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Sibille K, Mickle A, Garvan C, Mohamed B, Hill CV, Keil A. Advancing health disparities research and improving health for all. BMJ 2024; 385:q1093. [PMID: 38768973 DOI: 10.1136/bmj.q1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Kimberly Sibille
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Angela Mickle
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Cynthia Garvan
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Basma Mohamed
- Divisions of Perioperative Medicine and Neuroanesthesia, Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Andreas Keil
- Department of Psychology, University of Florida, Gainesville, FL, USA
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Lynch EB, Tangney C, Ruppar T, Zimmermann L, Williams J, Jenkins L, Epting S, Avery E, Olinger T, Berumen T, Skoller M, Wornhoff R. Heart 2 Heart: Pilot Study of a Church-Based Community Health Worker Intervention for African Americans with Hypertension. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:22-33. [PMID: 37418177 PMCID: PMC11133067 DOI: 10.1007/s11121-023-01553-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 07/08/2023]
Abstract
African Americans (AAs) have higher prevalence of uncontrolled hypertension than Whites, which leads to reduced life expectancy. Barriers to achieving blood pressure control in AAs include mistrust of healthcare and poor adherence to medication and dietary recommendations. We conducted a pilot study of a church-based community health worker (CHW) intervention to reduce blood pressure among AAs by providing support and strategies to improve diet and medication adherence. To increase trust and cultural concordance, we hired and trained church members to serve as CHWs. AA adults (n = 79) with poorly controlled blood pressure were recruited from churches in a low-income, segregated neighborhood of Chicago. Participants had an average of 7.5 visits with CHWs over 6 months. Mean change in systolic blood pressure across participants was - 5 mm/Hg (p = 0.029). Change was greater among participants (n = 45) with higher baseline blood pressure (- 9.2, p = 0.009). Medication adherence increased at follow-up, largely due to improved timeliness of medication refills, but adherence to the DASH diet decreased slightly. Intervention fidelity was poor. Recordings of CHW visits revealed that CHWs did not adhere closely to the intervention protocol, especially with regard to assisting participants with action plans for behavior change. Participants gave the intervention high ratings for acceptability and appropriateness, and slightly lower ratings for feasibility of achieving intervention behavioral targets. Participants valued having the intervention delivered at their church and preferred a church-based intervention to an intervention conducted in a clinical setting. A church-based CHW intervention may be effective at reducing blood pressure in AAs.
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Affiliation(s)
- Elizabeth B Lynch
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Christy Tangney
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
- Dept. of Clinical Nutrition, Rush University Medical Center, Chicago, IL, USA
| | - Todd Ruppar
- Dept. of Adult Health and Gerontological Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Laura Zimmermann
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Joselyn Williams
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - LaDawne Jenkins
- Dept. of Community Health Equity and Engagement, Rush University Medical Center, Chicago, IL, USA
| | - Steve Epting
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
- Hope Community Church, Chicago, IL, USA
| | - Elizabeth Avery
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Tamara Olinger
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Teresa Berumen
- Dept. of Community Health Equity and Engagement, Rush University Medical Center, Chicago, IL, USA
| | - Maggie Skoller
- Center for Health and Social Care Integration, Rush University Medical Center, Chicago, IL, USA
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Baxter SLK, Zare H, Thorpe RJ. Race Disparities in Hypertension Prevalence Among Older Men. Int J Aging Hum Dev 2024; 98:10-26. [PMID: 37150878 DOI: 10.1177/00914150231172119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This study aimed to examine whether hypertension prevalence varies by race/ethnicity and within age groups in a nationally representative sample of men in the United States. Hypertension was defined as blood pressure (BP) readings of 140 mm Hg and higher for systolic BP, 90 mm Hg and higher for diastolic BP, or self-reports of taking medication for hypertension. Modified Poisson models estimated prevalence ratios (PRs) and 95% confidence intervals (CI) for race and age group associations with hypertension. The prevalence of hypertension was 38% overall and 46% of the men were aged 50 and older. Analyses that focused on older men (50 years of age or older) found that non-Hispanic Black men had a higher prevalence of hypertension (PR = 1.28, 95% CI: 1.19 - 1.37) compared to non-Hispanic White men. We suggest future research utilize life course perspectives to better identify which cumulative experiences impact hypertension disparities.
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Affiliation(s)
- Samuel L K Baxter
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- School of Business, University of Maryland Global Campus (UMGC), Baltimore, MD, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Johns Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Baltimore, MD, USA
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Robinson-Lane SG, Johnson FU, Tuyisenge MJ, Kirch M, Christensen LL, Malani PN, Solway E, Singer DC, Kullgren JT, Koumpias AM. Racial and ethnic variances in preparedness for aging in place among US adults ages 50-80. Geriatr Nurs 2023; 54:357-364. [PMID: 37802755 DOI: 10.1016/j.gerinurse.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES To investigate the preparations made by adults to age in place and identify disparities. METHODS A cross-sectional survey was conducted among U.S. adults ages 50-80 years old (n = 2277). Individual, environmental, social, and community factors influencing readiness for aging in place were examined using chi-square tests and logistic regression. RESULTS Income, disability status, and household composition, emerged as influential factors, often negatively affecting minority aging. Participants' consideration of aging in place was related to their disability status (OR 1.80 [1.32, 2.45]) and age (OR age 60-69 2.06 [1.54, 2.74], age 70-80 (OR 1.98 [1.46,2.67]), compared with age 50-59). Indigenous and Black older adults reported significantly higher levels of consideration for aging in place than White older adults (Indigenous OR 7.89 [2.35, 26.42], Black OR 1.71 [1.11, 2.64]). CONCLUSION Aging in place is best facilitated by inclusive communities that prioritize adaptive homes and accessible community services.
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Affiliation(s)
- Sheria G Robinson-Lane
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | - Florence U Johnson
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Marie Jeanne Tuyisenge
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Loretta L Christensen
- Indian Health Services, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Dianne C Singer
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Departments of Internal Medicine and Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Antonios M Koumpias
- Department of Social Sciences, University of Michigan - Dearborn, Dearborn, MI, USA
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Feger DM, Willis SL, Deal J, Dean LT, Gross AL. Disparities in First Instrumental Activity of Daily Living Difficulty between Black and White Older Adults: Findings from the Advanced Cognitive Training in Independent and Vital Elderly Study. J Aging Health 2023; 35:51S-58S. [PMID: 34047230 PMCID: PMC8805632 DOI: 10.1177/08982643211023005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Few studies have examined differences in age of onset of first self-reported instrumental activities of daily living difficulty, much less differences by race. Our objective was to determine whether there are differences in the first reported difficulty with IADLs between Black and white older adults. Methods: We analyzed data from N = 1168 participants in the Advanced Cognitive Training in Independent and Vital Elderly (ACTIVE) study. A multiple group discrete-time multiple-event process survival mixture (MEPSUM) model was used to estimate the hazard of incident IADL difficulty in seven IADL task groups. Results: No statistically significant differences were identified in the first reported IADL task group difficulty between Black and white older adults. Discussion: Our findings indicate similar patterns of early IADL difficulty in Black and white older adults, suggesting that previously reported racial disparities in ability to perform IADLs may be attributable to differences in absolute risk, not timing.
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Affiliation(s)
- Danielle M. Feger
- Center on Aging and Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sherry L. Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Jennifer Deal
- Center on Aging and Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alden L. Gross
- Center on Aging and Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Mickle AM, Domenico LH, Tanner JJ, Terry EL, Cardoso J, Glover TL, Booker S, Addison A, Gonzalez CE, Garvan CS, Redden D, Staud R, Goodin BR, Fillingim RB, Sibille KT. Elucidating factors contributing to disparities in pain-related experiences among adults with or at risk for knee osteoarthritis. FRONTIERS IN PAIN RESEARCH 2023; 4:1058476. [PMID: 36910251 PMCID: PMC9992984 DOI: 10.3389/fpain.2023.1058476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2023] Open
Abstract
Background and purpose We and others have reported ethnic/race group differences in clinical pain, physical function, and experimental pain sensitivity. However, recent research indicates that with consideration for socioenvironmental factors, ethnicity/race differences become less or non-significant. Understanding of factors contributing to pain inequities are needed. Guided by the NIA and NIMHD Health Disparities Research Frameworks, we evaluate the contributions of environmental and behavioral factors on previously reported ethnic/race group differences in: (1) clinical pain, (2) physical function, and (3) experimental pain in individuals with knee pain. Methods Baseline data from Understanding of Pain and Limitations in Osteoarthritis Disease (UPLOAD) and UPLOAD-2 studies were analyzed. Participants were adults 45 to 85 years old who self-reported as non-Hispanic white (NHW) or black (NHB) with knee pain. A health assessment and quantitative sensory testing were completed. Sociodemographics, environmental, health, clinical and experimental pain, and physical functioning measures were included in nested regressions. Results Pooled data from 468 individuals, 57 ± 8 years of age, 63% women, and 53% NHB adults. As NHB adults were younger and reported greater socioenvironmental risk than the NHW adults, the term sociodemographic groups is used. With inclusion of recognized environmental and behavioral variables, sociodemographic groups remained a significant predictor accounting for <5% of the variance in clinical pain and physical function and <10% of variance in experimental pain. Conclusion The incorporation of environmental and behavioral factors reduced relationships between sociodemographic groups and pain-related outcomes. Pain sites, BMI, and income were significant predictors across multiple models. The current study adds to a body of research on the complex array of factors contributing to disparities in pain-related outcomes.
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Affiliation(s)
- Angela M. Mickle
- College of Medicine, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, United States
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Lisa H. Domenico
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | - Jared J. Tanner
- College of Public Health and Health Professionals, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Ellen L. Terry
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | - Josue Cardoso
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Toni L. Glover
- School of Nursing, Oakland University, Rochester, MI, United States
| | - Staja Booker
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | - Adriana Addison
- Department of Psychology, College of Arts and Science, University of Birmingham Alabama, Birmingham, AL, United States
| | - Cesar E. Gonzalez
- Department of Psychology, College of Arts and Science, University of Birmingham Alabama, Birmingham, AL, United States
| | - Cynthia S. Garvan
- College of Medicine, Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - David Redden
- Department of Biostatistics, School of Public Health, University of Birmingham Alabama, Birmingham, AL, United States
| | - Roland Staud
- College of Medicine, Department of Rheumatology, University of Florida, Gainesville, FL, United States
| | - Burel R. Goodin
- Department of Psychology, College of Arts and Science, University of Birmingham Alabama, Birmingham, AL, United States
| | - Roger B. Fillingim
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Kimberly T. Sibille
- College of Medicine, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, United States
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
- College of Medicine, Department of Anesthesiology, University of Florida, Gainesville, FL, United States
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Fabius CD, Parker LJ, Thorpe RJ. The Influence of Race and Gender on Receiving Assistance with Daily Activities among Older Americans. Innov Aging 2021; 6:igab060. [PMID: 35233471 PMCID: PMC8874838 DOI: 10.1093/geroni/igab060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives Nearly 8.2 million community-dwelling, older Medicare beneficiaries receive support from long-term services and supports (LTSS) with routine daily activities. Prior work demonstrates disability-related disparities; however, it is unclear whether these patterns persist among LTSS recipients and across specific sets of activities. We examine race and gender differences in receiving help with self-care (e.g., eating), mobility (e.g., getting around the house), and household (e.g., shopping) activities in a nationally representative sample of community-dwelling Medicare beneficiaries receiving LTSS. Research Design and Methods Cross-sectional analysis of 1,808 White and Black older adults receiving assistance with routine daily activities in the 2015 National Health and Aging Trends Study. Bivariate statistics were used to describe the sample and provide comparisons of characteristics by race and gender. Logistic regression models examined race and gender differences in receiving assistance with self-care, mobility, and household activities after adjusting for sociodemographic and health characteristics. Results Race and gender differences were observed across all sociodemographic and health characteristics, as well as for all forms of assistance. Relative to White men, Black men had lower odds of receiving help with self-care activities. White and black women had higher odds and Black men had lower odds of getting help with mobility activities than White men. Black men and White and Black women all had higher odds of receiving assistance with household tasks compared to White men. Discussion and Implications Our findings indicate that, despite prior evidence of disability-related disparities, the receipt of help with self-care, mobility, and household activities varies by race and gender. Findings reveal several target areas for future research. Future work should examine the role of cultural and social preferences for care, as well as the appropriateness of help, as evidenced by health service use and changes in quality of life.
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Affiliation(s)
- Chanee D Fabius
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lauren J Parker
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Roland J Thorpe
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Sardina AL, Gamaldo AA, Andel R, Johnson S, Baker TA, Thorpe RJ, McEvoy C, Evans MK, Zonderman AB. Cross-Sectional Examination of Musculoskeletal Pain and Physical Function in a Racially and Socioeconomically Diverse Sample of Adults. J Gerontol A Biol Sci Med Sci 2021; 76:368-377. [PMID: 33009550 DOI: 10.1093/gerona/glaa251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Musculoskeletal pain alters physiological function, which may be evidenced as early as middle age. Previous research has concluded that middle-aged adults are a high-risk group for musculoskeletal pain and report functional limitations similar to older adults. However, few studies have examined the relationships between musculoskeletal pain and physical function, using objective performance measures in a sample of racially and socioeconomically diverse adults. Thus, this study examined musculoskeletal pain in relation to physical function in middle-aged (30-64 years) White and Black adults and investigated whether the relationship varied by sociodemographic characteristics. METHODS This cross-sectional examination incorporated data from the Healthy Aging in Neighborhoods of Diversity across the Life-Span Study. Participants (n = 875) completed measures of musculoskeletal pain and objective measures of physical performance (ie, lower and upper body strength, balance, and gait abnormalities). Physical performance measures were standardized to derive a global measure of physical function as the dependent variable. RESULTS Approximately, 59% of participants identified at least 1 pain sites (n = 518). Multivariable regression analyses identified significant relationships between greater musculoskeletal pain and poorer physical function (β = -0.07, p = .031), in mid midlife (β = -0.04, p = .041; age 40-54) and late midlife (β = -0.05, p = .027; age 55-64). CONCLUSIONS This study observed that musculoskeletal pain was associated with poorer physical function within a diverse group of middle-aged adults. Future research should longitudinally explore whether chronic musculoskeletal pain identified at younger ages is associated with greater risk for functional limitation and dependence in later life.
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Affiliation(s)
- Angie L Sardina
- Department of Recreation Therapy, College of Health and Human Services, University of North Carolina Wilmington, Baltimore, Maryland
| | - Alyssa A Gamaldo
- Laboratory of Epidemiology & Population Sciences, National Institute on Aging, National Institute on Aging, Biomedical Research Center, Baltimore, Maryland.,Human Development and Family Studies, Penn State University, University Park, Pennsylvania
| | - Ross Andel
- University of South Florida, College of Behavioral and Community Sciences, School of Aging Studies, Tampa.,Department of Neurology, Memory Clinic, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Shanthi Johnson
- Faculty of Kinesiology and Health Studies, Saskatchewan Population Health and Evaluation Research Unit, University of Regina, Canada
| | - Tamara A Baker
- Department of Psychiatry, School of Medicine, The University of North Carolina at Chapel Hill, Baltimore, Maryland
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Cathy McEvoy
- University of South Florida, College of Behavioral and Community Sciences, School of Aging Studies, Tampa
| | - Michele K Evans
- Laboratory of Epidemiology & Population Sciences, National Institute on Aging, National Institute on Aging, Biomedical Research Center, Baltimore, Maryland
| | - Alan B Zonderman
- Laboratory of Epidemiology & Population Sciences, National Institute on Aging, National Institute on Aging, Biomedical Research Center, Baltimore, Maryland
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Sternfeld B, Colvin A, Stewart A, Appelhans BM, Cauley JA, Dugan SA, El Khoudary SR, Greendale GA, Strotmeyer E, Karvonen-Gutierrez C. Understanding Racial/Ethnic Disparities in Physical Performance in Midlife Women: Findings From SWAN (Study of Women's Health Across the Nation). J Gerontol B Psychol Sci Soc Sci 2020; 75:1961-1971. [PMID: 31412129 PMCID: PMC7566973 DOI: 10.1093/geronb/gbz103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Evaluate degree to which racial/ethnic differences in physical performance are mediated by sociodemographic, health, behavioral, and psychosocial factors. METHODS Physical performance was evaluated using a decile score derived from grip strength, timed 4 m walk, and timed repeat chair stand in 1,855 African American, Caucasian, Chinese, Hispanic, and Japanese women, mean age = 61.8 (SD = 2.7) in the Study of Women's Health Across the Nation. Mediators included education, financial strain, comorbidities, pain, body mass index (BMI), physical activity, and perceived stress. Structural equation models provided estimates of the total difference in physical performance between Caucasians and each race/ethnic groups and differences due to direct effects of race/ethnicity and indirect effects through mediators. RESULTS The mean decile score for Caucasian women was 16.9 (SD = 5.6), 1.8, 2.6, and 2.1 points higher than the model-estimated scores in African Americans, Hispanics and Chinese, respectively, and 1.3 points lower than the Japanese. Differences between Caucasians and the Chinese and Japanese were direct effects of race/ethnicity whereas in African Americans and Hispanics 75% or more of that disparity was through mediators, particularly education, financial strain, BMI, physical activity, and pain. DISCUSSION Addressing issues of poverty, racial inequality, pain, and obesity could reduce some racial/ethnic disparity in functional limitations as women age.
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Affiliation(s)
| | - Alicia Colvin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Andrea Stewart
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Bradley M Appelhans
- Department of Physical Medicine and Rehabilitation for affiliation, Rush University Medical Center, Chicago, Illinois
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Sheila A Dugan
- Department of Physical Medicine and Rehabilitation for affiliation, Rush University Medical Center, Chicago, Illinois
| | - Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Gail A Greendale
- Department of Gerontology, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Elsa Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
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Bhattarai J'J, Bentley J, Morean W, Wegener ST, Pollack Porter KM. Promoting equity at the population level: Putting the foundational principles into practice through disability advocacy. Rehabil Psychol 2020; 65:87-100. [PMID: 32297777 PMCID: PMC7285891 DOI: 10.1037/rep0000321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Rehabilitation psychology is based on foundational principles that can guide us toward health equity among disabled and nondisabled communities. We summarize the literature on disparities in the disability community and underscore the urgency to address underlying inequities to eliminate disparities. We include examples of population-level interventions that promote equity in the disability community. We conclude with a call for a broader mission for rehabilitation psychologists based on the field's foundational principles, and outline emerging opportunities to widen our impact and advance equity. Our foundational principles, built on systems theory, call on rehabilitation psychologist to work at macrosystemic levels. As rehabilitation psychologists, we need to widen our focus from the micro (individual) to the macro (population) level. We need to bring the respect, dignity, and collaborative spirit that inspire our work with individuals to the broader community by advocating for structures and policies that promote equity for disabled persons. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Jacob Bentley
- Department of Clinical Psychology, Seattle Pacific University
| | - Whitney Morean
- Department of Clinical Psychology, Seattle Pacific University
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine
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VanPuymbrouck L, Friedman C, Feldner H. Explicit and implicit disability attitudes of healthcare providers. Rehabil Psychol 2020; 65:101-112. [PMID: 32105109 PMCID: PMC9534792 DOI: 10.1037/rep0000317] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE/OBJECTIVE Health care providers' attitudes of marginalized groups can be key factors that contribute to health care access and outcome disparities because of their influence on patient encounters as well as clinical decision-making. Despite a growing body of knowledge linking disparate health outcomes to providers' clinical decision making, less research has focused on providers' attitudes about disability. The aim of this study was to examine providers' explicit and implicit disability attitudes, interactions between their attitudes, and correlates of explicit and implicit bias. Research Method/Design: We analyzed secondary data from 25,006 health care providers about their disability attitudes. In addition to analyzing people's explicit and implicit attitudes (Disability Attitudes Implicit Association Test), we used Son Hing, Chung-Yan, Hamilton, & Zanna's (2008) model of two-dimensional prejudice to compare provider's explicit and implicit attitudes. Finally, we used linear regression models to examine correlates of providers' explicit and implicit attitudes. RESULTS While on average, provider's explicit attitudes (M = 4.41) indicated little prejudice, their implicit attitudes (M = 0.54) revealed they moderately preferred nondisabled people-they were aversive ableists. Correlates of providers' explicit and implicit attitudes also included age, gender, political orientation, and having relationships with disability (friends, family, and being a person with disability). CONCLUSIONS/IMPLICATIONS This study revealed that despite a majority of providers self-reporting not being biased against people with disabilities, implicitly, the overwhelming majority were biased. This study's findings can be used to better understand how provider disability bias can contribute to inequitable health care access and health outcomes for people with disabilities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Thorpe RJ, Bruce MA, Howard DL, LaVeist TA. Race differences in mobility status among prostate cancer survivors: The role of socioeconomic status. Adv Cancer Res 2020; 146:103-114. [PMID: 32241385 DOI: 10.1016/bs.acr.2020.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of this paper was to determine whether there were any race differences in mobility limitation among PCa survivors, and understand the impact of socioeconomic status (SES) on this relationship. Data consisted of 661 PCa survivors (296 Black and 365 White) from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes (DAD) Study. Mobility limitation was defined as PCa survivors who reported difficulty walking a quarter mile or up 1 flight of stairs. Race was based on the PCa survivors self-identification of either White or Black. SES consisted of education level (i.e., less than high school, high school/GED, some college/associate, bachelors, masters/PhD) and annual household income (i.e., less than $50,000; $50,000-$100,000; greater than $100,000). Adjusting for age, marital status, health insurance, Gleason Score, treatment received, and time to treatment, Black PCa survivors had a higher prevalence of mobility limitation (PR=1.58, 95% CI: 1.17-2.15) relative to White PCa survivors. When adding education and income to the adjusted model, Black PCa survivors had a similar prevalence of mobility limitation (PR=1.12, 95% CI: 0.80-1.56) as White PCa survivors. The unequal distribution of SES resources between Black and White PCa survivors accounted for the observed race differences in mobility limitation. This work emphasizes the importance of SES in understanding race differences in mobility among PCa survivors.
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Affiliation(s)
- Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Marino A Bruce
- Program for Research on Faith and Health, Center for Research on Men's Health, Vanderbilt University, Nashville, TN, United States
| | - Daniel L Howard
- Public Policy Research Institute and Department of Sociology, Texas A&M University, College Station, TX, United States
| | - Thomas A LaVeist
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health Policy and Management, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
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Fillenbaum GG, Sloane R, Burchett BM, Hall K, Pieper CF, Whitson HE, Colón-Emeric CS. Determinants of Maintenance and Recovery of Function in a Representative Older Community-Resident Biracial Sample. J Am Med Dir Assoc 2020; 21:1141-1147.e1. [PMID: 32037299 DOI: 10.1016/j.jamda.2019.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Focus on decline in performance of activities of daily living (ADL) has not been matched by studies of recovery of function. Advised by a broad conceptual model of physical resilience, we ascertain characteristics that identify (1) maintenance, (2) decline, and (3) recovery of personal self-maintenance activities over six years in an older, community representative, African American and white sample. DESIGN Longitudinal study, analyses included descriptive statistics and repeated measures proportional hazards. SETTING/PARTICIPANTS Community-representative participants of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE), unimpaired at baseline (n = 3187; 46% white, 54% African American; 64% female, 36% male), followed annually for up to 6 years. MEASURES Data included information on basic activities of daily living (BADL), demographic characteristics, health status, social services provided and received, household size, neighborhood safety, and survival status. RESULTS Over 6 years, ∼75% remained unimpaired, of whom 30% were unimpaired when they dropped out or died. Of ∼25% who became impaired, just under half recovered. Controlled analyses indicated that those who became impaired were in poorer health, younger, and more likely to be African American. Characteristics of recovery included younger age, not hospitalized in the previous year, and larger household size. CONCLUSIONS/IMPLICATIONS Maintenance of health status facilitated continued unimpaired BADL. While decline was associated with poorer health, younger age, and being African American, recovery was also associated with younger age, together with larger household size, and no further deterioration in health as measured here. Maintenance of good health is preferred, but following decline in functioning, increased effort to improve health and avoid further decline, which takes into account not only physical but also personal social conditions, is needed.
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Affiliation(s)
- Gerda G Fillenbaum
- Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC.
| | - Richard Sloane
- Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
| | | | - Katherine Hall
- Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC; Geriatric Research Education and Clinical Center, Durham Veteran Affairs Health Care System, Durham, NC
| | - Carl F Pieper
- Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC; Geriatric Research Education and Clinical Center, Durham Veteran Affairs Health Care System, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Heather E Whitson
- Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC; Geriatric Research Education and Clinical Center, Durham Veteran Affairs Health Care System, Durham, NC
| | - Cathleen S Colón-Emeric
- Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC; Geriatric Research Education and Clinical Center, Durham Veteran Affairs Health Care System, Durham, NC
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McKellar MS, Kuchibhatla MN, Oursler KAK, Crystal S, Akgün KM, Crothers K, Gibert CL, Nieves-Lugo K, Womack J, Tate JP, Fillenbaum GG. Racial Differences in Change in Physical Functioning in Older Male Veterans with HIV. AIDS Res Hum Retroviruses 2019; 35:1034-1043. [PMID: 30963773 DOI: 10.1089/aid.2018.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Little is known about longitudinal change in physical functioning of older African American/Black and White HIV-infected persons. We examined up to 10 years of data on African American (N = 1,157) and White (N = 400) men with HIV infection and comparable HIV-negative men (n = 1,137 and 530, respectively), age 50-91 years from the Veterans Aging Cohort Study Survey sample. Physical functioning was assessed using the SF-12 (12-Item Short Form Health Survey) physical component summary (PCS) score. Mixed-effects models examined association of demographics, health conditions, health behaviors, and selected interactions with PCS score; HIV biomarkers were evaluated for HIV-infected persons. PCS scores were approximately one standard deviation below that of the general U.S. population of similar age. Across the four HIV/race groups, over time and through ages 65-75 years, PCS scores were maintained; differences were not clinically significant. PCS score was not associated with race or with interactions among age, race, and HIV status. CD4 and viral load counts of African American and White HIV-infected men were similar. Older age, low socioeconomic status, chronic health conditions and depression, lower body mass index, and smoking were associated with poorer PCS score in both groups. Exercising and, counterintuitively, being HIV infected were associated with better PCS score. Among these older African American and White male veterans, neither race nor HIV status was associated with PCS score, which remained relatively stable over time. Chronic disease, depression, and lack of exercise were associated with lower PCS score. To maintain independence in this population, attention should be paid to controlling chronic conditions, and emphasizing good health behaviors.
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Affiliation(s)
- Mehri S. McKellar
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | | | - Kris Ann K. Oursler
- Department of Internal Medicine, Salem Veterans Affairs Medical Center, Salem, Virginia
- Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Kathleen M. Akgün
- Department of Internal Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Kristina Crothers
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Cynthia L. Gibert
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Karen Nieves-Lugo
- Department of Psychology, George Washington University, Washington, District of Columbia
| | - Julie Womack
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Nursing, New Haven, Connecticut
| | - Janet P. Tate
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Gerda G. Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
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Taylor JL, Roberts L, Hladek MD, Liu M, Nkimbeng M, Boyd CM, Szanton SL. Achieving self-management goals among low income older adults with functional limitations. Geriatr Nurs 2019; 40:424-430. [PMID: 30799154 DOI: 10.1016/j.gerinurse.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 11/29/2022]
Abstract
Although self-management interventions can improve symptoms and disease among older adults, there is a dearth of literature on how self-management behaviors may improve factors related to the older adults' physical function. To fill this gap in the literature, we describe the patient-directed self-management goals in nursing visits that relate to physical function as part of a multi-component program. We analyze the self-management goals and outcomes of 367 low- income older adults with functional limitations who participated in the CAPABLE program: a program to reduce the health effects of impaired physical function in low-income older adults. We focus on the following self-management goals that participants chose with the nurses: pain management, depressive symptoms, incontinence, fall prevention, and communication with healthcare providers. The majority of participants chose pain (50%) or fall prevention (51%) as goals and partially or fully met their goals. Improvements across these areas may lead to improved physical function.
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Affiliation(s)
- Janiece L Taylor
- Johns Hopkins School of Nursing, USA; Johns Hopkins School of Nursing Center of Innovative Care in Aging, USA.
| | | | | | - Minhui Liu
- Johns Hopkins School of Nursing, USA; Johns Hopkins School of Nursing Center of Innovative Care in Aging, USA
| | | | | | - Sarah L Szanton
- Johns Hopkins School of Nursing, USA; Johns Hopkins School of Nursing Center of Innovative Care in Aging, USA
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Ma L, Li Z, Tang Z, Sun F, Diao L, Li J, He Y, Dong B, Li Y. Prevalence and socio-demographic characteristics of disability in older adults in China: Findings from China Comprehensive Geriatric Assessment Study. Arch Gerontol Geriatr 2017; 73:199-203. [DOI: 10.1016/j.archger.2017.07.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 07/29/2017] [Accepted: 07/31/2017] [Indexed: 01/28/2023]
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Brown TH, Hargrove TW, Griffith DM. Racial/Ethnic Disparities in Men's Health: Examining Psychosocial Mechanisms. FAMILY & COMMUNITY HEALTH 2015; 38:307-18. [PMID: 26291191 PMCID: PMC4547357 DOI: 10.1097/fch.0000000000000080] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This study uses data from the Health and Retirement Study and an approach informed by the Biopsychosocial Model of Racism as a Stressor to examine the extent to which socioeconomic status, stressors, discrimination, and neighborhood conditions are mechanisms underlying racial/ethnic disparities in functional limitations among men. Results reveal that racial/ethnic differences in socioeconomic status, stressors, discrimination, and neighborhood conditions-individually and collectively-account for a substantial proportion of racial/ethnic disparities in functional limitations. Findings suggest that the social determinants of health for men of color need to be more seriously considered in investigations of and efforts to address health disparities.
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Affiliation(s)
- Tyson H Brown
- Department of Sociology, Vanderbilt University, Nashville, Tennessee
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Hargrove TW, Brown TH. A Life Course Approach to Inequality: Examining Racial/Ethnic Differences in the Relationship between Early Life Socioeconomic Conditions and Adult Health Among Men. Ethn Dis 2015; 25:313-20. [PMID: 26674267 DOI: 10.18865/ed.25.3.313] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Previous research has documented a relationship between childhood socioeconomic conditions and adult health, but less is known about racial/ethnic differences in this relationship, particularly among men. This study utilizes a life course approach to investigate racial/ethnic differences in the relationships among early and later life socioeconomic circumstances and health in adulthood among men. DESIGN Panel data from the Health and Retirement Study and growth curve models are used to examine group differences in the relationships among childhood and adult socioeconomic factors and age-trajectories of self-rated health among White, Black and Mexican American men aged 51-77 years (N=4147). RESULTS Multiple measures of childhood socioeconomic status (SES) predict health in adulthood for White men, while significantly fewer measures of childhood SES predict health for Black and Mexican American men. Moreover, the health consequences of childhood SES diminish with age for Black and Mexican American men. The childhood SES-adult health relationship is largely explained by measures of adult SES for White men. CONCLUSIONS The life course pathways linking childhood SES and adult health differ by race/ethnicity among men. Similar to arguments that the universality of the adult SES-health relationship should not be assumed, results from our study suggest that scholars should not assume that the significance and nature of the association between childhood SES and health in adulthood is similar across race/ethnicity among men.
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Affiliation(s)
| | - Tyson H Brown
- 1. Sociology Department, Vanderbilt University, Nashville, Tenn
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