151
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Freedenthal S. Racial disparities in mental health service use by adolescents who thought about or attempted suicide. Suicide Life Threat Behav 2007; 37:22-34. [PMID: 17397277 DOI: 10.1521/suli.2007.37.1.22] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Differences in rates and predictors of mental health service use among 2,226 Black, Hispanic, and White adolescents (aged 12-17) who reported recent suicidal thoughts or an attempt were examined. Black adolescents were 65% (OR = .65, p < .05), and Hispanic adolescents were 55% (OR = .55, p < .001), as likely as White adolescents to report service use, even when controlling for need for care and ability to secure services. Suicide attempt and psychiatric symptoms each interacted with race to increase the odds of service use uniquely for White adolescents. Results indicate that racial disparities characterize adolescents' mental health service use even when suicide risk increases.
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Affiliation(s)
- Stacey Freedenthal
- Graduate School of Social work at the University of Denver, Denver, CO 80208, USA.
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152
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Rupp R, Rosenthal SL, Middleman AB. Vaccination: an opportunity to enhance early adolescent preventative services. J Adolesc Health 2006; 39:461-4. [PMID: 16982378 DOI: 10.1016/j.jadohealth.2006.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 03/31/2006] [Accepted: 04/07/2006] [Indexed: 11/27/2022]
Abstract
New vaccines are being developed that will be recommended for adolescents Adolescence is a time period when adolescent-parent dynamics change and when adolescents may be confronted with increasing opportunities to engage in risk-taking behaviors such as sexual behavior and substance use. Despite clear recommendations regarding preventative counseling, many adolescents do not receive adequate preventive care. In this manuscript, we provide suggestions as to how a new vaccination schedule can be used to enhance preventative services to both adolescents and their parents.
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Affiliation(s)
- Richard Rupp
- Department of Pediatrics and Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, Texas, USA.
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153
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Claro LBL, March C, Mascarenhas MTM, de Castro IAB, Rosa MLG. Adolescentes e suas relações com serviços de saúde: estudo transversal em escolares de Niterói, Rio de Janeiro, Brasil. CAD SAUDE PUBLICA 2006; 22:1565-74. [PMID: 16832528 DOI: 10.1590/s0102-311x2006000800005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo transversal, realizado nas escolas de um bairro do Município de Niterói, Rio de Janeiro, Brasil, descreve a relação de adolescentes, entre 12 e 17 anos, com os serviços de saúde, através dos indicadores morbidade referida, auto-avaliação do estado de saúde, necessidade de saúde sentida, demanda, utilização, fidelidade aos serviços de saúde e adesão aos cuidados de saúde e sua associação com variáveis sócio-demográficas. O nível sócio-econômico, representado pelo tipo de escola, mostrou-se associado a todos os indicadores. Os alunos das escolas públicas tinham uma chance maior do que os alunos das escolas privadas de avaliarem seu estado de saúde como regular ou ruim e uma chance menor de expressarem necessidade sentida positivamente, demandarem serviços de saúde, obterem acesso aos serviços procurados e manterem-se fiéis aos serviços utilizados. As meninas apresentaram maior chance de auto-avaliarem seu estado de saúde como ruim ou muito ruim e de demandarem serviços de saúde. A adesão, tanto à realização de exames quanto ao tratamento prescrito por médicos, mostrou-se elevada na amostra investigada.
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154
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Martins D, Tareen N, Zadshir A, Pan D, Vargas R, Nissenson A, Norris K. The association of poverty with the prevalence of albuminuria: data from the Third National Health and Nutrition Examination Survey (NHANES III). Am J Kidney Dis 2006; 47:965-71. [PMID: 16731291 PMCID: PMC3863615 DOI: 10.1053/j.ajkd.2006.02.179] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 02/24/2006] [Indexed: 11/11/2022]
Abstract
BACKGROUND Albuminuria is a major risk factor for the development and progression of chronic kidney disease (CKD) and cardiovascular disease. Socioeconomic factors also have been reported to modify CKD and cardiovascular risk factors and clinical outcomes. The extent to which poverty influences the prevalence of albuminuria, particularly among racial/ethnic minority populations, is not well established. The influence of poverty on the prevalence of albuminuria and the implication of this relationship for the racial and/or ethnic differences in the prevalence of albuminuria were examined. METHODS We examined data from 6,850 male and 7,634 female adults from a national probability survey conducted between 1988 and 1994. RESULTS In univariate analysis, poverty, defined as less than 200% federal poverty level (FPL), was associated with the presence of both microalbuminuria (odds ratio [OR], 1.35; 95% confidence interval, 1.22 to 1.49) and macroalbuminuria (OR, 1.78; 95% confidence interval, 1.40 to 2.26). The association of less than 200% FPL with microalbuminuria persisted in a multivariate model controlling for age, sex, race, education, obesity, hypertension, diabetes, reduced glomerular filtration rate, and medication use (OR, 1.18; 95% confidence interval, 1.05 to 1.33). FPL less than 200% was not associated with macroalbuminuria in the multivariate model. When multivariate analysis is stratified by FPL (<200% and > or =200%), differences in ORs for microalbuminuria and macroalbuminuria among racial/ethnic minority participants compared with whites were more apparent among the less affluent participants in the FPL-less-than-200% stratum. CONCLUSION FPL less than 200% is associated with microalbuminuria, and differences in FPL levels may account for some of the observed differences in prevalence of albuminuria between racial/ethnic minority participants and their white counterparts.
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Affiliation(s)
- David Martins
- Department of Medicine, Charles R. Drew University, Los Angeles, CA, USA.
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155
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Shavers VL, Shavers BS. Racism and health inequity among Americans. J Natl Med Assoc 2006; 98:386-96. [PMID: 16573303 PMCID: PMC2576116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
UNLABELLED Research reports often cite socioeconomic status as an underlying factor in the pervasive disparities in health observed for racial/ethnic minority populations. However, often little information or consideration is given to the social history and prevailing social climate that is responsible for racial/ethnic socioeconomic disparities, namely, the role of racism/racial discrimination. Much of the epidemiologic research on health disparities has focused on the relationship between demographic/clinical characteristics and health outcomes in main-effects multivariate models. This approach, however, does not examine the relationship between covariate levels and the processes that create them. It is important to understand the synergistic nature of these relationships to fully understand the impact they have on health status. PURPOSE A review of the literature was conducted on the role that discrimination in education, housing, employment, the judicial system and the healthcare system plays in the origination, maintenance and perpetuation of racial/ethnic health disparities to serve as background information for funding Program Announcement, PA-05-006, The Effect of Racial/ Ethnic Discrimination/Bias on Healthcare Delivery (http:// grants.nih.gov/grants/ guide/pa-files/PA-05-006.html). The effect of targeted marketing of harmful products and environmental justice are also discussed as they relate to racial/ethnic disparities in health. CONCLUSION Racial/ethnic disparities in health are the result of a combination of social factors that influence exposure to risk factors, health behavior and access to and receipt of appropriate care. Addressing these disparities will require a system that promotes equity and mandates accountability both in the social environment and within health delivery systems.
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Affiliation(s)
- Vickie L Shavers
- Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
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156
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Probst JC, Moore CG, Baxley EG. Update: health insurance and utilization of care among rural adolescents. J Rural Health 2006; 21:279-87. [PMID: 16294649 DOI: 10.1111/j.1748-0361.2005.tb00096.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
CONTEXT Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences. PURPOSE To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents. METHODS Cross-sectional design using data from the 1999-2000 National Health Interview Survey, a nationally representative sample of US households. Analysis was restricted to white, black, and Hispanic children aged 12 through 17 (8,503 observations). Outcome measures included health insurance, ambulatory visit within past year, usual source of care (USOC), and well visit within past year. Independent variables included race, residence, demographics, facilitating/enabling characteristics, and need. RESULTS Across races, rural adolescents were as likely to have insurance (86.8% vs 87.7%) but less likely to report a preventive visit (60.1% vs 65.5%) than urban children; residence did not affect the likelihood of a visit or a USOC. Minority rural adolescents were less likely than whites to be insured, report a visit, or have a USOC. Most race-based differences were not significant in multivariate analysis holding constant living situation, caretaker education, income, and insurance. Low caretaker English fluency, limited almost exclusively to Hispanics, was an impediment to all outcomes. CONCLUSIONS Most barriers to care among rural and minority youth are attributable to factors originating outside the health care system, such as language, living situation, caretaker education, and income. A combination of outreach activities and programs to enhance rural schools and economic opportunities will be needed to improve coverage and utilization among adolescents.
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Affiliation(s)
- Janice C Probst
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
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157
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158
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Bailey TM, Delva J, Gretebeck K, Siefert K, Ismail A. A systematic review of mammography educational interventions for low-income women. Am J Health Promot 2005; 20:96-107. [PMID: 16295701 PMCID: PMC1820866 DOI: 10.4278/0890-1171-20.2.96] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We conducted a systematic review to examine the effectiveness of educational interventions in increasing mammography screening among low-income women. DATA SOURCES Bibliographic databases, including MEDLINE, The Cochrane Central Register of Controlled Trials, The Cochrane Database of Systematic Reviews, and the ISI Web of Science, were searched for relevant articles. STUDY INCLUSION AND EXCLUSION CRITERIA Randomized, community-based trials targeting low-income women and published between January 1980 and March 2003 were included. DATA EXTRACTION The search yielded 242 studies; 24 met all inclusion criteria. DATA SYNTHESIS Three studies used mammography vans, three used low-cost vouchers or provided free mammograms, three used home visits, one used community education alone, one provided referrals, five incorporated multiple intervention strategies, two used phone calls, one used videos and print material, and five used primarily print material. RESULTS Of nine studies that reduced barriers to care via mammography vans, cost vouchers, or home visits, eight showed statistically significant increases in mammography screening. Seven of the eight studies that used peer educators had significant increases in screening, as did four of the five studies that used multiple (intervention) components. CONCLUSIONS Interventions that used peer educators, incorporated multiple intervention strategies, or provided easy access via vans, cost vouchers, or home visits were effective in increasing screenings. Mailed letter or telephone reminders were not effective in trials involving low-income women, which is contrary to findings from middle/upper-income studies.
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Affiliation(s)
- Tatiana M Bailey
- School of Dentistry, University of Michigan, Ann Arbor 48109, USA
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159
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Isong U, Weintraub JA. Determinants of dental service utilization among 2 to 11-year-old California children. J Public Health Dent 2005; 65:138-45. [PMID: 16171258 DOI: 10.1111/j.1752-7325.2005.tb02803.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The 2001 California Health Interview Survey (CHIS) was designed to elicit population-based estimates about health care access and insurance coverage. This study aimed to determine factors associated with dental service utilization among children ages 2 to 11 years in California. METHODS CHIS was a random digit dialing telephone survey. Interviews were conducted with the adult in the household that was most knowledgeable about the child's care, and information was collected on the child's last dental visit. RESULTS Data on dental visits were collected on 10,569 children ages 2-11 years. In 2001, 73.5 (+/- 0.6)% of children had a dental visit, 58.2 (+/- 0.6)% a preventive dental visit, while 18.3 (+/- 0.5)% had never visited the dentist. Nearly 1 million children had never visited the dentist, primarily children ages 2-5 years. Overall, 76.3 (+/- 0.6)% of children had dental insurance. Children with a past-year dental visit were likely to be school age, insured and from high-income households. Other predictors of utilization were the responding adult's age and educational attainment. CONCLUSION Dental service utilization is determined by a mix of parental, child and household factors.
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Affiliation(s)
- Umo Isong
- Department of Preventive and Restorative Dental Sciences, University of California, 3333 California Street, Ste. 495, San Francisco, CA 94143-1361, USA.
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160
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Chen E, Martin AD, Matthews KA. Socioeconomic status and health: do gradients differ within childhood and adolescence? Soc Sci Med 2005; 62:2161-70. [PMID: 16213644 DOI: 10.1016/j.socscimed.2005.08.054] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Indexed: 11/25/2022]
Abstract
Socioeconomic status (SES) gradients may not be static across the lifespan, but instead may vary in strength across different life stages. This study examined the periods in childhood when SES and health relationships emerge and are strongest among US children. Data came from the National Health Interview Survey, 1994, a cross sectional, nationally representative sample of 33,911 US children ages 0-18. Parents were asked about family SES and child health status. Global health measures included overall ratings of child health, activity and school limitations. Acute conditions included childhood injuries and respiratory illnesses. For all global child health measures, lower family SES was associated with poorer child health in a gradient fashion (P < .001); these differences did not vary across age. For specific conditions, interaction effects of SES with age were found (P < .05). Interaction effects revealed that for injury and acute respiratory illness, expected SES gradients (lower SES with poorer outcomes) were evident during adolescence. In contrast, respiratory illness had a reverse SES gradient in early childhood. In sum, for global child health measures, associations of lower SES with poorer health throughout childhood suggest that factors that do not change with age (e.g., health care quality) may best explain overall health status. However, for acute conditions, the relationship between low SES and poor child health appears most consistently during adolescence. This suggests that normal development-related changes during adolescence, such as increasing peer group affiliation, may help explain these gradients. These patterns are important to understand for optimally timing interventions to reduce SES disparities in US children's health.
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Affiliation(s)
- Edith Chen
- Department of Psychology, University of British Columbia, Vancouver, Canada.
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161
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Emerson E, Graham H, Hatton C. Household income and health status in children and adolescents in Britain. Eur J Public Health 2005; 16:354-60. [PMID: 16207724 DOI: 10.1093/eurpub/cki200] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mortality, health, and well-being across the lifespan are associated with socioeconomic position (typically operationalised as occupational status). There is some evidence that adolescence represents a period of 'relative equalisation' of health inequalities. Our aim was to examine the association between inequalities in household income and health in childhood and adolescence. METHODS Cross-sectional survey using multistage stratified random sample of households in Britain. Information was collected on 10438 children aged 5-15 years. RESULTS Low levels of equivalised household income was associated with poorer health for 13 out of the 22 indicators examined (odds ratio P < 0.05 for > or =1 income quintile). Multivariate analyses controlling for child characteristics, parental socioeconomic status and household composition indicated that low levels of equivalised household income increased the odds of poor health for 9 out of the 22 indicators examined. There was little evidence of any systematic differences in the extent of health inequalities across age groups (5-10 and 11-15 years). CONCLUSION Household income is related to a range of health outcomes for children and adolescents, even when other indicators of socioeconomic status are taken into account. We found little evidence that adolescence represents a period of relative equalisation of health inequalities.
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Affiliation(s)
- Eric Emerson
- Institute for Health Research, Lancaster University, UK.
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162
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Shone LP, Dick AW, Klein JD, Zwanziger J, Szilagyi PG. Reduction in racial and ethnic disparities after enrollment in the State Children's Health Insurance Program. Pediatrics 2005; 115:e697-705. [PMID: 15930198 DOI: 10.1542/peds.2004-1726] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Racial/ethnic disparities are associated with lack of health insurance. Although the State Children's Health Insurance Program (SCHIP) provides health insurance to low-income children, many of whom are members of racial/ethnic minority groups, little is known about whether SCHIP affects racial/ethnic disparities among children who enroll. OBJECTIVES The objectives of this study were to (1) describe demographic characteristics and previous health insurance experiences of SCHIP enrollees by race, (2) compare racial/ethnic disparities in medical care access, continuity, and quality before and during SCHIP, and (3) determine whether disparities before or during SCHIP are explained by sociodemographic and health system factors. METHODS Pre/post-parent telephone survey was conducted just after SCHIP enrollment and 1 year after enrollment of 2290 children who had an enrollment start date in New York State's SCHIP between November 2000 and March 2001, stratified by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic). The main outcome measures were usual source of care (USC), preventive care use, unmet needs, patterns of USC use, and parent-rated quality of care before versus during SCHIP. RESULTS Children were white (25%), black (31%), or Hispanic (44%); 62% were uninsured > or =12 months before SCHIP. Before SCHIP, a greater proportion of white children had a USC compared with black or Hispanic children (95%, 86%, and 81%, respectively). Nearly all children had a USC during SCHIP (98%, 95%, and 98%, respectively). Before SCHIP, black children had significantly greater levels of unmet need relative to white children (38% vs 27%), whereas white and Hispanic children did not differ significantly (27% vs 29%). During SCHIP, racial/ethnic disparities in unmet need were eliminated, with unmet need at 19% for all 3 racial/ethnic groups. Before SCHIP, more white children made all/most visits to their USC relative to black or Hispanic children (61%, 54%, and 34%, respectively); all improved during SCHIP with no remaining disparities (87%, 86%, and 92%, respectively). Parent-rated visit quality improved for all groups, but preexisting racial/ethnic disparities remained during SCHIP, with improved yet relatively lower levels of satisfaction among parents of Hispanic children. Sociodemographic and health system factors did not explain disparities in either period. CONCLUSIONS Enrollment in SCHIP was associated with (1) improvement in access, continuity, and quality of care for all racial/ethnic groups and (2) reduction in preexisting racial/ethnic disparities in access, unmet need, and continuity of care. Racial/ethnic disparities in quality of care remained, despite improvements for all racial groups. Sociodemographic and health system factors did not add to the understanding of racial/ethnic disparities. SCHIP improves care for vulnerable children and reduces preexisting racial/ethnic disparities in health care.
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Affiliation(s)
- Laura P Shone
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA.
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