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PubMed2005

The use of film, literature, and music in becoming culturally competent in understanding african americans.

Increasing the cultural competence of child and adolescent psychiatrists through the use of film, literature, and music can improve their ability to understand what African Americans experience and the impact these experiences have on mental health. It also may help clinicians recognize their own underlying biases. This understanding, in turn, could improve their ability to address effectively in treatment the issues pertinent to the African-American community and help eliminate the well-documented disparities in the health care quality and health status of minorities.

Black or African American↗
PubMed2005

Changes in reporting of race/ethnicity, socioeconomic status, gender, and age over 10 years.

BACKGROUND: The recognition of health disparities as an important aspect of US health care has led to renewed interest in the reporting of race/ethnicity and socioeconomic status (SES) in original research reports. PURPOSE: To describe reporting of race/ethnicity and SES, in comparison with age and gender, and to report changes with time. METHODS: All original research articles that focused on children and asthma that were published in The Journal of the American Medical Association, The New England Journal of Medicine, Pediatrics, The Journal of Pediatrics, and Archives of Pediatrics and Adolescent Medicine were reviewed for 2 time periods, 1991-1993 and 2000-2002. Each report was assessed for coding of age, gender, race/ethnicity (number of groups and which groups), and SES. RESULTS: In 1991-1993, 27 reports met the inclusion criteria; in 2000-2002, 74 were reviewed. Overall, significantly more reports described age (90.1%) and gender (78.2%) than SES (41.6%) and race/ethnicity (54.5%). During the 2 study periods, there were significant increases in studies reporting race/ethnicity (from 29.6% to 63.5%) but not in studies reporting SES or gender. Coding of race/ethnicity, even in the later time period, was largely confined to white (78.7%) and black (89.4%). Fewer reports coded Latino (55.3%) or Asian (14.9%). Only 2 of the 31 articles that coded Latino subjects contained information on ethnic subgroups, whereas none of the 8 articles included Asian subgroups. CONCLUSIONS: Original research reports in a specific area (asthma) for which health disparities have been well documented still contain few data on race/ethnicity and SES, particularly in comparison with age and gender. There has been some improvement in the past decade in the reporting of race/ethnicity, but the reporting of Latino and Asian subgroups remains poor. If we are to understand health disparities, then more appropriate reporting of SES and race/ethnicity is necessary.

Adolescent↗
PubMedDate not supplied

Postscript: health disparity and collaborative care.

In this report, we compare healthcare processes for patients with low (n = 7467) and adequate financial status (n = 43,701) after adjustment for age, gender, burden of illness, and health behaviors. Patients with low financial status were 10% to 30% less likely to report good service and collaborative care; they report that markers of disease management and prevention were 7% to 18% below the levels of patients with adequate income. From the patient perspective, these results confirm that inadequate financial status has a broad and adverse influence on health and healthcare. Technology for patient-centered, collaborative care alone will not remedy the problem of health disparity.

Cooperative Behavior↗
PubMed2006

Health disparities between racial groups in South Africa: a decomposition analysis.

This article explores the sources of self-rated health status inequalities among South Africans. We propose a decomposition of observed health disparities between racial groups using a procedure based on an extended version of Oaxaca-Blinder decomposition methods which addresses explicitly the specificities associated with the analysis of subjective measures. This method allows for a decompositions of differences in self-rated health status between races and isolates what may be due to observed socioeconomic inequality between racial groups, i.e. an "indirect racial effect" (Whites and Africans with different socio-economical characteristics have different health), from what could be due to unexplained racial differences, i.e. a "direct racial effect" (Whites and Africans with similar socio-economical characteristics have different health). Unsurprisingly, we find a strong indirect racial effect in favor of Whites. However, our analysis tends to show that the issue of direct racial discrimination on health is more complex and closely linked with that of economical inequality and discrimination. Our results thus stress the necessity not only to open access for Africans to the more sophisticated sector of health care but also to provide them with the economical opportunity to use it.

Adult↗
PubMed2001

Merging education with measurement: a focus on the Hispanic community.

There is an increasing need for community health promotion efforts directed to populations that are often disenfranchised from the health care system. The rapidly growing Hispanic population can benefit from outreach efforts that provide health education and promote community awareness of health status and health problems. This article describes a cost effective survey system that measured health status, health needs and provided individualized health feedback and education to Hispanic residents. The results underscore the importance of culturally and linguistically appropriate community-based initiatives that assess health status to aid in setting policy, eliminate health disparities, and determine priorities to meet the health needs of the growing Hispanic population.

Adult↗
PubMed2006

Oral health status of mississippi delta 3- to 5-year-olds in child care: an exploratory study of dental health status and risk factors for dental disease and treatment needs.

OBJECTIVES: For poor and minority young children, disparities exist in dental health and treatment. In rural impoverished areas, institutions that reach young children and potentially offer access to care are limited. In the current Mississippi Delta study, child care centers were examined as potential venues for oral health intervention and research, and potential risk factors for dental caries and treatment urgency in high-risk preschool children were explored. METHODS: Child care centers were selected and attending children recruited. Data on oral health practices were collected from surveys of center directors and parents/caregivers. Children were examined for caries and treatment urgency at centers by dentists. Bivariate and multivariate analyses with a 0. 05 alpha were used to examine data. RESULTS: A total of 346 preschool children at 15 participating centers were examined: 46% were female, 68% minority. Minority children and those with public insurance were more than twice as likely to have caries and urgent treatment needs as non-minorities or those with private insurance. The odds of children having caries were half as great if parents reported using floss and nearly twice as great if the parent had experienced a dental abscess. For every soft drink the parent consumed daily, the odds of dental caries for children increased by 44%. CONCLUSIONS: Conducting oral health exams and research in child care venues was possible, yet presented challenges. The combined use of two parental variables, reported soft drink consumption and abscess history, appears promising for caries prediction. Implementation of oral health programs and research in child care venues merits further exploration.

Carbonated Beverages↗
PubMed2005

Children's Health Care in the First National Healthcare Quality Report and National Healthcare Disparities Report.

BACKGROUND: The first National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) are landmark events for children's health care quality and are expected to stimulate local measurement, benchmarking, and quality improvement efforts. METHOD: The authors select findings from the NHQR and NHDR, focusing on topics reflecting a range of health care and health care settings affecting children. They highlight disparities by race/ethnicity, socioeconomic status, and insurance source. They critique the first NHQR and NHDR from a child health perspective. SELECT NHQR/DR FINDINGS: Quality-of-care issues in the effectiveness domain were identified for black infant mortality, low and very low birth weight rates, antibiotic use for the common cold, and childhood hospitalizations for asthma. Immunization rates have improved. Patient centeredness and timeliness results vary by race, ethnicity and income. The NHDR found that Hispanic and low-income children are most likely to be uninsured for part of the year. Groups of children most likely to have public coverage are American Indian/Alaska native, black, and Hispanic. CRITIQUE OF REPORTS: The structure and criteria used for the first reports limit their usefulness from a child health perspective. A basic problem is that the conceptualizations of health and health care that are driving national initiatives on quality are based largely on an adult chronic care model focused on conditions with high expenditures as treated in the mainstream health care delivery system. CONCLUSION: NHQR and NHDR provide essential information on children's health care quality. Future reports can be improved by including child-relevant perspectives in priority-setting and data-gathering efforts.

Adolescent↗
PubMedDate not supplied

Engendering health disparities.

How is gender implicated in our exploration of health disparities in Canada? Set against the backdrop of federal government policy, this review paper examines the ways in which gender intersects with other health determinants to produce disparate health outcomes. An overview of salient issues including the impact of gender roles, environmental exposures, gender violence, workplace hazards, economic disparities, the costs of poverty, social marginalization and racism, aging, health conditions, interactions with health services, and health behaviours are considered. This review suggests health is detrimentally affected by gender roles and statuses as they intersect with economic disparities, cultural, sexual, physical and historical marginalization as well as the strains of domestic and paid labour. These conditions result in an unfair health burden borne in particular by women whose access to health determinants is--in various degrees--limited. While progress has certainly been made on some fronts, the persistence of health disparities among diverse populations of women and men suggests a postponement of the vision of a just society with health for all that was articulated in the Federal Plan on Gender Equality. Commitment, creativity and collaboration from stakeholders ranging from various levels of government, communities, academics, non-governmental agencies and health professionals will be required to reduce and eliminate health disparities between and among all members of our society.

Adult↗
PubMed2003

Social participation and health in a community rich in stock of social capital.

In Finland, members of the Swedish-speaking minority, many of whom live in the province of Ostrobothnia, intermingle with the Finnish-speaking majority. Although the two language communities are quite similar to each other in most societal respects, including socioeconomic status, education and use of health services, significant disparities have been reported in the morbidity, disability and mortality between the Swedish-speaking minority and the Finnish-speaking majority. Since the population genetic, ecological and socioeconomic circumstances are equal, Swedish speakers' longer active life is difficult to explain by conventional health-related risk factors. A great deal of health inequality (between the language groups) seems to derive from uneven distribution of social capital, i.e. the Swedish-speaking community holds a higher amount of social capital that is associated with their well-being and health. Factor analysis revealed four patterns of social capital measures, i.e. voluntary associational activity, friendship network, religious involvement and hobby club activity, of which associational activity, friendship network and religious involvement were significantly associated with good self-rated health. Also, trustful friendship network, hobby club activity and religious involvement as well as avoidance of intoxication-prone drinking behavior were significantly more frequent among the individuals of the Swedish-speaking community. We suggest that health promotion should seek ways of working which would encourage social participation.

Adolescent↗
PubMed2005

Overview of current state of research on pregnancy outcomes in minority populations.

Pregnancy outcomes improved significantly over the 20th century in the United States but currently vary widely between women of different ethnic and racial backgrounds. The current health disparities that exist are based, in part, only on differences in socioeconomic status or education. There is wide variability in pregnancy outcomes within specific subgroups of women. Disparities may be due to underlying differences in health before pregnancy, differences in community norms, and individual lifestyle choices and to differences in health care delivery systems. Areas for needed research and promising new models of care are reviewed.

Delivery of Health Care↗
PubMed2004

REACH 2010 Surveillance for Health Status in Minority Communities --- United States, 2001--2002.

PROBLEM/CONDITION: The U.S. population continues to diversify, and certain racial/ethnic minorities are growing at a substantially more rapid pace than the majority population. Limited large-scale population-based surveys and surveillance systems are designed to monitor the health status of minority populations. The Racial and Ethnic Approaches to Community Health (REACH) 2010 Risk Factor Survey is conducted annually in minority communities in the United States. The survey focuses on four minority populations (blacks, Hispanics, Asians/Pacific Islanders [A/PIs], and American Indians). REPORTING PERIOD COVERED: 2001-2002. DESCRIPTION OF SYSTEM: Telephone (n = 18 communities) and face-to-face (n = 3 communities) interviews were conducted in 21 communities located in 14 states (Alabama, California, Georgia, Illinois, Louisiana, Massachusetts, Michigan, New York, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Washington). An average of 1,000 minority residents aged >/=18 years in each community was sampled. Interviews were administered in English, Spanish, Vietnamese, Khmer, or Mandarin Chinese. The median response rate for household screenings was 74.0% for households that were reached and 72.0% for family members interviewed. The self-reported data from the community were compared with data derived from the Behavioral Risk Factor Surveillance System (BRFSS) for the metropolitan/micropolitan statistical area (MMSA) or the state where the community was located and compared with national estimates from BRFSS. RESULTS: Reported education level and household income were markedly lower in minority communities than the general population living in the comparison MMSA or state. More minorities reported being in fair or poor health, but they did not see a doctor because of the cost. Substantial variations were observed in the prevalence of health-risk factors and selected chronic conditions among minority populations and in communities within the same racial/ethnic minority. The median prevalence of obesity among A/PI men and women was 2.9% and 3.6%, respectively, whereas 39.2% and 37.5% of American Indian men and women were obese, respectively. Cigarette smoking was common in American Indian communities, with a median of 42.2% for men and 36.7% for women. Compared with the national level, fewer minority adults reported eating >/=5 fruits and vegetables daily and met recommendations for moderate or vigorous leisure-time physical activity. American Indian communities had a high prevalence of self-reported cardiovascular disease, hypertension, high blood cholesterol, and diabetes. A high prevalence of hypertension and diabetes was also observed in black communities (32.0% and 10.9%, respectively, for men and 40.4% and 14.3%, respectively, for women). Compared with the general U.S. population, a substantially lower percentage of Hispanics and A/PIs had reported receiving preventive services (e.g., cholesterol screenings; glycosylated hemoglobin tests and foot examinations for patients with diabetes; mammograms and Papanicolaou smear tests; and vaccination for influenza and pneumonia among adults aged >/=65 years). INTERPRETATION: Data from the REACH 2010 Risk Factor Survey demonstrate that residents in the minority communities bear greater risks for disease compared with the general population living in the same MMSA or state. Substantial variations in the prevalence of risk factors, chronic conditions, and use of preventive services among different minority populations and in communities within the same racial/ethnic population provide opportunities for public health interventions. These variations also indicate that different racial/ethnic populations and different communities should have different priorities in eliminating health disparities. PUBLIC HEALTH ACTIONS: The continuous surveillance of health status in minority communities is necessary so that culturally sensitive prevention strategies can be tailored to these communities and program interventions evaluated.

Behavioral Risk Factor Surveillance System↗
PubMedDate not supplied

Opportunity cost: the impact of contextual risk factors on the cardiovascular health of low-income rural southern African American women.

Low-income rural southern African American women experience a high prevalence of morbidity and mortality from coronary heart disease (CHD) as well as other related cardiovascular (CV) diseases. Few models have taken into account the full impact of the contextual influences encountered on a daily basis by these women, and the effect of these influences on their CV health status. There are clearly demarcated examples of existing health disparities that occur in various ethnic/racial, underserved, and vulnerable populations. Yet, to date, there is no conceptual model that offers a plausible explanation as to why health disparities exist. Consequently, there is a lack of guidance as to where interventions should be focused for effective CV risk reduction. Because African American women continue to die at a disproportionately higher rate, and at earlier ages than do Caucasian women, it is imperative that new theoretical models capable of driving empirically based interventions be developed, tested, and implemented. One possible choice is the conceptual model proposed in this article. The model is based on the interrelationships between contextual risk factors, rational choice theory (RCT), and opportunity cost. Conceivably, this model may serve as a foundation to ground conceptual thought and drive theory-based interventions to reduce the health disparities in the CV health of low-income rural southern African American women. A model is presented in an attempt to provide guidance for advanced practice nurses who must struggle with addressing the critical need to reduce ethnic and race-associated CV health disparities.

Adaptation, Psychological↗
PubMed2004

R-E-S-P-E-C-T: patient reports of disrespect in the health care setting and its impact on care.

OBJECTIVE: The health care encounter is a setting in which racial/ethnic disparities can arise. Patients who experience disrespect in this encounter may be less likely to use health care services that improve outcomes. The objective of this study was to examine factors in the health care encounter and to model how negative perceptions of the encounter influence health care utilization. DESIGN, SUBJECTS, AND SETTING: Data were derived from the Commonwealth Fund 2001 Health Care Quality Survey, a nationwide random-digit-dial survey of 6722 adults, conducted between April 30 and November 5, 2001. Bivariate and multivariate analyses were performed on weighted data. MAIN OUTCOME MEASURES: Measures of negative perceptions of the patient-provider relationship included feelings of being treated with disrespect or being looked down upon, a belief that unfair treatment was received due to race or language spoken, and a belief that better treatment would have been received had the respondent had been of a different race. Measures of utilization included receipt of a physical exam within the prior year, receipt of optimal cancer screening and recommended elements of chronic disease care, delay of needed care, and not following the doctor's advice. MAIN RESULTS: Minorities were significantly more likely to report being treated with disrespect or being looked down upon in the patient-provider relationship. Specifically, 14.1% of blacks (P=.06), 19.4% of Hispanics (P<.001), and 20.2% if Asians (P<.001) perceived being treated with disrespect or being looked down upon, compared with only 9.4% of whites. Persons who thought that they would have received better treatment if they were of a different race were significantly less likely to receive optimal chronic disease screening and more likely to not follow the doctor's advice or put off care (P<.01). CONCLUSIONS: Perceptions of disrespect or of receiving unfair treatment within the patient-provider relationship are prevalent, particularly among racial/ethnic minorities. Such negative perceptions influence health care utilization and may contribute to existing health disparities.

Adult↗
PubMed2005

Women's status and health of two ethnic groups inhabiting a periurban habitat of Kolkata City, India: a micro-level study.

We studied the interrelationship of women's status in terms of socioeconomic inequality and its effect on women's health at micro level between two ethnic groups in a periurban area of Kolkata City, India. One-hundred twenty-seven women who belong to a tribal population (Munda) and 174 women who belong to a caste population (Poundrakshatriya) participated in this study. We found significant differences between various (socioeconomic, demographic, diet intake, and body mass index [BMI] factors among the two ethnic groups that indicated a better situation for the Pod women. The number of live births, dietary intake and BMI of the women of the two ethnic groups varied differentially among socioeconomic factors, such as women's education and working pattern and poverty level of the household, which are the most recognized measures of women's status. Thus, the diverse socioeconomic status in various cultural groups in traditional Indian societies reflects a more complex situation of women's status and their health. Different factors were responsible for the differential health status of women, which is culture and location specific. Women who are more educated and employed are not necessarily more healthy, since poverty remains an integral factor, base on which literacy and employment status of women in India is determined. Furthermore, suppression of women is rooted in the very fabric of the Indian society, in tradition, in religious doctrine and practices, within the educational systems, and within the families. Along with education, therefore, income-generating schemes for the women of the economically deprived population should be strengthened to bring equality in overall health status of a region that consists of diverse cultural populations with vast economic disparity.

Cultural Characteristics↗
PubMedDate not supplied

Racial and socioeconomic differences in risk factors for cardiovascular disease among Southern rural women.

BACKGROUND: African American women living in the Southeast experience a higher mortality due to cardiovascular (CV) disease than their White counterparts. It is unclear if this vulnerability to CV disease is due to race, socioeconomic status, or health behaviors. OBJECTIVES: To examine the disparities in cardiovascular health between Southern rural, African American and White women to determine if a CV Risk-Index differed by race, education, or income levels and if differences persisted when controlling for body mass index (BMI). METHODS: Subjects were 1,110 women (27% African American, 73% White) residing in rural North Carolina. Data were collected by mailed questionnaire and analyzed using analysis of variance (ANOVA) and analysis of covariance (ANCOVA). RESULTS: African American women had significantly lower education and lower income than Whites, higher BMI, and a much greater prevalence of hypertension, angina, and diabetes. In a three-way ANOVA including race, income, and education, education and race were significant predictors of the CV Risk Index, but when adjusted for BMI race was no longer significant (p =.3039); the only significant predictors were BMI and educational level. DISCUSSION: Women with the least education had the highest CV Risk-Index, regardless of race. These findings suggest the need to focus risk reduction interventions on all Southern rural women with limited education, not only African American women. This supports the current literature that suggests race should be viewed as a risk marker rather than a risk factor.

Adult↗
PubMed2004

Prevalence and correlates of high-quality basic pediatric preventive care.

BACKGROUND: The list of recommended pediatric preventive services has grown considerably in the past decade, and clinician variability, clinician distribution, and other correlates of provision of these basic preventive services (BPS) are not known. OBJECTIVE: To describe the proportion of high-quality basic pediatric preventive services, exclusive of immunizations, reported by parents and to identify sociodemographic and health system predictors and health service correlates of provision of these services. STUDY DESIGN: The study used cross-sectional data on 2041 children, 4 to 35 months of age, in the 2000 National Survey of Early Childhood Health. OUTCOME MEASURES: The BPS measure assesses the receipt of (1) developmental assessment, (2) injury prevention counseling, (3) screening for parental smoking, (4) guidance on reading to the child, and (5) guidance on 14 other topics (assessed as a composite score). The BPS scale categorizes the receipt of services as excellent, good, fair, or poor. RESULTS: Most children received excellent (34.9%) or good (31.5%) care, but many received fair (24.9%) or poor (8.7%) care. Sociodemographic and health care factors such as race/ethnicity, insurance, and practice setting were not associated with BPS levels. Higher BPS scores were associated with parental reports of longer well-child visits, more counseling regarding family and community risk factors, lower rates of delayed or missed care, and greater satisfaction. CONCLUSIONS: Two thirds of children receive good or excellent basic preventive care, as determined with this composite, and no disparities according to race/ethnicity, income, or health insurance status of families (which are often found to be associated with health care access) were found. This equitable distribution of high-quality care suggests a high level of clinician professionalism. Duration of visits may be a key factor to improve quality of care. Because of its association with other services, processes, and outcomes of care, the BPS scale may serve as a useful construct for monitoring quality and stimulating efforts to improve national pediatric preventive care.

Child, Preschool↗
PubMed2000

The development of Māori primary care services.

This paper provides a broad overview of the development of Māori primary care services over the last decade and an outline of the current scope of Māori primary care services. The paper also récognizes the number of challenges and opportunities that face Māori providers and will briefly discuss three that are relevant to all providers: frameworks, information and effectiveness. Developing frameworks for contract specification and performance criteria that reflect Māori models of health and well-being, intersectoral approaches and the use of kaupapa and tikanga Māori in service development and delivery is a major challenge. Current approaches, while acknowledging these areas, for example in contracts, are based within the frameworks of a Western medical model. We have yet to clearly identify how we can meaningfully incorporate these philosophical and practical approaches to providing services into contractual arrangements. Providers have identified a need for information. The providers pass significant amounts of information to the funding agency, however many feel that very little information is returned from the funding agencies to the provider organizations. These providers could well use information feedback from the funding agency when they are reviewing and developing their services. There are also other types of information, for example having access to detailed local epidemiological and demographic information, that would be very useful to providers who are reviewing existing programs and developing new services. The third 'universal' challenge is the need to begin to collect information about how effective current Māori health strategies are, and how effectively services are caring for Māori clients. Developing information on effectiveness could utilize a multi-faceted approach, with information being collected at the provider level as well as at population level. Other questions relate to the effectiveness of our health promoting, disease preventing or disease management interventions. These points are relevant to all providers, but information on the effectiveness of mainstream health services is just as limited. The disparity between Māori and non-Maori health status however, suggests that these services (both public and personal health services) have not been as effective as they could have been.

Attitude to Health↗