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Health Disparities (health + disparity)
Kinds of Health Disparities Selected AbstractsUsing Community-Based Participatory Research (CBPR) to Target Health Disparities in FamiliesFAMILY RELATIONS, Issue 4 2009Jerica M. Berge Community-based participatory research (CBPR) is an action research approach that emphasizes collaborative partnerships between community members, community organizations, health care providers, and researchers to generate knowledge and solve local problems. Although relatively new to the field of family social science, family and health researchers have been using CBPR for over a decade. This paper introduces CBPR methods, illustrates the usefulness of CBPR methods in families and health research, describes two CBPR projects related to diabetes, and concludes with lessons learned and strengths and weaknesses of CBPR. [source] NIH Summit: The Science of Eliminating Health DisparitiesJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 2 2009Edilma L. Yearwood PhD, FAAN Assistant Professor, PMHCNS [source] Health Disparities Related to Race and EthnicityJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2006Sue Thomas Hegyvary Editor [source] Health Disparities: Why Communication MattersJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2005Barbara J. Guthrie RN, FAAN Guest Editor No abstract is available for this article. [source] Is There a Genetic Basis for Health Disparities in Human Immunodeficiency Virus Disease?MOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 2 2010Cheryl Winkler PhD Abstract The highest global prevalence rates for human immunodeficiency virus and acquired immune deficiency syndrome have been recorded in southern Africa; in the United States, individuals of African descent are disproportionately affected by human immunodeficiency virus infection. Human immunodeficiency virus,infected individuals with African ancestry are also estimated to have a 17-fold or greater risk for developing human immunodeficiency virus,associated nephropathy in comparison with their counterparts of non-African descent. Several recent studies have implicated genetic alleles that are more frequent in populations of African descent and increase the risk of human immunodeficiency virus infection and the risk of human immunodeficiency virus,associated neuropathy (HIVAN). The supposition that persons of African descent are more susceptible to human immunodeficiency virus infection because of an underlying genetic predisposition is not supported by available evidence. However, strong, replicated data show that the increased risk for human immunodeficiency virus,associated nephropathy, as well as other major forms of kidney disease in individuals of African descent, is due in part to MYH9 (myosin, heavy chain 9, non-muscle) renal disease susceptibility alleles that are very frequent throughout sub-Saharan Africa but are infrequent or absent in non-Africans. Selection, drift, and demographic events shape the allelic architecture of the human genome: it is expected that these events will be reflected in geographic-specific differentiation in allele frequencies for a small subset of alleles that may be associated with either increased or reduced risk for complex and infectious diseases. Mt Sinai J Med 77:149,159, 2010. © 2010 Mount Sinai School of Medicine [source] Health Policy and Racial Health DisparitiesMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 1 2008Mark Chassin MD [source] Quality of Care and Racial Health Disparities: A Strategic OverviewMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 1 2008Mark R. Chassin MD Substantial racial and ethnic disparities in health and health care exist in the United States. The Department of Health Policy at the Mount Sinai School of Medicine has developed a strategy for reducing those disparities that builds upon its quality improvement experience. This article discusses the utility of applying quality improvement principles to the development of interventions to eliminate underuse of effective treatments and reduce the disparities that may arise from this quality problem. We present a conceptual model of racial disparities in health and our underuse hypothesis. Parallels between our disparities research strategy and six sigma quality improvement methods are described. Finally, the article provides an example of how we have been able to successfully implement proven-effective health improvement programs in the Harlem community even after grant funding has ended. Mt Sinai J Med 75:7,12, 2008. © 2008 Mount Sinai School of Medicine [source] Applying the Concept of Positive Deviance to Public Health Data: A Tool for Reducing Health DisparitiesPUBLIC HEALTH NURSING, Issue 6 2007Lorraine O. Walker ABSTRACT The concept of positive deviance (PD), which highlights uncommon practices that reduce risk in low-resource communities, has been effective in community mobilization and programming to improve health outcomes. We present a protocol for extending the concept to analysis of existing public health data. The protocol includes assessing whether PD fits the situation, identifying positive deviants, and identifying behaviors associated with positive deviants' healthy outcomes. Analyzing existing datasets from a PD perspective may aid public health nurses in efforts to reduce health disparities. The effectiveness of our protocol will be clarified in future research. [source] The Reserve Capacity Model as a Framework for Understanding Psychosocial Factors in Health DisparitiesAPPLIED PSYCHOLOGY: HEALTH AND WELL-BEING, Issue 1 2009Linda C. Gallo Substantial research has identified a robust, linear association between socioeconomic status (SES) and health, across many different populations and outcomes. Among myriad influences, psychosocial factors may contribute to SES-related gradients in health. In the current manuscript, we describe the Reserve Capacity Model (Gallo & Matthews, 2003) as a potential framework through which to examine psychosocial pathways in health disparities. The model posits that SES is connected to health, in part through associations with stress and concomitant negative emotions, and their subsequent links with bio-behavioral functioning. In addition, low SES may predict enhanced emotional and physiological reactivity to stress due to a deficiency in resilient psychosocial resources (i.e. "reserve capacity") and limited opportunities to replenish resource reserves. In addition, resources might represent a direct mediational pathway from SES to health. We describe several studies in which we have examined various tenets of the Reserve Capacity Model, and comment on future research directions to better understand the roles of psychosocial variables in health disparities. [source] The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental cariesCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 3 2007A. I. Ismail Abstract,,, This paper describes early findings of evaluations of the International Caries Detection and Assessment System (ICDAS) conducted by the Detroit Center for Research on Oral Health Disparities (DCR-OHD). The lack of consistency among the contemporary criteria systems limits the comparability of outcomes measured in epidemiological and clinical studies. The ICDAS criteria were developed by an international team of caries researchers to integrate several new criteria systems into one standard system for caries detection and assessment. Using ICDAS in the DCR-OHD cohort study, dental examiners first determined whether a clean and dry tooth surface is sound, sealed, restored, crowned, or missing. Afterwards, the examiners classified the carious status of each tooth surface using a seven-point ordinal scale ranging from sound to extensive cavitation. Histological examination of extracted teeth found increased likelihood of carious demineralization in dentin as the ICDAS codes increased in severity. The criteria were also found to have discriminatory validity in analyses of social, behavioral and dietary factors associated with dental caries. The reliability of six examiners to classify tooth surfaces by their ICDAS carious status ranged between good to excellent (kappa coefficients ranged between 0.59 and 0.82). While further work is still needed to define caries activity, validate the criteria and their reliability in assessing dental caries on smooth surfaces, and develop a classification system for assessing preventive and restorative treatment needs, this early evaluation of the ICDAS platform has found that the system is practical; has content validity, correlational validity with histological examination of pits and fissures in extracted teeth; and discriminatory validity. [source] Health disparities in the forensic sexual assault examination related to skin colorJOURNAL OF FORENSIC NURSING, Issue 4 2009FAAN, Marilyn S. Sommers PhD Abstract Little is known about the role of skin color in the forensic sexual assault examination. The purpose of this study was to determine whether anogenital injury prevalence and frequency vary by skin color in women after consensual sexual intercourse. The sample consisted of 120 healthy (63 Black, 57 White) women who underwent a forensic sexual assault examination following consensual sexual intercourse. Experienced sexual assault forensic examiners using visual inspection, colposcopy technique with digital imaging, and toluidine blue application documented the number, type, and location of anogenital injuries. Although 55% of the total sample was observed to have at least one anogenital injury of any type following consensual intercourse, the percentages significantly differed for White (68%) and Black (43%) participants (p= 0.02). When the presence of anogenital injury was analyzed by specific anatomical region, a significant difference between White and Black participants was only evident for the external genitalia (White = 56%, Black = 24%, p= .003), but not for the internal genitalia (White = 28%, Black = 19%, p= .20) or anus (White = 9%, Black = 10%, p= 0.99). A one standard deviation-unit increase in L* values (lightness) was related to a 150% to 250% increase in the odds of external genitalia injury prevalence (p < 0.001). While Black and White participants had a significantly different genital injury prevalence, dark skin color rather than race was a strong predictor for decreased injury prevalence. Sexual assault forensic examiners, therefore, may not be able to detect injury in women with dark skin as readily as women with light skin, leading to health disparities for women with dark skin. [source] Conceptual and methodological issues for research on tobacco-related health disparitiesADDICTION, Issue 2007Richard R. Clayton First page of article [source] Modelling opportunity in health under partial observability of circumstancesHEALTH ECONOMICS, Issue 3 2010Pedro Rosa Dias Abstract This paper proposes a behavioural model of inequality of opportunity in health that integrates John Roemer's framework of inequality of opportunity with the Grossman model of health capital and demand for health. The model generates a recursive system of equations for health and lifestyles, which is then jointly estimated by full information maximum likelihood with freely correlated error terms. The analysis innovates by accounting for the presence of unobserved heterogeneity, therefore addressing the partial-circumstance problem, and by extending the examination of inequality of opportunity to health outcomes other than self-assessed health, such as long-standing illness, disability and mental health. The results provide evidence for the existence of third factors that simultaneously influence health outcomes and lifestyle choices, supporting the empirical relevance of the partial-circumstance problem. Accounting for these factors, the paper corroborates that the effect of parental and early circumstances on adult health disparities is paramount. However, the particular set of circumstances that affect each of the analysed health outcomes differs substantially. The results also show that differences in educational opportunities, and in social development in childhood, are crucial determinants of lifestyles in adulthood, which, in turn, shape the observed health inequalities. Copyright © 2010 John Wiley & Sons, Ltd. [source] Does reporting heterogeneity bias the measurement of health disparities?HEALTH ECONOMICS, Issue 3 2008Teresa Bago d'Uva Abstract Heterogeneity in reporting of health by socio-economic and demographic characteristics potentially biases the measurement of health disparities. We use anchoring vignettes to identify socio-demographic differences in the reporting of health in Indonesia, India and China. Homogeneous reporting by socio-demographic group is rejected and correcting for reporting heterogeneity tends to reduce slightly estimated disparities in health by education (not China) and to increase those by income. But the method does not reveal substantial reporting bias in measures of health disparities. Copyright © 2007 John Wiley & Sons, Ltd. [source] Explaining the differences in income-related health inequalities across European countriesHEALTH ECONOMICS, Issue 7 2004Eddy van Doorslaer Abstract This paper provides new evidence on the sources of differences in the degree of income-related inequalities in self-assessed health in 13 European Union member states. It goes beyond earlier work by measuring health using an interval regression approach to compute concentration indices and by decomposing inequality into its determining factors. New and more comparable data were used, taken from the 1996 wave of the European Community Household Panel. Significant inequalities in health (utility) favouring the higher income groups emerge in all countries, but are particularly high in Portugal and , to a lesser extent , in the UK and in Denmark. By contrast, relatively low health inequality is observed in the Netherlands and Germany, and also in Italy, Belgium, Spain Austria and Ireland. There is a positive correlation with income inequality per se but the relationship is weaker than in previous research. Health inequality is not merely a reflection of income inequality. A decomposition analysis shows that the (partial) income elasticities of the explanatory variables are generally more important than their unequal distribution by income in explaining the cross-country differences in income-related health inequality. Especially the relative health and income position of non-working Europeans like the retired and disabled explains a great deal of ,excess inequality'. We also find a substantial contribution of regional health disparities to socio-economic inequalities, primarily in the Southern European countries. Copyright © 2004 John Wiley & Sons, Ltd. [source] The Effects of Health Sector Market Factors and Vulnerable Group Membership on Access to Alcohol, Drug, and Mental Health CareHEALTH SERVICES RESEARCH, Issue 3p1 2007Susan E. Stockdale Objective. This study adapts Andersen's Behavioral Model to determine if health sector market conditions affect vulnerable subgroups' use of alcohol, drug, and mental health services (ADM) differently than the general population, focusing specifically on community-level predisposing and enabling characteristics. Data Sources. Wave 2 data (2000,2001) from the Health Care for Communities study, supplemented with cases from wave 1 (1997,1998), were merged with area characteristics taken from Census, Area Resource File (ARF), and other data sources. Study Design. The study used four-level hierarchical logistic regression to examine access to ADM care from any provider and specialty ADM access. Interactions between community-level predisposing and enabling vulnerability characteristics with individual race/ethnicity, age, income category, and insurance type were explored. Principal Findings. Nonwhites, the poor, uninsured, and elderly had lower likelihoods of service use, but interactions between race/ethnicity, income, age and insurance status with community-level vulnerability factors were not statistically significant for any service use. For ADM specialty care, those with Medicare, Medicaid, private fully managed, and private partially managed insurance, the likelihood of utilization was higher in areas with higher HMO penetration. However, for those with other insurance or no insurance plan, the likelihood of utilization was lower in areas with higher HMO penetration. Conclusions. Community-level enabling factors explain part of the effect of disadvantaged status but, with the exception of the effect of HMO penetration on the relationship between insurance and specialty care use, do not modify any of the residual individual-level effects of disadvantage. Interventions targeting both structural and individual levels may be necessary to address the problem of health disparities. More research with longitudinal data is necessary to sort out the causal direction of social context and ADM access outcomes, and whether policy interventions to change health sector market conditions can shift ADM treatment utilization. [source] Improving Care for Minorities: Can Quality Improvement Interventions Improve Care and Outcomes For Depressed Minorities?HEALTH SERVICES RESEARCH, Issue 2 2003Controlled Trial, Results of a Randomized Objective. Ethnic minority patients often receive poorer quality care and have worse outcomes than white patients, yet practice-based approaches to reduce such disparities have not been identified. We determined whether practice-initiated quality improvement (QI) interventions for depressed primary care patients improve care across ethnic groups and reduce outcome disparities. Study Setting. The sample consists of 46 primary care practices in 6 U.S. managed care organizations; 181 clinicians; 398 Latinos, 93 African Americans, and 778 white patients with probable depressive disorder. Study Design. Matched practices were randomized to usual care or one of two QI programs that trained local experts to educate clinicians; nurses to educate, assess, and follow-up with patients; and psychotherapists to conduct Cognitive Behavioral Therapy. Patients and physicians selected treatments. Interventions featured modest accommodations for minority patients (e.g., translations, cultural training for clinicians). Data Extraction Methods. Multilevel logistic regression analyses assessed intervention effects within and among ethnic groups. Principal Findings. At baseline, all ethnic groups (Latino, African American, white) had low to moderate rates of appropriate care and the interventions significantly improved appropriate care at six months (by 8,20 percentage points) within each ethnic group, with no significant difference in response by ethnic group. The interventions significantly decreased the likelihood that Latinos and African Americans would report probable depression at months 6 and 12; the white intervention sample did not differ from controls in reported probable depression at either follow-up. While the intervention significantly improved the rate of employment for whites and not for minorities, precision was low for comparing intervention response on this outcome. It is important to note that minorities remained less likely to have appropriate care and more likely to be depressed than white patients. Conclusions. Implementation of quality improvement interventions that have modest accommodations for minority patients can improve quality of care for whites and underserved minorities alike, while minorities may be especially likely to benefit clinically. Further research needs to clarify whether employment benefits are limited to whites and if so, whether this represents a difference in opportunities. Quality improvement programs appear to improve quality of care without increasing disparities, and may offer an approach to reduce health disparities. [source] Health and Psychiatric Disparities in Children with Cognitive and Developmental Delays: Implications for Health Policy in QuebecJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 3 2009Jennifer S. Nachshen Background, Previous research on psychiatric and health disparities according to level of cognitive functioning has focused on adults within an American healthcare context. The current study compares children with and without cognitive and developmental delays in Quebec, Canada, using physician billing data from a longitudinal study of low-income, francophone families. Canada is an ideal context for studying medical billing data as its equal access healthcare system removes many socioeconomic biases. Methods, A large sample (n = 1050) of children is used to describe psychiatric and health disparities, as well as differences in Ambulatory Care Sensitive (ACS) conditions and primary healthcare, between children with (n = 107) and without (n = 943) diagnoses in their billing history indicative of delays. Results, The findings demonstrated a relatively high level of psychiatric diagnoses for children with delays. However, no difference was found between children with and without delays in regard to emergency room visits and hospitalizations for ACS conditions and primary healthcare. Conclusions, The findings suggest that, within a universal healthcare system, disparities in primary healthcare may not emerge until adulthood in individuals with delay status. [source] Message Effects and Social Determinants of Health: Its Application to Cancer DisparitiesJOURNAL OF COMMUNICATION, Issue 2006K. Viswanath Recent work on message effects theories offers a fruitful way to systematically explore how features, formats, structures of messages may attract audience attention and influence the audience and is of great relevance to public health communications. Much of this work, however, has been pursued primarily at the individual level of analysis. It is our contention that message effects on health outcomes could potentially be moderated and mediated by social contextual factors in public health such as social class, social organizations and neighborhoods among others, leading to differential effects among different audience sub-groups. This essay, through a selective review of literatures in communication and social epidemiology, will explore how major message effects may moderate and mediate the role of social determinants of health on cancer control, specifically cancer-related health disparities. [source] Health disparities in the forensic sexual assault examination related to skin colorJOURNAL OF FORENSIC NURSING, Issue 4 2009FAAN, Marilyn S. Sommers PhD Abstract Little is known about the role of skin color in the forensic sexual assault examination. The purpose of this study was to determine whether anogenital injury prevalence and frequency vary by skin color in women after consensual sexual intercourse. The sample consisted of 120 healthy (63 Black, 57 White) women who underwent a forensic sexual assault examination following consensual sexual intercourse. Experienced sexual assault forensic examiners using visual inspection, colposcopy technique with digital imaging, and toluidine blue application documented the number, type, and location of anogenital injuries. Although 55% of the total sample was observed to have at least one anogenital injury of any type following consensual intercourse, the percentages significantly differed for White (68%) and Black (43%) participants (p= 0.02). When the presence of anogenital injury was analyzed by specific anatomical region, a significant difference between White and Black participants was only evident for the external genitalia (White = 56%, Black = 24%, p= .003), but not for the internal genitalia (White = 28%, Black = 19%, p= .20) or anus (White = 9%, Black = 10%, p= 0.99). A one standard deviation-unit increase in L* values (lightness) was related to a 150% to 250% increase in the odds of external genitalia injury prevalence (p < 0.001). While Black and White participants had a significantly different genital injury prevalence, dark skin color rather than race was a strong predictor for decreased injury prevalence. Sexual assault forensic examiners, therefore, may not be able to detect injury in women with dark skin as readily as women with light skin, leading to health disparities for women with dark skin. [source] Health Screening and Developmental DisabilitiesJOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 3 2006Teresa Iacono Abstract, Adults with developmental disabilities often experience health disparities when compared with the general population. Early detection of risk of disease may help to reduce such disparities, but many adults often do not participate in preventive health care at recommended levels. The aim of the present study was to describe health screening activities involving a large group of adults and explore how factors, such as living arrangement, type and severity of disability, and age, influence reported rates of participation. The study involved administering surveys to adults with disabilities and their immediate support persons (parents, carers, and professional support workers) and asking whether adults had visited a general practitioner (GP) and what was their participation in preventive services during the previous 12-month period. Participation in preventive screening services ranged between 3% (screening for sexually transmitted infection) and 58% (screening for elevated blood pressure), and rates for certain services appeared low, particularly in comparison with equivalent screenings in the general population. Results showed a relationship between participation rates and living situation, type of disability, and age, but not severity of disability. The results suggest that higher rates of participation in preventative health activities among those enrolled in formal services may reflect a greater obligation or concern among paid workers and possibly a lack of awareness of health issues by families, and also that screening disparities may be attributed to GPs who may be applying guidelines from the general population but who are not aware of disability-specific issues when examining adults with disabilities. [source] Defining a National Health Research and Practice Agenda for Older Adults with Intellectual DisabilitiesJOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 1 2004Philip W. Davidson Abstract With the increasing number of adults with intellectual disabilities (ID) surviving into old age governments, provider agencies, and practitioners are recognizing the insufficiencies of available information related to the interaction of the aging process with lifelong disability, the incidence of disease and secondary conditions with advancing age, and the means to provide quality medical and health care. These insufficiencies were noted by a World Health Organization report that identified a need for more research on the health of older adults with IDs and reports from two meetings held by United States Public Health Service and the United States Surgeon General that examined health disparities among adults with ID. This paper reports the process and results of the Tampa Scientific Conference on Intellectual Disabilities, Aging, and Health, a meeting held in 2002 specifically to examine health issues germane to older adults with ID. The meeting produced a long-term research agenda for determining more effective physical and mental health outcomes for aging and older persons with ID and recommendations for aging-related medical and health surveillance practices that would improve the overall health status of adults with ID. [source] Attributes of an ideal oral health care systemJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2010DrPH, Scott L. Tomar DMD Abstract Objectives: The sense of urgency concerning the inadequacies of the current U.S. oral health care system in better preventing oral diseases, eliminating oral health disparities, and ensuring access to basic oral health services has increased in recent years. This paper sought to articulate the attributes that an ideal oral health care system would possess, which would be consistent with the principles of the leading authorities on the public's health. Methods: The authors reviewed policy statements and position papers of the World Health Organization, The Institute of Medicine, The American Public Health Association, Healthy People 2010 Objectives for the Nation, and the American Association of Public Health Dentistry. Results: Consistent with leading public health authorities, an ideal oral health care system would be have the following attributes: integration with the rest of the health care system; emphasis on health promotion and disease prevention; monitoring of population oral health status and needs; evidence-based; effective; cost-effective; sustainable; equitable; universal; comprehensive; ethical; includes continuous quality assessment and assurance; culturally competent; and empowers communities and individuals to create conditions conducive to health. Conclusions: Although there are some attributes of an ideal oral health care system on which the United States has made initial strides, it falls far short in many areas. The development of an oral health care delivery system that meets the characteristics described above is possible but would require tremendous commitment and political will on the part of the American public and its elected officials to bring it to fruition. [source] Successful fluoride plebiscite in the township of Deniliquin, New South Wales, AustraliaJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2 2010DPH (Dent), Shanti Sivaneswaran BDS Abstract Objectives: This article describes the strategies adopted to influence the outcome of a plebiscite held in March 2004 in favor of water fluoridation in Deniliquin, a rural town in New South Wales, Australia. Methods: The health promotion strategies undertaken included the following: a) the skillful use of media to educate the community on the benefits of water fluoridation; b) disseminating contemporary local data to demonstrate oral health disparities with neighboring fluoridated townships; and c) a well-established lobbying machine to mobilize the community. Results: Out of a total population of 5,280 on the electoral roll, 4,539 residents voted, giving a response rate of 86 percent. The wording of the plebiscite was "Do you support the addition of fluoride to Deniliquin town water supply?" There were 2,533 "yes" votes (55.8 percent), 1,879 "no" votes (41.4 percent), and 127 spoiled votes (2.8 percent). Conclusions: The council resolved to implement water fluoridation and the residents received fluoridated water in January 2005. [source] Oral Health Status of San Francisco Public School Kindergarteners 2000,2005JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 4 2006Lisa H. Chung DDS Abstract Objectives:To determine the prevalence of dental caries and oral health disparities in San Francisco kindergarten public school children from 2000,2005. Methods:The San Francisco Department of Public Health in partnership with the San Francisco Dental Society and assistance from the National Dental Association, has been conducting annual dental screenings of kindergarten children enrolled in the San Francisco Unified School District since 2000. Outcomes assessed from this series of cross-sectional screenings included prevalence of caries experience, untreated caries, treatment needs, and caries severity by child's sex, race/ethnicity, residential zip code, and a proxy for socioeconomic status. Results:Of 76 eligible schools, 62,72 participated, and 86,92% of enrolled children (n=3,354-3,527) were screened yearly. Although there was a small, significant decrease over the time period, in 2005, 50.1% of children had caries experience; 28.8% had untreated caries and 7.6% had urgent treatment needs. Each year caries prevalence was greatest for Asian children, those attending schools with > 50% children eligible for the free or reduced-price meal program, and children living in zip codes in and around Chinatown and San Francisco's southern border. Conclusions:Despite signs of improvement, caries remains a public health problem especially in Asian and Hispanic children, and children living in certain sections of San Francisco. [source] A Multilevel Analysis of Gender Differences in Psychological Distress Over TimeJOURNAL OF RESEARCH ON ADOLESCENCE, Issue 2 2009Amanda L. Botticello Females have higher rates of depression than males, a disparity that emerges in adolescence and persists into adulthood. This study uses hierarchical linear modeling to assess the effects of school context on gender differences in depressive symptoms among adolescents based on two waves of data from the National Longitudinal Study of Adolescent Health (N=9,709 teens, 127 schools). Analysis indicates significant school-level variation in both overall symptom levels and the average gender gap in depression net of prior symptoms and individual-level covariates. Aggregate levels of depressive symptomatology were positively associated with contextual-level socioeconomic status (SES) disadvantage. A cross-level contingency emerged for the relationship between gender and depressive symptoms with school SES and aggregate perceived community safety such that the gender "gap" was most apparent in contexts characterized by low SES disadvantage and high levels of perceived safety. These results highlight the importance of context to understanding the development of mental health disparities. [source] The HPV Vaccine: Framing the Arguments FOR and AGAINST Mandatory Vaccination of All Middle School GirlsJOURNAL OF SCHOOL HEALTH, Issue 6 2008Cheryl A. Vamos MPH ABSTRACT Background:, Human papillomavirus (HPV), the virus responsible for cervical cancer, is the most common viral sexually transmitted infection in the United States. A vaccine was approved in 2006 that is effective in preventing the types of HPV responsible for 70% of cervical cancers and 90% of genital warts. Proposals for routine and mandatory HPV vaccination of girls have become sources of controversy for parents of school-aged youth, legislators, members of the medical community, and the public at large. Methods:, The purpose of this article was to articulate the arguments used by advocates who either oppose or endorse routine, mandatory administration of the vaccine to school-aged girls, thereby assisting school health personnel in being effective participants in framing the relevant issues. Results:, Controversy is grounded in moral, religious, political, economic, and sociocultural arguments including whether concerns that the vaccine increases sexual risk taking, sends mixed messages about abstaining from sexual intercourse, usurps parental authority, and increases the potential for development of new health disparities are offset by the value of administering a cost-effective, age-appropriate public health measure targeting a life-threatening problem. Conclusions:, Careful consideration of the medical evidence and public health implications is critical but understanding the context of the debate is no less important to the task of responding to public concerns. School health personnel have a role in the discussion about HPV immunization. Being able to articulate the arguments presented herein can help authorities' responsiveness to parents and community groups as the dialogue about this particular health issue evolves further. [source] Early Adolescents Perceptions of Health and Health Literacy,JOURNAL OF SCHOOL HEALTH, Issue 1 2007Stephen L. Brown PhD ABSTRACT Background:, Health illiteracy is a societal issue that, if addressed successfully, may help to reduce health disparities. It has been associated with increased rates of hospital admission, health care expenditures, and poor health outcomes. Because of this, much of the research in the United States has focused on adults in the health care system. This study investigated the effect of aspects of health literacy on the motivation to practice health-enhancing behaviors among early adolescents. Methods:, Measures were generally based on 3 National Health Education Standards for grades 5-8. Data were obtained from 1178 9- to 13-year-old students visiting 11 health education centers in 7 states. Students responded via individual electronic keypads. Results:, Multivariate logistic regression revealed that, in addition to age, difficulty understanding health information and belief that kids can do little to affect their future health, decreased the likelihood for interest in and desire to follow what they were taught about health. Further, low interest independently decreased motivation to follow what was taught. Girls were more likely to turn to school, parents, and medical personnel for health information. Older students were more likely to turn to school and to the Internet. Conclusions:, Programs and curricula should be designed to increase student interest in health issues and their self-efficacy in controlling their own health destinies. Educators should also teach students to more effectively use nonconventional health information sources such as the Internet, parents, and medical professionals. [source] An overview of ethnicity and assessment of family history in primary care settingsJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 10 2006Ann Maradiegue PhD(c), FNP-C (Instructor, Family Nurse Practitioner Program) Abstract Purpose: To discuss the importance of and the nurse practitioner's (NP's) role in the assessment of ethnicity/family of origin in conducting a multigenerational family history in primary care settings. Data sources: A review of the literature on past research results addressing racial and ethnic disparities and current articles from scientific journals exploring the relationship between race and genetics. Web sites were from the National Institutes of Health, the Human Genome Research Institute, the National Cancer Institute, and the Health and Human Services Minority Health and Disparities report. Conclusions: The family history has received renewed interest due to the sequencing of the human genome. A multigenerational family history is an important first step in screening for a multitude of disorders impacted by genetic susceptibility, shared environments, and common behaviors. Assessment of the patient's ethnicity/family of origin is an integral part of the multigenerational family history, particularly in the diagnosis of chronic diseases and the assessment of risks for genetic disorders. The multigenerational family history is important in diagnosis, predictive genetic testing, disease prevention, and health promotion. Challenges facing NPs and the utilization of a multigenerational family history in the current U.S. health system include (a) training clinicians on the correct assessment and utilization of a multigenerational family history, (b) assessment of the subtleties of ethnicity and identifying multiple ethnic groups within a family, (c) collection of the family history in a manner that is sensitive to the cultural beliefs of individuals, and (d) avoidance of stereotyping Implications for practice: Significant advances in genetics and genetic testing requires that NPs be well versed in collecting and interpreting a multigenerational family history to include assessment of the patient/family's ethnicity/family of origin. The ability to effectively conduct and evaluate the individual's and family's health risk through a multigenerational family history will be important in diagnosis, health promotion, disease prevention, and the determination for genetic counseling referral and predictive testing when appropriate. Assessment of risk and prevention of disease is also important in reducing health disparities. [source] Primary care health issues among men who have sex with menJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 4 2006Royal Gee MSN Abstract Purpose: The purpose of the article is to examine "appropriate" health care for men who have sex with men (MSM), which is not to suggest "special" health care. As a group, MSM are at increased risk for sexually transmitted infections, anal cancer, and mental health disorders. Focus areas in this article will address health issues that the primary care nurse practitioner (NP) may encounter in clinical practice: anal carcinoma, sexually transmitted diseases (STDs), high-risk sexual practices, depression, and substance abuse were topics chosen for inclusion in this article. These topics were among those highlighted in the Healthy People 2010 Companion Document for LGBT Health, which served to examine the healthcare disparities and lack of access to needed services related to sexual orientation. Data source: Extensive literature review of research articles, journals, clinical practice guidelines, books, and public health department Internet Web sites. Conclusions: There are unique health disparities that exist for MSM related to social, emotional, and mental health factors, in addition to physical issues such as STDs. There is an increasing need for primary care providers to be aware of these disparities, as well as the factors that influence these disparities, in order to provide multidimensional care and health counseling that is unique to NP practice. Implications for practice: Both the primary care NP and the patient should be aware of the unique healthcare issues among MSM that should be incorporated into the patient's routine health maintenance program. As primary care providers, it is within the standards of practice for NPs to provide culturally competent care, along with health promotion and disease prevention for MSM. [source] | ||||||||||||||||||||||||||||||||||