RESEARCH
The following are selected articles published by members of the Health Disparity Research Group and information about ongoing and planned studies.
Cancer Screening
Breast, colorectal and skin cancer screening practices and family history of cancer in U.S. women
Shah M, Zhu K, Palmer RC, Jatoi I, Shriver C, Wu H. Journal of Women’s Health, 2007, 16:526-534.
Using data from the 2000 National Health Interview Survey, women with a family history of cancer were more likely to have colorectal, breast, and skin cancer screening examinations. This may be a result of more physicians' recommendations and higher personal motivation for getting cancer screening, suggesting that the efficacy of national guidelines has been increasing somewhat.
Detecting an association between socioeconomic status and late stage breast cancer using spatial analysis and area-based measures
MacKinnon JA, Duncan RC, Huang Y, Lee DJ, Fleming LE, Voti L, Rudolph M, Wilkinson JD.. Cancer Epi Biomarkers Prevention 2007;16:756-762.
Empowering factors for regular mammography screening in under-served populations: pilot survey results in Tennessee
Ahmed NU, Fort JG, Elzey JD, Belay, Y. Ethnicity & Disease, 2005 Summer, 15(3):387-394.
Influences that empower low-income women to comply with repeat mammogram screening include higher knowledge about risk factors and warning signs, as well as trust in the healthcare system, ability to work with physicians, and support by family and friends.
Colorectal cancer prevention: adherence patterns and correlates of tests done for screening purposes within United States populations
Ata A, Elzey JD, Insaf TZ, Grau AM, Stain SC, Ahmed NU. Cancer Detection and Prevention, 2006, 30(2):134-143. Epub: 2006 Apr 25
Using data from the 2000 NHIS, results showed that only 25% of the population reported colorectal cancer screening within recommended time frame. Of those screened, Blacks were more likely than Whites to be adherent, and Hispanics remained less likely to be tested even after multivariate adjustment.
Social disparities across the continuum of colorectal cancer: A systematic review
Palmer RC, Schneider EC. Cancer Causes and Control, 2005, 16:55-61.
An analysis of research on social inequalities in colorectal cancer across the continuum of care (prevention, treatment, outcome) found that the majority of research has focused primarily on the domain of inequality, race/ethnicity and racism, and cancer screening. There were few or no published research articles examining the influence of social inequalities on colorectal cancer.
Impact of a two-city community cancer prevention intervention on African Americans
Blumenthal DS, Fort JG, Ahmed NU, Semenya, KA, Schreiber GB, Perry S, Guillory J. Journal of the National Medical Association, 2005, 97(11):1479-1488.
Results of the first multisite, multicomponent community intervention trial focusing on cancer prevention in African Americans in Nashville TN and Atlanta, GA. Chattanooga, TN and Decatur, GA served as comparison cities. Modest gains were shown for Pap tests in Nashville, and CRC screenings and mammograms in Atlanta.
Correlates of mammography screening among Hispanic women living in farmworker communities in the Lower Rio Grande Valley
Palmer RC, Fernandez ME, Tortolero-Luna G, Gonzales A, Mullen PD. Health Education and Behavior, 2005, 32:488-503.
Findings through home-based Spanish-language personal interviews indicate that health insurance, self-efficacy and decisional balance were significantly related to screening mammography adherence. Results indicate increased need for access to health care services and efforts to increase self-efficacy and decrease negative attitudes and opinions.
Acculturation and mammography screening among Hispanic women living in farmworker communities
Palmer RC, Fernandez ME, Tortolero-Luna G, Gonzales A, Mullen PH. Cancer Control, 2005, 12:21-27.
Results of this study to investigate the effect of acculturation on mammography screening practices among Hispanic women found no significant effect for acculturation for the entire simple. Stratified post hoc analysis found that bicultural study participants were more likely to be adherent than those with low acculturation, suggesting distinct geographic differences between the study participants.
Repeat mammography screening among low-income and minority women: A qualitative study.
Fernandez ME, Palmer RC, Leong C. Cancer Control, 2005, 12: 77-83.
Qualitative interviews with African American and Hispanic women were conducted to understand the underutilization of mammography screening. Predisposing factors, enabling factors, and a reinforcing factor were identified and categorized utilizing the PRECEDE framework.
Empowering factors in repeat mammography: insights from the stories of underserved women
Ahmed NU, Fort JG, Elzey JD, Bailey S. Journal of Ambulatory Care Management, 2004, 27(4):348-355.
Using the Precede-Proceed model, this study explored how underserved women overcame barriers to repeat mammography screening. Personal factors that helped them overcome barriers to care included: awareness and knowledge of risk factors, knowledge and trust in early detection and treatment processes, personal responsibility about one’s own health and well-being; and pride in self and satisfaction with one’s own actions.
Healthcare System
Smoking prevalence and healthcare provider smoking cessation advice among US worker groups: The National Health Interview Survey (NHIS).
Lee D, Fleming LE, Christ SL, Arheart K, Chung-Bridges K, LeBlanc W, McCollister K, Caban A, Pitman T. Tobacco Control, 2007;16:325-328
Changes needed in the healthcare system: perspectives of lay health workers
Ahmed NU, Fort JG, Micah TH, Dickerson P, Belay Y. Journal of Ambulatory Care Management, 2006, 29(1):17-23.
Insights from lay health workers serving underserved communities regarding barriers they and their clients face in the health care system. Focus group discussion yielded recommendations including improved access to the facilities, management, scope of services offered, and provider behaviors. These recommendations would help utilize community resources and assist underserved populations in negotiating the system to obtain the services they need.
Effect of race on long-term survival of breast cancer patients: transinstitutional analysis from an inner city hospital and university medical center
Grau AM, Ata A, Foster L,Ahmed NU, Gorman DR, Shyr Y, Stain SC, Pearson AS. The American Surgeon, 2005, 71(2):164-170.
Data from tumor registries of breast cancer patients at a city hospital and university center were analyzed for overall and disease-specific survival, controlling for stage and treatment. Black race was found to be an independent prognostic factor for worse cancer outcome. The lower survival of black women with breast cancer is only partially explained by their advanced stage at diagnosis. Black women with potentially curable stage II cancer had a lower survival that is not explained by the variables measured.
Health Behavior
The health behaviors of the older US worker
Fleming LE, Lee DJ, Caban AJ, LeBlanc WG, Chung Bridges K, Christ SL, Arheart KL, McCollister KE, Pitman T. American Journal of Industrial Medicine 2007, 50(6):427-437.
Health behavior data from the 1997-2003 National Health Interview Survey was analyzed comparing older workers with older non-workers. Relative to older non-workers, older workers reported more current smoking and risky drinking, and higher levels of leisure time physical activity. Taken as a whole, less than 4% of the older US worker population reported overall healthy behaviors.
Leisure-time physical activity levels of the US workforce.
Caban AJ, Lee DJ, Fleming LE, LeBlanc WG, Gomez-Marin O, Chung-Bridges K, Christ SL, Arheart K, Pitman T. Preventive Medicine, 2007, 44(5):432-436
Using data from the 1997-2004 National Health Interview Survey, results of this study indicate that the proportion of US workers meeting recommended leisure-time physical activity levels were 31% in females and 36% in males. There was substantial variation in the gender-specific rates of LTPA by occupation, with the lowest rates noted in blue collar groups.
Behavioral risk profiles for CHD among apparently healthy individuals of African ancestry
Davis E, Huffman FG, Ethnicity & Disease, 2006, 16:114-119.
This study evaluated the differences in behavioral risk profiles for coronary heart disease among U.S. born African Americans (of any descent) and foreign born Afro Caribbeans. Foreign born Afro Caribbean males were significantly less likely to consume an unhealthy diet, be obese, smoke cigarettes, and consume alcoholic beverages. No significant differences were observed between the female ethnic groups.
Racial/ethnic disparity and predictors of leisure-time physical activity among U.S. men
Ahmed NU, Smith GL, Flores AM, Pamies RJ, Mason HRC, Woods KR, Stain SC. Ethnicity & Disease, 2005 Winter, 15(1):40-52.
Racial/ethnic disparities in leisure-time physical activity exist after accounting for socio-demographic characteristics, with Hispanics least likely to engage in LTPA, and non-citizen Hispanics twice as likely to be inactive as citizens.
Using focus groups to understand health-related practices and perceptions of African Americans: Nashville REACH 2010 preliminary findings
Miller ST, Mushi C, Ahmed NU, Larson C, McClellan L, Marrs M. Ethnicity & Disease, 2004 Summer, 14(3 Suppl 1):S70-76.
Focus groups conducted among 5 community groups revealed 3 categories of barriers to healthier living – personal, environmental, and systemic. The accessibility and quality of health care were the most pervasive systemic barriers identified. While these findings are not novel to urban African-American communities, they served as the framework by which Nashville REACH 2010 will implement strategies to reduce cardiovascular and diabetes disparities.
Issue in Health Disparity Research
Increasing minority research participation through community organization outreach.
Alvarez RA, Vasquez E, Mayorga CC, Feaster DJ, Mitrani VB. Western Journal of Nursing Research, 2006, 28 :541-560.
Creating a successful recruitment process for research involving ethnic minority populations is integral to the strength of a study. This article presents a recruitment model for community outreach strategies. The model can be adopted and adapted by researchers to enhance engagement of minority populations.
Mental Health
Structural ecosystems therapy for HIV-seropositive African-American women: Effects on psychological distress, family hassles, and family support
Szapocznik J, Feaster DJ, Mitrani VB, Prado G, Smith L, Robison-Batista C, Schwartz SJ, Mauer MH, Robbins MS. Journal of Consulting and Clinical Psychology, 2004, 72:288-303.
This study tested the efficacy of Structural Ecosystems Therapy (SET), a family-ecological intervention in improving psychosocial functioning. In comparison to control conditions, SET was more efficacious in reducing psychological distress and family-related hassles, but contrary to hypothesis, was not more efficacious in increasing family support. SET was most efficacious for women who were at or near the clinical threshold for psychological distress.
Religious involvement, coping, social support, and psychological distress in HIV+ African American women.
Prado G, Feaster D, Schwartz S, Pratt I, Smith L, Szapocznik J. AIDS and Behavior, 2004, 8(3):221-235.
The relationship among religious involvement, stress, coping responses, social support, and psychological distress were examined in 252 urban, low-income HIV+ African American mothers using structural equation modeling. The number of stressors reported by the mother was related to greater religious involvement, which in turn was negatively related to psychological distress.
Familias Unidas: the efficacy of an intervention to promote parental investment in Hispanic immigrant families
Pantin H, Coatsworth JD, Feaster DJ, Newman FL, Briones E, Prado G, Schwartz SJ, Szapocznik J. Prevention Science, 2003, 4(3):189-201.
Familias Unidas is a Hispanic-specific, ecologically focused, parent-centered preventive intervention, in promoting protection against and reducing risk for adolescent behavior problems. Results indicated that Familias Unidas was efficacious in promoting protection and reducing risk for adolescent problem behaviors in poor immigrant Hispanic families.
Nutrition
Micronutrient supplementation increases CD4 count in HIV-infected individuals on HAART: A prospective, double-blinded, placebo-controlled trial
Kaiser J, Campa A, Ondercin J, Leoung G, Pless R, Baum MK. Journal of Acquired Immune Deficiency Syndrome, 2006, 42(5):523-528.
This study examined the immunologic, metabolic and clinical effects of micronutrient supplementation in HIV-infected patients taking highly active antiretroviral therapy (HAART). Micronutrient supplementation significantly improved CD4 cell count reconstitution in these patients (24% vs. 0% in placebo group, p=0.01) and was well tolerated.
Folate and Vitamin B12 status of multi ethnic young adults
Nath S, Koutoubi S, Huffman FG. Journal of the National Medical Association, 2006, 98:67-72.
Cross sectional study of dietary intakes of folate and vitamin B12 among non-Hispanic White, non-Hispanic Black, and Hispanic college students. These substances are of particular interest for their diverse biological functions and preventive roles in many chronic diseases. The data suggested that there was no difference in overall mean intake of folate and vitaminB12 or serum concentrations in regard to gender or ethnicity. One-fourth of the female subjects failed to meet the recommended folate intake when supplementation was excluded.
Validation of a semiquantitative FFQ to assess energy and macronutrient intakes of Cuban Americans
Nath S,Huffman FG. International Journal of Food and Nutrition, 2005, 56(5): 309-314.
The aim of this study was to determine if the Willett Food Frequency Questionnaire (FFQ) was a reasonable instrument to assess the intakes of most macronutrients and alcohol among Cuban Americans. The food questionnaire was administered and food consumption on three random days were collected. There were no significant differences in the mean intakes of energy, macronutrients, cholesterol and alcohol estimated by the Willett FFQ and the 3-day food records.
Substance Use
Prevalence and correlates of initiation of smoking behavior among preteen Black and White children
Ahmed NU, Ahmed NS, Semenya KA, Elzey JD, Larson C, Bennett CR, Hinds JE. Journal of the National Medical Association, 2004, 96(2):200-208.
Factors associated with initiation of smoking among preteen Black and White children in Nashville, TN showed that Black 6th graders smoked at four times the rate of Black 5th graders, and 2.5 times the rate of White 6th graders. Additionally, relatives initiated 78% of Black smokers while friends initiated 68% of white smokers.
Impact of a Drug Abuse Resistance Education (DARE) program in preventing the initiation of cigarette smoking in fifth- and sixth-grade students
Ahmed NU, Ahmed NS, Bennett CR, Hinds JE. Journal of the national Medical Association, 2002, 94(f4):249-256.
The effect of the DARE program to prevent smoking was studied in 236 fifth- and sixth-graders in Nashville, TN. The DARE group had a lower rate of smoking and were less likely to initiate smoking compared with students who had not completed the Dare program. Students with higher knowledge scores had substantially lower rates of smoking – a finding consistent for both African-American and White children.
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