Background An ongoing public policy concern in the United States is disparities in health care for racial/ethnic minority populations. The National Healthcare Disparities Report (NHDR) addresses these disparities for chronic diseases such as diabetes that impose economic and health burdens on society that need to be partly managed by health care policies. One understudied aspect of diabetes care is racial/ethnic disparities in the pharmacological management of the disease. Objective The objective of this study was to determine whether racial/ethnic disparities exist in the pharmacological treatment of diabetes, and if so, how do individual characteristics such as socioeconomic status (SES) influence the differences. Methods This study used national survey data collected through the 2010 Medical Expenditure Panel Survey (MEPS). Racial/ethnic disparities in diabetes treatment were examined using a methodology based on the Institute of Medicine (IOM) definition of disparity that adjusts for health status factors while allowing SES factors to mediate differences. The effects of independent variables on receipt of antidiabetic medication prescriptions among individuals who self-reported a diagnosis of diabetes were examined. Regression analyses were performed on unadjusted data and on data transformed by a rank-and-replace method to approximate the IOM definition. Results Among 1,844 survey respondents with self-reported diabetes, significant differences were found for race/ethnicity, education, health insurance, and the co-morbidities of heart disease and eye problems/retinopathy. Race/ethnicity was a significant predictor of the receipt of antidiabetic prescriptions, with Hispanics being more than 2 times as likely as non-Hispanic whites to have received a prescription. This difference was magnified in the IOM model that controlled for health status. In the IOM model, no significant differences were observed between non-Hispanic whites and non-Hispanic blacks or other minorities. Having health insurance, higher education, or eye problems/retinopathy were also significant predictors of receiving antidiabetic prescriptions. Conclusion Using a methodology that adjusts for factors related to health status while allowing factors related to SES to mediate racial/ethnic differences, disparities were observed between non-Hispanic whites and minorities, particularly Hispanics, in the likelihood of receiving a prescription for antidiabetic medication. The agreement of these results with the few studies on the pharmacological management of diabetes is mixed, and suggests the need for additional studies. Application of a rigorous definition of racial/ethnic disparities and the implementation of methodologies that adjust for health status while allowing mediation by SES factors are needed to address important gaps in the treatment of diabetes. / acase@tulane.edu

acase@tulane.edu

In Mississippi, approximately 4,700 deaths are caused by smoking and approximately 3,500 young Mississippians begin smoking each year. Nearly 9 out of 10 smokers start smoking by age 18, and 99% start by age 26. Because of the early age of initiation, policy changes and other initiatives that affect smoking rates among youth are of particular interest, including tax increases. In 2009, Mississippi increased its state excise tax on tobacco from $.18 to $.68 per pack which was in addition to the federal tax increase to $1.0066 (an increase of $.6166 from the previous amount of $.39). This study examined the effect of Mississippi's tobacco tax increase on youth smoking initiation and tobacco consumption behavior using difference-in-difference analysis. Using the SmartTrackTM School Survey this study analyzed changes in youth who reported ever smoking and their recent consumption from the three years prior to the tax increase to the three years following it using data from the Louisiana Caring Communities Youth Survey as the control group since Louisiana did not experienced a state-level cigarette tax increase during this period. The analysis showed mixed results for a statistically significant difference in smoking initiation (ever smoked cigarettes) rates, and moderately supported the hypothesis of past 30 day youth smoking rates being reduced by the tax increase on cigarettes in Mississippi. While youth smoking rates declined significantly during the study period, the difference-in-difference analysis of youth who reported ever smoking showed only a small but statistically significant effect across all grades, but had a notable impact on 6th graders. The analysis of past 30 day use showed no short term effect on Mississippi youth in the year after the 2009 tax increase, but difference-in-difference comparisons showed a moderate and statistically significant impact on those rates the longer term. The results of this study will be of interest to scholars, policymakers, and tobacco control advocates as they make decisions about whether to increase state level taxes on cigarettes to prevent smoking initiation and curb youth tobacco use. / acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

Thesis (Sc.D.)--Massachusetts Institute of Technology, Dept. of Materials Science and Engineering, 1979. / Vita. / Includes bibliographical references. / by Stuart Forster Cogan. / Thesis (Sc.D.)--Massachusetts Institute of Technology, Dept. of Materials Science and Engineering, 1979.

acase@tulane.edu

acase@tulane.edu