Validation of self-reported measures in health disparities research

Validation of self-reported measures can be achieved effectively and accurately when data collection involves objective measures that can be clinically validated. On the other hand, validation of self-reported social constructs, often used in health disparities research is a much harder task to achieve, particularly when the outcome is hard to quantify (e.g. racism, discrimination and segregation experience). We discuss validation and the challenges faced, when using current approaches in health disparities research

Effect of Staff Training and Cost Support on Provision of Long-Acting Reversible Contraception in Community Health Centers

Objective To compare the proportion of women receiving same-day long-acting reversible contraception (LARC) between two different models of contraceptive provision adapted from the Contraceptive CHOICE Project. Study Design We used a controlled time-trend study design to compare 502 women receiving structured contraceptive counseling in addition to usual care (“Enhanced Care”) to 506 women receiving counseling plus healthcare provider education and cost support for LARC (“Complete CHOICE”) at three federally qualified health centers. We provided funds to health centers to ensure an “on-the-shelf” supply and no-cost LARC for uninsured women. We recorded the contraceptive method chosen after contraceptive counseling and the healthcare provider appointment as well as the contraceptive method received that day. Among women choosing LARC, we calculated proportions and performed Poisson regression with robust error variance to estimate relative risks for same-day insertion. Results Participant demographics reflected the health center populations; 69% were black, 66% had a high school diploma or less, 57% were publicly insured, and 75% reported household income less than 101% federal poverty line. There were 153 (30.5%) women in “Enhanced Care” and 273 (54.0%) in “Complete CHOICE” who chose LARC (p<0.01). Among women who chose LARC (n=426), those in “Complete CHOICE” were more likely to receive a same-day insertion, 53.8% vs. 13.7% (RRadj 4.73; 95%CI 3.20-6.98) compared to “Enhanced Care.” Conclusions A contraceptive care model that included healthcare provider education and cost support for LARC in addition to structured contraceptive counseling resulted in higher rates of same-day LARC insertion compared to contraceptive counseling and usual care alone

Chaos and Stability in The Crucible

The script of The Crucible is built on a structure of binary oppositions, particularly good vs. evil and stability vs. chaos. Revealing the structure deconstructs the binary oppositions and explains how the play challenges audiences to reconsider what they understand about good and evil in their contemporary times

Reducing health disparities by removing cost, access, and knowledge barriers

Background While the rate of unintended pregnancy has declined in the United States in recent years, unintended pregnancy among teens in the United States is the highest among industrialized nations, and disproportionately affects minority teens. Objective Our objective of this secondary analysis was to estimate the risk of unintended pregnancy for both Black and White teens age 15-19 years when barriers to access, cost, and knowledge are removed. Our hypothesis was that the Black-White disparities would be reduced when access, education, and cost barriers are removed. Study Design We performed an analysis of the Contraceptive CHOICE Project database. CHOICE is a longitudinal cohort study of 9256 sexually active girls and women ages 14-45 years in the St Louis, MO, region from 2007 through 2013. Two measures of disparities were used to analyze teenage pregnancy rates and pregnancy risk from 2008 through 2013 among teens ages 15-19 years. These rates were then compared to the rates of pregnancy among all sexually active teens in the United States during the years 2008, 2009, 2010, and 2011. We estimated an absolute measure (rate difference) and a relative measure (rate ratio) to examine Black-White disparities in the rates of unintended pregnancy. Results While national rates of unintended pregnancy are decreasing, racial disparities in these rates persist. The Black-White rate difference dropped from 158.5 per 1000 in 2008 to 120.1 per 1000 in 2011; however, the relative ratio disparity decreased only from 2.6-2.5, suggesting that Black sexually active teens in the United States have 2.5 times the rate of unintended pregnancy as White teenagers. In the CHOICE Project, there was a decreasing trend in racial disparities in unintended pregnancy rates among sexually active teens (age 15-19 years): 2008 through 2009 (rate difference, 18.2; rate ratio, 3.7), 2010 through 2011 (rate difference, 4.3; rate ratio, 1.2), and 2012 through 2013 (rate difference, –1.5; rate ratio, 1.0). Conclusion When barriers to cost, access, and knowledge were removed, such as in the Contraceptive CHOICE Project, Black-White disparities in unintended pregnancy rates among sexually active teens were reduced on both absolute and relative scales. The rate of unintended pregnancy was almost equal between Black and White teens compared to large Black-White disparities on the national level

Music of the 1960s: The Praxis of Ideological Change

In this article, we consider music as the praxis of ideology in the 1960s within the framework of Burke’s rhetoric of transformation. The 1960s were a period of cultural change in the United States and around the world—the civil rights movement, protests against the Vietnam War, challenges to communism in Eastern Europe, liberation politics around the world. The role of music as a unifying element among those people advocating change is well established in scholarship. We take that consideration of the role of music into a discussion of how music became the praxis of ideology, providing a place where millions of people could advocate for change and be part of the change by interacting with the music

Quantitative assessment of participant knowledge and evaluation of participant satisfaction in the CARES training program

BACKGROUND: The purpose of the Community Alliance for Research Empowering Social change (CARES) training program was to (1) train community members on evidence-based public health, (2) increase their scientific literacy, and (3) develop the infrastructure for community-based participatory research (CBPR). OBJECTIVES: We assessed participant knowledge and evaluated participant satisfaction of the CARES training program to identify learning needs, obtain valuable feedback about the training, and ensure learning objectives were met through mutually beneficial CBPR approaches. METHODS: A baseline assessment was administered before the first training session and a follow-up assessment and evaluation was administered after the final training session. At each training session a pretest was administered before the session and a posttest and evaluation were administered at the end of the session. After training session six, a mid-training evaluation was administered. We analyze results from quantitative questions on the assessments, pre- and post-tests, and evaluations. RESULTS: CARES fellows knowledge increased at follow-up (75% of questions were answered correctly on average) compared with baseline (38% of questions were answered correctly on average) assessment; post-test scores were higher than pre-test scores in 9 out of 11 sessions. Fellows enjoyed the training and rated all sessions well on the evaluations. CONCLUSIONS: The CARES fellows training program was successful in participant satisfaction and increasing community knowledge of public health, CBPR, and research method ology. Engaging and training community members in evidence-based public health research can develop an infrastructure for community–academic research partnerships

Breast reconstruction after mastectomy at a comprehensive cancer center

BACKGROUND: Breast reconstruction after mastectomy is an integral part of breast cancer treatment that positively impacts quality of life in breast cancer survivors. Although breast reconstruction rates have increased over time, African American women remain less likely to receive breast reconstruction compared to Caucasian women. National Cancer Institute-designated Comprehensive Cancer Centers, specialized institutions with more standardized models of cancer treatment, report higher breast reconstruction rates than primary healthcare facilities. Whether breast reconstruction disparities are reduced for women treated at comprehensive cancer centers is unclear. The purpose of this study was to further investigate breast reconstruction rates and determinants at a comprehensive cancer center in St. Louis, Missouri. METHODS: Sociodemographic and clinical data were obtained for women who received mastectomy for definitive surgical treatment for breast cancer between 2000 and 2012. Logistic regression was used to identify factors associated with the receipt of breast reconstruction. RESULTS: We found a breast reconstruction rate of 54 % for the study sample. Women who were aged 55 and older, had public insurance, received unilateral mastectomy, and received adjuvant radiation therapy were significantly less likely to receive breast reconstruction. African American women were 30 % less likely to receive breast reconstruction than Caucasian women. CONCLUSION: These findings suggest that racial disparities in breast reconstruction persist in comprehensive cancer centers. Future research should further delineate the determinants of breast reconstruction disparities across various types of healthcare institutions. Only then can we develop interventions to ensure all eligible women have access to breast reconstruction and the improved quality of life it affords breast cancer survivors