveillance of the Colorectal Cancer Disparities Among Demographic Subgroups - A Spatial Analysis
    (Southern Medical Association, 2006-09) Hsu, Chiehwen Ed; Soto Mas, Francisco; Hickey, Jessica; Miller, Jerry A; Lai, Dejian
    To understand the extent of the demographic and geographic disparities, the present study examined colorectal cancer mortality in 15 demographic groups in Texas counties between 1990 and 2001. The study confirmed the excess mortality in some Texas counties found in the literature, identified 13 additional excess mortality regions, and found 4 health regions with persistent excess mortality involving several population subgroups. The study suggested that Health disparities of colorectal cancer mortality continue to exist in Texas demographic subpopulations. Health education and intervention programs should be directed to the at-risk sub-populations in the identified regions.
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    Hispanic physicians' tobacco intervention practices: a cross-sectional study
    (BMC Public Health, 2005-11-14) Soto Mas, Francisco G; Papenfuss, Richard; Hsu, Chiehwen Ed; Jacobson, Holly E; Urrutia-Rojas, Ximena; Kane, William M
    Background: U.S. Hispanic physicians constitute a considerable professional collective, and they may be most suited to attend to the health education needs of the growing U.S. Hispanic population. These educational needs include tobacco use prevention and smoking cessation. However, there is a lack of information on Hispanic physicians' tobacco intervention practices, their level of awareness and use of cessation protocols, and the type of programs that would best address their tobacco training needs. The purpose of this study was to assess the tobacco intervention practices and training needs of Hispanic physicians. Methods: Data was collected through a validated survey instrument among a cross-sectional sample of self-reported Hispanic physicians. Data analyses included frequencies, descriptive statistics, and factorial analyses of variance. Results: The response rate was 55.5%. The majority of respondents (73.3%) were middle-age males. Less than half of respondents routinely performed the most basic intervention: asking patients about smoking status (44.4%) and advising smoking patients to quit (42.2%). Twenty-five percent assisted smoking patients by talking to them about the health risks of smoking, providing education materials or referring them to cessation programs. Only 4.4% routinely arranged followup visits or phone calls for smoking patients. The majority of respondents (64.4%) indicated that they prescribe cessation treatments to less than 20% of smoking patients. A few (4.4%) routinely used behavioral change techniques or programs. A minority (15.6%) indicated that they routinely ask their patients about exposure to tobacco smoke, and 6.7% assisted patients exposed to secondhand smoke in understanding the health risks associated with environmental tobacco smoke (ETS). The most frequently encountered barriers preventing respondents from intervening with patients who smoke included: time, lack of training, lack of receptivity by patients, and lack of reimbursement by third party payers. There was no significant main effect of type of physician, nor was there an interaction effect (gender by type of physician), on tobacco-related practices. Conclusion: The results indicate that Hispanic physicians, similarly to U.S. physicians in general, do not meet the level of intervention recommended by health care agencies. The results presented will assist in the development of tobacco training initiatives for Hispanic physicians.