As the United States' population ages and grows more diverse, scholars and practitioners have grown increasingly concerned about persistent disparities in the cost and quality of end-of-life health care, particularly with regard to African Americans. Although a variety of factors may influence these disparities, most scholars agree that the underutilization of hospice care by this population is an important contributor. Drawing from the culture-centered approach to health communication and narrative theory, the present study explores African American patients and caregivers' experiences with hospice care and takes an initial step toward addressing disparities in end-of-life care. I begin this study, first, by positioning it within existing literature on health disparities and the underutilization of hospice care. I then outline the study's context and the ethnographic methods I used to complete it. Next, I discuss (a) participants' understanding of disparities in hospice utilization, (b) how participants' narrate their decisions about and experiences with hospice care, and (c) co-constructed solutions for addressing disparities in end-of-life care by creating partnerships between community members and local hospice organizations.

Latino immigrants encounter an entanglement of rights and policies after occupational injury or illness. In collaboration with an immigrant worker center, ethnographic research and a survey are used to analyze injured workers’ experiences. The center uses survey results to identify common threads and systematic problems, and to explore potential direct action. Through interviews with workers and medical and legal professionals, I investigate the barriers Latino immigrants face following occupational injury or illness, how their lived experiences relate to the greater medicolegal frameworks that demarcate most formal processes of compensation and treatment, and the experiences of professionals who mediate these structures. Research results confirm that immigrant workers lack information about their labor rights and the workers’ compensation system, which prevents them from filing claims, and contributes to the underreporting of workplace injuries. However, this research project also documents how workers who do file claims and report injuries are systematically barred access to redress due to a confluence of factors including unresponsive and fraudulent employers, biases in the medical system, discourses of deservingness, insufficient protections from retaliation, and the effects of a market-based medical system. I argue that future work-related injury prevention efforts should go beyond rights education, and include reforms to the compensation system.

Health disparities in minorities and those of low socioeconomic status persist despite efforts to eliminate potential causes. Differences in the delivery of services can result in different healthcare outcomes and therefore, a health disparity. Some of this difference in care may attribute to discrimination resulting from clinical biases and stereotyping which may provide a possible source for the persistence of health disparities. Health disparities may occur because the delivery of services at some level is inadequate. Disparities resulting from the quality and quantity of care delivered by a practitioner result in differentiated delivery of healthcare, thus unequal health outcomes. The purpose of this study is to evaluate and identify potential disparities in routine screening practices of physician assistants.A randomized sample of practicing physician assistants in Kentucky were analyzed (N= 112) to determine if the race or socioeconomic status of a patient influenced their likelihood of offering different routine screening recommendations and screening test recommendations. Clinical vignettes were created with only the race and socioeconomic status of the patient modified, resulting in four separate vignettes. Through the use of a survey instrument, participants were randomly assigned to one of four written clinical vignettes. Statistical analysis using a MANOVA revealed that the race of a patient had a statistically significant multivariate effect on differences in screening recommendations and race and socioeconomic status had significant multivariate effects on screening test recommendations.Study results suggest that race and socioeconomic status continues to be a significant factor in the prevalence of healthcare disparities. More importantly, this study reveals that Physician Assistants may provide differentiated care based on a patient’s race. Limitations and future directions for this study may be used to examine PA educational curriculums for the inclusion of health disparities and possible continuing medical education opportunities for practicing PAs.

This paper analyzes heath risk and how it is communicated to, and understood within, a predominantly African American neighborhood in central Florida. Residents accuse the county department of public works of purposeful contamination and discrimination over a period of 30 years. I raise the questions of how risk is perceived and what roles race or class may play. I also developed a model for risk communication that includes all stakeholders. Finally, I expand the conversation of health disparities to include issues of widening gaps in perceptions of health. This was examined by looking at the following: 1. The lack of documentation into the subjectivity of the health risk assessment process - i.e. the critique of science 2. The differing modes for creating, communicating, and receiving risk in which the resident's perspective is not valued - i.e. the critique of power 3. The impact of race and class on furthering inequities and disparities in the environmental health risks message - i.e. the critique of policy. Underlining Key Factors: 1. The residents of Mitchell Heights (emic) perceive the contamination at the former Hernando County Department of Public Works site differently than the experts/officials (etic). 2. Race and class are factors in both the perception of risk and the communication of risk for the residents and the experts. 3. Policy concerning the determination and subsequent communication of risk is primarily concerning with the perspective of scientific data. Recommendations: 1. As it relates to assessing environmental risks, there needs to be a development of a more holistic set of methodologies that incorporate diverse perspectives in a bi-directional knowledge exchange. This should allow for acceptable risk to be understood as co-created through negotiation and compromise between the measured and lived experiences. Ethnographic methods should partner with epidemiology and environmental sciences. 2. Once these mixed-method, holistic methodologies are field-tested, they need to be adopted as formal procedure by agencies responsible for the analysis and communication of risks. Risk should include the technical and the relational. 3. Policymakers must widen their understanding of what constitutes "policy relevant knowledge." In addition, policies targeted at eliminating health disparities and inequalities need to value the broad differences the often exist in perceiving "health."

Background: Compared to the general United States (U.S.) population, Arizona counties along the U.S.-Mexico border have a higher prevalence of dental caries, which can be reduced with adequate fluoride exposure. Because of concern regarding local tap water quality, fluoride-free bottled water consumption is common in this region, raising concern that families are not receiving adequate fluoride to promote dental health. Objective: To evaluate the levels of fluoride in tap and bottled water as well as the use of fluoride supplements in an Arizona border community. Methods: Low-income Latino households (n = 90) who report use of bottled water as their primary source of water intake were recruited. Participants completed a questionnaire about their and their children's dental histories and use of fluoride supplements. Water samples (bottled and tap) were collected from a subset of households (n = 30) for analysis of fluoride. Results: Fluoride detection levels were significantly greater (p = 0.02, Fisher's exact test) in tap water (average = 0.49 mg/dL) than in bottled water, yet, the majority (22/30) were below the range for optimal dental health (0.7-1.2 mg/L). Concentration of fluoride in the majority (29/30) of bottled water samples was below the quantitative detection limit of 0.4 mg/L. Children were significantly less likely to have dental caries if they received fluoride varnishing treatments (p = 0.01, Fisher's exact test), lived in households that reported using fluoridated mouthwash (p < 0.001, Fisher's exact test), their parents received fluoride education (p = 0.01, Fisher's exact test), and their parents reported visiting a dentist yearly (p < 0.001, Fisher's exact test). Furthermore, none of the participants reported receiving recommendations from health-care providers about fluoride supplementation or variance in content by the type of water consumed. Conclusion: Although fluoride was significantly more likely to be detected in tap than bottled water, neither water source in this border community is likely to provide enough fluoride for optimal dental health. Low-income children in this region may benefit from regular access to fluoride varnishing treatments and/or use of fluoridated mouthwash, interventions that could be tested in future well-designed trials.

Social determinants of health (SDOH) are often used to discuss health inequities and systemic barriers experienced by minority populations. In the United States, the intersection of SDOH leaves these populations vulnerable to negative health outcomes. Missing from the SDOH discourse are the underlying historical causes for these disparities. Medical-Legal Partnerships (MLPs) have undertaken the role of educating the health and human services (HHS) workforce on interdisciplinary collaboration, cultural competence, and the skills to recognize experiences of negative SDOH. However, current research does not explore the foundational impact of historical trauma, more specifically Post Traumatic Slave Syndrome (PTSS), on experiences of negative SDOH. This ethnography primarily uses the personal accounts of black female HHS workforce members and participant observation from within a MLP to examine how historical trauma acts as a foundation for understanding the complex interactions of SDOH. The SDOH discourse does not challenge the medical and legal institutions that contribute to how minority populations experience negative SDOH. As currently structured, MLPs unintentionally reproduce a pedagogical narrative that erases the lived experiences of SDOH by only focusing on individual factors and not systems. Black female HHS workforce members agree that historical context is missing (e.g. PTSS) from the SDOH discourse and contemporary experiences of racism and discrimination. Historical context would change how HHS workforce members advocate for their patients as well as engage in system-challenging praxis within the medical and legal institutions. This suggests the need to examine how American institutions exclude particular histories and reinforces a white supremacist and patriarchal narrative.

While the concept of the community health worker (CHW) has existed since the mid-20th century, their function as a legitimate branch of the broader workforce in the United States has been tenuous. Their unique roles have the potential to reduce health disparities within marginalized communities, but stakeholder development of this position risks diminishing the crucial skills of these workers. Anthropological research on these workers has typically assessed them in the developing world, while public health research has focused primarily on their ability to impact specific health outcomes through quantitative studies. As a result of the limited and predominantly quantitative assessments of these workers, further research is needed to assess the lived realities of these workers at the grassroots level in the United States. The overarching aim of this project was to document the lived experience of CHWs in Indiana. Additionally, this project assessed their participation in advocacy and the impact of policy development on these workers. A collaborative approach was utilized in this project that embedded the researcher within a CHW organization while also amplifying the voice of the research partners. The project drew on the theoretical lenses of moral economy, deservingness, structural vulnerability, and the “regimes of care” and “politics of care.” The results demonstrate that CHWs face a variety of challenges within the professional workforce but have significant impacts within their communities. These workers emphasize empowerment through advocacy and building client self-sufficiency. Their participation in advocacy is split between impacts at the micro-, macro-, and professional-level. However, legislating the scope and responsibilities of this position by stakeholders unfamiliar with this model risks changing the foundation of the position itself. Steps to incorporate CHWs within the workforce must be collaborative and take into account their lived experience and input in order to allow them agency over the development of their position and to retain the most significant contributions. The contributions of this project are severalfold. First, this project advances theoretical debates within anthropology related to moral economy, regimes of care, politics of care while also addressing the legitimacy of CHWs as a complimentary member of the health care workforce. The findings also illustrate how the political economy of Indiana shapes the moral economy of care within which CHWs operate. Lastly, the project produced applied findings for CHWs, employers, and stakeholders to consider in further development of this position.

Expressed emotion (EE), the affective attitudes and behaviors of one toward another, can affect caregivers’ behaviors toward their child. Research examining associations between EE and child/family outcomes is mixed; these associations may be affected by other influences such as the presence of a chronic disease or parent mental health. In this study of families living in an urban area, we examined associations between EE and child outcomes (anxiety/depressive symptoms) and family functioning, with parent anxiety as a covariate. We evaluated child asthma status as a moderator as the presence of a chronic illness may strengthen the association between EE and child/family outcomes. Ninety-four children (mean±SD age=8.83±2.03 years, 48.9% female, 92.6% African American; 47 with asthma) and their parents (81.3% annual household income less than $25,000) completed an observational study including interviews and questionnaires. Measures included the Multidimensional Anxiety Scale for Children (MASC), Children’s Depressive Symptoms Inventory (CDI), Self-Report Family Inventory (SFI), Generalized Anxiety Disorder scale (GAD-7), and Five-Minute Speech Sample (FMSS) coded for EE. To examine study aims, regression analyses were conducted using PROCESS macro version 3.4. Asthma status (yes/no) was examined as a moderator. EE was associated with child anxiety symptoms, controlling for parent anxiety symptoms (F(1,70) =7.67, p=0.007). Criticism was also positively associated with asthma control (F(1,39)=4.33, p=.04, R2=.08). Asthma status did not moderate any of the associations. Results suggested that high levels of caregiver EE were associated with child anxiety symptoms, but asthma status did not moderate associations. It is possible that regardless of additional family demands related to asthma, EE is associated with child anxiety. Further examination into other systemic stressors (e.g., poverty, access to care) that may moderate these associations is warranted, as well as the impact that minimizing parent anxiety might have on overall EE.

Introduction: Long–standing disparities in colorectal cancer (CRC) outcomes and survival between Whites and Blacks have been observed. A person–centered approach using latent class analysis (LCA) is a novel methodology to assess and address CRC health disparities. LCA can overcome statistical challenges from subgroup analyses that would normally impede variable–centered analyses like regression. Aim was to identify risk profiles and differences in malignant CRC survivorship outcomes. Methods: We conducted an LCA on the Surveillance, Epidemiology, and End Results data from 1975 to 2016 for adults ≥18 (N = 525,245). Sociodemographics used were age, sex/gender, marital status, race, and ethnicity (Hispanic/Latinos) and stage at diagnosis. To select the best fitting model, we employed a comparative approach comparing sample-size adjusted BIC and entropy; which indicates a good separation of classes. Results: A four–class solution with an entropy of 0.72 was identified as: lowest survivorship, medium-low, medium-high, and highest survivorship. The lowest survivorship class (26% of sample) with a mean survival rate of 53 months had the highest conditional probabilities of being 76–85 years–old at diagnosis, female, widowed, and non-Hispanic White, with a high likelihood with localized staging. The highest survivorship class (53% of sample) with a mean survival rate of 92 months had the highest likelihood of being married, male with localized staging, and a high likelihood of being non-Hispanic White. Conclusion: The use of a person–centered measure with population-based cancer registries data can help better detect cancer risk subgroups that may otherwise be overlooked.

African American women have significantly higher mortality rates from heart disease and stroke than White women despite advances in treatment and the management of risk factors. Community health workers (CHWs) serve important roles in culturally relevant programs to prevent disease and promote health. This article describes the Pine Apple Heart and Stroke Project's activities to (1) revise the Women's Wellness Sourcebook Module III: Heart and Stroke to be consistent with national guidelines on heart disease and stroke and to meet the needs of African American women living in rural southern communities; (2) train CHWs using the revised curriculum; and (3) evaluate the training program. Revisions of the curriculum were based on recommendations by an expert advisory panel, the staff of a rural health clinic, and feedback from CHWs during training. Questionnaires after training revealed positive changes in CHWs' knowledge, attitudes, self-efficacy, and self-reported risk reduction behaviors related to heart disease, stroke, cancer, and patient-provider communication. This study provides a CHW training curriculum that may be useful to others in establishing heart disease and stroke programs in rural underserved communities.