Paper of the Month
December 2008
Breastfeeding Status on US Birth Certificates: Where Do We Go From Here?
Pediatrics 2008; 122: e1159-e1163.
Donna J. Chapman, Anne Merewood, Robert Ackatia Armah, and Rafael Pérez-Escamilla
Corresponding author: Donna Chapman
Email: donna.chapman@uconn.edu
Department of Nutritional Sciences, Center for Eliminating Health Disparities among Latinos, University of Connecticut, Storrs
OBJECTIVES. The objectives of this study were to assess the extent to which states collected breastfeeding data on the birth certificate, to verify the wording of the breastfeeding questions used, and to develop recommendations for future revisions of the breastfeeding question asked on the US Standard Certificate of Live Birth.
METHODS. Registrars of vital statistics in US states and territories were contacted via telephone with e-mail follow-up between April 2006 and May 2008 to determine whether their state/territory collected breastfeeding data on its birth certificate. Responses were categorized as follows: (1) breastfeeding data currently collected; (2) breastfeeding data not currently collected but implementation date set; or (3) breastfeeding data not currently collected and no implementation plans.
RESULTS. In May 2008, 56.6% (30 of 53) of US states and territories were collecting data on breastfeeding status at hospital discharge on their birth certificate. The questions used to collect breastfeeding data, however, had not been standardized. Approximately one quarter (12 of 53) reported that they were not yet collecting breastfeeding data on their birth certificate but that an implementation date had been set. Approximately one fifth (11 of 53) indicated that their state birth certificate did not plan to collect breastfeeding data by January 2010.
CONCLUSIONS. A total of 79% of the registrars reported that breastfeeding data were collected on the birth certificate or that the process would begin within the next 2 years. Future revisions to the Standard Certificate of Live Birth breastfeeding question should assess breastfeeding exclusivity. The revision process should include feedback from health professionals who collect these data, pretesting of the revised question for feasibility, and extensive training before data collection.
The abstract for this article can be downloaded here.
November 2008
Disparities in health: perspectives of a multi-ethnic, multi-racial America
Health Aff (Millwood). 2007 Sep-Oct;26(5):1437-47
Blendon RJ, Buhr T, Cassidy EF, Perez DJ, Hunt KA, Fleischfresser C, Benson JM, Herrmann MJ
Corresponding author: Robert Blendon
Email: rblendon@hsph.harvard.edu
Harvard School of Public Health, Boston, MA.
ABSTRACT: This 2006 survey of 4,157 randomly selected U.S. adults compared perceptions of health care disparities among fourteen racial and ethnic groups to those of whites. Findings suggest that many ethnic minority groups view their health care situations differently and, often, more negatively than whites. A substantial proportion perceived discrimination in receiving health care, and many felt that they would not receive the best care if they were sick. Most differences remained when socioeconomic characteristics were controlled for. The variety of responses across racial groups demonstrates the importance of examining ethnic subgroups separately rather than combined into a single category.
The abstract for this article can be downloaded here. (subscription may be required to access article)
October 2008
The prevalence of metabolic syndrome among US women of childbearing age
Am J Public Health. 2008 Jun; 98(6): 1122-7. Epub 2008 Apr 29.
Ramos RG, Olden K.
Corresponding author: Rosemarie Ramos
Email: ramosr@niehs.nih.gov
Laboratory of Molecular Carcinogenesis, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.
OBJECTIVES: We sought to determine whether the prevalence of metabolic syndrome among US women of childbearing age (18-44 years) has increased since 1988 and to estimate its current prevalence by race/ethnicity and risk that a maternal history of select metabolic syndrome characteristics imposes on offspring.
METHODS: We used survey-specific data analysis methods to examine data from the National Health and Nutrition Examination Surveys conducted from 1988 to 2004.
RESULTS: The prevalence of the metabolic syndrome phenotype and 2 of its clinical correlates significantly increased between 1988 and 2004 (increase for metabolic syndrome phenotype=7.6%, for obesity=13.3%, and for elevated C-reactive protein=10.6%; P < .001 for all 3). Hispanic women were more likely than were White women to possess the phenotype (P = .004). Women who reported that their mothers had been diagnosed with diabetes were more likely to possess the phenotype than those whose mothers had not been so diagnosed (odds ratio=1.9; 95% confidence interval=1.3, 2.8).
CONCLUSIONS: The current trends of metabolic syndrome among women of childbearing age demonstrate the need for additional rigorous investigations regarding its long-term effects in these women and their offspring.
The abstract for this article can be downloaded here. (subscription may be required to access article)
September 2008
Leisure-Time Physical Activity Disparities Among Hispanic Subgroups in the United States
Am J Public Health. 2008 Jun 12. [Epub ahead of print]
Neighbors CJ, Marquez DX, Marcus BH
Corresponding author: Charles J. Neighbors
Email: cneighbors@casa
National Center on Addiction and Substance Abuse, Columbia University, NY
ABSTRACT: Studies of leisure-time physical activity disparities for Hispanic individuals have not adjusted for sociodemographic confounds or accounted for variation by country of origin. We used the National Health Interview Survey to compare leisure-time physical activity among Hispanic and non-Hispanic White persons. All Hispanic subgroups were less active than were non-Hispanic White people, yet significant heterogeneity existed among Hispanic persons. Sociodemographic factors partly accounted for disparities among men; disparities among women persisted despite multivariate adjustments. Interventions must attend to these underserved yet varied subcommunities.
The abstract for this article can be downloaded here. (subscription may be required to access article)
August 2008
Does social class predict diet quality?
Am J Clin Nutr. 2008 May;87(5):1107-17.
Darmon N, Drewnowski A
Corresponding author: Nichole Darmon
Email: nichole.darmon@univmed.fr
INRA, UMR1260, Nutriments Lipidiques et Prévention des Maladies Métaboliques, Marseille, France
ABSTRACT: A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. Although micronutrient intake and, hence, diet quality are affected by SES, little evidence indicates that SES affects either total energy intakes or the macronutrient composition of the diet. The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Exploring the possible causal relations between SES and diet quality is the purpose of this review.
The abstract for this article can be downloaded here. (subscription may be required to access article)
July 2008
Impact of peer nutrition education on dietary behaviors and health outcomes among Latinos: a systematic literature review
J Nutr Educ Behav. 2008 Jul-Aug;40(4):208-25
Pérez-Escamilla R, Hromi-Fiedler A, Vega-López S, Bermúdez-Millán A, Segura-Pérez S
Corresponding author: Rafael Pérez-Escamilla
Email: rafael.perez-escamilla@uconn.edu
Department of Nutritional Sciences, University of Connecticut, Storrs
OBJECTIVE: This systematic review assesses the impact of peer education/counseling on nutrition and health outcomes among Latinos and identifies future research needs.
DESIGN: A systematic literature search was conducted by: (1) searching Internet databases; (2) conducting backward searches from reference lists of articles of interest; (3) manually reviewing the archives of the Center for Eliminating Health Disparities among Latinos; (4) searching the Journal of Nutrition Education and Behavior; and (5) directly contacting researchers in the field. The authors reviewed 22 articles derived from experimental or quasi-experimental studies.
OUTCOME MEASURES: Type 2 diabetes behavioral and metabolic outcomes, breastfeeding, nutrition knowledge, attitudes and behaviors.
RESULTS: Peer nutrition education has a positive influence on diabetes self-management and breastfeeding outcomes, as well as on general nutrition knowledge and dietary intake behaviors among Latinos.
CONCLUSIONS AND IMPLICATIONS: There is a need for longitudinal randomized trials testing the impact of peer nutrition education interventions grounded on goal setting and culturally appropriate behavioral change theories. Inclusion of reliable scales and the construct of acculturation are needed to further advance knowledge in this promising field. Operational research is also needed to identify the optimal peer educator characteristics, the type of training that they should receive, the client loads and dosage (ie, frequency and amount of contact needed between peer educator and client), and the best educational approaches and delivery settings.
The abstract for this article can be downloaded here. (subscription may be required to access article)
June 2008
The influence of perceived risk to health and immigration-related characteristics on substance use among Latino and other immigrants.
Am J Public Health. 2008 May;98(5):862-8. Epub 2008 Apr 1.
Ojeda VD, Patterson TL, Strathdee SA.
Corresponding author: Victoria D. Ojeda
Email: vojeda@ucsd.edu
Department of Family and Preventive Medicine, Division of International Health and Cross-Cultural Medicine, UCSD School of Medicine
OBJECTIVES: We examined whether immigration-related characteristics and perceptions of risk surrounding substance use were independently associated with lifetime use of cigarettes and various illicit substances among immigrant and native-born Latino and non-Latino White adults in the United States.
METHODS: Data were from the 2002 National Survey on Drug Use and Health. Analyses were limited to Latinos and non-Latino Whites 18 years and older. We used cross-tabulations and multivariate logistic regression to test relations between risk perceptions, immigration characteristics, and substance use.
RESULTS: More than two thirds of all respondents perceived moderate or great risk to health and well-being associated with all substances analyzed. The odds of lifetime substance use by Latino and non-Latino White immigrants were lower than for US-born non-Latino Whites. Immigrant Latinos' odds of lifetime substance use were lower than for US-born Latinos. Moderate or great perceived risk was associated with lower likelihood of lifetime use of all substances except cigarettes.
CONCLUSIONS: Foreign birth appeared to protect against substance use among both Latino and non-Latino White immigrants. Future studies should examine potential protective factors, including cultural beliefs and practices, acculturation, familial ties, and social network influences.
The abstract for this article can be downloaded here. (subscription may be required to access article)
May 2008
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.
The abstract for this article can be downloaded here. (subscription may be required to access article)
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.
The abstract for this article can be downloaded here. (subscription may be required to access article)
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.
This article can be downloaded here. (subscription may be required)
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.
This article can be downloaded here. (subscription may be required)
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.
This article can be downloaded here. (subscription may be required)
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