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The prevalence of diabetes and related services in Missouri and Missouri's progress towards meeting the Healthy People 2010 goals.

Since 1988, diabetes in Missouri increased by almost 50%. We examined diabetes' prevalence and associations with sociodemographic, risk factor, and comorbidity variables in Missouri. Additionally, we examined Missouri's progress towards Healthy People 2010 diabetes-related goals and prevalence of risk factor counseling. Analysis indicates diabetes is an increasing public health problem in Missouri. To stem increases in the prevalence of diabetes and its costs, delivery of, and access to, preventative care and counseling should be improved.

Adolescent↗
PubMed2004

National and regional health information infrastructures: making use of information technology to promote access to evidence.

The vision for national and regional health information infrastructures (HII) includes provision of a framework that is supportive of access and integration of health information with the goal of improving the health and safety of individuals, public health systems, and nations. Internationally, prominent examples of national and regional HIIs exist that provide a means for achievement of this goal. However, to fully realize benefits, an explicit mechanism is needed for linking national and regional HIIs with existing knowledge, automated processes and evaluation of the ability of HIIs to meet the information needs of primary recipients. Using the United States' Na-tion Health Information Infrastructure (NHII) as an example, the authors describe expansion of the conceptual framework to explicitly acknowledge the role of access to evidence at the overlap between the three dimensions of the NHII to create an "evidence-based" link between interrelated components. The role of national measures in setting e-communication goals and evaluating the evolving infrastructure in meeting informational needs of users is discussed. Additionally, automated knowledge management tools such as practice guidelines are presented as a means by which access to critical information is delivered to users, in a format that is appropriate for their health literacy level and that provides adequate support for informed decision making.

Decision Support Techniques↗
PubMed2004

Measuring progress in Healthy People 2010.

Background--Healthy People 2010 (HP2010) objectives are based on two overarching goals: 1) to increase years and quality of healthy life, and 2) to eliminate disparities among subgroups of the population. Four hundred and sixty-seven specific objectives consistent with these goals were outlined, baseline data were identified when available, and specific targets were set for the year 2010. This report discusses the techniques that are being used to measure progress toward these two goals. Process--In order to promote consistency in monitoring across different objectives, a minimum template of subgroups was adopted for the population-based objectives in HP2010. A workgroup of individuals representing the U.S. Department of Health and Human Services agencies involved in HP2010 was convened to consider the issues related to monitoring progress toward the two goals of HP2010. The workgroup concurred with the recommendations in this report. Recommendations--Progress toward target attainment can be monitored for all objectives with at least one data point beyond the baseline. For those objectives that are based on data for a population, progress toward target attainment can also be measured for subgroups of the population. Progress toward the elimination of disparity for individual population subgroups can be measured in terms of the percent difference between each subgroup rate and the most favorable or "best" subgroup rate in each domain. For purposes of measuring disparity relative to the "best" subgroup rate, all measures are expressed in terms of adverse events.

Demography↗
PubMed2004

Health status among REACH 2010 communities, 2001-2002.

The REACH 2010 Risk Factor Survey was conducted in 21 minority communities in the United States during June 2001-August 2002. The survey included 10,953 Blacks/African Americans, 4,257 Hispanics/Latinos, 4,204 Asians, and 1,791 American Indians. Data demonstrate that residents in the minority communities bear a greater socioeconomic, risk factor, and disease burden than do members of the general US population. However, substantial variations in the prevalence of risk factors and chronic conditions also indicated that public health priorities should vary among different racial/ethnic groups, and even among communities within each group, and that culturally sensitive primary and secondary prevention strategies should be tailored to meet community-specific needs.

Adolescent↗
PubMed2004

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↗
PubMed2004

Overcoming historical and institutional distrust: key elements in developing and sustaining the community mobilization against HIV in the Boston Haitian community.

The Metro Boston REACH 2010 HIV Coalition needs to develop innovative processes aimed at overcoming a history of distrust that has led to limited cooperation from the Haitian community. Among the key elements being implemented are the development of a community vision through a community mobilization process; the development of an innovative working group process, in which coalition members worked together to develop and implement culturally and linguistically appropriate HIV prevention curricula; participatory leadership and joint accountability processes, manifested in decision-making approaches, such as the fund allocation system, and in the provision of technical assistance workshops on team building, designed to engender cohesion, skills, and resources sharing among coalition members. The success of this venture is measured through the growing expectation that this coalition could serve as a community planning body for all HIV-related services aimed at reducing HIV infection in the Greater Boston Haitian population.

Adult↗
PubMed2004

The development of a community action plan to reduce breast and cervical cancer disparities between African-American and White women.

The purpose of this project was to establish a coalition of academic, state, and community-based organizations to develop a community action plan (CAP) to eliminate breast and cervical cancer morbidity and mortality disparities between African-American (AA) and Caucasian women. The project targeted rural and urban low-income AA women in Alabama. Based on the logic model, community capacity building was implemented, followed by the development of a community-driven CAP. For community capacity building, a coalition comprising 12 organizations was established, and a network of 84 community volunteers was formed. Community needs assessments identified 3 levels of barriers to breast and cervical cancer screening: 1) individual, 2) community systems, and 3) healthcare provider. Based on these findings, a community-driven CAP was developed. Our results indicate that a coalition of diverse organizations can partner and develop CAPs to improve the health of their communities.

Adult↗
PubMed2004

Using focus groups to understand health-related practices and perceptions of African Americans: Nashville REACH 2010 preliminary findings.

To gain an understanding of health-related practices and perceptions, Nashville REACH 2010 conducted focus studies among 5 community groups. Attitudes about health, personal risk behaviors, quality of health care, and models of personal behavior change were assessed. All focus-group sessions were transcribed and analyzed using a consensus panel methodology. A combined analysis of the focus groups revealed 3 categories of barriers to healthier living: 1) personal, 2) environmental, and 3) systemic. Personal barriers included lack of adequate finances, physical limitations, lack of knowledge, and stress. Environmental barriers were related to the unavailability of healthy food choices and adequate places to exercise in the community. The accessibility and quality of health care were the most pervasive systemic barriers identified. Though these findings are not novel to urban African-American communities, they will serve as the framework by which Nashville REACH 2010 will implement strategies to reduce and, ultimately, eliminate cardiovascular disease and diabetes disparities.

Adolescent↗
PubMed2004

People with diabetes: knowledge, perceptions, and applications of recommendations for diabetes management.

The purpose of this paper is to report results of the People with Diabetes survey conducted as part of the REACH 2010: Charleston and Georgetown Diabetes Coalition. The pilot data revealed that African Americans (AAs) (N=80) reported fewer A1c, lipid, and kidney testing, feet and eye exams, and less nutrition and diabetes self-management counseling during 1999-2000 than did Caucasians (Cs) (N=23). The survey was repeated in 2002 when data were collected from a convenience sample of 160 AAs and 150 Cs using the revised self-reported survey instrument. African Americans (AAs) were significantly likely to report that their understanding of results for the kidney function test were good as compared to Cs (P<.001) and were more likely to report receiving nutrition education (P=.003). Otherwise, there were no significant differences between AAs and Cs on the remaining items in the survey. Since REACH 2010 was actively involved in the AA community for 2 years between the pilot survey and the repeated survey, these results were anticipated and are also reflected in results of chart audits conducted within healthcare systems used by the same AA population.

Adult↗