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Abstract
Since the completion of the Human Genome Project, considerable progress has been made in translating knowledge about the genetic basis of disease risk and treatment response into clinical services and public health interventions that have greater precision. It is anticipated that more precision approaches to early detection, prevention, and treatment will be developed and will enhance equity in healthcare and outcomes among disparity populations. Reduced access to genomic medicine research, clinical services, and public health interventions has the potential to exacerbate disparities in genomic medicine. The purpose of this article is to describe these challenges to equity in genomic medicine and identify opportunities and future directions for addressing these issues. Efforts are needed to enhance access to genomic medicine research, clinical services, and public health interventions, and additional research that examines the clinical utility of precision medicine among disparity populations should be prioritized to ensure equity in genomic medicine. Expected final online publication date for the Annual Review of Genomics and Human Genetics, Volume 23 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA; .,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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Mendenhall R, Henderson L, Scott B, Butler L, Turi KN, Greenlee A, Robinson GE, Roberts BW, Rodriguez-Zas SL, Brooks JE, Lleras CL. Involving Urban Single Low-Income African American Mothers in Genomic Research: Giving Voice to How Place Matters in Health Disparities and Prevention Strategies. FAMILY MEDICINE AND PRIMARY CARE -- OPEN ACCESS 2020; 4:148. [PMID: 35373191 PMCID: PMC8970351 DOI: 10.29011/2688-7460.100048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article describes the process of using principles from community-based participatory action research to involve low-income, single, African American mothers on the south side of Chicago in genomic research, including as citizen scientists. The South Chicago Black Mothers' Resiliency Project used a mixed methods design to investigate how the stress of living in neighborhoods with high levels of violence affects mothers' mental and physical health. This article seeks to serve as a model for physicians and scholars interested in successfully involving low-income African American mothers in genomic research, and other health-related activities in ways that are culturally sensitive and transformative. The lives of Black mothers who struggle under interlocking systems of oppression that are often hidden from view of most Americans are at the center of this article. Therefore, we provide extensive information about the procedures used to collect the various types of data, the rationale for our procedures, the setting, the responses of mothers in our sample and methodological challenges. This study also has implications for the current COVID-19 pandemic and the need to train a corps of citizen scientists in health and wellness to avoid future extreme loss of life such as the 106,195 lives lost in the United States as of June 1, 2020.
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Affiliation(s)
- Ruby Mendenhall
- Department of Sociology, African American Studies & Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, USA
| | - Loren Henderson
- Department of Sociology and Anthropology, University of Maryland, Baltimore County, USA
| | - Barbara Scott
- Department of Sociology, Northeastern Illinois University, USA
| | - Lisa Butler
- Independent Scholar, Northeastern Illinois University, USA
| | - Kedir N Turi
- Department of Medicine, Vanderbilt University, Nashville, USA
| | - Andrew Greenlee
- Urban and Regional Planning, University of Illinois at Urbana-Champaign, USA
| | - Gene E Robinson
- Institute for Genomic Biology, Integrative Biology, University of Illinois at Urbana-Champaign, USA
| | - Brent W Roberts
- Center for Social and Behavioral Science Psychology, University of Illinois at Urbana-Champaign, USA
| | | | | | - Christy L Lleras
- Human Development & Family Studies, University of Illinois at Urbana-Champaign, USA
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Bacong AM, Holub C, Porotesano L. Comparing Obesity-Related Health Disparities among Native Hawaiians/Pacific Islanders, Asians, and Whites in California: Reinforcing the Need for Data Disaggregation and Operationalization. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2016; 75:337-344. [PMID: 27920944 PMCID: PMC5125359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Since the 2000 Census, Asians and Pacific Islanders have been categorized as separate races. Government initiatives have called for greater study of Asian, Native Hawaiian, and other Pacific Islander (NHPI) health outcomes. NHPI often have worse health outcomes than Asians and Whites. Despite this, the lack of operationalization of racial definitions may affect the magnitude of health disparities. This analysis examined how utilizing different sociological race definitions could influence NHPI health outcomes when compared to Asians and Whites. Utilizing data from the 2009 California Health Interview Survey, NHPI had significantly higher age adjusted obesity prevalence than Whites under the UCLA Center for Health Policy Research (CHPR) (OR = 1.72, P = .03) and Self-Report (OR = 1.57, P = .01) definitions, but not the Census definition (OR = 1.42, P = .11). NHPI had significantly higher age adjusted obesity prevalence than Asians under all definitions (Census OR = 4.05, P < .01; CHPR OR = 4.81, P < .01; Self-Report OR = 4.46, P < .01). NHPI had significantly higher age adjusted diabetes/pre-diabetes prevalence than Whites across all definitions (Census OR = 3.27, P < .01, CHPR OR = 3.03, P < .01, Self-Report OR = 1.99, P = .01) but only the Census (OR = 2.12, P = .01) and CHPR (OR = 1.86, P = .04) when NHPI were compared to Asians. Overall, race definition changed the identification of health disparities. Future studies should operationalize racial definitions, as health disparities are masked post-hoc when utilizing different race definitions.
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Affiliation(s)
- Adrian Matias Bacong
- San Diego State University Institute for Behavioral and Community Health, San Diego, CA (all)
| | - Christina Holub
- San Diego State University Institute for Behavioral and Community Health, San Diego, CA (all)
| | - Liki Porotesano
- San Diego State University Institute for Behavioral and Community Health, San Diego, CA (all)
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Hughes Halbert C, Welch B, Lynch C, Magwood G, Rice L, Jefferson M, Riley J. Social determinants of family health history collection. J Community Genet 2015; 7:57-64. [PMID: 26280996 DOI: 10.1007/s12687-015-0251-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 08/06/2015] [Indexed: 11/28/2022] Open
Abstract
Family health history (FHH) is the most basic form of genomic information. Although public health efforts have been made to promote FHH collection, empirical data on the extent to which community residents in rural areas actively collect FHH is limited. Therefore, we examined rates of FHH collection in a community-based sample of South Carolina residents. We conducted a structured telephone survey in a random sample of black and white South Carolina residents. Respondents were asked if they had ever actively collected FHH from relatives using an item developed by the Centers for Disease Control and Prevention. Overall, 42 % of respondents reported that they had actively collected their FHH. Blacks were significantly more likely than whites to have collected their FHH in bivariate analysis, but race did not have a significant association with FHH collection in the multivariate model (OR = 1.36, 95 % CI = 0.79, 2.35, p = 0.26). The likelihood of collecting FHH was increased among respondents whose last medical visit occurred in the past year compared to those whose last medical visit was more than 1 year ago (OR = 2.00, 95 % CI = 1.12, 3.56, p = 0.02). In addition, older respondents had a reduced likelihood of collecting their FHH (OR = 0.69, 95 % CI = 0.53, 0.90, p = .01). Lastly, women were about twice as likely as men to have collected their FHH (OR = 1.83, 95 % CI = 1.12, 2.99, p = 0.02). Greater efforts are needed to increase the collection of FHH information; these efforts may need to target men, the elderly, and individuals who have not had a recent medical visit.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA.
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veteran Administration Medical Center, Charleston, SC, USA.
| | - Brandon Welch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Cheryl Lynch
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veteran Administration Medical Center, Charleston, SC, USA
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Gayenell Magwood
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - LaShanta Rice
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Jodie Riley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Morrison DG, Farah C, Hock JM. Informed consent for biobanking research: cancer patient recruitment from rural communities in Maine. Biopreserv Biobank 2014; 11:107-14. [PMID: 24845431 DOI: 10.1089/bio.2012.0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Biobanking research seeks to improve the diversity, availability, and quality of human specimens critical for translational research, including biospecimen collections from disadvantaged minorities. American rural whites are seldom represented in such initiatives as geographic isolation makes obtaining informed consent challenging. We report a case series of 83 newly diagnosed cancer patients, attending a rural community medical center, who consented to participate in cancer research. To enable pooling with population studies, we created a BioGeoBank using 2007 NCI and ISBER Best Practices, after a protocol approval by Eastern Maine Medical Center (EMMC) IRB and OHP HRPO. Informed consent forms were at Flesch-Kincaid 8th Grade reading level, supplemented by NCI educational brochures. Of 108 patients identified, 85 were eligible. Of these, 83 patients (49 lung cancer, 21 breast cancer, and 13 other cancers) consented to donate data, blood, and tissue specimens for future research, and maintained eligibility. Two years later, we executed a legacy protocol to transfer specimens to NCI's biorepository. Of the 69 surviving patients, 9 patients could not be contacted. All those contacted (60) agreed to provide additional data on environmental risks, and consented to specimen transfer. Self-organizing map analyses showed no evidence that age, education, income, familial susceptibility, or lifestyle factors were associated with consent to donate data or biospecimens. Cancer cases reported 1-3 co-morbid chronic diseases (mostly cardiovascular), near lifetime smoking and/or alcohol consumption; familial cancer risks, and many had a prior cancer history. Anecdotally, willingness to consent was based on altruistic hopes that research would generate knowledge to reduce cancer incidence. Our study shows that cancer patients from disadvantaged white rural communities with health disparities associated with geographic isolation are motivated to consent to participate and support biobank research.
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Wallace PJ, Shah ND, Dennen T, Bleicher PA, Crown WH. Optum Labs: Building A Novel Node In The Learning Health Care System. Health Aff (Millwood) 2014; 33:1187-94. [DOI: 10.1377/hlthaff.2014.0038] [Citation(s) in RCA: 281] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Paul J. Wallace
- Paul J. Wallace ( ) is chief medical officer and senior vice president of clinical translation at Optum Labs, in Cambridge, Massachusetts
| | - Nilay D. Shah
- Nilay D. Shah is an associate professor of health services research, Department of Health Sciences Research, Mayo Clinic, in Rochester, Minnesota
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Cook BL, McGuire TG, Zaslavsky AM. Measuring racial/ethnic disparities in health care: methods and practical issues. Health Serv Res 2012; 47:1232-54. [PMID: 22353147 PMCID: PMC3371391 DOI: 10.1111/j.1475-6773.2012.01387.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To review methods of measuring racial/ethnic health care disparities. STUDY DESIGN Identification and tracking of racial/ethnic disparities in health care will be advanced by application of a consistent definition and reliable empirical methods. We have proposed a definition of racial/ethnic health care disparities based in the Institute of Medicine's (IOM) Unequal Treatment report, which defines disparities as all differences except those due to clinical need and preferences. After briefly summarizing the strengths and critiques of this definition, we review methods that have been used to implement it. We discuss practical issues that arise during implementation and expand these methods to identify sources of disparities. We also situate the focus on methods to measure racial/ethnic health care disparities (an endeavor predominant in the United States) within a larger international literature in health outcomes and health care inequality. EMPIRICAL APPLICATION: We compare different methods of implementing the IOM definition on measurement of disparities in any use of mental health care and mental health care expenditures using the 2004-2008 Medical Expenditure Panel Survey. CONCLUSION Disparities analysts should be aware of multiple methods available to measure disparities and their differing assumptions. We prefer a method concordant with the IOM definition.
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Affiliation(s)
- Benjamin Lê Cook
- Department of Psychiatry, Center for Multicultural Mental Health Research, Harvard Medical School, Somerville, MA 02143, USA.
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Williams DR, Kontos EZ, Viswanath K, Haas JS, Lathan CS, MacConaill LE, Chen J, Ayanian JZ. Integrating multiple social statuses in health disparities research: the case of lung cancer. Health Serv Res 2012; 47:1255-77. [PMID: 22568674 DOI: 10.1111/j.1475-6773.2012.01404.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To illustrate the complex patterns that emerge when race/ethnicity, socioeconomic status (SES), and gender are considered simultaneously in health care disparities research and to outline the needed research to understand them by using disparities in lung cancer risks, treatment, and outcomes as an example. PRINCIPAL FINDINGS SES, gender, and race/ethnicity are social categories that are robust predictors of variations in health and health services utilization. These are usually considered separately, but intersectionality theory indicates that the impact of each depends on the others. Each reflects historically and culturally contingent variations in social, economic, and political status. Distinct patterns of risk and resilience emerge at the intersections of multiple social categories and shape the experience of health, health care access, utilization, quality, and outcomes where these categories intersect. Intersectional approaches call for greater attention to understand social processes at multiple levels of society and require the collection of relevant data and utilization of appropriate analytic approaches to understand how multiple risk factors and resources combine to affect the distribution of disease and its management. CONCLUSIONS Understanding how race/ethnicity, gender, and SES are interactive, interdependent, and social identities can provide new knowledge to enhance our efforts to effectively address health disparities.
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Affiliation(s)
- David R Williams
- Department of Society, Human Development and Health, Harvard University, School of Public Health, 677 Huntington Avenue, 6th Floor, Boston, MA, 02215, USA.
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