A Human Capital Approach to Reduce Health Disparities

Objective: To introduce a human capital approach to reduce health disparities in South Carolina by increasing the number and quality of trained minority professionals in public health practice and research. Methods: The conceptual basis and elements of Project EXPORT in South Carolina are described. Project EXPORT is a community based participatory research (CBPR) translational project designed to build human capital in public health practice and research. This project involves Claflin University (CU), a Historically Black College University (HBCU) and the African American community of Orangeburg, South Carolina to reduce health disparities, utilizing resources from the University of South Carolina (USC), a level 1 research institution to build expertise at a minority serving institution. The elements of Project EXPORT were created to advance the science base of disparities reduction, increase trained minority researchers, and engage the African American community at all stages of research. Conclusion: Building upon past collaborations between HBCU’s in South Carolina and USC, this project holds promise for a public health human capital approach to reduce health disparities

Impact of Resilience on Quality of Life in Spinal Cord Injured Clients

Abstract Impact of Resilience on Quality of Life in Spinal Cord Injured Clients by Crystal D. Glover MSM, Troy University, 2006BSN, University of North Carolina at Greensboro, 1995 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 202

Emergency Department Utilization: A Qualitative Analysis of Illinois Medical Home Network Patients.

Background Inappropriate emergency department (ED) use continues to plague healthcare in terms of disease management and costs. In 2012, the State of Illinois implemented Medical Home Network (MHN) where Medicaid recipients were assigned to primary care providers to, in part, reduce overreliance on EDs. However, MHN patients have continued to use EDs. Objective The purpose of this study is to provide a qualitative analysis of Medicaid patient-identified barriers to primary care, facilitators of emergency use, and related mental health and psychosocial factors. Methods Patients who presented themselves at the ED located at an urban, academic medical center participated in one-time, individual interviews. Participants arrived with non-urgent, minor, or moderate acuity. Interviews were digitally audiorecorded and transcribed for data analysis. Researchers analyzed data using the Grounded Theory approach. Results Four themes were identified: 1) barriers related to visiting a primary care provider (not having an appointment and scheduling issues), 2) elements of ED use (the experience of physical pain), 3) mental health and stress (a lack of willingness to discuss mental health issues), and 4) varying perceptions of primary care and the ED (the ED provides care that is fast, solution-oriented, team-based, and patient-centered within an environment containing necessary equipment). Conclusions Findings may inform interventions such as the use of community health workers as liaisons between MHN, the ED, primary care, and patients. Addressing patient perceptions regarding the role of primary care and stigma surrounding mental health can lead to decreasing ED use and increasing continuous primary care use for vulnerable patients

Examination of Racial Disparities in Childhood Asthma Management Practices

Objective: To analyze asthma management plan practices for children with asthma in the United States considering race and other demographic and person-level characteristics. Methods: Univariate/Bivariate/Multivariate analysis was performed to examine asthma management plan physician recommendations among children in the United States utilizing secondary data analysis of the 2002 and 2003 National Health Interview Survey. Results: The majority of the study participants reported not having an asthma management plan at (59.00%). In multivariate analysis using SAS callable SUDAAN, Whites were significantly more likely to have an asthma management plan (OR=1.66, p=.0031). Conclusion: Findings from this study indicate that Black and Hispanic children with asthma are less likely to have an asthma management plan. Mandating all insurers to provide an asthma management plan to children with asthma may reduce the race-based inequities and requiring emergency room physicians to provide children with an asthma management plan may target those children that do not have a plan

Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health

Research reveals that the opportunities for healthy choices in homes, neighborhoods, schools, and workplaces can have decisive impacts on health. This article reviews scientific evidence from promising interventions focused on the social determinants of health, and describes ways in which they can improve population health and reduce health disparities. We show that there is sufficient evidence to support policy interventions targeted at education and early childhood; urban planning and community development; housing; income enhancements and supplements; and employment. When available, cost-effectiveness evaluations show that these interventions lead to long-term societal savings; however, more routine attention to cost considerations is needed for these interventions. We also discuss challenges to implementation, including the need for long-term financing in order to scale-up effective interventions for implementation at the local, state, or national level. Although we know enough to act, questions remain about how to optimally scale-up these interventions and maximize their benefits for the most vulnerable populations

FROM RECALLTO RESOLVE: SUPPORTING THE DEVELOPMENT OF CULTURALLY RESPONSIVE PRESERVICE TEACHERS IN A LANGUAGE ARTS METHODS COURSE

The need for culturally responsive teachers in an increasingly diverse educational system is paramount. The purpose of this study was to investigate preservice teachers’ developing understandings of culturally responsive pedagogy in a language arts methods class over the course of one semester. The study also sought to explore the relationship between preservice teachers’ cultural background and their receptiveness to culturally responsive pedagogy. Using the Critical Matrix of Literacy Domination as a guiding framework, this case study employed the use of innovative classroom practices designed to promote culturally relevant pedagogy within undergraduate literacy classes for preservice teachers. Data analysis revealed four major findings: 1. The Role of Cultural Background, 2. Personal Connections and the Desire to Help Others, 3. Understandings about Culturally Responsive Teaching, and 4. Clinical Experiences. Participants in the study progressed through three distinct stages-Recall, Reflect, and Resolve- related to the acquisition of culturally responsive pedagogical practice. There was also a suggestion within the data of the need for a fourth stage, React. These findings suggest a relationship between cultural background and receptiveness to culturally responsive teaching; a call for ongoing support and professional development regarding culturally responsive pedagogy for preservice teachers; and a need for diverse field experiences. Additionally, strong connections between the developmental stages coined, The Three R’s, and corresponding levels within the revised Bloom’s Taxonomy promote the existence of a developmental process involved in the procurement of culturally responsive pedagogy

Disparities in Mental Health Utilization among Persons with Chronic Diseases

This study used Aday and Andersen’s Behavioral Model of Health Services Use to examine the role of chronic disease and the joint impact of race and chronic disease type on mental health utilization. Using data from Community Tracking Survey Household Survey, we tested the assumption that chronic disease, chronic disease type, and race are related to lower rates of mental health visits when adjusted for predisposing, enabling, and need factors. After adjusting for population characteristics, we found that race significantly moderated the impact of chronic disease type on mental health utilization, showing that African Americans with cardiovascular disease were half as likely as whites with cardiovascular disease to have a mental health visit, and Hispanics relative to whites with other chronic diseases were two thirds a likely to have a mental health visit. Overall, chronic disease status was positively associated with mental health utilization. However, adjusted for chronic disease, mental health status, predisposing, enabling and need factors, African Americans and Hispanics were significantly less likely than whites to have a mental health visit. Clinicians and providers must be alert to the full spectrum of needs in underserved populations

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

Context: Asthma is a chronic respiratory illness that is increasing in prevalence among children in the United States. A limited number of studies have examined the relationship between rurality and the prevalence of asthma in minority children, and those studies found mixed results. The aim of this study is to examine urban/rural locality and its impact on asthma episodes and preventable emergency department visits, and to provide quantitative evidence concerning the relationship between patient characteristics and geographic location. Methods: This is a retrospective study and secondary data analysis of the 2000 National Health Interview Survey. Parametric testing using Univariate/Bivariate/Multivariate analysis was performed to examine emergency department utilization for asthma episodes among urban/rural children and adolescents in the United States. Findings: Regardless of the geographic location, Black children were more likely to visit the emergency room within the past twelve months (urban area (OR=1.59; 95% CI 0.87, 2.33) – rural area (OR=2.68; 95% CI 1.39, 4.05)). Additionally, children who experienced an asthma episode in the past twelve months were more likely to report not visiting the emergency department (OR=1.93; 95% CI 1.53, 2.44). Conclusions: Racial and urban/rural differences exist among children with asthma visits to the emergency department. Asthma prevalence and disparities continue to be a burden in the United States and its deficiencies across geographic locations reflect the health of the US population as a whole

Association of Left Atrial Function Index with Atrial Fibrillation and Cardiovascular Disease: The Framingham Offspring Study

BACKGROUND: Left atrial (LA) size, a marker of atrial structural remodeling, is associated with increased risk for atrial fibrillation (AF) and cardiovascular disease (CVD). LA function may also relate to AF and CVD, irrespective of LA structure. We tested the hypothesis that LA function index (LAFI), an echocardiographic index of LA structure and function, may better characterize adverse LA remodeling and predict incident AF and CVD than existing measures. METHODS AND RESULTS: In 1786 Framingham Offspring Study eighth examination participants (mean age, 66+/-9 years; 53% women), we related LA diameter and LAFI (derived from the LA emptying fraction, left ventricular outflow tract velocity time integral, and indexed maximal LA volume) to incidence of AF and CVD on follow-up. Over a median follow-up of 8.3 years (range, 7.5-9.1 years), 145 participants developed AF and 139 developed CVD. Mean LAFI was 34.5+/-12.7. In adjusted Cox regression models, lower LAFI was associated with higher risk of incident AF (hazard ratio=3.83, 95% confidence interval=2.23-6.59, lowest [Q1] compared with highest [Q4] LAFI quartile) and over 2-fold higher risk of incident CVD (hazard ratio=2.20, 95% confidence interval=1.32-3.68, Q1 versus Q4). Addition of LAFI, indexed maximum LA volume, or LA diameter to prediction models for AF or CVD did not significantly improve model discrimination for either outcome. CONCLUSIONS: In our prospective investigation of a moderate-sized community-based sample, LAFI, a composite measure of LA size and function, was associated with incident AF and CVD. Addition of LAFI to the risk prediction models for AF or CVD, however, did not significantly improve their performance

A Human Capital Approach to Reduce Health Disparities

Objective: To introduce a human capital approach to reduce health disparities in South Carolina by increasing the number and quality of trained minority professionals in public health practice and research. Methods: The conceptual basis and elements of Project EXPORT in South Carolina are described. Project EXPORT is a community based participatory research (CBPR) translational project designed to build human capital in public health practice and research. This project involves Claflin University (CU), a Historically Black College University (HBCU) and the African American community of Orangeburg, South Carolina to reduce health disparities, utilizing resources from the University of South Carolina (USC), a level 1 research institution to build expertise at a minority serving institution. The elements of Project EXPORT were created to advance the science base of disparities reduction, increase trained minority researchers, and engage the African American community at all stages of research. Conclusion: Building upon past collaborations between HBCU\u27s in South Carolina and USC, this project holds promise for a public health human capital approach to reduce health disparities