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Allenstown Elementary School, United States

Sheppard V.B.,Georgetown University | Mays D.,Georgetown University | La Veist T.,Hopkins Center for Health Disparities Solutions | Tercyak K.P.,Georgetown University
Journal of the National Medical Association

Clinical evidence supports the value of BRCA1/2 genetic counseling and testing for managing hereditary breast and ovarian cancer risk; however, BRCA1/2 genetic counseling and testing are underutilized among black women, and reasons for low use remain elusive. We examined the potential influence of sociocultural factors (medical mistrust, concerns about genetic discrimination) on genetic counseling and testing engagement in a sample of 100 black women at increased risk for carrying a BRCA1/2 mutation. Eligible participants fell into 1 of 3 groups: (1) healthy women with at least 1 first-degree relative affected by breast and/or ovarian cancer, (2) women diagnosed with breast cancer at age less than or equal to 50 years, and (3) women diagnosed with breast and/or ovarian cancer at age greater than or equal to 50 years with either 1 first-degree relative or 2 second-degree relatives with breast and/or ovarian cancer. Participants were recruited from clinical and community settings and completed a semistructured interview. Study variable relationships were examined using bivariate tests and multivariate regression analysis. As expected, genetic counseling and testing engagement among this sample was low (28%). After accounting for sociodemographic factors and self-efficacy (β = 0.37, p <.001), women with higher medical mistrust had lower genetic counseling and testing engagement (β = -0.26, p <.01). Community-level and individual interventions are needed to improve utilization of genetic counseling and testing among underserved women. Along with trust building between patients and providers, strategies should enhance women's personal confidence. The impact of medical mistrust on the realization of the benefits of personalized medicine in minority populations should be further examined in future studies. Source

Laveist T.A.,Hopkins Center for Health Disparities Solutions
Public Health Reports

The established relationships among social determinants of health (SDH), health disparities, and race/ethnicity highlight the need for health-care professionals to adequately address SDH in their encounters with patients. The ethnic demographic transition slated to occur during the next several decades in the United States will have numerous effects on the health-care sector, particularly as it pertains to the need for a more diverse and culturally aware workforce. In recent years, a substantial body of literature has developed, exploring the extent to which diversity in the health-care workforce may be used as a tool to eliminate racial/ethnic disparities in health and health care in the U.S. We explore existing literature on this topic, propose a conceptual framework, and identify next steps in health-care policy for reducing and eliminating health disparities by addressing SDH and diversification of the health-care workforce. © 2014 Association of Schools and Programs of Public Health. Source

Shippee T.P.,University of Minnesota | Ferraro K.F.,Purdue University | Thorpe R.J.,Hopkins Center for Health Disparities Solutions
Ethnicity and Health

Objectives. The purposes of this article are: (1) to systematically examine racial disparities in access to and use of cardiac care units (CCUs) in acute-care hospitals; and (2) to assess racial differences in post-hospital mortality following CCU stays. Design. Data from the National Health and Nutrition Examination Survey I: Epidemiologic Follow-up Study of adults aged 25 and older at baseline are analyzed to track CCU use and survival after hospitalization over 20 years (N=4227). Estimates are derived from Cox proportional-hazards models with time-dependent covariates and from negative binomial and tobit regression analyses. All analyses adjust for disease severity, hospitalization history, and resources. Results. Black adults were less likely than White adults to be admitted to a CCU, even after adjusting for morbidities, health behaviors, previous hospitalization experience, and socioeconomic status. Comparing Black and White adults admitted to CCUs, Black adults spent fewer days and a smaller proportion of their hospital stay in CCUs. Black adults also had fewer CCU stays over the 20-year period and were more likely to die post-discharge, although the latter result was mediated by disease severity. Conclusions. Higher morbidity, lower admission rates, fewer stays, and shorter stays reveal that racial inequality is far-reaching and exists even in such highly-specialized units as CCUs. The fact that Black individuals' greater post-discharge mortality was mediated by disease severity illustrated that even among high-risk individuals, the accumulation of morbidity factors (beyond cardiac problems) is a salient concern. Overall findings demonstrate that the accumulation of disadvantage for Black adults is not confined to discretionary medical measures, but also exists in critical care for serious health problems. © 2011 Taylor & Francis. Source

D'Souza G.,Johns Hopkins Hospital | Cullen K.,University of Maryland, Baltimore | Bowie J.,Behavior and Society | Thorpe R.,Hopkins Center for Health Disparities Solutions | And 2 more authors.

Purpose: This study explores whether gender, age and race differences in oral sexual behavior account for the demographic distribution of oral human papillomavirus infection (HPV) and HPV-positive oropharyngeal cancer (HPV-OSCC) Methods: This analysis included 2,116 men and 2,140 women from NHANES (2009-10) who answered a behavioral questionnaire and provided an oral-rinse sample for HPV detection. Weighted prevalence estimates and prevalence ratios (PR) were calculated for sexual behaviors and oral HPV infection by gender, age-cohort (20-29, 30-44, 45-59, 60-69), and race, and contrasted with incidence rate ratios (IRR) of OSCC from SEER 2009. Multivariate logistic regression was used to evaluate predictors of oral sexual behavior and oral HPV16 infection. Results: Differences in oral sexual behavior were observed by gender, age-cohort and race. Most men (85.4%) and women (83.2%) had ever performed oral sex, but men had more lifetime oral and vaginal sexual partners and higher oral HPV16 prevalence than women (each p<0.001). 60-69 year olds (yo) were less likely than 45-59 or 30-44 (yo) to have performed oral sex (72.7%, 84.8%, and 90.3%, p<0.001), although oral HPV16 prevalence was similar. Prevalence ratios (PR) of ever oral sex in men vs. women (PR = 1.03), and 45-59 vs. 30-44 year-old men (PR = 0.96) were modest relative to ratios for oral HPV16 infection (PRs = 1.3-6.8) and OSCC (IRR = 4.7-8.1). In multivariate analysis, gender, age-cohort, and race were significant predictors of oral sexual behavior. Oral sexual behavior was the primary predictor of oral HPV16 infection; once this behavior was adjusted for, age-cohort and race were no longer associated with oral HPV16. Conclusion: There are differences in oral sexual behaviors when considering gender, age-cohort and race which explain observed epidemiologic differences in oral HPV16 infection across these groups. © 2014 D'Souza et al. Source

Gaskin D.J.,Management Health Solutions | Thorpe R.J.,Management Health Solutions | McGinty E.E.,Management Health Solutions | Bower K.,Hopkins Center for Health Disparities Solutions | And 4 more authors.
American Journal of Public Health

Objectives. We sought to determine the role of neighborhood poverty and racial composition on race disparities in diabetes prevalence. Methods. We used data from the 1999-2004 National Health and Nutrition Examination Survey and 2000 US Census to estimate the impact of individual race and poverty and neighborhood racial composition and poverty concentration on the odds of having diabetes. Results. We found a race-poverty-place gradient for diabetes prevalence for Blacks and poor Whites. The odds of having diabetes were higher for Blacks than for Whites. Individual poverty increased the odds of having diabetes for both Whites and Blacks. Living in a poor neighborhood increased the odds of having diabetes for Blacks and poor Whites. Conclusions. To address race disparities in diabetes, policymakers should address problems created by concentrated poverty (e.g., lack of access to reasonably priced fruits and vegetables, recreational facilities, and health care services; high crime rates; and greater exposures to environmental toxins). Housing and development policies in urban areas should avoid creating highpoverty neighborhoods. © 2014, American Public Health Association Inc. All rights reserved. Source

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