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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. Sanford Creates Native American Health Office DISPARITIES IN RESEARCH 13. Culturally Targeted Educational Intervention to Increase Colorectal Health 14. Factors Associated with Pap Testing Among Hmong Women 15. Health Status and Health Services Utilization Among Older Asian Indian Immigrants 16. Patient Panel of Underserved Populations and Adoption of Electronic Medical Record DISPARITIES DATA SPOTLIGHT DISPARITIES IN THE NEWS 1. Sanford Creates Native American Health Office Sanford Health, the largest hospital system in the Dakotas, created an Office of Native American Health to help serve Native Americans living on reservations, the Associated Press reports. While Sanford does not operate hospitals on reservations, many of its facilities serve Native Americans. The new office will help address health issues like diabetes and kidney disease, which occur at high rates among Native Americans. Dr. Donald Ware, who will lead the office, "will coordinate activities among the hospital system, the federal Indian Health Service and the 28 tribes within Sanford's coverage region, which spans South Dakota, North Dakota, Minnesota, Iowa, and Nebraska." Sanford previously announced plans to create a digital mammography center that will serve underserved women in South Dakota, as well as provide transportation to the facility. "It's an important step to try to improve the health and welfare of folks on different reservations in Sanford Health's service area," said Mark Johnson, a Sanford Health vice president (Lammers, 8/12). 2. Renewed Effort to Lure Doctors to Rural Areas Faces Obstacles Focusing on the case of a young doctor at the Southern Albermarle Family Practice in Esmont VA, The Washington Post reports about efforts to bring young primary care doctors to underserved areas, and the challenge of retaining them once there. (Fears, 8/9). "Nearly 5,000 recent medical school graduates accepted federal grants to pay off tuition and school loans averaging $150,000 per student. The awards come with contracts that obligate the young doctors to remain in what are typically rural areas for three to five years." Through the stimulus package and the new health care legislation, the Obama administration provided over $1 billion to the National Health Services Corps to help recruit young doctors to practice in medically underserved areas. Sarah Carricaburu is director of the Southern Albermarle Family Practice, and serves as its only full-time doctor. Given some of the personal and professional challenges of practicing in rural areas, like technological difficulties, and what some view as limited social and cultural opportunities, she is unsure if she will stay in the rural town after her three-year, $50,000 federal contract expires in September 2011. Doctor retention is a problem for many practices located in medically underserved areas, with Southern Albermarle often having to turn patients away before Carricaburu arrived. The National Health Services Corps is hoping to recruit 2,800 students to practice in medically underserved areas next year, as a recent Corps' report estimated that the nearly 30,000 primary care physicians are needed to support the 45 million Americans residing in medically underserved areas (Fears, 8/9). 3. Health is a Top Concern for African Americans In a commentary, a Kansas City Star editor discusses the need to change the health habits of the African American community as a whole as discussed by health experts at the recent National Association of Black Journalists convention. Though data on health conditions like obesity, HIV/AIDS, and cancer are particularly bleak for African Americans, experts like Dr. Mehmet Oz of "The Dr. Oz Show" suggested that in order to best help people to adopt healthier habits, efforts should focus on appealing to people's feelings rather than presenting them with data. U.S. Surgeon General, Regina Benjamin, agreed saying that "we need to talk about how fun it is, how good it is to be healthy and live in a healthy way." She also said that the national health strategy must shift to one that promotes wellness and prevention. However, this can be complicated by those who profit from and/or market unhealthy habits to consumers. As Linda Blount, national vice president for health disparities at the American Cancer Society explained at the convention, "marketers have convinced us that smoking and drinking makes us look cool, … We really do need to sell the positive." Despite these obstacles, Dr. Clyde Yancy, medical director of the Baylor Heart and Vascular Institute at Baylor University Medical Center, is optimistic. During a session on black men's health at the convention he said, "We believe that the problem of poor health in African-American men is preventable and reversible" (Diuguid, 8/8). 4. UWM School of Public Health Site Places Program at Heart of Health Gap The Milwaukee Journal Sentinel reports on the University of Wisconsin-Milwaukee's plan to establish a new School of Public Health in downtown Milwaukee near a large urban hospital in a low-income and largely African American neighborhood, which supporters say "reinforces the school's commitment to be engaged in the community." A major focus of the School of Public Health will be to find ways to reduce many of the health disparities that persist in a city that ranks among the poorest in the nation. With infant mortality rates in some Milwaukee neighborhoods similar to those in less developed countries like Albania and Thailand, the school will focus initially on birth outcomes. The new school is set to receive a $900,000 grant from the Centers for Disease Control and Prevention to test various initiatives to reduce health disparities, and the health reform legislation also provided some funding for public health initiatives. The city's Health Department is also planning to move some of its programs to the new location, including the Wisconsin Center on Health Equity and its program on teen pregnancy. Construction is expected to begin in early 2011 and should be complete by 2013 (Boulton, 8/7). 5. L.A. County Death Rate Drops, Life Expectancy Increases, but Disparities Persist In two articles, the Los Angeles Times reports on a decrease in the death rate of Los Angeles County residents, and an increase in the county's average life expectancy, but racial and ethnic, and socioeconomic differences persist in both indicators. In separate reports from the Los Angeles County Department of Public Health, officials reported a 22% drop in the death rate of the county between 1998 and 2007, and an increase in the average life expectancy of county residents from 75.8 years in 1991 to 80.3 years in 2006. While death rates decreased for all racial and ethnic groups in the county over the 9-year period, longstanding disparities persisted. For example, Asians had the lowest mortality rate in L.A. County, and blacks, the highest. The mortality report also found that the death rate due to diabetes for blacks was more than twice the rate of whites — the same ratio found in 1998. Similarly, while the average life expectancy was about 80 years in 2006 for all residents, the life expectancy report found that Asian and Pacific Islander women had the longest life expectancy of 86.9 years, while black men had the shortest (69.4 years). The report also documented significant differences in life expectancy between wealthy and less wealthy communities, which county director of Public Health, Dr. Jonathan E. Fielding, referred to as "sobering and disconcerting." Fielding noted that lack of access to quality healthcare may be a factor in both the higher mortality among and life expectancy of some L.A. County residents, but that social and economic factors also play a large role (Hennessy-Fiske, 7/28 and 8/5). 6. Substance Abuse Rates Low in Hispanic Americans: U.S. Report According to a new report from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), "Hispanic-American adults have lower rates of alcohol and illicit drug use than the national averages," though rates differ by Hispanic subgroup and nativity, HealthDay News reports. Analyzing data on 227,791 adults aged 18 and older (including 31,848 Hispanic Americans) from the 2004–2008 National Survey on Drug Use and Health, the study found that 46% of Hispanic adults consume alcohol and about 7% use illicit drugs, compared to 55% of adults who drink alcohol and 8% who use illicit drugs, nationally. However, the study also found that Hispanics have slightly higher level of binge drinking (26.3% vs. 24.5%) and a higher level need for alcohol treatment in the past year (8.7% vs. 8.1%). The research also showed differences in rates of substance abuse within the Hispanic-American community. For example, U.S.-born Hispanics had higher levels of substance abuse than those born outside of the U.S., and the rate of illicit drug use among Spanish-Americans was over 3 times higher than the rate among Dominican Americans (13.1% vs. 3.9%). In a news release, SAMHSA administrator, Pamela S. Hyde said "through a more detailed understanding of this diverse community we can better tailor our prevention and treatment strategies to reach all of its members" (Preidt, 8/4). 7. Study Finds Latino Kids Face Hardships According a new report from Action for Children North Carolina, many Latino children in North Carolina "are denied access to health care, high quality education, safety and family economic security," the Richmond County Daily Journal (Rockingham, N.C.) reports. The report, "Latino Children in North Carolina," details the health, education, and economic status of Latino children in the state, who have grown by one-third over the past 3 years, and constitute the fast growing segment of children in North Carolina. The report also discusses some of systems in place that marginalize Latino families. In a press release accompanying the report, Action for Children North Carolina president and CEO, Barb Bradley, said that although most Latino children in the state have a working head-of-household, a higher percentage of these children lack health coverage, a primary doctor, and regular dental visits than other children in the state. "In addition, the report contends fewer Latina mothers receive adequate prenatal care than the general population, leading to lower birth weights and a higher rate of infant mortality." To address some of these issues, Martha Vance Brown, executive director of the Richmond County Partnership for Children, said that her organization has been looking to revamp the HealthChoice program, which allows parents of young children to get their children a check-up. "'Every child has the potential to be an asset for North Carolina,' Bradley said. 'It is the decisions we make today about what we are willing to invest in our children that will determine whether they all have the opportunity to fulfill that potential'" (Brown, 8/3). 8. Disparities in Organ Donation and Transplantation Around National Minority Donor Awareness Day on August 1, two papers reported on racial and ethnic disparities in organ donation and transplantation, and the efforts to make improvements in these areas. Pittsburgh Post-Gazette: Despite efforts to increase minority organ donations, racial and ethnic minorities constitute a disproportionately high percentage of the 107,800 people on the national waiting list to receive an organ, but receive them at a disproportionately low rate. In Pennsylvania, just over 40% of the nearly 8,000 people waiting for an organ are a minority, which is more than twice the percentage of minorities in the state. Dr. Clive Callender, a professor of surgery at Howard University said "it is critically important for minorities to participate in donation," as race and ethnicity factor into matching donor organs to recipients. Dr. Callender created the National Minority Organ Tissue Transplant Education Program (MOTTEP) after researching the black community's reluctance to donate organs, which includes reasons such as lack of education, religious misconceptions, and medical mistrust. In Pittsburgh, the Center for Organ Recovery and Education recently hosted a gospel fest of which about 400 people attended, with many signing up as donors. Diane Royster, a member of the multicultural taskforce at the Center, said "I'm going to try my best to do everything I can to promote it, so people will understand that we need to help each other" (Nereim, 8/2). The Capital Times (Madison, WI): Though African Americans comprise just 6% of Wisconsin's population, they account for roughly 25% of those on the kidney waiting list, and have received just 13% of kidney transplants in the state since 1988. In contrast, whites account for 58% of those on the waiting list, but have received 77% of transplants since the same time. At the University of Wisconsin — which has the third-largest kidney transplant center in the U.S. — waiting list data reveals significant racial disparities in renal transplant rates. According to the data, by the end of 2004, 22% of African Americans compared to 38% of whites had received a kidney transplant; 39% of African Americans compared to 53% of whites received a transplant by the end of 2005; and 43% of African Americans compared to 59% of whites had received a transplant by the end of 2006. Officials have been working to make both improvements in the transplant process and to increase the number of minority organ donors, another area where disparities are present. "One change officials seem close to enacting after years of debate would speed up the wait process for many African Americans by including time on dialysis as time waiting, one of the factors taken into account when selecting a transplant recipient" (Doherty, 7/30). 9. Parish Nursing Program Reaches Out to the Latino Community The Independent Tribune (Concord, NC) reports on the efforts of the parish nursing program at Carolinas Medical Center (CMC)-NorthEast, which enlists a Latino coordinator to inform the Latino community about health care issues that affect the population. A relatively new position for the parish nursing program at CMC-NorthEast, the goal of the Latino coordinator is to educate the Latino population about health care issues that affect their community, like heart disease and diabetes, which are among the leading causes of death for Hispanics. In discussing Latinos who are new to the country, current Latino coordinator, Veronica Guerola, explains that health may not be one of their priorities, but she aims to teach them of its importance. "When they come to this country their lifestyle changes. We end up having all these diseases, unfortunately," she said. Guerola said she often works through churches, with a member of a church serving as a liaison to the parish nursing program, and also works with Latino teens, addressing issues like teen pregnancy, depression, and bullying. "'I have seen that people have become more aware of the issues they are dealing with, and that they have the help they need and a contact through me,' Guerola said. 'If you don't let them see the value of using resources, the influence will not be as great.'" (Gardner, 8/1). 10. New Mental Health Initiative Focused on Native Youth Indian Country Today reports on a new media initiative from the Substance Abuse and Mental Health Services Administration (SAMHSA) that aims to raise awareness and spur dialogue about mental health issues among American Indian youth. In response to an "alarming rate" of mental health illness among young American Indian adults, SAMHSA's new initiative uses radio, print, and web public service announcements (PSAs) created by American Indian advertising agency, G & G Advertising, and the Ad Council, to direct youth to SAMHSA's "What a Difference a Friend Makes" website. There, people can find information about mental illness, related resources, and how to find help. "Creators are hoping the new media campaign will turn around the trend to silence and suffering common in Native communities. One part of the campaign addresses being strong and self-reliant as a hindrance to getting assistance in tribal settings. One emphasis is on seeking outside help." According to data from SAMHSA, between 2004 and 2007, 20.7% of Indians aged 18–25 reported serious psychological distress in the past year, but only 31% received care. These new PSAs are part of a larger effort to reach racial and ethnic minority populations who are less likely than whites to receive treatment for mental health conditions. "'This multicultural advertising effort will help decrease the stereotypes surrounding mental illnesses while providing young adults with the resources they need to support their friends living with mental health problems,' said Peggy Conlon, president and CEO of the Ad Council" (Ruckman, 7/27). 11. IHS Program Lauded for Anti-Domestic Abuse Efforts According to a new report from the Family Violence and Prevention Fund, the Domestic Violence Project — funded by the Department of Health and Human Services' Indian Health Service (IHS) and the Administration for Children and Families — "has shown dramatic success in improving the health system's response to domestic violence in Indian country," Indian Country Today reports. With studies showing that rates of domestic violence are higher for Native women than for women of other racial or ethnic groups, the Domestic Violence Project, managed by the Family Violence Prevention Fund in partnership with faculty from Sacred Circle and Mending the Sacred Hoop Technical Assistance Project, is a multifaceted response to domestic violence in Indian country. The project involved over 100 Indian, tribal and urban health care facilities and domestic violence organizations, and had the participation of Indian health centers in 18 of 35 states with federally recognized tribes. Among the findings of the Family Violence and Prevention Fund report, "Building Domestic Violence Health Care Responses," was that the project increased routine assessment for intimate partner and domestic violence of Native women 12-fold, raised public awareness about domestic violence, and trained over 100 staff on domestic violence health system change. In addition, health officials noted that just 4% of women at IHS facilities were screened for domestic violence in 2002, compared to 48% when the program ended in 2009. President of the Family Violence Center, Esta Soler, said that more programs should be funded that build off of the successes of the Domestic Violence Project, noting that "tribal communities will benefit if we replicate the promising practices and materials we've developed, continue to integrate domestic violence and sexual assault into trainings that improve the health care responses to violence, and strengthen the tribal response to sexual assault" (Capriccioso, 7/22). 12. Film Examines Minorities' Distrust of Medical Research "Medical Research, Bioethics and Race: Where Do We Go From Here?" a 30-minute film produced by WPXI-TV (Pittsburgh) and the University of Pittsburgh's Research Center of Excellence on Minority Health, examines minorities' use in, and distrust of, medical research. Pittsburgh Post-Gazette: The film "opens with the premise that a lack of trust limits minority participation in medical trials that could save lives. It traces a history of unethical research treatment of minorities, such as the Tuskegee syphilis study, as the reason for such distrust." Despite protections against unethical research, minority communities are still reluctant to participate in clinical trials. "'The legacy of distrust is a long one,' said Dr. Sandra Quinn, associate dean for student affairs of Pitt's Graduate School of Public Health. 'Doctors must learn how to bridge the gap of distrust'" (Smith, 7/21). Pittsburgh Tribune-Review: "The film aims to increase minority participation in medical research, and features Dr. Quinn and her colleague Dr. Stephen Thomas, lead researchers of two-year, $4 million study funded by the National Institutes of Health's National Center on Minority Health and Health Disparities. "The Pitt study, with partners at six other educational and clinical institutions, will survey the knowledge and attitudes of researchers and adult minorities before developing and pilot testing a comprehensive educational program" (Kanny, 7/22). DISPARITIES IN RESEARCH 13. Culturally Targeted Educational Intervention to Increase Colorectal Health Awareness Among African Americans Using a faith/community-based educational intervention to increase colorectal cancer knowledge, decrease cancer fatalism, and increase colonoscopy screening among African Americans in North Carolina, the authors of a new study in the Journal of Health Care for the Poor and Underserved's August 2010 supplement sponsored by Tuskegee University National Center for Bioethics in Research and Health Care and the Historically Black Colleges and Universities Research Network, found that the intervention achieved all three aims. Using a sample of 539 African Americans age 50 and older residing in the Fayetteville/Cumberland County area, the researchers found that people in the immediate intervention group (n=494) — who received a 90-minute culturally targeted education program on colorectal health — had a significantly greater percentage of receiving a colonoscopy within three months of the intervention compared to the control group (25.5% vs. 4.4%, respectively). Knowledge of colorectal cancer also significantly increased in the intervention group after the educational session, while cancer fatalism attitudes significantly decreased.
The authors concluded that their study "demonstrated that a person's knowledge and beliefs can dictate positive screening behavior and improve participation," and they have taken steps to share their findings with study participants, stakeholders, and community advocates.
14. Factors Associated with Pap Testing Among Hmong Women In a new study in the Journal of Health Care for the Poor and Underserved, researchers examined the association of between socio-demographic characteristics and the receipt of a Pap test among Hmong women in Sacramento, CA, finding that age, nativity, and marital status were all factors in Pap test rates. Between September and December 2006, 402 Hmong women were surveyed about their socio-demographic characteristics and Pap test screening history using a questionnaire administered in either Hmong or English by the Hmong Women's Heritage Association. The authors found that 74% of the women sampled had ever had a Pap test, with 61% having been screened in the past 3 years as currently recommended by the American Cancer Society. After adjusting for demographics factors, the odds of receiving a Pap test in the past three years was higher for women ages 21–30 and ages 31–40 compared to those ages 51–65 (odds ratio [OR] age 21–30: 3.0; OR age 31–40: 3.0); and the odds of receiving a Pap test were lower for U.S.-born Hmong women compared to those who have been in the country for less than 10 years (OR: 0.3) and lower for single Hmong women compared to those who were married or partnered (OR: 0.4).
The authors concluded that interventions are needed to increase the rate of regular Pap testing among Hmong women, focusing, particularly, on single, U.S.-born women.
15. Health Status and Health Services Utilization Among Older Asian Indian Immigrants In a new Journal of Immigrant and Minority Health study "based on a first-ever regional probability sample of older Asian Indian immigrants," the authors found that several factors, including age and health insurance, were predictors of health service use among older Asian Indian immigrants in New York City. Using data from the 2000 Asian American Elders in New York City Study (AAENYC), the authors found that older Asian Indians with higher numbers of medical conditions had a higher odds of having a physician visit (odds ratio [OR]: 1.80). They also found that those who were older and those who were enrolled in Medicare Part A had a higher odds of having been admitted to a hospital in the past year (OR age: 1.25; OR Medicare Part A: 8.13); those who were enrolled in Medicare Part B a higher odds of having used emergency department services in the past year (OR Medicare Part B: 6.09); and older Asian Indian immigrants who reported better English language proficiency had lower odds of using traditional medicine (OR: 0.75).
In the discussion, the authors note that "enabling factors rather than health-related need factors had more predictive power of the use of inpatient hospital and emergency department services," and conclude that helping older Asian Indian immigrants get Medicare and Medicaid will facilitate their use of health services.
16. Patient Panel of Underserved Populations and Adoption of Electronic Medical Record Systems by Office-Based Physicians In a new study in Health Services Research, the authors found a negative association between the likelihood of adopting electronic medical records (EMRs) and the proportion of Hispanic patients treated by a physician. Using data from 2,326 office-based physicians in the 2005 and 2006 National Ambulatory Medical Care Survey (NAMCS), the researchers sought to examine the relationship between EMR adoption by office-based physicians and patient panels of underserved populations, measured as proportions of racial and ethnic minorities, Medicaid recipients, or self-pay/no charge/charity care patients. After controlling for characteristics of physicians and their practices and the characteristics of their patient panels, they found that having a higher proportion of Hispanic patients treated by a physician was associated with lower likelihood of EMR adoption. They found no significant difference in EMR adoption between physicians who practiced in community health center setting as compared to those who practiced elsewhere, and no overall significant association between the proportion of Medicaid recipients treated and EMR adoption.
The authors note the large upfront costs that EMR requires as a main barrier to its adoption, and suggest that funding included in the stimulus package to promote EMR adoption may help some, but not all, physicians.
Five years after Hurricane Katrina, a Kaiser Family Foundation survey of the views and experiences of New Orleans residents finds that the perceptions of the city’s recovery differ by race. For example, African Americans are more than twice as likely as whites to say that their own lives are still disrupted from Katrina (42% of blacks vs. 16% of whites), and African Americans are more likely than whites to say that New Orleans has not yet recovered from Katrina (66% vs. 49%); the city is a worse place to live now than before the storm (42% vs. 28%); and that it is a bad time to be raising children in the city (51% vs. 35%). African Americans are also nearly three times as likely as whites to say that they are "very worried" that health care services might not be available if they need them (59% vs. 21%). Read more from the report, New Orleans Five Years After The Storm: A New Disaster Amid Recovery. |
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