|2008 Poster abstracts|
Lauren Gordon, MPH
Objectives: Little is known about the differential effect environment has on health among Asian and Pacific Islanders Americans (APIAs). Furthermore, the lack of national data and organized research on environmental health disparities affecting APIA subgroups make it increasingly difficult to create culturally appropriate intervention in this group. The aim of this review paper is to investigate factors (environmental exposure, socio-cultural position, workplace) that may leave APIA's more susceptible to the burden of disease.
Methods: A review of the literature was conducted using peer reviewed journal articles and publications from health advocacy groups and government agencies to examine environmental exposures and environmentally-mediated outcomes among APIA's.
Results: Segregation of APIA's in U.S. Chinatowns and other ethnic enclaves appear to be correlated with higher exposure to ambient pollution. The promotion of tobacco internationally, the use of traditional herbal medicine product's and dietary practices appear to place APIA's at higher risk of exposure to environmental tobacco smoke and toxic metals. APIA women appear to be at higher risk of exposure to occupational hazards. APIA's appear to suffer disproportionately from certain types of Cancers and have a high prevalence of chronic disease.
Conclusions: APIA's are comprised of over forty ethnic subgroups. The results suggest there is heterogeneity of exposure within APIA subgroups. More research is needed at the national and local level to uncover the variability of exposure to environmental hazards among APIA's. Identifying within group variation can be significant in characterizing both elevated exposure and risk.
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The Role of Ethnic Identity on the Health-Related Attitudes of African American and Jamaican Black Men in the South
Shanita Williams-Brown PhD, MPH, APRN
Lisa Hinton, MPH
Leslyn Wong, MPH
Introduction: Little is known about how the cultural and ethnic profiles of U.S.-born and Jamaican-born Black men living in the South impact their health attitudes and behaviors. Ethnic identity, defined as a sense of group or collective identity based on one's perception of a shared common ethnic heritage with a particular ethnic group is hypothesized to be protective against the challenging health and social outcomes that often accompany the southern Black male experience in the U.S.
Methods: The authors conducted one-hour individual guided interviews with a sample of men representing two black ethnic subgroups--U.S.-born and Jamaican-born Black men living in the metropolitan Atlanta area. Demographic and health attitudes surveys were administered to all participants prior to the interviews. Participants were asked to talk openly about their sense of self, their ethnicity and culture, and their health-related attitudes.
Results: Both U.S.-born and Jamaican-born Black men who communicated a sense of ethnic identity were more likely to have positive health attitudes when compared to men who did not communicate a sense of ethnic identity. Jamaican-born Black men were more likely to discuss attitudes and values consistent with a sense of ethnic identity and their health attitudes were frequently more positive and future-oriented when compared to U.S.-born Black men.
Conclusion: Ethnic identity was positively associated with the health-related attitudes of Black men in the South. The results of this study can be used to develop culturally-appropriate and effective health education and screening programs that target southern Black men.
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At the Intersections: Insights into Young HIV-Positive MSM of Color Experiences of Faith, Sexuality and Race
Molly Stapleton, BM
Erik Valera, BA
Marcie Fisher-Borne, MPH, MSW
Justin Smith, BA
Lisa Hightow-Weidman, MD, MPH
Background: Although only 24% of North Carolinians are Black, this group accounts for two thirds of HIV/AIDS cases in the state. In 2003, over 70% of new HIV cases among men aged 13-24 were among Black men. Project STYLE is a cohort study of young newly diagnosed or previously lost to care HIV+ MSM of color.
Methods: Participants were recruited through area HIV clinics and service organizations. Interviews occurred from 6/06 - 12/07 with HIV+ MSM of color, ages 17-24 years (N=34). Qualitative interviews explored participants' experiences related to race, sexual identity, spirituality, and social support.
Results: Nearly all (93%) respondents felt like they were part of the Black community and participants reported being "comfortable" or "very comfortable" with their sexual orientation (91.2%). Most expressed negative opinions of the "gay community." Growing up, a majority received strong faith-based messages that homosexuality would lead to "Hell and damnation" (68%) as well as to death by AIDS (68%).
Conclusion: Although participants received overwhelmingly negative messages about same-sex sexual behavior from family, community, and religious institutions, most were comfortable with their sexual identity. We observed a significant discordance between the respondents' high level of comfort with their sexuality and negative perceptions of, and lack of connection with, the "gay community." Further research is needed to better understand the factors that account for the resilience of this population and to explore how early messages influence sexual and racial identity development among Black MSM and its relationship to HIV infection.
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Use of Complementary and Alternative Medicine in the United States: Another Case of Healthcare Disparities?
Maria Chao, DrPH, MPA
Introduction: The Institute of Medicine has identified race, ethnicity, socioeconomic position, and acculturation as key dimensions of social disparities in health. Public health studies have examined how these factors are associated with healthcare, focusing primarily on conventional biomedical care. Complementary and alternative medicine (CAM) accounts for the majority of health seeking behaviors, but few studies have examined CAM use across these social dimensions.
Methods: Using data from national surveys, this study explores the effects of race/ethnicity, socioeconomic position (SEP), and acculturation on CAM utilization among multiethnic women.
Results: Minority women were the highest users of specific CAM domains (e.g., medicinal herb use among Mexican American women; acupuncture among Chinese American women). However, for all summary measures (i.e., used at least one type of CAM, professional and non-professional CAM) Non-Hispanic White women had the highest rates of use. White women used the broadest variety and the greatest number of CAM. Higher SEP was associated with greater CAM use among the population as a whole. However, SEP was not a predictor of CAM use in all racial/ethnic groups (i.e., Chinese Americans and African Americans). Among Mexican- and Chinese-American women, acculturation was not associated with CAM use.
Conclusion: Study findings highlight the complexity of how race/ethnicity interacts with other social factors to affect health behaviors. Social factors differentially predict CAM use among racial/ethnic subpopulations such that utilization disparities are not apparent for all CAM modalities. Overall rates of CAM use, however, suggest a trend towards disparities in CAM utilization.
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The Acceptability and Feasibility of Door-to-Door Rapid HIV Testing among Latino Residents in Durham, NC
Julia Gamble, MPH, FNP
Abigail Zeveloff, MPH
Chris McQuiston, RN, PhD
Arlene Seņa, MD, MPH
Introduction: Latino immigrants face unique barriers to clinic-based HIV testing, such as language issues and non-familiarity with local healthcare systems. To reduce these barriers, we assessed the acceptability and feasibility of door-to-door rapid HIV testing among Latinos in Durham, NC.
Methods: We conducted HIV outreaches door-to-door at predominantly Latino apartment complexes in high-risk neighborhoods. Promotores (lay health educators) recruited participants who were at least 18 years of age, not pregnant, and reported no prior HIV test in the previous month. Consenting participants completed a questionnaire regarding HIV risk factors and acceptance of rapid HIV testing. Trained bilingual HIV counselors administered confidential oral-fluid rapid HIV tests and provided pre- and post-test counseling.
Results: Promotores contacted 335 people in 9 apartment complexes. Of these, 58 completed the questionnaire only, and 179 (76% of participants) consented to the questionnaire and rapid HIV test. Based upon 237 completed surveys, participants believed they were at risk for HIV (46%) and reported risk factors including sex with commercial sex workers (42%). However, most had never been tested for HIV (65%). Additionally, participants were unaware of locations providing free HIV testing (57%) or medical assistance (41%). Ninety-two percent of participants preferred rapid over standard HIV testing, while 75% of people favoring rapid testing preferred it offered door-to-door or at community locations.
Conclusion: Community-based rapid HIV testing offered door-to-door mitigates barriers to clinic-based testing and is an acceptable and feasible strategy for screening Latino immigrants with high-risk sexual behaviors who may have limited access to healthcare.
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Prevention of Heat Stroke Fatalities on N.C. Farms
Regina Cullen Luginbuhl, MS
Introduction: In 2005, four agricultural workers died from heat stroke in N.C. Three of the four were here on the guest worker program (H-2A) and came with visas, passports, and permission to work on N.C. farms. In 2006, three agricultural workers died from heat stroke in N.C. Of these, one was a guest worker.
Methods: How does a preventable illness - heat stress - escalate into heat stroke and death? What steps are being taken on N.C. farms to prevent heat stroke? The N.C. Department of Labor conducted a survey in 2007 involving over 1,000 growers who register migrant farmworker housing in accordance with the Migrant Housing Act of N.C. (N.C. General Statutes 95-222 through 95-229). A total of 362 surveys were returned completed.
Results: Growers also suffered from heat stress. 45% or 165 respondents indicated that they, the grower, had experienced heat stress or heat stroke, either while doing farm work or in a non-farm activity. In spite of this, 79% (267) felt that their workers knew what to do if a heat emergency occurred.
Conclusion: Educational programs should address all aspects of heat stress, including causes, symptoms and prevention. Education on the recognition of heat stress, heat stroke, should involve both grower and farmworker. As a result of this survey, a Spanish/English language DVD on the recognition and prevention of heat stroke was produced.
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Effects of Early Childhood Lead Exposure on Elementary School Test Performance
Dohyeong Kim, PhD
Lynn Miranda, PhD
Jerome Reiter, PhD
Andy Hull, BS
S. Philip Morgan, PhD
Introduction: Research has long linked childhood lead exposure to deficits in neurocognitive function, with increasing evidence of negative impacts at blood lead levels well below the CDC action level. This study determines whether different exposures to lead contribute to the achievement gap between blacks and whites; and whether the effect of lead on educational achievement demonstrates a threshold effect.
Methods: We linked lead surveillance and early end of grade testing data for children in NC. We used multivariate regression analysis to examine the correlation of lead exposure with reading and math scores for the 100 counties in NC. Quantile regression was used to determine whether the impact of lead differed across the distribution of test scores. Average blood lead levels among students designated as "exceptional children" were tested for statistical differences.
Results: Lead exposure demonstrated a dose-response impact on reading and math scores, with no demonstrable threshold effect. The impact of lead exposure was greater and more highly variable at the low end of the distribution of math and reading scores. Children with learning and behavioral disorders had higher early childhood blood lead levels.
Conclusion: A blood lead level of 5 ug/dL (half the current CDC action level) has roughly the same impact on reading and math scores as participation in the free and reduced lunch program, a classic poverty indicator. The effects were more significant at the low end of the distribution of math and reading scores. Accounting for early childhood lead exposure attenuates, in part, the black-white achievement gap in test scores.
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Paul R. Smokowski, PhD
Introduction: Latinos are one of the largest growing groups in the United States. Large percentages of this population are under the age of 19 and have emigrated from Latin American countries. The stress associated with acculturating to another culture, in combination with the alarming rates of substance use among Latino adolescents, indicates a great need to understand the relationship between these two conditions. While there has been some research on the associations between acculturation stress and substance use among Latino adolescents, the results have been inconsistent and lack consideration of both family and peer relationships along with adolescent mental health outcomes. This research serves as an initial step into understanding these complex associations.
Methods: This study is part of the larger Latino Acculturation and Health Project; a longitudinal study of the acculturation experiences of Latino families in North Carolina and Arizona. The study sample consists of 286 adolescents; 66% were born in a Latin American country. Path analysis using AMOS 7.0 was conducted.
Results: Results of the path analysis revealed several significant effects with evidence of single, double, triple, quadruple, and even quintuple mediation. This suggests there are several factors that influence the association between acculturation stress and substance use for Latino adolescents.
Conclusions: The association between acculturation stress and substance use is complex. While adolescent mental health outcomes directly affect substance use, family and peer relationships are important mediators between acculturation stress and these direct effects. Further research is warranted to explore these associations in more detail.
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Accessing Health Care among Vulnerable Populations in Southern Arizona: Developing a Policy Media Toolkit
Introduction: Arizona is rapidly growing due to a large influx of immigrants. Regardless of citizen or immigrant status, these populations have encountered political opposition resulting in legislation excluding them from different types of social services. Understanding how these laws impact the well-being of the population is a role the public health field has taken on. Public health workers must be educated and informed of bills in consideration and recently enacted laws affecting the populations they serve.
Methods: The purpose of this project is to educate the public health workforce and health care providers about policies affecting all immigrants. Specific aims include informing all health departments within each of the fifteen counties in Arizona about the facts and myths of state laws pertaining to all immigrants; including laws related to health care, education, financial assistance, and employment.
Five focus groups will be conducted in communities along the southern border, made up of five community members and two public health officials. A focus group with officials from the Arizona Department of Health Services will also be conducted. The final product will be a policy media toolkit to be disseminated to county health departments and other community organizations as a means to inform the populations they serve about state policies.
Results and Conclusion: At this time, the focus groups have not been conducted. They will begin in February 2008 and conclude in March 2008. Once all of them have been conducted, all data will be analyzed to begin development of the toolkit.
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How Public Health is Impacted at the U.S.-Mexico Border
Introduction: The U.S. has witnessed an increase in legislation to curb undocumented migration, which has led to increased militarization at the U.S.-Mexico border. This militarization has produced a "funnel effect" forcing immigrants to cross harsh desert regions, resulting in over 2,000 deaths since 1994. Immigration is often discussed in a limited political context, rarely considering outcomes, such as deaths along the U.S.-Mexico border.
Methods: The Global Health Alliance (GHA), a student organization, organized a symposium in February 2007 to recognize deaths at the U.S.-Mexico border as a public health crisis. A diverse panel of experts, faculty, and students gathered to discuss the hazards of border crossing and the impact of border deaths in communities.
Results: Main outcomes of the symposium included: 1.) The need to address the root causes of immigration; 2.) Recognizing that border security and immigration policies influence border deaths; and 3.) Encouraging a human-rights based approach to address migration and border deaths.
The GHA crafted a position statement on border deaths and presented it to border organizations, including the U.S.-Mexico Border Commission. GHA also presented the statement to student organizations, academic professionals, staff, and faculty at the College.
Conclusion: This process highlights the importance of recognizing the role of student organizations in mobilizing universities to address critical issues in their own communities. Universities and colleges must have a process in place to manage emerging issues recognized by students, faculty, and staff.
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"Get Real Get Tested" North Carolina's Statewide HIV Testing Campaign
Bernard Davis, BS
Constance Jones, BS
Holly Watkins, BS
Introduction: In recent years, North Carolina has averaged about 1,800 new HIV reports annually, which is up from the number of cases reported in the late 1990s. Approximately 67% of all HIV/AIDS cases reported in North Carolina are among African Americans. Many of the individuals affected do not have access to transportation and are in poor, rural communities. These factors indicates the need for increased HIV testing, education and early referral to care in North Carolina.
Method: A targeted outreach campaign was conducted throughout the state. Partnering with local community based organizations and local health departments; the HIV/STD Prevention and Care Branch selected several different communities in the state, based on reported morbidity rates.
Results: The targeted outreach campaign went to 11 locales across North Carolina. The first event was held in Fayetteville in December 2006 and the final event was held in Charlotte in October 2007.
2,248 people were tested during the 2006-2007 Get Real, Get Tested events. Of the 2,248 people tested, we identified 27 people who tested positive for the HIV-1 antibody and 23 people who tested positive for syphilis.
Conclusions: This campaign taught us valuable lessons, including the importance of going into neighborhoods and testing door-to-door. Since lack of transportation can make it difficult or impossible for some people to be tested at specific locations, they appreciate having testing and education brought to them. We found that people were very responsive and willing to be tested.
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Violence: Where are We Heading? What Can We Do? A Significant Public Health Matter.
Shveta Sanghani, PhD, MPH
Samah Arsanious, BA, MPH
Melissa Myers, BS, MPH
Tracy Frost, BS, MPH
Stephanie Do, BS, MPH
Patti Herring, PhD, RN
Elizabeth Holzhauser, MPH
Introduction: Violence is escalating in the city of San Bernardino, in Southern CA affecting significant physical, emotional, social, and economic consequences. A regional advocacy group for violence prevention conferred a D grade to San Bernardino City for interventions with youth violence.
Methods: As part of the efforts to curve the problem a needs assessment was conduced in the area which is known to hold the city's worst crime rate. Ten key informant interviews, one confirmatory focus group, and ethnographic observations were performed. The Theory of Planned Behavior was used as the over-arching guide for data collection and the data were coded and analyzed using the grounded theory approach.
Results: The emerging themes revealed a massive mistrust, enormous fear, lack of communication, and misunderstanding between the community and local law enforcement. Other unique factors that were found to contribute to this violence included family's socio-economic status, lack of parental and spiritual guidance, and mostly importantly, immense influences of the media.
Conclusion: Accordingly, a pilot program was developed promoting parental awareness and participation in violence prevention behaviors including getting their children involved in after-school programs, and family relationship and communication building. Additionally, a community welfare workshop was initiated for face-to-face interaction between community residents and the police for relationship and trust building. During and after implementation, the program was evaluated (process & impact) for program improvement and sustainability.
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Mothers' Perception about Weight Status of Children with Mental Retardation
Introduction: Although obesity rate among persons with mental retardation (MR) is highly greater than that of general population, little is known about overweight children with MR and overweight risk factors regarding weight perception. Therefore, the purpose of this study is to identify the relationship between mothers' perception about their children's weight status and BMI of children with MR in Korea.
Methods: During 2005, participants were recruited from five public special schools in Korea. Participants were mothers who had a child with MR, aged between 8-18 years. Children with MR had no genetic syndrome such as Down syndrome. The self-administered questionnaire was collected from 193 mothers with 74.2% response rate. Mothers' weight perception about their children was compared with BMI of children with MR. Frequency and Cochran-Mantel-Haenszel Chi-square was performed.
Results: Mothers' perception about their children's weight status and actual weight (BMI) were significantly correlated (p <0.0001). For underweight children with MR, only 57% of mothers accurately perceived that their children were thin, the rest of mothers misperceived their children's weight as normal. For normal weight children with MR, about 62% of mothers perceived their children's body weight was normal, but nearly 24% of mothers misperceived that their children were fat. For overweight children with MR, 86% of mothers correctly perceived. There were significant associations for participation of future weight management program (p < 0.0001).
Conclusion: Weight perception is an important factor to be targeted in a weight intervention study, especially among mothers with mentally retarded children. Of particular note is that overall 32% of mothers perceived incorrectly about their children's weight status.
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Robert L. Woldman, MA
Caroline P. Chappell, MPA
Matthew R. Avery, MA
Introduction: Recent data on the burden of asthma in North Carolina show that racial/ethnic minorities are disproportionately affected by asthma. This study investigates the disparities between whites, African Americans (AAs), Native Americans (NAs), and Hispanics with respect to asthma prevalence and mortality, and selected asthma-related behaviors.
Methods: We analyzed asthma data from the North Carolina Behavioral Risk Factor Surveillance System for 2005 and 2006 to investigate differences in lifetime prevalence, current prevalence, asthma episodes, inhaler use, asthma medication use, emergency department (ED) visits, and healthcare provider visits between the four racial/ethnic groups of asthmatic adults. Logistic regression models were used to test the significance of these differences between whites and the three non-white groups. Vital statistics from 1999-2006 were used to determine differences in mortality due to asthma.
Results: Native Americans had the highest rates for lifetime and current prevalences, asthma episodes, inhaler use, and asthma medication use, while African Americans had the highest rates for ED and healthcare provider visits. Significant differences between whites and the minority groups were found for: lifetime and current asthma prevalences (all minority groups), asthma episodes (AAs only), inhaler use (NAs only), ED visits (AAs only), and healthcare provider visits (AAs only). Asthma-related mortality rates were highest among African Americans, followed by American Indians, and whites.
Conclusion: Racial/ethnic disparities are notable with respect to asthma prevalence and asthma-related behaviors among adults in North Carolina. Cultural, demographic, environmental, and access to health care issues play important roles for these disparities.
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An African American and Latino Male Lay Health Advisor (LHA) Program: Examining Impact of LHA and Relationship Characteristics on Healthcare Utilization
Anh N. Tran, PhD(c), MPH
Eugenia Eng, DrPH, MPH
Introduction: Men of color in the US experience poor health outcomes and significant barriers to healthcare. Lay Health Advisor (LHA) programs can potentially reduce men's health disparities. One reason, however, for few male LHA programs may be the lack of understanding about the functional aspects of male friendships - how they relate to and influence each other in behavior change.
Methods: This study analyzed data from an African American and Latino male LHA intervention program (MAN For Health) aimed at improving men's (Confidants') preventive health behaviors. This study examines the effects of (a) Confidant-LHA structural relationship characteristics and (b) LHA healthcare visits on Confidant healthcare visits in past six months. Confidant-LHA relationship characteristics included closeness, diversity, length, and interaction frequency. Healthcare visits were with a healthcare provider for checkup and/or screening tests. We also examined Confidant and LHA demographic covariates. Data included baseline and six-month questionnaires from 227 African American and Latino men in North Carolina. Data was analyzed using generalized hierarchal linear regression models.
Results: Confidant age and baseline healthcare visits were positively associated with six-month Confidant healthcare visits (p<.05). Furthermore, an interaction effect existed between LHA healthcare visits and Confidant closeness to LHA (p<.05). The closer Confidants felt to LHAs, the stronger the positive effect between LHA and Confidant healthcare visits.
Conclusion: The results support examining further, within male LHA programs, LHA and relationship characteristic effects on Confidant health outcomes. This information can help develop more effective Confidant-LHA dyad profiles to improve health outcomes for men of color.
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Breaking the Cycle: Poverty, Incarceration, and Sexually Transmitted Infections in North Carolina
Brooke A. Levandowski, MPA
Elizabeth A. Torrone, MSPH
Malika Roman Isler, MPH
James C. Thomas, MPH, PhD
Introduction: Structural violence, or violence purveyed by a "faceless entity" such as an institution, creates linkages to construct a cycle of poverty, incarceration and sexually transmitted infections (STIs). Using examples from North Carolina (NC) at individual, partnership, community and county levels, we examine specific pathways by which structural violence is enacted.
Methods: We use mixed methodology to provide empirical evidence supporting the links between poverty, incarceration and STIs. We highlight data from all NC county health departments and ethnographic interviews with 14 ex-offenders and 10 female partners of ex-offenders. We present quantitative findings from analyses of data from the US Census and NC Departments of Health and Corrections and offer recommendations for interventions to minimize the effects of structural violence on STI transmission.
Results: Structural violence is evident at each examined level in NC: through the justice system in terms of racially disparate sentencing laws; the effect on the community by high rates of incarceration; insufficient STI services in the correctional system; and reduced employment opportunities for ex-felons.
Conclusion: The cycle of poverty, incarceration and STI transmission is driven by societal structures. Root causes of poverty must be addressed through systemic change such as improving educational and economic opportunities at the community level to provide viable alternatives to illegal activities. Increased STI services in correctional facilities will help curb the cycle of STI transmission in the community upon release of incarcerated individuals. Such interventions are concrete examples of ways that work to disrupt this cycle and break down these structures.
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Kim D. Jaffee, PHD, MSW
Sandra Lane, MPH, PhD
Introduction: Healthy People 2010 goals seek to eliminate birth outcome disparities. Poor minority neighborhoods face environmental risks that increase the rates of chronic illnesses such as hypertension, diabetes, and asthma. Maternal asthma is associated with preterm birth and low birthweight. Disparities in asthma rates between blacks and whites are particularly troubling and may have an impact on birth outcome disparities. The objective of this study was to: determine the prevalence of asthma in child-bearing women by race and ethnicity; determine the relationship between lung disease and other medical risk factors; and examine the association between low birthweight and lung disease by race/ethnicity.
Methods: Frequency distributions and bivariate analyses were used to analyze the 1996- 2003 Central New York Perinatal Dataset.
Results: Of the 24,242 women who gave birth, 60.7% were White, while 28.1% were Black, and 4.9% were Hispanic. Hispanic women had the highest rate of Lung Disease (12.1%) compared to Blacks (8.5%) and Whites (9.0%). However, the difference in the low birthweight rate for Blacks with lung disease compared to those without lung disease (15.8% and 13.2, respectively) was significantly higher than for Whites (7.9% and 7.0%, respectively).
Conclusion: Lung disease in Central New York was found to have more critical implications for minority women. Compared with Whites, Black women had more negative birth outcomes due to lung disease. Viewing asthma and birth outcomes within a political and social context sheds light on the need for structural changes as well as improvement in asthma detection and access to treatment.
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Superwoman Schema and Emotional Suppression in African American Women: A Preliminary Examination of the Contribution of Cultural, Historical, and Interpersonal Phenomena to Current Mental and Physical Health Disparities
Cheryl Woods-Giscombe, PhD, RN
Introduction: Superwoman Schema (SWS) in African American women involves feeling obligated to remain silent about feelings of stress or vulnerability in order to project an image of strength. This method of responding to stress may be detrimental to the health of African American women as a result of increased psychological distress, heightened physiological stress responses, or the use of maladaptive coping behaviors (e.g., stress-related overeating) to manage the circumstances that are hidden from others or internalized. In order to determine how SWS relates to negative psychological and physiological health outcomes, more effort needs to be placed on clearly conceptualizing this phenomenon.
Methods: Eight qualitative focus groups were conducted using a purposively-selected, demographically diverse sample of African American women to identify critical components and important contextual elements (e.g., sociocultural, historical, economic, generational) of SWS. Data was analyzed using analytic induction and grounded theory methods.
Results: A preliminary multidimensional structure of SWS was identified. In addition antecedents, interpersonal motivations, and health behaviors associated with SWS were identified. Cultural, sociohistorical, and interpersonal events and phenomena contributed to endorsement of SWS ideology, including emotional suppression. The conceptual data generated from this research has led to the preliminary development of a conceptual framework and instrument to measure SWS.
Conclusion: SWS appears to play an important role in African American women's risk for adverse mental and physical health outcomes. The results of this study and further empirical research can advance understanding of the development of disparate health conditions among African American women.
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Disparities in Neighborhood Environment and Differential Relationships with Physical Activity by Race and Income: The CARDIA Study
Janne E. Boone
David R. Jacobs Jr.
Introduction: Disparities in amenities are hypothesized to contribute to health disparities. Neighborhood safety is often ignored; the association between neighborhood amenities and physical activity (PA) may differ across sociodemographic groups and after accounting for neighborhood safety.
Methods: Black and white adults 38-50 years in 2005-06 (n=3,549) of the Coronary Artery Risk Development in Young Adults (CARDIA) study were analyzed. Logistic models compared perceived neighborhood characteristics across race-income tertiles, adjusting for age, sex, education, and study center, with and without accounting for perceived safety. Associations were recalculated for perceived amenities in safe neighborhoods (where exercising outdoors was not affected by crime or unleashed dogs). Logistic models compared self-reported outdoor PA (any running, biking, walking) with perceived neighborhood characteristics, controlling for sociodemographics.
Results: Perceived neighborhood exercise facilities, parks, sidewalks, and paths were more common in low and high income blacks and low income whites compared to high income whites [ORadj (95% CI) e.g, low income blacks: 2.12 (1.48, 3.03) for parks, 5.85 (4.07, 8.41) for sidewalks]. Associations for "safe" amenities were attenuated or negative [e.g, low income blacks: 0.70 (0.53, 0.93) for parks, 1.33 (1.01, 1.74) for sidewalks]. "Safe" sidewalks were associated with PA across race and income [1.39 (1.03, 1.86)]; "safe" paths were associated with PA only in low income groups [Whites: 1.48 (1.01, 2.17), Blacks: 2.56 (1.54, 4.26)].
Conclusion: Accounting for neighborhood safety may be important when examining disparities in neighborhood amenities. Association between perceived amenities and physical activity may be differential across population subgroups.
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Relationship of Neighborhood and Individual Socioeconomic Characteristics to Type 2 Diabetes in African Americans: The Atherosclerosis Risk in Communities Study, 1987-1998
Introduction: While the association of socioeconomic status with diabetes is not clearly understood, the greatest excess prevalence of type 2 diabetes among African Americans has been found in individuals with lower socioeconomic status. In this study we investigated the independent and interactive effects of individual socioeconomic factors and neighborhood socioeconomic characteristics on diabetes.
Methods: The study consisted of 2,569 middle-aged African American participants (875 men, 1,694 women) in the Atherosclerosis Risk in Communities (ARIC) study from Jackson, MS. A summary score for neighborhood characteristics was constructed from indicators of wealth, income, education, and occupation from the 1990 U.S. Census using census tracts as neighborhood proxies. Age-adjusted multilevel models included neighborhood characteristics and individual-level indicators (household income, education, and occupation).
Results: There was a statistically significant difference in type 2 diabetes prevalence between the highest and lowest levels of all indicators for all African Americans. Proportions ranged from 13 to 22 percent for income and education and from 13 to 31 percent for occupation. For men there was no obvious linear pattern of association between neighborhood socioeconomic status and the incidence of diabetes. The highest rate (50.6 per 1,000 person-years) was found in the middle tertile of neighborhood socioeconomic characteristics. For women the incidence of diabetes was inversely associated with neighborhood disadvantage. Rates increased from 43.2 in the lowest tertile to 51.4 in the highest SEC tertile.
Conclusions: While individual-level socioeconomic indicators generally were associated with diabetes, living in disadvantaged neighborhoods was not consistently associated with increased diabetes.
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Exploring Selected Social Facilitators of Condom Use and HIV Testing among Sexually Active Black Males in Fulton County, Georgia
Warner L. McGee, BA
David J. Malebranche, MD, MPH
Kisha Braithwaite PhD
Introduction: Much of the focus of HIV prevention within the Black community in the U.S. has been with women and men who have sex with men. Even still these studies explore the barriers associated with HIV testing and Condom use. As a result intervention strategies reflect the deficit model and few studies focus on the Asset Mapping approach. This study explored how gender roles, spirituality, and racial identity influence HIV testing and condom use practices among sexually active Black Males in Fulton, County Georgia. There is little knowledge about facilitators among young black males and this information proves useful in developing intervention and prevention programs geared towards increasing condom use and HIV testing among young Black males.
Methods: 20 Black males ages 18-24 participated in face to face in depth interviews. Selected facilitators included: lived experiences, racial identity, Gender Roles, and Spirituality.
Results: Positive definitions of manhood, strong spiritual beliefs, positive racial identity, and peer relationships were identified as major factors in the sexual script development of the young men and consequently influenced condom use and HIV testing practices.
Conclusion: It is evident that social and lived experiences of these young men play a major role in their sexual decision making. More research is needed to identify other facilitators of condom use and HIV testing practices and validate the ones found in this investigation
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|Last updated March 04, 2011|