Nurse Faculty Scholars - Health Disparities/Vulnerable Populations

Are local health department expenditures related to racial disparities in mortality?

lsharp — Mon, 07 Feb 2011 15:11:50 +0000

Published Date:

Fri, 2010-12-10 (All day)

This study estimated whether 1990-1997 changes in expenditures per capita of local health departments (LHDs) and percentage share of local public revenue allocated to LHDs were associated inversely with 1990-1997 changes in mortality rates for Black and White racial/ethnic groups in the US. Population was 883 local jurisdictions with 1990 and 1997 mortality rates for Black and White racial populations from the Centers for Disease Control and Prevention Wonder Compressed Mortality File and LHD expenditures from the National Association of County and City Health Officials. Using a time-trend ecologic design, changes in LHD expenditures per capita and percentage share of public revenue were not related to reductions in Black/White disparities in total, all-cause mortality rates. Increased LHD expenditures or percentage share were associated with reduced Black/White disparities for adults aged 15-44 and males. LHD expenditures or percentage share were related to absolute reductions in mortality for infants, Blacks, and White females but did not close Black-White mortality differences for these groups. Therefore, disparities in Black and White mortality rates for subgroups with the greatest mortality gaps may be more likely to be reduced by public investment in local health departments than disparities in Black and White total, all-cause mortality rates.

Do neighborhood economic characteristics, racial composition, and residential stability predict perceptions of stress associated with the physical and social environment? Findings from a multilevel analysis in Detroit.

nfs — Mon, 27 Sep 2010 12:48:30 +0000

Published Date:

Mon, 2008-09-01 (All day)

As the body of evidence linking disparities in the health of urban residents to disparate social, economic and environmental contexts grows, efforts to delineate the pathways through which broader social and economic inequalities influence health have burgeoned. One hypothesized pathway connects economic and racial and ethnic inequalities to differentials in stress associated with social and physical environments, with subsequent implications for health. Drawing on data from Detroit, Michigan, we examined contributions of neighborhood-level characteristics (e.g., poverty rate, racial and ethnic composition, residential stability) and individual-level characteristics (e.g., age, gender) to perceived social and physical environmental stress. We found that neighborhood percent African American was positively associated with perceptions of both social and physical environmental stress; neighborhood percent poverty and percent Latino were positively associated with perceived physical environmental stress; and neighborhood residential stability was negatively associated with perceived social environmental stress. At the individual level, whites perceived higher levels of both social and physical environmental stress compared to African American residents of the same block groups, after accounting for other variables included in the models. Our findings suggest the importance of understanding and addressing contributions of neighborhood structural characteristics to perceptions of neighborhood stress. The consistency of the finding that neighborhood racial composition and individual-level race influence perceptions of both social and physical environments suggests the continuing importance of understanding the role played by structural conditions and by personal and collective histories that vary systematically by race and ethnicity within the United States.

Culturally- Tailored Intervention for Rural African Americans with Type 2 Diabetes

nfs — Wed, 14 Jul 2010 16:49:29 +0000

Published Date:

Wed, 2008-10-01 (All day)

PURPOSE: The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans. Social Cognitive Theory provided the framework for the study. METHODS: Twenty-two participants were recruited and randomly assigned to either Group or Individual diabetes self-management (DSME). Group DSME included story-telling, hands-on activities, and problem-solving exercises. Individual DSME sessions focused on goal-setting and problem-solving strategies. Sessions were offered in an accessible community center over a 10-week period. RESULTS: Outcomes included glycosylated hemoglobin (A1C), self-care actions, self-efficacy level, goal attainment, and satisfaction with DSME. Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities, A1C level, and goal attainment. Although differences were not statistically significant, trends indicate improved scores on dietary actions, foot care, goal attainment, and empowerment for those experiencing Group DSME. CONCLUSIONS: The culturally tailored approach was well received by all participants. Improvements among those receiving Individual DSME may indicate that brief sessions usinga culturally tailored approach could enhance self-care and glycemic control. Additional testing among more participants over a longer time period is recommended.

Recruiting African-American Barbershops for Prostate Cancer Education

nfs — Wed, 14 Jul 2010 16:45:16 +0000

Published Date:

Mon, 2008-09-01 (All day)

Prostate cancer is the most common cause of cancer in men and the second leading cause of cancer deaths. African-American men bear a disproportionate burden of prostate cancer diagnosis and mortality. Current guidelines for prostate cancer screening differ among various medical organizations. Therefore, it is important that African-American men have the appropriate information needed to make informed decisions about prostate cancer screening. Unfortunately, a large percentage of African-American men could potentially be excluded from receiving culturally appropriate prostate cancer education. Therefore, a study was designed to recruit and intervene with African-American men and barbershops for increasing prostate cancer screening decision-making. The purpose of this study was to learn effective strategies for recruiting African-American barbershops for prostate cancer education and to determine barbershop proprietors' willingness to allow their barbershops to be used for research. In this paper, we present the outcomes of our recruitment methods for African-American barbershops, including a comparative description of participating and nonparticipating barbershops using the iMark Data System. One-hundred percent of the surveyed proprietors reported that they would allow their clients to learn about prostate cancer. Ninety-six percent reported they would consider allowing their clients to have access to handheld computers to learn about prostate cancer. We conclude from this study that African-American barbershops in general are welcoming environments in which to implement community-based prostate cancer education and public health research.

Effects of parity on blood pressure among African-American women

nfs — Wed, 19 May 2010 14:48:38 +0000

Published Date:

Mon, 2008-12-01 (All day)

It is a well established fact that age, ethnicity, weight, and lifestyle behaviors can affect blood pressure (BP). Co-morbid conditions such as HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), pre-eclampsia, and previous hypertension diagnosis might also be risks for chronic hypertension among women who have had children. Although parity has been linked to changes in blood pressure in White women, these findings have not been replicated among African-American women. The purpose of this study was to determine if the number of pregnancies urban African-American women have effects BMI and blood pressure readings later in life. Results indicated that women with a previous diagnosis of hypertension had higher SBP and DBP, and a slightly higher BMI than women who had never been diagnosed. Additionally, women with a prior history of hypertension had more children than those without a diagnosis of hypertension. As parity increased, SBP increased. However, DBP decreased after 3 to 4 children, even with increases in BMI. This study shows that parity may increase African-American women's risk for hypertension in terms of increased SBP and BMI with increased parity. However, increased parity and BMI may also serve as protective factors in lowering DBP. Further studies, with larger samples followed throughout their pregnancies, is needed before more definitive statements may be drawn about the effects of parity on BMI and blood pressure readings among African-American women can be made.

Effects of genetic counseling for hypertension on changes in lifestyle behaviors among African-American women

nfs — Wed, 19 May 2010 14:33:10 +0000

Published Date:

Wed, 2009-07-01 (All day)

Genetic counseling research has been used for diseases such as breast and other cancers, but genetic counseling for hypertension has been understudied. African-American women have the highest prevalence of hypertension and cardiovascular disease of any group in the United States. Because hypertension and related cardiovascular sequela have a profound impact on the health and well being of African-American women, providing genetic counseling for hypertension is important in order to determine risk and to provide early interventions. The purpose of this study is to examine lifestyle changes among urban African-American women following genetic counseling for hypertension as compared to baseline. Specific lifestyle factors include the impact of changes in physical activity, of sodium intake, and of body mass index on systolic and diastolic blood pressure and pulse pressure. Results of this study indicated that systolic and diastolic blood pressure readings and pulse pressure readings decreased six months after genetic counseling, although the findings were not statistically significant. Body mass index remained relatively unchanged after genetic counseling, but minutes of increased physical activity was reported, although this was not significant. However, a statistically significant decrease in sodium intake (p = .033) was noted from baseline to 6-month follow-up after genetic counseling. With the exception of sodium, changes in lifestyle behaviors, blood pressure, and pulse pressure readings did not differ significantly from baseline. However, changes in lifestyle behaviors in a positive direction are important and worth noting. Further studies on genetic counseling for hypertension with longer follow-up periods are needed to determine the effectiveness of genetic counseling on changes in lifestyle behaviors and blood pressure readings.

Breast Cancer in the Context of Intimate Partner Violence: A Qualitative Study

nfs — Wed, 19 May 2010 14:16:31 +0000

Published Date:

Wed, 2010-05-19 (All day)

Purpose/Objectives: To describe the experiences of women who were diagnosed with breast cancer while also encountering intimate partner violence (IPV). IPV was determined by scores on the Women's Experience With Battering Scale and the Abuse Assessment Screen.

Research Approach: Qualitative interviews were conducted with a convenience sample of seven women. Data were analyzed with a hermeneutic phenomenologic approach.

Setting: Community settings in central Virginia and Maryland.

Participants: 7 participants ranging in age from 37-63 years (X = 50 years); age at diagnosis ranged from 36-58 years (X = 46 years). All were in relationships with men, and relationship length ranged from 2-29 years (X = 12 years).

Methodologic Approach: Each participant had one semistructured qualitative interview.

Main Research Variables: Experiences of women simultaneously experiencing breast cancer and IPV.

Findings: A number of themes emerged, including: (a) reassessing life, (b) believing that stress from the relationship caused the cancer, (c) valuing support from others, and (d) the significance of the breast.

Conclusions: For all of the participants, the breast cancer diagnosis changed their intimate relationships in some way. The cancer was an opportunity for the women to engage in life review, focus inward, and, in some cases, change the relationship status.

Interpretation: Increased awareness and screening for IPV are needed in oncology clinical settings. Women with cancer are members of a vulnerable population and use the diagnosis to reassess their intimate relationships.