Browsing by Subject "disparities"
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Item 80. Disparities in Perceived Vulnerability to COVID-19 Consequences Among U.S. Adolescents and Young Adults: Findings from a Nationally Representative Survey(Elsevier, 2021-02) Hensel, Devon J.; Rosenberg, Molly; Luetke, Maya; Herbenick, Debby; Pediatrics, School of MedicineGlobal research has documented the adverse impact of COVID-19 on the health and well-being of adolescents and young adults (AYA). Pandemic conditions can increase AYA vulnerability to COVID-19-related health (e.g. getting sick or missing medical appointments), social (e.g. not having enough to eat) and economic (e.g. job loss) consequences. Structural inequalities may further exacerbate exposure to these outcomes. We used nationally representative data to examine AYA perceived vulnerability to health/social outcomes early in the COVID-19 pandemic.Item Assessment and Treatment Recommendations for Pediatric Pain: The Influence of Patient Race, Patient Gender, and Provider Pain-Related Attitudes(Elsevier, 2019) Miller, Megan M.; Williams, Amy E.; Zapolski, Tamika C. B.; Rand, Kevin L.; Hirsh, Adam T.; Psychology, School of SciencePrevious studies have documented that racial minorities and women receive poorer pain care than their demographic counterparts. Providers contribute to these disparities when their pain-related decision-making systematically varies across patient groups. Less is known about racial and gender disparities in children with pain or the extent to which providers contribute to these disparities. In a sample of 129 medical students (henceforth referred to as "providers"), Virtual Human methodology and a pain-related version of the Implicit Association Test (IAT) were used to examine the effects of patient race/gender on providers’ pain assessment/treatment decisions for pediatric chronic abdominal pain, as well as the moderating role of provider implicit pain-related race/gender attitudes. Findings indicated that providers rated Black patients as more distressed (mean difference [MD] = 2.33, P < .01, standard error [SE] = .71, 95% confidence interval [CI] = .92, 3.73) and as experiencing more pain-related interference (MD = 3.14, P < .01, SE = .76, 95% CI = 1.63, 4.64) compared to White patients. Providers were more likely to recommend opioids for Black patients than White patients (MD = 2.41, P < .01, SE = .58, 95% CI = 1.05, 3.76). Female patients were perceived to be more distressed by their pain (MD = 2.14, P < .01, SE = .79, 95% CI = .58, 3.70) than male patients, however there were no gender differences in treatment recommendations. IAT results indicated that providers held implicit attitudes that Black Americans (M = .19, standard deviation [SD] = .29) and males (M = .38, SD = .29) were more pain-tolerant than their demographic counterparts; however, these implicit attitudes did not significantly moderate their pain assessment/treatment decisions. Future studies are needed to elucidate specific paths through which the pain experience and care of children differ across racial and gender groups.Item Behavioral Health Disparities in Indiana(Richard M. Fairbanks School of Public Health, 2016-02) Tao, Ling; Greene, MarionThe burden of illness, premature death, and disability is distributed unequally throughout the nation, leading to vast differences in health status or outcomes between specific groups. Such health disparities are persistent and occur across a wide range of physical and behavioral conditions.Item Black Adult Patients With Acute Liver Failure Are Sicker and More Likely to Undergo Liver Transplantation Than White Patients(Wiley, 2019) Nephew, Lauren; Zia, Zahra; Ghabril, Marwan; Orman, Eric; Lammert, Craig; Chalasani, Naga; Medicine, School of MedicineRacial and ethnic differences in the presentation and outcomes of patients wait‐listed with acute liver failure (ALF) have not been explored. Adult patients with ALF wait‐listed for liver transplantation (LT) from 2002 to 2016 were investigated using the United Network for Organ Sharing database. Clinical characteristics and causative etiologies were compared between white, black, Hispanic, and Asian patients with ALF who were wait‐listed as status 1. A competing risk analysis was used to explore differences in LT and wait‐list removal rates. Kaplan‐Meier survival curves were used to explore differences in 1‐year posttransplant survival. There were 8208 patients wait‐listed with a primary diagnosis of ALF; 4501 were wait‐listed as status 1 (55.3% of whites, 64.4% of blacks, 51.6% of Hispanics, 40.7% of Asians; P < 0.001). Black patients had higher bilirubin and Model for End‐Stage Liver Disease at wait‐listing than other groups. White patients were the most likely to have acetaminophen toxicity as a causative etiology, whereas black patients were the most likely to have autoimmune liver disease. Black patients were significantly more likely to undergo LT than white patients (hazard ratio, 1.20; 95% confidence interval, 1.08‐1.30). There was no difference in wait‐list removal because of death or clinical deterioration among racial/ethnic groups. The 1‐year posttransplant survival was lowest in black patients (79.6%) versus white (82.8%), Hispanic (83.9%), and Asian (89.3%) patients (P = 0.02). In conclusion, etiologies of ALF vary by race and ethnicity. Black patients with ALF were more likely to be wait‐listed as status 1 and undergo LT than white patients, but they were sicker at presentation. The 1‐year posttransplant survival rate was lowest among black patients.Item Evaluation of Race and Ethnicity Across a Statewide System of Early Autism Evaluation(Elsevier, 2023-03) Martin, Ann Marie; Ciccarelli, Mary R.; Swigonski, Nancy; McNally Keehn, Rebecca; Pediatrics, School of MedicineWe evaluated racial and ethnic disparities across the Early Autism Evaluation Hub system, a statewide network for autism diagnosis. Our findings suggest that this system has the potential to reduce longstanding disparities in autism spectrum disorder diagnosis for children from racial and ethnic minority backgrounds.Item Last Mile: COVID-19, Telehealth, and Broadband Disparities in Rural Indiana(Indiana University School of Social Work, 2021-06) Funk, Kristin; School of Social WorkThis critical review of literature evaluates the impact of COVID-19 on health and mental health care delivery in rural Indiana, specifically the move to increased telehealth services. Telehealth has been a mostly positive experience for patients and providers. However, many Indiana residents are without the option of telehealth due to underdeveloped infrastructure that is necessary to support broadband access. This disparity is evidence of a larger social and health justice issue and illuminates a call to action for social workers on all levels to collaborate with community members, government agencies, and local programs to push the issue towards the public health arena and to promote broadband access as a human right.Item Latin Dance and Working Memory: The Mediating Effects of Physical Activity Among Middle-Aged and Older Latinos(Frontiers, 2022-04-15) Aguiñaga, Susan; Kaushal, Navin; Balbim, Guilherme M.; Wilson, Robert S.; Wilbur, JoEllen E.; Hughes, Susan; Buchner, David M.; Berbaum, Michael; McAuley, Edward; Vásquez, Priscilla M.; Marques, Isabela G.; Wang, Tianxiu; Marquez, David X.; Health Sciences, School of Health and Human SciencesBackground Physical activity (PA) is a promising method to improve cognition among middle-aged and older adults. Latinos are at high risk for cognitive decline and engaging in low levels of PA. Culturally relevant PA interventions for middle-aged and older Latinos are critically needed to reduce risk of cognitive decline. We examined changes in cognitive performance among middle-aged and older Latinos participating in the BAILAMOS™ dance program or a health education group and compared the mediating effects of PA between group assignment and change in cognitive domains. Methods Our 8-month randomized controlled trial tested BAILAMOS™, a 4-month Latin dance program followed by a 4-month maintenance phase. A total of 333 older Latinos aged 55+ were randomized to either BAILAMOS™, or to a health education control group. Neuropsychological tests were administered, scores were converted to z-scores, and specific domains (i.e., executive function, episodic memory, and working memory) were derived. Self-reported PA was assessed, and we reported categories of total PA, total leisure PA, and moderate-to-vigorous PA as minutes/week. A series of ANCOVAs tested changes in cognitive domains at 4 and 8 months. A mediation analysis tested the mediating effects of each PA category between group assignment and a significant change in cognition score. Results The ANCOVAs found significant improvement in working memory scores among participants in the dance group at month 8 [F(1,328) = 5.79, p = 0.017, d = 0.20], but not in executive functioning [F(2,328) = 0.229, p = 0.80, Cohen’s d = 0.07] or episodic memory [F(2,328) = 0.241, p = 0.78, Cohen’s d = 0.05]. Follow-up mediation models found that total PA mediated the relationship between group assignment and working memory, in favor of the dance group (β = 0.027, 95% CI [0.0000, 0.0705]). Similarly, total leisure PA was found to mediate this relationship [β = 0.035, 95% CI (0.0041, 0.0807)]. Conclusion A 4-month Latin dance program followed by a 4-month maintenance phase improved working memory among middle-aged and older Latinos. Improvements in working memory were mediated by participation in leisure PA. Our results support the current literature that leisure time PA influences cognition and highlight the importance of culturally relevant PA modalities for Latinos. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [NCT01988233].Item Racial and Ethnic Disparities in Diabetes Complications in the Northeastern United States: The Role of Socioeconomic Status(2013) Osborn, Chandra Y.; de Groot, Mary; Wagner, Julie A.The role of socioeconomic status (SES) in explaining racial/ethnic disparities in diabetes remains unclear. We investigated disparities in self-reported diabetes complications, and the role of macro (e.g., income, education) and micro (e.g., ‘owning a home’ or ‘having a checking account’) SES indicators in explaining these differences. The sample included individuals with a diagnosis of diabetes (N=795) who were on average 55 years old, and 55.6% non-Hispanic White, 25.0% African American, and 19.4% Hispanic. Approximately 8% reported nephropathy, 35% reported retinopathy, and 16% reported cardiovascular disease. There were significant disparities in the rates of complications among non-Hispanic White, African American and Hispanic participants, with Hispanics having the highest rates of nephropathy, retinopathy, and cardiovascular disease. Macro SES indicators (e.g., income) mediated racial differences (i.e., non-Hispanic Whites vs. African Americans) in self-reported retinopathy, a combination of macro and more micro SES indicators (e.g., education, income, and ‘owning a home’ or ‘having a checking account’) mediated racial/ethnic differences (i.e., non-Hispanic Whites vs. Hispanics) in self-reported cardiovascular disease, and only micro SES indicators (e.g., ‘owning a home’ or ‘having a checking account’) mediated differences between lower income SES racial/ethnic minority groups (i.e., African Americans vs. Hispanics) in self-reported retinopathy and cardiovascular disease. Findings underscore that indicators of SES must be sensitive to the outcome of interest and the racial/ethnic groups being compared.Item Racial and Ethnic Diversity in Grounded Theory Research(Nova Southeastern University, School of Social and Systematic Studies, 2014) Burke Draucker, Claire; Al-Khattab, Halima; Hines, Dana D.; Mazurczyk, Jill; Russell, Anne C.; Stephenson, Pam Shockey; Draucker, ShannonNational initiatives in the United States call for health research that addresses racial/ethnic disparities. Although grounded theory (GT) research has the potential to contribute much to the understanding of the health experiences of people of color, the extent to which it has contributed to health disparities research is unclear. In this article we describe a project in which we reviewed 44 GT studies published in Qualitative Health Research within the last five years. Using a framework proposed by Green, Creswell, Shope, and Clark (2007), we categorized the studies at one of four levels based on the status and significance afforded racial/ethnic diversity. Our results indicate that racial/ethnic diversity played a primary role in five studies, a complementary role in one study, a peripheral role in five studies, and an absent role in 33 studies. We suggest that GT research could contribute more to health disparities research if techniques were developed to better analyze the influence of race/ethnicity on health-related phenomena.Item Racial and Socioeconomic Disparities in Cancer-Related Knowledge, Beliefs, and Behaviors in Indiana(AACR, 2019-03) Rawl, Susan M.; Dickinson, Stephanie; Lee, Joy L.; Roberts, Jamie L.; Teal, Evgenia; Baker, Layla B.; Kianersi, Sina; Haggstrom, David A.; School of NursingBackground: This statewide survey examined differences in cancer-related knowledge, beliefs, and behaviors between racial and socioeconomic groups in select counties in Indiana. Methods: A stratified random sample of 7,979 people aged 18–75 who lived in one of 34 Indiana counties with higher cancer mortality rates than the state average, and were seen at least once in the past year in a statewide health system were mailed surveys. Results: Completed surveys were returned by 970 participants, yielding a 12% response rate. Black respondents were less likely to perceive they were at risk for cancer and less worried about getting cancer. Individuals most likely to perceive that they were unlikely to get cancer were more often black, with low incomes (less than $20,000) or high incomes ($50,000 or more), or less than a high school degree. Black women were greater than six times more likely to be adherent to cervical cancer screening. Higher income was associated with receiving a sigmoidoscopy in the last 5 years and a lung scan in the past year. Those with the highest incomes were more likely to engage in physical activity. Both income and education were inversely related to smoking. Conclusions: Socioeconomic and racial disparities were observed in health behaviors and receipt of cancer screening. Black individuals had less worry about cancer. Impact: Understanding populations for whom cancer disparities exist and geographic areas where the cancer burden is disproportionately high is essential to decision-making about research priorities and the use of public health resources.