Showing papers in "Journal of Health Care for the Poor and Underserved in 2010"
TL;DR: It is suggested that mistrust remains an important barrier to research participation among African Americans and researchers should incorporate strategies to reduce mistrust and thereby increase participation amongAfrican Americans.
Abstract: This paper describes results of a qualitative study that explored barriers to research participation among African American adults A purposive sampling strategy was used to identify African American adults with and without previous research experience A total of 11 focus groups were conducted Groups ranged in size from 4-10 participants (N=70) Mistrust of the health care system emerged as a primary barrier to participation in medical research among participants in our study Mistrust stems from historical events including the Tuskegee syphilis study and is reinforced by health system issues and discriminatory events that continue to this day Mistrust was an important barrier expressed across all groups regardless of prior research participation or socioeconomic status This study illustrates the multifaceted nature of mistrust, and suggests that mistrust remains an important barrier to research participation Researchers should incorporate strategies to reduce mistrust and thereby increase participation among African Americans
630 citations
TL;DR: A review of the literature is conducted to explore the interaction between race/ethnicity, cultural influences; pain perception, assessment, and communication; provider and patient characteristics; and health system factors and how they might contribute to racial/ethnic disparities in receipt of effective pain management.
Abstract: Introduction. There is reliable evidence that racial/ethnic minorities suffer disproportionately from unrelieved pain compared with Whites. Several factors may contribute to disparities in pain management. Understanding how these factors influence effective pain management among racial/ethnic minority populations would be helpful for developing tailored interventions designed to eliminate racial/ethnic disparities in pain management. We conducted a review of the literature to explore the interaction between race/ethnicity, cultural influences; pain perception, assessment, and communication; provider and patient characteristics; and health system factors and how they might contribute to racial/ethnic disparities in receipt of effective pain management. Methods. The published literature from 1990–2008 was searched for articles with data on racial/ethnic patterns of pain management as well as racially, ethnically, and culturally-specific attitudes toward pain, pain assessment, and communication; provider prescribing patterns; community access to pain medications; and pain coping strategies among U.S. adults. Results. The literature suggests that racial/ethnic disparities in pain management may operate through limited access to health care and appropriate analgesics; patient access to or utilization of pain specialists; miscommunication and/or misperceptions about the presence and/or severity of pain; patient attitudes, beliefs, and behaviors that influence the acceptance of appropriate analgesics and analgesic doses; and provider attitudes, knowledge and beliefs about patient pain.
272 citations
TL;DR: For instance, the authors found that food insecurity is associated with suboptimal glycemic control among adults with diabetes, and the mechanisms for this association have not been studied, but they hypothesized that increased difficulty with diabetes self-management and more frequent episodes of clinically significant hypoglycemia may encourage clinicians to relax glycemic targets.
Abstract: In 2008, 14.6% of households in the United States (more than 49 million people) were food insecure, or at risk of going hungry because of an inability to afford food.1 Food insecurity exists whenever “the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways [e.g., without resorting to emergency food supplies, scavenging, stealing or other coping strategies] is limited or uncertain.”2[p.1560] There are a number of ways in which food insecurity might impair diabetes self-management. First, to maintain caloric intake, food-insecure adults often shift their diets toward energy-dense, nutritionally-poor foods (such as refined carbohydrates, added sugars, and added fats), which diabetic patients are counseled to avoid in order to optimize glycemic control. Such foods are less expensive than equicaloric portions of fruits, vegetables, and dairy products.3,4 Second, daily caloric and carbohydrate intake may fluctuate widely in response to food availability, making blood glucose levels unpredictable and complicating the development of optimal medication and insulin regimens.5,6 Finally, the cost of food among those with food insecurity may present a competing demand with costs of diabetes medication and supplies. Prior research has shown that food insecurity is associated with suboptimal glycemic control among adults with diabetes,7,8 but mechanisms for this association have not been studied. We hypothesized that the association between food insecurity and suboptimal glycemic control is due to increased difficulty with diabetes self-management and more frequent episodes of clinically significant hypoglycemia (which may encourage clinicians to relax glycemic targets).
217 citations
TL;DR: Qualitative issues, challenges, and potential solutions to addressing the collection, analysis, and reporting of disaggregated data on Asian Americans are examined.
Abstract: There are close to 15 million Asian Americans living in the United States, and they represent the fastest growing populations in the country. By the year 2050, there will be an estimated 33.4 million Asian Americans living in the country. However, their health needs remain poorly understood and there is a critical lack of data disaggregated by Asian American ethnic subgroups, primary language, and geography. This paper examines meth- odological issues, challenges, and potential solutions to addressing the collection, analysis, and reporting of disaggregated (or, granular) data on Asian Americans. The article explores emerging efforts to increase granular data through the use of innovative study design and analysis techniques. Concerted efforts to implement these techniques will be critical to the future development of sound research, health programs, and policy efforts targeting this and other minority populations.
180 citations
TL;DR: The Southern Community Cohort Study is a unique national resource for assessing determinants of racial/ethnic differentials in diseases.
Abstract: Summary: Over 73,700 adults age 40–79, nearly 70% African American, were recruited at community health centers across 12 southeastern states; individual characteristics were recorded and biologic specimens collected at baseline for later follow-up. The Southern Community Cohort Study is a unique national resource for assessing determinants of racial/ethnic differentials in diseases.
178 citations
TL;DR: Efforts to assess housed women veterans' risk factors for homelessness should be integrated into clinical care programs within and outside the Veterans Administration.
Abstract: Background. Women veterans are three to four times more likely than non-veteran women to become homeless. However, their risk factors for homelessness have not been defined. methods. Case-control study of non-institutionalized homeless women veterans (n533) and age-matched housed women veterans (n5165). Health, health care, and factors associated with homelessness were assessed using multiple logistic regression with a Monte Carlo algorithm to estimate exact standard errors of the model coefficients and p-values. r esults. Characteristics associated with homelessness were sexual assault during military service, being unemployed, being disabled, having worse overall health, and screening positive for an anxiety disorder or post-traumatic stress disorder. Protective factors were being a college graduate or married. Conclusions. Efforts to assess housed women veterans' risk factors for homelessness should be integrated into clinical care programs within and outside the Veterans Administration. Programs that work to ameliorate risk factors may prevent these women's living situations from deteriorating over time.
129 citations
TL;DR: The role of religiosity is studied: prayer is viewed as fundamental to health, but the church is not perceived as an aid in physical health-seeking, and examples of respondents who navigate between the two systems within the interplay of culture and structure are discussed.
Abstract: Barriers to health care and use of cultural alternatives are studied from open-ended interviews of 96 Latino immigrants, 12 hometown association leaders, and five pastors and health outreach workers. Frequently mentioned barriers to approaching hospitals and clinics included problems in communication, establishing financial eligibility, and extremely long waits for service. We found frequent use of cultural alternatives, such as herbal medications, obtaining care from Mexican doctors, and some use of traditional healers. The role of religiosity is studied: prayer is viewed as fundamental to health, but the church is not perceived as an aid in physical health-seeking. Health care for Latino immigrants often involves a blend of mainstream and traditional medicine; the study discusses examples of respondents who navigate between the two systems within the interplay of culture and structure.
117 citations
TL;DR: Statistically significant improvements in BMI, blood pressure, and academic scores, among low-income Hispanic and White children in particular, were seen in the intervention versus controls.
Abstract: Introduction . Successfully addressing childhood onset obesity requires multilevel (individual, community, and governmental), multi-agency collaboration. Methods . The Healthier Options for Public Schoolchildren (HOPS)/OrganWise Guys® (OWG) quasi-experimental controlled pilot study (four intervention schools, one control school, total N=3,769; 50.2% Hispanic) was an elementary school-based obesity prevention intervention designed to keep children at a normal, healthy weight, and improve health status and academic achievement. The HOPS/OWG included the following replicable, holistic components: (1) modified dietary offerings, (2) nutrition/lifestyle educational curricula; (3) physical activity component; and (4) wellness projects. Demographic, anthropometric (body mass index [BMI]), blood pressure, and academic data were collected during the two-year study period (2004-6). Results . Statistically significant improvements in BMI, blood pressure, and academic scores, among low-income Hispanic and White children in particular, were seen in the intervention versus controls. Conclusion . Holistic school-based obesity prevention interventions can improve health outcomes and academic performance, in particular among high-risk populations.
113 citations
TL;DR: The performance of the Patient Activation Measure for patients attending three inner-city health centers was assessed and resultant scores with those of the general U.S. adult population were compared.
Abstract: Patient activation refers to people's ability to engage in self-management of their health and health care. We assessed the performance of the Patient Activation Measure (PAM) for patients attending three inner-city health centers and compared resultant scores with those of the general U.S. adult population. We approached 801 patients and 527 (65.8%) participated; the majority were Latino(a) or African American/Black. No differences in activation were seen according to age. Males and more educated patients were more activated (p<.05) and patients with better self-rated health and adequate health literacy were more activated than their counterparts (p<.001). Patterns of scores resembled those of the U.S. general population for educational attainment and self-rated health but not for gender and age. Compared with the general population, more patients were characterized as level 1 (least activated). Developing strategies that enhance patient activation is critical to improving health outcomes, particularly in less advantaged populations.
100 citations
TL;DR: This work describes how community-partnered participatory research was used to design Community Partners in Care, a randomized trial of community engagement to activate a multiple-agency network versus support for individual agencies to implement depression QI in underserved communities.
Abstract: Quality improvement (QI) for depression in primary care can reduce disparities in outcomes. We describe how community-partnered participatory research was used to design Community Partners in Care, a randomized trial of community engagement to activate a multiple-agency network versus support for individual agencies to implement depression QI in underserved communities.
91 citations
TL;DR: This study suggests that adding an attorney to the medical team increases awareness of and access to social and legal services and significantly decreased proportions of families avoiding health care due to lack of health insurance or concerns about cost.
Abstract: As a preliminary investigation of the effectiveness of medical-legal partnership in pediatrics, we conducted a 36-month prospective cohort study of the impact of clinic- and hospital-based legal services. We hypothesized that integration of legal services into pedi- atric settings would increase families' awareness of and access to legal and social services, decrease barriers to health care for children, and improve child health. Methods. Health care providers referred families with legal or social needs to the Peninsula Family Advo- cacy Program (FAP). r esults. Fifty four families completed both baseline and six-month follow-up assessments. Comparison of follow-up with baseline demonstrated significantly increased proportions of families who utilized food and income supports and significantly decreased proportions of families avoiding health care due to lack of health insurance or concerns about cost. Two-thirds of respondents reported improved child health and well-being. Conclusions. This study suggests that adding an attorney to the medical team increases awareness of and access to social and legal services.
TL;DR: Self-administered clinician post-visit surveys compared the quality of interpretation and communication, visit satisfaction, degree of patient engagement, and cultural competence of visits using untrained people acting as interpreters, in-person professional, or video conferencing professional interpretation for 283 visits.
Abstract: Linguistic interpretation ameliorates health disparities disfavoring underserved limited English-proficient patients, yet few studies have compared clinician satisfaction with these services. Self-administered clinician post-visit surveys compared the quality of interpretation and communication, visit satisfaction, degree of patient engagement, and cultural competence of visits using untrained people acting as interpreters (ad hoc), in-person professional, or video conferencing professional interpretation for 283 visits. Adjusting for clinician and patient characteristics, the quality of interpretation of in-person and video conferencing modes were rated similarly (OR 1.79, 95% CI 0.74, 4.33). The quality of in-person (OR 5.55, 95% CI 1.50, 20.51) and video conferencing (OR 3.10, 95% CI 1.16, 8.31) were rated higher than ad hoc interpretation. Self-assessed cultural competence was better for in-person versus video conferencing interpretation (OR 2.32, 95% CI 1.11, 4.86). Video conferencing interpretation increases access without compromising quality, but cultural nuances may be better addressed by in-person interpreters. Professional interpretation is superior to ad hoc (OR 4.15, 95% CI 1.43, 12.09).
TL;DR: Perceiving racial discrimination in clinical encounters may be an important barrier to appointment attendance for African American hypertensive patients.
Abstract: Objectives. To examine African American patient perceptions of racial discrimination in clinical encounters. General barriers to hypertension management were also investigated. Methods. Six focus groups with 37 African American hypertensive patients were conducted and the transcribed sessions were analyzed for content. Results. Patients valued providers who shared information regarding self-care behaviors to manage hypertension and those who provided information regarding treatment options. Provider assumptions about patient inability to afford services, and provider apathy in reaching diagnoses were perceived as racially discriminatory. Patients discussed providers' avoidance of touch during physical exams as overtly discriminatory. Patients reacted to discriminatory experiences by not keeping appointments with providers perceived as racially discriminatory. Barriers to hypertension management were associated with family responsibilities and lifestyle factors, but were not attributed to provider racial biases. Conclusion. Perceiving racial discrimination in clinical encounters may be an important barrier to appointment attendance for African American hypertensive patients.
TL;DR: Recommendations for changing the approach of services to take full advantage of pregnancy as a potential catalyst event for change in this highly vulnerable and underserved population of street youths are offered.
Abstract: Young, homeless women often become pregnant, but little is known about how street youth experience their pregnancies. We documented 26 pregnancy outcomes among 13 homeless women (ages 18-26) and eight homeless men through interviews and participant-observation. Eight pregnancies were voluntarily terminated, three were miscarried, and fifteen were carried to term. Regardless of pregnancy outcome, street youths' narratives focused on ambivalence about parenting, traumatic childhood experiences, and current challenges. Despite significant obstacles, almost all were convinced of their personal capacity to change their lives. While most wanted to be parents, the majority lost custody of their newborns and consequently associated contact with medical and social services with punitive outcomes. Most of the youth who chose to terminate successfully sought safe medical care. We offer recommendations for changing the approach of services to take full advantage of pregnancy as a potential catalyst event for change in this highly vulnerable and underserved population.
TL;DR: The association of both substance use and psychiatric disorders with past homelessness was quite strong, but non-substance use psychiatric disorders was not as strong an independent risk factor as substance abuse disorders.
Abstract: This study uses data from a nationally representative epidemiologic survey, the National Comorbidity Survey Replication, to investigate the association of mental health and substance use disorders, along with other factors, with past homelessness. Approximately 5% of the 5,251 adults reported having been homelessness. Multivariate analysis showed the strongest independent risk factors for past homelessness were past receipt of welfare payments (odds ratio [OR]=5.7), incarceration for 27 or more days (OR=3.9), exposure to personal violence (OR=2.7), lifetime substance use disorder (OR=2.4), and Black race (OR=2.1). Several non-substance use psychiatric disorders were also significantly, if less strongly (OR 1.4 to 1.6), associated with past homelessness. Past homelessness is associated with a broad array of sociodemographic, economic, and mental health problems. While the association of both substance use and psychiatric disorders with past homelessness was quite strong, non-substance use psychiatric disorders was not as strong an independent risk factor as substance abuse disorders.
TL;DR: Both everyday and major discrimination are associated with not having received a Pap smear, even after adjusting for other variables, which is associated with poorer utilization of Pap smears for cervical cancer screening among Black women.
Abstract: Perceived discrimination has been shown to be related to health screening behavior. The present study examines the effect of discrimination on cancer screening among women in the Black Women's Health Study. Five self-report items measured discrimination in everyday life and three items measured experiences of major discrimination. Logistic regression was used to test associations of discrimination with Pap smear, mammography, or colonoscopy utilization. At the start of follow-up, 88.8% had a Pap smear in the previous year, 52.7% had a mammogram, and 20.0% had received a colonoscopy. Both everyday and major discrimination were associated with not having received a Pap smear, even after adjusting for other variables. Discrimination was not associated with mammography or colonoscopy utilization. In conclusion, perceived everyday and major discrimination is associated with poorer utilization of Pap smears for cervical cancer screening among Black women.
TL;DR: Where disparities exist, the primary cause may be that minorities are more likely to receive care in lower-performing hospitals, and policies to reduce disparities should include targeting resources to facilities serving a high percentage of minority patients.
Abstract: Background. Little is known about whether disparities occur within or between hospitals for national Hospital Quality Alliance (HQA) measures. Methods. We examined patient-level data from 4,450 non-federal hospitals in the U.S. for over 2.3 million Black, His- panic, Asian, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander patients who received care for acute myocardial infarction, heart failure, or pneumonia in 2005. r esults. There were 37 out of 95 findings of disparities after adjusting for patient characteristics. Eleven of the disparities were explained entirely by where minorities received care and the magnitude for 25 of the others was substantially reduced after adjusting for site of care. Discussion. Adjusting for between-hospital quality differences accounted for a large proportion of the disparities. Where disparities exist, the primary cause may be that minorities are more likely to receive care in lower-performing hospitals. Policies to reduce disparities should include targeting resources to facilities serving a high percentage of minority patients.
TL;DR: Objections to distributing naloxone to non-medical personnel persist despite a lack of scientific evidence, so this work responds to some common objections and their implications.
Abstract: Opiate overdose persists as a major public health problem, contributing to significant morbidity and mortality among opiate users globally. Opiate overdose can be reversed by the timely administration of naloxone. Programs that distribute naloxone to opiate users and their acquaintances have been successfully implemented in a number of cities around the world and have shown that non-medical personnel are able to administer naloxone to reverse opiate overdoses and save lives. Objections to distributing naloxone to non-medical personnel persist despite a lack of scientific evidence. Here we respond to some common objections to naloxone distribution and their implications.
TL;DR: A culturally targeted faith/community-based educational intervention can increase CRC knowledge, decrease cancer fatalism, and increase screening for CRC among African Americans.
Abstract: Background/objectives . Colorectal cancer (CRC) is the third cause of cancer deaths for African Americans. Objectives: 1) increase CRC knowledge, 2) decrease cancer fatalism, and 3) increase colonoscopy screening for CRC among African Americans in North Carolina.
Methods . Churches and community-based organizations were randomized into intervention and control groups. The intervention group received a 90-minute culturally targeted educational program on colorectal health. Pre-test and post-test questionnaires were completed by both groups.
Results . A total of 539 African American men and women 50 years of age and older participated in this study. The intervention group had a significantly greater proportion of those receiving a colonoscopy within three months after the educational session than the control group. In the intervention group, CRC knowledge significantly increased and cancer fatalism attitudes significantly decreased.
Conclusions . A culturally targeted faith/community-based educational intervention can increase CRC knowledge, decrease cancer fatalism, and increase screening for CRC among African Americans.
TL;DR: Racial/ethnic disparities in cancer survival can be partially explained by SES except for women in the poorest areas and a SES gradient in the risk of cancer death after adjusting for age and stage at diagnosis.
Abstract: We investigated racial/ethnic and socioeconomic disparities in cancer survival and assessed if racial disparities can be explained by socioeconomic status (SES) using New Jersey State Cancer Registry data. We included cancer cases diagnosed during 1986-1999 (n=471,939). Hazard ratios were calculated for all cancers combined and female breast, colorectal, lung, and prostate cancers by race/ethnicity and SES for cases diagnosed in 1993-1999. Survival rates were compared for diagnosis years 1986-1992 and 1993-1999. We observed worse survival in Black patients and a SES gradient in the risk of cancer death after adjusting for age and stage at diagnosis. Following adjustment by SES, the higher risks of cancer death for Blacks were attenuated for breast, colorectal, and prostate cancer and became non-significant for lung cancer. Racial/ethnic disparities in cancer survival can be partially explained by SES. Cancer survival rates improved significantly from 1986-1992 to 1993-1999 except for women in the poorest areas.
TL;DR: Results affirmed the significant role of CHCs as safety-net providers for vulnerable populations, and indicated that CHCs provide adequate care compared with POs although there remains room for improvement.
Abstract: The overall aim was to determine whether health care delivery for vulnerable populations served by community health centers (CHCs) was comparable to care for mainstream Americans primarily seen in physicians' offices (POs). Data came from the 2006 National Ambulatory Medical Care Survey. Patient visits occurring in CHCs were largely from younger, uninsured or Medicaid-insured, minority populations, while POs catered mainly to older, Medicare- or privately-insured, White patients. Communities served by CHCs were more often in low-income, low-education, urban regions. A greater proportion of visits to CHCs were from diabetic, obese, and depressed patients; CHCs also offered more evening/weekend visits and provided more health education during visits, but spent less time per visit than POs and had more difficulty referring patients to specialists. Results affirmed the significant role of CHCs as safety-net providers for vulnerable populations, and indicated that CHCs provide adequate care compared with POs although there remains room for improvement.
TL;DR: Most SCD patients reported that they were insufficiently involved in decisions and staff gave conflicting information, and it wasn't easy to find someone to discuss concerns and fears, and doctors' answers to questions were not clear.
Abstract: Background Adults with sickle cell disease (SCD) have often reported difficulties obtaining care during vaso-occlusive crisis (VOC) in qualitative studies Methods We measured the experiences of 45 SCD patients who received in-hospital care for VOC using the Picker Patient Experience Questionnaire (PPE-15), and used the one sample binomial test to compare with national norms Results Most SCD patients reported that they were insufficiently involved in decisions (86%), staff gave conflicting information (64%), it wasn't easy to find someone to discuss concerns (61%), doctors' answers to questions were not clear (58%), nurses' answers to questions were not clear (56%), doctors did not always discuss fears and anxieties (53%), and nurses did not always discuss fears and anxieties (52%) A greater percentage of SCD patients than the US sample in 9 of 12 areas reported problems Conclusions Further research is needed to determine the consequences of and potential interventions to improve these poor experiences
TL;DR: Differences across racial groups in diabetes patients' medication-related beliefs and adherence problems due to cost concerns are understood, but unknown factors explain higher rates of cost-related adherence problems among African American compared with White patients.
Abstract: Objectives. This study sought to understand differences across racial groups in diabetes patients' medication-related beliefs and adherence problems due to cost concerns. Research design and methods. We surveyed 806 African American and White diabetes patients about their beliefs regarding medications, cost-related adherence problems, socioeconomic status and communication about treatments with their clinicians. Results. Many patients endorsed statements such as "Most prescription medications are addictive" (35%) and "Insurance plans push generics to save themselves money at the expense of my health" (65%). African Americans expressed more negative attitudes than White patients and were more likely than White patients to report cost-related medication underuse (19% versus 13%; p5.02). Medication-related attitudes did not explain the higher rates of cost-related medication underuse among Black patients. Conclusions. Many diabetes patients have negative beliefs about their medications. Other unknown factors however, explain higher rates of cost-related adherence problems among African American compared with White patients.
TL;DR: Perioperative pain treatment in children is correlated with the patient's ethnicity, and the cause of this difference is unknown and prospective studies are necessary to elucidate the reasons.
Abstract: Purpose. Adult studies suggest pain treatment is influenced by patient's race/ ethnicity. The present study aims to evaluate the effect of the patient's race/ethnicity on pain treatment in children. Methods. Retrospective cohort study comparing perioperative analgesic administration for tonsillectomy and adenoidectomy (TA median amount in morphine equivalents was 0.05 (0–0.14) vs. 0.07 (0–0.90) mg/kg for Latino and Caucasian patients respectively (p5.02). Conclusion. This study suggests that perioperative pain treatment in children is correlated with the patient's ethnicity. The cause of this difference is unknown and prospective studies are necessary to elucidate the reasons.
TL;DR: It is demonstrated that few NTDs have received much attention from mathematical models, and that some have received no attention at all, and simple mathematical models could contribute significantly to the understanding of these diseases and the efforts required to control them, at very little cost.
Abstract: We survey the current state of a group of parasitic and microbial diseases called the Neglected Tropical Diseases (NTDs). These diseases currently infect a billion people, primarily in socioeconomically depressed areas of the world, are a leading cause of worldwide disability, and are responsible for approximately 534,000 deaths per year. We focus on several subcategories: protozoans, helminthes and bacterial diseases. We identify the populations most at risk from these diseases, and outline symptoms and other disease burdens. We examine the progress being made in controlling NTDs, including the current state of drug development. We also examine mathematical modeling of NTDs. While mathematical modeling is not bound by many of the strictures of access, data collection and infrastructure funding, we nevertheless demonstrate that few NTDs have received much attention from mathematical models, and that some have received no attention at all. Simple mathematical models could contribute significantly to our understanding of these diseases and the efforts required to control them, at very little cost. Further investment in prevention, treatment and awareness of NTDs is urgently warranted.
TL;DR: The risk of mortality was not significantly different among African Americans and Hispanics compared with Whites in specific tumor sites of head and neck cancer except a marginally elevated risk of all-cause mortality in African Americans with oral cavity tumor.
Abstract: To determine whether racial disparities persist in Medicare-insured elderly patients with head and neck cancer, we studied 7,480 patients diagnosed with head and neck cancer at age 65 or older in 1991-2002, identified from tumor registries maintained by the 16 areas participating in the Surveillance, Epidemiology and End Results program. Patients receiving cancer-directed surgery had significantly lower risks of both all-cause and disease-specific mortality than others; those with lower socioeconomic status were more likely to die of all causes than patients with higher socioeconomic status. African Americans had a marginally higher risk of all-cause mortality (hazard ratio = 1.19, 95% CI: 1.07-1.33), but had no significantly different risk of disease-specific mortality compared with Whites (1.09, 0.91-1.30). In conclusion, the risk of mortality was not significantly different among African Americans and Hispanics compared with Whites in specific tumor sites of head and neck cancer except a marginally elevated risk of all-cause mortality in African Americans with oral cavity tumor.
TL;DR: There were differences between groups in adherence to medication regimens, with African Americans and lower-income groups significantly more likely to be non-adherent to medication Regimens.
Abstract: Nationally, a higher proportion of the medically underserved than of the general population suffer from hypertension. Poorer adherence to recommended therapies (includ- ing medication regimens, salt intake reduction, and regular visits with provider) has been linked to poorer blood pressure control. To identify whether differences in adherence are associated with racial/ethnic and socioeconomic characteristics, we administered a sur- vey to 141 African American and non-Hispanic White hypertensive patients within two hospital-based clinics in an urban setting in the Northeast U.S. There were no differences in adherence to follow-up appointments or dietary recommendations between racial/ ethnic or income groups. However, there were differences between groups in adherence to medication regimens, with African Americans and lower-income groups significantly more likely to be non-adherent to medication regimens. When treating patients or implementing interventions aimed at improving adherence, special attention should be paid to African Americans and patients from low-income communities.
TL;DR: This article conducted interviews with 26 doctors and nurses and found that four major categories of responses emerged to explain why Black patients are less likely to receive the same levels of medical care as Whites: access to care, physician bias, Black patients' perceived shortcomings, and White patients' demands.
Abstract: Racial inequality in medical treatment is a problem whose sources are not fully understood. To gain better insight into how race may affect treatment, semi-structured interviews were conducted with 26 doctors and nurses. Using an open coding scheme, the explanations of racial inequality in treatment were coded by two people. Four major categories of responses emerged to explain why Black patients are less likely to receive the same levels of medical care as Whites: access to care, physician bias, Black patients' perceived shortcomings, and White patients' demands. Interviewees commonly cited access and patient factors before naming physician bias. The majority questioned the validity of studies reporting disparities. Educational campaigns should emphasize evidence that racial disparities persist even after controlling for factors such as insurance and patient characteristics. Educational programs should also address subconscious racial bias and how it may operate in a clinical setting.
TL;DR: In 2000, using National Institutes of Health/National Cancer Institute U54 funds, a clinical trials shared resource was established at Nashville General Hospital at Meharry to attract more African Americans to national cancer clinical trials.
Abstract: In 2000, using National Institutes of Health/National Cancer Institute (NIH/NCI) U54 funds, a clinical trials shared resource was established at Nashville General Hospital at Meharry to attract more African Americans to national cancer clinical trials. This Report from the Field describes the model used to achieve this end.
TL;DR: Spanish/English computerized decision aids are feasible and can facilitate the use of effective treatments for smoking cessation among underserved smokers.
Abstract: Introduction . People with poor access to medical care are more likely to smoke but are less likely to receive nicotine dependence treatment. Objective . To assess preliminary outcomes of a computer-based, bilingual smoking cessation decision-aid to facilitate utilization of resources. Methods . A computer kiosk with a smoking cessation decision-aid was integrated at three safety-net clinics and two health fairs. The kiosk queries participants about smoking behaviors, guides them to set a quit date and select treatment, provides printed materials, and prompts fax-referral to quitline. Results . Among the 163 smokers referred to the kiosk, 78.5% participated in the study and 30% completed the kiosk in Spanish. Few had previously used cessation resources. During completion of the decision-aid, 95.3% requested pharmacotherapy, and 70.3% opted for counseling. Among those reached for two-month follow-up (69.5%), 20.2% reported they had quit smoking. Conclusion . Spanish/English computerized decision aids are feasible and can facilitate the use of effective treatments for smoking cessation among underserved smokers.