This article presents a mechanism for tracking and reporting

Size: px
Start display at page:

Download "This article presents a mechanism for tracking and reporting"

Transcription

1 Enhancing the Measurement of Health Disparities for Vulnerable Populations Leiyu Shi, Gregory D. Stevens, Lydie A. Lebrun, Pegah Faed, and Jenna Tsai This article presents a mechanism for tracking and reporting health disparities data that are based on a general model of vulnerability. We briefly discuss the origins of this model and describe its focus on the cumulative impact of multiple risk factors on health-related outcomes. We then demonstrate how the model can be applied to inform the collection and reporting of health disparities data by providing three examples. Since national and state datasets contain information on a wide range of risk factors, researchers and policy makers would benefit from examining the multiple risks that affect vulnerable populations simultaneously, as we have demonstrated in the three examples. These examples suggest that the determinants of health and healthcare problems are multifactorial and that they can be studied in an integrative approach using risk profiles. This research methodology can strengthen our existing knowledge of health disparities and aid in the recognition of points of intervention to successfully improve health and healthcare for vulnerable populations. KEY WORDS: health disparities, insurance enhancing the measurement of health disparities for vulnerable populations, race/ethnicity, SES, vulnerable populations A large body of literature documents health and healthcare disparities in the United States and delineates the causal pathways that lead to these disparities. 1,2 However, although this body of literature collectively demonstrates that the causes of disparities are multifaceted, many studies have tended to focus on single categories of vulnerability, such as minority race/ethnicity, low income, or lack of insurance coverage Even studies that include other risk factors commonly use these variables as controls to reveal J Public Health Management Practice, 2008, November(Suppl), S45 S52 Copyright C 2008 Wolters Kluwer Health Lippincott Williams & Wilkins the specific effect of the one key variable of interest. A more realistic and accurate approach should account for situations in which vulnerable populations experience multiple, interrelated factors simultaneously We present a mechanism for tracking and reporting health disparities data that are based on a general model of vulnerability. We discuss the origins of this model and describe its focus on the cumulative impact of multiple risk factors on health-related outcomes. We then demonstrate how the model can be applied to inform the reporting of health disparities data by providing three examples. Finally, we discuss the implications of using such an approach. The General Model of Vulnerability Vulnerability has been defined as a multidimensional construct reflecting a convergence of many risk factors at both the individual and community levels, which influence health and healthcare experiences. 24 Vulnerable populations typically experience risks in clusters, and groups predisposed to multiple risk factors are more vulnerable to poor outcomes than groups affected by a single risk factor. The general model of vulnerability Corresponding Author: Leiyu Shi, DrPH, MPA, MBA, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, 624 N Broadway, Room 409, Baltimore, MD (lshi@jhsph.edu). Leiyu Shi, DrPH, MPA, MBA, is Professor of health policy and health services research from Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University. He is Codirector of Johns Hopkins Primary Care Policy Center, Baltimore, Maryland. Gregory D. Stevens, PhD, MHS, is a faculty of the Center for Community Health Studies, Department of Family Medicine, USC Keck School of Medicine, Alhambra, California. Lydie A. Lebrun, PhD, is candidate from Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland. Pegah Faed, MPH, student from the Center for Community Health Studies, Department of Family Medicine, USC Keck School of Medicine, Alhambra, California. Jenna Tsai, EdD, is an Associate Professor from Hungguang University, Taiwan. S45

2 S46 Journal of Public Health Management and Practice FIGURE 1 A General Model of Vulnerability (Figure 1) encourages us to more comprehensively and explicitly examine the contributions of multiple risks, allowing us to assess whether the collective impact of several risks adds up to more than the sum of its parts. 24 The general model of vulnerability was derived from previous foundational works that delineated individual or community risk factors for poor health and healthcare access Aday s comprehensive model of vulnerability incorporates both individual and community risk factors for health and well-being, thus presenting a more comprehensive and accurate reflection of reality. 29 Finally, Aday and Andersen s highly cited access-to-care framework categorizes the predisposing, enabling, and need factors that influence individuals ability to obtain healthcare. 30 The general model of vulnerability provides the next logical step and features some distinctive characteristics from these previous models. It emphasizes a convergence of multiple individual and community risks, which can have a cumulative effect on outcomes. In other words, the model considers those who experience multiple risks to be more vulnerable to poor outcomes than those with one or no risks. The model also considers predisposing, enabling, and need factors for poor quality of care and poor health outcomes, not just for poor access to care. Operationalizing the General Model of Vulnerability Certain risk factors tend to have an impact on a wide variety of health and healthcare outcomes, including the ones in the three examples below. Race/ethnicity has been linked to health and healthcare through several pathways, including socioeconomic status, cultural factors, discrimination, and healthcare system characteristics Socioeconomic status (ie, income, education) is associated with health-related outcomes through material deprivation of resources, stress, and opportunities for social participation Health insurance influences access to, and utilization of, healthcare and quality of care In addition to these common risk factors, other risk factors are relevant to specific outcomes of interest; these are also included in each of the three examples. One approach for measuring and presenting the effects of multiple risk factors is to use interaction terms in statistical models. Interaction terms allow the relationship between a factor of interest and an outcome to vary depending on additional factors. However, these are often difficult to understand by anyone other than experienced researchers. In addition, interaction terms usually only account for the moderating effects of one or two additional variables, which is inadequate for models attempting to simultaneously consider numerous factors. To avoid these complications, we employ an alternative approach to account for multiple risk factors, where we create risk profiles to characterize individuals according to the presence or absence of certain vulnerable characteristics. Risk profiles enable us to summarize the number and types of risk factors experienced by individuals, are easier to comprehend than interaction terms, and are thus a preferable approach to account for multiple risk factors. Risk profiles also allow us to visualize whether the effects of combining risk factors are additive or multiplicative, which is not

3 Enhancing the Measurement of Health Disparities S47 always obvious from analyses that control for other risk factors or analyses containing interaction terms. Example 1: Disparities in unmet healthcare needs among adults A primary goal for the United States is to reduce or eliminate disparities in healthcare. 49 Using data from the 2000 National Health Interview Survey, risk profiles were created for five common measures of patientreported unmet healthcare needs, all of which were due to concerns over costs. These included lack of medical care, delayed medical care, delayed filling of prescription, delayed mental healthcare, and delayed dental care. Several risk factors for these unmet healthcare needs were selected on the basis of Aday and Andersen s access to care model. 30 These included individual-level predisposing (ie, race/ethnicity) and enabling factors (ie, income, health insurance, regular source of care). The analyses were also adjusted for demographic and community factors, including age, gender, marital status, education, employment, health status, metropolitan statistical area, and geographic region. 50 Table 1 presents the independent effects of risk factors on having delayed or missed healthcare. Controlling for demographic and community characteristics, each risk factor was associated with greater odds of having unmet needs. Compared with Whites, racial/ethnic minority groups had reduced odds of missing needed medical care or delaying medical care, prescription filling, mental health care, and dental care. Low-income adults had increased odds of reporting unmet healthcare needs than high-income adults. Lacking private health insurance and a regular source of care were also associated with unmet healthcare needs. Figure 2 depicts the relationship between the risk profiles and the likelihood of delaying needed medical care, after controlling for demographic and community covariates, for the total sample and for each racial/ethnic group separately. It shows a stepwise increase across all racial/ethnic groups in the likelihood of delaying care with increasing numbers of risk factors. The largest jump in probability of unmet needs occurs between 1 and 2 risk factors. Compared with having none of the risk factors included in the model, having a single risk factor roughly doubles the probability of having unmet needs. However, adding a second risk factor can triple the likelihood of having an unmet need compared with no risk factors. In addition, Whites are more likely to express delays in needed medical care than other racial/ethnic groups. This may be because Whites have different perceptions of health needs and feel more entitled to medical care, making them more likely to report unmet needs. On the other hand, minorities may have lower expectations from the healthcare system because of negative prior experiences, discrimination, and poorer quality of care, and thus are less likely to report unmet healthcare needs Some racial/ethnic minority groups may also have lower health literacy, contributing to less frequent reports of unmet needs. 55 Another important finding is that some of the risk factor combinations appear to have multiplicative effects, rather than simply additive effects, depending on racial/ethnic group. Understanding these potentially multiplicative effects deserves particular research and policy attention. These profiles of multiple risk factors capture a more comprehensive view of unmet healthcare needs: regardless of race/ethnicity, having low income, lacking insurance coverage, and not having a regular source of care combine to create substantial TABLE 1 Associations of independent risk factors with missed or delayed care due to costs (N = ) a Delayed needed Did not get needed Delayed filling Delayed mental Delayed dental medical care medical care a prescription healthcare healthcare OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) Race/ethnicity (ref White) African American 0.56 ( ) 0.76 ( ) 0.73 ( ) 0.57 ( ) 0.66 ( ) Hispanic 0.39 ( ) 0.45 ( ) 0.47 ( ) 0.41 ( ) 0.46 ( ) Asian 0.40 ( ) 0.36 ( ) 0.42 ( ) 0.30 ( ) 0.41 ( ) Low income (ref high) 1.50 ( ) 1.58 ( ) 2.12 ( ) 1.77 ( ) 1.65 ( ) Health insurance coverage (ref private) Public coverage 1.67 ( ) 1.93 ( ) 1.65 ( ) 1.35 ( ) 1.89 ( ) Uninsured 6.13 ( ) 7.33 ( ) 4.55 ( ) 4.94 ( ) 4.69 ( ) No RSC (ref having an RSC) 1.31 ( ) 1.37 ( ) 1.20 ( ) 1.14 ( ) 1.44 ( ) Abbreviation: RSC, regular source of care. a 2000 National Health Interview Survey. 50 Logistic regression models for each measure of missed or delayed care were conducted adjusting for age, gender, marital status, education, employment, health status, metropolitan statistical area, and geographic region.

4 S48 Journal of Public Health Management and Practice FIGURE 2 Percentage of Delayed Needed Medical Care by the Number of Risk Factors for Each Racial/Ethnic Group a a 2000 National Health Interview Survey. 50 All risk profiles within each race/ethnicity were statistically significant at P <.001 (compared with a profile of 0 risk factor) using t tests, except for the 1 risk factor profile for Hispanics (P <.1) and 1 and 2 risk factor profiles for Asians (P <.01). barriers to accessing needed health services. One in five US adults has multiple risk factors for unmet healthcare needs and these barriers create up to a fivefold increase in rates of unmet needs. 50 Example 2: Disparities in receipt of recommended preventive services Another national priority involves improving the delivery of primary and preventive services to vulnerable populations. In this example, the outcome of interest was receipt of blood pressure screening during the past year. The risk factors examined included three enabling characteristics: low income (household income less than 200% of the federal poverty line), health insurance, and regular source of care. Low education (less than high school), a predisposing factor, was also examined. Data came from the 1996 Medical Expenditure Survey. Vulnerability risk profiles for the total sample and for racial/ethnic groups (results not shown) were created on the basis of these factors. 56 Findings for each racial/ethnic group were similar to those for the total sample. Figure 3 shows that there is a declining pattern in blood pressure screening by the number of risk factors. It also demonstrates that the particular combination of risk factors may have larger or smaller effects on the receipt of a blood pressure screening. For example, among individuals with a two risk factor profile, only 54 percent of those without insurance and a regular source of care had a screening in comparison with 86 percent of those with low income and low education. This example demonstrates that a substantial proportion of US adults have multiple risk factors and these factors are associated with more than a twofold difference in the proportion of those receiving preventive care between the highest and lowest risk profiles. Example 3: Disparities in children s health status and developmental risk Child health is defined as the extent to which children are able or enabled to develop and realize their potential, satisfy their needs, and develop the capacities that allow them to interact successfully with the biological, physical, and social environment. 56(p1) This definition

5 Enhancing the Measurement of Health Disparities S49 FIGURE 3 Percentage Receipt of Blood Pressure Screening During Past Year by Risk Factor Combination a a 1996 Medical Expenditure Panel Survey. 56 is distinct from that of adult health because it considers important developmental processes. Children are considered a vulnerable group because they often have multiple risk factors for poor health such as living in poverty and lacking insurance coverage. We hypothesized that having a greater number of risk factors would be associated in a dose-response manner with poorer child health status and risk of developmental delays. There are four strong and consistent predictors of poor child health, all of which were included in the models that are as follows: child minority race/ethnicity, lower family social class (based on poverty status and maternal education), child uninsurance, and poor maternal mental health (measured by Mental Health Inventory scores, with the bottom tertile representing poorer mental health). All multiple logistic models were adjusted for child age and gender, maternal age and employment, and single parent household. Data came from the 2000 National Survey of Early Childhood Health. 57 Table 2 demonstrates that each of the four risk factors was independently associated with poor child health, after adjusting for covariates. African American and Latino children were more likely than White children to have poorer health status. Children from lower social class families were more likely than those from higher social class families to have poorer health status. Uninsured children were more likely to have poorer health status and more likely to be at higher risk of developmental delays. Both bottom and middle tertiles of maternal mental health scores were associated with lower child health status and higher risk of developmental delays. Figure 4 shows a stepwise increase in the proportion of children in lower health status associated with increasing numbers of risk factors. Multiple risk factors are prevalent in the United States, with about 3.1 million young children aged 4 to 35 months having two or more risk factors. 57 This suggests that addressing disparities in the health status of vulnerable children requires the recognition of multiple risk factors. What Can Be Learned From Analyzing Multiple Risk Factors? We have analyzed nationally representative data from three sources to explore the negative influence of multiple risk factors on healthcare access, receipt of preventive care, and children s health. Certain methodological approaches should be considered when conducting research on vulnerability. It may be useful to stratify analyses by immutable factors such as race/ethnicity

6 S50 Journal of Public Health Management and Practice TABLE 2 Association of independent risk factors with child health status and developmental risk among children aged 4 to 35 months (N = 2 068) a Odds ratio (95% confidence interval) Risk factors GFP status b HRDD GFP or HRDD Child race/ethnicity (ref White) African American 1.76 c ( ) 1.22 ( ) 1.52 d ( ) Latino 2.21 e ( ) 1.53 d ( ) 2.00 e ( ) Other 1.93 ( ) 1.46 ( ) 1.75 ( ) Family social class f (ref higher) Lower 1.98 c ( ) 1.53 ( ) 1.56 c ( ) Middle 1.32 ( ) 1.19 ( ) 1.23 ( ) Child health insurance (ref private) Public insurance 1.55 ( ) 1.05 ( ) 1.38 ( ) Other insurance 0.99 ( ) 1.37 ( ) 1.43 ( ) Uninsured 2.50 e ( ) 2.75 e ( ) 3.21 e ( ) Maternal mental health g (ref top tertile) Middle tertile 1.79 d ( ) 1.77 c ( ) 1.72 e ( ) Bottom tertile 1.71 e ( ) 1.47 e ( ) 1.89 e ( ) Abbreviations: GFP, good, fair, or poor health; HRDD, higher risk for developmental delays. a 2000 National Survey of Early Childhood Health. 57 Logistic regression models are adjusted for child age and gender, maternal age and employment, and single parent household. b Compared with excellent or very good health status. c P <.05. d P <.01. e P <.001 for the odds ratio of the category versus the given reference group. f Based on maternal education level and family poverty status. g Based on Mental Health Inventory scores (bottom: 0 72 points, middle: points, top: points). FIGURE 4 Proportion of Children in Good, Fair, or Poor Health (Versus Excellent or Very Good Health) by Risk Factor Combination a a 2000 National Survey of Early Childhood Health. 57 No statistically significant differences were found among the risk factor combinations within each risk profile category (ie, 1 risk factor, 2 risk factors, etc), however differences were statistically significant between the combinations within a given risk factor category (eg, 1 risk factor) and the combinations within another risk factor category (eg, 2 risk factors), P <.05.

7 Enhancing the Measurement of Health Disparities S51 and to create risk profiles using factors that are more amenable to policy interventions (eg, insurance coverage, regular source of care). It is also informative to consider both the number and type of risk factors. In the case of unmet healthcare needs, the analysis of multiple factors demonstrates a dose-response relationship in the likelihood of delaying care as the number of risk factors increases, regardless of race/ethnicity. One in five US adults experiences multiple risk factors for unmet healthcare needs, so using the vulnerability model to address these needs will lead to a more effective approach. In addition to this gradient relationship, certain combinations of risk factors may create more detrimental risk profiles than other combinations, and it is important to identify these vulnerability risk profiles. For instance, for blood pressure screening, a two risk profile of being uninsured and having no regular source of care is far worse than other two risk profiles. This information can guide interventions by identifying the most disadvantaged populations. Achieving equity in the access to and quality of care for all Americans is a tremendous challenge for the nation. One strategy for reducing disparities is to measure health and healthcare indicators and their related risk factors. However, these data are frequently reported by focusing on single risk factors rather than in a manner that emphasizes the cumulative effects of multiple risk factors as proposed by the general model of vulnerability. Since national and state datasets contain information on a wide range of risk factors, researchers and policy makers would benefit from explicitly examining the multiple risks that affect vulnerable populations simultaneously, as we have demonstrated in the three examples above. These examples suggest that the determinants of health and healthcare problems are multifactorial and that they can be studied in an integrative approach using risk profiles. This research methodology can strengthen our existing knowledge of health disparities and provide guidance on potential policy interventions to target limited resources toward the most vulnerable groups. REFERENCES 1. Smedley B, Stith A, Nelson A, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health care. Washington, DC: Institute of Medicine; Agency for Healthcare Research and Quality. National Healthcare Disparities Report, Rockville, MD: US Department of Health and Human Services; Ayanian J, Weissman J, Schneider E, Ginsburg J, Zaslavsky A. Unmet health needs of uninsured adults in the united states. JAMA. 2000;284: Guendelman S, Angulo V, Oman D. Access to health care for children and adolescents in working poor families: recent findings from California. Med Care. 2005;43: Ayanian J, Kohler B, Abe T, Epstein A. The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med. 1993;329(5): Backlund E, Sorlie P, Johnson N. A comparison of the relationships of education and income with mortality: the national longitudinal mortality study. Soc Sci Med. 1999;49(10): Fiscella K, Franks P, Doescher M, Saver B. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2002;40: Franks P, Clancy C, Gold M. Health insurance and mortality. Evidence from a national cohort. JAMA. 1993;270(6): Gaskin D, Hoffman C. Racial and ethnic differences in preventable hospitalizations across 10 states. Med Care Res Rev. 2000;57(suppl 1): Hayward M, Heron M. Racial inequality in active life among adult Americans. Demography. 1999;36(1): Newacheck P, Jameson W, Halfon N. Health status and income: the impact of poverty on child health. J Sch Health. 1994;64(6): Newacheck P, Stoddard J, Hughes D, Pearl M. Health insurance and access to primary care for children. N Eng J Med. 1998;338(8): Schneider E, Zaslavsky A, Epstein A. Racial disparities in the quality of care for enrollees in Medicare managed care. JAMA. 2002;287(10): Weinick R, Krauss N. Racial/ethnic differences in children s access to care. Am J Public Health. 2000;90: Casper M, Barnett E, Armstrong D, Giles W, Blanton C. Social class and race disparities in premature stroke mortality among men in North Carolina. Ann Epidemiol. 1997;7(2): Freeman H, Corey C. Insurance status and access to health services among poor persons. Health Serv Res. 1993;28(5): Grant E, Lyttle C, Weiss K. The relation of socioeconomic factors and racial/ethnic differences in US asthma mortality. Am J Public Health. 2000;90(12): Klein J, Wilson K, McNulty M, Kapphahn C, Collins K. Access to medical care for adolescents: results from the 1997 Commonwealth Fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2): Merkin S, Stevenson L, Powe N. Geographic socioeconomic status, race, and advanced-stage breast cancer in New York City. Am J Public Health. 2002;92(1): Pappas G, Hadden W, Kozak L, Fisher G. Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups. Am J Public Health. 1997;87(5): Sameroff A, Seifer R, Barocas R, Zax M, Greenspan S. Intelligence quotient scores of 4-year-old children: socialenvironmental risk factors. Pediatrics. 1987;79(3): Shi L, Forrest C, Von Schrader S, Ng J. Vulnerability and the patient-practitioner relationship: the roles of gatekeeping and primary care performance. Am J Public Health. 2003;93(1): Shi L, Stevens G. Vulnerability and the receipt of recommended preventive services: the influence of multiple risk factors. Med Care. 2005;43(2):

8 S52 Journal of Public Health Management and Practice 24. Shi L, Stevens GD. Vulnerable Populations in the United States. San Francisco, CA: Jossey-Bass; Rogers A. Vulnerability, health and health care. J Adv Nurs. 1997;26: Aday L. Health status of vulnerable populations. Annu Rev Public Health. 1994;15: Hamburg D, Elliott G, Parron D. Health and Behavior: Frontiers of Research in the Biobehavioral Sciences. Washington, DC: National Academies Press; Flaskerud J, Winslow B. Conceptualizing vulnerable populations health-related research. Nurs Res. 1998;47: Aday L. At Risk in America: The Health and Health Care Needs of Vulnerable Populations in the United States. 2nd ed. San Francisco, CA: Jossey-Bass; Aday L, Andersen R. Equity of access to medical care: a conceptual and empirical overview. Med Care. 1981;19(12, suppl): DeNavas-Walt C, Cleveland R, Roemer M. Money Income in the United States Washington, DC: US Census Bureau; Ferguson W, Candib L. Culture, language, and the doctorpatient relationship. Fam Med. 2002;34: Flores G, Vega L. Barriers to health care access for Latino children: a review. Fam Med. 1998;30(3): Guyll M, Matthews K, Bromberger J. Discrimination and unfair treatment: relationship to cardiovascular reactivity among African American and European American women. Health Psychol. 2001;20(5): Karlsen S, Nazroo J. Relation between racial discrimination, social class, and health among ethnic minority groups. Am J Public Health. 2002;92(4): McBean A, Gornick M. Differences by race in the rates of procedures performed in hospitals for Medicare beneficiaries. Health Care Financ Rev. 1994;15(4): Van Ryn M, Fu S. Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? Am J Public Health. 2003;93(2): Adler N, Ostrove J. Socioeconomic status and health: what we know and what we don t. Ann N Y Acad Sci. 1999;896: Gallo L, Matthews K. Understanding the association between socioeconomic status and physical health: do negative emotions play a role? Psychol Bull. 2003;129(1): Marmot M. The influence of income on health: views of an epidemiologist. Health Aff. 2002;21(2): Ross C, Mirowsky J. Family relationships, social support and subjective life expectancy. J Health Soc Behav. 2002;43(4): Winkleby M, Cubbin C, Ahn D, Kraemer H. Pathways by which SES and ethnicity influence cardiovascular disease risk factors. Ann N Y Acad Sci. 1999;896: Hadley J. Sicker and poorer the consequences of being uninsured: a review of the research on the relationship between health insurance, medical care use, health, work, and income. Med Care Res Rev. 2003;60(3):3S 75S. 44. McBride D, Drumm R, Terry-McElrath Y, Chitwood D. Back to basics: the role of health insurance in getting a physical exam. Soc Work Health Care. 2005;42(1): Zlotnick C, Soman L. The impact of insurance lapse among low-income children. J Urban Health. 2004;81(4): Szilagyi P, Dick A, Klein J, Shone L, Zwanziger J, McInerny T. Improved access and quality of care after enrollment in the New York State Children s Health Insurance Program (SCHIP). Pediatrics. 2004;113:e395 e Anderson G, Brook R, Williams A. A comparison of costsharing versus free care in children: effects on the demand for office-based medical care. Med Care. 1991;29(9): Starfield B, Cassady C, Nanda J, Forrest C, Berk R. Consumer experiences and provider perceptions of the quality of primary care: implications for managed care. J Fam Pract. 1998;46(3): US Department of Health and Human Services. Healthy People Washington, DC: US Government Printing Office; Shi L, Stevens G. Vulnerability and unmet health care needs. The influence of multiple risk factors. J Gen Intern Med. 2005;20(2): Lurie N, Zhan C, Sangl J, Bierman A, Sekscenski E. Variation in racial and ethnic differences in consumer assessments of health care. Am J Manag Care. 2003;9: Williams D. Race, socioeconomic status, and health: the added effects of racism and discrimination. Ann N Y Acad Sci. 1999;896: van Ryn M, Burke J. The effect of patient race and socioeconomic status on physicians perceptions of patients. Soc Sci Med. 2000;50: LaVeist T, Nickerson K, Bowie J. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000;57(suppl 1): Weathers A, Minkovitz C, O Campo P, Diener-West M. Access to care for children of migratory agricultural workers: factors associated with unmet need for medical care. Pediatrics. 2004;113:e276 e National Research Council and Institute of Medicine, ed. Children s Health, the Nation s Wealth: Assessing and Improving Child Health. Washington, DC: National Academies Press; Stevens G. Gradients in the health status and developmental risks of young children: the combined influences of multiple social risk factors. Matern Child Health J. 2006;10(2):

Leiyu Shi, DrPH, MBA, MPA; Jenna Tsai, EdD; Patricia Collins Higgins, PhD, MPH; Lydie A. Lebrun, MPH

Leiyu Shi, DrPH, MBA, MPA; Jenna Tsai, EdD; Patricia Collins Higgins, PhD, MPH; Lydie A. Lebrun, MPH J Ambulatory Care Manage Vol. 32,. 4, pp. 342 350 Copyright c 2009 Wolters Kluwer Health Lippincott Williams & Wilkins Racial/Ethnic and Socioeconomic Disparities in Access to Care and Quality of Care

More information

HEALTH, BEHAVIOR, AND HEALTH CARE DISPARITIES: DISENTANGLING THE EFFECTS OF INCOME AND RACE IN THE UNITED STATES

HEALTH, BEHAVIOR, AND HEALTH CARE DISPARITIES: DISENTANGLING THE EFFECTS OF INCOME AND RACE IN THE UNITED STATES Inequalities in Health in the U.S. HEALTH, BEHAVIOR, AND HEALTH CARE DISPARITIES: DISENTANGLING THE EFFECTS OF INCOME AND RACE IN THE UNITED STATES Lisa C. Dubay and Lydie A. Lebrun The literature on health

More information

Racial Variation In Quality Of Care Among Medicare+Choice Enrollees

Racial Variation In Quality Of Care Among Medicare+Choice Enrollees Racial Variation In Quality Of Care Among Medicare+Choice Enrollees Black/white patterns of racial disparities in health care do not necessarily apply to Asians, Hispanics, and Native Americans. by Beth

More information

Health Disparities Research. Kyu Rhee, MD, MPP, FAAP, FACP Chief Public Health Officer Health Resources and Services Administration

Health Disparities Research. Kyu Rhee, MD, MPP, FAAP, FACP Chief Public Health Officer Health Resources and Services Administration Health Disparities Research Kyu Rhee, MD, MPP, FAAP, FACP Chief Public Health Officer Health Resources and Services Administration Outline on Health Disparities Research What is a health disparity? (DETECT)

More information

HEALTH DISPARITIES AMONG ADULTS IN OHIO

HEALTH DISPARITIES AMONG ADULTS IN OHIO OHIO MEDICAID ASSESSMENT SURVEY 2012 Taking the pulse of health in Ohio HEALTH DISPARITIES AMONG ADULTS IN OHIO Amy K. Ferketich, PhD 1 Ling Wang, MPH 1 Timothy R. Sahr, MPH, MA 2 1The Ohio State University

More information

Health Disparities Research

Health Disparities Research Health Disparities Research Kyu Rhee, MD, MPP, FAAP, FACP Chief Public Health Officer Health Resources and Services Administration Outline on Health Disparities Research What is a health disparity? (DETECT)

More information

PRINCIPLES FOR ELIMINATING DISPARITIES THROUGH HEALTH CARE REFORM. John Z. Ayanian, MD, MPP

PRINCIPLES FOR ELIMINATING DISPARITIES THROUGH HEALTH CARE REFORM. John Z. Ayanian, MD, MPP PRINCIPLES FOR ELIMINATING DISPARITIES THROUGH HEALTH CARE REFORM John Z. Ayanian, MD, MPP Harvard Medical School Brigham and Women s Hospital Harvard School of Public Health 8 th Annual National Summit

More information

Impact of insurance coverage on dental care utilization of Iowa children

Impact of insurance coverage on dental care utilization of Iowa children University of Iowa Iowa Research Online Theses and Dissertations Spring 2015 Impact of insurance coverage on dental care utilization of Iowa children Simi Mani University of Iowa Copyright 2015 Simi Mani

More information

Oral Health in Children in Iowa

Oral Health in Children in Iowa December 2012 Oral Health in Children in Iowa An Overview From the 2010 Iowa Child and Family Household Health Survey Peter C. Damiano Director Jean C. Willard Senior Research Assistant Ki H. Park Graduate

More information

Unequal Treatment: Disparities in Access, Quality, and Care

Unequal Treatment: Disparities in Access, Quality, and Care Unequal Treatment: Disparities in Access, Quality, and Care Brian D. Smedley, Ph.D. National Collaborative for Health Equity www.nationalcollaborative.org Healthcare Disparities: Are We Making Progress?

More information

Will Equity Be Achieved Through Health Care Reform?

Will Equity Be Achieved Through Health Care Reform? Will Equity Be Achieved Through Health Care Reform? John Z. Ayanian, MD, MPP Director & Alice Hamilton Professor of Medicine Mass Medical Society Public Health Leadership Forum April 4, 214 OBJECTIVES

More information

To identify physician practices providing primary care, we. used the 2007 statewide physician directory of the Massachusetts

To identify physician practices providing primary care, we. used the 2007 statewide physician directory of the Massachusetts Technical Appendix Study Data and Methods Primary care practices To identify physician practices providing primary care, we used the 2007 statewide physician directory of the Massachusetts Health Quality

More information

An Update on Assessing Development in the Pediatric Office: Has Anything Changed After Two Policy Statements?

An Update on Assessing Development in the Pediatric Office: Has Anything Changed After Two Policy Statements? An Update on Assessing Development in the Pediatric Office: Has Anything Changed After Two Policy Statements? Alma D. Guerrero, MD, MPH; Nicole Garro, MPH; John T. Chang, MD, PhD, MPH; Alice A. Kuo, MD,

More information

Impact of Poor Healthcare Services

Impact of Poor Healthcare Services Competency 3 Impact of Poor Healthcare Services Updated June 2014 Presented by: Lewis Foxhall, MD VP for Health Policy Professor, Clinical Cancer Prevention UT MD Anderson Cancer Center Competency 3 Objectives

More information

Racial disparities in health outcomes and factors that affect health: Findings from the 2011 County Health Rankings

Racial disparities in health outcomes and factors that affect health: Findings from the 2011 County Health Rankings Racial disparities in health outcomes and factors that affect health: Findings from the 2011 County Health Rankings Author: Nathan R. Jones, PhD University of Wisconsin Carbone Cancer Center Introduction

More information

Access Provided by Johns Hopkins University at 10/20/11 7:09PM GMT

Access Provided by Johns Hopkins University at 10/20/11 7:09PM GMT Access Provided by Johns Hopkins University at 10/20/11 7:09PM GMT part 2: Original Paper Cancer Screening among Racial/Ethnic and Insurance Groups in the United States: A Comparison of Disparities in

More information

Changing Patient Base. A Knowledge to Practice Program

Changing Patient Base. A Knowledge to Practice Program Changing Patient Base A Knowledge to Practice Program Learning Objectives By the end of this tutorial, you will: Understand how demographics are changing among patient populations Be aware of the resulting

More information

Role of Insurance Coverage on Diabetes Preventive Care

Role of Insurance Coverage on Diabetes Preventive Care European Journal of Environment and Public Health, 2017, 1(1), 02 ISSN: 2468-1997 Role of Insurance Coverage on Diabetes Preventive Care Alicestine Ashford 1, Ji Lynda Walls 1, C. Perry Brown 1, Rima Tawk

More information

Oral Health in Children in Iowa: An Overview From the 2010 Iowa Child and Family Household Health Survey

Oral Health in Children in Iowa: An Overview From the 2010 Iowa Child and Family Household Health Survey Health Policy 12-1-2012 Oral Health in Children in Iowa: An Overview From the 2010 Iowa Child and Family Household Health Survey Peter C. Damiano University of Iowa Jean C. Willard University of Iowa Ki

More information

Conceptual framework! Definitions of race and ethnicity Census Questions, Genetics! Social Class, migration, language proficiency!

Conceptual framework! Definitions of race and ethnicity Census Questions, Genetics! Social Class, migration, language proficiency! Conceptual framework! Definitions of race and ethnicity Census Questions, Genetics! Social Class, migration, language proficiency! Patient-physician communication! Clinical Research Examples! Options for

More information

Dental Care Remains the No. 1 Unmet Health Care Need for Children and Low-Income Adults

Dental Care Remains the No. 1 Unmet Health Care Need for Children and Low-Income Adults Oral Health and Access to Dental Care for Ohioans, 2007 Dental Care Remains the No. 1 Unmet Health Care Need for Children and Low-Income Adults Oral Health and Access to Dental Care for Ohioans, 2007

More information

Health Disparities and Community Colleges:

Health Disparities and Community Colleges: Health Disparities and Community Colleges: Being Part of the Solution Elmer R. Freeman, MSW Annual Convention of the American Association of Community Colleges Monday, April 11, 2005 Mission The mission

More information

Less than 40 percent of Medicaid-enrolled children in the study States received dental care during the study period.

Less than 40 percent of Medicaid-enrolled children in the study States received dental care during the study period. Children s Dental Care Access in Medicaid: The Role of Medical Care Use and Dentist Participation Tooth decay is one of the most preventable childhood diseases, yet dental care remains the most prevalent

More information

A PHILANTHROPIC PARTNERSHIP FOR BLACK COMMUNITIES. Health and Wellness BLACK FACTS

A PHILANTHROPIC PARTNERSHIP FOR BLACK COMMUNITIES. Health and Wellness BLACK FACTS A PHILANTHROPIC PARTNERSHIP FOR BLACK COMMUNITIES Health and Wellness BLACK FACTS THE COST OF MAINTAINING A HEALTHY DIET FOR A FAMILY IS OUT OF REACH FOR MANY AFRICAN AMERICAN FAMILIES. 2 A Philanthropic

More information

RACE-ETHNICITY DIFFERENCES IN ADOLESCENT SUICIDE IN THE 2009 DANE COUNTY YOUTH ASSESSMENT

RACE-ETHNICITY DIFFERENCES IN ADOLESCENT SUICIDE IN THE 2009 DANE COUNTY YOUTH ASSESSMENT 1 P age RACE-ETHNICITY DIFFERENCES IN ADOLESCENT SUICIDE IN THE 2009 DANE COUNTY YOUTH ASSESSMENT Andrew J. Supple, PhD Associate Professor Human Development & Family Studies The University of North Carolina

More information

Measuring Equitable Care to Support Quality Improvement

Measuring Equitable Care to Support Quality Improvement Measuring Equitable Care to Support Quality Improvement Berny Gould RN, MNA Sr. Director, Quality, Hospital Oversight, and Equitable Care Prepared by: Sharon Takeda Platt, PhD Center for Healthcare Analytics

More information

In the 2001 Surgeon General s report, Measuring Trends in Mental Health Care Disparities,

In the 2001 Surgeon General s report, Measuring Trends in Mental Health Care Disparities, Measuring Trends in Mental Health Care Disparities, 2000 2004 Benjamin L. Cook, Ph.D., M.P.H. Thomas McGuire, Ph.D. Jeanne Miranda, Ph.D. Objective: This study measured trends in disparities in mental

More information

Community Engagement to Address Health Disparities

Community Engagement to Address Health Disparities Community Engagement to Address Health Disparities Health Disparities Service-Learning Collaborative Meeting April 11, 2007, Toronto, ON Canada Elmer R. Freeman, Executive Director Center for Community

More information

Disparities in Access to Primary Care and Emergency Department Utilization in a Large Medicaid Program

Disparities in Access to Primary Care and Emergency Department Utilization in a Large Medicaid Program 1 Disparities in Access to Primary Care and Emergency Department Utilization in a Large Medicaid Journal of Health Disparities Research and Practice Volume 11, Issue 4, Winter 2018, pp. 1-13 2011 Center

More information

Pre-Conception & Pregnancy in Ohio

Pre-Conception & Pregnancy in Ohio Pre-Conception & Pregnancy in Ohio Elizabeth Conrey, PhD 1 January 217 1 State Maternal and Child Health Epidemiologist, Ohio Department of Health EXECUTIVE SUMMARY The primary objective of the analyses

More information

Rural residents lag in preventive services use; Lag increases with service complexity. Carolina. South. Rural Health Research Center

Rural residents lag in preventive services use; Lag increases with service complexity. Carolina. South. Rural Health Research Center Rural residents lag in preventive services use; Lag increases with service complexity South Carolina Rural Health Research Center At the Heart of Health Policy 2 Stoneridge Dr., Ste 4 Columbia, SC 292

More information

Appendix D: Statistical Modeling

Appendix D: Statistical Modeling Appendix D: Statistical Modeling Cluster analysis Cluster analysis is a method of grouping people based on specific sets of characteristics. Often used in marketing and communication, its goal is to identify

More information

Disparities in Vison Loss and Eye Health

Disparities in Vison Loss and Eye Health Disparities in Vison Loss and Eye Health Xinzhi Zhang, MD, PhD, FACE, FRSM National Institute on Minority Health and Health Disparities National Institutes of Health Disclaimer The findings and conclusions

More information

Racial and Socioeconomic Disparities in Appendicitis

Racial and Socioeconomic Disparities in Appendicitis Racial and Socioeconomic Disparities in Appendicitis Steven L. Lee, MD Chief of Pediatric Surgery, Harbor-UCLA Associate Clinical Professor of Surgery and Pediatrics David Geffen School of Medicine at

More information

By understanding and using data and statistics, you will become well informed about the state of health in the county and learn the most recent health information and activities pertinent to your specific

More information

Trends in Seasonal Influenza Vaccination Disparities between US non- Hispanic whites and Hispanics,

Trends in Seasonal Influenza Vaccination Disparities between US non- Hispanic whites and Hispanics, Trends in Seasonal Influenza Vaccination Disparities between US non- Hispanic whites and Hispanics, 2000-2009 Authors by order of contribution: Andrew E. Burger Eric N. Reither Correspondence: Andrew E.

More information

Assessing the Contribution of the Dental Care System to Oral Health Care Disparities

Assessing the Contribution of the Dental Care System to Oral Health Care Disparities UCLA CENTER FOR HEALTH POLICY RESEARCH Assessing the Contribution of the Dental Care System to Oral Health Care Disparities Final Report to The National Institute for Dental and Craniofacial Research Project

More information

California 2,287, % Greater Bay Area 393, % Greater Bay Area adults 18 years and older, 2007

California 2,287, % Greater Bay Area 393, % Greater Bay Area adults 18 years and older, 2007 Mental Health Whites were more likely to report taking prescription medicines for emotional/mental health issues than the county as a whole. There are many possible indicators for mental health and mental

More information

The Relationship Between Living Arrangement and Preventive Care Use Among Community-Dwelling Elderly Persons

The Relationship Between Living Arrangement and Preventive Care Use Among Community-Dwelling Elderly Persons The Relationship Between Living Arrangement and Preventive Care Use Among Community-Dwelling Elderly Persons Denys T. Lau, PhD, and James B. Kirby, PhD Ensuring the timely use of preventive care services

More information

Health Disparities Matter!

Health Disparities Matter! /KirwanInstitute www.kirwaninstitute.osu.edu Health Disparities Matter! Kierra Barnett, Research Assistant Alex Mainor, Research Assistant Jason Reece, Director of Research Health disparities are defined

More information

Diabetes Disparities in the African- American Community

Diabetes Disparities in the African- American Community Diabetes Disparities in the African- American Community Sherita Hill Golden, MD, MHS Hugh P. McCormick Family Professor of Endocrinology and Metabolism Executive Vice-Chair, Department of Medicine Division

More information

Children s Oral Health and Access to Dental Care in the United States

Children s Oral Health and Access to Dental Care in the United States Children s Oral Health and Access to Dental Care in the United States Bruce Dye, DDS, MPH Institute of Medicine Oral Health Access to Services Meeting: 4 March 2010 U.S. DEPARTMENT OF HEALTH AND HUMAN

More information

Identifying Geographic & Socioeconomic Disparities in Access to Care for Pediatric Cancer Patients in Texas

Identifying Geographic & Socioeconomic Disparities in Access to Care for Pediatric Cancer Patients in Texas Identifying Geographic & Socioeconomic Disparities in Access to Care for Pediatric Cancer Patients in Texas Mary T. Austin, MD, MPH Assistant Professor, Pediatric Surgery University of Texas Health Science

More information

The elimination of disparities in health and health care is a central. Do HMOs Affect Educational Disparities In Health Care?

The elimination of disparities in health and health care is a central. Do HMOs Affect Educational Disparities In Health Care? Do HMOs Affect Educational Disparities In Health Care? Kevin Fiscella, MD, MPH 1 Peter Franks, MD 2 Mark P. Doescher, MD, MSPH 3 Barry G. Saver, MD, MPH 3 1 Departments of Family Medicine, and Community

More information

Self Perceived Oral Health Status, Untreated Decay, and Utilization of Dental Services Among Dentate Adults in the United States: NHANES

Self Perceived Oral Health Status, Untreated Decay, and Utilization of Dental Services Among Dentate Adults in the United States: NHANES Self Perceived Oral Health Status, Untreated Decay, and Utilization of Dental Services Among Dentate Adults in the United States: NHANES 2011 2012 Sayo Adunola, D.D.S., M.P.H. Dental Public Health Resident

More information

Health Reform: An Opportunity to Address Health Disparities among Women

Health Reform: An Opportunity to Address Health Disparities among Women Health Reform: An Opportunity to Address Health Disparities among Women A woman s access to quality health care in the U.S. is a function of where she lives, her race and ethnicity, her family income,

More information

Alameda County Public Health Department. Adult Preventable Hospitalizations: Examining Impacts, Trends, and Disparities by Group

Alameda County Public Health Department. Adult Preventable Hospitalizations: Examining Impacts, Trends, and Disparities by Group Adult Preventable Hospitalizations: Examining Impacts, Trends, and Disparities by Group Abstract Preventable hospitalizations occur when persons are hospitalized for a medical condition that could have

More information

Access to Mental Health Treatment by English Language Proficiency and Race/Ethnicity

Access to Mental Health Treatment by English Language Proficiency and Race/Ethnicity Access to Mental Health Treatment by English Language Proficiency and Race/Ethnicity Tetine Sentell, PhD 1, Martha Shumway, PhD 1, and Lonnie Snowden, PhD 2 1 Department of Psychiatry, University of California,

More information

NIH Public Access Author Manuscript Med Care Res Rev. Author manuscript; available in PMC 2011 May 23.

NIH Public Access Author Manuscript Med Care Res Rev. Author manuscript; available in PMC 2011 May 23. NIH Public Access Author Manuscript Published in final edited form as: Med Care Res Rev. 2009 October ; 66(5): 578 589. doi:10.1177/1077558709336445. Segregation and Disparities in Health Services Use

More information

Racial and Ethnic Disparities in Health and Health Care: The Impact on Women s Health

Racial and Ethnic Disparities in Health and Health Care: The Impact on Women s Health Racial and Ethnic Disparities in Health and Health Care: The Impact on Women s Health Joseph R. Betancourt, M.D., M.P.H. Director, The Disparities Solutions Center Senior Scientist, Mongan Institute for

More information

Recognizing Racial Ethnic Disparities in Maternity Care

Recognizing Racial Ethnic Disparities in Maternity Care Recognizing Racial Ethnic Disparities in Maternity Care Louise Marie Roth, PhD Associate Professor of Sociology, University of Arizona Racial-Ethnic Disparities in Health Outcomes Black Americans suffer

More information

medicaid and the The Role of Medicaid for People with Diabetes

medicaid and the The Role of Medicaid for People with Diabetes on medicaid and the uninsured The Role of for People with Diabetes November 2012 Introduction Diabetes is one of the most prevalent chronic conditions and a leading cause of death in the United States.

More information

ELIMINATING HEALTH DISPARITIES IN AN URBAN AREA. VIRGINIA A. CAINE, M.D., DIRECTOR MARION COUNTY HEALTH DEPARTMENT INDIANAPOLIS, INDIANA May 1, 2002

ELIMINATING HEALTH DISPARITIES IN AN URBAN AREA. VIRGINIA A. CAINE, M.D., DIRECTOR MARION COUNTY HEALTH DEPARTMENT INDIANAPOLIS, INDIANA May 1, 2002 ELIMINATING HEALTH DISPARITIES IN AN URBAN AREA VIRGINIA A. CAINE, M.D., DIRECTOR MARION COUNTY HEALTH DEPARTMENT INDIANAPOLIS, INDIANA May 1, 2002 Racial and ethnic disparities in health care are unacceptable

More information

Status of Vietnamese Health

Status of Vietnamese Health Status of Vietnamese Health Santa Clara County, CALIFORNIA 2011 December 12, 2011 December 12, 2011 To Whom It May Concern: To the Residents of Santa Clara County: As part of my State of the County Address

More information

Translating Health Services Research in Sickle Cell Disease to Policy

Translating Health Services Research in Sickle Cell Disease to Policy Translating Health Services Research in Sickle Cell Disease to Policy Jean L. Raphael, MD, MPH Associate Professor of Pediatrics Baylor College of Medicine Director, Center for Child Health Policy and

More information

The Social Determinants of Drug Abuse

The Social Determinants of Drug Abuse The Social Determinants of Drug Abuse Investigation into the Etiology of the Opioid Epidemic Bioethics Symposium South Carolina Medical Association April 28, 2018 Ponder these images Objectives Briefly

More information

Americans for Nonsmokers Rights

Americans for Nonsmokers Rights Americans for Nonsmokers Rights Helping you breathe a little easier Engaging the Latino/Hispanic Community in Clean Indoor Air Campaigns June 3 Secondhand smoke in the workplace is a health justice issue;

More information

Disparity Data Fact Sheet General Information

Disparity Data Fact Sheet General Information Disparity Data Fact Sheet General Information Tobacco use is a well-recognized risk factor for many cancers, respiratory illnesses and cardiovascular diseases within Michigan. rates have continued to decline

More information

Health Disparities, Social Determinants of Health, and Health Equity

Health Disparities, Social Determinants of Health, and Health Equity Centers for Disease Control and Prevention Health Disparities, Social Determinants of Health, and Health Equity Leandris Liburd, PhD, MPH Associate Director for Minority Health and Health Equity SOPHE

More information

INSECURITY. Food. Though analyses at the regional and national levels

INSECURITY. Food. Though analyses at the regional and national levels Food INSECURITY The Southern Rural Development Center addresses... Report from RIDGE-funded research in the Southern Region Food insecurity and emotional well-being among single mothers in the rural South

More information

Working Towards Addressing Women s Health Disparities in Arizona

Working Towards Addressing Women s Health Disparities in Arizona Working Towards Addressing Women s Health Disparities in Arizona Suncerria Tillis, MBA Arizona Health Disparities Center December 6, 2006 National Conference of State Legislatures Women s Health Pre-Conference

More information

Behavioral Health Disparities in Indiana

Behavioral Health Disparities in Indiana February 2016 Improving Community Health Through Policy Research 16-H72 Behavioral Health Disparities in Indiana INTRODUCTION The burden of illness, premature death, and disability is distributed unequally

More information

Exploring the Association Between Caregivers Oral Health Literacy & Children s Caries Status

Exploring the Association Between Caregivers Oral Health Literacy & Children s Caries Status Exploring the Association Between Caregivers Oral Health Literacy & Children s Caries Status David Avenetti, DDS Pediatric Dental Resident MSD and MPH Candidate Penelope Leggott, BDS, MS, Committee Chair

More information

Diversity and Dementia

Diversity and Dementia Diversity and Dementia Kala M. Mehta, DSc, MPH January 17, 2012 Overview Background Incidence and Prevalence of Dementia Why are these differences found? What s important for diverse dementia patients

More information

HD RP. Examination of Racial Disparities in Childhood Asthma Management Practices. Abstract. Introduction

HD RP. Examination of Racial Disparities in Childhood Asthma Management Practices. Abstract. Introduction JOURNAL OF HD RP Journal of Health Disparities Research and Practice Volume 2, Number 3, Fall 2008, pp. 1 15 2008 Center for Health Disparities Research School of Public Health University of Nevada, Las

More information

CHRONIC DISEASE PREVALENCE AMONG ADULTS IN OHIO

CHRONIC DISEASE PREVALENCE AMONG ADULTS IN OHIO OHIO MEDICAID ASSESSMENT SURVEY 2012 Taking the pulse of health in Ohio CHRONIC DISEASE PREVALENCE AMONG ADULTS IN OHIO Amy Ferketich, PhD Ling Wang, MPH The Ohio State University College of Public Health

More information

Oral Health of New Brunswick s Children

Oral Health of New Brunswick s Children Oral Health of New Brunswick s Children Data from the Healthier New Brunswick Community Survey The New Brunswick Health Task Force & Community Health Advisory Group Meeting Thursday September 14, 2006

More information

Oral Health Care in California: State of the State. Dissemination Workshop August 4,2011

Oral Health Care in California: State of the State. Dissemination Workshop August 4,2011 Oral Health Care in California: State of the State Dissemination Workshop August 4,2011 Introduction 2011 IOM Reports on Oral Health Advancing Oral Health in America Improving Access to Oral Health Care

More information

LATINO OLDER ADULTS AND ALCOHOL USE: A DESCRIPTIVE ANALYSIS. Andrea Soria California State University, Long Beach May 2015

LATINO OLDER ADULTS AND ALCOHOL USE: A DESCRIPTIVE ANALYSIS. Andrea Soria California State University, Long Beach May 2015 LATINO OLDER ADULTS AND ALCOHOL USE: A DESCRIPTIVE ANALYSIS Andrea Soria California State University, Long Beach May 2015 INTRODUCTION The purpose of this cross-sectional study was to gain a better understanding

More information

UNDERSTANDING RACIAL AND ETHNIC DISPARITIES IN COLORECTAL CANCER SCREENING: BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, 2002 AND 2004

UNDERSTANDING RACIAL AND ETHNIC DISPARITIES IN COLORECTAL CANCER SCREENING: BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, 2002 AND 2004 UNDERSTANDING RACIAL AND ETHNIC DISPARITIES IN COLORECTAL CANCER SCREENING: BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, 2002 AND 2004 Introduction: Racial/ethnic disparities in colorectal cancer (CRC)

More information

2011 Survey of Dental Care Affordability and Accessibility: Highlights from the Nationally Representative Survey

2011 Survey of Dental Care Affordability and Accessibility: Highlights from the Nationally Representative Survey 2011 Survey of Dental Care Affordability and Accessibility: Highlights from the Nationally Representative Survey August 2011 Prof. David Neal, Ph.D. Empirica Research & The University of Southern California

More information

What Factors are Associated with Where Women Undergo Clinical Breast Examination? Results from the 2005 National Health Interview Survey

What Factors are Associated with Where Women Undergo Clinical Breast Examination? Results from the 2005 National Health Interview Survey 32 The Open Clinical Cancer Journal, 2008, 2, 32-43 Open Access What Factors are Associated with Where Women Undergo Clinical Breast Examination? Results from the 2005 National Health Interview Survey

More information

Association of Body Mass Index and Prescription Drug Use in Children from the Medical Expenditures Panel Survey,

Association of Body Mass Index and Prescription Drug Use in Children from the Medical Expenditures Panel Survey, Association of Body Mass Index and Prescription Drug Use in Children from the Medical Expenditures Panel Survey, 2003-2006 Yvonne Lin MCH Research Festival June 10, 2009 BMI Changes with Age in Children

More information

Christopher Okunseri, BDS, MSc, MLS, DDPHRCSE, FFDRCSI, Elaye Okunseri, MBA, MSHR, Thorpe JM, PhD., Xiang Qun, MS.

Christopher Okunseri, BDS, MSc, MLS, DDPHRCSE, FFDRCSI, Elaye Okunseri, MBA, MSHR, Thorpe JM, PhD., Xiang Qun, MS. Dental Health Services Research Team Christopher Okunseri, BDS, MSc, MLS, DDPHRCSE, FFDRCSI, Elaye Okunseri, MBA, MSHR, Thorpe JM, PhD., Xiang Qun, MS., Aniko Szabo, PhD Research Support: National Institute

More information

Jayson K. Jones, LMSW Women as the Face of Aids Summit 2016

Jayson K. Jones, LMSW Women as the Face of Aids Summit 2016 Jayson K. Jones, LMSW Women as the Face of Aids Summit 2016 People of color are disproportionality impacted by poverty Poverty Rates by Race in 2014 30 25 20 15 10 5 0 Black Latino Asian White (DeNavas-Walt

More information

Neighbourhood deprivation and smoking outcomes in South Africa

Neighbourhood deprivation and smoking outcomes in South Africa Neighbourhood deprivation and smoking outcomes in South Africa Lisa Lau, MPH. Department of Epidemiology, School of Public Health, University of Michigan.! Jamie Tam, MPH. Department of Health Management

More information

Maryland s Health Enterprise Zones Addressing Social Determinants of Health

Maryland s Health Enterprise Zones Addressing Social Determinants of Health Maryland s Health Enterprise Zones Addressing Social Determinants of Health Michelle Spencer, MS Associate Director, Bloomberg American Health Initiative Associate Scientist, Health Policy and Management

More information

State Health System Performance: A Detailed Look at the Lone Star State

State Health System Performance: A Detailed Look at the Lone Star State State Health System Performance: A Detailed Look at the Lone Star State How does Texas fare in the Commonwealth Fund Scorecard on State Health System Performance? A DETAILED LOOK AT THE LONE STAR STATE

More information

Discrimination and the Health of Asian Americans

Discrimination and the Health of Asian Americans Discrimination and the Health of Asian Americans 13 th Annual Summer Public Health Research Videoconference on Minority Health Gilbert C. Gee, Ph.D. University of Michigan Health Behavior & Health Education

More information

Racial and ethnic disparities in access and utilization of dental services among children in Iowa:

Racial and ethnic disparities in access and utilization of dental services among children in Iowa: University of Iowa Iowa Research Online Theses and Dissertations Summer 2010 Racial and ethnic disparities in access and utilization of dental services among children in Iowa: Alejandra Valencia University

More information

Road Map. Requirements for reporting Defining health disparities Resources for data

Road Map. Requirements for reporting Defining health disparities Resources for data Health Disparities Road Map Requirements for reporting Defining health disparities Resources for data Health disparities and substance use Resources for data Challenges Building data sources Environmental

More information

Office of Minority Health. A Call to Action November 17, 2010

Office of Minority Health. A Call to Action November 17, 2010 Office of Minority Health A Call to Action November 17, 2010 Office of Minority Health Mission Improve the health of racial and ethnic minority populations through the development of health policies and

More information

HEALTH DISPARITIES By Hana Koniuta November 19, 2010

HEALTH DISPARITIES By Hana Koniuta November 19, 2010 HEALTH DISPARITIES By Hana Koniuta November 19, 2010 "We need to focus on the uninsured and those who suffer from health care disparities that we so inadequately addressed in the past." Sen. Bill Frist

More information

Social determinants, health and healthcare outcomes 2017 Intermountain Healthcare Annual Research Meeting

Social determinants, health and healthcare outcomes 2017 Intermountain Healthcare Annual Research Meeting Social determinants, health and healthcare outcomes 2017 Intermountain Healthcare Annual Research Meeting Andrew J Knighton PHD CPA Intermountain Institute for Healthcare Delivery Research Adversity is

More information

Financial Hardship in Cancer Survivors

Financial Hardship in Cancer Survivors Financial Hardship in Cancer Survivors Robin Yabroff Robin.yabroff@hhs.gov The views expressed are those of the speaker and do not necessarily represent the official position of Department of Health and

More information

Table of Contents. 2 P age. Susan G. Komen

Table of Contents. 2 P age. Susan G. Komen RHODE ISLAND Table of Contents Table of Contents... 2 Introduction... 3 About... 3 Susan G. Komen Affiliate Network... 3 Purpose of the State Community Profile Report... 4 Quantitative Data: Measuring

More information

ENDING HEALTH DISPARITIES: A Congressional Black Caucus Priority

ENDING HEALTH DISPARITIES: A Congressional Black Caucus Priority ENDING HEALTH DISPARITIES: A Congressional Black Caucus Priority Congresswoman Donna Christensen at the Roundtable on Value and Science-Driven Health Care with the Clinical Effectiveness Research Innovation

More information

WISCONSIN MEDICAL JOURNAL

WISCONSIN MEDICAL JOURNAL Wisconsin Physicians Advising Smokers to Quit: Results from the Current Population Survey, 1998-1999 and Behavioral Risk Factor Surveillance System, 2000 Anne M. Marbella, MS; Amanda Riemer; Patrick Remington,

More information

NIH Public Access Author Manuscript Med Care Res Rev. Author manuscript; available in PMC 2009 October 21.

NIH Public Access Author Manuscript Med Care Res Rev. Author manuscript; available in PMC 2009 October 21. NIH Public Access Author Manuscript Published in final edited form as: Med Care Res Rev. 2009 February ; 66(1): 23 48. doi:10.1177/1077558708323607. Measuring Trends in Racial/Ethnic Health Care Disparities

More information

Inequality in America: The Contribution of Health Centers in Reducing and Eliminating Disparities in Access to Care

Inequality in America: The Contribution of Health Centers in Reducing and Eliminating Disparities in Access to Care MCR&R Politzer et 58:2 al. (June / Inequality 2001) in America Data and Trends Inequality in America: The Contribution of Health Centers in Reducing and Eliminating Disparities in Access to Care Robert

More information

Enrollment under the Medicaid Expansion and Health Insurance Exchanges. A Focus on Those with Behavioral Health Conditions in Michigan

Enrollment under the Medicaid Expansion and Health Insurance Exchanges. A Focus on Those with Behavioral Health Conditions in Michigan Enrollment under the Medicaid Expansion and Health Insurance Exchanges A Focus on Those with Behavioral Health Conditions in Michigan Methods for Estimating Uninsured with M/SU Conditions by FPL From NSDUH,

More information

Community-Based Strategies for Cancer Control

Community-Based Strategies for Cancer Control Community-Based Strategies for Cancer Control Chanita Hughes Halbert, Ph.D. Department of Psychiatry and Behavioral Sciences Hollings Cancer Center Medical University of South Carolina 1900: Ten Leading

More information

2014 Butte County BUTTE COUNTY COMMUNITY HEALTH ASSESSMENT

2014 Butte County BUTTE COUNTY COMMUNITY HEALTH ASSESSMENT 2014 Butte County BUTTE COUNTY COMMUNITY HEALTH ASSESSMENT EXECUTIVE SUMMARY 2015 2017 EXECUTIVE SUMMARY TOGETHER WE CAN! HEALTHY LIVING IN BUTTE COUNTY Hundreds of local agencies and community members

More information

Health Status Disparities in New Mexico Identifying and Prioritizing Disparities

Health Status Disparities in New Mexico Identifying and Prioritizing Disparities Health Status Disparities in New Mexico Identifying and Prioritizing Disparities Public Health Division March 23 Health Status Disparities in New Mexico Identifying and Prioritizing Disparities New Mexico

More information

Health System Members of the Milwaukee Health Care Partnership

Health System Members of the Milwaukee Health Care Partnership Health System Members of the Milwaukee Health Care Partnership Aurora Health Care Children s Hospital of Wisconsin Columbia St. Mary s Health System Froedtert Health Wheaton Franciscan Healthcare In Collaboration

More information

The History and Principles of Patient Navigation. Report to the Nation on Cancer and the Poor

The History and Principles of Patient Navigation. Report to the Nation on Cancer and the Poor The History and Principles of Patient Navigation March 30, 2012 Harold P Freeman, M.D. President & CEO Harold P. Freeman Patient Navigation Institute Report to the Nation on Cancer and the Poor In 1989,

More information

birthplace and length of time in the US:

birthplace and length of time in the US: Cervical cancer screening among foreign-born versus US-born women by birthplace and length of time in the US: 2005-2015 Meheret Endeshaw, MPH CDC/ASPPH Fellow Division Cancer Prevention and Control Office

More information

Preventable Asthma Episodes Among Urban/Rural Children and Adolescents: A Comparative Study

Preventable Asthma Episodes Among Urban/Rural Children and Adolescents: A Comparative Study JOURNAL OF HD RP Journal of Health Disparities Research and Practice Volume 4, Number 2, Fall 2010, pp. 41 49 2010 Center for Health Disparities Research School of Community Health Sciences University

More information

Issues in Women & Minority Health

Issues in Women & Minority Health Issues in Women & Minority Health Dr. Dawn Upchurch Professor Department of Community Health Sciences PH 150 Dr. Upchurch 1 Overview of Session HP 2010 Model: Determinants of Health Review of HP 2010 Goals

More information

Chlamydia trachomatis (CT) infection is the most commonly

Chlamydia trachomatis (CT) infection is the most commonly POLICY Association of Insurance Coverage With Chlamydia Screening Nadereh Pourat, PhD; Guoyu A. Tao, PhD; and Cathleen M. Walsh, DrPh Chlamydia trachomatis (CT) infection is the most commonly reported

More information