Browsing by Subject "Minority groups"
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Item Feasibility Assessment of the ICF Minimal Generic Set as a Disability Screening Tool in Rural Nepal(University of Gondar, 2021) Witte, Paul; Tamang, Suresh; Groves, Christine C.; House, Darlene R.; Khadka, Laxman; Bhotia, Thorang; Hartman, Jeff; Emergency Medicine, School of MedicinePurpose: Nepal’s 2017 Disability Rights law provided a new national definition of disability consistent with the UN Convention on the Rights of Persons with Disabilities (CRPD). Updated measurement methods are now indicated to assess disability, suitable for use in populations where self-report tools may be sub-optimal. This study describes the development and field testing of a screening methodology using a clinical assessment conducted by trained non-professionals to score the ICF Minimal Generic Set (MGS). Method: A prospective, 2-stage assessment of disability was conducted over an eight-month period among a convenience sample of individuals aged ≥ 18, admitted to a rural District Hospital in Northeastern Nepal. After 30 hours of training, non-professional assessors completed Stage 1 screening during hospital admission, with positive screening thresholds set on the basis of MGS scores. A physiotherapist completed Stage 2 assessments in the homes of participants with long-term disability, after their hospital discharge. Results: Data from 161 participants was analysed, with 159 (98.8%) screening positive for either temporary or long-term disability. Stage 1 screening was completed independently by assessors in 8-12 minutes. Of the 35 participants (21.7%) with positive screening for long-term disability, 13 (37.1%) underwent Stage 2 detailed evaluation. Disability was confirmed in all Stage 2 assessments, indicating feasibility of the screening process. Conclusion: Disability screening conducted by trained non-professional assessors using clinical assessment to score the MGS appears to be a promising methodology, and warrants further investigation. If it is found to be valid, it could provide a powerful tool to increase the visibility of disability among some of the most vulnerable populations.Item Health Literacy among Medically Underserved: The Role of Demographic Factors, Social Influence, and Religious Beliefs(Taylor & Francis, 2017-11) Christy, Shannon M.; Gwede, Clement K.; Sutton, Steven K.; Chavarria, Enmanuel; Davis, Stacy N.; Abdulla, Rania; Ravindra, Chitra; Schultz, Ida; Roetzheim, Richard; Meade, Cathy D.; Psychology, School of ScienceThe current study examined the sociodemographic and psychosocial variables that predicted being at risk for low health literacy among a population of racially and ethnically diverse patients accessing primary care services at community-based clinics. Participants (N = 416) were aged 50-75 years, currently not up-to-date with colorectal cancer (CRC) screening, at average CRC risk, and enrolled in a randomized controlled trial (RCT) aimed at promoting CRC screening. Participants completed a baseline interview that assessed health literacy as measured by Rapid Estimate of Adult Literacy in Medicine-Revised, sociodemographic factors, and psychosocial variables (e.g., health beliefs) prior to randomization and receipt of an intervention. Thirty-six percent of the participants were found to be at risk for low health literacy. Sociodemographic and psychosocial variables were assessed as predictors of being at risk for low health literacy using logistic regression. In the final model, predictors were male gender, being from a racial/ethnic minority group, being unable to work, having higher social influence scores, and having higher religious belief scores. These findings suggest several patient characteristics that may be associated with low health literacy, and highlight the importance of supporting all patients through simplified and clear communications and information to improve understanding of CRC screening information.Item Incorporating Health Equity Into COVID-19 Reopening Plans: Policy Experimentation in California(American Public Health Association, 2021-08) Largent, Emily A.; Persad, Govind; Mello, Michelle M.; Wenner, Danielle M.; Kramer, Daniel B.; Tucker Edmonds, Brownsyne; Peek, Monica; Obstetrics and Gynecology, School of MedicineCalifornia has focused on health equity in the state's COVID-19 reopening plan. The Blueprint for a Safer Economy assigns each of California's 58 counties into 1 of 4 tiers based on 2 metrics: test positivity rate and adjusted case rate. To advance to the next less-restrictive tier, counties must meet that tier's test positivity and adjusted case rate thresholds. In addition, counties must have a plan for targeted investments within disadvantaged communities, and counties with more than 106 000 residents must meet an equity metric. California's explicit incorporation of health equity into its reopening plan underscores the interrelated fate of its residents during the COVID-19 pandemic and creates incentives for action. This article evaluates the benefits and challenges of this novel health equity focus, and outlines recommendations for other US states to address disparities in their reopening plans.Item Racial and Ethnic Disparities in Buprenorphine and Extended-Release Naltrexone Filled Prescriptions During the COVID-19 Pandemic(American Medical Association, 2022) Nguyen, Thuy; Ziedan, Engy; Simon, Kosali; Miles, Jennifer; Crystal, Stephen; Samples, Hillary; Gupta, Sumedha; Economics, School of Liberal ArtsImportance: COVID-19 disrupted delivery of buprenorphine and naltrexone treatment for opioid use disorder (OUD), and during the pandemic, members of racial and ethnic minority groups experienced increased COVID-19 and opioid overdose risks compared with White individuals. However, whether filled buprenorphine and naltrexone prescriptions varied across racial and ethnic groups during the COVID-19 pandemic remains unknown. Objective: To investigate whether disruptions in filled buprenorphine and naltrexone prescriptions differed by race and ethnicity and insurance status or payer type. Design, setting, and participants: This cross-sectional study used retail pharmacy claims from May 2019 to June 2021 from the Symphony Health database, which includes 92% of US retail pharmacy claims, with race and ethnicity data spanning all insurance status and payer categories. Interrupted time series were used to estimate levels and trends of dispensed buprenorphine and naltrexone prescriptions before and after pandemic onset. Included individuals were those who filled buprenorphine and extended-release naltrexone prescriptions. Data were analyzed from July 2021 through March 2022. Main outcomes and measures: Weekly rates of dispensed buprenorphine and extended-release naltrexone prescription fills per 1000 patients and proportion of longer (ie, ≥14 days' supply) buprenorphine prescription fills were calculated. Analyses were stratified by patient race and ethnicity and further by insurance status and payer type for White and Black patients. Results: A total of 1 556 860 individuals who filled buprenorphine prescriptions (4359 Asian [0.3%], 94 657 Black [6.1%], 55 369 Hispanic [3.6%], and 664 779 White [42.7%]) and 127 506 individuals who filled extended-release naltrexone prescriptions (344 Asian [0.3%], 8186 Black [6.4%], 5343 Hispanic [4.2%], and 53 068 White [41.6%]) from May 6, 2019, to June 5, 2021, were analyzed. Prepandemic increases in buprenorphine fill rate flattened for all groups after COVID-19 onset (30.5 percentage point difference in trend; P < .001) compared with prepandemic trends. Significant level decreases in buprenorphine fills (ranging from 2.5% for Black patients; P = .009 to 4.0% for Hispanic patients; P = .009) at pandemic onset were observed for members of racial and ethnic minority groups but not White patients. At pandemic onset, rate of buprenorphine fills decreased in level for Medicare and cash-paying patients but with greater decreases for Black patients (Medicare: 10.0%; P < .001; cash: 20.0%; P < .001) than White patients (Medicare: 3.5%; P = .004; cash: 15.0%; P < .001). No decreases were found among Medicaid patients. Unlike buprenorphine, extended-release naltrexone had uniform level (from 10.0% for White patients with private insurance; P < .001 to 23.3% for Black patients with Medicare; P < .001) and trend (from 15.5 percentage points for White patients with Medicaid; P = .001 to 52.0 percentage points for Black patients with private insurance; P < .001) decreases across groups. Conclusions and relevance: This study found that the COVID-19 pandemic was associated with immediate decreases in filled buprenorphine prescriptions by members of racial and ethnic minority groups but not White individuals. These findings suggest that members of racial and ethnic minority groups had larger losses in buprenorphine access during the pandemic across payer types.Item Underrepresented racial minorities in biomedical informatics doctoral programs: graduation trends and academic placement (2002–2017)(Oxford University Press, 2020-11-01) Wiley, Kevin; Dixon, Brian E.; Grannis, Shaun J.; Menachemi, Nir; Health Policy and Management, School of Public HealthObjective: Biomedical informatics attracts few underrepresented racial minorities (URMs) into PhD programs. We examine graduation trends from 2002 to 2017 to determine how URM representation has changed over time. We also examine academic job placements by race and identify individual and institutional characteristics associated with URM graduates being successfully placed in academic jobs. Materials and methods: We analyze a near census of all research doctoral graduates from US-accredited institutions, surveyed at graduation by the National Science Foundation Survey of Earned Doctorates. Graduates of biomedical informatics-related programs were identified using self-reported primary and secondary disciplines. Data are analyzed using bivariate and multivariable logistic regressions. Results: During the study period, 2426 individuals earned doctoral degrees in biomedical informatics-related disciplines. URM students comprised nearly 12% of graduates, and this proportion did not change over time (2002-2017). URMs included Hispanic (5.7%), Black (3.2%), and others, including multi-racial and indigenous American populations (2.8%). Overall, 82.3% of all graduates accepted academic positions at the time of graduation with significantly more Hispanic graduates electing to go into academia (89.2%; P < .001). URM graduates were more likely to be single (OR = 1.38; P < .05), have a dependent (1.95; P < .01), and not receive full tuition remission (OR = 1.37; P = .05) as a student. URM graduates accepting an academic position were less likely to be a graduate of a private institution (OR = 0.70; P < .05). Discussion and conclusion: The proportion of URM candidates among biomedical informatics doctoral graduates has not increased over time and remains low. In order to improve URM recruitment and retention within academia, leaders in biomedical informatics should replicate strategies used to improve URM graduation rates in other fields.Item Use of the “Future Life Map” exercise to improve awareness of career options and opportunities in underrepresented minority undergraduate students pursuing STEM careers(PLOS, 2022-02-10) Whitehead, Anne; Alves, Nathan J.; Emergency Medicine, School of MedicineObjectives: There has long existed significant underrepresentation of minority students in STEM training and careers. Ongoing efforts to improve opportunities and participation for underrepresented minority students have focused on multiple areas, from increased funding to early exposure to research in STEM. We developed the novel Future Life Map career planning exercise with the goal of contributing to this multi-faceted approach. The exercise emphasizes on the consideration of multiple potential career destinations and routes to those destination. The exercise was designed with the goal of improving participant awareness of options and career planning self-efficacy to improve success and retention of underrepresented minority student participation and retention in STEM. Methods: We implemented the Future Life Map exercise with 2 separate groups of under-represented minority undergraduate students pursuing careers in STEM. Participants then completed an anonymous survey to evaluate the exercise and describe the value they derived from completing the Future Life Map. Results: The exercise presentation and its supporting documents were highly rated by participants with >81% of respondents rating it as "very informative" (4 or 5 on a 5-point Likert Scale). Participants reported that they were very likely to recommend the exercise to others (25 of 27 participants) and were likely to repeat the activity for their own future decision making (22 participants). Themes that emerged from participant reporting of the value of the exercise were: increased awareness of career and training options, improved understanding of the research required to make informed career/life decisions, and new awareness of specific information about career options under consideration. Conclusion: The Future Life Map exercise was successful in improving participant awareness of career options, career planning ability, and helped participants to feel more empowered. This is likely of particular benefit for improving participation and retention of under-represented minority students pursuing careers in STEM.