Minority Health and Health Equity Archive
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Item A Gender-Centered Ecological Framework Targeting Black Men Living With Diabetes: Integrating a "Masculinity" Perspective in Diabetes Management and Education Research(2010) Jack, L.; Toston, T.; Jack, N. H.; Sims, M.Abstract available at publisher's website.Item Quality Improvement Implementation and Disparities(2011) Chin, Marshall H.Abstract available at publisher's web site.Item Racial disparities in diabetes care processes, outcomes, and treatment intensity.(2003) Heisler, Michele; Smith, Dylan M; Hayward, Rodney A; Krein, Sarah L; Kerr, Eve AWe found racial disparities in some diabetes care process and intermediate outcome quality measures, but not in intensity of treatment for those patients with poor control. Disparities in receipt of eye examinations were the result of black patients being more likely to receive care at lower-performing facilities, whereas for other quality measures, racial disparities within facilities were substantial.Item Diabetes Care in Black and White Veterans in the Southeastern U.S.(2010) Twombly, J. G.; Long, Q.; Zhu, M.; Wilson, P. W. F.; Narayan, K. M. V.; Fraser, L. A.; Webber, B. C.; Phillips, L. S.Abstract available at publisher's web site.Item Process evaluation of a multi-institutional community-based program for diabetes prevention among First Nations(2007) Rosecrans, A. M.; Gittelsohn, J.; Ho, L. S.; Harris, S. B.; Naqshbandi, M.; Sharma, S.Epidemic rates of diabetes among Native North Americans demand novel solutions. Zhiiwaapenewin Akino'maagewin: Teaching to Prevent Diabetes was a community-based diabetes prevention program based in schools, food stores and health offices in seven First Nations in northwestern Ontario, Canada. Program interventions in these three institutions included implementation of Grades 3 and 4 healthy lifestyles curricula; stocking and labeling of healthier foods and healthy recipes cooking demonstrations and taste tests; and mass media efforts and community events held by health agencies. Qualitative and quantitative process data collected through surveys, logs and interviews assessed fidelity, dose, reach and context of the intervention to evaluate implementation and explain impact findings. School curricula implementation had moderate fidelity with 63% delivered as planned. Store activities had moderate fidelity: availability of all promoted foods was 70%, and appropriate shelf labels were posted 60% of the time. Cooking demonstrations were performed with 71% fidelity and high dose. A total of 156 posters were placed in community locations; radio, cable TV and newsletters were utilized. Interviews revealed that the program was culturally acceptable and relevant, and suggestions for improvement were made. These findings will be used to plan an expanded trial in several Native North American communities.Item Preventing diabetes and obesity in American Indian communities: the potential of environmental interventions(2011) Gittelsohn, J.; Rowan, M.Obesity, diabetes, and other diet-related chronic diseases persist in American Indians at rates that are significantly higher than those in other ethnic minority populations. Environmental interventions to improve diet and increase physical activity have the potential to improve these health outcomes, but relatively little work has taken place in American Indian communities. We reviewed the experiences and findings of the following 3 case studies of intervention trials in American Indian communities: the Pathways trial, which was a school-based trial that focused on children; the Apache Healthy Stores program, which was a food-store program that focused on food preparers and shoppers; and the Zhiwaapenewin Akino'maagewin trial, which was a multiinstitutional trial for First Nations adults that worked with food stores, elementary schools, and health and social services agencies. All 3 trials showed mixed success. Important lessons were learned, including the need to focus on supply and demand, institutional and multilevel approaches, and the identification of institutional bases to sustain programs.Item The Relation of Diabetes, Impaired Fasting Blood Glucose, and Insulin Resistance to Left Ventricular Structure and Function in African Americans: The Jackson Heart Study(2011) Fox, E. R.; Sarpong, D. F.; Cook, J. C.; Samdarshi, T. E.; Nagarajarao, H. S.; Liebson, P. R.; Sims, M.; Howard, G.; Garrison, R.; Taylor, H. A.OBJECTIVE We assessed the relation of diabetes and insulin resistance (IR) on left ventricular (LV) structure and function in African Americans. RESEARCH DESIGN AND METHODS Among those receiving echocardiograms in cycle 1 of the Jackson Heart Study, we assessed the sex-specific relation of fasting blood glucose (FBG), diabetes, and IR to LV structure and function, adjusting for age, systolic blood pressure, antihypertensive medications, and BMI. RESULTS Among 2,399 participants, LV mass index (Pwomen = 0.0002 and Pmen = 0.02), posterior wall thickness (Pwomen = 0.01 and Pmen = 0.05), and interventricular septal wall thickness (Pwomen = 0.01) were related to FBG categories. Among those with normal FBG and no diabetes, concentric remodeling and low ejection fraction in women and LV mass index and posterior wall thickness in men were related to IR. CONCLUSIONS In the largest study of its kind in a community-based cohort of African Americans, we found a relation of FBG category and IR to LV structure and function.Item Healthy Eating and Exercising to Reduce Diabetes: Exploring the Potential of Social Determinants of Health Frameworks Within the Context of Community-Based Participatory Diabetes Prevention(2005) Schulz, A. J.; Zenk, S.; Odoms-Young, A.; Hollis-Neely, T.; Nwankwo, R.; Lockett, M.; Ridella, W.; Kannan, S.Objectives. We examined a community-based participatory diabetes intervention to identify facilitators of and barriers to sustained community efforts to address social factors that contribute to health. Methods. We conducted a case study description and analysis of the Healthy Eating and Exercising to Reduce Diabetes project in the theoretical context of a conceptual model of social determinants of health. Results. We identified several barriers to and facilitators of analysis of social determinants of a community-identified disease priority (in this case, diabetes). Barriers included prevailing conceptual models, which emphasize health behavioral and biomedical paradigms that exclude social determinants of health. Facilitating factors included (1) opportunities to link individual health concerns to social contexts and (2) availability of support from diverse partners with a range of complementary resources. Conclusions. Partnerships that offer community members tangible resources with which to manage existing health concerns and that integrate an analysis of social determinants of health can facilitate sustained engagement of community members and health professionals in multilevel efforts to address health disparities.Item Even a little too much ‘sugar’ in your blood is bad(2011) Wilkins, Consuelo H.I always look forward to attending the National Medical Association’s annual convention and this year was no exception. The theme for this year’s convention, ‘Health Equity: Lead, Reform, Deliver’, is very timely as we try to address health disparities with the era of health care reform.Item Cultural Barriers to Care: Inverting the Problem(2001) Tripp-Reimer, T.; Choi, E.; Kelley, L. S.; Enslein, J. C.In working with diverse populations, health practitioners often view patients’ culture as a barrier to care. Inverting this problem by viewing the barriers as arising from the culture of biomedicine provides greater direction for practice. Integral to the delivery of culturally appropriate diabetes care are practitioner competencies in specific areas of cultural knowledge, as well as specific skills in intercultural communication, tripartite cultural assessment, selecting among levels of intensity of cultural interventions (neutral, sensitive, innovative, or transformative), adapting patient education, and developing community partnerships.