In spite of the National Asthma Education and Prevention Program guidelines outlining how to diagnose, treat, and educate asthmatics, asthma morbidity and mortality rates are still mounting. Furthermore, the minority population has disproportionately higher rates of unfavorable outcomes from asthma, thereby diminishing their quality of life. The study's theoretical framework was based on the health belief model and explored associations of asthma control with self-efficacy and asthma education. Few studies focus on asthma inequity. The purpose of this quantitative study was to assess relationships between asthma control, race, asthma education, and healthcare utilization amongst asthmatic children residing in the Midwest. Secondary data from the Centers for Disease Control's Behavioral Risk Factor Surveillance System's Asthma Call-back Survey were used (n=477,221). Participant characteristics were examined using descriptive statistics. A sequence of bivariate and logistic regression analysis was used to test each hypothesis. The findings revealed significant associations amongst asthma control, race, asthma education, and healthcare utilization. In addition, children with uncontrolled asthma have greater visits to the emergency department and to their pediatrician's office due to their asthma symptoms. Moreover, the study results indicated that African American children experienced uncontrolled asthma at a higher rate when compared to other children, consequently decreasing their quality of life. The study showed the need for policy change to expand funding and programs aimed at decreasing uncontrolled asthma by improving asthma education, especially in African American communities, in hope of empowering asthmatics to play a vital role in their health and increasing their quality of life.

An improved understanding of the role of housing in asthma prevalence among African-American children is essential to addressing the issues associated with asthma and housing that perpetuate racial and ethnic health disparities. This study was conducted to examine the influence of substandard housing on the odds of asthma among low-income African-American children. The social ecological model was used as the theoretical framework for this study, that allowed consideration of the housing environment where African-American children live as an influential determinant of respiratory health. A cross-sectional research design using data obtained from the 2012 National Health Interview Survey and Comprehensive Housing Affordability Strategy were used to examine the association between income level and asthma and substandard housing and asthma among African-American children. Odds ratios derived from logistic regressions were used to determine the significance of the association between family income level and asthma diagnosis among African-American children. Linear regression was used to assess the strength of the association between an affirmative asthma diagnosis and substandard housing among low-income African-American children. The findings derived from this study suggest that income level was the most significant predictor of asthma risk among African-American children between the ages of 5-14 regardless of the absence or presence of housing issues within the child's home environment. The conclusions of this study have the potential to enact social change by demonstrating the need for improved population health data and additional research into other variables, beyond the scope of housing, that contribute to asthma risk in African-American children.

acase@tulane.edu

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

The objective of the present study is to investigate key aspects of ovarian and breast cancers, which are two main causes of mortality among women. Identification of the true behavior of survivorship and influential risk factors is essential in designing treatment protocols, increasing disease awareness and preventing possible causes of disease. There is a commonly held belief that African Americans have a higher risk of cancer mortality. We studied racial disparities of women diagnosed with ovarian cancer on overall and disease-free survival and found out that there is no significant difference in the survival experience among the three races: Whites, African Americans and Other races. Tumor sizes at diagnosis among the races were significantly different, as African American women tend to have larger ovarian tumor sizes at the diagnosis. Prognostic models play a major role in health data research. They can be used to estimate adjusted survival probabilities and absolute and relative risks, and to determine significantly contributing risk factors. A prognostic model will be a valuable tool only if it is developed carefully, evaluating the underlying model assumptions and inadequacies and determining if the most relevant model to address the study objectives is selected. In the present study we developed such statistical models for survival data of ovarian and breast cancers. We found that the histology of ovarian cancer had risk ratios that vary over time. We built two types of parametric models to estimate absolute risks and survival probabilities and to adjust the time dependency of the relative risk of Histology. One parametric model is based on classical probability distributions and the other is a more flexible parametric model that estimates the baseline cumulative hazard function using spline functions. In contrast to women diagnosed with ovarian cancer, women with breast cancer showed significantly different survivorship among races where Whites had a poorer overall survival rate compared to African Americans and Other races. In the breast cancer study, we identified that age and progesterone receptor status have time dependent hazard ratios and age and tumor size display non-linear effects on the hazard. We adjusted those non-proportional hazards and non-linear effects by using an extended Cox regression model in order to generate more meaningful interpretations of the data.

The colorectal cancer (CRC) incidence in Ashkenazi Jews has been found to be highest of any ethnic group in the world (Feldman, 2001). It is currently unclear how culture and religion influence health behaviors of U.S. Ashkenazi Jews, as well as what other socio-cultural factors influence AJ women's attitudes towards CRC risk and screening practices. This study aimed at exploring and describing the cultural and religious influences on health behaviors and beliefs related to CRC in Ashkenazi Jewish women. Research participants included seven key informants (rabbis) and forty-two Ashkenazi Jewish women ages 50 and up. Methods included in-depth, qualitative interviews and focus groups. The study also utilized a demographic survey which included questions about baseline knowledge of colorectal cancer in Ashkenazi Jews, and a ten-item American Cancer Society's Questionnaire on Experiences with and Attitude toward CRC Screening. Participants were recruited from Tampa synagogues and community using non-probabilistic sampling. Results revealed only 5% of participants were aware of the increased prevalence of colorectal cancer in Ashkenazi Jews; still, most participants (88%) were up to date on colorectal cancer screening. Judaic purity laws did not resonate with many participants, and for those who did follow them, they did not take a view of bodily functions as being impure. A consistent description of a 'Jewish way' of looking at health emerged, involving both the push for education, which increases knowledge about and access to healthcare, as well as the core Jewish tenet of the infinite value of life. No significant differences were found among the screening practices of the three self-identified denominations, and only breast and cervical cancer screening were found to be significantly different between those who have ever had a CRC screening and those who have not. Recommendations highlight the need for future research in this area including larger samples, further exploring core Jewish tenets as related to health behaviors in this population, partnering with the Jewish community for interventions, and addressing ways to better track CRC incidence, mortality and screening in this population in order to raise awareness.

The growth in the number of black women in the prison system necessitates more research become rooted in an intersectional approach. This quantitative study will empirically apply intersectionality to address the unique circumstances of imprisoned black women by comparing and analyzing sentence convictions shared between black and white incarcerated women in Georgia. Drawing on 600 inmate profiles published by Georgia Department of Corrections, this study will address the statistical significance of race, class and gender on the length of sentence for incarcerated white and black women using regression models.

Introduction . Non-Hispanic blacks (blacks) are more insulin resistant compared to non-Hispanic whites (whites), increasing their risk for Type 2 diabetes. The role played by ethnic/racial disparities in the response to physical activity in mediating those higher rates of insulin resistance in blacks is unknown. Because the beneficial effects of exercise are transient and require subsequent doses of exercise to maintain the effect; the metabolic and psychosocial responses to single exercise bouts have strong implications for both opposing insulin resistance and raising the probability that an individual will continue to exercise. Purpose . To compare the metabolic and psychosocial responses to individual bouts of exercise, at the intensity and duration corresponding to the current Institute of Medicine guidelines, in blacks and age/gender/BMI-matched whites. Methods . Insulin sensitivity (hyperinsulinemic-euglycemic clamp) and metabolic flexibility (suppression of resting fat oxidation) along with exercise task self-efficacy, mood, and state-anxiety were assessed before and after a bout of exercise in black and white men and women (metabolic n = 21; psychosocial n = 31). Participants walked on a treadmill at 75% of maximum heart rate for 75 minutes. Exercise sessions were repeated on three separate occasions to assess the cumulative change in psychosocial responses to exercise. Results . There were no ethnic/racial differences in baseline measures of whole-body insulin sensitivity (p = 0.95). Black participants demonstrated larger improvements in the insulin sensitivity response to individual bouts of exercise compared to their white counterparts (+18% vs. -1.8%), which was primarily the result of enhanced non-oxidative glucose disposal during the clamp. Additionally, blacks demonstrated a greater capacity to switch from primarily fat oxidation at rest to primarily carbohydrate oxidation during the clamp (p <0.003). There were no ethnic/racial differences in the psychosocial response to individual bouts of exercise; individual bouts of exercise improved exercise task self-efficacy and reduced psychological distress in both black and white participants (p = 0.006). Black participants reported higher positive in-task mood during all three bouts of exercise (p = 0.003) and lower RPE scores (p = 0.04) during the third exercise bout compared to white participants, despite similar heart rates in both groups. Conclusions . These data demonstrate that metabolic and psychosocial responses to individual bouts of exercise do not help to explain the increased insulin resistance and lower adherence rates to exercise programs reported in blacks compared to whites. If these results are confirmed in a larger, more diverse, free-living population, future research should focus on social determinants of insulin resistance and physical inactivity to obtain a better understanding of the root causes of increased risk of Type 2 diabetes in black populations.

Introduction: Domestic research studies focused on the interrelationships between political ideology characteristics inherent in policy decisions and the contributions these political determinants exert over health indicators and outcomes are limited. Given the paucity of research that focuses on political and policy support of health at the county-level, this study sets out to utilize the University of Wisconsin Population Health Institute’s (UWPHI) annual County Health Rankings data and examine them within the context of county-based majority political partisanship and economic measures. Methods: This exploratory ecological study examined differences between independent variables: partisan voting behavior (trichotomized as conservative, moderate, and liberal) and median per capita household income in U.S. dollars (by quartile) on dependent variables related to mortality (years of productive life lost) and morbidity (number of poor mental and physical health days) at the county-level to compare differences in political and ideological underpinnings that may act as influencers on health outcomes. Multiple data sources were combined and matched to all 3,140 counties located in the U.S. Two-way between-subjects ANOVA statistical tests were conducted to determine if there is an effect of partisan voter index category on the three aforementioned dependent variables related to health outcomes, and median per capita income by quartile. Results: There was a statistically significant main interaction between median per capita household income by quartile and partisan voter index category on years of productive life lost, F(6,2789) = 19.3, p < .000, partial η2 = .040. While there were also statistically significant interactions between the independent and dependent variables of poor mental and physical health days, results of those analyses should be interpreted with caution. Pertaining to years of productive life lost, post hoc analyses of significant interactions revealed significant differences at the lower income quartile, but not in the expected direction. The conservative category had statistically significant lower years of productive life lost in comparison to the liberal category (M = -8.21, SE = 1.47, p = .000). Also, there were significant differences detected in the upper quartile suggesting that the liberal category has lower years of productive life lost in comparison to the conservative category (M = 7.06, SE = 1.06, p = .000). Conclusion: Results should be interpreted with caution and suggest more research and methodological refinements are needed, particularly related to categorizing county-level political dynamics.

It has been argued, albeit with some degree of success, that the challenges facing the 21st century Canadian classroom are highly complex. A troubled economy riddled with cutbacks to the education system, ongoing enrolment decline and challenges in embracing a growth in the diversity of students are among the changes that have made classrooms increasingly difficult to navigate. Though the last assertion may be true, disciplinary policies and the tools used to address unwanted student behaviour have remained relatively unchanged within the education system. Using Critical Race Theory, the author examines the implications of school suspension and expulsion programs on students and provides an analysis of current literature on alternative disciplinary methods in public schools. Findings suggest that a mixture of strategies within various disciplinary programs can benefit some students, but more work must be done to address socioeconomic disparities plaguing the majority of students found in these programs.