It Is Not Just the Southeast-Geographically Pervasive Racial Disparities in Neisseria gonorrhoeae Between Non-Hispanic Black and White US Women

Background:

Spatial analyses of gonorrhea morbidity among females often highlight the southeastern US but may not provide information on geographic variation in the magnitude of racial disparities; such maps also focus on geographic space, obscuring underlying population characteristics. We created a series of visualizations depicting both county-level racial disparities in female gonorrhea diagnoses and variations in population size.

Methods:

We calculated county- and region-level race-specific relative rates (RelR) and between-race rate differences (RD) and rate ratios (RR) comparing gonorrhea case rates in non-Hispanic Black (NHB) vs non-Hispanic White (NHW) females. We then created proportional symbol maps with color representing counties’ RelR/RD/RR category and symbol size representing counties’ female population.

Results:

Gonorrhea rates among NHB females were highest in the Midwest (718.7/100,000) and West (504.8), rates among NHW females were highest in the West (74.1) and Southeast (72.1). RDs were highest in the Midwest (654.6 excess cases/100,000) and West (430.7), while RRs were highest in the Northeast (12.4) and Midwest (11.2). Nearly all US counties had NHB female rates ≥3x those in NHW females, with NHB females in most highly populated counties experiencing ≥9-fold difference in gonorrhea rates.

Conclusions:

Racial disparities in gonorrhea were not confined to the Southeast; both relative and absolute disparities were equivalent or larger in magnitude in areas of the Northeast, Midwest, and West. Our findings help counter damaging regional stereotypes, provide evidence to refocus prevention efforts to areas of highest disparities, and suggest a useful template for monitoring racial disparities as an actionable public health metric.

Racial disparities in female gonorrhea rates are not confined to the Southeast; both relative and absolute disparities are equivalent or larger in areas of the Northeast, Midwest, and West.

Telehealth Services: Implications for Enhancing Sexually Transmitted Infection Prevention

ABSTRACT

In the United States, sexually transmitted infections (STIs) are among the most persistent threats to health equity. Increasing access to STI prevention and control services through the provision of Remote Health and Telehealth can improve sexual health outcomes. Telehealth has been shown to increase access to care and even improve health outcomes. The increased flexibility offered by Telehealth services accommodates both patient and provider. Although both Telehealth and Remote Health strategies are important for STI prevention, share common attributes, and, in some circumstances, overlap, this article will focus more specifically on considerations for Telehealth and how it can contribute to increasing health equity by offering an important complement to and, in some cases, substitute for in-person STI services for some populations. Telehealth assists a variety of different populations, including those experiencing STI disparities; however, although the Internet offers a promising resource for many American households and increasing percentages of Americans are using its many resources, not all persons have equal access to the Internet. In addition to tailoring STI programs to accommodate unique patient populations, these programs will likely be faced with adapting services to fit reimbursement and licensing regulations.

Improving Sexual Health in U.S. Rural Communities: Reducing the Impact of Stigma

Sexually transmitted infections (STI), including HIV, are among the most reported diseases in the U.S. and represent some of America’s most significant health disparities. The growing scarcity of health care services in rural settings limits STI prevention and treatment for rural Americans. Local health departments are the primary source for STI care in rural communities; however, these providers experience two main challenges, also known as a double disparity: (1) inadequate capacity and (2) poor health in rural populations. Moreover, in rural communities the interaction of rural status and key determinants of health increase STI disparities. These key determinants can include structural, behavioral, and interpersonal factors, one of which is stigma. Engaging the expertise and involvement of affected community members in decisions regarding the needs, barriers, and opportunities for better sexual health is an asset and offers a gateway to sustainable, successful, and non-stigmatizing STI prevention programs.

Critical Elements of Community Engagement to Address Disparities and Related Social Determinants of Health: The Centers of Disease Control and Prevention Community Approaches to Reducing Sexually Transmitted Disease Initiative

BACKGROUND

Community Approaches to Reducing Sexually Transmitted Disease (CARS), a unique initiative of the US Centers for Disease Control and Prevention, promotes the use of community engagement to increase sexually transmitted disease (STD) prevention, screening, and treatment and to address locally prioritized STD-related social determinants of health within communities experiencing STD disparities, including youth, persons of color, and sexual and gender minorities. We sought to identify elements of community engagement as applied within CARS.

METHODS AND MATERIALS

Between 2011 and 2018, we collected and analyzed archival and in-depth interview data to identify and explore community engagement across 8 CARS sites. Five to 13 interview participants (mean, 7) at each site were interviewed annually. Participants included project staff and leadership, community members, and representatives from local community organizations (e.g., health departments; lesbian, gay, bisexual, transgender, and queer-serving organizations; faith organizations; businesses; and HIV-service organizations) and universities. Data were analyzed using constant comparison, an approach to grounded theory development.

RESULTS

Twelve critical elements of community engagement emerged, including commitment to engagement, partner flexibility, talented and trusted leadership, participation of diverse sectors, establishment of vision and mission, open communication, reducing power differentials, working through conflict, identifying and leveraging resources, and building a shared history.

CONCLUSIONS

This study expands the community engagement literature within STD prevention, screening, and treatment by elucidating some of the critical elements of the approach and provides guidance for practitioners, researchers, and their partners as they develop, implement, and evaluate strategies to reduce STD disparities.

Research utilization in the health administration profession

The utilization of new research to affect treatment access, quality, and cost-effectiveness has become a major concern in the rapidly changing U.S. health care delivery system. Yet traditional health administration programs are more accustomed to focusing on the methodology of research than on its utilization. This article examines the growing interest in research utilization, presents three projects that illustrate different forms of the utilization of research findings, and offers suggestions on how health administration programs can prepare future health administrators to become more effective users of research.

Traditional sexually transmitted disease prevention and control strategies: tailoring for African American communities

African Americans carry the largest disease burden for bacterial sexually transmitted diseases (STDs) in the United States. These infections can have a devastating impact on sexual and reproductive health if they are not diagnosed and treated. Traditionally, public health efforts to prevent and control bacterial STDs have been through surveillance, clinical services, partner management, and behavioral intervention strategies. However, the persistence of disparities in STDs indicates that these strategies are not achieving sufficient impact in African American communities. It may be that factors such as limited access, acceptability, appropriateness, and affordability of services reduce the efficacy of these strategies for African American communities. In this article we describe the STD prevention strategies and highlight the challenges and implications of these strategies in addressing disparities in African American communities.

Strategic management and health workforce policy

Among the many consequences of health care restructuring is the impact such changes have on the training requirements for the health professions. Since workforce planning has been difficult and sometimes controversial in relatively stable times, it is likely to be even more problematic amid the turbulent changes ahead as the U.S. health care system restructures for the 21 century. Strategic management models emphasizing stakeholder involvement offer a middle ground between the extremes of government mandates and free markets by engaging a variety of participants with a stake in the planning outcome. The following report on the New Jersey effort to engage a variety of health care stakeholders in a participatory management process to shape the state physician workforce may provide useful insights for both managers and policy-makers.

Health reform planning models. The case of veterans hospitals

As part of the national effort to reform healthcare, the Department of Veterans Affairs is undergoing a major reassessment of its healthcare mission. As Veterans Affairs prepares to meet the challenges of the twenty-first century, one underlying issue of critical importance is which planning assumptions will be selected and employed. Will historical patterns of veterans' use be interpreted as indicators of the market demand for Veterans Affairs healthcare services, or will estimates of disease prevalence among veterans be used as indicators of future healthcare need? If Veterans Affairs is to continue as a critical component of the nation's healthcare delivery system, its selection of a planning basis will have major implications for tomorrow's healthcare system.

Facilitating effective healthcare policy formulation

Health policy is increasingly shaped by national, state, and local public advisory committees. Health professionals selected to serve on these committees must be prepared to deal not only with considerable amounts of data, but also with widely varying interpretations of those data. In addition, they must be prepared to deal with different political and personal perspectives, including those of nonhealth professionals. The successful management of that broad range of professional and cultural diversity affects the extent to which different perspectives are successfully integrated into final committee recommendations. This article offers suggestions to future advisory committee members on facilitating effective healthcare policy formulation.

Evaluating policy change in physician manpower planning

The decade of the 1980s witnessed a revitalization of free-market interest in the use of incentives and voluntary participation to promote activities in a wide range of fields. Because of its history of decentralized control over physician residency training, the state of New Jersey found such an approach appealing when it sought to restructure its graduate medical education system. Two statewide task forces spent a year developing policy changes designed to produce voluntary changes in such areas as the size and growth of the state system. However, a 2-year follow-up survey of the directors of state residency programs revealed little perceivable change.

A strategy for executive staffing

The selection of executive staff has long been a concern of successful businesses. In the early 1950s, William H. Whyte, Jr., wrote in Fortune magazine of how corporations carefully screened spouses as well as executive candidates in efforts to safeguard the corporations' futures. He then went on to portray the struggles of those aspiring to such positions in his classic novel The Organization Man (1956). By the 1980s, executive selection had become so important that search firms had proliferated and corporate CEOs like General Electric's Jack Welch were receiving national recognition for their executive succession strategies.

In the market for a CEO? A shopping list of needed attributes is an important first step

Changes in the health care environment are revitalizing the role of hospital administrators. Consequently, executive search firms are expanding their activities from the boardrooms of corporations into those of not-for-profit hospitals. But if you don't want to pay the search firms' prices, you can still benefit from some of their strategies.

Morphometric analysis of atrophic changes in human lingual epithelium in iron deficiency anaemia

A stereological analysis of epithelial structure at the lateral surface of the tongue showed that iron deficiency anaemia was associated with reduced epithelial thickness despite the absence of overt mucosal abnormalities. The epithelial atrophy was entirely due to a reduction in the size and number of cells in the maturation compartment. By contrast, the progenitor cell compartment was increased in thickness due to an increase in the number of cells. This hyperplastic reaction may be a trophic response to the overall loss of epithelium in this condition.

A histological analysis of the early effects of alcohol and tobacco usage on human lingual epithelium

Macroscopically normal tongues were examined from 161 necropsies. Two types of lingual epithelium were investigated by morphometry and the results were statistically analysed in relation to known levels of alcohol and tobacco usage in each case. Alcohol and tobacco were each associated with a reduction in epithelial thickness brought about by a reduction in the maturation layer due mainly to cell shrinkage. By contrast, the progenitor layer increased in size, due to hypertrophy rather than hyperplasia. Changes occurred in each type of epithelium and were more severe with alcohol. There was no significant interaction between alcohol and tobacco. The structural changes appeared to be non-specific reactions to local toxic effects of alcohol and tobacco. They could, if accompanied by equivalent functional decrements, indicate an increased vulnerability to carcinogens, whether or not these derive from alcoholic drinks or tobacco smoke.

A quantitative histological analysis of the effects of age and sex on human lingual epithelium

After exclusion criteria had eliminated changes of pathological origin, tongues were obtained from 86 necropsies evenly divided by sex and age from 16-98 years. Epithelium was examined from two precisely defined sites on the lateral and dorsal lingual surfaces. Morphometric techniques were employed to determine various epithelial parameters. The epithelium was thicker in males but rates of ageing change between the sexes were similar. Generally, age changes were similar at each site: the mean epithelial thickness underwent a 30% reduction over the age range studied; the progenitor cell layer remained of constant thickness but its nuclear/cytoplasm ratio reduced significantly; significant reductions also occurred in the rete surface area of the lateral epithelium and in the papillary surface area of the dorsal epithelium. Although some of the parameters showed steeper rates of change in the younger half of the age range, the overall pattern of ageing in the lingual epithelium suggested a continuous trend towards atrophy and simplification of structure occurring evenly throughout the entire adult life span.

Induction of anaemia in monkeys

20 healthy young adult male rhesus monkeys were bled 3 times a week in an attempt to induce an anaemia and a depletion of iron stores. A mean haemoglobin of 6·1 g/100 ml and a haematocrit of 23% were obtained by 30 days. The iron saturation had fallen to a level of 11% and the reticulocyte response to 4·6%. Of note was the short period required to induce these haematological changes, and the minimal impact on the animals.