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.

1. Connecticut Ranked Fourth-Healthiest State In The U.S.

An article in The Hartford Courant discussed the findings of a new report from UnitedHealth Group's foundation on the nation's health, which included state health rankings.

The study ranked states on a variety of measures, including access to care, smoking, obesity, diabetes, drinking, deaths from cancer and heart disease, and health disparities. Overall, the nation's health improved, but challenges remain. While the rate of tobacco use reached a 21-year low, rates for diabetes and obesity increased. The view from the states varied significantly. States in the New England region continued to rank among the top in the nation. Vermont maintained its position as the healthiest state, while Mississippi ranked 50^th. Several states were able to improve their rankings from 2009. For example, Georgia made the greatest gains, moving from 43^rd to 36^th, and Connecticut moved from 7^th to 4^th. Connecticut's improvement was attributed in part to lower rates of smoking, obesity and child poverty, and higher immunization rates.

Although Connecticut was able to improve its overall ranking, the article noted that it still has barriers to overcome, including high rates of binge drinking and infectious diseases, and an increase in the uninsured rate of its residents to 11 percent (Velsey 12/8).

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2. A Healthy Trend at Medical Schools

A recent article from the Boston Globe discussed the findings of a recent study from the Association of American Medical Colleges, which found a rise in minority student enrollment in medical schools across the country.

The study, reporting on the diversity of first-year medical students, noted that Native Americans experienced the largest enrollment growth, up 24.8 percent. Gains were found for other racial and ethnic populations as well, but the improvement was not as large as it was for Native Americans. Hispanics saw a 9 percent increase, while enrollment among African-Americans and Asians increased by less than 3 percent. Joyce Sackey, dean for multicultural affairs and global heath at the Tufts medical school noted that enrollment of underrepresented minorities at Tufts rose to 13 percent. She thinks the growth is partially the result of "an increasing number of scholarships for economically disadvantaged students."

In spite of the gains, there is still work that needs to be done. In the mind of Jonathan Woodson, an associate dean at Boston University School of Medicine, those issues are "primarily preparation for professional school as well as support for students while they are in medical school (Dunham 12/5)

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3. HIV Drugs Can Prevent Infection

The Windy City Times reported on a recent study published in the New England Journal of Medicine that found that Truvada used as a preexposure prophylaxis therapy can significantly reduce HIV infections among HIV-negative men who have sex with men (MSM).

The study included 2,499 men at 11 locations in 4 continents, and is the first large biochemical prevention study targeting the MSM community. The clinical trial divided participants into either the experimental group taking Truvada or the control group taking a placebo. In addition to the drug placement, both groups received routine counseling on HIV prevention. The authors found a 43.8 percent protection rate among individuals taking Truvada which was observed to increase up to 72.8 percent for individuals who took at least 90 percent of their medication. Dr. Robert Grant, M.D., the principle investigator of the study recorded the levels of the drug in the blood of those who became infected and found that "no drug was detected in 91 percent … which could explain all of the infections that did occur." Preexposure prophylaxis use of Truvada shows a significant step in preventing new HIV cases, however such advancement may be cost prohibitive to some who meet the treatment guidelines. Truvada costs $14,000 annually in the United States, and generic versions of the drug can be purchased for 40 cents a day in developing countries.

Dr. Anthony Fauci, director of the NIH National Institute of Allergy and Infectious Diseases said, "The iPrEx study results are extremely important and provide strong evidence that PrEP [ preexposure prophylaxis ] can reduce HIV acquisition among a segment of society disproportionately affected by HIV/AIDS," but added that "correct and consistent use of condoms and a reduction in the number of sex partners still remain the most effective ways to protect yourself from HIV infection" (Roehr 12/01).

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4. NAAM Exhibit Eyes African-American Health Issues

The Seattle Times recently reported on the Northwest African American Museum's (NAAM) effort to highlight health issues that disproportionately affect the African American community.

African Americans living in King County, Washington are disproportionately affected by certain conditions, including diabetes and heart disease. King County statistics show that one in three African American women over the age of 40 have not received a recent mammogram and that African Americans face a diabetes mortality rate that is three times higher than that of non-Hispanic Whites. NAAM's "checking our pulse" exhibit focused on heart disease, diabetes, HIV/AIDS, mother and infant issues, and breast cancer, five health issues for which African Americans are overrepresented. Each health issue featured a member of the medical community with an excerpt on how he or she has been affected by it. Devon Love, a project director for the Center for MultiCultural Health, portrays her family's struggle with heart disease, AIDS, and diabetes. It is hoped that the exhibit's bright colors and interactive displays will attract a wide range of museum-goers so that individuals can "see themselves reflected in the exhibit … and change medicine for the better." The museum's interactive portion features blood pressure checks, the Wii Fit video game, and on certain days it will have a mammogram truck on site.

According to the museum's deputy director, Brian Carter "We could have done it as a documentary, a lecture or a panel, but we decided an exhibit would be best … as a cultural institution … to be a change agent in the community" (Liu 11/26).

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5. Cancer Diagnosed Late Despite Effective Detection Methods

A recent article in the Journal Sentinel reported on a CDC study highlighting disparities in cancer screening rates and late-stage diagnoses among minority and elderly individuals.

The report, based on 2004 and 2006 data, found that more cancers in black men and women were diagnosed as late-stage relative to other racial and ethnic populations, and Hispanic women have the highest incidence of late-stage cervical cancer diagnosis, the most preventable gynecological cancer. The study also found differences in late-stage cancer diagnosis by age, with late-stage breast and cervical cancer screening rates being highest among women ages 70 to 79 and ages 50 to 79 years respectively. Late-stage cancers are more difficult to treat and have a higher death rate than cancers detected in earlier stages. "If the patient doesn't have insurance, they likely won't get screenings because it's a choice between an expensive test and putting food on the table," said Dr. Julie Schuller, a physician and vice president of clinical affairs at the Sixteenth Street Community Health Center. Dr. James P. Tomas, professor of hematology and oncology at the Medical College of Wisconsin states that health care access and a lack of cancer screening recommendations to patients contribute to the late-stage diagnoses. Alonzo Walker, director of Froedtert & the Medical College of Wisconsin Breast Care Center, thinks education is the key to reducing the incidence of late-state cancer diagnoses. He recommends that hospitals partner with community health centers to provide patients with information about screening guidelines, as well as access to resources including follow-up care.

Health care reform legislation aims to alleviate health disparities by requiring private health insurers and Medicare to provide free recommended screening tests (Herzog 11/24).

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6. Health Officials Look to Boost Flu Shots in Black, Latino Communities

The Daily Breeze, reported on a recent effort to increase immunization rates for the flu vaccine in the black and Latino communities of Los Angeles.

Ethnic and racial minorities experience higher flu-related mortality rates than non-Hispanic blacks partly due to disparities in flu immunization rates which are further complicated by the population's higher rate of diabetes and chronic conditions compared to non-Hispanic whites. Recent studies have found that black residents are less likely to get a flu shot than non-Hispanic whites (45% vs. 70%). Dr. Oliver Brooks, chair of the pediatrics department at the Watts Healthcare Corp. and chairman of the Immunize LA Families coalition, estimates that if disparities in flu vaccines had been eliminated, then last year there would have been 1,300 fewer deaths in the black community and 550 fewer deaths in the Latino community. Several clinics including Immunize L.A. Families are targeting underserved groups throughout Los Angeles to provide free flu vaccinations. In order to be successful, the program will overcome a lack of trust in the government, something Jessica Marshall, a health educator and member of the Immunize L.A. Families coalition says is, "one of the biggest problems in reaching minorities, particularly the black community."

Immunize LA Families is run by the South Los Angeles Health Projects and initiated with funding from the U.S. Centers for Disease Control and Prevention (Evans 11/22).

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7. Study Provides a Great Service

Allbusiness (Tennessee) recently reported on an 18-month study of hospital care for cardiovascular patients at Methodist North Hospital, that found differences in treatment and health outcomes between African American and white patients.

At a national level, African Americans are more likely to get heart disease at a younger age, to experience more complications, and to have a higher mortality rate from the disease than the general population. The study, which was part of the Aligning Forces for Quality initiative sponsored by the Robert Wood Johnson Foundation, found similar results among its African American patient population. African American cardiac patients at Methodist North Hospital had shorter hospital stays, and had lower re-admittance rates compared with white patients. Explanations for the observed disparities are unclear at the moment, but the findings from Methodist North Hospital and the other participating hospitals are "laying the groundwork to reduce racial and ethnic disparities and provide models for national reform."

The Equity Quality Improvement Collaborative is targeting 17 communities across the country with the goal of improving quality of care (LexisNexus 11/16).

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8. Health Report: Income a 'Really Significant Factor' in Wellness

In a recent survey reported in Knoxville News Sentinel, epidemiologists from Knox County, Tennessee examined health outcomes across numerous areas and compared them with statewide findings. Among other things, they found that income, more than race, age and gender is the biggest factor contributing to health outcomes and access to health care.

When funding is available, the Knox County Health Department conducts a survey every three years to assess many aspects of the health of its community. Some of the findings from the survey included a 28 percent obesity rate, 9 percent asthma rate, and a 12 percent uninsured rate among adults in Knox County. Epidemiologists also found that as income decreases, the rate of health problems increases. Dr. Kathy Brown, director of Community Assessment and Health Promotion for Knox County said that, "although there are certain categories in which race is a huge factor, if you're low-income, regardless of race, you're more likely to have poor (health) outcomes … and (health care) access issues." Compared to low income individuals, those with a household income greater than $50,000 experienced fewer teeth extractions and lower rates of tooth decay or gum disease. Being poor also takes a toll on an individual's mental health and ability to perform "normal activities." Individuals from households with an income less than $15,000 experience higher rates of stress and depression, and have lower rates of social and emotional support.

Although the report highlighted several health challenges, according to Dr. Brown, "there are glimmers of hope." Specifically, the obesity rate "shows signs of reaching a plateau, a precursor to dropping," and "Knox County adults report dropping an average of 11.5 pounds in the past year." (Nelson 11/15).

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DISPARITIES IN RESEARCH

9. Comparing Narrative and Informational Videos to Increase Mammography in Low-income African American Women

In an effort to increase the effectiveness of breast cancer interventions in low-income African American women, the authors of a study published in the journal Patient Education and Counseling found that relative to informational videos, narrative videos increased mammography rates, patient confidence, and greater recall of health information.

In the study, researchers recruited 489 low-income African American women, ages 40 and older from the St. Louis area. The women were asked to complete a baseline questionnaire, which measured among other things, mammography use, cancer fatalism, medical mistrust, and whether any of their family or friends had breast cancer. The women were randomly assigned to watch either an informational video or a narrative video that included stories from cancer survivors. After viewing the video, the women were asked to complete another questionnaire to assess their perceptions of the video, unprompted recall of its content, cancer-related beliefs, and whether the learned any new information. After three and six months, the women were contacted to complete follow-up questionnaires. The authors found that the narrative video was better liked than the informational video (p < .01). The women who watched the narrative video scored higher in cancer fear scores and expression to get a mammogram following the study than women who watched the informational video. The narrative video women were also able to recall more information than the information video women at both the 3-month (72% vs. 60%) and 6-month (70% vs. 58%) follow-ups. Unprompted recall increased from the 3 to 6 month follow-up for women who watched the narrative video (63% to 72%), but not among those who watched the information video. No significant increase in mammography use following the video was observed. However, stratified analyses indicate that women with less than 12 years of education who watched the narrative video had higher mammography rates than those who watched the information video (65% vs. 32%). Mammography rates also increased among women who did not have a close friend or family member with a history of breast cancer, who had lower levels of trust for cancer information, and who were ages 60 years and older.

The authors noted that approaching health education through narrative information may be useful in overcoming resistance to health information or health-related recommendations made by health care providers.

(Kreuter M, Holmes K, Alcaraz, K, et al. Comparing narrative and informational videos to increase mammography in low-income African-American women. Patient Education and Counseling, (2010), doi: 10.1016/j.pec.2010.09.008.)

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10. Sacramento Area Breast Cancer Epidemiology Study: Use of Post-Mastectomy Breast Reconstruction Along the Rural-to-Urban Continuum

In a recent study published in the journal Plastic and Reconstructive Surgery researchers assessed rates of breast reconstruction following mastectomy for breast cancer on a rural-to-urban continuum, and found that patients living in near-metro and rural areas are less likely to undergo breast reconstruction than urban patients.

Researchers used the Surveillance, Epidemiology, and End Results (SEER) database and identified 3552 patients who underwent mastectomy-treated carcinoma in the Sacramento area from 2000 to 2006 and categorized them into rural, near-metro, or urban living environments using codes from the U.S. Department of Agriculture. While the majority of patients had unilateral mastectomies (97.9%) compared to bilateral mastectomies (2.1%), only ten percent of all patients underwent breast reconstruction. Researchers found that patients living in rural and near-metro counties were less likely to undergo breast reconstruction than patients living in urban counties. Factors increasing breast reconstruction included patients who had bilateral mastectomy surgery, infiltrating lobular carcinoma histology, and T4 tumors. Authors also noted differences with respect to race and ethnicity with Asian, black, and Hispanic patients being less likely to undergo breast reconstruction than white patients regardless of geography. Increased age was associated with a decreased likelihood of undergoing breast reconstructive surgery. Similar results were found when researchers assessed each Sacramento County separately. To identify possible barriers contributing to the urban-rural disparity, in health-care provider analyses, the authors found that rural counties did not have a plastic surgeon available compared to 20 and 25 surgeons in the near-metro and urban counties respectively.

The authors noted that their findings led to more questions, as there is likely an interaction between the rural-to-urban continuum and other factors such as income, education and employment. The authors suggested that "further studies are needed to evaluate the causes of these disparities and identify potential areas of improvement."

(Tseng WH, Stevenson TR, Canter RJ, et al. "Sacramento Area Breast Cancer Epidemiology Study: Use of Postmastectomy Breast Reconstruction along the Rural-to-Urban Continuum" Plastic Reconstruction Surgery, 126, no 6. (December 2010): 1815-24.)

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11. Hombres Sanos: Evaluation of a Social Marketing Campaign for Heterosexually Identified Latino Men Who Have Sex With Men and Women

In a recent study published in the American Journal of Public Health, researchers evaluated Hombres Sanos, a social marketing campaign in northern San Diego for its effectiveness in increasing condom use and HIV testing among heterosexual Latino men, and found the campaign was associated with reduced rates of unprotected sex, and increases in condom carrying and perceived HIV risk.

Adult and adolescent Latino males represent 5.6% of the U.S. population, yet they comprise 18.7% of HIV/AIDS cases. The Hombres Sanos Campaign targeted self-identified heterosexual Latino men who have sex with men and women (MSMW) to encourage condom use and frequent HIV testing. The Hombres Sanos campaign utilized context-evoked cues Latino MSMW could recognize to market condom use as a way to keep same-sex practices secret and protect MSMW from social stigma and homophobia. The researchers conducted surveys before, during, and after the Hombres Sanos campaign recruiting approximately 260 Latino men during each survey wave from low-risk to high-risk venues to evaluate the campaign's effectiveness. Low risk venues were identified as migrant camps, the workplace, and shopping centers while high-risk venues were identified as adult bookstores, clubs, and bars. About 5.6% of survey respondents were heterosexually identified Latino MSMW and 94.4% as heterosexual men. Rates of heterosexually identified Latino MSMW varied substantially by location. The authors found reduced rates of unprotected sex with women for heterosexually identified MSMW (OR = 0.17, CI = 0.04-0.69) during the campaign and post campaign phase of evaluation. Furthermore, during the social marketing campaign and four months afterward, HIV risk perception increased, knowledge of testing locations increased, condom carrying increased, and knowledge of community clinics increased. However HIV testing decreased significantly. These sexual risk behavior changes were not observed for Latino men who have sex with women (MSW) as the number of unprotected sexual practices increased during the campaign.

The authors noted the importance of targeting the MSMW community as previous studies have indicated they are more likely to identify as heterosexual males and have unprotective sex due to low risk perception.

(Martinez-Donate AP, Zellner JA, Sanudo F, et al. "Hombres Sanos: Evaluation of a Social Marketing Campaign for Heterosexually Identified Latino Men Who Have Sex With Men and Women." American Journal of Public Health, 100, No. 12. (December 2010): 2532-2540.)

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12. Declining Child Mortality and Continuing Racial Disparities in the Era of the Medicaid and SCHIP Insurance Coverage Expansions

In a recent study published in the American Journal of Public Health, researchers evaluated child mortality data from the National Center for Health Statistics and found that increasing public health programs like Medicaid and SCHIP decreased child mortality, but had no affect on racial and ethnic health disparities.

Using the National Center for Health Statistics data, researchers used files from 1985 to 2004 to analyze child mortality by state, race, and age. The researchers found that Medicaid and SCHIP expansion was related to a decline in child mortality for both external causes and for natural causes. Natural causes of death included those that were disease-related, while external causes included injuries, homicide, and suicide. By categorizing children into three race categories, black, white, and other, they were able to calculate a black-white mortality ratio. Regardless of race, the highest mortality rates were observed in preschool-aged children for natural causes and in adolescents and teens for external causes. Although mortality rates decreased over time for all ethnic and racial groups, the black-white mortality ratio remained unchanged. The authors also noted that the pattern of decline in mortality rates differed across the three age groups. Beginning in 1990, deaths from natural causes in young children began to decline significantly. This delay was not seen among school-aged children until 1996, and among adolescents, the initial decline in mortality rates was interrupted by an increase in mortality rates in the mid 1990s. The authors also conducted analyses to examine the impact of Medicaid and CHIP eligibility expansions on child mortality, and found there was a 10 percentage point increase in Medicaid eligibility which corresponded to a 3.73% decline in child mortality. However, when analyzing the data using year-fixed effects, the decline was not linear, suggesting that the factors which affect mortality rates had a greater impact in some years over others. After analyzing whether the Medicaid and SCHIP expansion affected Black and White children differently, the authors found no changes or reductions in black-white disparities in child mortality.

The authors noted that reducing racial and ethnic health disparities requires a national and community level approach where expanding health coverage is one of many approaches to closing the health gap.

(Howell E, Decker S, Hogan S, et al. "Declining Child Mortality and Continuing Racial Disparities in the Era of the Medicaid and SCHIP Insurance Coverage Expansions." American Journal of Public Health, 100, no. 12 (December 2010): 2500-2506.)

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13. The 2007-09 Recession and Health Insurance Coverage

In a recent study published in Health Affairs, the author reviewed the effect of the 2007-2009 recession on health insurance coverage and found that all Americans, especially whites, native-born citizens, and individuals living in the Midwest and Southern parts of the U.S. were affected through lost of coverage. However, children experienced fewer problems because states expanded coverage through Medicaid and SCHIP programs.

Using data from the Census Bureau's Current Population Survey, the author reviewed the changes in coverage experienced by groups from low, middle, and high income backgrounds. Because changes in the economy are reflected on health coverage, the number of uninsured increased from 45 million at the beginning of the recession in 2007 to 50 million in 2009, the majority of whose incomes were below 200 percent of the federal poverty level. Children who lost employer based coverage were able to regain health coverage through state eligibility expansion of Medicaid and CHIP programs decreasing the number of uninsured children by 600,000. The study found that more than 60 percent of newly uninsured Americans were white Americans, largely due to their large U.S. population make-up, compared to blacks and Hispanics. Although employment-based insurance decreased for blacks and Hispanics, it was offset by increases in Medicaid and CHIP. Furthermore, the uninsured rate for Hispanic groups remained unchanged due to their high starting baseline. The study also found that native-born US citizens and groups from Southern and Midwest regions experienced higher uninsured rates due in part to lower incomes compared to northeast regions.

The author noted that health care reform will expand coverage to many uninsured individuals, but they will not help large portions of the population until 2014 when many of the coverage provisions are implemented.

(Holahan J. "The 2007-09 Recession and Health Insurance Coverage." Health Affairs, 30, no. 1. (January 2011).)

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14. Gender Differences in Mental Health Diagnoses Among Iraq and Afghanistan Veterans Enrolled in Veterans Affairs Health Care

The American Journal of Public Health recently published a study documenting gender differences in mental health diagnoses among veterans of the wars in Iraq and Afghanistan. The researchers found that female veterans were more likely to receive a diagnosis of depression, while male veterans were more likely to receive a diagnosis of PTSD or alcohol use disorders.

During the course of the past 10 years, the military has seen a significant increase in the number of women in its ranks, yet there have been a limited number of studies that have focused on the associations between demographic and military service characteristics and mental health outcomes among newly returning veterans. Therefore, researchers conducted a retrospective, cross-sectional analysis of information from existing VA databases and examined demographic, military service, and mental health information on 329,049 veterans from Iraq and Afghanistan. Women comprise a little more than 12 percent of the study population (N = 40,701). Mental health diagnoses of interest included: PTSD, depression, anxiety, adjustment disorders, alcohol use disorders, substance use disorders, and eating disorders. The researchers found that women were more likely to receive depression diagnoses than men, and men were more likely than women to receive diagnoses of PTSD and alcohol use disorder. There were also significant differences in diagnoses when examining demographic characteristics. For example, women who had never been married were more likely to receive a PTSD diagnosis, and were at a higher risk than men of receiving a depression diagnosis. Differences were also observed by branch of service, and whether the individual was actives duty versus reserve or National Guard.

The authors suggest that the demographic differences observed in their study have implications for mental health services, and state that their findings "emphasize the need to include young and racially/ethnically diverse women in all studies" of veterans of the wars in Iraq and Afghanistan.

(Maguen S, Ren L, Bosch J, et al. "Gender differences in mental health diagnoses among Iraq and Afghanistan veterans enrolled in Veterans Affairs health care." American Journal of Public Health, 100, no. 12. (December 2010): 2450-2456.)

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15. English Language Proficiency and Mental Health Service Use Among Latino and Asian Americans with Mental Disorders

A recent study published in Medical Care, examined the relationship between lifetime health care utilization among Latino and Asian Americans with mental disorders and English proficiency. The authors found that compared with English-proficient (EP) individuals those with limited English proficiency (LEP) use fewer mental health care services, see less of a need for the services, and have longer durations without treatment.

A growing segment of the U.S. population consists of individuals with limited English proficiency. Although there are some studies that have examined their usage of the health care system, few studies have looked at lifetime usage, particularly for mental health services. Using data from the National Latino and Asian American Study, which is a national representative sample of 2,554 Latino and 2,095 Asian Americans adults in the U.S. between 2002 and 2003 the researchers looked at access to care, barriers to care and quality of care among individuals with a mental disorder. The authors found there were similar rates of LEP among Asians (34.4%) and Latinos (39.3%). LEP individuals also tended to be older, less educated, and were more likely to be immigrants and uninsured than EP individuals. Although there was no difference in access to general medical services, LEP individuals accessed lifetime services as a significantly lower rate than EP individuals (42.8% vs. 54.2%, p < 0.01). LEP individuals tended to live longer with an untreated disorder, and over the course of their lifetime, were less likely to get treatment. Significant predictors of lifetime treatment included perceived need and disorder severity, but embarrassment and discomfort did not.

The researchers noted that perceived need for treatment was strongly associated with accessing care, and that LEP patients were less likely to indicate they needed treatment. They offered several hypotheses as to why this decreased need exists, including cultural differences in the threshold for illness recognition, greater reliance on family and social networks for emotional support, and lower levels of mental health literacy. They also suggested their findings "raise the possibility that intervention that target access to care and mental health literacy among LEP communities may provide opportunities to reduce disparities in mental health care."

(Bauer A, Chen C, and Alegria M. "English language proficiency and mental health service use among Latino and Asian Americans with mental disorders." Medical Care, 48, no. 12. (December 2010): 1097-1104.)

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16. Family Acceptance in Adolescence and the Health of LGBT Young Adults

A recent study published in the Journal of Child and Adolescent Psychiatric Nursing examined the relationship between family acceptance and the psychosocial and physical health of young LGBT adults, and found that family acceptance was associated with greater self-esteem, social support, health status, and was negatively associated with depression, substance abuse, and suicidal ideation and behaviors.

As part of the Family Acceptance Project, researchers recruited 245 LGBT Latino and non-Latino white adults between the ages of 21 and 25 years, who self-identified as LGBT, homosexual or nonheterosexual during adolescence, and whose sexual orientation was known to at least one parent for the study. They were asked to complete a survey that measured family acceptance, demographic characteristics including sexual identity, childhood religious affiliation, childhood family religiosity, and parents' occupational status, health and youth adjustment (e.g. social support and self-esteem). The study did not find a difference in family acceptance by sexual identity, but did find significant associations between family acceptance and self-esteem (p < 0.001), social support (p < 0.001), general health (p < 0.01), depression (p < 0.001), substance abuse in the past 5 years (p < 0.01), suicidal thoughts (p < 0.05), and attempted suicide (p < 0.01). After controlling for background characteristics, family acceptance remained highly significant for each outcome. Gender was significantly associated with self-esteem, social support, suicidal ideation in the past 6 months, and ever attempting suicide. The researchers noted that individuals who self-identified as "queer," had more than twice the rate of lifetime suicide attempts, but there was no difference in recent suicidal thoughts.

The authors noted that the lack of other racial and ethnic groups and the fact that the study was retrospective were limitations, but felt that in spite of these limitations, their "approach to directly measuring LGBT-specific behaviors that express family and caregiver acceptance during adolescence is an important step toward better understanding LGBT health, and offers the opportunity for focused prevention and intervention with diverse families that have LGBT children."

(Ryan C, Russell S, Huebner D, et al. "Family acceptance in adolescence and the health of LGBT young adults." Journal of Child and Adolescent Psychiatric Nursing, 23, no. 4. (November 2010): 205-213.)

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17. Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines

A recent study in the Journal of General Internal Medicine examined black-white disparities in adherence to colorectal cancer screening guidelines, and the factors associated with them among users of VA medical facilities. The authors found that blacks had slightly lower rates of adherence to the guidelines, and that adherence varied significantly by income, education and marital status.

Colorectal cancer is one of the more common cancers, and is the second leading cause of cancer death in the United States. Individuals using the Veterans Administration medical facilities have equal access to care, which should help reduce the barriers to care that can lead to disparities. Using survey data collected from veterans between the ages of 50 and 75 years, who had at least one primary care visit between January 2005 and December 2006 to one of 124 centers, the final sample included 3,025 veteran survey respondents. Adherence was recorded via self-report, and confirmed via administrative claims data. The authors found black respondents tended to be younger, less educated, poorer, sicker, and had more comorbidities than their white counterparts. They were also less likely to answer colorectal cancer knowledge questions correctly. Physician recommendations for screening did not differ by race. When looking at adherence to colorectal cancer screening guidelines, the researchers found blacks were less likely to be adherent (72% vs. 77%, p < 0.05). After adjusting for demographic characteristics, health related factors, and environmental factors, race was no longer significant, but it was in a model that adjusted for cognitive factors (OR = 0.66, p ≤ 0.01). The authors also noted the presence of interactions between income, education and marital status, such that among individuals who were unmarried, and had lower levels of education, adherence was higher for blacks, but among individuals who were married and had higher levels of education, adherence was higher for whites.

Regardless of race, colorectal cancer screening rates were higher at the VA medical centers than they were nationally. The authors suggested that the difference may be the result of several efforts initiated over the past 10 years to improve adherence to colorectal cancer screening guidelines. The authors concluded that in addition to more research being needed to understand the "reverse" disparities, it is important to ensure that individuals who screen positive receive follow up care. They pointed out that "although follow-up rates are similar for black and white veterans, they are disappointingly low for both groups."

(Burgess D, van Ryn M, Grill J, et al. "Presence and correlates to racial disparities in adherence to colorectal cancer screening guidelines." Journal of General Internal Medicine, (November 2010).)

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18. Validation of Self-Reported Health Literacy Questions Among Diverse English and Spanish-Speaking Populations

A growing body of research suggests health literacy, which is defined as "the ability to obtain, process, or understand basic health information needed to make appropriate health care decisions," is an important determinant of health disparities. However, for many reasons including time, health literacy continues to prove difficult to measure in survey research. A recent study published in the Journal of General Internal Medicine sought to validate self-reported health literacy questions among Spanish-speaking and diverse English-speaking populations. The study found that a single question about confidence with forms and a three-question scale was able to distinguish between English and Spanish speakers with adequate health literacy and those with inadequate and/or inadequate plus marginal health literacy.

Data were collected during a diabetes self-management trial that was part of a larger intervention sponsored by the San Francisco Department of Public Health (SFDPH), and included individuals over the age of 17 with type 2 diabetes, self-reported fluency in English and Spanish, a hemoglobin AIc value greater than or equal to 8 percent, and who had at least one primary care visit in the prior year. The researchers found that 47% of study participants had inadequate health literacy, and 12% had marginal literacy. More than half (57%) of respondents said they were "somewhat" or less confident with forms, while 42% said they "sometimes" or more frequently needed help reading and 45% said they "sometimes" or more frequently had trouble learning. People who tended to report the aforementioned difficulties and those with higher summative scale measures also tended to have inadequate health literacy. When the researchers separated their analyses by language for inadequate and inadequate plus marginal health literacy, three questions had higher sensitivity and lower specificity among Spanish speakers as compared to English speakers. Finally the researchers found self-reported questions were able to distinguish individuals with inadequate health literacy after controlling for demographic characteristics.

The authors acknowledge the difficulty in generalizing the results of their study since they focused on a specific patient population, but they conclude their findings indicate the ability of the single "confident with forms" question and the summative scale of the three questions to distinguish health literacy among English and Spanish speakers "warrants application and further assessment in epidemiologic and clinical research involving diverse populations."

(Sarkar U, Schillinger D, Lopez A, et al. "Validation of self-reported health literacy questions among diverse English and Spanish-speaking populations." Journal of General Internal Medicine, (November 2010).)

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DISPARITIES DATA SPOTLIGHT

SOURCE: CDC. HIV Surveillance Report, Vol. 20; 2010. CDC, MMWR, Vol. 57, No. 36; 2008.

Black and Latino Americans continue to be disproportionately represented among those affected by HIV/AIDS. Approximately 1.1 million people in the United States are living with the disease, and nearly 700,000 of them are either black or Latino. Blacks and Latinos comprise 27 percent of the U.S. population, yet they represent 62 percent of new infections, and once diagnosed, have more difficulty than their white counterparts accessing care.

To read more about the impact of HIV/AIDS on the black and Latino communities, please read two recently updated fact sheets, Black Americans and HIV/AIDS and Latinos and HIV/AIDS.