Class of 2012 Abstract / Specific Aims: Health disparities are contributing to differences in access to healthcare and health outcomes among diverse groups in the United States. Causes of health disparities are multifactorial. One approach to minimize health inequalities is through educating future health care professionals. The purpose of this review is to identify and describe approaches for developing health disparities curriculum for health professions programs in the United States. Methods: A systematic review was conducted in April of 2012 to identify articles describing medical and nursing school curricula, educational courses, and activities focusing on health disparities in the United States. The search was conducted by utilizing Medline PubMed database. Articles describing a specific educational course/curriculum in health disparities in medical and nursing undergraduate or graduate programs were included in the review. The review did not take into account continuing education programs. All articles describing educational programs focus on healthcare disparities in the United States. Main Results: The search identified 153 articles focusing on specific health disparities curricula or education programs. Out of those articles 30 were included in the analysis. Results are pending. Conclusions: Anticipated results will aid in identifying successful and effective health disparities curricula for health professions programs in the United States.

INTRODUCTION: In the United States, Blacks and Hispanics compared to Whites are disproportionately infected with HIV. Testing for HIV is critical to reduce HIV transmission, lower risk behaviors, and improve access to treatment among persons living with HIV. However, racial & ethnic minorities are tested at later stages of HIV. Previous studies that examined racial discrimination and HIV testing reported inconsistent findings and additional knowledge is needed to understand whether differential treatment based on race is an important barrier to HIV testing. AIM: We examined whether HIV testing is influenced by how an individual reacts to race-based treatment, rather than experiences of discrimination alone, among Whites, Blacks, and Hispanics; and we determined if this relationship was modified race and ethnicity. METHODS: We performed a cross-sectional analysis of the 2012 Behavioral Risk Factor Surveillance System’s (n=12,579) self-reported HIV testing data and Reaction to Race (RR) module, which captures experiences of differential treatment based on race and an individual’s reaction to racialized treatment. Multivariable logistic regression was used to assess the association between RR-based treatment and HIV testing. Statistical interaction between RR-based treatment and race was assessed. RESULTS: Approximately 21% participants reported ever being tested for HIV, and 19% of the participants had one or more experiences of RR-based treatment. Prevalence of HIV testing was higher among Blacks (62%) and Hispanics (33%) compared to Whites (32%). In an adjusted model, the odds of HIV testing among those who reported one experience of Reactions to Race based treatment was 1.37 (95% CI: 1.08-1.75) times the odds among those with no experiences of RR-based treatment. We did not detect statistical interaction between RR-based treatment and HIV testing by race. DISCUSSION: Our findings suggest that experiences of racial discrimination may be counter intuitively associated with increased HIV testing overall and within each racial and ethnic group. Additional research is needed to clarify settings in which experiences of race-based treatment and the associated reactions to the treatment can positively or negatively influence HIV testing behaviors.

Evidence continues to demonstrate that racial/ethnic minority groups experience a disproportionate burden of disease and mortality in cardiovascular-related diseases (CVDs). However, emerging evidence suggests a health advantage for Latinos despite a high risk profile. The current study explored the hospital utilization trends of Latino and non-Latino patients and examined the possibility of an advantage for Latinos within the context of CVD-related events with retrospective data collected over a 12-month period from a local safety-net hospital. Contrary to my hypotheses, there was no advantage for in-hospital mortality, length of stay or re-admission in Latinos compared to non-Latinos; rather, Latinos hospitalized for a CVD-related event had a significantly longer length of stay and had greater odds for re-admission when compared to non-Latinos. Despite data suggesting a general health advantage, Latinos may experience a relative disparity within the context of hospital utilization for CVD-related events. Findings have implications for understanding the hospital utilization trends of Latinos following a CVD-related event and suggest a call for action to advance understanding of Latino cardiovascular health.

Master of Public Health / Food, Nutrition, Dietetics and Health / Sandra B. Procter / Purpose: The objective of this study was to compare characteristics of urban and rural counties in Kansas in order to identify and seek explanations for differences in health factors and population health outcomes. Methods: Select data from the County Health Rankings and Roadmaps program were examined within or using the context of the USDA, Economic Research Service 2013 Rural-Urban Continuum Code (RUC) classification scheme. A comparison of all 19 urban counties vs. all 86 rural counties was conducted, followed by a comparison of counties as they were classified on the rural-urban continuum. Findings: More evidence of health disparities was observed when using the rural-urban continuum comparison than by the strict urban vs. rural comparison. Health determinants, behaviors, and outcomes, were generally more unfavorable in rural counties, but this was mostly captured through the RUC comparison. On average, RUC 4 and RUC 5 communities (both rural) were most disadvantaged when compared to counties that fell somewhere else on the continuum. Overall, there were higher rates of injury death, preventable hospital stays, and premature death in rural areas. Conclusions: The favorable and unfavorable health factors and health outcomes did not present only in urban areas nor only in rural areas nor did they present only in one RUC. These findings showed that there is a complexity to health disparities that cannot be easily captured or addressed without careful attention to the nature of the specific communities in which they are found.

Alcohol abuse is positively associated with incarceration and is the most common substance abuse problem among offenders. However, most prisons and jails do not offer alcohol treatment and only 10% of offenders who need treatment receive it. Among those who do receive treatment, alcohol-related problems following release and recidivism are drastically reduced. Guided by the Socio-Cultural Framework for Health Services Disparities, this dissertation sought to describe past and future trends of treatment utilization in correctional settings, as well as identify predictors of treatment completion among offenders with alcohol as their primary substance of abuse. Racial/ethnic disparities have been identified repeatedly throughout the criminal justice system (CJS) and include the underrepresentation of racial/ethnic minorities in treatment in prisons and jails. Therefore, racial/ethnic disparities were a primary focus of this research. Study 1 used the Treatment Episode Dataset – Admissions (1992-2014) to compare racial/ethnic differences in treatment utilized in a correctional setting (versus non-correctional settings) among treatment-seekers with alcohol as their primary substance of abuse (n=5,565,884). A higher within-group proportion of African Americans (2.4%) received treatment in a prison or jail, versus 1.2% of Whites and 1.1% of Hispanics. Using forecasted estimates from a generalized linear model (2015-2025), African American men had significantly higher odds of utilizing treatment in a correctional setting in 2025, compared to White men (adjusted odds ratio [aOR] = 1.52, 95% confidence interval [95% CI] = 1.45-1.60). No significant difference between Hispanics and Whites was identified. Study 2 used the Treatment Episode Dataset – Discharges (TEDS-D) (2006-2014) to model treatment completion with individual and system-level factors among offenders with alcohol as their primary substance of abuse (n=23,655). African Americans had 29% lower odds of treatment completion compared to Whites (aOR = 0.71, 95% CI = 0.65-0.76). African Americans and Hispanics referred to treatment by the CJS demonstrated lower odds of treatment completion, compared to Whites also referred by the CJS (aOR = 0.63, 95% CI = 0.57-0.70; and aOR = 0.85, 95% CI = 0.74-0.98, respectively). African Americans and Hispanics referred by the CJS demonstrated even lower odds of treatment completion, compared to Whites referred by any non-CJS source (aOR = 0.50, 95% CI = 0.41, 0.61; aOR = 0.74, 95% CI = 0.57-0.97, respectively). Study 3 used a reduced TEDS-D dataset (2013-2014) to investigate state-level characteristics and treatment completion (n=3,798). Whites and Hispanics were largely unaffected by state-level factors. Among African Americans, those in states where the level of alcohol consumption was high (versus low) and in states which spent a higher percent of their budget on corrections (versus lower) were less likely to complete treatment (aOR = 0.11, 95% CI = 0.02-0.55; and aOR = 0.24, 95% CI = 0.08-0.75, respectively). African Americans in states where the incarceration disparity was high between Hispanics and Whites (versus low) and in states with a high percentage of Republican legislators (versus low) were more likely to complete treatment (aOR = 4.39, 95% CI = 1.10, 17.50; and aOR = 3.88, 95% CI = 1.21, 12.44, respectively). African Americans experienced disparities in treatment services utilization and completion on multiple ecological levels. Few differences between Hispanics and Whites were identified throughout all three studies. A comprehensive outlook of future trends in treatment utilization in correctional settings provides needed perspective on the scope and size of the challenge ahead. Better understanding predictors of treatment completion among offenders may inform interventions aimed at reforming the CJS, improving correctional health services, and promoting evidence-based state legislative priorities.

Life expectancy and overall health have improved in recent years for most Americans, thanks in part to an increased focus on preventive medicine and dynamic new advances in medical technology. However, not all Americans are benefiting equally. This suggests a level of urgency for need to assist our public health professionals in obtaining specific skills sets that will assist them in working better with ethnic and racial minority populations. The overall goal of the research was to assess cultural competence knowledge and programmatic skill sets of individuals employed by an urban department of health located in the southwest region of the US. The Theory of Planned Behavior (TPB) guided the research design to effectively evaluate the correlation between behavior and beliefs, attitudes and intention, of an individual, as well as their level of perceived control. Within the program design, 90 participants were identified using convenience sampling. In order to effectively evaluate these constructs, a quantitative research approach was employed to assess attitudes, beliefs, knowledge and competencies of the subject matter. Participants completed the Cultural Competence Assessment (CCA), which is designed to explore individual knowledge, feelings and actions of respondents when interacting with others in health service environments (Schim, 2009). The instrument is based on the cultural competence model, and measures cultural awareness and sensitivity; cultural competence behaviors and cultural diversity experience on a 49 item scale. It seeks to assess actual behaviors through a self report, rather than self-efficacy of performing behaviors. In addition, information was obtained to assess participant perception of organizational promotion of culturally competent care and; availability of opportunities to participate in professional development training. The analysis suggested healthcare professionals who are more knowledgeable and possess attitudes which reflect increased cultural sensitivity, are more likely to engage in culturally competent behaviors. In addition, positive attitudes and increased knowledge were associated with diversity training participation. Respondents reported high levels of interaction with patients from ethnic and racial minorities. Observing the clinical and non-clinical respondents, approximately 47% and 57% respectively, stated their cultural diversity training was an employer sponsored program.

This dissertation investigates race as a determinant of health trajectories for immigrants to the United States. Previous research suggests that integration into U.S. society can be detrimental to the health and mortality outcomes of many minority immigrant groups. Popular explanations for post-migration health changes have focused on individual-level mechanisms, such as behavioral changes associated with acculturation. I use multiple sources of data and a variety of quantitative methods to situate these changes in a context of racial inequality for three migrant groups. In my first case, I draw on historical data collected from the Vital Statistics of the United States and the U.S. Census to analyze the changing health trajectories associated with European immigrants’ transition from marginalized minorities to members of the white majority in the early 20th century. My second case draws on restricted-use data from the National Survey of American Life to test how interpersonal and institutionalized racial discrimination influence health patterns of black immigrants from the Caribbean. In my third case, I use population-level birth data from New York City (2000-2010) to investigate changes in birth outcomes associated with elevated anti-Muslim sentiment after the attacks of September 11, 2001. Taken together, these cases demonstrate how racial formation in the United States shapes patterns of post-migration outcomes. I find that marginalized European immigrants exhibited patterns of worsening mortality trajectories, but the overall gap between European immigrants and native-born whites narrowed as racial categories were redefined in the early 20th century. This pattern of intergenerational health improvement contrasts with the segmented trajectories of contemporary Caribbean black immigrants, whose health is shaped by experiences of both interpersonal and institutionalized racism. Similarly, rates of low birth weight births increased for Middle Eastern and Asian Indian immigrants in the decade after the attacks of September 11, 2001, likely due to increased experiences of discrimination. By tying health trajectories and outcome disparities to the construction and stratification of racial boundaries, I advance theory about the "upstream" social causes of health and illness and develop a framework for analyzing the sociohistorical formation of health disparities.

Introduction and Background Individuals in rural areas do not have the same access to health care as individuals who live in urban areas. Individuals who live in rural areas tend to not get the care that they need due to income and location. Purpose Statement Healthcare differs for those who live in rural versus urban populations. How can the intervention of telehealth help to decrease the health disparities for individuals who live in rural communities? Literature Review We searched the phrases “rural and urban” and “health disparities” in google scholar and restricted the search to articles that were published from 2018 to now and we narrowed it down to 3 articles. For the two articles that included our intervention of telehealth we did a Google Scholar advanced search and used the keywords “telehealth” and “health disparities” and filtered the search to where the most recent would be shown and we narrowed it down to 2 articles. Findings The research that we collected strongly suggests that there are health disparities among rural areas compared to urban areas, meaning that rural areas do not have as good of access to adequate health care. The intervention of telehealth however could help improve the health disparities for those in rural areas. Conclusions Rural areas do not have as good of access to healthcare as those who live in urban areas. Our research gave a variety of different examples of how rural areas have a disadvantage when it comes to the quality of healthcare individuals receive. Telehealth can help to decrease these health disparities and improve the quality of care that individuals in rural areas receive.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / My first aim identified enrollment patterns and variables that predict enrollment in a diverse underserved population and evaluated barriers to enrollment. We analyzed data from the INGENIOUS, (Indiana GENomics Implementation and Opportunity for the UnderServed), pharmacogenomics implementation clinical trial conducted at a community hospital for underserved subjects and a statewide healthcare system. Our main finding revealed, African-Americans were less likely to refuse the study than non-Hispanic Whites (Safety net, OR =0.68, p<0.002; Academic hospital, OR=0.64, p<0.001), using a logistic regression model. The most frequent barriers to enrollment included not being interested, being too busy, transportation, and illness in African-American and non-Hispanic White subjects. In conclusion, improving research awareness, widening the inclusion criteria, and hiring recruiters who represent potential enrollees, should improve enrollment in African-Americans and other diverse populations. My 2nd research aim evaluated racial/ethnic differences in pharmacokinetics, safety, efficacy, and pharmacogenetics in 213 new molecular entities (NMEs). The current approved drug label for NMEs between 2014 to 2018 was updated in the FDA database. A qualitative analysis revealed ~ 9% (n=20/213) of NMEs reported racial/ethnic differences in the approved product label for PK, safety, efficacy, and/or pharmacogenetics. In conclusion, evaluating racial/ethnic differences in drug exposure and response early in the drug development program is essential to providing recommendations for different racial/ethnic subpopulations. My final aim 3, identified genetic biomarkers of Taxane Induced Peripheral Neuropathy (TIPN) in African-American breast cancer patients. We used an innovative computational tool, ALDY, to identify genetic variants in CYP2C8, CYP3A4, and CYP3A5 in 207 breast cancer subjects. TaqMan SNP genotyping for SNP, rs776746 (T>C) was performed in 160 subjects. Subjects were collapsed into three metabolizer groups; normal, intermediate, and poor metabolizer to test the association of peripheral neuropathy, dose reductions and CYP2C8/CYP3A5 metabolizer status. A logistic regression revealed CYP2C8 metabolizer status is associated with grades 3-4 peripheral neuropathy (p=0.04, OR= 2.21). CYP2C8*2 was modestly associated with dose reductions. In conclusion, evaluating pharmacogenetic and pharmacokinetic studies of paclitaxel and CYP2C8 is important. These studies may lead to clinical actionable prescribing of paclitaxel and improve the tolerance and efficacy in African-American breast cancer patients. / 2022-02-16