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Condella A, Lindo EG, Badulak J, Johnson NJ, Maine R, Mandell S, Town JA, Luks AM, Elizaga S, Bulger EM, Stewart BT. Veno-venous Extracorporeal Membrane Oxygenation for COVID-19: A Call For System-Wide Checks to Ensure Equitable Delivery For All. ASAIO J 2023; 69:272-277. [PMID: 36847809 PMCID: PMC9949367 DOI: 10.1097/mat.0000000000001823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) has emerged in the COVID-19 pandemic as a potentially beneficial yet scare resource for treating critically ill patients, with variable allocation across the United States. The existing literature has not addressed barriers patients may face in access to ECMO as a result of healthcare inequity. We present a novel patient-centered framework of ECMO access, providing evidence for potential bias and opportunities to mitigate this bias at every stage between a marginalized patient's initial presentation to treatment with ECMO. While equitable access to ECMO support is a global challenge, this piece focuses primarily on patients in the United States with severe COVID-19-associated ARDS to draw from current literature on VV-ECMO for ARDS and does not address issues that affect ECMO access on a more international scale.
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Affiliation(s)
- Anna Condella
- From the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Washington
| | - Edwin G. Lindo
- School of Medicine, University of Washington, Washington
| | - Jenelle Badulak
- Department of Emergency Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Washington
| | - Nicholas J. Johnson
- Department of Emergency Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Washington
| | - Rebecca Maine
- Department of Surgery, University of Washington, Washington
| | - Samuel Mandell
- Parkland Hospital, University of Texas Southwestern, Dallas, Texas
| | - James A. Town
- From the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Washington
| | - Andrew M. Luks
- From the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Washington
| | - Shelby Elizaga
- Cardiothoracic Surgery, University of Washington, Washington
| | | | - Barclay T. Stewart
- Department of Surgery, University of Washington, Harborview Injury Prevention and Research Center, Washington
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Williams BE, Kondo KK, Ayers CK, Kansagara D, Young S, Saha S. Preventing Unequal Health Outcomes in COVID-19: A Systematic Review of Past Interventions. Health Equity 2022; 5:856-871. [PMID: 35018320 PMCID: PMC8742307 DOI: 10.1089/heq.2021.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background: We sought to identify interventions that reduced disparities in health outcomes in infectious disease outbreaks or natural disasters in the United States to understand whether these interventions could reduce health disparities in the current COVID-19 pandemic. Methods: We searched MEDLINE and other databases to May 2020 to find studies that examined interventions to mitigate health inequalities in previous infectious disease pandemics or disasters. We assessed study quality using the Newcastle-Ottawa Scale and the Critical Appraisal Skills Program (CASP) Checklist for Qualitative Studies. Results: We included 14 articles (12 studies) and 5 Centers for Disease Control (CDC) stakeholder meeting articles on pandemic influenza preparedness in marginalized populations. Studies called for intervention and engagement before pandemic or disaster onset. Several studies included interventions that could be adapted to COVID-19, including harnessing technology to reach disadvantaged populations, partnering with trusted community liaisons to deliver important messaging around disease mitigation, and using culturally specific communication methods and messages to best reach marginalized groups. Discussion: To our knowledge this is the first systematic review to examine interventions to mitigate health inequities during an infectious disease pandemic. However, given that we identified very few disparities-focused infectious disease intervention studies, we also included studies from the disaster response literature, which may not be as generalizable to the current context of COVID-19. Overall, community outreach and tailored communication are essential in disease mitigation. More research is needed to evaluate systemic interventions that target the distal determinants of poor health outcomes among marginalized populations during pandemics and natural disasters.
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Affiliation(s)
- Beth E Williams
- Primary Care, VA Portland Health Care System, Portland, Oregon, USA
| | - Karli K Kondo
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA.,Research Integrity Office, Oregon Health and Science University, Portland, Oregon, USA
| | - Chelsea K Ayers
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA
| | - Devan Kansagara
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Sarah Young
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Division of General Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
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3
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DeHaven MJ, Gimpel NA, Kitzman H. Working with communities: Meeting the health needs of those living in vulnerable communities when Primary Health Care and Universal Health Care are not available. J Eval Clin Pract 2021; 27:1056-1065. [PMID: 33051956 DOI: 10.1111/jep.13495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/10/2020] [Accepted: 09/21/2020] [Indexed: 01/01/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The health care delivery model in the United States does not work; it perpetuates unequal access to care, favours treatment over prevention, and contributes to persistent health disparities and lack of insurance. The vast majority of those who suffer from preventable diseases and health disparities, and who are at greatest risk of not having insurance, are low-income minorities (Native Americans, Hispanics, and African-Americans) who live in high risk and vulnerable communities. The historical lack of support in the United States for Universal Health Care (UHC) and Primary Health Care (PHC)-with their emphasis on health care for all, population health, and social determinants of health-requires community health scientists to develop innovative local solutions for addressing unmet community health needs. METHODS We developed a model community health science approach for improving health in fragile communities, by combining community-oriented primary care (COPC), community-based participatory research (CBPR), asset-based community development, and service learning principles. During the past two decades, our team has collaborated with community residents, local leaders, and many different types of organizations, to address the health needs of vulnerable patients. The approach defines health as a social outcome, resulting from a combination of clinical science, collective responsibility, and informed social action. RESULTS From 2000 to 2020, we established a federally funded research programme for testing interventions to improve health outcomes in vulnerable communities, by working in partnership with community organizations and other stakeholders. The partnership goals were reducing chronic disease risk and multimorbidity, by stimulating lifestyle changes, increasing healthy behaviours and health knowledge, improving care seeking and patient self-management, and addressing the social determinants of health and population health. Our programmes have also provided structured community health science training in high-risk communities for hundreds of doctors in training. CONCLUSION Our community health science approach demonstrates that the factors contributing to health can only be addressed by working directly with and in affected communities to co-develop health care solutions across the broad range of causal factors. As the United States begins to consider expanding health care options consistent with PHC and UHC principles, our community health science experience provides useful lessons in how to engage communities to address the deficits of the current system. Perhaps the greatest assets US health care systems have for better addressing population health and the social determinants of health are the important health-related initiatives already underway in most local communities. Building partnerships based on local resources and ongoing social determinants of health initiatives is the key for medicine to meaningfully engage communities for improving health outcomes and reducing health disparities. This has been the greatest lesson we have learned the past two decades, has provided the foundation for our community health science approach, and accounts for whatever success we have achieved.
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Affiliation(s)
- Mark J DeHaven
- Academy for Research on Community Health, Engagement, and Services (ARCHES), University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Nora A Gimpel
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Heather Kitzman
- Robbins Institute for Health Policy & Leadership, Baylor Scott & White Health and Wellness, Dallas, Texas, USA
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4
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Mackey K, Ayers CK, Kondo KK, Saha S, Advani SM, Young S, Spencer H, Rusek M, Anderson J, Veazie S, Smith M, Kansagara D. Racial and Ethnic Disparities in COVID-19-Related Infections, Hospitalizations, and Deaths : A Systematic Review. Ann Intern Med 2021; 174:362-373. [PMID: 33253040 PMCID: PMC7772883 DOI: 10.7326/m20-6306] [Citation(s) in RCA: 706] [Impact Index Per Article: 235.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Data suggest that the effects of coronavirus disease 2019 (COVID-19) differ among U.S. racial/ethnic groups. PURPOSE To evaluate racial/ethnic disparities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and COVID-19 outcomes, factors contributing to disparities, and interventions to reduce them. DATA SOURCES English-language articles in MEDLINE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus, searched from inception through 31 August 2020. Gray literature sources were searched through 2 November 2020. STUDY SELECTION Observational studies examining SARS-CoV-2 infections, hospitalizations, or deaths by race/ethnicity in U.S. settings. DATA EXTRACTION Single-reviewer abstraction confirmed by a second reviewer; independent dual-reviewer assessment of quality and strength of evidence. DATA SYNTHESIS 37 mostly fair-quality cohort and cross-sectional studies, 15 mostly good-quality ecological studies, and data from the Centers for Disease Control and Prevention and APM Research Lab were included. African American/Black and Hispanic populations experience disproportionately higher rates of SARS-CoV-2 infection, hospitalization, and COVID-19-related mortality compared with non-Hispanic White populations, but not higher case-fatality rates (mostly reported as in-hospital mortality) (moderate- to high-strength evidence). Asian populations experience similar outcomes to non-Hispanic White populations (low-strength evidence). Outcomes for other racial/ethnic groups have been insufficiently studied. Health care access and exposure factors may underlie the observed disparities more than susceptibility due to comorbid conditions (low-strength evidence). LIMITATIONS Selection bias, missing race/ethnicity data, and incomplete outcome assessments in cohort and cross-sectional studies must be considered. In addition, adjustment for key demographic covariates was lacking in ecological studies. CONCLUSION African American/Black and Hispanic populations experience disproportionately higher rates of SARS-CoV-2 infection and COVID-19-related mortality but similar rates of case fatality. Differences in health care access and exposure risk may be driving higher infection and mortality rates. PRIMARY FUNDING SOURCE Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development. (PROSPERO: CRD42020187078).
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Affiliation(s)
- Katherine Mackey
- VA Evidence Synthesis Program, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (K.M., K.K.K., S.S., D.K.)
| | - Chelsea K Ayers
- VA Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon (C.K.A., S.Y., J.A., S.V.)
| | - Karli K Kondo
- VA Evidence Synthesis Program, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (K.M., K.K.K., S.S., D.K.)
| | - Somnath Saha
- VA Evidence Synthesis Program, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (K.M., K.K.K., S.S., D.K.)
| | - Shailesh M Advani
- Social Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland (S.M.A.)
| | - Sarah Young
- VA Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon (C.K.A., S.Y., J.A., S.V.)
| | - Hunter Spencer
- Oregon Health & Science University, Portland, Oregon (H.S., M.R.)
| | - Max Rusek
- Oregon Health & Science University, Portland, Oregon (H.S., M.R.)
| | - Johanna Anderson
- VA Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon (C.K.A., S.Y., J.A., S.V.)
| | - Stephanie Veazie
- VA Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon (C.K.A., S.Y., J.A., S.V.)
| | - Mia Smith
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon (M.S.)
| | - Devan Kansagara
- VA Evidence Synthesis Program, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (K.M., K.K.K., S.S., D.K.)
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5
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Saura JR, Reyes-Menendez A, Thomas SB. Gaining a deeper understanding of nutrition using social networks and user-generated content. Internet Interv 2020; 20:100312. [PMID: 32300536 PMCID: PMC7153295 DOI: 10.1016/j.invent.2020.100312] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 11/18/2019] [Accepted: 02/28/2020] [Indexed: 12/20/2022] Open
Abstract
Using user-generated content (UGC) on Twitter, the present study identifies the main themes that revolve around the concept of healthy diet and determine user feelings about various foods. Using a dataset of tweets with the hashtag "#Diet" or "#FoodDiet" (n = 10.591), we first use a Latent Dirichlet Allocation (LDA) model to identify the food categories most discussed on Twitter. Then, based on the results of the LDA model, we apply sentiment analysis to divide the identified tweets into three groups (negative, positive and neutral) based on the feelings expressed in corresponding tweets. Finally, the text mining approach is performed to identify foods according to the feelings expressed about those in corresponding tweets, as well as to derive key indicators that collectively present the UGC-based knowledge of healthy eating. The results of the present study show that among the foods most negatively perceived in the UGC are bacon, sugar, processed foods, red meat, and snacks. By contrast, water, apples, salads, broccoli and spinach are evaluated more positively. Furthermore, our findings suggest that the collective UGC knowledge is lacking on such healthy foods as fish, poultry, dry beans, nuts, as well as yogurt and cheese. The results of the present study can help the World Health Organization (WHO), as well as other institutions concerned with the study of healthy eating, to improve their communication policies on healthy products and preparation of balanced diets.
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Buseh AG, Stevens PE, Millon-Underwood S, Townsend L, Kelber ST. Community leaders' perspectives on engaging African Americans in biobanks and other human genetics initiatives. J Community Genet 2013; 4:483-94. [PMID: 23813337 PMCID: PMC3773318 DOI: 10.1007/s12687-013-0155-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 06/17/2013] [Indexed: 01/26/2023] Open
Abstract
There is limited information about what African Americans think about biobanks and the ethical questions surrounding them. Likewise, there is a gap in capacity to successfully enroll African Americans as biobank donors. The purposes of this community-based participatory study were to: (a) explore African Americans' perspectives on genetics/genomic research, (b) understand facilitators and barriers to participation in such studies, and (c) enlist their ideas about how to attract and sustain engagement of African Americans in genetics initiatives. As the first phase in a mixed methods study, we conducted four focus groups with 21 African American community leaders in one US Midwest city. The sample consisted of executive directors of community organizations and prominent community activists. Data were analyzed thematically. Skepticism about biomedical research and lack of trust characterized discussions about biomedical research and biobanks. The Tuskegee Untreated Syphilis Study and the Henrietta Lacks case influenced their desire to protect their community from harm and exploitation. Connections between genetics and family history made genetics/genomics research personal, pitting intrusion into private affairs against solutions. Participants also expressed concerns about ethical issues involved in genomics research, calling attention to how research had previously been conducted in their community. Participants hoped personalized medicine might bring health benefits to their people and proposed African American communities have a "seat at the table." They called for basic respect, authentic collaboration, bidirectional education, transparency and prerogative, and meaningful benefits and remuneration. Key to building trust and overcoming African Americans' trepidation and resistance to participation in biobanks are early and persistent engagement with the community, partnerships with community stakeholders to map research priorities, ethical conduct of research, and a guarantee of equitable distribution of benefits from genomics discoveries.
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Affiliation(s)
- Aaron G. Buseh
- />College of Nursing, University of Wisconsin—Milwaukee, 1921 East Hartford Avenue, Cunningham Hall, Room 569, P.O. Box 413, Milwaukee, WI 53201 USA
| | - Patricia E. Stevens
- />College of Nursing, University of Wisconsin—Milwaukee, P. O. Box 413, Cunningham Hall, Room 566, Milwaukee, WI 53201 USA
| | - Sandra Millon-Underwood
- />College of Nursing, University of Wisconsin—Milwaukee, 1921 E. Hartford Avenue, Cunningham Hall, Room 422/423, P. O. Box 413, Milwaukee, WI 53201 USA
| | - Leolia Townsend
- />College of Nursing, University of Wisconsin—Milwaukee, P. O. Box 413, Cunningham Hall, Room 527, Milwaukee, WI 53201 USA
| | - Sheryl T. Kelber
- />College of Nursing Center for Nursing Research and Evaluation, University of Wisconsin—Milwaukee, P. O. Box 413, Milwaukee, WI 53201 USA
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7
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Rodriguez EM, Torres ET, Erwin DO. Awareness and interest in biospecimen donation for cancer research: views from gatekeepers and prospective participants in the Latino community. J Community Genet 2013. [PMID: 23733683 DOI: 10.1007/s12687-013-0152-2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Latinos are one of the fastest-growing population groups in the USA, and are underrepresented in scientific research and even more so in genetic research. The disproportionately lower number of certain subpopulations participating in biomedical research has a significant impact on the representativeness of scientific outcomes. We established a collaboration with scientists at a designated National Cancer Institute comprehensive cancer center to test the feasibility of community-based approaches for engaging Latinos in biospecimen donation for cancer genomic research. A methods triangulation approach was applied to gain a deeper understanding from the community, that included key informant interviews with Latino community leaders (N = 6), four focus groups (N = 22) with members of the Latino community, and the use of an audience response system within the focus groups to capture quantitative data. Overall, the majority of participants had never participated in biospecimen donation; however, despite being unaware of the biobank, they expressed willingness to participate as a way to help advance research. Themes included: Confusion on what biospecimen donation process entails; Barriers to and incentives for participation; Strategies and locations for reaching the Latino community. Clear communication of the "public good" as it relates to biospecimen donation by healthy/non-patient participants is a less clearly conceptualized message; yet, the significance of delivering this message is important to gaining participation and increasing the diversity of samples available for cancer genomic studies from a broader community context.
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Affiliation(s)
- Elisa Marie Rodriguez
- Department of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA,
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8
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Rodriguez EM, Torres ET, Erwin DO. Awareness and interest in biospecimen donation for cancer research: views from gatekeepers and prospective participants in the Latino community. J Community Genet 2013; 4:461-8. [PMID: 23733683 DOI: 10.1007/s12687-013-0152-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/22/2013] [Indexed: 01/13/2023] Open
Abstract
Latinos are one of the fastest-growing population groups in the USA, and are underrepresented in scientific research and even more so in genetic research. The disproportionately lower number of certain subpopulations participating in biomedical research has a significant impact on the representativeness of scientific outcomes. We established a collaboration with scientists at a designated National Cancer Institute comprehensive cancer center to test the feasibility of community-based approaches for engaging Latinos in biospecimen donation for cancer genomic research. A methods triangulation approach was applied to gain a deeper understanding from the community, that included key informant interviews with Latino community leaders (N = 6), four focus groups (N = 22) with members of the Latino community, and the use of an audience response system within the focus groups to capture quantitative data. Overall, the majority of participants had never participated in biospecimen donation; however, despite being unaware of the biobank, they expressed willingness to participate as a way to help advance research. Themes included: Confusion on what biospecimen donation process entails; Barriers to and incentives for participation; Strategies and locations for reaching the Latino community. Clear communication of the "public good" as it relates to biospecimen donation by healthy/non-patient participants is a less clearly conceptualized message; yet, the significance of delivering this message is important to gaining participation and increasing the diversity of samples available for cancer genomic studies from a broader community context.
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Affiliation(s)
- Elisa Marie Rodriguez
- Department of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA,
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Howarter AD, Bennett KK. Perceived discrimination and health-related quality of life: testing the Reserve Capacity Model in Hispanic Americans. The Journal of Social Psychology 2013; 153:62-79. [PMID: 23421006 DOI: 10.1080/00224545.2012.703973] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study tested aspects of the Reserve Capacity Model (Gallo & Matthews, 2003; Gallo, Penedo Espinosa de los Monteros, & Arguelles, 2009) as a means of understanding disparities in health-related quality of life appraisals among Hispanic Americans. Questionnaire data were collected from 236 Hispanic participants, including measures of perceived discrimination, optimism, social support, symptoms of trait anxiety, and physical and mental health-related quality of life. Path analysis indicated direct, negative associations between perceived discrimination and both forms of health-related quality of life. Results also showed that these relationships were partially mediated by the reserve capacity variable of optimism and by symptoms of anxiety, though evidence for mediation by anxiety was stronger than for optimism. Findings suggest that perceived discrimination depletes intrapersonal reserves in Hispanic Americans, which, in turn, induces negative emotions. Implications for community-level interventions are discussed.
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Affiliation(s)
- Alisha D Howarter
- University of Missouri-Kansas City, Department of Psychology, 5030 Cherry St., Room 302, Kansas City, MO 66410, USA
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10
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Long KA, Thomas SB, Grubs RE, Gettig EA, Krishnamurti L. Attitudes and beliefs of African-Americans toward genetics, genetic testing, and sickle cell disease education and awareness. J Genet Couns 2011; 20:572-92. [PMID: 21748660 DOI: 10.1007/s10897-011-9388-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 06/23/2011] [Indexed: 11/28/2022]
Abstract
Research among African-Americans indicates this population perceives sickle cell (SCD) to be a serious disease and sickle cell trait (SCT) screening an important intervention. However, studies have consistently demonstrated a lower than desired uptake of SCD education, inadequate knowledge regarding personal and family trait status, and a low perceived susceptibility of giving birth to a child with the disease. We examined general attitudes and beliefs regarding genetics and genetic testing including prenatal testing and newborn screening; we used this information as the foundation to more specifically assess attitudes and beliefs regarding SCD and perceived barriers to SCD education and awareness. Thirty-five African-American adult men and women participated in one of four focus groups. Thematic analysis identified that both prenatal testing and newborn screening are acceptable forms of genetic testing. Based largely on their personal experiences, participants possessed an understanding of the natural progression of SCD but had a limited understanding of the inheritance and probable risk of giving birth to a child with the disease. Barriers to education and greater awareness of SCD were classified as personal, familial, and societal. Community based interventions focused on sharing the stories of individuals with first-hand experiences with SCD should be considered.
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Affiliation(s)
- Katie A Long
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA.
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11
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Wilf-Miron R, Peled R, Yaari E, Vainer A, Porath A, Kokia E. The association between socio-demographic characteristics and adherence to breast and colorectal cancer screening: analysis of large sub populations. BMC Cancer 2011; 11:376. [PMID: 21867544 PMCID: PMC3176246 DOI: 10.1186/1471-2407-11-376] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 08/25/2011] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Populations having lower socioeconomic status, as well as ethnic minorities, have demonstrated lower utilization of preventive screening, including tests for early detection of breast and colorectal cancer. THE OBJECTIVE To explore socio-demographic disparities in adherence to screening recommendations for early detection of cancer. METHODS The study was conducted by Maccabi Healthcare Services, an Israeli HMO (health plan) providing healthcare services to 1.9 million members. Utilization of breast cancer (BC) and colorectal cancer (CC) screening were analyzed by socio-economic ranks (SERs), ethnicity (Arab vs non-Arab), immigration status and ownership of voluntarily supplemental health insurance (VSHI). RESULTS Data on 157,928 and 303,330 adults, eligible for BC and CC screening, respectively, were analyzed. Those having lower SER, Arabs, immigrants from Former Soviet Union countries and non-owners of VSHI performed fewer cancer screening examinations compared with those having higher SER, non-Arabs, veterans and owners of VSHI (p < 0.001). Logistic regression model for BC Screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab and having a lower SER. The model for CC screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant. The model estimated for BC and CC screening among females revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant. CONCLUSION Patients from low socio-economic backgrounds, Arabs, immigrants and those who do not own supplemental insurance do fewer tests for early detection of cancer. These sub-populations should be considered priority populations for targeted intervention programs and improved resource allocation.
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Affiliation(s)
- Rachel Wilf-Miron
- Quality Management in Health Care, Maccabi Healthcare Services, Tel-Aviv, Israel
- Faculty of Management, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronit Peled
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Einat Yaari
- Quality Management in Health Care, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Anna Vainer
- Quality Management in Health Care, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Avi Porath
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- Central Management, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Ehud Kokia
- Faculty of Management, Tel-Aviv University, Tel-Aviv, Israel
- Central Management, Maccabi Healthcare Services, Tel-Aviv, Israel
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12
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Natale-Pereira A, Enard KR, Nevarez L, Jones LA. The role of patient navigators in eliminating health disparities. Cancer 2011; 117:3543-52. [PMID: 21780089 PMCID: PMC4121958 DOI: 10.1002/cncr.26264] [Citation(s) in RCA: 234] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite many important efforts to increase equity in the US health care system, not all Americans have equal access to health care-or similar health outcomes. With the goal of lowering costs and increasing accessibility to health care, the nation's new health care reform legislation includes certain provisions that expand health insurance coverage to uninsured and underinsured populations, promote medical homes, and support coordination of care. These provisions may help narrow existing health care disparities. Many of the most vulnerable patients, however, may continue to have difficulty accessing and navigating the complex US health care delivery system. This article explores the unique role that patient navigation can play in improving health outcomes for racial and ethnic minorities, as well as other underserved populations, in the context of a changing healthcare environment. Patient navigators can not only facilitate improved health care access and quality for underserved populations through advocacy and care coordination, but they can also address deep-rooted issues related to distrust in providers and the health system that often lead to avoidance of health problems and non-compliance with treatment recommendations. By addressing many of the disparities associated with language and cultural differences and barriers, patient navigators can foster trust and empowerment within the communities they serve. Specific patient navigator activities are discussed, and metrics to evaluate program efforts are presented.
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Affiliation(s)
- Ana Natale-Pereira
- University of Medicine and Dentistry, New Jersey Medical School, Newark, New Jersey
| | - Kimberly R. Enard
- Center for Research on Minority Health, The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Houston, Texas
| | - Lucinda Nevarez
- Center for Research on Minority Health, The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Houston, Texas
| | - Lovell A. Jones
- Center for Research on Minority Health, The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Houston, Texas
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Murthy VS, Garza MA, Almario DA, Vogel KJ, Grubs RE, Gettig EA, Wilson JW, Thomas SB. Using a family history intervention to improve cancer risk perception in a black community. J Genet Couns 2011; 20:639-49. [PMID: 21773879 DOI: 10.1007/s10897-011-9389-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 06/23/2011] [Indexed: 12/12/2022]
Abstract
Few studies examine the use of family history to influence risk perceptions in the African American population. This study examined the influence of a family health history (FHH) intervention on risk perceptions for breast (BRCA), colon (CRC), and prostate cancers (PRCA) among African Americans in Pittsburgh, PA. Participants (n = 665) completed pre- and post-surveys and FHHs. We compared their objective and perceived risks, classified as average, moderate, or high, and examined the accuracy of risk perceptions before and after the FHH intervention. The majority of participants had accurate risk perceptions post-FHH. Of those participants who were inaccurate pre-FHH, 43.3%, 43.8%, and 34.5% for BRCA, CRC, and PRCA, respectively, adopted accurate risk perceptions post-FHH intervention. The intervention was successful in a community setting. It has the potential to lead to healthy behavior modifications because participants adopted accurate risk perceptions. We identified a substantial number of at-risk individuals who could benefit from targeted prevention strategies, thus decreasing racial/ethnic cancer disparities.
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Affiliation(s)
- Vinaya S Murthy
- Department of Clinical Genetics, The Permanente Medical Group, San Jose, CA 95123, USA
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14
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Thomas SB, Quinn SC, Butler J, Fryer CS, Garza MA. Toward a fourth generation of disparities research to achieve health equity. Annu Rev Public Health 2011; 32:399-416. [PMID: 21219164 PMCID: PMC3419584 DOI: 10.1146/annurev-publhealth-031210-101136] [Citation(s) in RCA: 185] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Achieving health equity, driven by the elimination of health disparities, is a goal of Healthy People 2020. In recent decades, the improvement in health status has been remarkable for the U.S. population as a whole. However, racial and ethnic minority populations continue to lag behind whites with a quality of life diminished by illness from preventable chronic diseases and a life span cut short by premature death. We examine a conceptual framework of three generations of health disparities research to understand (a) data trends, (b) factors driving disparities, and (c) solutions for closing the gap. We propose a new, fourth generation of research grounded in public health critical race praxis, utilizing comprehensive interventions to address race, racism, and structural inequalities and advancing evaluation methods to foster our ability to eliminate disparities. This new generation demands that we address the researcher's own biases as part of the research process.
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Affiliation(s)
- Stephen B. Thomas
- Center for Health Equity, School of Public Health, University of Maryland, College Park, Maryland 20742-2611
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland 20742-2611
| | - Sandra Crouse Quinn
- Center for Health Equity, School of Public Health, University of Maryland, College Park, Maryland 20742-2611
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland 20742-2611
| | - James Butler
- Center for Health Equity, School of Public Health, University of Maryland, College Park, Maryland 20742-2611
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland 20742-2611
| | - Craig S. Fryer
- Center for Health Equity, School of Public Health, University of Maryland, College Park, Maryland 20742-2611
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland 20742-2611
| | - Mary A. Garza
- Center for Health Equity, School of Public Health, University of Maryland, College Park, Maryland 20742-2611
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland 20742-2611
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15
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Kumar S, Quinn SC, Kriska AM, Thomas SB. "Food is directed to the area": African Americans' perceptions of the neighborhood nutrition environment in Pittsburgh. Health Place 2010; 17:370-8. [PMID: 21169050 DOI: 10.1016/j.healthplace.2010.11.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 11/21/2010] [Accepted: 11/28/2010] [Indexed: 11/18/2022]
Abstract
Studies have shown racial disparities in neighborhood access to healthy food in the United States. We used a mixed methods approach employing geographic information systems, focus groups, and a survey to examine African Americans' perceptions of the neighborhood nutrition environment in Pittsburgh. We found that African Americans perceive that supermarkets serving their community offer produce and meats of poorer quality than branches of the same supermarket serving White neighborhoods (p<0.001). Unofficial taxis or jitneys, on which many African Americans are reliant, provide access from only certain stores; people are therefore forced to patronize these stores even though they are perceived to be of poorer quality. Community-generated ideas to tackle the situation include ongoing monitoring of supermarkets serving the Black community. We conclude that stores should make every effort to be responsive to the perceptions and needs of their clients and provide an environment that enables healthy eating.
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Affiliation(s)
- Supriya Kumar
- Graduate School of Public Health, University of Pittsburgh, 702 Parran Hall, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
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16
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Ford AF, Reddick K, Browne MC, Robins A, Thomas SB, Crouse Quinn S. Beyond the cathedral: building trust to engage the African American community in health promotion and disease prevention. Health Promot Pract 2010; 10:485-9. [PMID: 19809000 DOI: 10.1177/1524839909342848] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Effective efforts to eliminate health disparities must be grounded in strong community partnerships and trusting relationships between academic institutions and minority communities. However, there are often barriers to such efforts, including the frequent need to rely on time-limited funding mechanisms that take categorical approaches. This article provides an overview of health promotion and disease prevention projects implemented through the Community Outreach and Information Dissemination Core (COID) of the Center for Minority Health, within the Graduate School of Public Health at the University of Pittsburgh. The COID is one of five Cores that comprised the University of Pittsburgh's NIH Excellence in Partnerships for Community Outreach, and Research on Disparities in Health and Training (EXPORT Health) funded from 2002 to 2007 by the National Center on Minority Health and Health Disparities. Based in large part on the success of the community engagement activities, in 2007, the National Center on Minority Health and Health Disparities, National Institutes of Health, designated the CMH as a Research Center of Excellence on Minority Health Disparities. COID major initiatives included the Community Research Advisory Board, Health Disparity Working Groups, Health Advocates in Reach, Healthy Class of 2010, and the Healthy Black Family Project. Lessons learned may provide guidance to other academic institutions, community-based organizations, and health departments who seek to engage minority communities in changing social norms to support health promotion and disease prevention.
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Affiliation(s)
- Angela F Ford
- Center for Minority Health (CMH) at the Graduate School of Public Health (GSPH), University of Pittsburgh.
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Cancer prevention behaviors in low-income urban whites: an understudied problem. J Urban Health 2009; 86:861-71. [PMID: 19597995 PMCID: PMC2791816 DOI: 10.1007/s11524-009-9391-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 06/26/2009] [Indexed: 10/20/2022]
Abstract
Low-income urban whites in the United States have largely gone unexamined in health disparities research. In this study, we explored cancer prevention behaviors in this population. We compared data on whites with low socioeconomic status (SES) from the 2003 Exploring Health Disparities in Integrated Communities Study in Southwest Baltimore, Maryland (EHDIC-SWB) with nationally representative data for low SES white respondents from the 2003 National Health Interview Survey (NHIS). Rates for health behaviors and health indicators for whites from the EHDIC-SWB study as compared to NHIS prevalence estimates were as follows: current cigarette smoking, 59% (31% nationally); current regular drinking, 5% (5% nationally); overweight, 26% (32% nationally); obesity, 30% (22% nationally); mammography in the past 2 years, 50% (57% nationally); Pap smear in the past 2 years, 64% (68% nationally); screening for colon cancer in the past 2 years, 41% (30% nationally); and fair or poor self-reported health, 37% (22% nationally). Several cancer prevention behaviors and health indicators for white EHDIC-SWB respondents were far from the Healthy People 2010 objectives. This study provides rare estimates of cancer-related health and health care measures in an understudied population in the United States. Findings illustrate the need for further examination of health behaviors in low SES white urban populations who may share health risks with their poor minority urban counterparts.
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Crouse Quinn S. Crisis and emergency risk communication in a pandemic: a model for building capacity and resilience of minority communities. Health Promot Pract 2009; 9:18S-25S. [PMID: 18936256 DOI: 10.1177/1524839908324022] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As public health agencies prepare for pandemic influenza, it is evident from our experience with Hurricane Katrina that these events will occur in the same social, historical, and cultural milieu in which marked distrust of government and health disparities already exist. This article grapples with the challenges of crisis and emergency risk communication with special populations during a pandemic. Recognizing that targeting messages to specific groups poses significant difficulties at that time, this article proposes a model of community engagement, disaster risk education, and crisis and emergency risk communication to prepare minority communities and government agencies to work effectively in a pandemic, build the capacity of each to respond, and strengthen the trust that is critical at such moments. Examples of such engagement and potential strategies to enhance trust include tools familiar to many health educators.
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Affiliation(s)
- Sandra Crouse Quinn
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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