This free, monthly update synthesizes news coverage from hundreds of print and broadcast news sources related to health and health care issues affecting underserved and racial and ethnic communities.

The update also summarizes recent journal articles and other research developments in the field and features a data slide from a relevant Kaiser Family Foundation publication.

DISPARITIES IN THE NEWS

1. Reports Highlight Regional Drinking Problem

A recent article from The Daily Times (New Mexico) reported on the high rates of alcohol-related deaths in three counties in northwest New Mexico, which are among the worst in the state and the country.

According to Joe Roeber, New Mexico’s alcohol epidemiologist, New Mexico’s per capita death rate has been one of the highest in the country every year since 1981. According to the latest data, the rates in three of its counties (San Juan, Mckinley, and Rio Arriba) are the highest in the state, and in some categories they are more than five times the national average. Examples of alcohol-related deaths include vehicle crashes, falls, suicides, and chronic diseases such as liver disease. Roeber notes that “there are different underlying patterns of heavy drinking in the different counties.” He went on to discuss the pattern in San Juan County where the data showed “high rates of binge drinking leading to high rates of alcohol-related injury death and lower rates of heavy drinking leading to chronic disease death.” The data also show marked racial and ethnic differences among New Mexico’s high death rates. In particular, the death rates for American Indians were significantly higher than those for whites.

Increasing the cost of alcohol has been shown to be an effective way to reduce binge drinking, according to the Centers for Disease Control and Prevention, and a bill under consideration in the New Mexico Legislature would do just that. The proposed bill would raise the excise tax on alcoholic beverages by 50 percent to 140 percent, and could potentially bring in $1 million to San Juan County annually that could be invested in substance abuse treatment facilities (Boetel 2/14).

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2. Occupational Dangers High for Migrant Workers

A recent article from the Merced Sun-Star (California) reported on the high occupational dangers faced by migrant workers, which were formally discussed at an event sponsored by the UC Merced Center of Excellence on Health Disparities.

According to experts, disparities in occupational injuries can be attributed to migrant workers taking more hazardous jobs, linguistic and cultural barriers, and their recent arrival in the country. Dr. Xochitl Castaneda, director of Health Initiative of the Americas at the School of Public Health at UC Berkeley noted that the difficulty in navigating government safety net programs places workers in a vulnerable situation. Marc Schenker, professor of medicine and public health at the UC Davis School of Medicine said that among the jobs migrant workers tend to work, construction and transportation have the highest rates of occupational fatalities. Schenker cited the case of a 17-year-old migrant worker who died of heat stroke in 2008. He noted that high temperatures and her inability to complain beyond her field supervisor played a role in her death.

The event also addressed disparities in occupational injuries and illnesses of global migrants (Amaro 2/9).

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3. Get Tested for HIV, Lessen Stigma

In acknowledgement of National Black HIV/AIDS Awareness Day, the Aiken Standard (South Carolina) recently discussed the disproportionate number of HIV cases present in the African-American community, and some of the services available in parts of South Carolina through HopeHealth.

Although African-Americans comprise 13 percent of the total population in the United States, they account for approximately half of the HIV cases in the United States. According to the Department of Health and Human Services’ STD/HIV Division Surveillance Report, African-Americans account for 70 percent of the almost 24,000 known HIV cases in South Carolina. According to Christine Gordon, Regional Director at HopeHealth, a nonprofit organization providing medical care and counseling to HIV/AIDS-infected individuals in Aiken, Allendale and Barnwell counties in South Carolina, “The face of AIDS has changed over the years, and everyone needs a test….no one is exempt from the disease.” The CDC notes that such disproportionate rates can be due to several factors related to poverty, including a limited access to health care, a lack of awareness, and decreased access to prevention education. According to client service specialist Barbara Hightower of HopeHealth, the disproportionate rates may also be due to the stigma associated with HIV and AIDS along with lack of knowledge. T, an HIV patient at HopeHealth since 2009, encourages individuals to get themselves and their partners tested. “Fear of being ostracized may prevent someone with HIV/AIDS from finding out their status and seeking the medical care they need,” T notes.
HopeHealth offers HIV testing on a walk-in basis, support groups for men and women, along with prescription assistance, transportation, and other services (Dolianitis 2/07).

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4. Knox County Middle-Schoolers List Risky Behavior

A recent article in Knoxnews (Tennessee) discussed the findings of the 2010 Youth Risk Behavior Survey, in which racial and ethnic differences in behaviors including bullying, sexual intercourse, and smoking were found among middle school students in Knox County, Tennessee.

For the second time, the researchers from the Knox County Health Department asked adolescents to self-report their behaviors. For the first time, the survey included a question on bullying at school and the first time there was enough of a sample to report reliable estimates for the “other races” population. Among students who self-identified as “other races,” 45 percent reported being bullied, compared to 40 percent of white students and 21 percent of black students. Students who self-reported as “other races” also reported seriously contemplating suicide at a higher rate than white and black students. The survey also asked about sexual activity and found that 17 percent of seventh- and eighth-graders had engaged in sexual activity, with higher rates for boys than girls, and for blacks than whites.

In addition to assessing risky behavior, the authors assessed diet and exercise behaviors among middle school students and noted that while 15 percent of students were overweight, about 75 percent said they participated in “vigorous” physical activity for at least 20 minutes three or more times per week. Nearly half of the overweight students reported they were attempting to lose weight. Among those attempting to lose weight, the most common methods reported were diet and exercise, with significantly smaller percentages of students reporting fasting and taking pills without a doctor’s consent. Epidemiologist Kathy Brown notes the results “give insight and a better understanding of the scope of some preteen behaviors (Nelson 2/07).

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5. How to Tell if You’re Having a Heart Attack

A recent article from the Los Angeles Times reported on gender differences for heart attack symptoms among American men and women.

Coronary heart disease is the number one cause of death for both women and men in the United States, however the initial symptoms often differ from the “classic” chest-splitting, gasping for-breath symptoms. According to Dr. David Rizik, director of Interventional Cardiology for Scottsdale Healthcare Hospitals in Arizona, symptoms “can be very different from person to person, between women and men and even within an individual who has more than one heart attack.” Common symptoms of a heart attack include “mild to strong discomfort in the center of the chest, which may be prolonged, or come and go, or may feel like pressure”; discomfort in other parts of the body, including the arms, back, neck, jaw and or stomach; shortness of breath; and cold sweats, nausea and/or lightheadedness. According to the National Heart, Lung, and Blood Institute at National Institutes of Health and the Centers for Disease Control and Prevention, women are more likely than men to experience shortness of breath, nausea, vomiting, back or jaw pain, indigestion, flu-like symptoms and shoulder pain. Health experts note that women are more likely than men to ignore or misinterpret heart attack symptoms further delaying medical care.

Dr. Rizik added that “the patient’s symptoms and an EKG (electrocardiogram) are the best way to establish a diagnosis of a heart attack.” Confirmatory results would then result in the patient receiving blood-thinning agents, followed by angioplasty to determine whether there are any blocked arteries (Markowitz 2/7).

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6. Healthy Homework: Convenience Often Trumps Nutrition

A recent article in the Merced Sun-Star (California) discussed the challenges associated with trying to get young people to change their eating habits, particularly those living in low-income neighborhoods.

The article noted that despite the efforts of organizations such as The Network for a Healthy California, many people aren’t getting the message about improving nutrition and increasing healthy eating habits. The article notes this is the result of numerous factors including the marketing of as well as the affordability and accessibility of fast food, a lack of education, and economic disparities, and eating habits taught at home, all contribute to eating behaviors. The fast-food industry spent $4.2 billion in television commercials and other ads in 2009. The Network for a Healthy California and other organizations have significantly fewer financial resources available to counteract the advertising budget of the fast-food industry. In addition to the fast-food industry’s advertising, obesity prevention programs also have to contend with the convenience and affordability of fast-food, and the messages children are receiving at home. According to a 2010 study from the Rudd Center for Food Policy and Obesity at Yale University, 84 percent of parents said they take their children to a fast-food restaurant at least once a week. According to Claudia Corchado, program manager for the Central Regional Obesity Prevention Program in Merced, “The environment is a huge factor in people’s health.” Low-income communities are less likely to have supermarkets supplying fresh produce, and more likely to have fast-food restaurants and liquor stores than affluent neighborhoods. A study from the Merced County Department of Public Health found that Southeast Merced has several convenience stores and fast-food venues, however only one large grocery store and no farmers’ market, and southwest Merced has many convenience stores and small markets, but no large supermarkets.

The article concluded by noting that rates of Type II diabetes, a disease that until recently was only found in adults, are on the rise in children. In order to “reverse those trends, children and youngsters must be more aware of what they eat,” because the foods they eat now will impact their health as they age. (Amaro 2/05).

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7. City’s High Abortion Rate Defies Easy Explanation

A recent article from The New York Times discussed a “rare moment of synchronicity between the Catholic Church and pro-choice women’s groups” on the high abortion rate of New York City, which stands at twice the national rate.

The New York Health Department released its annual Vital Statistics report which highlighted that in 2009, 41 percent of pregnancies, excluding miscarriages, ended in abortion. Marked racial and ethnic differences in abortion among teenagers were present with blacks and Asians having the highest percentage, both 74 percent, followed by whites and Hispanics, 66 percent and 53 percent respectively. Although the New York abortion rate surpasses the national rate, the teenage pregnancy rate and abortion rate have fallen by 16 percent. However racial and ethnic differences persist. “If you look at the pregnancy rates by race and ethnicity in New York City versus nationally, they are essentially the same for black and Hispanic teenagers, and lower for whites,” said Susan Craig, a spokeswoman for the city’s health department. Health experts noted that the decreasing abortion rate among teenagers did not alter the overall abortion rate since the majority of abortion occurs among women in their 20s and 30s. Health officials and advocacy groups say the numbers are the result of a series of complex social and legal factors, including fewer obstacles to abortion in state law, the absence of mandatory sex education, poverty, and a lack of education on contraception (Hartocollin 2/3).

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8. Health Care Providers Look For New Ways to Serve Diverse LGBT Community

A recent article from The Oregonian discussed “shifting public health perspectives” of health officials to focus on the unique needs of members of the LGBT community.

Although gay men continue to be disproportionately affected with HIV and AIDS, advancements in science and technology have made the disease more manageable which has led to a new focus on chronic diseases, mental illness, and general wellness of the LGBT community. As the LGBT community grows in states like Oregon and Washington, health professionals are being educated to address unique health care needs. “People in medical school actually don’t get a lot of training on how to talk about someone’s sexual health… for a lot of health care providers those can be uncomfortable (conversations) for people to have,” says Toevs, manager of the STD, HIV, Hepatitis C Program in Multnomah County. The Benton County Health Department has taken the initiative to address access and equity barriers by offering its staff transgender health training and is also planning to expand its efforts to medical professionals. Although gay and lesbian health concerns have surfaced among the medical community, health access for transgender people continues to be a problem, despite the efforts of some organizations such as Outside In Clinic, a nonprofit in Portland which began a monthly transgender clinic eight years ago to give patients an opportunity to be seen by health professionals who understand their unique needs.

Hector Vargas, executive director of the Gay & Lesbian Medical Association, notes that the efforts underway in Portland and nationwide are the result of efforts “to not only educate the health care providers about disparities that affect the LBGT community, but also to educate LGBT individuals and patients so that they can be empowered.” (Navas 2/01).

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9. How Much Help Someone Gets from Medicaid in New York State Depends on Where They Live

The Post-Standard (New York) recently explored New York’s geographic disparity in personal care services paid for by Medicaid, and found that while elderly New York City residents are provided with more personal care services than elderly residents in Onondaga County, they have decreased usage of nursing home care.

Medicaid is the government program that provides health care services to some low income, elderly and disabled residents. New York is experiencing an “upstate-downstate disparity” in home health care as individuals in New York City are more likely to be approved for up to 24 hours a day of personal care compared to Onondaga County’s average of 10 hours a week. According to Sarah Merrick, of Onondaga County Social Services Department, “there are no more than two cases of around-the-clock personal care.” Spending and enrollment on personal care also varies. New York City spends about $32,671 per patient on personal care and has 54,626 patients enrolled. Onondaga County spends about $10,002 per patient and has 925 patients enrolled. According to experts, the regional variations stem from “inconsistencies in the way local governments run Medicaid.” State Senator John DeFrancisco (R-Syracuse) noted that “there’s no incentive for New York City to control personal care spending because those costs go on the back of state taxpayers,” and he spoke out against the “abuse of what personal care is supposed to be about.” The federal government sued New York City for overbilling Medicaid for improperly approving 24-hour personal care for 17,500 people over the last 10 years which accumulated to $75,000 to $100,000 for each person.

Personal care services are just one part of the total long-term care spending paid for by Medicaid. A recent report by Michael Birnbaum of the United Hospital Fund, found usage of nursing home care, which is more expensive than personal care services, was greater in Upstate New York (Mulder 1/30).

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10. Chinese Health Initiative Aims to Tackle Health Disparities

A recent article from The Mercury News (California) discussed the efforts of El Camino Hospital in Silicon Valley to improve the health of its Asian population by launching a Chinese health initiative program.

In response to an Asian population in the Silicon Valley that increased 26 percent between 2000 and 2007, El Camino Hospital launched the first Chinese Health Initiative in Silicon Valley. Health disparities are well documented in the Asian and Pacific Islander community. According to a recent report from the California Office of Statewide Health Planning and Development, Asians and Pacific Islanders have the highest mortality rate for heart attack, stroke, pneumonia, coronary artery treatment, and coronary bypass graft surgery. Asian and Pacific Islanders are also more likely than the general U.S. population to be diagnosed with Hepatitis B, a virus that often leads to liver cancer. Dr. Peter Fung, medical director of the El Camino Hospital Stroke Center, noted that “access to culturally appropriate and language-specific providers has traditionally been lacking,” which often “creates obstacles to their ability to seek needed preventive care, diagnosis, and treatment.”

Health screenings and preventive services are only part of the efforts to increase culturally competent care, Jean Yu, manager of the Chinese Health Initiative, noted that El Camino Hospital has included Chinese porridge to their inpatient breakfast menu (Wilson 1/27).

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11. Racial Stereotypes Can Follow Us to the Grave, Researchers Say

A recent article in the Los Angeles Times discussed the findings of a new study from the journal PLoS ONE, which found that the identification of an individual’s race on their death certificate may be influenced by racial stereotypes held by the coroner.

Using data from the 1993 National Mortality Followback Survey, researchers analyzed 22,905 comparing the racial classification of an individual on the death certificate with that of family identification, and found that in 1.1% of cases, racial classification on the death certificate was incorrect. According to sociologists from UC Irvine and the University of Oregon in Eugene, an official’s perception of racial classification may be influenced by the way the person died. The researchers noted that African Americans and Native Americans were more likely to be subjected to racial stereotypes. For example, Native Americans are 2.6 times more likely to die of cirrhosis of the liver than other racial or ethnic groups, but when researchers controlled for demographic factors (income, residence, etc.), people who died of cirrhosis were 2.9 times more likely to be identified as Native Americans. Similar findings held true for homicide victims whom researchers found were 4.4 times more likely to be perceived as African Americans when controlling for demographic factors (Income, occupation, etc.).

The authors noted that these findings “undermine the accuracy of important data on disease and public health risks” which may skew official vital statistics (Kaplan 1/26).

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DISPARITIES IN RESEARCH

12. Insurance-Associated Disparities in Hospitalization Outcomes of Michigan Children

A recent study from The Journal of Pediatrics examined hospitalization outcomes among children with private, public, or no health insurance, and found that children with private insurance had better health outcomes, fewer hospital charges, and lower readmission rates for neonatal related problems.

Using 2001-2006 data from the Michigan Inpatient Database (MIDB), the authors compared the hospitalization rates for children in Michigan and found that out of the 63,261 total hospitalizations in 2006, 59% had private insurance and 41% had either public or no insurance. Between 2001 and 2006, hospitalization rates significantly increased for children with public or no insurance whereas rates for children in private insurance plans decreased (OR=1.68, p<0.001). Hospitalization for emergency department admission, chronic disease, asthma, diabetes, vaccine-preventable disease contributed to the differences with the exception of hospitalization rate for appendectomy with appendicitis. The authors also found adverse birth outcomes in all category-specific hospitalization rates (e.g. bronchiolitis, psychiatric disease, etc.) for children with public or no insurance compared to children with private insurance, with the exception of hypoglycemia, where the rates were lower but did not significantly different. Hospital charges also varied between both insurance types with children in public or no insurance paying $464 more per child compared to those with a private plan. Excess hospital charges were estimated to be $401.8 million for children covered with public insurance and pediatric patients.

The authors noted that although Michigan has one of the lowest uninsured rates among children, significant insurance-associated disparities in hospitalization exists in morbidity and mortality, and state that “there is an urgent need for more robust and transparent data sources if we are to understand and remedy the causes of these disparities in outcome.”

(Peterson TH, Peterson T, et al. “Insurance-Associated Disparities in Hospitalization Outcomes of Michigan Children.” The Journal of Pediatrics, 158, no. 2. (February 2011): 313-318).

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13. The Cross-Cultural Variation of Predictors of Human Papillomavirus Vaccination Intentions

A recent study from the Journal of Women’s Health examined cross-cultural variation of predictors of vaccination intentions among Hispanic, non-Hispanic white, and African American mothers of adolescent girls, and found racial and ethnic variations in the predictors of vaccinations intentions.

A total of 150 African American, Hispanic, and non-Hispanic white mothers were recruited via convenience sample and asked to complete a questionnaire that was available in both English and Spanish. In addition to being asked about their intention to vaccinate their daughter(s) against HPV, the mothers were also asked about their perceptions of the benefits their daughter(s) would receive from the vaccination, whether any of their friends’ daughters had been vaccinated (norms), and perceived harm associated with the vaccine, which included not only vaccine side effects, but unintended consequences related to sexual activity. To control for demographic factors, the authors recruited mothers who were receiving services through the Women Infant and Children (WIC) federal program at one of four clinics in Milwaukee, Wisconsin. However, significant differences in education level and insurance status remained. Hispanic mothers were less likely to be insured and more likely to have only a high school education than both white and African American mothers. Prior experience with HPV, cancer, and STI varied among ethnic groups. Non-Hispanic white and African American mothers were more likely than Hispanic mothers to know a relative or friend with a cervical cancer diagnosis or STI. The authors found that having friends whose daughters had been vaccinated was the only variable that predicted vaccination intentions for Hispanic mothers, knowing a relative or friend who has been diagnosed with cancer and health beliefs predicted vaccination intentions for non-Hispanic white mothers, and prior diagnosis of an STI and health beliefs were significant predictors for African American mothers. Although demographic characteristics varied by education and insurance status, both factors were not found to emerge as significant predictors.

The authors noted that culturally tailored interventions to promote HPV vaccination are needed. For instance, reaching out to Hispanic women may be done by targeting norms, instead of attitudes, while reaching out to African American mothers may be done by targeting risk perceptions of HPV.

(Lechuga J, Swain GR, and Weinhardt LS. “The Cross-Cultural Variation of Predictors of Human Papillomavirus Vaccination Intentions.” Journal of Women’s Health, 20, no. 2. (February 2011): 225-230).

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14. Obesity Is Associated With Breast Cancer in African-American Women but Not Hispanic Women in South Los Angeles

A recent study published in the journal Cancer examined the relationship between obesity and breast cancer among African American and Hispanic women in South Los Angeles, and found that African American women in South Los Angeles were more likely to exhibit a greater association between obesity and breast cancer.

African American and Hispanic women from the Mammography Clinic or the Hematology/Oncology Clinic at the Martin Luther King Ambulatory Care Center (MACC) located in South Los Angeles were recruited for the study between 1995 and 2007. Women were included or excluded based on self-reported race and ethnicity (analyses were limited to African American and Hispanic women only), the confirmed presence or absence of breast cancer, being over 30 years old, baseline body mass index (BMI), and the confirmed presence of at least one comorbidity. The final sample size consisted of 471 women, 237 cases and 234 controls. Controls were matched by age and race and ethnicity. The authors found an association between breast cancer and obesity for the entire population, such that women diagnosed with breast cancer were more likely to be obese than women without breast cancer. In stratified analyses, the relationship between obesity and breast cancer was significant for African American women, but not for Hispanic women. Similar findings were noted for postmenopausal women and breast cancer among African American women, but not among Hispanic women. The authors also found that premenopausal status in African American women remained significant after controlling for BMI status.

The authors noted that Hispanic women may have protective factors which decrease their likelihood of breast cancer with obesity including differences in metabolic processes and genetic differences. The authors also suggest there is a need for community oriented and culturally appropriate public health interventions in the African American community.

(Sarkissyan M, Wu Y, and Vadgama JV. “Obesity Is Associated With Breast Cancer in African-American Women But Not Hispanic Women in South Los Angeles.” Cancer, (Februrary 8, 2011).

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15. Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care

Black Medicare patients and patients from minority-serving hospitals have higher readmission rates after hospitalizations for heart attack, congestive heart failure, and pneumonia than non-minority recipients, according to the findings of a study published in the The Journal of the American Medical Association.

Few studies have documented racial and ethnic disparities in readmission rates, and this is the first time the study is performed at a national level for three common conditions: acute myocardial infarction (MI), congestive heart failure (CHF), and pneumonia. Using data from the Medicare Provider Analysis Review (MedPAR), the authors examined hospitalizations with discharge diagnoses of acute MI, CHF, or pneumonia, compiling a final sample size of 3,163,011 discharges. The authors identified hospital characteristics (size, patient insurance, and nurse to census ratio) and minority-serving hospitals based on the proportion of its Medicare patients who were black, to evaluate site of care influences on risk-adjusted adds of all-cause 30-day readmission. The authors found that overall black patients had a 13% higher odds of readmission than white patients (p<0.001), and patients being treated in hospitals designated as minority-serving had a 23% higher odds of readmission than patients from non-minority serving hospitals. Patient race and site of health care were both significantly associated with readmission rates when analyzing the three conditions separately. Furthermore, regardless of site of care, black patients with acute MI had a 13% higher odds of readmission (OR = 1.13; 95% CI: 1.10-1.16; p<0.001) and patients from minority-serving hospitals had 22% higher odds of readmission, irrespective of race (OR = 1.22; 95% CI: 1.17-1.27; p<.001). White patients from non-minority serving hospitals had the lowest readmission, while black patients in minority-serving hospitals had the highest readmission rate. The authors also noted that minority serving hospitals were more often large public teaching hospitals, were staffed by fewer nurses per 1,000 patient days, served a higher proportion of Medicaid patients, and had lower performance on quality and cost measures (HQA scores) than non-minority hospitals.

The authors noted that racial and ethnic disparities in hospital readmission rates are possibly due to a “system problem” and not differential outcomes between racial groups. With sites of care influencing patient health outcome, the authors suggest that limited availability of high-quality outpatient care from minority-serving hospitals, failure to prioritize quality, and poor coordination of care may contribute to readmission disparities. The authors also note that policies penalizing for poor hospital performance may disproportionately affect minority-serving hospitals, and suggest experts evaluate how such penalties will affect disparities in care.

(Joynt KE, Orav EJ, Jha AK. “Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care.” Journal of American Medical Association, 158, no. 2. (February 2011): 313-318).

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16. Gender Differences in Financial Hardships of Medical Debt

According to the findings of a study published in the Journal of Health Care for the Poor and Underserved, women were less likely to report having financial hardships associated with medical debt than men.

Using data from the 2003 Community Tracking Study (CTS) Household Survey, the authors collected health and health care market information from 60 communities across the United States to analyze gender differences in financial hardships of medical debt. The researchers analyzed predisposing factors (i.e., gender, race/ethnicity, age, marital status, and education), enabling factors (i.e., rural residency, income, type of health coverage, usual source of care, employment status, and total out-of-pocket expenditures in last 12 months), and a need factor (perceived health status) in a final sample size of 4,747 respondents, to analyze self-reported financial hardship resulting from medical debt. Analyses revealed that women were more likely to be insured, have more than a high school education, have less out-of-pocket medical costs, report lower incomes, and more likely to report poor/fair health status than men. Consistent with previous research, the authors found that medical debt has financial consequences such as having problems with paying for living necessities requiring the use of savings and credit cards to pay for medical debt. Women were less likely to report financial hardships (b = -0.24, p<.05), being contacted by a collection agency (b = -0.15, p<.05), and using savings (b = -0.23, p<.005) associated with medical debt than men. Low income individuals and the uninsured were also more likely to incur financial hardships associated with medical debt compared to high-income individuals and those who are privately insured.

The authors noted that implementation of health care reform may reduce the number of uninsured individuals, but affordability of health coverage may continue to be a barrier to health care access. By ensuring resources to low-income serving health care facilities, incurring medical debt by low income and uninsured individuals can be avoidable.

(Wiltshire JC, Dark T, et. al. “Gender Differences in Financial Hardships of Medical Debt.” Journal of Health Care for the Poor and Underserved, 22, no.1. (February 2011): 371-88).

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17. Prevalence Differences of Psychiatric Disorders Among Youth After Nine Months or More of Incarceration by Race/Ethnicity and Age

In a recent study published in the Journal of Health Care for the Poor and Underserved, researchers evaluated racial, ethnic, and age differences in psychiatric disorders among incarcerated youth and found that white males had the highest burden of psychiatric disorder.

The authors conducted a nine month post-incarceration diagnostic interview on 790 (140 girls) youth from the California Department of Correction and Rehabilitation, Division of Juvenile Justice (DJJ) between October 1997 and June 1999, to identify disparities in psychiatric disorders. Diagnoses were made using the Structured Clinical Interview for DSM-IV (SCID) and the Diagnostic Interview for Children and Adolescents (DICA). The final sample was 28% African American, 47% Hispanic, 17% non-Hispanic White, and 8% other races and ethnicities. Fifty four percent of the youth were committed for violent offenses, 29% for property offenses, 6% for drug offenses, and 11% for other offenses. The authors found that among boys, whites had the highest burden of any psychiatric disorder and psychosis. Hispanic and white boys shared the highest burden of each of the substance-related disorders, and marijuana dependence was highest among African American boys. Furthermore, older boys exhibited a higher level of substance dependence and anxiety disorder than younger boys. Among girls, the researchers found that whites tended to have the highest rates for each psychiatric disorder, and the rate for mania was higher in older girls.

The authors underscored the importance of understanding racial and ethnic differences in mental health disparities to provide appropriate interventions. The authors also suggested that our society re-examine mental health care services within the juvenile justice system to provide a “culturally and developmentally-informed approach to treating psychopathology among juvenile offenders.

(Karnik NS, Soller MV, et.al. “Prevalence Differences of Psychiatric Disorders Among Youth After Nine Months or More of Incarceration by Race/Ethnicity and Age.” Journal of Health Care for the Poor and Underserved, 21, no. 1. (February 2011): 237-50).

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18. Young Asian Americans’ Knowledge and Perceptions of Cervical Cancer and the Human Papillomavirus

In a recent study published in the Journal of Immigrant and Minority Health, researchers evaluated knowledge and perceptions of Asian American males and females regarding cervical cancer and HPV, and found disparities in knowledge exist across Asian subgroups with Filipino women having the greatest amount of information on cervical cancer and HPV.
Cervical cancer and HPV disparities persist in Asian American women. Previous research has focused on cultural attitudes, knowledge, and perception to identify contributing factors to disparities in HPV and cervical cancer diagnosis. With the aid of community-based organizations, the authors identified 52 participants (16 Korean, 18 Vietnamese, and 18 Filipino), including men and women, and evaluated cervical cancer screening rates and knowledge content. Using a focus group and interview approach, the authors found that Korean and Vietnamese women had the lowest rates of Pap testing, 13% and 10% respectively, and the rate among Filipino women was highest at 70%. Knowledge was evaluated by asking respondents “if they ever heard of cervical cancer, cervical cancer screening, or HPV.” The results showed that Filipino men and women have greater knowledge of HPV and cervical cancer screening. All Vietnamese women said they had heard of cervical cancer compared to 90% of Filipinas and 63% of Koreans. In all cases, male respondents were less likely to have heard of “cervical cancer” or “HPV” than their female counterparts. When asked to discuss their knowledge content of HPV or cervical cancer, Filipino females provided the most knowledge content.

The authors concluded that there are marked differences among the three Asian American groups regarding their knowledge and perception of cervical cancer and HPV and more information regarding their risks and prevention is needed for each. The authors noted that this was the first study to include male participants in an Asian American cervical cancer study.

(Gor BJ, Chilton JA, et.al. Young Asian Americans’ Knowledge and Perceptions of Cervical Cancer and the Human Papillomavirus.” Journal of Immigrant and Minority Health, 13, no. 1. (February 2011): 81-86).

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19. Immunization Disparities by Hispanic Ethnicity and Language Preference

A recent study in the journal of Archives of Internal Medicine compared pneumococcal and seasonal influenza immunization rates among Hispanic seniors with language preferences with those of non-Hispanic whites, and found disparities in both influenza and pneumococcal immunization rates between English- and Spanish-speaking Hispanics and non-Hispanic whites.

The authors used data from the 2008 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS), a stratified random sample of Medicare beneficiaries, and included in their study population data from community-dwelling Hispanic and non-Hispanic white beneficiaries ages 65 years and older who reside in the continental US. The final study sample included 247,832 respondents who identified as either Hispanic or non-Hispanic white and answered at least one of the immunization questions. The authors found that a greater share of non-Hispanic white seniors (76%) reported receiving an influenza immunization than English-preferring (68%) and Spanish-preferring Hispanic seniors (64%, p<0.001). Similar results were observed for receipt of the pneumonia vaccine. One-third of pneumococcal immunization disparities and one-half of the influenza immunization disparities were associated with differences in socio-demographic characteristics. When looking at differences in the type of Medicare a beneficiary has (e.g. Medicare Advantage (MA) vs. fee-for-service (FFS)), the authors found greater disparities between Spanish- and English-preferring Hispanics in pneumococcal immunization rates for patients in FFS compared to MA. The authors also found that for all groups, areas identified as being high in linguistic isolation, as measured by the proportion of the population in the county with limited English proficiency and who speak Spanish at home, had low immunization rates compared to areas identified as low linguistic isolation. Although immunization rates were low for all groups, Hispanic individuals had lower immunization rates than non-Hispanic whites. Long standing Hispanic communities were also studied and found to have small to non-existing influenza immunization disparities. This finding did not hold true for pneumococcal immunizations as all groups had low pneumococcal immunization rates.

The authors noted the importance of improving cultural and linguistic access to care services for Hispanic seniors living in high risk areas and the significance managed care plays in improving the health of Hispanic seniors regardless of language preferences.

(Haviland AM, Elliott MN, et. al. “Immunization Disparities by Hispanic Ethnicity and Language Preference.” Archives of Internal Medicine, 171, no. 2. January 2011): 158-65).

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20. Social Disparities in Internet Patient Portal Use in Diabetes: Evidence that the Digital Divide Extends Beyond Access

A recent study published in the Journal of the American Medical Informatics Association examined differences in utilization of information technology among diabetic patients in Northern California, and found that African Americans, Latinos, and people with lower levels of education were less likely to use the internet-based patient portal to access medical care services than non-Hispanic Caucasians or persons with a higher level of education.

Using data from the Kaiser Permanente Northern California (KPNC) Diabetes Registry, researchers identified obtained survey responses for 20,188 patients about their usage of members-only web portal, and included data from 14,102 patients who reported speaking and reading English, had adequate vision, and had been enrolled in KPNC for all of 2006. Respondents were tracked to determine whether they requested a password, activated their accounts, logged on, and completed the log on step that would allow them to view lab results, email their provider, make appointments, and request medication refills. The authors found differences in utilization among racial and ethnic groups and among individuals with different levels of educational attainment. Compared to 51% of non-Hispanic whites, only 31% of African-Americans and 21% of Latinos requested a password (p<0.01). Similar differences were found when the authors analyzed educational attainment and web portal usage. Compared to those with a college degree, patients with lower levels of educational attainment had a greater odds of never logging on. Use of individual web functions (e.g. viewing lab results, emails, appointments, etc.) also differed by race and ethnicity and educational attainment, such that individuals with lower educational attainment and racial and ethnic minorities were less likely to use the web functions than non-Hispanic whites and individuals with higher educational attainment.

The authors offered several theories to explain the observed differences and underscored the internet’s potential to enhance comprehensibility of health care and health promotion. They noted that “barriers to internet-based healthcare services require attention to disadvantaged groups and tailoring services as well as expanded computer/internet access.”

(Sarkar U, Karter AJ, et. al. “Social Disparities in Internet Patient Portal Use in Diabetes: Evidence that the Digital Divide Extends Beyond Access.” Journal of the American Medical Informatics Association, (January 24, 2011) doi: 10.1136/jamia.2010.006015).

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21. Receipt of Preventive Counseling among Reproductive-Aged Women in Rural and Urban Communities

According to the findings of a study published in the Rural and Remote Health Journal, women living small or isolated rural areas are less likely to receive preventive counseling compared to women living in large rural and urban areas.

Prior research has focused on availability of health care providers and health literacy levels as contributors to rural and urban health disparities. Few studies have focused on the availability of preventive counseling as a contributing factor to rural and urban health disparities. Analyzing data from the Central Pennsylvania Women’s Health Study’s (CePAWHS’s) random digit-dial telephone survey that oversampled rural communities, the researchers evaluated the receipt of four preventive services with Level A or B recommendations from the US Preventive Services Task Force (USPSTF). These included screening and counseling for tobacco, screening and counseling for alcohol misuse, periodic routine counseling about effective contraception for adults at risk of unintended pregnancy, intensive counseling and behavioral interventions to promote sustained weight loss among obese patients. The authors found that both urban and rural women were equally likely to report having a regular health care provider. However, both groups of women had low rates of receiving preventive counseling services, ranging from 12% for alcohol counseling to 37% for diet and nutrition. Although both rural and urban counseling receipt were low, rural women were less likely to receive nutritional and physical activity counseling compared to urban women, and women living in isolated rural areas were significantly less likely than urban and rural women to receive smoking, alcohol/drug use, and birth control counseling. However, after controlling for demographic, healthcare access, and health behaviors in a multivariate model, no independent association was found between rurality and the receipt of such preventive counseling, with the exception of physical activity counseling. The authors also found that women who were younger, who had higher educational attainment, and who saw an obstetrician-gynecologist had greater odds of receiving preventive counseling.

The authors suggested that since living in a rural community was not typically associated with access to counseling services, there may be predisposing, enabling, and need predicting factors may account for urban health disparities. The authors suggest that efforts to reduce these disparities should focus on “increasing health literacy of the reproductive-age rural population, educating providers about preventive counseling, and expanding access to obstetrician-gynecologists in rural communities.”

(Gor BJ, Chilton JA, et al. “Receipt of Preventive counseling Among Reproductive-aged Women in Rural and Urban Communities.” Rural and Remote Health Journal, 13, no.1. (January 28, 2011): 81-86).

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DISPARITIES DATA SPOTLIGHT

Note: No opinion answers not shown.
Source: Washington Post/Kaiser Family Foundation/Harvard University Race and Recession Survey (conducted January 27-February 9, 2011)

The Washington Post/Kaiser Family Foundation/Harvard University Race and Recession Survey, conducted Jan. 27-Feb. 9, 2011, examined the impact the recent recession has had on individuals and families across the country. The recession had a broad impact on the lives of many Americans, and in some instances the impact was worse for blacks and Hispanics. Yet, in spite of the challenges they face, 6 in 10 blacks and about half of Hispanics are optimistic that their family’s financial situation will improve over the course of the next year.

To read more about the findings of the survey, please read The Washington Post/Kaiser Family Foundation/Harvard University Race and Recession Survey.