Clinical trials to reduce diabetes risk in children from underserved minority populations.
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Journal Article↗
Biomedical subjects
David G Schlundt
Publications and source records attributed to David G Schlundt.
Seat belt law enforcement and racial disparities in seat belt use.
BACKGROUND: Numerous reports have documented a lower prevalence of seat belt use among blacks in the United States, compared with whites. Limited data suggest that black-white disparities in states with primary seat belt laws (motorists can be stopped and cited solely for violating a seat belt law) are less marked than in states with secondary laws (motorists can be cited for violating a seat belt law only if stopped for another offense). METHODS: Data from the Fatality Analysis Reporting System were analyzed in 2005 to compare seat belt use among 11,574 blacks and 73,639 whites aged 16 or more years killed in crashes from 1999 to 2003 in 33 states with a primary or secondary adult seat belt law and annual reporting of race for 80% or more of decedents. After stratification of states by type of seat belt law, logistic regression was used to calculate odds ratios and 95% confidence intervals (CIs) for seat belt use among blacks, relative to whites, with adjustment for age, gender, seat position, urban/rural region, and income. RESULTS: Odds ratios and 95% CIs for seat belt use among blacks were 1.05 (0.97-1.13) and 0.89 (0.83-0.95), in primary- and secondary-law states, respectively. CONCLUSIONS: Black-white disparities in seat belt use were mitigated in states with primary seat belt laws. Only 24 states have primary laws. Enacting primary laws in other states might reduce or eliminate racial disparities in seat belt use.
Accidents, Traffic↗
Seatbelt law enforcement and motor vehicle crash fatalities among blacks and whites in Louisiana and Mississippi.
BACKGROUND: Seatbelt laws save lives. Primary enforcement (allowing citations solely for seatbelt nonuse) is a more effective means of saving lives, yet seven southern states have no primary laws, due in part to concern about racial profiling. METHODS: Non-Hispanic, black:white (B:W), occupant motor vehicle crash mortality rate ratios (MRRs) were compared across the 15 to 64 age range over two time periods in two demographically comparable southern states (Louisiana and Mississippi). RESULTS: From 1992 to 1994 (when neither state had primary law) to 1996 to 1998 (when Louisiana had primary law) B:W MRRs were 0.73 (95% confidence interval = 0.61, 0.88) and 0.72 (0.60, 0.86) in Louisiana and 1.01 (0.9, 1.12) and 1.22 (1.10, 1.35) in Mississippi. CONCLUSIONS: Successful opposition to primary seat belt enforcement may have the unintended effect of producing racial disparities in motor vehicle crash mortality that adversely affects blacks.
Accidents, Traffic↗
Parent perceptions of caring for adolescents with type 2 diabetes.
OBJECTIVE: No studies have been performed to examine parent perceptions of caring for adolescents with type 2 diabetes. In this qualitative study, we examined parent perceptions of barriers and strategies to address barriers to self-care in adolescents with type 2 diabetes. RESEARCH DESIGN AND METHODS: Families of adolescents with type 2 diabetes were recruited from a pediatric diabetes clinic. Focus groups were used to elicit parent experiences and perceptions of diabetes management of their adolescents with type 2 diabetes. Questions concerning barriers to self-care behaviors were asked by trained group facilitators. Transcripts were coded into themes by three reviewers. Qualitative analyses were conducted using NVIVO software. RESULTS: Between 2003 and 2005, six focus groups were conducted with a total of 27 parents or guardians. Parents identified many barriers to and practical strategies for positive adolescent self-management. Five domains that influence self-management were identified: the role of others with diabetes, parenting skills, perceived lack of normalcy, environment, and adolescent development. Parents identified many barriers to dietary and exercise habits that were unique to the circumstances of adolescents with type 2 diabetes. CONCLUSIONS: Parents identified many barriers to self-management that may be unique to adolescents with type 2 diabetes. The importance of others and environmental influences in the self-management behavior of adolescents with type 2 was evident. Interventions that are designed to improve self-management should include components that address multiple influences such as peers, school professionals, parents, siblings, and/or family systems.
Adolescent↗
The Fatality Analysis Reporting System as a tool for investigating racial and ethnic determinants of motor vehicle crash fatalities.
The Fatality Analysis Reporting System (FARS) is a Department of Transportation database in the public domain that contains detailed information about fatalities resulting from motor vehicle crashes on public roadways in the United States since 1975. However, data on race and Hispanic ethnicity were not collected by FARS until 1999. Since then, completeness of reported racial and ethnic information has varied from State to State. To assess utility of FARS for investigating race- and ethnicity-specific risk factors associated with motor vehicle crash mortality, we examined yearly national and State-specific reporting rates of race and Hispanic ethnicity for 168,863 motor vehicle crash fatalities from 1999 to 2002. In 1999, national reporting was 85% for race and 78% for Hispanic ethnicity. Over the 4-year study period, a significant linear increase in annual reporting for both race and Hispanic ethnicity was evident at the national level, as reporting by individual States improved over time. In 2002, national reporting rates reached 90% for race and 88% for Hispanic ethnicity. Our findings indicate that FARS has become a valuable resource for population-based studies of motor vehicle crash mortality disparities that exist among racial and ethnic subpopulations in the United States.
Accidents, Traffic↗
Southern community cohort study: establishing a cohort to investigate health disparities.
OBJECTIVES: To demonstrate the methods of recruitment of a low-income, predominantly African-American study population for the Southern Community Cohort Study (SCCS), a prospective epidemiologic investigation of racial disparities in cancer risk. METHODS: Partnerships with community health centers (CHCs) were formed to reach underserved populations throughout the south. Recruitment of participants (aged 40-79) in CHCs began in March 2002. Participants complete a comprehensive baseline interview and provide a blood or buccal cell sample. Recruitment will expand to the general population of the south to achieve a broad cross-section of socioeconomic status, The final cohort size is expected to be approximately 100,000. RESULTS: A high level of cooperation and recruitment was achieved in the CHCs. From March 2002 to October 2004, 32,632 participants (80% black, 41% male, 62% with total household income < $15,000, 34% with < 12 years schooling) enrolled. Participants reported a high prevalence of medical conditions (21% diabetic, 44% obese) and adverse health behaviors (45% current smokers). CONCLUSIONS: Working in CHCs is successful for recruiting a population that has been difficult to reach in previous studies. The SCCS is a unique cohort that will provide a rich resource for evaluating disparities in cancer and other chronic disease risk as it is followed over time.
Adult↗
Exploring ethnic disparities in diabetes, diabetes care, and lifestyle behaviors: the Nashville REACH 2010 community baseline survey.
In order to gain a better understanding of diabetes-related health disparities, Nashville REACH 2010 conducted a community baseline survey on health status. A total of 3204 randomly selected African-American (AA) and Caucasian (C) residents of North Nashville, and a comparison sample of residents living in Nashville/Davidson County were interviewed using a computer-assisted telephone interviewing system. Diabetes prevalence was determined, and similarities/differences relative to access to health care, co-morbid conditions, diabetes care, and lifestyle behaviors, were examined. Age-adjusted prevalence of diabetes was 1.7 times higher among AAs. Increasing age (P<.0001) and being AA (P<.01) were predictive of diabetes status in a regression model. African Americans were more likely to be uninsured (P<.01), while Cs had to travel farther to get medical care (P<.0002). Compared to Caucasians, African Americans were 1.6 times more likely to have co-morbid hypertension (P<.004). Reported insulin use was higher (P<.0001) in AAs, and more Cs (25.5% vs 9.1%, respectively) reported taking no medications. African Americans were more likely to report (P<.0001) daily glucose self-monitoring, while more Cs (P<.04) reported having had an eye exam in the last 1 to 2 years. Caucasians reported more (P<.05) active lifestyle behaviors, while AA reported more (P<.001) fat-increasing behaviors. In conclusion, interventions addressing diabetes disparities in the target population should focus on insuring equitable awareness of, and access to, insurance options; managing co-morbidities; improving provider adherence to standards of care; and establishing multi-level supports for lifestyle modifications.
Adolescent↗
The Eating Behavior Patterns Questionnaire predicts dietary fat intake in African American women.
OBJECTIVE: To develop a behavioral assessment of eating that would be predictive of fat intake in African American women. DESIGN: Questionnaires were developed using a three-stage design, involving item generation, item refinement, and questionnaire validation. SUBJECTS: Focus groups sessions were conducted with 40 African American women, initial questionnaire development employed 80 African American women, and questionnaire validation involved 310 African American women from diverse socioeconomic backgrounds. Statistical analyses Transcripts of focus groups were used to generate 113 behavioral questionnaire items. The initial questionnaire was administered along with a food frequency questionnaire, and the item pool was reduced to 51 items. Factor analysis was used to create subscales. Correlation (r) and multiple regression analysis (R) were used to evaluate construct validity. RESULTS: Factor analysis revealed six subscales: low-fat eating, emotional eating, snacking on sweets, cultural/ethnic, haphazard planning, and meal skipping. The scales are significant predictors of micronutrient (R values from 0.22 to 0.47) and macronutrient intakes (R values from 0.33 to 0.58) assessed using a food frequency questionnaire and show construct validity in relationship to other measures of eating behavior (r values from 0.22 to 0.65). APPLICATIONS: The Eating Behavior Patterns Questionnaire (EBPQ) may be a useful tool for clinical assessment, clinical and community nutrition intervention studies, and epidemiologic research with African American women.
Adult↗
Compliance barriers in glaucoma: a systematic classification.
PURPOSE: To systematically identify and describe common obstacles to medication adherence (i.e., compliance) for patients with glaucoma. METHODS: A prospective case series of structured interviews were conducted with 48 patients with glaucoma. The subjects' responses were recorded verbatim on interview forms as well as recorded on audiotapes. Situational obstacles to medication adherence were elicited. Using hierarchical cluster analysis, the situational descriptions were stratified, grouped, and analyzed by frequency distribution. RESULTS: Seventy-one unique situational obstacles were reported. These were then grouped into 4 defined and separate categories: situational/environmental factors (35 of 71 situations; 49%), medication regimen (23 of 71; 32%), patient factors (11 of 71; 16%), and provider factors (2 of 71; 3%). CONCLUSION: Significant barriers to compliance exist for patients with glaucoma in addition to those cited by previous ophthalmic studies. A systematic classification (i.e., taxonomy) of these barriers was formulated to assist in optimizing patient education and problem-solving regarding prescribed therapeutic regimens.
Adult↗
Improving the skills of health professionals in engaging patients in diabetes-related problem solving.
INTRODUCTION: Despite instruction, many patients do not employ diabetes-related self-management skills recommended by health professionals. One problem suggested by research is that many health professionals do not often use teaching and counseling skills widely considered to be effective. Among these are specific skills that help health professionals conduct adherence-related assessments, brainstorm workable solutions to obstacles, collaborate during long-term follow-up, and provide effective direct instruction. METHODS: "Effective Patient Teaching and Problem Solving" was developed and taught in a block of 24 hours over 3 days to groups of health professionals. Course content emphasized 13 operationally defined skills in four major categories: (A) assessment, (B) brainstorming, (C) collaboration, and (D) direct instruction skills. To evaluate participants' (n = 33) use of the various skills, a standardized patient teaching exercise was videotaped at both the beginning and end of the course. RESULTS: Total mean scores increased significantly (t = 7.7, p < .001) from 1.8 to 2.5 on a scale that ranged from 1 to 5. Skills improved in all four major categories (p < .003). The length of teaching sessions did not change, lasting 13.2 minutes before the course and 13.6 minutes after the intervention. DISCUSSION: Health professionals play a crucial role in patient education but rarely receive training in effective teaching and counseling techniques. The "Effective Patient Teaching and Problem Solving" course improved several kinds of important skills. As standards of diabetes care for improved glycemic control become more widespread, and as health providers attempt not just to teach but also to help patients overcome considerable obstacles to consistent diabetes self-management, a premium will be placed on the ability of health professionals to counsel efficiently and effectively.
Diabetes Mellitus↗
Contextual factors influencing the eating behaviours of African American women: a focus group investigation.
OBJECTIVES: African American women suffer disproportionately from many chronic diseases, and it is well acknowledged that eating patterns and habits are important contributory factors. Our goal was to describe and understand how personal and contextual factors among African American women contribute to food choices that increase the risk for chronic disease. DESIGN: Focus groups were conducted with 40 African American women. Two experimenters abstracted and categorized statements about eating attitudes, beliefs and behaviours from the focus group transcripts. RESULTS: A total of 139 statements were sorted into 10 major categories: (1). specific meals, (2). planning, (3). family/social, (4). snacking, (5). food preferences, (6). health awareness, (7). shopping, (8). food preparation, (9). eating out and (10). emotional. These categories were subdivided into 49 sub-categories to reveal more specific patterns of behaviour. CONCLUSION: African American women showed considerable variability in how they approached planning, choosing, preparing and eating food. A plethora of habits and food meanings-influenced by the personal, cultural, and environmental context-place these women at high risk for chronic disease. There were attempts to eat 'healthy', but these were overcome by traditions, social influences, habits and price. Individualized assessments to determine how each woman uses contextual information to make her food choices should be conducted in order to facilitate permanent eating behaviour change.
Black or African American↗
Obesity, appearance, and psychosocial adaptation in young African American children.
OBJECTIVE: To evaluate the contributions of weight status, skin tone, peer teasing, and parental appraisals of child's size to self-esteem and psychosocial adjustment in overweight African American children. METHOD: Overweight to very obese 5- to 10-year-old African American children (N = 117) completed measures of self-esteem, skin tone satisfaction, peer teasing, and body size perception. Caregivers completed the Child Behavior Checklist and rated their child's body size. RESULTS: Overweight was associated with low appearance self-esteem, and body size dissatisfaction with low global self-worth and low appearance self-esteem in children 8 and older. Appearance self-esteem but not global self-worth was lower in girls than boys. Parental perception of child's size as heavier than average was associated with low child appearance self-esteem. Heavier children also had more parental report of behavior and psychosocial problems, but their scores were in the nonclinical range. Child skin tone dissatisfaction was associated with low global self-worth. Weight-related peer teasing was associated with low self-esteem. CONCLUSIONS: The relationship between obesity and self-esteem in African American children depends upon age, gender, and children's experiences with teasing and parental evaluation of their size. Other factors, like skin tone satisfaction, contribute to a child's sense of self-worth.
Adaptation, Psychological↗
Geographic clustering of obesity, diabetes, and hypertension in Nashville, Tennessee.
To better understand how neighborhood environments contribute to health outcomes by encouraging or discouraging healthy lifestyles, we studied the clustering of health outcomes, health behaviors, and environmental characteristics in Nashville, Tenn. Data from 2 large telephone surveys (N = 7606) were geocoded and linked to the long-form census data at the census-tract level. Cluster analysis was used to create 12 scales that measured neighborhood characteristics using census variables. A geographic information system was used to map patterns of health, health behavior, and neighborhood characteristics at the census-tract level. Pearson correlations across the 129 census tracts were in the 0.20 to 0.60 range and provided evidence for spatial clustering of health outcomes, health behaviors, and neighborhood characteristics.
Black or African American↗
Relationship between symptoms of depression, functional health status, and chronic disease among a residential sample of African Americans.
Depression and psychological distress often go unrecognized and untreated in primary care settings. The association between depression, socioeconomic status, and chronic disease underscore the importance of incorporating mental health education and screening into community-based health initiatives. This is particularly critical for African Americans who bear a disproportionate burden of poverty and chronic disease. This descriptive study assessed associations between symptoms of depression, socioeconomic status, healthcare utilization, physical and mental health functioning, and reactions to race among a sample of low-income African Americans. Consistent with the findings of previous research, respondents with symptoms of depression reported lower levels of physical and mental health functioning, and perceived that they had been treated worse by others at work, and had worse healthcare experiences than those of other races. Community-based programs for reducing disparities in physical illness may need to address the burden of undiagnosed and untreated depression in order to become optimally effective.
Adult↗
An evaluation of the Nashville REACH 2010 community health screening strategy.
Community-based screening is 1 of 4 strategies selected by the Nashville REACH 2010 project for reducing disparities in heart disease and diabetes among African Americans in North Nashville, Tenn. We evaluated our screening efforts by asking 4 questions: (1) Are the screening participants representative of the target population? (2) How often were screening participants with possible undiagnosed hypertension, high cholesterol, and diabetes identified? (3) How often were screening participants with an elevated risk for developing hypertension, high cholesterol, and diabetes identified? and (4) How often did we identify screening participants with known hypertension, high cholesterol, and diabetes whose disease management was suboptimal? Results from 1757 persons screened were compared to telephone surveys from 16,199 Nashville residents. Those screened were younger and healthier than the target population. Rates of potentially undiagnosed cases among African Americans were 0.8% for diabetes, 17.4% for hypertension, and 32.7% for high cholesterol. High-risk individuals were identified 13.1% of the time for diabetes, 45.3% of the time for hypertension, and 21.3% of the time for total cholesterol. Rates of poorly controlled known disease were 23.5% for diabetes, 39.0% for hypertension, and 58.2% for total cholesterol. Although we reached a younger and healthier group than the community population, community-based screenings identified many people with potential health risks. We present a model of how to organize and implement successful community-based screening.
Adult↗