Sinai Urban Health Institute

Chicago, IL, United States

Sinai Urban Health Institute

Chicago, IL, United States
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Rauscher G.H.,University of Illinois at Chicago | Allgood K.L.,Sinai Urban Health Institute | Whitman S.,Sinai Urban Health Institute | Conant E.,University of Pennsylvania
Journal of Women's Health | Year: 2012

Background: Black and Hispanic women are diagnosed at a later stage of breast cancer than white women. Differential access to specialists, diffusion of technology, and affiliation with an academic medical center may be related to this stage disparity. Methods: We analyzed data from a mammography facility survey for the metropolitan region of Chicago, Illinois, to assess in part whether quality breast imaging services were equally accessed by non-Hispanic white, non-Hispanic black, and Hispanic women and by women with and without private insurance. Of 49 screening facilities within the city of Chicago, 43 facilities completed the survey, and 40 facilities representing about 149,000 mammograms, including all major academic facilities, provided data on patient race/ethnicity. Results: Among women receiving mammograms at the facilities we studied, white women were more likely than black or Hispanic women to have mammograms at academic facilities, at facilities that relied exclusively on breast imaging specialists to read mammograms, and at facilities where digital mammography was available (p<0.001). Women with private insurance were similarly more likely than women without private insurance to have mammograms at facilities with these characteristics (p<0.001). Conclusions: Black and Hispanic women and women without private insurance are more likely than white women and women with private insurance to obtain mammography screening at facilities with less favorable characteristics. A disparity in use of high-quality mammography may be contributing to disparities in breast cancer mortality. © 2012, Mary Ann Liebert, Inc.

Rosenstock S.,Sinai Urban Health Institute | Whitman S.,Sinai Urban Health Institute | West J.F.,Sinai Urban Health Institute | Balkin M.,Chicago Medical School
Journal of Urban Health | Year: 2014

While studies have consistently shown that in the USA, non-Hispanic Blacks (Blacks) have higher diabetes prevalence, complication and death rates than non-Hispanic Whites (Whites), there are no studies that compare disparities in diabetes mortality across the largest US cities. This study presents and compares Black/White age-adjusted diabetes mortality rate ratios (RRs), calculated using national death files and census data, for the 50 most populous US cities. Relationships between city-level diabetes mortality RRs and 12 ecological variables were explored using bivariate correlation analyses. Multivariate analyses were conducted using negative binomial regression to examine how much of the disparity could be explained by these variables. Blacks had statistically significantly higher mortality rates compared to Whites in 39 of the 41 cities included in analyses, with statistically significant rate ratios ranging from 1.57 (95 % CI: 1.33–1.86) in Baltimore to 3.78 (95 % CI: 2.84–5.02) in Washington, DC. Analyses showed that economic inequality was strongly correlated with the diabetes mortality disparity, driven by differences in White poverty levels. This was followed by segregation. Multivariate analyses showed that adjusting for Black/White poverty alone explained 58.5 % of the disparity. Adjusting for Black/White poverty and segregation explained 72.6 % of the disparity. This study emphasizes the role that inequalities in social and economic determinants, rather than for example poverty on its own, play in Black/White diabetes mortality disparities. It also highlights how the magnitude of the disparity and the factors that influence it can vary greatly across cities, underscoring the importance of using local data to identify context specific barriers and develop effective interventions to eliminate health disparities. © 2014, The New York Academy of Medicine.

Allgood K.L.,Sinai Urban Health Institute | Rauscher G.H.,University of Illinois at Chicago | Whitman S.,Sinai Urban Health Institute | Vasquez-Jones G.,Sinai Urban Health Institute | Shah A.M.,University of California at Los Angeles
Cancer Epidemiology Biomarkers and Prevention | Year: 2014

Background: Most health surveys ask women whether they have had a recent mammogram, all of which report mammography use (past 2 years) at about 70% to 80% regardless of race or residence. We examined the potential extent of overreporting of mammography use in low income African-American and Latina women, and whether self-report inaccuracies might bias estimated associations between patient characteristics and mammography use. Methods: Using venue-based sampling in two poor communities on the west side of Chicago, we asked eligible women living in two west side communities of Chicago to complete a survey about breast health (n = 2,200) and to provide consent to view their medical record. Of the 1,909 women who screened eligible for medical record review, 1,566 consented (82%). We obtained medical records of all women who provided both permission and a valid local mammography facility (n = 1,221). We compared the self-reported responses from the survey with the imaging reports found in the medical record (documented). To account for missing data, we conducted multiple imputations for key demographic variables and report standard measures of accuracy. Results: Although 73% of women self-reported a mammogram in the last 2 years, only 44% of self-reports were documented. Overreporting of mammography use was observed for all three ethnic groups. Conclusions: These results suggest considerable overestimation of prevalence of use in these vulnerable populations. Impact: Relying on known faulty self-reported mammography data as a measure of mammography use provides an overly optimistic picture of utilization, a problem that may be exacerbated in vulnerable minority communities. © 2014 American Association for Cancer Research.

Margellos-Anast H.,Sinai Urban Health Institute | Gutierrez M.A.,Sinai Urban Health Institute | Whitman S.,Sinai Urban Health Institute
Journal of Asthma | Year: 2012

Objectives. Asthma affects 25-30% of children living in certain disadvantaged Chicago neighborhoods, a rate twice the national prevalence (13%). Children living in poor, minority communities tend to rely heavily on the emergency department (ED) for asthma care and are unlikely to be properly medicated or educated on asthma self-management. A pilot project implemented and evaluated a community health worker (CHW) model for its effectiveness in reducing asthma morbidity and improving the quality of life among African-American children living in disadvantaged Chicago neighborhoods. Methods. Trained CHWs from targeted communities provided individualized asthma education during three to four home visits over 6 months. The CHWs also served as liaisons between families and the medical system. Seventy children were enrolled into the pilot phase between 15 November 2004 and 15 July 2005, of which 96% were insured by Medicaid and 54% lived with a smoker. Prior to starting, the study was approved by an institutional review board. Data on 50 children (71.4%) who completed the entire 12-month evaluation phase were analyzed using a before and after study design. Results. Findings indicate improved asthma control. Specifically, symptom frequency was reduced by 35% and urgent health resource utilization by 75% between the pre- and post-intervention periods. Parental quality of life also improved by a level that was both clinically and statistically significant. Other important outcomes included improved asthma-related knowledge, decreased exposure to asthma triggers, and improved medical management. The intervention was also shown to be cost-effective, resulting in an estimated5.58 saved per dollar spent on the intervention. Conclusions. Findings suggest that individualized asthma education provided by a trained, culturally competent CHW is effective in improving asthma management among poorly controlled, inner-city children. Further studies are needed to affirm the findings and assess the model's generalizability. © 2012 Informa Healthcare USA, Inc.

Benjamins M.R.,Sinai Urban Health Institute | Hirschman J.,Lawrence Family Medicine Residency | Hirschtick J.,Sinai Urban Health Institute | Whitman S.,Sinai Urban Health Institute
Ethnicity and Health | Year: 2012

Objectives. Self-rated health (SRH) is a robust predictor of subsequent health and mortality. Although age, gender, and race differences in SRH have been explored, less work has examined ethnic differences, particularly in the US. Design. The current study uses representative data from six Chicago communities to compare levels and determinants of fair-poor health for Blacks, Whites, Mexicans, and Puerto Ricans (n=1311). Results. Mexicans and Puerto Ricans were at least three times more likely to report fair or poor health than Whites, while African-Americans were over twice as likely. In adjusted logistic regression models, only Mexicans remain significantly more likely to report fair-poor health than Whites (OR = 4.3, CI = 1.8-9.8). However, this effect disappears when controlling for acculturation. No variable predicted poor subjective health for all groups, though depression was associated with poor health for most. Conclusion. Together, these analyses suggest that the single item measure of SRH might not be appropriate for comparing health status across members of different race/ethnic groups. More research is needed to understand what factors influence how an individual perceives his or her health. © 2012 Copyright Taylor and Francis Group, LLC.

Discrimination is detrimental to health behaviors and outcomes, but little is known about which measures of discrimination are most strongly related to health, if relationships with health outcomes vary by race/ethnicity, and if coping responses moderate these associations. To explore these issues, the current study assessed race/ethnic differences in five measures of race/ethnic discrimination, as well as emotional and behavioral coping responses, within a population-based sample of Whites, African Americans, Mexicans, and Puerto Ricans (n = 1,699). Stratified adjusted logistic regression models were run to examine associations between the discrimination measures and mental, physical, and health behavior outcomes and to test the role of coping. Overall, 86 % of the sample reported discrimination. Puerto Ricans were more likely than Mexicans and Whites to report most types of discrimination but less likely than Blacks. Discrimination was most strongly related to depression and was less consistently (or not) associated with physical health and health behaviors. Differences by measure of discrimination and respondent race/ethnicity were apparent. No support was found to suggest that coping responses moderate the association between discrimination and health. More work is needed to understand the health effects of this widespread social problem. In addition, interventions attempting to reduce health disparities need to take into account the influence of discrimination. © 2013 The New York Academy of Medicine.

Whitman S.,Sinai Urban Health Institute | Shah A.M.,Sinai Urban Health Institute | Benjamins M.R.,Sinai Urban Health Institute
Urban Health: Combating Disparities with Local Data | Year: 2011

The 1980s opened a discussion of the varying nature of health in different segments of the United States. Falling under the rubric of 'health disparities', a great deal of research has been published demonstrating the substantial differences in health status within a population. The causes of health disparities are varied and not always clear but most researchers agree that disparities are a reflection of social and economic inequities and political injustice. One of the obstacles to addressing disparities is the lack of meaningful health data especially for vulnerable populations, which is often nonexistent despite being a critical factor for informing health programs and policies at the local level. This book provides a model for combating health disparities by describing how local health information was gathered, with the community engaged at every step of the process, creating movement toward evidence-based sustainable change. This book describes how a landmark health survey in Chicago generated dramatic data that are allowing investigators throughout the city to move from data to action and from observation to intervention. © 2011 by Oxford University Press. All rights reserved.

Fitchett G.,Rush University Medical Center | Benjamins M.R.,Sinai Urban Health Institute | Skarupski K.A.,Rush University Medical Center | Mendes De Leon C.F.,University of Michigan
Journals of Gerontology - Series B Psychological Sciences and Social Sciences | Year: 2013

Objectives. We examined the contribution of religious involvement to age-related declines in health by examining the association of worship attendance with measures of different stages in the disability continuum.Method. Participants included 5,863 Black and White older adults from the Chicago Health and Aging Project. Worship attendance was coded in 3 levels: very frequent (several times a week or more), frequent (several times a month), and infrequent (several times a year or less). Measures of disability included self-reported instrumental activities of daily living (IADL) and activities of daily living (ADL) disability as well as observed physical function.Results. In multiple regression models adjusted for demographic factors, compared with those with infrequent worship attendance, those with frequent or very frequent attendance had lower levels of IADL and ADL disability and higher levels of physical performance at baseline. These associations remained significant in models that adjusted for health and cognitive status. There was no association between frequency of worship attendance and change in disability or physical function over time.Discussion. These results suggest that more frequent worship attendance does not contribute to slowing the progress of disability in late life. Future research is needed to better understand the development of the differences in disability associated with worship attendance observed at baseline. © 2012 The Author.

Orsi J.M.,Sinai Urban Health Institute | Margellos-Anast H.,Sinai Urban Health Institute | Whitman S.,Sinai Urban Health Institute
American Journal of Public Health | Year: 2010

Objectives. In an effort to examine national and Chicago, Illinois, progress in meeting the Healthy People 2010 goal of eliminating health disparities, we examined whether disparities between non-Hispanic Black and non-Hispanic White persons widened, narrowed, or stayed the same between 1990 and 2005. Methods. We examined 15 health status indicators. We determined whether a disparity widened, narrowed, or remained unchanged between 1990 and 2005 by examining the percentage difference in rates between non-Hispanic Black and non-Hispanic White populations at both time points and at each location. We calculated Pvalues to determine whether changes in percentage difference over time were statistically significant. Results. Disparities between non-Hispanic Black and non-Hispanic White populations widened for 6 of 15 health status indicators examined for the United States (5 significantly), whereas in Chicago the majority of disparities widened (11 of 15, 5 significantly). Conclusions. Overall, progress toward meeting the Healthy People 2010 goal of eliminating health disparities in the United States and in Chicago remains bleak. With more than 15 years of time and effort spent at the national and local level to reduce disparities, the impact remains negligible.

Hunt B.R.,Sinai Urban Health Institute
Journal of Cancer Epidemiology | Year: 2016

Background. This paper presents data on breast cancer prevalence and mortality among US Hispanics and Hispanic subgroups, including Cuban, Mexican, Puerto Rican, Central American, and South American. Methods. Five-year average annual female breast cancer prevalence and mortality rates for 2009-2013 were examined using data from the National Health Interview Survey (prevalence) and the National Center for Health Statistics and the American Community Survey (mortality rates). Results. Overall breast cancer prevalence among US Hispanic women was 1.03%. Although the estimates varied slightly by Hispanic subgroup, these differences were not statistically significant. The breast cancer mortality rate for Hispanics overall was 17.71 per 100,000 women. Higher rates were observed among Cubans (17.89), Mexicans (18.78), and Puerto Ricans (19.04), and a lower rate was observed among Central and South Americans (10.15). With the exception of the rate for Cubans, all Hispanic subgroup rates were statistically significantly different from the overall Hispanic rate. Additionally, all Hispanic subgroups rates were statistically significantly higher than the Central and South American rate. Conclusion. The data reveal significant differences in mortality across Hispanic subgroups. These data enable public health officials to develop targeted interventions to help lower breast cancer mortality among the highest risk populations. © 2016 Bijou R. Hunt.

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