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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. 1. D.C. Residents See AIDS as City's Biggest Health Problem
DISPARITIES IN RESEARCH 9. Disparities in Breast Cancer Characteristics and Outcomes by Race/Ethnicity
DISPARITIES DATA SPOTLIGHT Most Blacks and Latinos Looking for More Information on HIV/AIDS
DISPARITIES IN THE NEWS 1. D.C. Residents See AIDS as City's Biggest Health Problem An article published in The Washington Post discussed the findings of a recent poll in which residents of the District of Columbia said HIV/AIDS is the most urgent health problem facing the District, and in which racial disparities in the level of concern were observed. The poll, a product of a partnership between the Washington Post and the Kaiser Family Foundation, was conducted by telephone between May 10 and 31, 2011, and included 1,342 adults in the District. More than one in three D.C. residents considers HIV/AIDS to be the city's most urgent health problem. The poll also measured personal concern for becoming infected and found significant racial differences. While 1 in 10 white residents said they were concerned about becoming infected personally, more than 4 in 10 black residents said they were concerned. "This is very serious in the District," said Leon Williams, a retired machine operator. "I have a friend personally that has it, and I've seen all the drugs he takes to stay alive." Approximately 16,000 people are living with the disease in the District, and with more than 3 percent of residents over the age of 12 infected, the District has one of the highest prevalence rates in the country. Not surprisingly, District residents are more apt to say the either know someone who is living with the disease or has died from it when compared to those surveyed nationally (58 percent vs. 41 percent)(Fears, Craighill, and Arnsdorf 6/20).
2. Feds Seek to Close African-American Health Gap An article in USA Today reported on the efforts of several individuals in Alabama working with the Federal government to tackle health disparities among blacks. Through a program operated by the Centers for Disease Control and Prevention (CDC) and the University of Alabama Birmingham, Clara Robertson from Montgomery, Alabama, has been given a chance to help local community members make healthier decisions by providing education and support to women facing cancer. The article acknowledged that blacks are progressing in areas of the economy and education, but the gaps between blacks and other racial and ethnic populations persists for many health conditions. According to the CDC, the heart disease death rate for blacks is 247 per 100,000 deaths, and 191 per 100,000 for all other racial and ethnic populations. Furthermore, the cancer death rate for blacks is 216 per 100,000 deaths and 178 per 100,000 for all other racial and ethnic populations. Michelle Gourdine, a pediatrician at John Hopkins School of Public Health, noted that poverty and a fatalistic attitude contribute to the persistent disparities. As part of the new health care law, The Department of Health and Human Services (HHS) issued a plan in April that is aimed at better understanding and addressing health disparities. In May, HHS announced that it would make available $100 million to be used as community grants for programs that promote healthier lifestyles among groups that experience higher rates of chronic illness. Regarding her work, Ms. Robertson commented that "One thing I've learned: They don't want sympathy. They just want to get through . . . Sometimes, it's just listening, getting them transportation, [and] getting the utility bills paid so they can begin to recover." (Heller 6/16).
3. Life Expectancy of U.S. Women Slips in Some Regions According to an article published in the Chicago Tribune, women's life expectancy rates have decreased in the last decade in some areas of the United States. Although the life expectancy rates among men and women in the United States have risen over the past two decades, the gap between the most and least healthy places to live in America has widened for women, and in some places life expectancies have actually declined. More than 730 counties in the United States documented a decline in women life expectancy rates between 1997 and 2007, up from 227 between 1987 and 1997. These declines are made worse by smoking, obesity and high blood pressure. In some areas, these rates are comparable to those seen in countries like Syria, Panama, and Vietnam. According to the data from the United Nations, women's life expectancy at birth in the United States was 81.3 years in 2007, placing the country 35th in the world. That is down from 20th in 1987. In regards to the findings, Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, where the study was conducted, said "There are just lots of places where things are getting worse." Dr. Murray and others noted that culture and sustained public health efforts appear to help. For example, New York City initiated aggressive anti-smoking and anti-obesity campaigns and has one of the higher life expectancy rates in the nation. Moreover, 12 states, including Pennsylvania those in New England had no counties that experienced a decline in life expectancy (Levey 6/15).
4. Socioeconomics Influence HIV/AIDS Infection Rate A recent article from The Columbia Daily Tribune discussed a new interactive map from the Rollins School of Public Health at Emory University, which highlighted geographic disparities in HIV prevalence rates. According to Dana Hughes, HIV health educator for the Columbia/Boone Country Department of Public Health and Human Services, "There's growing evidence that social determinants influence health." She went on to say that HIV is a "problem that has left the spotlight a little bit but continues to persists, locally, and globally," and providers remain focused on prevention and early treatment efforts (Jackson Jr. 6/14).
5. Mammograms' Value Debated, Especially For Older Women The role of mammograms in reducing breast cancer mortality was the topic of conversation at a forum at the Harvard School of Public Health and of a recent article from The Washington Post. The forum, which consisted of doctors and policy officials, debated the role annual mammograms have in reducing breast cancer mortality as compared to treatment advances. When mammograms first became available, women were encouraged to "catch-it-early-when-it's-curable." Over time however, the understanding of breast cancer has changed as scientists have learned more about the biology of cells. "There are some tiny cancers that are destined to relapse no matter how early you find them, while other large aggressive cancers may not even spread," said Julie Gralow, a professor of oncology at the University of Washington Medical School. Experts noted that access to good care was a contributing factor in reducing death rates from the disease. The article also noted that the debate for when it is most efficacious to screen persists. Whereas European countries recommend mammography screening for women between the ages 50 to 69 years, the United States encourages annual screening, beginning at age 40. Opponents believe that over-detection may lead to unnecessary medical treatments causing more harm than good including surgery, drugs, or radiation. The article noted that sometimes research and personal experiences collide. For example, Mette Kalager, a surgeon at Oslo University Hospital and a visiting scientist at the Harvard School of Public Health, discussed the findings of a study she led in Norway that analyzed the records of 40,075 women who were diagnosed with breast cancer between 1986 and 2005, and found that only a third of the decline in death rates was due to screening. She said, "The evidence seems to be that mammography screening plays less and less of a role in reducing mortality in countries of the Western world." These findings contradicted the experience of Felicia Knaul, director of the Harvard Global Equity Initiative, who was diagnosed with breast cancer during her baseline mammogram at age 41. "If anything saved my life, in addition [to expert care], it is that mammogram," she said. The author concluded that in the end, "there's a lot of sorting out to do." (Trafford 6/13).
6. Children on Medicaid Shown to Wait Longer For Care A recent article from The New York Times discussed the findings of a study from The New England Journal of Medicine, which found that children with Medicaid-CHIP coverage are more likely to have poor access to medical specialists compared to those with private health coverage. Medicaid-CHIP (Children's Health Insurance Program) provides health insurance to many low-income children. The study had researchers pose as the parent of a sick or injured child. They called more than 270 specialty practices in Cook County, Illinois to schedule appointments between January and May 2010. The authors found that 66 percent of "parents" who said their child was covered through Medicaid-CHIP were either denied an appointment or waited an average of 22 days longer than 11 percent of "parents" who said their children had private insurance. According to Dr. Karin V. Rhodes, an author of the study and director of Emergency Care Policy Research in the Department of Emergency Medicine at the University of Pennsylvania, said the idea for the study came from a law suit filed by health advocates in 2004, against the state of Illinois on behalf of 600,000 children covered by Medicaid. As she put it, "There's never been a study this comprehensive or this rigorous that actually measured access to specialty care, let alone children's access." Other studies by Dr. Rhodes and her colleagues have found more challenges accessing dental and psychiatric care for individuals with public insurance coverage than for those with private coverage. Mike Claffey, a spokesman for the Illinois Department of Healthcare and Family Services, said the study "highlights an issue that has been and continues to be an area of focus" for his agency and Medicaid programs in all states (Grady 6/12).
DISPARITIES IN RESEARCH 7. Racial and Ethnic Disparities in Postpartum Depression Care among Low-Income Women A recent study from the journal Psychiatric Services examined racial and ethnic differences in the use of mental health care related to postpartum depression among Medicaid recipients, and found that black and Latina women were less likely to initiate care or to receive follow-up treatment compared to white women. Previous studies have shown that postpartum depression rates do not differ by race and ethnicity. However, information on utilization rates among low income women from racial and ethnic minority groups remains limited. Using administrative data from the New Jersey Medicaid program, the researchers identified 29,601 women who gave birth between July 1, 2004 and October 31, 2007, had their delivery covered by Medicaid, and were continuously enrolled in Medicaid for at least six months before they gave birth and one year afterwards. Outcome measures included: 1) the initiation of postpartum mental health treatment, as measured by having filled a prescription for an antidepressant or having had an outpatient mental health visit within six months of delivery; 2) follow-up, as measured by refilling a prescription for an antidepressant or having a second outpatient visit; and 3) receipt of continued care, as measured by filling a prescription at least three times or having three visits. The results indicated that black (4%) and Latina (5%) women were less likely to initiate antidepressant treatment or outpatient mental health services in the six months after delivery, compared to white women (9%). Black (23%) and Latina (27%) women were also less likely to receive follow-up care than white (44%) women. Among women who initiated treatment, black (AOR = 0.37) and Latina (AOR = 0.43) women had a lower odds of refilling a prescription within the 120-day acute treatment phase compared to white women. Racial and ethnic disparities were also found in the time between delivery and treatment initiation, which was greater for black and Latina women than for whites. The authors concluded that their study demonstrates evidence of racial and ethnic disparities in the rates of postpartum depression treatment initiation and continuation. They suggested that their findings point "to the need for clinical and institutional policies and programs to address the particular barriers to mental health care faced by black and Latinas in the months after delivery." (Kozhimannil KB, Trinacty CM, et. al. "Racial and ethnic disparities in postpartum depression care among low-income women." Psychiatric Services. June 2011; 62(6): 619-25).
8. Obesity among Working Age Adults: The Role of County-Level Persistent Poverty in Rural Disparities A recent study from the journal of Health and Place examined the factors related to obesity among residents living in persistently poor, rural, and urban counties, and found that both individual and county-level factors influence a resident's likelihood of being obese. Using data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS), from over 230,000 adults between the ages of 18 and 65 years, combined with county-level data extracted from the Area Resource File (ARF) and the Food Environment Atlas of the US Department of Agriculture, the authors compared obesity rates in three geographic areas: 1) Urban, 2) Persistent Poverty Rural (PRR) (i.e. a county with 20% or more of the population below the poverty level in the census years 1960, 1970, 1980, and 1990), and 3) Other Rural. Fewer than 2% of sample resided in PPR counties; 82% resided in Urban counties, and 16% resided in Other Rural counties. Residents of Persistent Poverty Rural and Other Rural counties were more likely to be obese than residents of urban counties. The relationship between county type and obesity remained significant after controlling for sociodemographic variables including race, age, gender and marital status, but was no longer significant after controlling for county-level variables (e.g. the number of grocery stores per square miles, per capita fast food expenditure, access to quality food sources, etc.). However, even after controlling for individual and county-level characteristics, including being African American, female, low income, having lower educational attainment, and deferring needed health care due to cost were significantly associated with an increased odds of obesity. The authors concluded that community-level and individual characteristics contribute to the high rates of obesity found in PRR counties and suggested that in order to reduce obesity rates in these areas, efforts should be targeted towards those "factors that can be amenable to policy interventions, such as food availability and SNAP benefit levels." (Bennett KJ, Probst JC, et al. "Obesity among working age adults: The role of county-level persistent poverty in rural disparities." Health Place. 2011 Jun 10; doi:10.1016/j.healthplace.2011.05.012).
9. Disparities in Breast Cancer Characteristics and Outcomes by Race/Ethnicity A recent study published in Breast Cancer Research and Treatment examined racial and ethnic disparities within Asian, Hispanic and Pacific Islander subgroups of women and found higher rates of late-stage breast cancer diagnoses, as well as increased mortality rates among specific racial and ethnic subgroups. Racial and ethnic disparities in breast cancer are well documented; however, few studies have focused on breast cancer outcomes among racial and ethnic subgroups. Using data from 17 population-based cancer registries that participate in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program, the authors analyzed data from 229,594 women between the ages of 40 and 79 years who were diagnosed with invasive breast cancer between January 2000 and December 2006. The researchers were primarily interested in stage of diagnosis, joint estrogen receptor status, receipt of appropriate treatment, and breast cancer mortality. Analyses focused on four Hispanic subgroups - Mexican, South/Central American, Puerto Rican, and Cuban women; six Asian subgroups - Filipino, Chinese, Japanese, Asian Indian/Pakistani, Korean, and Vietnamese women; and two Pacific Islander subgroups - Hawaiian and Samoan women. Except for Asians, non-Hispanic white women had a lower odds of being diagnosed with stage IV tumors relative to all minority population groups. Among the Hispanic subgroups, Mexican and Puerto Rican women had the highest odds of being diagnosed with stage IV tumors, while Filipino and American/Pakistani women more likely to be diagnosed than the other Asian subgroups. Of all the women studied, Samoan women had the highest odds of having stage IV breast cancer (OR: 7.1; CI: 3.6-14.0), the highest odds of receiving inappropriate treatment (OR: 5.1; CI: 2.0-13.0), and a higher odds of breast cancer mortality (OR: 1.8; CI: 1.1-3.0). Black, Mexican and South/Central American women also had higher odds of receiving inappropriate treatment compared to non-Hispanic whites, and black, Hispanic white, and Hawaiian women had a higher odds of breast cancer-specific mortality compared to non-Hispanic whites. The authors noted that the disparities observed in their study are the result of many factors including socioeconomic status, access to care, lifestyle, and biology, but they also noted that many of the disparities observed remained even after controlling for some of these factors. (Ooi SL, Martinez ME, and Li CI. Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Research and Treatment. 2011 Jun; 127(3): 729-38).
10. High Asthma Prevalence and Increased Morbidity among Rural Children in a Medicaid Cohort A recent study published in the Annals of Allergy, Asthma & Immunology found evidence of some disparities in asthma prevalence and treatment between rural and urban Medicaid-enrolled children in Tennessee. Researchers followed 117,080 children continuously enrolled in Tennessee's Medicaid program in rural, suburban, and urban communities for the first 5½ years of their life to determine whether there are geographic differences in the prevalence and treatment of asthma. The children included in the study represented almost one in four of the live births in the state between 1995 and 2000. Among the children studied, 45 percent resided in urban counties, 23 percent resided in suburban counties, and 33 percent in rural counties. A greater proportion of the suburban and rural groups were white, whereas many of the children in the urban group were black. The results indicated that rural children had higher rates of asthma and allergic rhinitis compared to urban children, and had more outpatient visits, but had similar use of asthma rescue medications and similar asthma hospitalization rates. The study also found that urban children were more likely to have been prescribed inhaled corticosteroids (ICS). After controlling for demographic characteristics, rural children continued to experience higher rates of asthma and allergic rhinitis, and reported a slightly greater number of outpatient visits. The authors noted that this is one of a limited number of studies published that examines the relationship between asthma and rural children. They suggested that further research should expand on the present study and "identify appropriate interventions that are likely to differ from those for urban populations to improve outcomes in this disadvantaged population." (Valet RS, Gebretsadik T, Carroll KN, et. al. High asthma prevalence and increased morbidity among rural children in a Medicaid cohort. Annals of Allergy, Asthma & Immunology. 2011 Jun; 106(6): 467-73. Epub 2011 Apr 8).
11. Community-Level Determinants of Tobacco Use Disparities in Lesbian, Gay, and Bisexual Youth The result of a recent study published in Archives Pediatrics and Adolescents found that lesbian, gay, and bisexual (LGB) youth were less likely to report having used tobacco recently when they were in a more supportive environment. Using data from the Oregon Healthy Teens (OHT) study, which is modeled after the Youth Risk Behavior Survey (YRBS), researchers combined data from 2006 to 2008 to examine whether the social environment of LBG youth has an impact on their tobacco use in the past 30 days. The study included data from 31,852 youths in 297 schools and 34 counties. The researchers combined four indicators: 1) the proportion of same-sex couples in the county, 2) the proportion of schools with gay-straight alliances, 3) the proportion of schools with anti-bullying policies that specifically protect gay students, and 4) the proportion of schools with anti-discrimination policies that include sexual orientation, into an index of the social environment. The majority of respondents self-identified as heterosexual (90.3%), with 0.9% identifying as gay or lesbian, and 3.3% as bisexual. LGB respondents were significantly more likely to have smoked in the past 30 days compared to their heterosexual peers. The results indicated that high exposure to tobacco marketing and advertisements had very little impact on the amount of tobacco usage by LGB adolescents. In the final adjusted model, LGB youth still reported a greater odds of tobacco use. The social climate, school exposure, and the community socioeconomic status were all significant factors associated with tobacco use. The researchers suggested that because tobacco use is a leading preventable cause of death in the United States, "careful attention to common and unique concerns of LGB adolescents are needed to ensure that such population-based interventions attenuate, rather than exacerbate, existing sexual orientation-related disparities in tobacco use." (Hatzenbuehler ML, Wieringa NF, and Keyes KM. Community-level determinants of tobacco use disparities in lesbian, gay, and bisexual youth. Archives of Pediatrics and Adolescent Medicine. 2011; 165(6): 527-532. doi:10.1001/archpediatrics.2011.64).
12. Maternal Morbidity and Perinatal Outcomes among Foreign-Born Cambodian, Laotian, and Vietnamese Americans in Washington State, 1993 - 2006 The Journal of Immigrant and Minority Health published a study that examined the relationship between maternal nativity and birth outcomes among Southeast Asian women in Washington, and found significant differences in prenatal care and perinatal outcomes. Using data from the University of Washington Birth Events Records Database (UW_BERD), the researchers identified women who gave birth between January 1, 1993 and December 31, 2006, and compared the obstetric and birth outcomes of Cambodian, Laotian and Vietnamese women to those of non-Hispanic white women. The sample size included information from 3,858 Cambodian, 2,223 Laotian, and 12,949 Vietnamese, and a random sample of 35,581 white women. The researchers wanted to capture possible pre and post pregnancy complications. The outcomes measured included gestational diabetes mellitus (GDM), chronic hypertension, anemia, and more. The study found that compared to white women, Southeast Asian (SEA) women had greater odds of gestational diabetes, anemia, and certain SEA populations had an increased risk for preeclampsia, abruption placentae, and febrile illnesses. In contrast, SEA women had a lower odds of having many conditions including pre-gestational hypertension, cardiac disease, and acute/chronic lung disease, to name a few. After controlling for maternal nativity, SEA women were found to have a greater odds of delivering a low-birth weight infant than white women. The researchers concluded that within SEA women, foreign-born status is associated with a lower likelihood of adverse birth outcomes. The authors noted that their findings demonstrate the importance of considering nativity when "designing and carrying out interventions to prevent adverse pregnancy morbidity and outcomes." (Cripe SM, O'Brien W, Gelaye B, et. al. Maternal morbidity and perinatal outcomes among foreign-born Cambodian, Laotian, and Vietnamese Americans in Washington State, 1993 - 2006. Journal of Immigrant and Minority Health. 2011; 13(3): 417-425. doi: 10.1007/s10903-010-9328-6).
HIV/AIDS at 30: A Public Opinion Perspective
Compared to whites, blacks and Latinos would like to have more information on numerous HIV related topics. Seven in ten blacks say they want information on how to stop HIV from spreading and just as many want more information on how to talk to children about HIV. Six in ten want to know more about who should get an HIV test and where they might go to get one. For each topic, Latinos tend to express just as much interest as blacks. In sharp contrast, significantly fewer whites are interested in having more information. These findings are part of the results from the Foundation's eighth national survey on HIV/AIDS, which are detailed in the report, HIV/AIDS at 30: A Public Opinion Perspective. In addition to examining broad national trends in public opinion over the past few decades, the report also takes a closer look at the views and experiences of black Americans and young adults. To learn more about the findings from this national survey, please read HIV/AIDS at 30: A Public Opinion Perspective. |
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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. 
