New evidence regarding racial and ethnic disparities in mental health: policy implications.
Health Aff (Millwood). 2008 Mar-Apr;27(2):393-403.
McGuire TG, Miranda J.
Corresponding author: Jeanne Miranda
Email: mirandaj@ucla.edu
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
ABSTRACT: Minorities have, in general, equal or better mental health than white Americans, yet they suffer from disparities in mental health care. This paper reviews the evidence for mental health and mental health care disparities, comparing them to patterns in health. Strategies for addressing disparities in health care, such as improving access to and quality of care, should also work to eliminate mental health care disparities. In addition, a diverse mental health workforce, as well as provider and patient education, are important to eliminating mental health care disparities.
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April 2008
Nine-year trends and racial and ethnic disparities in women's awareness of heart disease and stroke: an American Heart Association national study
J Womens Health (Larchmt). 2007 Jan-Feb;16(1):68-81.
Christian AH, Rosamond W, White AR, Mosca L.
Corresponding author: Lori Mosca
Email: ljm10@columbia.edu
New York-Presbyterian Hospital, New York
BACKGROUND: The purpose of this study was to evaluate trends in women's awareness, knowledge, and perceptions related to cardiovascular disease (CVD) since 1997, when the American Heart Association initiated a national campaign for women.
METHODS AND RESULTS: A nationally representative sample of 1,005 women identified through random digit dialing (mean age 50 years, 71% white) was surveyed in 2006, and results were compared with results of similar surveys conducted in 2003, 2000, and 1997. Awareness, knowledge, and perceptions related to CVD were evaluated using a standardized interviewer-assisted questionnaire. In 2006, awareness of heart disease as the leading cause of death among women was 57%; significantly higher than in prior surveys (p < 0.001). Awareness was lower among black and Hispanic women compared with white women (31% and 29% vs. 68%, p < 0.05), and the racial/ethnic difference has not appreciably changed over time. More than twice as many women felt uninformed about stroke compared to heart disease in 2006 (23% vs. 11%, p < 0.05). Hispanic women were more likely than white women to report that there is nothing they can do to keep themselves from getting CVD (22% vs. 11%, p < 0.05). The majority of respondents (> or = 50%) reported confusion related to basic CVD prevention strategies.
CONCLUSIONS: CVD awareness has increased significantly among women since 1997, yet the racial/ethnic gap in awareness has not narrowed. Educational efforts to increase heart disease and stroke awareness should be targeted to racial/ethnic minorities, especially Hispanics. Methods to reinforce basic CVD prevention strategies are needed.
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March 2008
Disparities in A1C levels between Hispanic and non-Hispanic white adults with diabetes: a meta-analysis
Diabetes Care. 2008 Feb;31(2):240-6.
Kirk JK, Passmore LV, Bell RA, Narayan KM, D'Agostino RB Jr, Arcury TA, Quandt SA.
Corresponding author: Julienne Kirk
Email: jkirk@wfubmc.edu
Department of Family and Community Medicine, Wake Forest University School of Medicine
OBJECTIVE: Hispanics have higher rates of diabetes and diabetes-related complications than do non-Hispanic whites. A meta-analysis was conducted to estimate the difference between the mean values of A1C for these two groups.
RESEARCH DESIGN AND METHODS: We executed a PubMed search of articles published from 1993 through July 2007. Data sources included PubMed, Web of Science, Cumulative Index to Nursing and Allied Health, the Cochrane Library, Combined Health Information Database, and Education Resources Information Center. Data on sample size, age, sex, A1C, geographical location, and study design were extracted. Cross-sectional data and baseline data from clinical trials and cohort studies for Hispanics and non-Hispanic whites with diabetes were included. Studies were excluded if they included individuals <18 years of age or patients with pre-diabetes or gestational diabetes.
RESULTS: A total of 495 studies were reviewed, of which 73 contained data on A1C for Hispanics and non-Hispanic whites, and 11 met the inclusion criteria. Meta-analysis revealed a statistically significant mean difference (P < 0.0001) of -0.46 (95% CI -0.63 to -0.33), correlating to an approximately 0.5% higher A1C for Hispanics. Grouping studies by design (cross-sectional or cohort), method of data collection for A1C (chart review or blood sampling), and care type (managed or nonmanaged) yielded similar results.
CONCLUSIONS: In this meta-analysis, A1C was approximately 0.5% higher in Hispanic patients with diabetes than in non-Hispanic patients. Understanding the reasons for this disparity should be a focus for future research.
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February 2008
Socioeconomic position, race/ethnicity, and inflammation in the multi-ethnic study of atherosclerosis
Circulation. 2007 Nov 20;116(21):2383-90.
Ranjit N, Diez-Roux AV, Shea S, Cushman M, Ni H, Seeman T.
Corresponding author: Nalini Ranjit
Email: nranjit@umich.edu
Center for Social Epidemiology and Population Health,
University of Michigan, Ann Arbor, MI
BACKGROUND: Low socioeconomic position is known to be associated with cardiovascular events and atherosclerosis. Reasons for these associations remain a topic of research. Inflammation could be an important mediating mechanism linking socioeconomic position to cardiovascular risk.
METHODS AND RESULTS: This cross-sectional study used data from the baseline examination of the Multi-Ethnic Study of Atherosclerosis (MESA), a study of 6814 men and women 45 to 84 years of age. Race- and ethnicity-stratified regression analyses were used to estimate associations of household income and education with C-reactive protein and interleukin-6 before and after adjustment for infection and medication use, psychosocial factors, behaviors, adiposity, and diabetes mellitus. Low income was associated with higher concentrations of interleukin-6 in all race/ethnic groups. Percent differences associated with 1-SD-lower income were 9% (95% confidence interval [CI], 7 to 11), 6% (95% CI, 1 to 10), 8% (95% CI, 4 to 11), and 8% (95% CI, 3 to 13) for whites, Chinese, blacks, and Hispanics. Low levels of education were associated with higher levels of interleukin-6 only among whites and blacks (percent difference in interleukin-6 associated with 1-SD-lower education: 9% [95% CI, 6 to 12] among Whites, and 7% [95% CI, 3 to 10] among blacks). Similar patterns were observed for C-reactive protein. Adiposity was the single most important factor explaining socioeconomic position associations, especially among blacks and whites. A smaller effect was seen for psychosocial factors and behaviors in all race groups.
CONCLUSIONS: Both household income and education are associated with inflammation, but associations vary across race/ethnic groups. Associations likely result from socioeconomic position patterning of adiposity and other factors.
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January 2008
Conceptualization and development of a theory-based healthful eating and physical activity intervention for postpartum women who are low income
Health Promot Pract. 2007 Jan;8(1):50-9. Epub 2006 Jul 13.
Ebbeling CB , Pearson MN, Sorensen G, Levine RA, Hebert JR, Salkeld JA, Peterson KE.
Corresponding author: Cara B. Ebbling
Email: cara.ebbeling@childrens.harvard.edu
Obesity Research at Children's Hospital, Boston, MA
ABSTRACT: Eating and physical activity behaviors that confer risk for chronic disease are prominent among women from varying ethnic and racial groups who are low income. Conceptualization and development of a theory-based behavioral intervention to address their unique needs during the first year following childbirth comprised four steps: (a) translating public health guidelines and emerging epidemiologic data into specific intervention messages; (b) developing practical strategies to operationalize theoretical constructs, in the context of a social ecological framework; (c) stating achievement-based objectives and writing scripts for five home visits; and (d) conducting formative research. Focus group participants expressed a desire for a "health mentor," not somebody who "nags" or "stresses you out." Paraprofessionals from the Expanded Food and Nutrition Education Program (EFNEP) were directly involved in pretesting the intervention and remain involved as health mentors. This intervention can serve as a basis for future organizational partnerships to benefit the health of populations who are low income.
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