Minority Health and Health Equity Archive
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Item Racial and Ethnic Differences in Patient Perceptions of Bias and Cultural Competence in Health Care(2004) Johnson, Rachel L.; Saha, Somnath; Arbelaez, Jose J.; Beach, Mary Catherine; Cooper, Lisa A.Abstract available at publisher's web site.Item Commentary on "Increasing Minority Participation in Clinical Research": A White Paper from The Endocrine Society(2007) Alexander-Bridges, M.; Doan, L. L.Underrepresentation of racial and ethnic minorities in clinical research limits the applicability of trial results to diverse subpopulations. Recognizing an ongoing need to increase participation by minorities, The Endocrine Society established a task force of thought leaders from all stakeholder groups—the pharmaceutical industry, federal agencies, academia, and community groups—to develop a white paper outlining recommendations for meeting this need. The primary goal is to ensure that clinical research supporting the safety and efficacy of pharmaceutical products and the validity of biomarkers used to design therapeutic strategies is based on statistically powered data derived from minority subpopulations. To realize…Item Estimated HIV Incidence in the United States, 2006–2009(2011) Prejean, Joseph; Song, Ruiguang; Hernandez, Angela; Ziebell, Rebecca; Green, Timothy; Walker, Frances; Lin, Lillian S.; An, Qian; Mermin, Jonathan; Lansky, Amy; Hall, H. Irene; Lee, VernonBackground The estimated number of new HIV infections in the United States reflects the leading edge of the epidemic. Previously, CDC estimated HIV incidence in the United States in 2006 as 56,300 (95% CI: 48,200–64,500). We updated the 2006 estimate and calculated incidence for 2007–2009 using improved methodology. Methodology We estimated incidence using incidence surveillance data from 16 states and 2 cities and a modification of our previously described stratified extrapolation method based on a sample survey approach with multiple imputation, stratification, and extrapolation to account for missing data and heterogeneity of HIV testing behavior among population groups. Principal Findings Estimated HIV incidence among persons aged 13 years and older was 48,600 (95% CI: 42,400–54,700) in 2006, 56,000 (95% CI: 49,100–62,900) in 2007, 47,800 (95% CI: 41,800–53,800) in 2008 and 48,100 (95% CI: 42,200–54,000) in 2009. From 2006 to 2009 incidence did not change significantly overall or among specific race/ethnicity or risk groups. However, there was a 21% (95% CI:1.9%–39.8%; p = 0.017) increase in incidence for people aged 13–29 years, driven by a 34% (95% CI: 8.4%–60.4%) increase in young men who have sex with men (MSM). There was a 48% increase among young black/African American MSM (12.3%–83.0%; p<0.001). Among people aged 13–29, only MSM experienced significant increases in incidence, and among 13–29 year-old MSM, incidence increased significantly among young, black/African American MSM. In 2009, MSM accounted for 61% of new infections, heterosexual contact 27%, injection drug use (IDU) 9%, and MSM/IDU 3%. Conclusions/Significance Overall, HIV incidence in the United States was relatively stable 2006–2009; however, among young MSM, particularly black/African American MSM, incidence increased. HIV continues to be a major public health burden, disproportionately affecting several populations in the United States, especially MSM and racial and ethnic minorities. Expanded, improved, and targeted prevention is necessary to reduce HIV incidence.Item National Stakeholder Strategy for Achieving Health Equity(2011) Beadle, Mirtha R.; Graham, Garth N.The National Stakeholder Strategy for Achieving Health Equity provides a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities -- and other underserved groups -- reach their full health potential. The strategy -- a product of the National Partnership for Action (NPA) -- incorporates ideas, suggestions and comments from thousands of individuals and organizations across the country. Local groups can use the National Stakeholder Strategy to identify which goals are most important for their communities and adopt the most effective strategies and action steps to help reach them.Item Examining the Health Disparities Research Plan of the National Institutes of Health: Unfinished Business(National Academies Press, 2006) Thomson, Gerald E.; Mitchell, Faith; Williams, MoniqueIn the United States, health among racial and ethnic minorities, as well as poor people, is significantly worse than the overall U.S. population. Health disparities are reflected by indices such as excess mortality and morbidity and shorter life expectancy. Examining the Health Disparities Research Plan of the National Institutes of Health is an assessment of the National Institutes of Health (NIH) Strategic Research Plan and Budget to Reduce and Ultimately Eliminate Health Disparities. It focuses on practical solutions to remedy the state of the current health disparity crisis. The NIH has played the leading role in conducting extensive research on minority health and health disparities for more than two decades. Although additional research is critical to facilitating a better understanding of the overarching social, economic, educational, and environmental factors that predispose groups to specific diseases and conditions, there is also a great need to translate the existing and new information into best care practices. This means increasing communication with affected populations and their communities. Examining the Health Disparities Research Plan of the National Institutes of Health presents solutions to improving the health disparities nationwide and evaluates the NIH strategy plan designed to actively correct and combat the ongoing health disparities dilemma.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 Improving Data Collection to Reduce Health Disparities(2011) UNSPECIFIEDMany racial and ethnic minorities, people with disabilities, lesbian, gay, bisexual, and transgender (LGBT) communities, and other commonly underserved populations face unique health challenges, have reduced access to health care and insurance, and often pay the price with poorer health throughout their lives. These underserved populations are less likely to get the preventive care they need to stay healthy and are more likely to suffer from serious illnesses like diabetes and heart disease. When these populations do get sick, they are less likely to have access to quality health care. As a result, health disparities persist.Item Study to Examine Type II Diabetes & Race Differences in NNY(2011) SUNY , PotsdamA SUNY Potsdam professor and a student researcher are conducting a study, funded by the College's Kilmer Undergraduate Research Award, to examine the health status of the North Country's population. Dr. Kelly Bonnar, an assistant professor in the Department of Community Health, and senior Samantha Paige of Norfolk, N.Y., are surveying Northern New York residents to determine whether there are disparities, or avoidable differences, in Type II Diabetes between area residents of different races and ethnicities.Item Toward a fourth generation of disparities research to achieve health equity(2011) Thomas, Stephen B.; Quinn, Sandra Crouse; Butler, James; Fryer, Craig S.; Garza, Mary A.Achieving health equity, driven by the elimination of health disparities, is a goal of Healthy People 2020. In recent decades, the improvement in health status has been remarkable for the U.S. population as a whole. However, racial and ethnic minority populations continue to lag behind whites with a quality of life diminished by illness from preventable chronic diseases and a life span cut short by premature death. We examine a conceptual framework of three generations of health disparities research to understand (a) data trends, (b) factors driving disparities, and (c) solutions for closing the gap. We propose a new, fourth generation of research grounded in public health critical race praxis, utilizing comprehensive interventions to address race, racism, and structural inequalities and advancing evaluation methods to foster our ability to eliminate disparities. This new generation demands that we address the researcher's own biases as part of the research process.Item Rectifying Institutional Bias in Medical Research(2009) Saha, SomnathIncreasing the representation of women and racial and ethnic minorities in human research has become a national priority. Federal agencies have made inclusion of women and minorities an explicit criterion on which applications for clinical research funding are judged.1 The need for this affirmative action stems from a historical bias favoring white men. As with most other institutions in the United States, medical research no longer actively excludes women and minorities. But the history of these institutions, the way they were designed and built—predominantly by and for white men—slants them in a way that continues to limit access for other groups. Federal efforts to remedy this institutional bias have not been very successful. Data from cancer clinical trials suggest that minority representation in research has not only failed to increase but has actually declined over time.