1
|
Qiu Y, Liao K, Zou Y, Huang G. A Bibliometric Analysis on Research Regarding Residential Segregation and Health Based on CiteSpace. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10069. [PMID: 36011701 PMCID: PMC9408714 DOI: 10.3390/ijerph191610069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Considerable scholarly attention has been directed to the adverse health effects caused by residential segregation. We aimed to visualize the state-of-the-art residential segregation and health research to provide a reference for follow-up studies. Employing the CiteSpace software, we uncovered popular themes, research hotspots, and frontiers based on an analysis of 1211 English-language publications, including articles and reviews retrieved from the Web of Science Core Collection database from 1998 to 2022. The results revealed: (1) The Social Science & Medicine journal has published the most studies. Roland J. Thorpe, Thomas A. LaVeist, Darrell J. Gaskin, David R. Williams, and others are the leading scholars in residential segregation and health research. The University of Michigan, Columbia University, Harvard University, the Johns Hopkins School of Public Health, and the University of North Carolina play the most important role in current research. The U.S. is the main publishing country with significant academic influence. (2) Structural racism, COVID-19, mortality, multilevel modelling, and environmental justice are the top five topic clusters. (3) The research frontier of residential segregation and health has significantly shifted from focusing on community, poverty, infant mortality, and social class to residential environmental exposure, structural racism, and health care. We recommend strengthening comparative research on the health-related effects of residential segregation on minority groups in different socio-economic and cultural contexts.
Collapse
Affiliation(s)
- Yanrong Qiu
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou 510060, China
| | - Kaihuai Liao
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou 510060, China
| | - Yanting Zou
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou 510060, China
| | - Gengzhi Huang
- School of Geography and Planning, Sun Yat-sen University, Guangzhou 510275, China
| |
Collapse
|
2
|
Rogers CR, Rogers TN. Psychosocial determinants of colorectal Cancer screening uptake among African-American men: understanding the role of masculine role norms, medical mistrust, and normative support. ETHNICITY & HEALTH 2022; 27:1103-1122. [PMID: 33249920 PMCID: PMC8163893 DOI: 10.1080/13557858.2020.1849569] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/02/2020] [Indexed: 05/04/2023]
Abstract
OBJECTIVES Despite having the highest colorectal cancer (CRC) incidence and mortality across all major racial/ethnic groups, African-American men consistently have poor CRC screening rates. Gendered and racialized beliefs and norms have been associated with African-American men's lower medical assistance-seeking rates, but how these notions influence African-American men's CRC screening practices merits further investigation. The purpose of this study was to examine the influence of psychosocial determinants of men's health on CRC screening uptake among African-American men in three states. DESIGN Participants were recruited via CuttingCRC.com and through culturally-tailored flyers, newspaper ads, and snowball sampling, among other methods. From April 2019-August 2019, 11 focus groups were conducted with English-speaking Black/African-American men who (a) were between ages 45-75, (b) were born in the United States, (c) had a working telephone, and (d) lived in Minnesota, Ohio, or Utah. Multiple-cycle coding, Hatch's 9-step approach, and constant comparative data analysis was employed for de-identified transcript data. RESULTS Eighty-four African-American men met inclusion criteria and participated. Their mean age was 59.34 ± 7.43. In regards to CRC screening status, Ohio had the most previously screened participants (85%), followed by Minnesota (84%) and Utah (76%). Two major CRC screening barriers (masculine role norms and medical mistrust) - both encompassed 3-5 subthemes, and one major facilitator (normative support from family members or social networks) emerged. CONCLUSIONS Despite CRC screening's life-saving potential, African-American men have had the lowest 5-year relative survival for more than 40 years. When developing interventions and health promotion programs aiming to eliminate the racial disparity in CRC outcomes, addressing both masculine role norms and medical mistrust barriers to CRC screening completion among African-American men is warranted.
Collapse
Affiliation(s)
- Charles R. Rogers
- University of Utah School of Medicine, Department of Family & Preventive Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
| | - Tiana N. Rogers
- University of Utah - David Eccles School of Business, Sorenson Impact Center, 85 Fort Douglas Blvd, Building #602, Salt Lake City, UT 84113, USA
| |
Collapse
|
3
|
Wilson-Howard D, Vilaro MJ, Neil JM, Cooks EJ, Griffin LN, Ashley TT, Tavassoli F, Zalake MS, Lok BC, Odedina FG, Modave F, Carek PJ, George TJ, Krieger JL. The development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Applications for and by Black Men: A Qualitative Study. JMIR Form Res 2021; 5:e28709. [PMID: 34780346 PMCID: PMC8751682 DOI: 10.2196/28709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/21/2021] [Accepted: 10/06/2021] [Indexed: 01/06/2023] Open
Abstract
Background Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one’s home. Objective The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. Methods Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user’s psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. Results In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established. The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as “brother-doctor,” and participants stated “wanting to interact with ALEX over their regular doctor.” Conclusions Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men.
Collapse
Affiliation(s)
- Danyell Wilson-Howard
- Department of Natural Sciences, Bethune Cookman University, 640 Mary McLeod Blvd., Daytona, US.,STEM Translational Communication Center, College of Journalism, University of Florida, Gainesville, US
| | - Melissa J Vilaro
- STEM Translational Communication Center, College of Journalism, University of Florida, Gainesville, US
| | - Jordan M Neil
- Harvard Medical School, Haarvard University, Boston, US.,Mongan Institute's Health Policy Research Center, Massachusetts General Hospital, Boston, US
| | - Eric J Cooks
- STEM Translational Communication Center, College of Journalism, University of Florida, Gainesville, US.,Health Cancer Center, University of Florida, Gainesville, US
| | - Lauren N Griffin
- STEM Translational Communication Center, College of Journalism, University of Florida, Gainesville, US
| | - Taylor T Ashley
- Department of Natural Sciences, Bethune Cookman University, 640 Mary McLeod Blvd., Daytona, US
| | - Fatemeh Tavassoli
- Computer and Information Science and Engineering, University of Florida, Gainesville, US
| | - Mohan S Zalake
- Computer and Information Science and Engineering, University of Florida, Gainesville, US
| | - Benjamin C Lok
- Computer and Information Science and Engineering, University of Florida, Gainesville, US
| | - Folakemi G Odedina
- College of Pharmacy, University of Florida, Gainesville, US.,College of Medicine, University of Florida, Gainesville, US
| | - Francois Modave
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Floridal, Gainesville, US
| | - Peter J Carek
- Familly Medicine, University of Florida, Gainesville, US
| | - Thomas J George
- Gastrointestinal (GI) Oncology Center, University of Florida, Gainesville, US.,UF Health Medical Oncology - Davis Cancer, University of Florida, Gainesville, US
| | - Janice L Krieger
- STEM Translational Communication Center, College of Journalism, University of Florida, Gainesville, US.,UF Health Cancer Center, University of Florida, Gainesville, US
| |
Collapse
|
4
|
Thorpe RJ, Cobb R, King K, Bruce MA, Archibald P, Jones HP, Norris KC, Whitfield KE, Hudson D. The Association Between Depressive Symptoms and Accumulation of Stress Among Black Men in the Health and Retirement Study. Innov Aging 2020; 4:igaa047. [PMID: 33354627 PMCID: PMC7737789 DOI: 10.1093/geroni/igaa047] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Among the multiple factors posited to drive the health inequities that black men experience, the fundamental role of stress in the production of poor health is a key component. Allostatic load (AL) is considered to be a byproduct of stressors related to cumulative disadvantage. Exposure to chronic stress is associated with poorer mental health including depressive symptoms. Few studies have investigated how AL contributes to depressive symptoms among black men. The purpose of the cross-sectional study was to examine the association between AL and depressive symptoms among middle- to old age black men. RESEARCH DESIGN AND METHODS This project used the 2010 and 2012 wave of the Health and Retirement Study enhanced face-to-face interview that included a biomarker assessment and psychosocial questionnaire. Depressive symptoms, assessed by the endorsement of 3 or more symptoms on the Center for Epidemiological Studies-Depression 8-item scale, was the outcome variable. The main independent variable, AL, score was calculated by summing the number values that were in the high range for that particular biomarker value scores ranging from 0 to 7. black men whose AL score was 3 or greater were considered to be in the high AL group. Modified Poisson regression was used to estimate prevalence ratios (PRs) and corresponding 95% confidence intervals (CIs). RESULTS There was a larger proportion of black men in the high AL group who reported depressive symptoms (30.0% vs. 20.0%) compared with black men in the low AL group. After adjusting for age, education, income, drinking, and smoking status, the prevalence of reporting 3 or more depressive symptoms was statistically significant among black men in the high AL group (PR = 1.61 [95% CI: 1.20-2.17]) than black men in the low AL group. DISCUSSION AND IMPLICATIONS Exposure to chronic stress is related to reporting 3 or more depressive symptoms among black men after controlling for potential confounders. Improving the social and economic conditions for which black men work, play, and pray is key to reducing stress, thereby potentially leading to the reporting of fewer depressive symptoms.
Collapse
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, Maryland
| | - Ryon Cobb
- Department of Sociology, University of Georgia, Athens
| | - Keyonna King
- Department of Health Promotion, University of Nebraska Medical Center, Omaha
| | - Marino A Bruce
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson
| | - Paul Archibald
- Department of Social Work, College of Staten Island, The City University of New York
| | - Harlan P Jones
- Department of Microbiology, Immunology and Genetics, University of North Texas Health Science Center, Fort Worth
| | - Keith C Norris
- Department of Medicine, University of California, Los Angeles
| | | | - Darrell Hudson
- Brown School at Washington University in St. Louis, Missouri
| |
Collapse
|
5
|
Hale D, Smith G, Bowie J, Laveist TA, Thorpe RJ. Disentangling Race and Place in Depressive Symptoms in Men. FAMILY & COMMUNITY HEALTH 2020; 42:221-226. [PMID: 31107733 PMCID: PMC6557436 DOI: 10.1097/fch.0000000000000230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
African American men report lower levels of depressive symptoms that their white peers in national data. However, the value of these studies is often undermined by data that confound race, socioeconomic status, and segregation. We sought to determine whether race differences in depressive symptoms were present after minimizing the effects of socioeconomic status and segregation within a cohort of southwest Baltimore (SWB) men using the data from the Exploring Health Disparities in Integrated Communities (EHDIC), a novel study of racial disparities within communities where African American and non-Hispanic white males live together and have similar median incomes. Using the Patient Health Questionnaire, a standard instrument for assessing mental disorders, we categorized participants as experiencing depressive symptoms (including depressive syndrome and major depression) or not experiencing depressive symptoms. Logistic regression was performed to examine the association between depressive symptoms and race in EHDIC-SWB, adjusting for age, marital status, income, education, insurance, physical inactivity, current smoking or drinking status, poor/fair health, hypertension, heart disease, diabetes, stroke, and obesity. Of the 628 study participants, 12.6% of white men and 8.6% of African American men reported depressive symptoms. African American males had similar odds of reporting depressive symptoms (odds ratio = 0.61, 95% confidence interval = 0.34-1.11) as compared with white men. Within this low-income urban racially integrated community, race differences in depressive symptoms among men were not observed. This finding suggests that social and environmental conditions may impact the race differences in depressive symptoms.
Collapse
Affiliation(s)
- Diamond Hale
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions
| | - Genee Smith
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
| | - Janice Bowie
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Thomas A. Laveist
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Roland J. Thorpe
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| |
Collapse
|
6
|
Brownlow BN, Sosoo EE, Long RN, Hoggard LS, Burford TI, Hill LK. Sex Differences in the Impact of Racial Discrimination on Mental Health Among Black Americans. Curr Psychiatry Rep 2019; 21:112. [PMID: 31686220 DOI: 10.1007/s11920-019-1098-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Greater racial discrimination is associated with poorer mental health among Black Americans; yet, there remains an incomplete understanding of sex differences in exposure to racial discrimination, and further, of how sex differences in coping with racial discrimination may heighten or diminish risk for poorer mental health. RECENT FINDINGS Black men may experience greater exposure to both structural and communal forms of racial discrimination, whereas Black women may face both a wider range of potential sources, as well as encounter greater variability in the subjective experience of racial discrimination. For both Black women and men, racial discrimination may be similarly associated with maladaptive coping strategies (i.e., emotional eating, rumination) that also are linked to poorer mental health; however, emerging findings suggest that mindfulness may partially buffer these deleterious effects. Overall, the recent literature reveals mixed findings with respect to sex differences in the experience and negative mental health impact of racial discrimination. Despite this heterogeneity, evidence documents sex differences in the settings, type, and qualitative experience of racial discrimination among Black Americans. Additionally, growing evidence indicating that racial discrimination is associated with physiological markers of stress reactivity and psychopathology risk further bolsters its characterization as a unique form of chronic stress among Black Americans and other minority groups in the USA.
Collapse
Affiliation(s)
- Briana N Brownlow
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Effua E Sosoo
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Risa N Long
- Department of Family Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lori S Hoggard
- Department of Psychology, Rutgers-The State University of New Jersey, New Brunswick, NJ, USA
| | - Tanisha I Burford
- Department of Psychology, North Carolina Central University, Durham, NC, USA
| | - LaBarron K Hill
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Box 3119, Durham, NC, 27710, USA.
- Center for Biobehavioral Health Disparities Research, Duke University-Social Science Research Institute, Durham, NC, USA.
- Center for the Study of Aging and Human Development, Duke University Medical Center, Box 3119, Durham, NC, 27710, USA.
| |
Collapse
|
7
|
Tsai R, Alterman T, Grosch JW, Luckhaupt SE. Availability of and Participation in Workplace Health Promotion Programs by Sociodemographic, Occupation, and Work Organization Characteristics in US Workers. Am J Health Promot 2019; 33:1028-1038. [PMID: 31014070 DOI: 10.1177/0890117119844478] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine how the availability of and participation in workplace health promotion programs (WHPPs) vary as a function of sociodemographic, occupation, and work organization characteristics. DESIGN Cross-sectional study. SETTING 2015 National Health Interview Survey and Occupational Health Supplement. PARTICIPANTS The study sample included 17 469 employed adults who completed the WHPP questions. MEASURES The 2 dependent outcome measures were availability of WHPPs and participation in these programs when available. Independent variables included occupation and 8 work organization and employment characteristics: company size, hours worked, supervisory responsibility, hourly pay, paid sick leave, health insurance offered by employer, work schedule, and work arrangement. ANALYSIS Poisson regression analyses were conducted with SUDAAN 11.0.1. RESULTS Overall, 57.8% of 46.6% employees who have WHPPs available reported participating in these programs. This study found that adults who worked ≤20 h/wk, worked regular night shifts, were paid by the hour, or worked for temporary agencies were less likely to participate in WHPPs. Workers who supervised others were 13% more likely to participate than nonsupervisors. Borderline associations were seen for having access to employer-sponsored health insurance and working at a site with <10 employees. CONCLUSION Despite the potential for improving physical and mental health, only 58% of US workers participated in WHPPs. Since barriers to WHPP participation (eg, time constraints, lack of awareness, and no perceived need) may vary across occupations and work organization characteristics, employers should tailor WHPPs based on their specific work organization characteristics to maximize participation.
Collapse
Affiliation(s)
- Rebecca Tsai
- 1 Division of Surveillance, Hazard Evaluation and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, OH, USA
| | - Toni Alterman
- 1 Division of Surveillance, Hazard Evaluation and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, OH, USA
| | - James W Grosch
- 2 Division of Applied Research and Technology, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Sara E Luckhaupt
- 1 Division of Surveillance, Hazard Evaluation and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, OH, USA
| |
Collapse
|
8
|
Amuneke-Nze CG, Bamgbade BA, Barner JC. An Investigation of Health Management Perceptions and Wellness Behaviors in African American Males in Central Texas. Am J Mens Health 2019; 13:1557988318813490. [PMID: 30428764 PMCID: PMC6775563 DOI: 10.1177/1557988318813490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/06/2018] [Accepted: 10/10/2018] [Indexed: 11/24/2022] Open
Abstract
Little is known regarding interventions that incorporate health management perceptions among African American (AA) men, to reduce the risk for developing various medical conditions. Using the Theory of Planned Behavior (TPB), the study objective was to better understand health-care perceptions of AA men by assessing participants' attitudes, subjective norms (SNs), and perceived behavioral control (PBC) regarding health management. AA adult males in Texas were recruited to participate in one of four qualitative focus groups. The TPB was used to assess participants' attitudes (advantages/disadvantages), SNs (approvers/disapprovers), and PBC (enablers/barriers) regarding health management. All four sessions were audiotaped, transcribed, and independently analyzed by researchers to identify major themes. Participants ( n = 23) were 45.2 ± 16.2 years of age (range 24-74). Regarding attitudes toward health management, participants viewed increased longevity and avoiding future health problems as advantages; however, increased cost, lack of confidence in health care, and social pressures were disadvantages. Regarding SNs, parents and children were positive influencers, while spouses and coworkers were both positive and negative influencers. For PBC, a support system and health awareness were identified as enablers, while medical mistrust, fear, and culture were barriers. The results convey that health management behaviors in AA males are multifaceted. Health-care providers should seek to understand these factors, discuss these issues with AA males, and integrate treatment strategies that are culturally informed and patient centered. Findings from this study may be used to develop targeted interventions that improve health outcomes for AA males.
Collapse
Affiliation(s)
- Chibuokem G. Amuneke-Nze
- Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Benita A. Bamgbade
- Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, MA, USA
| | - Jamie C. Barner
- Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
9
|
Fenton AT, Burkhart Q, Weech-Maldonado R, Haviland AM, Dembosky JW, Shih R, Wilson-Frederick SM, Gaillot S, Elliott MN. Geographic context of black-white disparities in Medicare CAHPS patient experience measures. Health Serv Res 2018; 54 Suppl 1:275-286. [PMID: 30467831 PMCID: PMC6341209 DOI: 10.1111/1475-6773.13091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine whether black-white patient experience disparities vary by geography and within-county contextual factors. DATA SOURCES 321 300 Medicare beneficiaries responding to the 2015-2016 Medicare Consumer Assessment of Health care Providers and Systems (MCAHPS) Surveys; 2010 Census data for several within-county contextual factors. STUDY DESIGN Mixed-effects regression models predicted three MCAHPS patient experience measures for black and white beneficiaries from geographic random effects, contextual fixed effects, and beneficiary-level case-mix adjustors. PRINCIPAL FINDINGS Black-white disparities in patient experiences were smaller in counties with higher average patient experiences. Black-white disparities in patient experiences were not associated with county-level poverty or racial segregation. However, county racial segregation and some measures of poverty were significantly associated with all beneficiaries' level of health care access. Getting Needed Care scores were higher with greater racial segregation, while Getting Care Quickly scores were lower with higher poverty and racial segregation. CONCLUSIONS Efforts to reduce black-white disparities in patient experiences should focus on areas with low average patient experiences. Attempts to reduce disparities in timely access to health care should target primarily black, low-income, and racially and economically segregated areas. Positive associations of racial segregation with accessing needed care were unexpected.
Collapse
Affiliation(s)
| | - Q Burkhart
- RAND Corporation, Santa Monica, California
| | | | - Amelia M Haviland
- Carnegie Mellon University, Pittsburgh, Pennsylvania.,RAND Corporation, Pittsburgh, Pennsylvania
| | | | | | | | - Sarah Gaillot
- Centers for Medicare & Medicaid Services, Baltimore, Maryland
| | | |
Collapse
|
10
|
Local authority commissioning of NHS Health Checks: A regression analysis of the first three years. Health Policy 2018; 122:1035-1042. [PMID: 30055899 DOI: 10.1016/j.healthpol.2018.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 05/24/2018] [Accepted: 07/12/2018] [Indexed: 11/21/2022]
Abstract
In April 2013, the public health function was transferred from the NHS to local government, making local authorities (LAs) responsible for commissioning the NHS Health Check programme. The programme aims to reduce preventable mortality and morbidity in people aged 40-74. The national five-year ambition is to invite all eligible individuals and to achieve an uptake of 75%. This study evaluates the effects of LA expenditure on the programme's invitation rates (the proportion of the eligible population invited to a health check), coverage rates (the proportion of the eligible population who received a health check) and uptake rates (attendance by those who received a formal invitation letter) in the first three years of the reforms. We ran negative binomial panel models and controlled for a range of confounders. Over 2013/14-2015/16, the invitation rate, coverage rate and uptake rate averaged 57% 28% and 49% respectively. Higher per capita spend on the programme was associated with increases in both the invitation rate and coverage rate, but had no effect on the uptake rate. When we controlled for the LA invitation rate, the association between spend and coverage rate was smaller but remained statistically significant. This suggests that alternatives to formal invitation, such as opportunistic approaches in work places or sports centres, may be effective in influencing attendance.
Collapse
|
11
|
Buchanich JM, Doerfler SM, Lann MF, Marsh GM, Burke DS. Improvement in racial disparities in years of life lost in the USA since 1990. PLoS One 2018; 13:e0194308. [PMID: 29694402 PMCID: PMC5918944 DOI: 10.1371/journal.pone.0194308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 02/28/2018] [Indexed: 11/19/2022] Open
Abstract
Objective To examine changes in cause-specific Years of Life Lost (YLL) by age, race, and sex group in the USA from 1990 to 2014. Methods 60 million death reports from the National Center for Health Statistics (NCHS) were categorized by age group, sex, race, and cause of death. YLL were calculated using age-specific life expectancies. Age groups were: infants <1, children 1–19, adults 20–64, and older adults 65+. Results Blacks have historically experienced more years of life lost than whites or other racial groups in the USA. In the year 1990 the YLL per 100,000 population was 21,103 for blacks, 14,160 for whites, and 7,417 for others. Between 1990 and 2014 overall YLL in the USA improved by 10%, but with marked variations in the rate of change across age, race, and sex groups. Blacks (all ages, both sexes) showed substantial improvement with a 28% reduction in YLL, compared to whites (all ages, both sexes) who showed a 4% reduction. Among blacks, improvements were seen in all age groups: reductions of 43%, 48%, 28%, and 25% among infants, children, adults, and older adults, respectively. Among whites, reductions of 33%, 44%, and 18% were seen in infants, children, and older adults, but there was a 6% increase in YLL among white adults. YLL increased by 18% in white adult females and declined 1% in white adult males. American Indian/Alaska Native women also had worsening in YLL, with an 8% increase. Asian Pacific Islanders consistently had the lowest YLL across all ages. Whites had a higher proportion of YLL due to overdose; blacks had a higher proportion due to homicide at younger ages and to heart disease at older ages. Conclusions Race-based disparities in YLL in the USA since 1990 have narrowed considerably, largely as a result of improvements among blacks compared to whites. Adult white and American Indian / Alaskan Native females have experienced worsening YLL, while white males have experienced essentially no change. If recent trajectories continue, adult black/white disparities in YLL will continue to narrow.
Collapse
Affiliation(s)
- Jeanine M. Buchanich
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
- * E-mail:
| | - Shannon M. Doerfler
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Michael F. Lann
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Gary M. Marsh
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Donald S. Burke
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| |
Collapse
|
12
|
Hashim D, Manczuk M, Holcombe R, Lucchini R, Boffetta P. Cancer mortality disparities among New York City's Upper Manhattan neighborhoods. Eur J Cancer Prev 2017; 26:453-460. [PMID: 27104595 PMCID: PMC5074912 DOI: 10.1097/cej.0000000000000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The East Harlem (EH), Central Harlem (CH), and Upper East Side (UES) neighborhoods of New York City are geographically contiguous to tertiary medical care, but are characterized by cancer mortality rate disparities. This ecological study aims to disentangle the effects of race and neighborhood on cancer deaths. Mortality-to-incidence ratios were determined using neighborhood-specific data from the New York State Cancer Registry and Vital Records Office (2007-2011). Ecological data on modifiable cancer risk factors from the New York City Community Health Survey (2002-2006) were stratified by sex, age group, race/ethnicity, and neighborhood and modeled against stratified mortality rates to disentangle race/ethnicity and neighborhood using logistic regression. Significant gaps in mortality rates were observed between the UES and both CH and EH across all cancers, favoring UES. Mortality-to-incidence ratios of both CH and EH were similarly elevated in the range of 0.41-0.44 compared with UES (0.26-0.30). After covariate and multivariable adjustment, black race (odds ratio=1.68; 95% confidence interval: 1.46-1.93) and EH residence (odds ratio=1.20; 95% confidence interval: 1.07-1.35) remained significant risk factors in all cancers' combined mortality. Mortality disparities remain among EH, CH, and UES neighborhoods. Both neighborhood and race are significantly associated with cancer mortality, independent of each other. Multivariable adjusted models that include Community Health Survey risk factors show that this mortality gap may be avoidable through community-based public health interventions.
Collapse
Affiliation(s)
- Dana Hashim
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marta Manczuk
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Cancer Epidemiology, Maria Skłodowska-Curie Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Randall Holcombe
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roberto Lucchini
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Occupational Medicine, University of Brescia, Italy
| | - Paolo Boffetta
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
13
|
Ribeiro CR, Gomes R, Moreira MCN. Fatherhood and parenting as health issues facing the rearrangements of gender. CIENCIA & SAUDE COLETIVA 2017; 20:3589-98. [PMID: 26602736 DOI: 10.1590/1413-812320152011.19252014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/31/2015] [Indexed: 11/22/2022] Open
Abstract
In this theoretical essay we aim to discuss paternity as a health issue in the context of contemporary gender roles by considering two lines of argument: (a) paternity, parenting and rearrangements of gender roles; and (b) paternity and parenting as a mutual relationship based on care. In our discussion, we highlight the inclusion of men in the health system from the point of view of paternity. At present this appears to be operating in an instrumental manner, with the mother-infant dyad still a major concern and men not being viewed as individuals with rights to health. Thus, we seek to question the system itself, in relation to its perceptions of the current state of paternity, by taking into consideration recent discussions about gender and sexuality as well as and new family arrangements that may challenge beliefs about the roles of families, fathers and mothers, which have impacts on care. Among other aspects, we conclude that we need to reinvent ourselves because we were not raised under the aegis of diversity and we were also not trained as professionals with a basis in the current problematic divisions that exist between father/mother and sex/gender, among many other previous certainties, all of which does not always help us to promote actions in the area of health.
Collapse
Affiliation(s)
| | - Romeu Gomes
- Instituto Fernandes Figueira, Fiocruz, Rio de Janeiro, RJ, Brasil,
| | | |
Collapse
|
14
|
Sohn EK, Porch T, Hill S, Thorpe RJ. Geography, Race/Ethnicity, and Physical Activity Among Men in the United States. Am J Mens Health 2017; 11:1019-1027. [PMID: 28147893 PMCID: PMC5675347 DOI: 10.1177/1557988316689498] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Engaging in regular physical activity reduces one’s risk of chronic disease, stroke, cardiovascular disease, and some forms of cancer. These preventive benefits associated with physical activity are of particular importance for men, who have shorter life expectancy and experience higher rates of chronic diseases as compared to women. Studies at the community and national levels have found that social and environmental factors are important determinants of men’s physical activity, but little is known about how regional influences affect physical activity behaviors among men. The objective of this study is to examine the association between geographic region and physical activity among men in the United States, and to determine if there are racial/ethnic differences in physical activity within these geographic regions. Cross-sectional data from men who participated the 2000 to 2010 National Health Interview Survey (N = 327,556) was used. The primary outcome in this study was whether or not men had engaged in sufficient physical activity to receive health benefits, defined as meeting the 2008 Physical Activity Guidelines for Americans. Race/ethnicity and geographic region were the primary independent variables. Within every region, Hispanic and Asian men had lower odds of engaging in sufficient physical activity compared to white men. Within the Northeast, South, and West, black men had lower odds of engaging in sufficient physical activity compared to white men. The key findings indicate that the odds of engaging in sufficient physical activity among men differ significantly between geographic regions and within regions by race/ethnicity.
Collapse
Affiliation(s)
- Elizabeth Kelley Sohn
- 1 Program of Research for Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tichelle Porch
- 1 Program of Research for Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah Hill
- 1 Program of Research for Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J Thorpe
- 1 Program of Research for Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
15
|
Prostate and Colorectal Cancer Screening Uptake among US and Foreign-Born Males: Evidence from the 2015 NHIS Survey. J Community Health 2016; 42:612-623. [DOI: 10.1007/s10900-016-0296-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
16
|
Leone JE, Rovito MJ, Mullin EM, Mohammed SD, Lee CS. Development and Testing of a Conceptual Model Regarding Men's Access to Health Care. Am J Mens Health 2016; 11:262-274. [PMID: 27698256 PMCID: PMC5675291 DOI: 10.1177/1557988316671637] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Epidemiologic data suggest men often experience excessive morbidity and early mortality, possibly compromising family and community health over the lifespan. Moreover, the negative financial/economic consequences affected by poor male health outcomes also has been of great concern in the United States and abroad. Early and consistent access to preventative health care may improve health outcomes; however, men are far less likely to access these services. The purpose of this study was to understand what factors preclude men from accessing health care. We surveyed 485 participants using a 58-item online survey built from a conceptual model previously developed by the researchers using hegemonic masculinity theory, the theory of normative contentment, and the health belief model. For men, three items significantly ( ps < .05) predicted whether they had seen a health care provider in the past year: "I/Men do not access healthcare because I do not think there is anything wrong with me," "My health is only about me," and "I/Men do not access healthcare because most men in my family do not access healthcare." Other correlations of practical significance also were noted. Results suggest gender norms and masculine ideals may play a primary role in how men access preventative health care. Future programming targeting males should consider barriers and plan programs that are gender-sensitive in addition to being gender-specific. Clinical implications are discussed.
Collapse
Affiliation(s)
- James E Leone
- 1 Bridgewater State University, Bridgewater, MA, USA
| | | | | | | | | |
Collapse
|
17
|
Williams R, White P, Nieto J, Vieira D, Francois F, Hamilton F. Colorectal Cancer in African Americans: An Update. Clin Transl Gastroenterol 2016; 7:e185. [PMID: 27467183 PMCID: PMC4977418 DOI: 10.1038/ctg.2016.36] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 05/09/2016] [Indexed: 12/15/2022] Open
Abstract
This review is an update to the American College of Gastroenterology (ACG) Committee on Minority Affairs and Cultural Diversity's paper on colorectal cancer (CRC) in African Americans published in 2005. Over the past 10 years, the incidence and mortality rates of CRC in the United States has steadily declined. However, reductions have been strikingly much slower among African Americans who continue to have the highest rate of mortality and lowest survival when compared with all other racial groups. The reasons for the health disparities are multifactorial and encompass physician and patient barriers. Patient factors that contribute to disparities include poor knowledge of benefits of CRC screening, limited access to health care, insurance status along with fear and anxiety. Physician factors include lack of knowledge of screening guidelines along with disparate recommendations for screening. Earlier screening has been recommended as an effective strategy to decrease observed disparities; currently the ACG and American Society of Gastrointestinal Endoscopists recommend CRC screening in African Americans to begin at age 45. Despite the decline in CRC deaths in all racial and ethnic groups, there still exists a significant burden of CRC in African Americans, thus other strategies including educational outreach for health care providers and patients and the utilization of patient navigation systems emphasizing the importance of screening are necessary. These strategies have been piloted in both local communities and Statewide resulting in notable significant decreases in observed disparities.
Collapse
Affiliation(s)
- Renee Williams
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
| | - Pascale White
- Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Jose Nieto
- Borland Groover Clinic, Jacksonville, Florida, USA
| | - Dorice Vieira
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
| | - Fritz Francois
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
| | | |
Collapse
|
18
|
Thorpe RJ, Kelley E, Bowie JV, Griffith DM, Bruce M, LaVeist T. Explaining Racial Disparities in Obesity Among Men: Does Place Matter? Am J Mens Health 2015; 9:464-72. [PMID: 25249452 PMCID: PMC4864070 DOI: 10.1177/1557988314551197] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
National data indicate that Black men have higher rates of obesity than White men. Black men also experience earlier onset of many chronic conditions and premature mortality linked to obesity. Explanations for these disparities have been underexplored, and existing national-level studies may be limited in their ability to explicate these long-standing patterns. National data generally do not account for race differences in risk exposures resulting from racial segregation or the confounding between race and socioeconomic status. Therefore, these differences in obesity may be a function of social environment rather than race. This study examined disparities in obesity among Black and White men living in the same social and environmental conditions, who have similar education levels and incomes using data from the Exploring Health Disparities in Integrated Communities-SWB (EHDIC-SWB) study. The findings were compared with the 2003 National Health Interview Survey (NHIS). Logistic regression was used to examine the association between race and obesity adjusting for demographics, socioeconomic status, and health conditions. In the NHIS, Black men had a higher odds of obesity (odds ratio=1.29, 95% confidence interval=1.12-1.49) than White men. However in the EHDIC-SWB, which accounts for social and environmental conditions of where these men live, Black men had similar odds of obesity (odds ratio=1.06, 95% confidence interval=0.70-1.62) compared with White men. These data highlight the importance of the role that setting plays in understanding race disparities in obesity among men. Social environment may be a key determinant of health when seeking to understand race disparities in obesity among Black and White men.
Collapse
Affiliation(s)
- Roland J Thorpe
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Kelley
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janice V Bowie
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Derek M Griffith
- Institute for Research on Men's Health, Vanderbilt University, Nashville, TN, USA
| | - Marino Bruce
- Center for Health of Minority Males, University of Mississippi Medical Center, Jackson, MS, USA Jackson State University, Jackson, MS, USA
| | - Thomas LaVeist
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
19
|
Thorpe RJ, Kennedy-Hendricks A, Griffith DM, Bruce MA, Coa K, Bell CN, Young J, Bowie JV, LaVeist TA. Race, Social and Environmental Conditions, and Health Behaviors in Men. FAMILY & COMMUNITY HEALTH 2015; 38:297-306. [PMID: 26291190 PMCID: PMC5052072 DOI: 10.1097/fch.0000000000000078] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although understanding race differences in health behaviors among men is an important step in reducing disparities in leading causes of death in the United States, progress has been stifled when using national data because of the confounding of race, socioeconomic status, and residential segregation. The purpose of this study is to examine the nature of disparities in health behaviors among African American and white men in the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore, which was conducted in a racially integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey. After adjusting for age, marital status, insurance, income, educational attainment, poor or fair health, and obesity status, African American men in National Health Interview Survey had greater odds of being physically inactive (odds ratio [OR] = 1.48; 95% confidence interval [CI], 129-1.69), reduced odds of being a current smoker (OR = 0.77; 95% CI, 0.65-0.90), and reduced odds of being a current drinker (OR = 0.58; 95% CI, 0.50-0.67). In the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore sample, African American and white men had similar odds of being physically inactive (OR = 0.79; 95% CI, 0.50-1.24), being a current smoker (OR = 0.86; 95% CI, 0.60-1.23), or being a current drinker (OR = 1.34; 95% CI, 0.81-2.21). Because race disparities in these health behaviors were ameliorated in the sample where African American and white men were living under similar social, environmental, and socioeconomic status conditions, these findings suggest that social environment may be an important determinant of health behaviors among African American and white men. Public health interventions and health promotion strategies should consider the social environment when seeking to better understand men's health disparities.
Collapse
Affiliation(s)
- Roland J. Thorpe
- Program for Men’s Health Research, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Alene Kennedy-Hendricks
- Program for Men’s Health Research, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Derek M. Griffith
- Institute for Research on Men’s Health, Vanderbilt University
- Center for Medicine, Health and Society, Vanderbilt University
| | - Marino A. Bruce
- Center for Health of Minority Males, University of Mississippi Medical Center & Jackson State University
- Department of Criminal Justice and Sociology, Jackson State University
| | - Kisha Coa
- Program for Men’s Health Research, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Caryn N. Bell
- Program for Men’s Health Research, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Jessica Young
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Janice V. Bowie
- Program for Men’s Health Research, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Thomas A. LaVeist
- Program for Men’s Health Research, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| |
Collapse
|
20
|
Bruce MA, Griffith DM, Thorpe RJ. Social Determinants of Men's Health Disparities. FAMILY & COMMUNITY HEALTH 2015; 38:281-283. [PMID: 26291188 PMCID: PMC4876596 DOI: 10.1097/fch.0000000000000083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Marino A. Bruce
- Center for Health of Minority Males, Myrlie Evers-Williams Institute for the Elimination of Health Disparities, Jackson MS, USA
- Department of Sociology and Criminal Justice, Jackson State University, Jackson, MS
| | - Derek M. Griffith
- Institute for Research on Men’s Health, Vanderbilt University, Nashville, TN, USA
- Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN, USA
| | - Roland J. Thorpe
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Baltimore, MD, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
21
|
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: 20] [Impact Index Per Article: 2.2] [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.
Collapse
Affiliation(s)
- Tyson H Brown
- Department of Sociology, Vanderbilt University, Nashville, Tennessee
| | | | | |
Collapse
|
22
|
Hill LK, Sims Wright R, Aiken-Morgan AT, Gamaldo A, Edwards CL, Whitfield KE. Perceived Control Predicts Pulse Pressure in African American Men: The Baltimore Study of Black Aging. Ethn Dis 2015; 25:263-70. [PMID: 26676156 DOI: 10.18865/ed.25.3.263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Poorer health profiles among African American men throughout the life course evince greater rates of cardiovascular disease (CVD) and significantly earlier mortality compared with other groups. Despite growing emphasis on identifying how psychosocial factors influence disparate disease risk, little of this research has focused intently on African American men. METHODOLOGY Using hierarchical linear regression, we explored the additive influence of stress, depression, and perceived control on pulse pressure, an established marker of CVD risk, in a sample (N = 153) of African American men (mean age = 66.73 ± 9.29) from the Baltimore Study of Black Aging (BSBA). RESULTS After accounting for age and health status indicators, perceived control emerged as a significant predictor of pulse pressure. DISCUSSION These findings suggest that greater belief in one's own efficacy is a protective factor for cardiovascular health among African American men. Future research should examine whether enhancing perceived control can have an appreciable impact on the immense CVD burden in this and other at-risk populations.
Collapse
Affiliation(s)
- LaBarron K Hill
- 1. Duke University Medical Center - Center for the Study of Aging and Human Development ; 2. Duke University - Department of Psychiatry and Behavioral Sciences ; 3. Duke University - Center on Biobehavioral Health Disparities Research
| | | | | | | | - Christopher L Edwards
- 2. Duke University - Department of Psychiatry and Behavioral Sciences ; 3. Duke University - Center on Biobehavioral Health Disparities Research
| | - Keith E Whitfield
- 3. Duke University - Center on Biobehavioral Health Disparities Research ; 4. Duke University - Department of Psychology and Neuroscience
| |
Collapse
|
23
|
Abstract
OBJECTIVE To consider how manhood is a key social determinant of minority men's health. DESIGN This commentary explicates how manhood intersects with other determinants of health to shape minority men's stress responses, health behaviors and health outcomes across the life course. RESULTS Manhood, which perpetually needs to be proven, is an aspirational identity that is defined by the intersection of age, race/ethnicity and other identities. Minority men seek to and successfully embody US-cultural and ethnic-specific aspects of manhood in their daily lives by engaging in behaviors that constantly reaffirm their gender identity through a complex internal and social calculus that varies by intra-personal characteristics and context. Manhood and health are relational constructs that highlight how the salience of masculinities are shaped by perceived and actual social norms and expectations. A life course perspective adds a framework for considering how some gendered beliefs, goals and behaviors change over time while others remain static. Three life course frameworks highlight different mechanisms through which minority men's life experiences and physiological and behavioral responses to gendered social norms, beliefs and expectations become embodied as premature mortality and other health outcomes over the life course. CONCLUSION Manhood represents an important lens to understand how minority men's identities, goals and priorities affect their health, yet the role of manhood in minority men's health is understudied and underdeveloped. To achieve health equity, it is critical to consider how manhood shapes minority men's lives and health across the life course, and to address how manhood affects gendered and non-gendered mechanisms and pathways that explain minority men's health over time.
Collapse
Affiliation(s)
- Derek M. Griffith
- 1. Institute for Research on Men’s Health, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
24
|
"If you do nothing about stress, the next thing you know, you're shattered": Perspectives on African American men's stress, coping and health from African American men and key women in their lives. Soc Sci Med 2015; 139:107-14. [PMID: 26183018 DOI: 10.1016/j.socscimed.2015.06.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 05/27/2015] [Accepted: 06/27/2015] [Indexed: 11/22/2022]
Abstract
Stress has been implicated as a key contributor to poor health outcomes; however, few studies have examined how African American men and women explicitly describe the relationships among stress, coping, and African American men's health. In this paper, we explore strategies men use to cope with stress, and beliefs about the consequences of stress for African American men's health behaviors, morbidity and mortality from the perspectives of African American men and women. A phenomenological analytic approach was used to examine focus group data collected from 154 African American men (18 focus groups) and 77 African American women (8 focus groups). Women's perspectives were captured because women often observe men under stress and can provide support to men during stressful times. Our findings indicate that African American men in this study responded to stress by engaging in often identified coping behaviors (i.e., consumption of calorie dense food, exercise, spiritually-related activities). Men in our study, however, did not always view their responses to stress as explicit coping mechanisms. There was also some discordance between men's and women's perceptions of men's coping behaviors as there were occasions where they seemed to interpret the same behavior differently (e.g., resting vs. avoidance). Men and women believed that stress helped to explain why African American men had worse health than other groups. They identified mental, physical and social consequences of stress. We conclude by detailing implications for conceptualizing and measuring coping and we outline key considerations for interventions and further research about stress, coping and health.
Collapse
|
25
|
Eisen CH, Bowie JV, Gaskin DJ, LaVeist TA, Thorpe RJ. The contribution of social and environmental factors to race differences in dental services use. J Urban Health 2015; 92:415-21. [PMID: 25680951 PMCID: PMC4456482 DOI: 10.1007/s11524-015-9938-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dental services use is a public health issue that varies by race. African Americans are less likely than whites to make use of these services. While several explanations exist, little is known about the role of segregation in understanding this race difference. Most research does not account for the confounding of race, socioeconomic status, and segregation. Using cross-sectional data from the Exploring Health Disparities in Integrated Communities Study, we examined the relationship between race and dental services use. Our primary outcome of interest was dental services use within 2 years. Our main independent variable was self-identified race. Of the 1408 study participants, 59.3% were African American. More African Americans used dental services within 2 years than whites. After adjusting for age, gender, marital status, income, education, insurance, self-rated health, and number of comorbidities, African Americans had greater odds of having used services (odds ratio = 1.48, 95% confidence interval 1.16, 1.89) within 2 years. Within this low-income racially integrated sample, African Americans participated in dental services more than whites. Place of living is an important factor to consider when seeking to understand race differences in dental service use.
Collapse
Affiliation(s)
- Colby H Eisen
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ste 441, Baltimore, MD, 21205, USA
| | | | | | | | | |
Collapse
|
26
|
Horner-Johnson W, Dobbertin K, Beilstein-Wedel E. Disparities in dental care associated with disability and race and ethnicity. J Am Dent Assoc 2015; 146:366-74. [DOI: 10.1016/j.adaj.2015.01.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/20/2014] [Accepted: 01/18/2015] [Indexed: 12/13/2022]
|
27
|
Thorpe RJ, McCleary R, Smolen JR, Whitfield KE, Simonsick EM, LaVeist T. Racial disparities in disability among older adults: finding from the exploring health disparities in integrated communities study. J Aging Health 2015; 26:1261-79. [PMID: 25502241 DOI: 10.1177/0898264314534892] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Persistent and consistently observed racial disparities in physical functioning likely stem from racial differences in social resources and environmental conditions. METHOD We examined the association between race and reported difficulty performing instrumental activities of daily living (IADL) in 347 African American (45.5%) and Whites aged 50 or above in the Exploring Health Disparities in Integrated Communities-Southwest Baltimore, Maryland Study (EHDIC-SWB). RESULTS Contrary to previous studies, African Americans had lower rates of disability (women: 25.6% vs. 44.6%, p = .006; men: 15.7% vs. 32.9%; p = .017) than Whites. After adjusting for sociodemographics, health behaviors, and comorbidities, African American women (odds ratio [OR] = 0.32, 95% confidence interval [CI] = [0.14, 0.70]) and African American men (OR = 0.34, 95% CI = [0.13, 0.90]) retained their functional advantage compared with White women and men, respectively. CONCLUSION These findings within an integrated, low-income urban sample support efforts to ameliorate health disparities by focusing on the social context in which people live.
Collapse
Affiliation(s)
- Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Center on Biobehavorial Health Disparities Research, Duke University, Durham, NC, USA
| | - Rachael McCleary
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jenny R Smolen
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keith E Whitfield
- Center on Biobehavorial Health Disparities Research, Duke University, Durham, NC, USA
| | - Eleanor M Simonsick
- Johns Hopkins School of Medicine, Baltimore, MD, USA National Institute on Aging, Baltimore, MD, USA
| | - Thomas LaVeist
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
28
|
Porch TC, Bell CN, Bowie JV, Usher T, Kelly EA, LaVeist TA, Thorpe RJ. The Role of Marital Status in Physical Activity Among African American and White Men. Am J Mens Health 2015; 10:526-532. [PMID: 25804218 DOI: 10.1177/1557988315576936] [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: 12/31/2022] Open
Abstract
Racial differences in physical activity among men are well documented; however, little is known about the impact of marital status on this relationship. Data from the National Health and Examination Survey (NHANES) 1999-2006 was used to determine whether the association of race and physical activity among men varied by marital status. Marital status was divided into two categories: married and unmarried. Physical activity was determined by the number of minutes per week a respondent engaged in household/yard work, moderate and vigorous activity, or transportation (bicycling and walking) over the past 30 days. The sample included 7,131 African American (29%) and White(71%) men aged 18 years and older. All models were estimated using logistic regression. Because the interaction term of race and marital status was statistically significant (p < .001), the relationship between race, physical activity, and marital status was examined using a variable that reflects the different levels of the interaction term. After adjusting for age, income, education, weight status, smoking status, and self-rated health, African American married men had lower odds (odds ratio = 0.53, 95% confidence interval = [0.46-0.61], p < .001) of meeting federal physical activity guidelines compared with White married men. Possible dissimilarities in financial and social responsibilities may contribute to the racial differences observed in physical activity among African American and White married men.
Collapse
Affiliation(s)
- Tichelle C Porch
- Emory University College of Arts and Sciences, Atlanta, GA, USA Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caryn N Bell
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janice V Bowie
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Therri Usher
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Kelly
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas A LaVeist
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
29
|
Thorpe RJ, Bell CN, Kennedy-Hendricks A, Harvey J, Smolen JR, Bowie JV, LaVeist TA. Disentangling race and social context in understanding disparities in chronic conditions among men. J Urban Health 2015; 92:83-92. [PMID: 25168686 PMCID: PMC4338129 DOI: 10.1007/s11524-014-9900-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Disparities in men's health research may inaccurately attribute differences in chronic conditions to race rather than the different health risk exposures in which men live. This study sought to determine whether living in the same social environment attenuates race disparities in chronic conditions among men. This study compared survey data collected in 2003 from black and white men with similar incomes living in a racially integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey. Multivariable logistic regression models estimated to determine whether race disparities in chronic conditions were attenuated among men living in the same social environment. In the national sample, black men exhibited greater odds of having hypertension (odds ratio [OR] = 1.58, 95% confidence interval [CI] 1.34, 1.86) and diabetes (OR = 1.62, 95% CI 1.27-2.08) than white men. In the sample of men living in the same social context, black and white respondents had similar odds of having hypertension (OR = 1.05, 95% CI 0.70, 1.59) and diabetes (OR = 1.12, 95% CI 0.57-2.22). There are no race disparities in chronic conditions among low-income, urban men living in the same social environment. Policies and interventions aiming to reduce disparities in chronic conditions should focus on modifying social aspects of the environment.
Collapse
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, USA,
| | | | | | | | | | | | | |
Collapse
|
30
|
Gibbons MC, Lowry SZ, Patterson ES. Applying Human Factors Principles to Mitigate Usability Issues Related to Embedded Assumptions in Health Information Technology Design. JMIR Hum Factors 2014; 1:e3. [PMID: 27025349 PMCID: PMC4797669 DOI: 10.2196/humanfactors.3524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 10/07/2014] [Indexed: 11/30/2022] Open
Abstract
Background There is growing recognition that design flaws in health information technology (HIT) lead to increased cognitive work, impact workflows, and produce other undesirable user experiences that contribute to usability issues and, in some cases, patient harm. These usability issues may in turn contribute to HIT utilization disparities and patient safety concerns, particularly among “non-typical” HIT users and their health care providers. Health care disparities are associated with poor health outcomes, premature death, and increased health care costs. HIT has the potential to reduce these disparate outcomes. In the computer science field, it has long been recognized that embedded cultural assumptions can reduce the usability, usefulness, and safety of HIT systems for populations whose characteristics differ from “stereotypical” users. Among these non-typical users, inappropriate embedded design assumptions may contribute to health care disparities. It is unclear how to address potentially inappropriate embedded HIT design assumptions once detected. Objective The objective of this paper is to explain HIT universal design principles derived from the human factors engineering literature that can help to overcome potential usability and/or patient safety issues that are associated with unrecognized, embedded assumptions about cultural groups when designing HIT systems. Methods Existing best practices, guidance, and standards in software usability and accessibility were subjected to a 5-step expert review process to identify and summarize those best practices, guidance, and standards that could help identify and/or address embedded design assumptions in HIT that could negatively impact patient safety, particularly for non-majority HIT user populations. An iterative consensus-based process was then used to derive evidence-based design principles from the data to address potentially inappropriate embedded cultural assumptions. Results Design principles that may help identify and address embedded HIT design assumptions are available in the existing literature. Conclusions Evidence-based HIT design principles derived from existing human factors and informatics literature can help HIT developers identify and address embedded cultural assumptions that may underlie HIT-associated usability and patient safety concerns as well as health care disparities.
Collapse
Affiliation(s)
- Michael C Gibbons
- Johns Hopkins University, Departments of Medicine, Public Health, and Health Informatics, Baltimore, MD, United States.
| | | | | |
Collapse
|
31
|
Thorpe RJ, Richard P, Bowie JV, Laveist TA, Gaskin DJ. Economic Burden of Men's Health Disparities in the United States. ACTA ACUST UNITED AC 2014. [DOI: 10.3149/jmh.1203.195] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
32
|
Taylor NK, Buttenheim AM. Improving utilization of and retention in PMTCT services: can behavioral economics help? BMC Health Serv Res 2013; 13:406. [PMID: 24112440 PMCID: PMC3852550 DOI: 10.1186/1472-6963-13-406] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/26/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The most recent strategic call to action of the World Health Organization sets the elimination of pediatric HIV as a goal. While recent efforts have focused on building infrastructure and ensuring access to high-quality treatment, we must now turn our focus to the behavior change needed to eliminate vertical transmission. We make the case for the application of concepts from the field of behavioral economics to prevention of mother-to-child transmission (PMTCT) programs to more effectively address demand-side issues of uptake and retention. DISCUSSION We introduce five concepts from the field of behavioral economics and discuss their application to PMTCT programs: 1) Mentor mothers who come from similar circumstances as PMTCT patients can serve as social references who provide temporally salient modeling of utilization of services and adherence to treatment. 2) Economic incentives, like cell phone minutes or food vouchers, that reward adherence to PMTCT protocols leverage present bias, the observation that people are generally biased toward immediate versus future awards. 3) Default bias, our preference for the default option, is already being used in many countries in the form of opt-out testing, and could be expanded to all PMTCT programs. 4) We are hardwired to avoid loss more than to pursue an equivalent gain. PMTCT programs can take advantage of loss aversion through the use of commitment contracts that incentivize mothers to return to the clinic in order to avoid both reputational and financial loss. SUMMARY Eliminating vertical transmission of HIV is an ambitious goal. To close the remaining gap, innovations are needed to address demand for PMTCT services. Behavioral economics offers a set of tools that can be engineered into PMTCT programs to increase uptake and improve retention with minimal investment.
Collapse
Affiliation(s)
- Nicholas Kenji Taylor
- Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA 19104, USA.
| | | |
Collapse
|
33
|
Thorpe RJ, Wilson-Frederick SM, Bowie JV, Coa K, Clay OJ, LaVeist TA, Whitfield KE. Health behaviors and all-cause mortality in African American men. Am J Mens Health 2013; 7:8S-18S. [PMID: 23649171 PMCID: PMC4086642 DOI: 10.1177/1557988313487552] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Because of the excess burden of preventable chronic diseases and premature death among African American men, identifying health behaviors to enhance longevity is needed. We used data from the Third National Health and Nutrition Examination Survey 1988-1994 (NHANES III) and the NHANES III Linked Mortality Public-use File to determine the association between health behaviors and all-cause mortality and if these behaviors varied by age in 2029 African American men. Health behaviors included smoking, drinking, physical inactivity, obesity, and a healthy eating index score. Age was categorized as 25-44 years (n = 1,045), 45-64 years (n = 544), and 65 years and older (n = 440). Cox regression analyses were used to estimate the relationship between health behaviors and mortality within each age-group. All models were adjusted for marital status, education, poverty-to-income ratio, insurance status, and number of health conditions. Being a current smoker was associated with an increased risk of mortality in the 25- to 44-year age-group, whereas being physically inactive was associated with an increased risk of mortality in the 45- to 64-year age-group. For the 65 years and older age-group, being overweight or obese was associated with decreased mortality risk. Efforts to improve longevity should focus on developing age-tailored health promoting strategies and interventions aimed at smoking cessation and increasing physical activity in young and middle-aged African American men.
Collapse
Affiliation(s)
- Roland J. Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Janice V. Bowie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kisha Coa
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Olivio J. Clay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | |
Collapse
|