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Biomedical subjects

E Richard Brown

Publications and source records attributed to E Richard Brown.

At least 19 recordsLinked to original sources
PubMed2006

A population-based survey of prostate-specific antigen testing among California men at higher risk for prostate carcinoma.

BACKGROUND: Despite the lack of evidence demonstrating a survival benefit from prostate-specific antigen (PSA) screening, its use has become widespread, organizations have encouraged physicians to discuss early detection of prostate carcinoma, and two higher risk groups have been recognized. In the current study, the authors examined whether African-American men and men who had a family history of prostate carcinoma underwent PSA testing preferentially, and patterns of test use were examined according to age, race, and other factors. METHODS: Data regarding self-reported PSA test use in the past year among men age 50 years and older without a history of prostate carcinoma (n = 8713 men) were analyzed from the 2001 California Health Interview Survey. RESULTS: The overall rate of PSA use was 43.0%. Older age, higher socioeconomic status, having a usual source of healthcare, and a family history of prostate carcinoma were the strongest predictors of testing. Higher risk African-American men age 50 years and older were no more likely to be tested than white men. Men at higher risk who had a family history of prostate carcinoma were more likely to have been tested than men who had no such family history. CONCLUSIONS: Rates of PSA use among higher risk men who had a family history of prostate carcinoma were higher compared with the rates among men without such a family history. However, PSA testing rates among higher risk African-American men were no different than the rates among lower risk white men, suggesting that some risk factors for prostate carcinoma (but not others) are associated with preferential testing. Testing in all groups was associated with access to care variables, highlighting the importance of removing barriers to preventive healthcare services.

Black or African American↗
PubMed2006

Emergency department visits for asthma: the role of frequent symptoms and delay in care.

BACKGROUND: Use of the emergency department (ED) for asthma care is a costly form of health care that is largely preventable. However, little is known about how to reduce the number of people using the ED for asthma care. OBJECTIVE: To identify modifiable factors related to ED visits for asthma among a diverse nonelderly adult population. METHODS: This study used cross-sectional data from the 2001 California Health Interview Survey. A total of 4,359 adult respondents ages 18 to 64 years who reported being diagnosed as having asthma and experiencing symptoms in the past year were included. Any ED visits due to asthma in the previous 12 months among all nonelderly respondents with asthma, with stratification by those with daily or weekly symptoms and with less frequent symptoms, were examined. RESULTS: Adults with daily or weekly asthma symptoms, with fair or poor health status, and who delayed care for asthma because of cost or insurance issues were more likely to visit the ED for asthma. Stratification of the study population into those with daily or weekly symptoms and those with less frequent symptoms revealed that delay in care due to cost or insurance issues and fair or poor health status remained significant for both groups. Latinos and women were more likely to visit the ED in the severe asthma group, whereas Asian, African American, and uninsured adults were more likely to visit the ED in the group with less severe asthma. CONCLUSIONS: Results suggest that to prevent ED visits for asthma, it is important to control asthma symptoms. However, it is equally if not more important to reduce delays in receiving asthma care.

Adolescent↗
PubMed2006

Variation in complementary and alternative medicine (CAM) use across racial/ethnic groups and the development of ethnic-specific measures of CAM use.

OBJECTIVES: The use of complementary and alternative medicine (CAM) is likely to vary among racial/ethnic groups because its use is related to cultural and health beliefs. Understanding patterns of CAM use among ethnic groups could inform clinical practice and the study of CAM use in a diverse population. The authors compared CAM use among Asian-Americans, American Indians, African Americans, Latinos, whites, and other racial/ethnic groups in order to develop ethnic-specific measures of CAM use and explore factors associated with such CAM use across ethnic groups. DESIGN: A cross-sectional survey of a sample of 9187 adults representative of the California population was performed. OUTCOME MEASURES: Ethnic-specific constructs for Asian-Americans, American Indians, African Americans, Latinos, and whites were devised. RESULTS: The authors identified ethnic-specific CAM modalities for each ethnic group. Demographic and clinical factors associated with use of ethnic-specific CAM differed from the predictors of overall CAM use in the general population and varied by ethnicity. CONCLUSIONS: Patterns of CAM use and ethnic-specific CAM use vary across racial/ethnic groups. Evaluation of CAM use in ethnically diverse populations should recognize ethnic-specific modalities and variation across ethnicity.

Adult↗
PubMed2006

Is there a language divide in pap test use?

OBJECTIVE: We sought to determine whether primary language use, measured by language of interview, is associated with disparities in cervical cancer screening. DATA SOURCES: We undertook a secondary data analysis of a pooled sample of the 2001 and 2003 California Health Interview Surveys. The surveys were conducted in English, Spanish, Cantonese, Mandarin, Korean, and Vietnamese. STUDY DESIGN: The study was a cross-sectional analysis of 3-year Pap test use among women ages 18 to 64, with no reported cervical cancer diagnosis or hysterectomy (n = 38,931). In addition to language of interview, other factors studied included race/ethnicity, marital status, income, educational attainment, years lived in the United States, insurance status, usual source of care, smoking status, area of residence, and self-rated health status. DATA COLLECTION/EXTRACTION METHODS: We fit weighted multivariate logit models predicting 3-year Pap test use as a function of language of interview, adjusting for the effects of specified covariates. PRINCIPAL FINDINGS: Compared with the referent English interview group, women who interviewed in Spanish were 1.65 times more likely to receive a Pap test in the past 3 years. In contrast, we observed a significantly reduced risk of screening among women who interviewed in Vietnamese (odds ratio [OR] 0.67; confidence interval [CI] 0.48-0.93), Cantonese (OR 0.44; 95% CI 0.30-0.66), Mandarin (OR 0.48; 95% CI 0.33-0.72), and Korean (OR 0.62; 0.40-0.98). CONCLUSIONS: Improved language access could reduce cancer screening disparities, especially in the Asian immigrant community.

Adolescent↗
PubMed2006

Language barriers to health care access among Medicare beneficiaries.

This study examined language barriers to health care access among a population-based sample of Medicare seniors in California in 2001 and 2003. Results indicate that Medicare beneficiaries with limited English proficiency (LEP) had less access to a usual source of care and were less likely to receive preventive cancer screening tests. LEP Medicare beneficiaries who also were covered by Medicaid tended to fare better than those without Medicaid. This could be due to federal civil rights rules that require Medicaid health care providers to offer free language assistance, but exclude from these requirements physicians who provide only Medicare services. Findings suggest the federal government should take steps to reduce language barriers in Medicare.

Aged↗
PubMed2006

Less than one-quarter of California adults walk regularly.

This policy brief presents information about the walking habits of California adults based on data from the 2003 California Health Interview Survey (CHIS 2003). We examine the prevalence of regular walking and no walking by socio-demographic and neighborhood characteristics. Regular walking is defined as walking on at least five separate occasions for a combined total of at least 150 minutes in the previous seven days. This definition is based on the recommendation that adults engage in moderate physical activity for at least 30 minutes on five or more days of the week. Occasional walking is defined as walking at least once for 10 or more minutes in the previous seven days. No walking is defined as not walking at least once for 10 or more minutes in the previous seven days.

Adolescent↗
PubMed2006

One in five Californians were uninsured in 2005 despite modest gains in coverage.

Six and one-half million Californians were uninsured for all or some of 2005, a number that is as large as the combined populations of nine other states. The number of uninsured represented one in five children and nonelderly adults, a rate that was slightly lower than in 2003 due to California's tight labor markets and expanding enrollment and retention in California's public coverage programs for children. These marginal improvements are unlikely to continue unabated given the instability of employment-based insurance coverage in the face of rising costs. In this policy brief, we compare insurance coverage over time using the California Health Interview Surveys conducted in 2001, 2003 and 2005. We look at the type of coverage over the past 12 months for both children and nonelederly adults.

Adult↗
PubMed2006

Nearly six million Californians suffer from asthma symptoms or asthma-like breathing problems.

In California, 4.5 million adults, adolescents and children had been diagnosed with asthma (13% of all Californians) in 2003, up from four million (12%) in 2001. This increase is consistent in younger children, adolescents and adults (Exhibit 1). Nationally, 10% of the population has been diagnosed with asthma. Among the 4.5 million Californians diagnosed with asthma, more than 2.5 million suffered from an asthma attack or other asthma symptoms in 2003 (56% of those diagnosed). An additional 3.4 million Californians who have not been diagnosed with asthma-10% of all Californians-suffer from asthma-like breathing problems. Some of these respondents might have other respiratory conditions, while others are likely to have asthma that has not been diagnosed. Based on data from the 2003 California Health Interview Survey (CHIS 2003), this policy brief examines the prevalence of lifetime asthma diagnoses and asthma symptoms, as well as the prevalence of asthma-like breathing problems in the absence of an asthma diagnosis. Where possible, it also describes how prevalence has changed since 2001, based on data from CHIS 2001. Lifetime prevalence refers to people who have ever been diagnosed with asthma by a doctor. The prevalence of asthma symptoms refers to people who report having been diagnosed with asthma and who also reported experiencing an asthma attack or other asthma symptoms in the past year. The prevalence of asthma-like symptoms refers to people who have not been diagnosed with asthma but who experienced breathing problems, such as wheezing or whistling in the chest in the past year.

Adolescent↗
PubMed2005

The use of complementary and alternative medicine among california adults with and without cancer.

This article examines the extent and correlates of complementary and alternative medicine (CAM) use among a population-based sample of California adults that is highly diverse in terms of sociodemographic characteristics and health status. As a follow-up to a state-wide health survey of 55,428 people, 9187 respondents were interviewed by phone regarding their use of 11 different types of CAM providers, special diets, dietary supplements, mind-body interventions, self-prayer and support groups. The sample included all participants in the initial survey who reported a diagnosis of cancer, all the non-white respondents, as well as a random sample of all the white respondents. The relation of CAM use to the respondents' demographic characteristics and health status is assessed. CAM use among Californians is generally high, and the demographic factors associated with high rates of CAM use are the same in California as have been found in other studies. Those reporting a diagnosis of cancer and those who report other chronic health problems indicate a similar level of visits to CAM providers. However, those with cancer are less likely to report using special diets, and more likely to report using support groups and prayer. Health status, gender, ethnicity and education have an independent impact upon CAM use among those who are healthy as well as those who report suffering from chronic health problems, although the precise relation varies by the type of CAM used.

Journal Article↗
PubMed2005

Community-based participatory research in the California Health Interview Survey.

INTRODUCTION: The California Health Interview Survey, the largest state health survey in the United States, uses community-based participatory research principles to develop each cycle. Other large-scale health surveys rarely include participatory research approaches. Every 2 years, the California Health Interview Survey generates state and local population-based data on health insurance coverage, access to health care, chronic disease prevalence and management, health behaviors and disease prevention, and other health issues in California. The survey is used for policy and program development, advocacy, and research. METHODS: The development of the California Health Interview Survey involves more than 145 people from more than 60 state and local policymaking bodies, public health agencies, advocacy groups, research organizations, and health care organizations. They participate as volunteers in an advisory board, on technical advisory committees, and in work groups that interact with California Health Interview Survey research staff in an accountable advisory process that shapes survey topics, measures, and sample design and determines languages selected for translation. Survey results and data are provided to the communities involved in the survey. RESULTS: California Health Interview Survey data have been widely used by local, state, and national public health leaders, policymakers, advocates, and researchers to improve access to health insurance and health care services and to develop and target prevention programs for obesity and chronic illnesses. CONCLUSION: The California Health Interview Survey participatory research model has been an effective approach to planning and implementing a health survey and should be considered by developers of other large health surveys.

California↗
PubMed2005

The impact of private and public health insurance on medication use for adults with chronic diseases.

This article examines the impact of public and private health insurance on the use of medications for California adults with any of four chronic diseases: heart disease, high blood pressure, diabetes, and asthma. The data set used is the 2001 California Health Interview Survey. Multivariate analyses were conducted on individuals who had been diagnosed with each of these diseases. Controlling for various demographic, health status, and employment characteristics, the authors find that the uninsured are far less likely to be taking medications for each of the conditions than those with private insurance. Interestingly, those with Medicaid coverage are even more likely than those with private insurance to be taking such medications. The results of this study underscore the importance of health insurance for all persons with chronic conditions and the benefits of Medicaid in particular for low-income adults with chronic conditions.

Adolescent↗
PubMed2005

Mind the gap: parents' citizenship as predictor of Latino children's health insurance.

Parents' citizenship appears to be correlated with high rates of uninsurance and low rates of job-based insurance among Latino citizen children in families headed by citizens and non-citizens. Few studies have examined the direct relationship between parents' citizenship and children's insurance status. Data for U.S.-born Latino and non-Latino white children ages 0-18 years in working two-parent households obtained from the March 2001 Current Population Survey were analyzed. Results from logistic regressions were adjusted for a design effect to account for survey design. After controlling for other sociodemographic and employment characteristics, only Latino children in families headed by non-citizen couples are more likely to be uninsured and less likely to have employer-based insurance than others in the dataset. Even controlling for non-citizen parents' duration in the U.S., citizenship status of the head of household predicts children's coverage. Latino children are more likely to have health insurance if they have at least one citizen parent. Continued and varied efforts are needed to promote coverage among U.S.-born Latino children.

Adolescent↗
PubMed2005

Job-based coverage drops for adults and children but public programs boost children's coverage.

Based on data from the 2003 California Health Interview Survey (CHIS 2003), this policy brief provides a profile of nonelderly Californians' health insurance coverage and lack of coverage, as well as estimates of children and adults who are uninsured but eligible for coverage through public programs. It also describes how this profile has changed since 2001, based on data from CHIS 2001.

Adolescent↗