Statistics for Spatial Data.

www.mobilehealthmap.org 617‐442‐3200 New research shows that mobile health clinics improve health outcomes for hard to reach populations in cost‐effective and culturally competent ways . A Harvard Medical School study determined that for every dollar invested in a mobile health clinic, the US healthcare system saves $30 on average. Mobile health clinics, which offer a range of services from preventive screenings to asthma treatment, leverage their mobility to treat people in the convenience of their own communities. For example, a mobile health clinic in Baltimore, MD, has documented savings of $3,500 per child seen due to reduced asthma‐related hospitalizations. The estimated 2,000 mobile health clinics across the country are providing similarly cost‐effective access to healthcare for a wide range of populations. Many successful mobile health clinics cite their ability to foster trusting relationships. Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves. A communications academic argued that mobile health clinics’ unique use of space is important in facilitating these relationships. Mobile health clinics park in the heart of the community in familiar spaces, like shopping centers or bus stations, which lend themselves to the local community atmosphere.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Economics and Information Theory

While urban disamenities and pollution sources have received considerable attention in environmental justice research, few studies have examined sociospatial inequities associated with the distribution of desirable land uses. In this paper we focus on addressing this limitation by investigating the environmental equity implications of street trees—an important publicly financed amenity that provides several direct and indirect benefits to urban residents. The specific objective was to determine if the spatial distribution of public right-of-way trees is equitable with respect to race and ethnicity, income, and housing tenure in the city of Tampa, Florida, USA. We seek to extend research on equity analysis of urban amenities through several methodological innovations, including: (a) accounting for the heterogeneity of urban land use; (b) utilizing high-resolution remote sensing techniques to quantify parcel-specific tree cover; and (c) using multivariate regression models that control for spatial dependenc...

Street Trees and Equity: Evaluating the Spatial Distribution of an Urban Amenity

Recent advances in alcohol research continue to build our understanding of alcohol consumption and related consequences for U.S. ethnic minority groups. National surveys show variations across ethnicities in drinking, alcohol use disorders, alcohol problems, and treatment use. Higher rates of high-risk drinking among ethnic minorities are reported for Native Americans and Hispanics, although within-ethnic group differences (e.g., gender, age-group, and other subpopulations) also are evident for ethnicities. Whites and Native Americans have a greater risk for alcohol use disorders relative to other ethnic groups. However, once alcohol dependence occurs, Blacks and Hispanics experience higher rates than Whites of recurrent or persistent dependence. Furthermore, the consequences of drinking appear to be more profound for Native Americans, Hispanics, and Blacks. Disparities in alcohol treatment utilization are most apparent for Hispanics. Explanations for these differences are complex, likely affected by risky drinking behaviors, immigration experiences, racial/ethnic discrimination, economic and neighborhood disadvantage, and variations in alcohol-metabolizing genes. Research must maintain a systematic, strong, and growing focus on ethnic minorities. A more complete understanding of these effects for ethnic minority groups is needed to enable researchers to face the challenges of reducing and ultimately eliminating health disparities in the alcohol field.

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Ethnicity and Health Disparities in Alcohol Research

Reducing racial and ethnic disparities in health is a national priority with large potential benefits to the nation (U.S. Department of Health and Human Services 2000). Reducing mortality among African Americans to levels experienced by white Americans would have prevented over 880,000 deaths between 1991 and 2000 (Woolf et al. 2004). Racial disparities in alcohol-related morbidity and mortality are of special concern given the relationship between alcohol consumption and numerous other health conditions. Alcohol consumption is causally related to more than 60 medical conditions and responsible for about 4 percent of the global burden of disease, roughly the same share of death and disability attributable to hypertension or tobacco consumption (Room et al. 2005). In the United States, approximately 8.5 percent of adults meet Diagnostic and Statistical Manual of Mental Disorders 4th Edition criteria for alcohol abuse or dependence (Grant et al. 2004). The considerable burden of alcohol-related health problems falls disproportionately on African American and other minority populations, who have two to five times the rate of alcohol morbidity and mortality than whites, despite similar lifetime prevalence of frequent problem drinking (Group for the Advancement of Psychiatry 1996; Caetano 2003; Grant et al. 2004).

Racial disparities in adverse drinking consequences to health are not well understood and could result from a number of factors, including differences in access to health care, economic resources generally, social and cultural practices, and drinking preferences and patterns (Blendon et al. 1989; Mayberry et al. 2000; Williams and Collins 2001; Caetano 2003; Fiscella and Williams 2004; Bluthenthal et al. 2005). Differences in alcohol treatment services are another potential explanation. Generally, treatment for alcohol abuse and dependence has been shown to reduce medical problems and medical care expenditures (Holder and Blose 1992; Holder et al. 2000). However, rates of publicly funded treatment utilization among African Americans and Hispanics were already nearly twice the rate of whites in the United States as of the mid-1990s, reversing a pattern of comparatively lower utilization in earlier decades (Group for the Advancement of Psychiatry 1996). Whether racial differences in the effectiveness of treatment exist has yet not been adequately studied. The few studies that have examined the issue have produced mixed results. For example, in Project Match, a clinical trial that randomized alcohol treatment clients to three psychosocial therapies, racial differences in treatment adherence were eliminated after controlling for occupation (Tonigan 2003). A small number of naturalistic studies have also found lower retention for African Americans compared with whites, but in no case have these findings prompted adequate discussion or a follow-on research study (Wickizer et al. 1994; Veach et al. 2000; Hser et al. 2001).

In this article, we compare rates of treatment completion among white, African American, and Hispanic patients with alcohol problems at all publicly funded outpatient and residential treatment programs in Los Angeles, which, after New York, is home to the largest publicly funded system of drug and alcohol treatment services in the nation (U.S. Department of Health and Human Services 2003).1 We aim to establish whether significant differences in completion of alcohol treatment exist and whether differences in patient characteristics are related to any racial differences in treatment completion rates identified. Three research questions guide our analysis:



Are African American and Hispanic patients less likely to complete treatment than white patients?


Do African American, Hispanic, and white patients differ in ways that would be expected to lead to differences in treatment completion based on the treatment literature?


if so, to what extent can differences in patient factors explain differences in completion?




We hypothesize that four sets of characteristics previously associated with treatment outcomes are related to racial/ethnic differences in treatment completion: demographics; addiction severity; economic resources; and source of referral, particularly when resulting from legal involvement. While particular studies have documented associations between each of these characteristics and retention (e.g., McClellan et al. 1994; Wickizer et al. 1994; Young and Belenko 2002), findings in the retention literature have varied from sample to sample. To date no set of predictors that is consistent across samples has been identified. The positive effect of legal coercion into treatment on treatment retention is probably the most consistent finding in this literature (Anglin and Hser 1990).

/pdf/racial-disparities-in-completion-rates-from-publicly-funded-2srmtmhhjx.pdf

Racial disparities in completion rates from publicly funded alcohol treatment: economic resources explain more than demographics and addiction severity.

Objective: To determine whether racial and ethnic disparities in publicly funded alcohol treatment completion are due to racial differences in attending outpatient and residential treatment. Methods: Statistical analysis of alcohol treatment completion rates using alcohol treatment patients’ discharge records from all publicly funded treatment facilities in Los Angeles County from 1998 to 2000 (n = 10,591). Results: Among these patients, African American (OR = 0.52; 95% CI 0.47, 0.57) and Hispanic (OR = 0.89; 95% CI 0.81, 0.99) patients were significantly less likely to complete treatment as compared with White patients. We found that the odds of being in outpatient versus residential care were 1.42 (95% CI 1.29, 1.55) and 2.05 (95% CI 1.85, 2.26) for African American and Hispanic alcohol treatment patients, respectively, compared with White patients. Adjusting for addiction characteristics, employment, other patient-level factors that might influence treatment enrollment, and unobserved facility-level differences through a random effects regression model, these odds increased to 1.89 (95% CI 1.22, 2.94) for African American and to 2.12 (95% CI 1.40, 3.21) for Hispanics. We developed a conditional probability model to assess the contribution of racial differences in treatment modality to racial disparities in treatment completion. Estimates from this model indicate that were African American and Hispanic patients observed in outpatient care in this population to have the same probability of receiving residential care as White patients with otherwise similar characteristics, the White–African American difference in completion rates would be reduced from 13.64% (95% CI 11.58%, 15.71%) to 11.09% (95% CI 8.77%, 13.23%) and the White–Hispanic difference would disappear, changing from 2.63% (95% CI 0.29%, 4.95%) to )0.45% ()3.52%, 2.43%). Conclusion: It appears that reductions in racial disparities in treatment completion could be gained by increasing enrollment in residential alcohol treatment for African American and Hispanic alcohol abusers in Los Angeles County. Further research addressing why minority alcohol abusers are less likely to receive residential alcohol treatment should be conducted, as well as research that examines why African American alcohol treatment patients have lower completion rates as compared with White patients regardless of treatment modality.

Are racial disparities in alcohol treatment completion associated with racial differences in treatment modality entry? Comparison of outpatient treatment and residential treatment in Los Angeles County, 1998 to 2000.

Racial Disparities in Completion Rates from Publicly Funded Alcohol Treatment

Objective To estimate the numbers of female sex workers (FSW) and men who have sex with men (MSM) in San Salvador, El Salvador. Design and methods A capture–recapture exercise was conducted among MSM and FSW in San Salvador in 2008. The first capture was done by distributing key chains to both MSM and FSW populations through local non-governmental organizations (NGO) that work with these groups. The second capture was done during the course of an integrated behavioural and biological survey (IBBS) using respondent-driven sampling (RDS). The proportion receiving a key chain estimated from the IBBS study was adjusted by RDS-derived weights. Results The first capture included 400 FSW and 400 MSM. Of the 624 MSM interviewed in the IBBS, 36 (5.8% crude; 3.2% adjusted RDS) had received the key chain. The estimated population size of MSM in San Salvador was 12 480 (95% CI 7235 to 17 725). Of the 663 FSW interviewed in the IBBS, 39 (5.9% crude; 6.9% adjusted RDS) had received the key chain. The estimated number of FSW was 5765 (95% CI 4253 to 7277). Conclusions The capture–recapture exercise was successfully linked to an IBBS to obtain city-level population sizes for MSM and FSW, providing valuable information at a low cost. Size estimates are crucial for programme planning for national AIDS programmes, NGOs and stakeholders working with these populations and for HIV projection models.

https://sti.bmj.com/content/sextrans/87/4/279.full.pdf

How many men who have sex with men and female sex workers live in El Salvador? Using respondent-driven sampling and capture–recapture to estimate population sizes

A Multilevel Decomposition Approach to Estimate the Role of Program Location and Neighborhood Disadvantage in Racial Disparities in Alcohol Treatment Completion

Jerry O. Jacobson

Papers

Racial disparities in completion rates from publicly funded alcohol treatment: economic resources explain more than demographics and addiction severity.

Are racial disparities in alcohol treatment completion associated with racial differences in treatment modality entry? Comparison of outpatient treatment and residential treatment in Los Angeles County, 1998 to 2000.

Racial Disparities in Completion Rates from Publicly Funded Alcohol Treatment

How many men who have sex with men and female sex workers live in El Salvador? Using respondent-driven sampling and capture–recapture to estimate population sizes

A Multilevel Decomposition Approach to Estimate the Role of Program Location and Neighborhood Disadvantage in Racial Disparities in Alcohol Treatment Completion