Showing papers in "Journal of Health Care for the Poor and Underserved in 1997"
TL;DR: Characteristics of ambulatory service utilization for adolescents aged 11 through 17 were examined and inequities were related more to lack of usual source of care rather than socioeconomic characteristics.
Abstract: Using data from the 1987 National Medical Expenditure Survey, characteristics of ambulatory service utilization for adolescents aged 11 through 17 were examined. Access to health care was further explored by identifying adolescents at risk of not receiving an ambulatory service in the event of symptomatology. Approximately two-thirds of an estimated 25 million adolescents experienced an outpatient visit. African American race, Hispanic ethnicity, middle income, and lack of insurance and a usual source of care placed adolescents at risk for not receiving an ambulatory service. Sixteen million adolescents experienced symptomatology, but only one-third saw a physician. Those lacking a usual source of care were at greater odds of not receiving care. For symptom-based care, inequities were related more to lack of usual source of care rather than socioeconomic characteristics. Health care reform efforts may benefit from ensuring that adolescents have an identified usual source of care to ensure equity of access to care.
79 citations
TL;DR: A medical terminology achievement reading test administered to patients was developed for health care practitioners and researchers and it was thought that its design and use of medical terminology makes the MART less threatening to patients than other literacy tests.
Abstract: A medical terminology achievement reading test (MART) administered to patients was developed for health care practitioners and researchers. In this study, 405 respondents from five populations (nursing home patients, college students, high school students, adult basic education students, and shopping mall customers) took both the MART and the Wide Range Achievement Test (WRAT). Cronbach's reliability test alpha indicated a high level (alpha = 0.98) of likelihood that the MART score is a good estimate of the true score (WRAT), and, therefore, reading ability. MART is designed to resemble a prescription label with its use of small print size, glossy cover, and medical terminology. This design allows practitioners and researchers to assess patients' inability to read the test. It is thought that its design and use of medical terminology makes the MART less threatening to patients than other literacy tests. Further studies of the MART in low-literate populations could determine whether this is true.
68 citations
TL;DR: Community-based programs at locations where people congregate—for example, churches, barbershops, beauty salons, firehouses, housing projects, and worksites—can play a valuable role in increasing the number of African American hypertensives who receive treatment.
Abstract: Hypertension is the number one public health problem in the United States, particularly among African Americans. Although the National High Blood Pressure Education Program, started in 1972, led the way to a substantial decrease in morbidity and mortality from this disease, the percentage of African American hypertensives whose condi- tions are detected, treated, and controlled continues to lag behind that of white hypertensives. Community-based programs at locations where people congregate—for example, churches, barbershops, beauty salons, firehouses, housing projects, and worksites—can play a valuable role in increasing the number of African American hypertensives who receive treatment. Physicians can be a potent force for the development of these programs by acting as consultants to define the scope and function of lay volunteers and by promoting these programs in a variety of other ways.
56 citations
TL;DR: The Healthy Heart Community Prevention Project is an ongoing program of cardiovascular risk identification and modification in the African American community in New Orleans, Louisiana, which continues to have higher rates of coronary heart disease, stroke, and overall cardiovascular mortality than the general population.
Abstract: The Healthy Heart Community Prevention Project (HHCPP) is an ongoing program of cardiovascular risk identification and modification in the African American community in New Orleans, Louisiana. The program targets low socioeconomic status African American populations, which continue to have higher rates of coronary heart disease, stroke, and overall cardiovascular mortality than the general population. Among the HHCPP's initiatives have been the use of barbershops and beauty salons as blood pressure screening sites. Church-based programs, in which ministers provide "healthy heart sermons," as well as screenings at sports events, where volunteers provide health advice, have proven to be successful aspects of the program. The HHCPP has also offered educational sessions to a broad cross-section of health professionals, including physicians as well as nurse practitioners and nutritionists. Future initiatives include the establishment of cholesterol screening programs.
56 citations
TL;DR: Findings from a survey of 134 homeless people living in 42 urban encampments in central Los Angeles suggest that public hospitals and clinics remain the major source of primary medical care for homeless peopleliving in encampments.
Abstract: This paper reports findings from a survey of 134 homeless people living in 42 urban encampments in central Los Angeles. These data, of concern to public health officials, include the physical conditions in the camps, the health status of residents, their use of drugs and alcohol, and their access to and use of health care services such as substance abuse treatment. Many encampment residents report poor health status; over 30 percent report chronic illnesses, and 40 percent report a substance abuse problem. Although outreach efforts have had success in bringing HIV and tuberculosis screening services to encampments, residents report significant barriers to using primary health care and drug and alcohol treatment services. Public hospitals and clinics remain the major source of primary medical care for homeless people living in encampments. Outreach and case management continue to be critical components of improved access to health care for homeless people.
51 citations
TL;DR: Fear, embarrassment, susceptibility to breast cancer, inconvenience, cost, concerns about efficacy of mammography, fear of acquiring cancer, and scheduling difficulties were identified as important concerns.
Abstract: Although overall use of mammography is steadily increasing, low-income and minority women consistently have relatively lower screening rates than white, middle-class women. To assess the mammography-seeking behavior of low-income women using an urban public hospital, this study sought to understand why women in this population decide whether or not to obtain a screening mammogram. Two qualitative techniques, elicitation interviews and focus groups, were used to develop an understanding of attitudes, concerns, and barriers of this group relative to mammography. Fear, embarrassment, susceptibility to breast cancer, inconvenience, cost, concerns about efficacy of mammography, fear of acquiring cancer, and scheduling difficulties were identified as important concerns. "People in the news" were the most influential social referents for mammography decision making, followed by physicians, family members, and friends. The insights gained from these women will assist in developing interventions that encourage mammography-seeking behavior by low-income women.
45 citations
TL;DR: Risk factor levels in youth can predict CVD events several years later; predictors may differ between racial groups, and best predictors were cigarette smoking, cholesterol, and paternal history in white physicians, and blood pressure in African American physicians.
Abstract: Differences in cardiovascular disease (CVD) were studied in a cohort of medical students from the classes of 1958-65 of Meharry Medical College (n = 435), all African Americans, and the classes of 1957-64 of Johns Hopkins University (n = 580), all white. At baseline, African Americans were older (27 vs. 24 years, p = 0.001), more likely to smoke (71 vs. 47 percent), had greater body mass index (24 vs. 23 kg/m), and had higher systolic blood pressure (120 vs. 116 mmHg). At follow-up (23-35 years later), African American physicians had higher CVD risk (RR = 1.65, 95% CI = 1.3-2.41), higher incidence of coronary artery disease (1.4 times), and much higher case fatality (51.5 vs. 9.4 percent). Risk factor levels in youth can predict CVD events several years later; predictors may differ between racial groups. Best predictors were cigarette smoking, cholesterol, and paternal history in white physicians, and blood pressure in African American physicians.
42 citations
TL;DR: Results showed that Latino Americans had higher continuity of care with their regular physician than white or African Americans, and the need to consider not only access to care but the nature of the provider-patient relationship is drawn.
Abstract: This study used data from the 1987 National Medical Expenditure Survey to examine African and Latino Americans' reliance on a regular provider for medical care. Results showed that Latino Americans had higher continuity of care with their regular physician than white or African Americans. Persons with low continuity of care had one-third higher average health care expenditures per year than those with high continuity of care. Multivariate analyses indicated that the availability of medical services during the evenings and weekends enhanced the degree of continuity for white Americans; medical services during the evenings enhanced the degree of continuity for some Latino Americans. Controlling for other characteristics, the degree of continuity of care varied by both the race/ethnicity of respondent and the race/ethnicity and gender of their regular physician. These findings draw attention to the need to consider not only access to care but the nature of the provider-patient relationship.
36 citations
TL;DR: Given the high prevalence of overweight among African Americans, especially women, the issue is not whether weight reduction should be a component of hypertension prevention and treatment but how to design and implement programs that will help overweight African American men and women achieve permanent weight loss.
Abstract: Blood pressure is strongly related to body weight, and control of obesity is a critical component of hypertension prevention and control. Data from multicenter studies such as the Trials of Hypertension Prevention, the Trials of Antihypertensive Interventions and Management, and the Trial of Nonpharmacologic Interventions in the Elderly help to set aside previous questions about whether the association of obesity with hypertension applies to African Americans. Given the high prevalence of overweight among African Americans, especially women, the issue is not whether weight reduction should be a component of hypertension prevention and treatment but how to design and implement programs that will help overweight African American men and women achieve permanent weight loss. Modest weight losses can not only prevent or reverse blood pressure elevations but also have a favorable impact on obesity-related cardiovascular risk factors such as diabetes and hyperlipidemia.
32 citations
TL;DR: Effective church-based community health programs must take a holistic approach when dealing with health problems among African Americans, and stress ways to improve the quality of life, in keeping with the messages conveyed by the church.
Abstract: Effective church-based community health programs must take a holistic approach when dealing with health problems among African Americans. Such an approach emphasizes the relationship between the physiological, psychological, and spiritual selves. These programs must also ensure the complete involvement of clergy and church members, who can participate in programs by providing a certain level of skill, thereby engendering a sense of partnership in the process. Also necessary is an emphasis on healthy living instead of a fear of dying. Rather than framing health issues in mortality statistics, church-based programs need to stress ways to improve the quality of life, in keeping with the messages conveyed by the church. By taking these approaches, health organizations will find a religious community more willing to accept health messages.
30 citations
TL;DR: HIV seroprevalence appears to be associated with socioeconomic status in this group of voluntarily tested individuals in Massachusetts, and low-income ZIP codes in Massachusetts were four times more likely to have high serop revalence rates among residents voluntarily testing for HIV.
Abstract: Although anecdotal information suggests that there is a relationship between socioeconomic status and HIV risk, there have been few investigations of that possible relationship Understanding that relationship can have important implications for designing and implementing prevention programs This study investigated the relationship between indicators of socioeconomic status and HIV prevalence in Massachusetts using seroprevalence data from publicly funded test sites HIV seroprevalence was found to differ depending on demographic groups and the health care insurance/provider Those who had no insurance or were Medicaid recipients had higher rates of HIV infection Homeless individuals were also at higher risk Further, low-income ZIP codes in Massachusetts were four times more likely to have high seroprevalence rates among residents voluntarily testing for HIV Thus, HIV seroprevalence appears to be associated with socioeconomic status in this group of voluntarily tested individuals
TL;DR: It was found that African American children had significantly fewer primary care visits than their white counterparts, even after adjusting for potential confounding variables, and it is concluded that racial disparity exists in primary care access among children with asthma.
Abstract: Asthma-related hospitalizations and mortality have risen at alarming rates in the past two decades, taking a disproportionate toll on African American children. Adverse asthma outcomes have been attributed to inadequacies in primary care, raising concerns about the quality of primary care delivered to African American children. To assess differences in care between African American and white children, the authors identified 500 children enrolled in Massachusetts Medicaid and hospitalized for asthma, and reviewed their medical claims data for the six-month period after hospitalization. It was found that African American children had significantly fewer primary care visits than their white counterparts, even after adjusting for potential confounding variables. In contrast, emergency service utilization did not differ by race. The authors conclude that racial disparity exists in primary care access among children with asthma. Interventions should be designed to target poor African American children who suffer disproportionately from this life-threatening yet treatable disease.
TL;DR: The results suggest that there is need for the development of public policies that seek to increase Latinas' labor force participation rate since any expansion has the potential to have a positive impact on their health status.
Abstract: This paper explores the relative effects of employment and family responsibility on the perceived health status of Latino women. The data source analyzed for this study was the 1990 Panel Study of Income Dynamics/Latino National Political Survey (PSID/LNPS) Early-Release File (n = 1,502). Regression analyses were used to investigate the contributions of variables associated with perceived health status, including sociodemographics, Latino ethnicity, language, employment, and family responsibility. The results suggest that annual employment hours, occupation, and family responsibilities, such as child care and weekly housework, significantly affect self-reported health status of employed Latinas. Both social causation and social selection may be underlying the associations found. The results suggest that there is need for the development of public policies that seek to increase Latinas' labor force participation rate since any expansion has the potential to have a positive impact on their health status.
TL;DR: A two-year community-based project was initiated to reduce the incidence of stroke and its associated risk factors among African Americans in Tennessee, using both adults and youth as mentors.
Abstract: African Americans have a higher rate of stroke than other U.S. population groups. As part of the U-state "Stroke Belt" region, Tennessee has the fifth highest death rate from stroke in the country. In 1993, a two-year community-based project was initiated to reduce the incidence of stroke and its associated risk factors among African Ameri- cans. Three counties, Shelby (Memphis), Davidson (Nashville), and Hamilton (Cfattanooga), were selected as project sites because of their large African American populations. Specific objectives of the project were to promote risk factor awareness in African Americans, assist African American churches and community groups in developing and implement- ing intervention programs/and build the capacity for intervention pro- grams within African American communities by collaborating with a variety of community organizations. This article describes the program's approach, which included using both adults and youth as mentors. In addition, it presents major accomplishments and lessons learned in project implementation.
TL;DR: An analysis of data collected for the Ryan White Care Act needs assessment in Houston, Texas, was performed to assess the effects of socioeconomic and demographic factors on unmet needs for existing medical, social, and counseling services, and indicated that lower income and Hispanic ethnicity were associated with the unmet need for medical services.
Abstract: HIV/AIDS is indicative of general institutional neglect that disproportionately affects minorities, poor, and underserved populations. Among women and minorities, HIV infection is associated with preexisting economic distress. Moreover, socioeconomic resources, gender, and race/ethnicity may determine access to medical and nonmedical services that affect disease progression. An analysis of data collected for the Ryan White Care Act needs assessment in Houston, Texas, was performed to assess the effects of socioeconomic and demographic factors on unmet needs for existing medical, social, and counseling services, adjusting for the effects of illness and substance abuse. Results indicated that lower income and Hispanic ethnicity were associated with the unmet need for medical services. Higher income was positively associated and African American ethnicity was negatively associated with the unmet need for social services. Also, higher income and private insurance were negatively associated with counseling services. The authors suggest that these latter findings may result from program eligibility requirements and respondents' hierarchy of needs, respectively.
TL;DR: All patients who smoke be offered smoking cessation treatments such as nicotine replacement therapy, social supports, and skills training to achieve smoking abstinence, and such treatments should also include nutritional counseling and programs of appropriate physical activity.
Abstract: One-fifth of all heart disease-related deaths are due to cigarette smoking. Smoking alone doubles the risk of heart failure. African Americans suffer the highest death rates from smoking among all U.S. population groups. Excess risk of heart disease caused by smoking can be reduced by half after just one year of quitting smoking. Therefore, the Agency for Health Care Policy and Research recommends that all patients who smoke be offered smoking cessation treatments such as nicotine replacement therapy, social supports, and skills training to achieve smoking abstinence. Such treatments should also include nutritional counseling and programs of appropriate physical activity. Other strategies to reduce the prevalence of smoking among youth include curtailing marketing efforts that glamorize smoking and strict enforcement of the minimum-age-of-sale laws. With proper nutrition, moderate physical activity, and the cessation of smoking, the risk factors associated with heart disease could be greatly reduced.
TL;DR: Logistic regression indicated that those with reported chronic disease, males, whites, and those living on the street were more likely to have returned to the clinic for care than those without chronic illness, females, nonwhites, andThose living in some type of shelter.
Abstract: Associations between characteristics of homeless clients and their return visits to a nurse-managed primary health care clinic were examined using a retrospective chart review of 1,467 records from clients seen between 1991 and 1994. Client characteristics examined included age, education, race, gender, sheltered status, report of chronic disease, and report of family living in the area. Only 47 percent of clients made return visits to the clinic. Logistic regression indicated that those with reported chronic disease, males, whites, and those living on the street were more likely to have returned to the clinic for care than those without chronic illness, females, nonwhites, and those living in some type of shelter. Results suggest the need for program planning and evaluation for this population, which particularly considers women, nonwhites, and those without chronic disease as target groups for services.
TL;DR: The results of a community health outreach program conducted during the 1994 and 1995 migrant seasons to provide tuberculosis screening and treatment for migrant farmworkers and their families in Orleans and Monroe Counties in northwest New York State are described.
Abstract: There are an estimated 3 to 5 million migrant and seasonal farmworkers in the United States working in every state. Migrant farmworkers have more health problems and suffer from infectious diseases more frequently than the general population.1"4 Tuberculosis is one of the chief public health concerns in migrant farmworkers, up to 48 percent of whom have positive purified protein derivative (PPD)-tuberculin skin tests.5 This paper describes the results of a community health outreach program conducted during the 1994 and 1995 migrant seasons to provide tuberculosis screening and treatment for migrant farmworkers and their families in Orleans and Monroe Counties in northwest New York State. This area is home to an estimated 3,000 migrant and seasonal farmworkers during the months of June through November. Migrant farmworkers face a number of barriers in obtaining health care, including lack of health insurance, language and cultural differences, uncertain immigration status, fear of deportation, and different interpretations of health and illness.6'7 Several studies have documented the multiple problems migrant farmworkers encounter in obtaining health care services.6'8"10 It is estimated that migrant health centers serve less than 20 percent of migrant farmworkers in the United States.111
TL;DR: A faith-based center of excellence model is proposed that would establish a middle ground between the secular and "sacred" aspects of health care, thus providing a new model of ministry.
Abstract: Churches are often caught in the middle of the struggle between health care institutions and managed care organizations. A faith-based center of excellence model is proposed that would establish a middle ground between the secular and "sacred" aspects of health care. Such a model would focus on using the faith community to influence the behavior and lifestyle of persons within the organized public health model, thus providing a new model of ministry. This process can increase an understanding of the tools needed for the clergy to be better caregivers, more influential co-change agents, and more informed about data-driven outcome ministry. This integrated process is critical for real change in health outcomes, for the improvement of primary prevention, and for reducing disease mortality.
TL;DR: A framework is provided that contrasts the structure, process, and outcome characteristics of these two models, delineating key similarities and differences and is used in profiling a service delivery system model that integrates the two systems and in discussing issues related to operationalizing the proposed integration.
Abstract: Motivated by the need for fundamental change, reform of the health care delivery system is continuing despite the recent failure of national initiatives. One aspect of this reform is the restructuring of managed care systems to include low-income, at-risk populations in their health delivery programs. It is a move that threatens current "safety-net" providers, which already serve these populations with programs that combine public health and traditional primary care. This paper explores this potential conflict by providing a brief history and comparison of the main features of the community-oriented primary care (COPC) and health maintenance organization (HMO) models. The authors provide a frame- work that contrasts the structure, process, and outcome characteristics of these two models, delineating key similarities and differences. The frame- work is used in profiling a service delivery system model that integrates the two systems and in discussing issues related to operationalizing the proposed integration.
TL;DR: This paper uses secondary data to analyze trends in access to family planning services, with a particular focus on poor women and young women, to ensure that pregnancies are intended and not the result of lack of access to effectivefamily planning services.
Abstract: Family planning services are important because they can prevent unintended pregnancies and improve prenatal outcomes. This paper uses secondary data to analyze trends in access to family planning services, with a particular focus on poor women and young women. Trends from the 1980s showed a small decline in family planning visits and an upsurge in the percentage of births that were unwanted at the time of conception. These changes were particularly marked for poor women. Over the same decade, public expenditures for contraceptive services declined dramatically. The health insurance system with respect to family planning must be modernized to meet the needs of women and couples today. Future improvements in infant health and survival will depend in large part on ensuring that pregnancies are intended and not the result of lack of access to effective family planning services.
TL;DR: A working group on research in Coronary Heart Disease in Blacks identified 10 priority research areas, which are treatment, epidemiology, evaluation of chest pain and diagnosis of CHD, prevention and behavior, risk factors, genetics, vascular biology, left ventricular hypertrophy, coronary microvasculature, and sudden cardiac death.
Abstract: Research on coronary heart disease (CHD) has contributed to the decline in cardiovascular disease morbidity and mortality during the past three decades. However, life expectancy and rates of illness and death from CHD have not improved for blacks as for whites. Blacks have not experienced the full benefit of research advancements for a variety of reasons, including insufficient scientific data, lack of research focused on minority populations, and limited access to health care resources and technology. In order to address these disparities in prevention, diagnosis, treatment, and outcomes of CHD in blacks, the National Heart, Lung, and Blood Institute converted a Working Group on Research in Coronary Heart Disease in Blacks. In its deliberations, the working group identified 10 priority research areas, which are treatment, epidemiology (data collection and analysis), evaluation of chest pain and diagnosis of CHD, prevention and behavior, risk factors, genetics, vascular biology, left ventricular hypertrophy, coronary microvasculature, and sudden cardiac death.
TL;DR: This review provides strategies for the suppression, containment, and eventual eradication of resurgent tuberculosis among ethnic minority communities.
Abstract: This review provides strategies for the suppression, containment, and eventual eradication of resurgent tuberculosis. Some ethnic minority communities are at greatest risk because of the prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome, poverty and malnutrition, congregate living situations, aberrant lifestyles, illegal immigration, and underemployment among these populations. Proposed strategies include the education of the population at risk as well as health care providers to permit the optimization of preventive, diagnostic, and therapeutic technologies. Also necessary is the development of effective, safe, newer medications to enhance patient compliance and decrease drug resistance. Strategic planning embraces national socioeconomic policy to permit adequate resources to combat poverty and malnutrition, to rebuild the infrastructure of the public health system, and to improve access to health care among rural and urban dwellers. It is concluded that these efforts must continue to ensure the eradication of tuberculosis.
TL;DR: It was found that community and migrant health centers have higher percentages of minorities in top management positions than general management but do not necessarily reflect the minority composition of those being served, and there is room for improvement.
Abstract: Community and migrant health centers (CHC/MHCs) play a secondary role as avenues for the development of minority and women health care professionals, groups traditionally underrepresented in admin- istrative and managerial positions within the health care system. This paper focuses on the role of CHC/MHCs in eliminating the barriers that typically limit the professional advancement of these groups. In a survey of both rural and urban CHC/MHC administrators, it was found that CHC/MHCs have higher percentages of minorities in top management positions than general management but do not necessarily reflect the minority composition of those being served. Of the CHC/MHC adminis- trators, 10 percent were African American, less than the population served (31 percent) but greater than the percentage of African Americans in the general U.S. population (12 percent). This suggests that CHC/MHCs have partially met the original goal of upward mobility and that there is room for improvement.
TL;DR: Comparing the costs and care quality of ambulatory visits for two childhood illnesses, urinary tract infection (UTI) and suppurative otitis media (OM), in the fee-for-service Medicaid program in Alabama across three care settings found visits to outpatient hospital departments were more expensive than those to return office settings.
Abstract: Medicaid claims data were used to compare the costs and care quality of ambulatory visits for two childhood illnesses, urinary tract infection (UTI) and suppurative otitis media (OM), in the fee-for-service Medicaid program in Alabama across three care settings: offices where patients had been seen before, offices where patients had not been seen before, and outpatient hospital departments. Forty percent of UTI visits and 46 percent of OM visits occurred in return office settings. Visits to outpatient hospital and first-time office settings were more expensive than those to return office settings, due to the billing of facility fees and the provision of additional services. Adherence to common measures of quality of care for both types of visits was low; 52 percent of UTI visits included urine cultures and 40 percent of OM visits included recheck visits. Adherence to these quality measures was significantly lower in visits occurring in hospital settings.
TL;DR: As the health care system moves in a new direction, toward managed care, the critical role of public health in society's efforts to mitigate illness and the realization of health become more apparent.
Abstract: As the health care system moves in a new direction, toward managed care, the critical role of public health in society's efforts to mitigate illness and the realization cf health become more apparent. Indeed, the public health problems of this era will not yield to simple solutions.They require a multitude o)resources, bothhumanandmaterial, and a myriad of services arrived from these resources. Public health's role is to serve as the government's presence in assessing health status, developing policy, evaluating the effectiveness of policy implementation, and assuring access to ana quality cf comprehensive health services. Increasingly, public health must coordinate a wide array of systems in both the private and public sectors to fulfill its purpose. The decade of the 1990s is a critical turning point for every element of the nation's health services system. Significant advances in biomedical sd- ences and technology are changing health care polides, practices, and proce- dures. Institutions and organizations, in meeting after meeting, are working to balance an inherent optimism about the future with a realistic assessment of the effects of our rapidly changing health service system. Medical schools and teaching hospitals are forming unions in an effort to become more effident in the face of new demands from the other multiple components of the health care system. Some unions have gone far beyond previous partnerships in creating new bastions of research and health care.
TL;DR: The Volunteer State Medical Association has been involved in state health care reform and has formed the Tennessee Coalition for Quality Health Care, a group of African American politicians, physicians, educators, and health care administrators who can negotiate with state and federal officials in the issue of healthCare reform.
Abstract: Health care reform presents both challenges and opportunities for African Americans. On the one hand, reform could result in the closure of black medical institutions and fewer black physicians. On the other hand, reform gives African Americans an opportunity to bargain for available resources to gain equality in health care services. To this end, the Volunteer State Medical Association has been involved in state health care reform. Its goals are to resolve the current financial crisis at black medical institutions; to assist in the survival and development of local black managed care organizations; to assure that all licensed black physicians have continued access to patients; and to develop black-owned health-related businesses. The association has formed the Tennessee Coalition for Quality Health Care, a group of African American politicians, physicians, educators, and health care administrators who can negotiate with state and federal officials in the issue of health care reform.
TL;DR: The model suggests that public opinions are influenced by multiple factors and that race/ethnicity may interact with any number of these factors to explain differences between African Americans and whites in their level of support of alcohol control policies.
Abstract: The incidence of alcohol-related morbidity and mortality in the United States is significant. Ethnic minority communities are particularly vulnerable to alcohol-related problems.1-3 One avenue for reducing these problems is through the implementation of alcohol control policies. Alcohol control policies refer to the constellation of laws and regulations that affects how alcoholic beverages are manufactured, packaged, distributed, sold, and consumed.4 Effective implementation of public policies designed to minimize alcohol-related problems requires a significant level of public support.5,6 Moreover, public attitudes and opinions may well vary significantly across ethnic subgroups, and such differences must be understood for successful implementation of alcohol control policies. Race/ethnicity, however, has not been a major variable of interest in studies of alcohol control policy opinions, despite the debate and controversy that surrounds a number of alcohol control policy initiatives in African American communities (for example, the decision to rebuild liquor stores damaged during the Watts rebellion in South Central Los Angeles). In 1994, the authors designed a five-year study to examine whether African American and white adults differ in their opinions regarding alcohol control policies and whether similar or different factors are related to support for alcohol control policies in the two groups. The purpose of this paper is to describe the overall design of the study. The model on which the present research is based is depicted in Figure 1. The model suggests that public opinions are influenced by multiple factors and that race/ethnicity may interact with any number of these factors to explain differences between African Americans and whites in their level of support of alcohol control policies.
TL;DR: To provide opportunities for minorities in biomedical research, minority institutions must be given expanded opportunities to participate in federally sponsored biomedical research programs and governmental and private agencies need to apprise minority research institutions of the kinds of assistance available and how to access funds.
Abstract: Minorities have long been excluded from biomedical research programs, both as researchers and as study participants. One reason for the dearth of minority researchers is their lack of awareness that federal and private financial assistance programs exist on their behalf. To provide opportunities for minorities in biomedical research, minority institutions must be given expanded opportunities to participate in federally sponsored biomedical research programs. Thus both governmental and private agencies need to appraise minority research institutions of the kinds of assistance available and how to access funds. One means of disseminating such information would be to post it on the Internet. Minority institutions, for their part, must make basic research a priority and engage in mentorship programs that encourage minority precollege students to pursue careers in the sciences. Researchers can gain the trust of African Americans through outreach programs, which may lead to the greater inclusion of this population in clinical trials.