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PubMedDate not supplied

Being born in Manitoba: a look at perinatal health issues.

OBJECTIVE: The Manitoba Centre for Health Policy was commissioned by Manitoba's provincial health department to examine the health of newborns born 1994 through 1998, using three indicators: preterm birth (< 37 weeks gestation), birthweight, and type of infant feeding. METHODS: Data were derived from the Population Health Research Data Repository and the National Longitudinal Survey of Children and Youth 1996. Variation by 12 Regional Health Authorities (RHAs) and by 12 Winnipeg Community Areas (CAs) was examined, as well as associations with the population's health and socioeconomic well-being. RESULTS: Manitoba's preterm birth rate was 6.7% of live births, from 5.3% to 7.4% by RHA, and 5.7% to 8.0% by Winnipeg CA. Manitoba's low birthweight rate (< 2500 g) was 5.3%, from 2.7% to 5.7% by RHA, and 4.4% to 7.2% by Winnipeg CA. The lower the income, the greater the likelihood of low birthweight (p < 0.05). Manitoba's breastfeeding initiation rate was 78%, from 64% to 87% by RHA, and 66% to 90% by Winnipeg CA. The lower the income and the poorer the health status of the population, the lower the breastfeeding rate (p < 0.001). Of those initiating breastfeeding, 42% breastfed for at least six months. CONCLUSION: Factors affecting child health in Manitoba could be addressed through systematic programs both during pregnancy and during the postpartum period, including support for nutritional counselling, promotion of breastfeeding, smoking cessation programs, and social policy decisions designed to overcome disparities within low-income groups and populations with poorer health status.

Birth Rate↗

PubMed2001

Social context, stressors, and disparities in women's health.

OBJECTIVE: to describe stressors experienced by women living in an economically disenfranchised urban community and test the relationships between those stressors and women's self-reported health status. METHODS: We used a stress process framework to examine the implications of economic divestment and race-based residential segregation on the lives and health of women raising children in Detroit. We conducted qualitative analysis of in-depth interviews with 48 community residents and surveyed 679 women raising children in this community. Regression models controlling for age, education, and income examined the relationships of each of these stressors to symptoms of depression and general health status. RESULTS: Stressors described by women in the in-depth interviews included financial, work, family, safety, police and other municipal services, and disrespect or unfair treatment. Financial, police, and safety stress and unfair treatment were significantly associated with symptoms of depression; financial and family stress were significantly associated with self-reported general health status. CONCLUSION: Our results support the hypothesis that life stressors associated with economic divestment contribute to the disproportionate burden of disease experienced by African-American women residing in urban communities. Efforts to address racial and socioeconomic disparities in women's health should include policies that support economic development and municipal infrastructure as fundamental to the maintenance of health.

Adult↗

PubMed2002

Overweight status and eating patterns among adolescents: where do youths stand in comparison with the healthy people 2010 objectives?

OBJECTIVES: This study determined the prevalence of Minnesota urban youths reaching the Healthy People 2010 objectives for obesity and intake of fat, calcium, fruits, vegetables, and grains and compared prevalence rates across sociodemographic characteristics. METHODS: The study sample included 4746 adolescents (aged 11-18 years) from the Minneapolis/St. Paul area who completed dietary surveys and participated in anthropometric measurements as part of a school-based population study. RESULTS: Considerable gaps were seen between the existing prevalence rates for obesity and nutrient and food patterns and the targeted Healthy People 2010 prevalence rates. For example, 12.5% of the girls and 16.6% of the boys had body mass index values at or greater than the 95th percentile (target = 5%). Only 29.5% of the girls and 42.5% of the boys were meeting the daily recommended intakes for calcium (target = 75%). Similarly, percentages of youths consuming the recommended amounts of fat, fruits, vegetables, and grains were lower than the targeted percentages. There were large sociodemographic disparities in obesity and eating patterns, particularly across race/ethnicity and socioeconomic status. CONCLUSIONS: Concerted public health efforts are needed to achieve the Healthy People 2010 objectives for obesity and nutrition and to reduce racial/ethnic and socioeconomic disparities.

Adolescent↗

PubMed2003

Oral health disparities between ranks in a military environment: Israel Defense Force as a model.

UNLABELLED: Some studies have demonstrated a relationship between occupational status and position in the workplace to use of dental services and oral health status. Ranks symbolize social status in the military hierarchy, which is different from that accepted in civilian workplace. OBJECTIVE: This study was aimed at analyzing differences between officers and noncommissioned personnel in regard to dental treatment needs and use of dental services. METHODS: One-thousand, one-hundred thirty-nine personnel of the Israel Defense Force were examined, using DMFT (decayed, missing, filled permanent teeth and CPITN (community periodontal index of treatment needs indices to define oral health status. A questionnaire was used to calculate utilization rates. RESULTS: Noncommissioned personnel had on average 50% more unmet caries treatment needs, and 19.1% of them suffered from deep periodontal pockets. No differences were demonstrated in utilization rates CONCLUSIONS: Military rank influences oral treatment needs the way civilian organizational structure does with the exception of utilization rates of dental services.

Adult↗

PubMed2004

Generations of loss: contemporary perspectives on black infant mortality.

The U.S. black infant mortality rate (IMR) remains a significant public health concern. Although improved during the last four decades, the U.S. IMR remains within the lowest tier of IMRs for all industrialized countries, and black American infants remain disproportionately represented in low birthweight (LBW) and infant death statistics. Numerous risk factors have been analyzed for their relative contributions to the U.S. IMR and black-white infant survival health disparities. Those factors include prenatal care quality and access, maternal socioeconomic status (SES), HIV/AIDS status, infections, intrapartum risk factors, existing comorbidities, social support, and nutritional status. However, the role of these and other factors have not fully explained the higher infant mortality risks for black infants. This review will discuss a variety of risk factors that contribute to infant mortality disparities between non-Hispanic black and white infants. Among those factors, the goal will be to review selected topics pertaining to maternal SES, LBW, preterm birth, perinatology advances, birth record data quality, maternal stress, prenatal care adequacy, and physical and substance abuse, and the relationships of those topics to black-white IMR health disparities.

Black or African American↗

PubMed2005

A brief conceptual tutorial on multilevel analysis in social epidemiology: interpreting neighbourhood differences and the effect of neighbourhood characteristics on individual health.

STUDY OBJECTIVE: Using a conceptual rather than a mathematical approach, this article proposed a link between multilevel regression analysis (MLRA) and social epidemiological concepts. It has been previously explained that the concept of clustering of individual health status within neighbourhoods is useful for operationalising contextual phenomena in social epidemiology. It has been shown that MLRA permits investigating neighbourhood disparities in health without considering any particular neighbourhood characteristic but only information on the neighbourhood to which each person belongs. This article illustrates how to analyse cross level (neighbourhood-individual) interactions, how to investigate associations between neighbourhood characteristics and individual health, and how to use the concept of clustering when interpreting those associations and geographical differences in health. DESIGN AND PARTICIPANTS: A MLRA was performed using hypothetical data pertaining to systolic blood pressure (SBP) from 25 000 subjects living in the 39 neighbourhoods of an imaginary city. Associations between individual characteristics (age, body mass index (BMI), use of antihypertensive drug, income) or neighbourhood characteristic (neighbourhood income) and SBP were analysed. RESULTS: About 8% of the individual differences in SBP were located at the neighbourhood level. SBP disparities and clustering of individual SBP within neighbourhoods increased along individual BMI. Neighbourhood low income was associated with increased SBP over and above the effect of individual characteristics, and explained 22% of the neighbourhood differences in SBP among people of normal BMI. This neighbourhood income effect was more intense in overweight people. CONCLUSIONS: Measures of variance are relevant to understanding geographical and individual disparities in health, and complement the information conveyed by measures of association between neighbourhood characteristics and health.

Antihypertensive Agents↗

PubMed2004

Interactions between anxiety, social support, health status and buspirone efficacy in elderly patients.

Psychosocial factors are among the etiological factors of anxiety, and have been shown to affect the anxiolytic efficacy of buspirone in laboratory rodents. Disparate human studies suggest that a similar interaction may be valid for anxious patients. However, this interaction is poorly known at present. It was hypothesized that social support and health status are especially relevant psychosocial problems in elderly, and as such, have a large impact on both anxiety and the efficacy of anxiolytic treatment with buspirone. The hypothesis was assessed by three independent studies performed in a total number of 384 elderly in-patients (109 males, 275 females, age approximately 80 years). A low number of social contacts associated with a large number of diseases proved to be a strong risk factor for anxiety, whereas the reverse condition (many contacts/few diseases) was associated with considerably lower Hamilton Rating Scale for Anxiety (HAM-A) scores. Buspirone ameliorated anxiety significantly in general, but the "many contacts/many diseases" condition was associated with twice as much improvement as the "few contacts/few diseases" condition. The patient's self-evaluation of health status was predicted strongly by the disease score used in the above two studies. Taken conjointly, data suggest that the major Axis-IV problems faced by the age class studied (social support and health status) have a strong effect on both anxiety and buspirone responsiveness in elderly patients. Thus, drug responses appear to be modulated by nonpharmacological factors, and research directed towards identifying such factors would provide information important to a more appropriate patient targeting of certain medications.

Aged↗

PubMed2003

Geographic differences in tooth loss and denture-wearing among the elderly in Norway.

OBJECTIVES: The purpose of this study was to estimate the prevalence of teeth and dentures in individuals aged 67 years and above. METHODS: A representative random sample of 1152 individuals was drawn from 11 of the 19 counties of Norway. In all, 582 subjects were interviewed and examined clinically by the same dentist (BMH) in 1996-99. Fifty-four had died before contact was established, and the response rate was 53%. The mean age of those examined was 76.4 +/- 5.9 years, range 67-99 years. RESULTS: In all, 40.0% had 'own teeth only', 27.9% 'own teeth and dentures' and 31.6% 'dentures only'. Three participants had neither teeth nor dentures. Interviews with 35 nonparticipants disclosed no statistically significant differences regarding dental/denture status compared to participants. By using stepwise polychotomous logistic regression, three regions of Norway could be identified with respect to the occurrence of teeth and dentures; significant differences existed between them and nonsignificant differences were found within them. In region A (South-East counties including the capital Oslo), region B (West-Central counties), and region C (Northern counties) the prevalence of 'own teeth only', 'own teeth and dentures' and 'dentures only' were 62.0, 26.5 and 11.1% in region A, 27.7, 28.9 and 43.1% in region B and 2.9, 28.6 and 65.7% in region C, respectively. Teeth were observed in 394 individuals, the mean number being 19,15 and 11 in regions A, B and C, respectively (over all mean 17 teeth). CONCLUSIONS: There are large geographical disparities with respect to dental/denture status in Norway. The oral health goals for the year 2000 suggested by WHO/FDI were far from met in large areas of the country at the time when the data were collected, (1996-99).

Age Factors↗

PubMed2005

Stormy weather: race, gene expression, and the science of health disparities.

In the current US political climate, conservative foundations are seeking to frame debates over determinants of racial/ethnic health disparities as a matter of "politically correct" unscientific ideology (concerning the health impacts of discrimination) vs scientific yet "politically incorrect" expertise rooted in biological facts (concerning genes). I draw on historical and contemporary examples to place conservative polemics in context, and also highlight fundamental flaws in their arguments involving the use of spurious categories (e.g., Caucasian), logical fallacies, temporal fallacies, and an erroneous emphasis on gene frequency over gene expression. The larger goal is to strengthen development of a more critical, reflexive, and rigorous science capable of generating evidence useful for rectifying--rather than perpetuating--social disparities in health.

Gene Expression↗

PubMed2002

Perinatal and infant health among rural and urban American Indians/Alaska Natives.

OBJECTIVES: We sought to provide a national profile of rural and urban American Indian/Alaska Native (AI/AN) maternal and infant health. METHODS: In this cross-sectional study of all 1989-1991 singleton AI/AN births to US residents, we compared receipt of an inadequate pattern of prenatal care, low birthweight (< 2500 g), infant mortality, and cause of death for US rural and urban AI/AN and non-AI/AN populations. RESULTS: Receipt of an inadequate pattern of prenatal care was significantly higher for rural than for urban mothers of AI/AN infants (18.1% vs 14.4%, P </=.001); rates for both groups were over twice that for Whites (6.8%). AI/AN postneonatal death rates (rural = 6.7 per 1000; urban = 5.4 per 1000) were more than twice that of Whites (2.6 per 1000). CONCLUSIONS: Preventable disparities between AI/ANs and Whites in maternal and infant health status persist.

Adolescent↗

PubMed2005

Disparities despite coverage: gaps in colorectal cancer screening among Medicare beneficiaries.

BACKGROUND: Despite its effectiveness in reducing mortality, colorectal cancer (CRC) screening rates are low, especially among low-income and minority groups; however, physician recommendation can increase screening rates. METHODS: We performed a multilevel analysis of the Medicare Current Beneficiary Survey data linked to Medicare claims and the Area Resource File to identify determinants of racial and socioeconomic disparities in CRC screening among 9985 Medicare Parts A and B beneficiaries with a usual physician. Recent CRC screening was defined as receipt of either a home fecal occult blood test, flexible sigmoidoscopy, or colonoscopy at recommended intervals. RESULTS: Unadjusted rates of screening were 48% for white and 39% for black beneficiaries (P<.001). Racial differences in CRC screening receipt were eliminated after adjustment for socioeconomic status as measured by income and education. Socioeconomic status disparities decreased but remained significant after adjustment for personal and health system factors. Awareness of CRC (adjusted odds ratio, 2.76; 95% confidence interval, 2.29-3.33) and having a primary care generalist (vs another specialist) as one's usual physician (adjusted odds ratio, 1.31; 95% confidence interval, 1.12-1.53) were associated with higher odds of screening, controlling for other factors. The odds of screening were also higher among those whose usual physician was rated more highly on information-giving skills. CONCLUSIONS: Racial differences in CRC screening rates among Medicare beneficiaries with a usual physician are explained by differences in socioeconomic status. Beneficiaries with a primary care generalist as their usual physician had higher rates of CRC screening receipt. Increased efforts to make Medicare beneficiaries aware of the benefits of CRC screening may capitalize on the associations found in this study between CRC knowledge, physician information giving, and timely screening.

Aged↗

PubMed2003

Racial and ethnic disparities in health: an emergency medicine perspective.

Significant disparities exist in health care based on race. Even when controlling for socioeconomic factors, minorities still have lower rates of utilization for certain procedures, higher mortality rates, and differences in usual source of care. There are a multitude of causes for these disparities, including differences based on access to care, the patient-doctor relationship, and insurance status. This article addresses possible factors that account for persistent disparities in health based on race and suggests approaches to remedying these disparities. Although many studies have been done on this topic, further research is needed to examine factors specifically in the emergency department setting.

Delivery of Health Care↗

PubMed2005

Race, socioeconomic status, and the perceived importance of positive self-presentation in health care.

Hundreds of studies have documented disparities in medical treatment in the USA. These findings have generated research and initiatives intended to understand and ameliorate such disparities. Many articles examine disadvantaged patients' beliefs and attitudes toward health care, but generally limit their investigation to how these beliefs and attitudes influence adherence and utilization. Thus, this approach fails to consider whether patients use particular strategies to overcome providers' potentially negative perceptions of them and/or obtain quality medical care. In this paper, we examine positive self-presentation as a strategy that may be used by disadvantaged groups to improve their medical treatment. Analysis of survey data (the 2004 Greater Cincinnati Survey) suggests that both African Americans and lower socioeconomic status persons are more likely than whites or higher socioeconomic status persons to report that positive self-presentation is important for their getting the best medical care. Based on these findings, we suggest several routes for future research that will advance our understanding of patients' everyday strategies for getting the best health care.

Adolescent↗

PubMed2005

Trends in contacts with mental health professionals and cost barriers to mental health care among adults with significant psychological distress in the United States: 1997-2002.

OBJECTIVES: I assessed recent trends in prevalence of any contact with mental health professionals and nonuse of mental health care or prescription medications owing to cost among adults with significant psychological distress. METHODS: In samples drawn from the National Health Interview Survey of 1997-2002, multiple logistic regression analysis was used to examine the association of survey year with mental health professional contacts and nonuse of mental health care or prescription medications owing to cost. RESULTS: The prevalence of any contact with mental health professionals increased from 29.1% in 1997 to 35.5% in 2002 (P<.05). The prevalence of nonuse of services because of cost also increased-from 15.6% to 20.0% for mental health care (P<.05) and from 27.7% to 34.1% for medication use (P<.001). Age, racial/ethnic, income, and insurance status disparities in receiving care persisted over the study period. CONCLUSIONS: The number of individuals in need of mental health care who contacted mental health professionals grew in recent years, as did the number of individuals who encountered cost barriers to such care. Barring dramatic improvements in health insurance coverage, more individuals will likely face such barriers in coming years.

Adolescent↗

PubMed2006

Expanding the frame of understanding health disparities: from a focus on health systems to social and economic systems.

Policy makers are increasingly attending to the problem of racial and ethnic health disparities, but much of this focus has been on evidence of inequality in health care systems. This attention is important and laudable, but eliminating inequality in the health care system would be insufficient to eliminate racial and ethnic disparities and improve the health of all Americans. Social and economic factors, such as disadvantaged socioeconomic status, racism, discrimination, and geographic inequality shape virtually all risks for poor health. Interventions that focus solely on improving access to health care, or on reducing individual behavioral and psychosocial risks, therefore have limited potential to reduce racial and ethnic health disparities. The elimination of health disparities requires comprehensive, intensive strategies that address inequality in many sectors, including housing, education, employment, and health systems. These interventions must be targeted at many levels, including individuals and families, workplaces, schools, and communities.

Ethnicity↗

PubMed1995

Health and social characteristics and children's cognitive functioning: results from a national cohort.

OBJECTIVES: The purpose of this study was to examine the associations between cognitive functioning in children and sociodemographic, family, and health characteristics. METHODS: Data from phase 1 of the third National Health and Nutrition Examination Survey were used to evaluate performance on standardized cognitive tests in a representative sample of 2531 children 6 to 16 years of age. Multivariate analyses were used to assess independent associations between covariates and test performance. RESULTS: Lower income, minority status, and lower education of an adult reference person (one of the persons in the household who owned or rented the home) were independently associated with poorer performance on all cognitive subtests. To a lesser degree, general health status, history of birth complications, and sex also were independent predictors of performance for some of the subtests. CONCLUSIONS: These findings illustrate disparities in cognitive functioning across sociodemographic and health characteristics of children in the US population. They suggest the need for public health policies to take a multifaceted approach to optimizing childhood environments in order to overcome the effects of socioeconomic and minority status.

Adolescent↗

PubMed2005

Racial and ethnic disparities in breast cancer stage, treatment, and survival in the United States.

Several studies indicate that African-American, Hispanic White, and Native American women with breast cancer present with more advanced stages and have poorer survival rates than non-Hispanic Whites, while Asians/Pacific Islanders do not. However, Asians/Pacific Islanders and Hispanic Whites are heterogeneous populations, and recent data indicate that certain subgroups of these populations have poorer breast cancer outcomes compared to non-Hispanic Whites, while others have better outcomes. Many of these disparities have persisted for decades, but until recently, detailed studies exploring the reasons behind these disparities have been limited. The results of these studies point to the effect of differences in socioeconomic status, access to health care (including both breast cancer screening and treatment services), lifestyle factors, and tumor characteristics on these disparities. Thus, these studies indicate that these disparities are multifactorial, and therefore strategies aimed at reducing them must involve advocacy, research, education, and healthcare services. A key component to the success of these strategies is not only support for them on the federal and state levels, but also the involvement of local communities in developing programs and policies that are culturally and linguistically appropriate for their communities in order to ensure not only the utility, but also the longevity, of these efforts.

Breast Neoplasms↗

PubMedDate not supplied

Primary care physicians' perceptions of the effect of insurance status on clinical decision making.

PURPOSE: Americans who do not have health insurance receive fewer health services and have poorer health status than those who have insurance. To better understand this disparity, in this study we characterize primary care physician's perceptions of what effect, if any, patients' insurance status has on their clinical decision making during office visits. METHODS: Twenty-five physician members of CAPRICORN, a primary care practice-based research network in metropolitan Washington, DC, completed a brief paper-card survey instrument immediately after each patient encounter during 2 half-day office sessions. Participants saw patients in their usual manner and were given no additional information about their patients or their insurance. RESULTS: Eighty-eight percent of participating physicians reported making at least 1 change in clinical management as a result of a patient's insurance status. They reported altering their management during 99 of 409 patient encounters (24.2%). There was a significant difference in the percentage of visits that involved a change in management for privately insured, publicly insured, and uninsured patients (18.7%, 29.5%, and 43.5% respectively, P = .01). Physicians reported discussing insurance issues with patients during 62.6% of visits during which they made a change in management based on insurance status. CONCLUSION: Physicians incorporate their patients' insurance status into their clinical decision making and acknowledge they frequently alter their clinical management as a result. Additional research is needed to understand the effect of these changes on patient health and to assist both physicians and patients in enhancing the quality of care delivered within the constraints of the current insurance system.

Adult↗