Showing papers in "Journal of Health Care for the Poor and Underserved in 2011"
TL;DR: In this paper, the authors assess recent trends in complementary and alternative medicine (CAM) use based on a comparative analysis of data from the 2002 and 2007 National Health Interview Survey (NHIS) and reveal that CAM use becomes more likely when access to conventional care has been restricted.
Abstract: In this study we seek to assess recent trends in complementary and alternative medicine (CAM) use based on a comparative analysis of data from the 2002 and 2007 National Health Interview Survey (NHIS). The findings suggest that CAM use, in par - ticular the use of provider-based CAM therapies such as chiropractic care, massage, and acupuncture, have grown significantly in the U.S. This growth was more pronounced among non-Hispanic Whites than among racial and ethnic minorities, increasing an already exist- ing White-minority gap in CAM use. Findings from this study also reveal that CAM use becomes more likely when access to conventional care has been restricted. In both 2002 and 2007, having unmet needs in medical care or having delayed care due to cost were associated with a higher chance of CAM use.
283 citations
TL;DR: A model, the Health Care Access Barriers Model (HCAB), is described, which provides a taxonomy and practical framework for the classification, analysis and reporting of those modifiable health care access barriers that are associated with health care disparities.
Abstract: The impact of social and economic determinants of health status and the existence of racial and ethnic health care access disparities have been well-documented. This paper describes a model, the Health Care Access Barriers Model (HCAB), which provides a taxonomy and practical framework for the classification, analysis and reporting of those modifiable health care access barriers that are associated with health care disparities. The model describes three categories of modifiable health care access barriers: financial, structural, and cognitive. The three types of barriers are reciprocally reinforcing and affect health care access individually or in concert. These barriers are associated with screening, late presentation to care, and lack of treatment, which in turn result in poor health outcomes and health disparities. By targeting those barriers that are measurable and modifiable the model facilitates root-cause analysis and intervention design.
213 citations
TL;DR: Key strategies to improve access include targeting social programs and mental health services, expanding Medicaid eligibility/enrollment, promoting community-based organizations, enforcing the use of trained medical interpreters, and improving cultural competency.
Abstract: Objective. Asylum seekers have poor access to health care. Qualitative data portray - ing their experience is lacking. Methods. We conducted focus groups and comprehensive interviews with 35 asylum seekers and 15 expert providers/advocacy organization repre- sentatives. Purposive sampling was used to recruit subgroups. Interviews were recorded, coded, and analyzed. results. Participants: 85% male, mostly from African countries. Major barriers: a) Internal, including mental illness, fatalism, mistrust, and perceived discrimi- nation; b) Structural, including affordability, limited services, inadequate interpretation, resettlement challenges such as shelter, food, and employment insecurity; health care for urgent care only; and poor cultural competency; c) Barriers in social assimilation, including difficulty navigating a complex system and inadequate community support. Conclusion. Significant inter-related barriers exist at the individual, provider, and system levels. Strategies to improve access include targeting social programs and mental health services, expanding Medicaid eligibility/enrollment, promoting community-based organizations, enforcing the use of trained medical interpreters, and improving cultural competency.
177 citations
TL;DR: The results of this study showed a low association between obesity and myocardial infarction rates; a moderate association with stroke rates; and a strong association with HBP rates.
Abstract: Obesity is among the leading causes of elevated cardiovascular disease (CVD) mortality and morbidity. In the present study, the associations between the increase in body mass index (BMI) and the increase rates of CVD and high blood pressure (HBP) in the states of Mississippi, Alabama, Louisiana, Tennessee, and Colorado are examined using regression analysis and by means of neural network models for obesity and HBP. Data from Behavioral Risk Factor Surveillance System were obtained and analyzed for obesity rates, percent of myocardial infarction, stroke, and HBP from 2005-2009. Results of this study showed a low association between obesity and myocardial infarction rates (R2=0.067); a moderate association with stroke rates ((R2=0.462); and a strong association with HBP rates ((R2=0.811). The highest rates of obesity, CVD, and HBP were found in Mississippi, while Colorado had the lowest rates. Maintaining healthy weight helps reduce the risks of developing CVD.
153 citations
TL;DR: Investigating negative contraception counseling experiences, including those felt to be coercive or discriminatory, in a population of postpartum urban minority women found that negative experiences with contraceptive counseling may affect contraception utilization.
Abstract: Background . Using in-depth qualitative methods, we investigated negative contraception counseling experiences, including those felt to be coercive or discriminatory, in a population of postpartum urban minority women. Methods . Brief surveys and semi-structured interviews were conducted with 30 consenting postpartum women who had received care at a Medicaid-funded obstetrics clinic. In-person one-on-one interviews were then reviewed for themes using an iterative process of qualitative analysis. Results . In this sample of African American (63%) and Hispanic (37%) women (median age 26), 73% had unplanned pregnancies. Features of negative counseling experiences included having insufficient, non-physician-directed and impersonal counseling. Most women had experienced episodes of poor communication with providers; 10 described feeling coerced or perceiving racially-based discrimination in counseling. Conclusions . Negative experiences with contraceptive counseling may affect contraception utilization. Contraceptive education should respect each individual's autonomy, culture, and values.
107 citations
TL;DR: It is suggested that inadequate access to food lowers self-efficacy among adults with diabetes, and supports provision of food to unstably housed adults as part of diabetes care.
Abstract: Limited data exist on whether structural factors associated with poverty such as inadequate housing and food insecurity affect diabetes care. In a sample of low-income participants with diabetes (N=711), we sought to determine if housing instability was associated with lower diabetes self-efficacy, and whether this relationship was mediated by food insecurity. We ordered housing from most to least stable. We observed a linear decrease in diabetes self-efficacy as housing instability increased (p<.01). After adjusting for age, sex, race/ethnicity, and alcohol or substance use, adults lacking a usual place to stay had lower self-efficacy than those who owned their own home (s-coefficient -0.94, 95% CI -1.88, -0.01). Food insecurity mediated the association between housing instability and diabetes self-efficacy (s-coefficient -0.64, 95% CI -1.57, 0.31). Our findings suggest that inadequate access to food lowers self-efficacy among adults with diabetes, and supports provision of food to unstably housed adults as part of diabetes care.
95 citations
TL;DR: Independent of health insurance, stage at diagnosis, and age, Black and Hispanic patients had higher risks of 30, 60, and 90-day treatment delay compared with White patients.
Abstract: Access to timely treatment may be one contributing factor to survival differences by race/ethnicity among breast cancer patients. In this study, we examined the relationship between race and treatment delay among breast cancer patients diagnosed between 2003 and 2006 with Stage I-III breast cancer from the National Cancer Database (n=250,007). We evaluated factors associated with receipt of initial treatment more than 30, 60, and 90 days after biopsy using multivariable log binomial models to estimate risk ratios (RR) and 95% confidence intervals (CI). The average time to treatment was 34.30 days (±31.77). Independent of health insurance, stage at diagnosis, and age, Black and Hispanic patients had higher risks of 30, 60, and 90-day treatment delay compared with White patients. Further studies are needed to define the role of structural, health system, physician, clinical and patient factors in treatment delay among Black and Hispanic women and appropriate interventions.
90 citations
TL;DR: The uninsured continued to be at a disadvantage for all three types of cancer screening, relative to the privately insured, as were publicly insured individuals with respect to colorectal cancer screening.
Abstract: Using the National Health Interview Survey, we examined associations among race/ ethnicity, insurance coverage, and cancer screening, and assessed changes in the magnitude of disparities over the past decade. Outcomes included recent cervical, breast, and colorectal cancer screening. Rates of colorectal screening increased for all racial/ethnic groups and some insurance groups from 2000 to 2008. However, rates of Pap tests and mammograms remained stagnant, and even decreased for certain groups. Some Hispanic-White and Asian-White disparities in cancer screening were reduced or eliminated over this time period. However, in 2008 Asians continued to have lower odds of Pap tests and Hispanics lower odds of colorectal cancer screening, even after accounting for potential confounders. There were no significant changes in Black-White disparities. The uninsured continued to be at a disadvantage for all three types of cancer screening, relative to the privately insured, as were publicly insured individuals with respect to colorectal cancer screening.
80 citations
TL;DR: It was found that African Americans, U.S.-born Caribbean Blacks, and Caribbean-born Blacks had significantly different self-ratings of their health and self-reports of being diagnosed with a chronic physical health condition: Caribbean- born Blacks had the best health outcomes and U.U.S-born Caribbean Black had the worst.
Abstract: There have been few empirical studies of ethnic differences in health within the American Black population. Logistic regressions were used to examine the relationships among ethnicity, nativity, depressive symptoms, and physical health in the two largest ethnic groups of American Blacks, African Americans and Caribbean Blacks. The data were from the National Survey of American Life, a national household survey representative of the non-institutionalized U.S. Black population. We found that African Americans, U.S.-born Caribbean Blacks, and Caribbean-born Blacks had significantly different self-ratings of their health and self-reports of being diagnosed with a chronic physical health condition: Caribbean-born Blacks had the best health outcomes and U.S.-born Caribbean Blacks had the worst. This finding remained significant even after considering self-reported depressive symptoms. This study highlights the importance of considering ethnic diversity, nativity and immigration as independent sources of variation in health status within the American Black population.
79 citations
TL;DR: In White men all four risk factors were inversely associated with socioeconomic position, although often associations were only present or were stronger for education than for income, and higher SES was associated with higher BMI in non-White men.
Abstract: Many studies document racial variation, gender differences, and socioeconomic status (SES) patterning in cardiovascular disease (CVD) risk factors but few studies have investigated heterogeneity in SES differences by race/ethnicity or gender Using data from the Multi-Ethnic Study of Atherosclerosis (N = 6,814) and stratified regression models, we investigated race/ethnic differences in the SES patterning of diabetes, hypertension, smoking, and body mass index (BMI) Inverse socioeconomic gradients in hypertension, diabetes, smoking, and BMI were observed in White and Black women but associations were weaker or absent in Hispanic and Chinese women (except in the case of diabetes for Hispanic women) Even greater heterogeneity in social patterning of risk factors was observed in men In White men all four risk factors were inversely associated with socioeconomic position, although often associations were only present or were stronger for education than for income The inverse socioeconomic patterning was much less consistent in men of other races/ethnic groups, and higher SES was associated with higher BMI in non-White men These findings have implications for understanding the causes of social patterning, for the analysis of SES adjusted race/ethnic differences, and for the targeting of interventions
63 citations
TL;DR: Perceptions of Dietary Approaches to Stop Hypertension and the food environment among African Americans with high blood pressure living in two low-income communities are examined and local food outlets are assessed.
Abstract: Background . We examined perceptions of Dietary Approaches to Stop Hypertension (DASH) and the food environment among African Americans (AA) with high blood pressure living in two low-income communities and objectively assessed local food outlets. Methods . Focus groups were conducted with 30 AAs; participants discussed DASH and the availability of healthy foods in their community. Sessions were transcribed and themes identified. Fifty-four stores and 114 restaurants were assessed using the Nutrition Environment Measures Survey (NEMS). Results . Common themes included poor availability, quality, and cost of healthy foods; tension between following DASH and feeding other family members; and lack of congruity between their preferred foods and DASH. Food outlets in majority AA census tracts had lower NEMS scores (stores: -11.7, p=.01, restaurants: -8.3, p=.001) compared with majority White areas. Conclusions . Interventions promoting DASH among lower income AAs should reflect the food customs, economic concerns, and food available in communities.
TL;DR: Depressed White students were more likely than depressed minority youth to report having received a prior diagnosis of depression and to have been treated for depression, suggesting ethnic disparities in obtaining needed mental health care may persist even in settings where access to equivalent care is readily available.
Abstract: Psychological problems are overlooked and undertreated in adolescents, especially in low-income and ethnically-diverse youth School-based health centers are one way to increase health care utilization, and may be particularly important for accessing hard-to-reach populations The present study examines adolescents' psychological health and their experiences with receiving needed mental health care Participants included 1,695 African-American (31%), Hispanic (38%), and White (31%) high-school students in southeast Texas All students were from the same high school and all had access to a school-based mental health clinic Twenty six percent of the sample had symptoms indicative of major depression, and 18% had scores consistent with subthreshold depression Across all ethnicities, the prevalence of depressive symptoms was highest among females Depressed White students were more likely than depressed minority youth to report having received a prior diagnosis of depression and to have been treated for depression Thus, ethnic disparities in obtaining needed mental health care may persist even in settings where access to equivalent care is readily available
TL;DR: Findings suggest fatalism and health literacy may play a role in shaping CRC screening adherence among low-income Hispanics, and researchers should continue investigating how sociocultural factors influence screening adherence, using larger and more geographically diverse samples.
Abstract: Few studies have examined barriers and facilitators to colorectal cancer (CRC) screening among Hispanics, particularly sociocultural factors that may be relevant. This paper examines the influence of sociocultural factors on adherence to fecal occult blood testing (FOBT) and colonoscopy. A survey was conducted among a sample of 400 low-income Hispanics in East Harlem, New York. Fatalism and health literacy were both significantly associated with colonoscopy screening adherence in bivariate models, though fatalism became non-significant and health literacy became less significant in multivariable models. With respect to adherence to colonoscopy or FOBT, both fatalism and health literacy were associated in bivariate models, though only fatalism remained significant in multivariable models (p=.03; OR: .94; 95% CI: .881-.992). These findings suggest fatalism and health literacy may play a role in shaping CRC screening adherence among low-income Hispanics. Researchers should continue investigating how sociocultural factors influence screening adherence among Hispanics, using larger and more geographically diverse samples.
TL;DR: Assessment of factors associated with HPV vaccine uptake among young African American women can be used to inform the development of targeted HPV vaccine promotion programs for AfricanAmerican women to prevent continued cervical cancer disparities.
Abstract: Factors associated with greater likelihood of human papillomavirus (HPV) vaccination among women who experience excess cervical cancer incidence and mortality requires further study. The purpose of this study was to assess factors associated with HPV vaccine uptake among young African American women. Three hundred sixty-three African American women aged 18-26 were recruited from Historically Black Colleges/Universities to complete a questionnaire to assess health beliefs associated with HPV vaccination. One quarter of participants reported uptake of the HPV vaccine. Women who reported uptake had significantly higher HPV knowledge, lower perceived barriers to vaccination, and were younger (all p<.05). Factors significantly associated with HPV vaccine uptake included HPV knowledge (OR=1.22), perceived severity of health outcomes (OR=0.48), perceived barriers to vaccination (OR=0.49), cues to action (OR=1.94), and age (OR=0.68). Findings can be used to inform the development of targeted HPV vaccine promotion programs for African American women to prevent continued cervical cancer disparities.
TL;DR: Focus group findings indicate that participants perceived poverty, food insecurity, lack of access to quality education, and unsafe environments as significant life stressors affecting maternal and child health.
Abstract: This qualitative research project explores how poverty, the built environment, education, working conditions, health care access, food insecurity and perceived discrimination are experienced by Puerto Rican Latinas through the course of their lives. Five focus groups were conducted with the primary objective of documenting community experiences and perspectives regarding: 1) stress, including perceived discrimination based on race/ethnicity (racism); 2) the impact of stress on Puerto Rican women of reproductive age, their families, and/or their community; and 3) stressors that affect maternal health. Focus groups were conducted in English and Spanish in the two cities with the highest rates of premature birth and low infant birthweight in the state of Connecticut. Focus group findings indicate that participants perceived poverty, food insecurity, lack of access to quality education, and unsafe environments as significant life stressors affecting maternal and child health.
TL;DR: Of the access to health care variables examined, greater waiting time predicted dissatisfaction with health care and the effect of the patient-physician interaction on dissatisfaction was mediated, in part, by waiting time.
Abstract: Despite growing interest in disparities in access to health care, relatively little is known about different facets of care among Latinas, their satisfaction with the care they receive, and the predictors of satisfaction. This study examined whether various health care access and context factors, the quality of the patient-physician interaction, and medical mistrust predict satisfaction with health care among Latina immigrants in New York City. Structured interviews were conducted with 220 Latinas predominantly from the Dominican Republic and aged 40 years or over. Of the access to health care variables examined, greater waiting time predicted dissatisfaction with health care. Greater quality of the patient- physician interaction predicted less dissatisfaction. The effect of the patient-physician interaction on dissatisfaction was mediated, in part, by waiting time. The results illustrate the important role of specific health care factors in satisfaction with care.
TL;DR: A qualitative investigation of Native Americans' cancer coping strategies and health education needs was undertaken, and approaches for reducing mistrust and building relationships between health care providers and Native communities are highlighted.
Abstract: Cancer is the second leading cause of death among Native Americans, who have-some of the poorest cancer survival rates of any race/ethnicity nationwide. Considering the cancer burden experienced by Native Americans and the lack of research exploring Northeastern tribal communities' cancer experiences, a qualitative investigation of Native Americans' cancer coping strategies and health education needs was undertaken. Data were collected through group (74) and individual (17) interviews with 91 Native Americans from the Northeast. Relationships between intergenerational mistrust, individual mistrust, and utilization of biomedical health care systems for Northeastern Native Americans are presented. Trust is central to the provider-patient relationship and the foundation for developing and maintaining connections to Native American communities. Intergenerational mistrust, shaped by historical and contemporary issues of prejudice and miscommunication, affect cancer health experiences and views. Approaches for reducing mistrust and building relationships between health care providers and Native communities are highlighted.
TL;DR: This work explored how vulnerable rural residents described social support in the context of self-management for multiple chronic conditions, finding participants generally felt support was available, though emotional/informational support was perceived as less available than other types of support.
Abstract: Social support generally is considered a valuable asset that may compensate for health service deficiencies among rural populations. Employing a mixed methods approach, we explored how vulnerable rural residents described social support in the context of self-management for multiple chronic conditions. Participants generally felt support was available, though emotional/informational support was perceived as less available than other types of support. Participants did not rely heavily on informal support to help them manage their multiple morbidities, preferring to call on their doctor and their own resources. We discuss implications of these findings for meeting this vulnerable population's self-management needs.
TL;DR: Non-Hispanic White Americans were likelier than members of all racial/ethnic minority groups to address substance abuse by accessing care through specialty addiction-treatment facilities, and were also less likely to access substance abuse care through non-specialty facilities.
Abstract: A secondary dataset, Collaborative Psychiatric Epidemiology Surveys (CPES), 2001-2003, was employed to examine racial/ethnic differences in access to specialty and non-specialty substance abuse treatment (compared with no access to treatment). The study found that non-Hispanic White Americans were (1) likelier than members of all racial/ethnic minority groups (other than Hispanics) to address substance abuse by accessing care through specialty addiction-treatment facilities, and were (2) also less likely to access substance abuse care through non-specialty facilities. Because non-specialty facilities may have staffs whose professional training does not target treating chronic, bio-psycho-social illness such as substance abuse, our results imply that treatment facilities deemed non-specialty may need to enhance staff training, in order to ensure individuals are properly screened for substance use conditions and are referred for or provided with effective counseling and medications as appropriate.
TL;DR: This commentary seeks to build an understanding of how access to abortion care is currently impeded for low-income women and women of color and calls for an end to that omission.
Abstract: Minority and low SES women have persistently and disproportionately higher rates of abortion than White and higher SES women, yet have limited access to these services. The response of governmental health agencies to these disparities in abortion has focused solely on decreasing the number of abortions, without attention to access to needed health services. This commentary seeks to build an understanding of how access to abortion care is currently impeded for low-income women and women of color and calls for an end to that omission.
TL;DR: This paper analyzed the 2007 National Survey of Children's Health to determine medical home prevalence among Latino children, stratified by language of parental interview, and found that most Latino children with a Spanish-language parental interview had a usual source of care, but only one-quarter had a medical home.
Abstract: Examination of Latino children in aggregate ignores important subgroup differences due to the parents' English language ability. Previous reports of the pediatric medical home have not stratified Latino children by parental language differences to compare the two groups directly. We analyzed the 2007 National Survey of Children's Health to determine medical home prevalence among Latino children, stratified by language of parental interview. Most Latino children with a Spanish-language parental interview had a usual source of care, but only one-quarter had a medical home. Striking medical home disparities persisted for Latino children with a Spanish-language interview, even after adjustment for potential confounders. Lack of a medical home was associated with disparities in the quality of care, more so than access disparities. Addressing health care disparities for Latino children requires particular attention to the unique needs of Latino children with parents who may experience language barriers during health care encounters.
TL;DR: The findings from this study may lead to the development of effective intervention and policies that increase cervical cancer screening in this population of women.
Abstract: Women who have not had a Papanicolaou (Pap) test in five years or more are at increased risk for developing invasive cervical cancer (ICC), 1 as one of the most common risk factors for this type of cancer is a deficient screening history2 Pap smear screening can detect precancerous lesions which may be treated effectively and can result in the prevention of cancer development The American Cancer Society1 reports that 60–80% of women newly diagnosed with ICC had not received a Pap test in the previous five years Indeed, ICC is nearly completely preventable if screenings are consistent with established recommendations Despite these encouraging facts, cervical cancer screening rates remain at less than optimal levels
Studies have shown that certain women, including minorities and low-income women, are less likely than other groups to be screened for cervical cancer and less likely to be diagnosed at early and more treatable stages of cancer3–6 Lack of a regular care provider, absence of provider’s recommendation, high cost of health care/insurance, inconvenience, inadequate English proficiency, and lack of social support have been identified as barriers to timely screening among many of these women4, 7–9
Although cervical cancer mortality has decreased over recent decades, certain groups continue to experience a greater burden from ICC Like other groups of historically underserved women, Appalachian women have a lower prevalence of Pap testing and a higher rate of ICC than women in other parts of the United States5, 10 Appalachian Kentucky has an ICC incidence rate (150/100,000) approximately 67% above the national average (90/100,000)11,12 At particularly elevated risk are those who are rarely- or never-screened, operationalized as those who have not had a Pap test in the previous five years or more, or ever, in their lifetimes Since these rarely- or never-screened women are at the highest risk for developing ICC, they constitute an important target for screening interventions to reduce the incidence of ICC in Appalachian Kentucky
Several studies have examined the determinants of cervical cancer screening among Appalachian women These studies have elucidated screening barriers that include the health care system (ie, availability of services, cost of care), the environmental or community context, and individuals’ characteristics13 For example, the Appalachian region struggles to maintain an adequate supply of health care professionals 14 This endemic shortage makes access to preventive health care a challenge for Appalachian women, directly contributing to lower screening rates than are reported nationally15 Environmental and community factors thwarting screening include poverty, lack of transportation, and low rates of adequate health insurance16 Finally, individual characteristics, including culturally-based beliefs and inadequate knowledge, may exert a strong influence on the receipt of Pap tests For example, some researchers have posited that culturally-based beliefs like fatalism undermine Pap tests and other cancer screening 17, Schoenberg and colleagues18 found that middle-aged and older Appalachian women may not receive Pap tests due to a constellation of these factors, including lack of regular reproductive health care, competing demands, and uncertainty about screening recommendations, given the change from one to two year screening interval recommendations and ambiguity about the ages at which to start and stop screening
Although these insights are essential to stem elevated rates of ICC, one limitation of most existing research is a nearly exclusive focus on women who have not been screened within the previous five years Since the risk of ICC becomes much higher for women unscreened for five or more years, critical information is lacking on a most susceptible subgroup: Appalachian women who have not been screened in five years or more, or ever in their lifetimes1 The purpose of this paper is to address this gap in knowledge regarding cervical screening behaviors by conducting an analysis of baseline data from a community-based intervention trial, Faith Moves Mountains, which aimed to increase Pap test use among Appalachian women who were out of compliance with screening recommendations 19 The current analysis examined the unique sociodemographic and personal characteristics that predicted belonging to the group of rarely- or never-screened Appalachian women (ie, last Pap test five or more years ago, or never), compared with the group of more recently-screened women (ie, last Pap test more than 12 months but less than five years ago) Rarely- or never-screened women often are considered “hard to reach” and therefore have not been included in studies of barriers to cervical cancer screening This study compares the characteristics of the more recently-screened women typically examined in the literature with those who are much more vulnerable to developing cervical cancer: rarely- or never-screened women Identification of predictors of belonging to the rarely- or never-screened group may guide the development of intervention and policy strategies targeted toward this high-need population
TL;DR: Establishing a national faith-based health research network is an excellent opportunity to create an evaluative infrastructure and generate new research on health programs and their effectiveness in FBO settings.
Abstract: Over the last three decades, there has been increasing interest in the role that faith-based organizations (FBOs) can play in promoting health and health care access among underserved populations Although the research literature on church-based health interventions is growing, there are relatively few rigorous evaluations of their effectiveness in addressing health and health care outcomes Establishing a national faith-based health research network is an excellent opportunity to create an evaluative infrastructure and generate new research on health programs and their effectiveness in FBO settings
TL;DR: In addition to race/ethnicity, health literacy and English proficiency may be bases of discrimination and evaluation is needed to determine whether patients are treated differently or more apt to perceive discrimination, and whether depression fosters and/or follows perceived discrimination.
Abstract: Objectives . We examined possible determinants of self-reported health care discrimination. Methods . We examined survey data from the Diabetes Study of Northern California (DISTANCE), a race-stratified sample of Kaiser diabetes patients. Respondents reported perceived discrimination, and regression models examined socioeconomic, acculturative, and psychosocial correlates. Results . Subjects (n = 17,795) included 20% Blacks, 23% Latinos, 13% East Asians, 11% Filipinos, and 27% Whites. Three percent and 20% reported health care and general discrimination. Health care discrimination was more frequently reported by minorities (ORs ranging from 2.0 to 2.9 compared with Whites) and those with poorer health literacy (OR51.10, 95% CI: 1.04–1.16), limited English proficiency (OR = 1.91, 95% CI: 1.32–2.78), and depression (OR = 1.53, 95% CI: 1.10–2.13). Conclusions . In addition to race/ethnicity, health literacy and English proficiency may be bases of discrimination. Evaluation is needed to determine whether patients are treated differently or more apt to perceive discrimination, and whether depression fosters and/or follows perceived discrimination.
TL;DR: Investigating the contribution of immigration status, socioeconomic factors, health care access, health status, and health insurance to usual source of health care (USOC) in a nationally representative sample of African American and Caribbean Black men found having health insurance was associated with higher odds of reporting a USOC for African American men but lower odds among Caribbean BlackMen.
Abstract: Purpose . The Aday-Andersen model was used as a framework for investigating the contribution of immigration status (i.e., nativity and acculturation), socioeconomic factors, health care access, health status, and health insurance to usual source of health care (USOC) in a nationally representative sample of African American (n = 551) and Caribbean Black men (n = 1,217). Methods . We used the 2001–2003 National Survey of American Life, a nationally representative household survey of non-institutionalized U.S. Blacks to conduct descriptive and logistic regression analyses. Results . Older age, more health conditions, neighborhood medical clinic access, and health insurance were associated with higher odds of reporting a USOC. Odds were lower for men with lower-middle incomes and poorer mental health status. Having health insurance was associated with higher odds of reporting a USOC for African American men but lower odds among Caribbean Black men. Odds were higher in the presence of more health conditions for African American men than for Caribbean Black men. Conclusions . Health care reform policies aimed solely at increasing health insurance may not uniformly eliminate USOC disparities disfavoring U.S. and foreign-born non-Hispanic Black men.
TL;DR: Recommendations are for culturally-appropriate education and interventions emphasizing community and cultural connectivity for improving wellness status and the best predictive model for wellness was obtained.
Abstract: Wellness is an important American Indian (AI) concept, understood as being in balance with one's body, mind, and environment. Wellness predictors are reported in this paper within the context of health. A cross-sectional randomized household survey of 457 AI adults at 13 rural health care sites in California was conducted. Measures included wellness perceptions, barriers, health status/health conditions, spirituality, cultural connectivity, high-risk behaviors and abuse history. Statistical analysis obtained the best predictive model for wellness. Predictors of wellness were general health status perception, participation in AI cultural practices and suicide ideation. Significant differences in wellness status were observed depending on experience of adverse events in childhood and adulthood (neglect, physical abuse, and sexual abuse). Cultural connectivity (speaking tribal language, participating in AI practices, and feeling connected to community) was also associated with perceptions of wellness. Recommendations are for culturally-appropriate education and interventions emphasizing community and cultural connectivity for improving wellness status.
TL;DR: Enrollment assistance for PAPs with additional medication services (e.g., counseling) was significantly associated with improved glycemic control and economic evaluations suggest free PAP medications offset health care institutions' costs for uncompensated medications and enrollment assistance programs.
Abstract: Pharmaceutical patient assistance programs (PAPs) have the potential to improve prescription drug accessibility for eligible patients, but currently there is limited information regarding their effectiveness. In an attempt to provide a systematic description of primary studies on PAPs, we reviewed 33 unique studies from commercial and grey literature (e.g., government publications, conference abstracts) sources: 15 health care outcome evaluations, seven economic evaluations, seven surveys and four miscellaneous studies. Enrollment assistance for PAPs with additional medication services (e.g., counseling) was significantly associated with improved glycemic (standardized mean difference=-0.40, 95% CI=-0.59,-0.20; k=3 one-group, pre-post-test; 1 comparison-group) and lipid (standardized mean difference=-0.52, 95% CI=0.78,-0.27; k=3 one-group, pre-post-test; 1 comparison group) control. Inadequately designed economic evaluations suggest free PAP medications offset health care institutions' costs for uncompensated medications and enrollment assistance programs. More rigorous research is needed to establish the clinical and cost-effectiveness of PAPs from a patient and health care institution perspective.
TL;DR: The epidemiology of vitamin D and CVD in African Americans and the emerging biological roles of Vitamin D in key CVD signaling pathways are reviewed to contribute to the epidemiological findings and provide the foundation for future therapeutic strategies for reducing health disparities.
Abstract: Cardiovascular disease (CVD), which includes coronary artery disease and stroke, is the leading cause of mortality in the nation. Excess CVD morbidity and premature mortality in the African American community is one of the most striking examples of racial/ ethnic disparities in health outcomes. African Americans also suffer from increased rates of hypovitaminosis D, which has emerged as an independent risk factor for all-cause and cardiovascular mortality. This overview examines the potential role of hypovitaminosis D as a contributor to racial and ethnic disparities in cardiovascular disease (CVD). We review the epidemiology of vitamin D and CVD in African Americans and the emerging biological roles of vitamin D in key CVD signaling pathways that may contribute to the epidemiological findings and provide the foundation for future therapeutic strategies for reducing health disparities.
TL;DR: Providing care that is truly patient-centered could address disparities in cancer screening and follow-up through better alignment between patient needs and health care resources available to address those needs.
Abstract: Health and health care disparities related to cancer are a major public health problem in the United States. Providing care that is truly patient-centered could address disparities in cancer screening and follow-up through better alignment between patient needs and health care resources available to address those needs. Key health care reforms offer promise for doing so.
TL;DR: American Indian cancer patients who received PN services during their cancer treatment showed improvement in levels of satisfaction with health, however, no improvements were observed inlevels of medical mistrust.
Abstract: Purpose . To assess the impact of patient navigation (PN) on satisfaction with health care and medical mistrust among American Indians (AI) undergoing cancer treatment. Methods . This was a pre-post cohort survey study of 52 AI cancer patients who participated in a culturally-tailored PN program during their cancer treatment. Surveys were administered prior to and after cancer treatment assessing medical mistrust and satisfaction with health care using two Likert-type scales. Results . Participation refusal rate was 7%. Mean scale scores for satisfaction with health care were significantly improved after PN compared with pre-navigation (p Conclusions . American Indian cancer patients who received PN services during their cancer treatment showed improvement in levels of satisfaction with health. However, no improvements were observed in levels of medical mistrust.