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.

This study's purpose is to investigate the expansion of social control efforts in American elementary and secondary school settings, particularly the use of zero-tolerance policies. These policies entail automatic punishments, such as suspensions, expulsions, and referrals to the juvenile and criminal justice systems for a host of school-based infractions. The widespread implementation of zero-tolerance policies and the application of harsh, exclusionary sanctions have intensified over the past decade. Numerous studies have documented this rise; however, there has been little effort to explore the explanation of the expansion of school-based social controls. A potential explanation is found in the application of political economic theories in relation to the increased use and evolving nature of social control in the neoliberal era of capitalism. As such, the current study employs a new theoretical approach, which utilizes neoliberal theory combined with theoretical components from existing metanarratives in the literature. By using this new approach in regard to school-based social control, the connection between the expansion of social control of the working class and marginal populations in the criminal justice process, and the retraction of the social safety nets that characterized neoliberal capitalism is extended to the explanation of trends in the social control of school-based infractions. This investigation incorporates a qualitative, empirical exploration of how these school criminalization efforts have been implemented and legitimized by the state, specifically through the authority of the courts. By engaging in textual analysis, the jurisprudential intent that informs both the relevant state appellate and Supreme Court decisions was subjected to legal exegeses to determine how and if the judicial system legitimizes the practice of zero tolerance in schools, which are consistent with neoliberal ideals. In addition, a quantitative component, to this overall study, examined nationally representative School Survey on Crime and Safety (SSOCS) data across three academic years to determine if school security measures and disciplinary actions were increasingly applied to marginal populations in elementary and secondary schools over time. Results from the qualitative inquiry revealed that in the overwhelming majority of court cases evaluated, the courts decided in a fashion that reinforces zero-tolerance policies as legitimate neoliberal social controls in schools. Several theoretically relevant themes emerged from the jurisprudential intent, which are transferable for further theory development and future research. Quantitative findings reveal that, over time, the total disciplinary actions and removals from school without continued educational services are disproportionately applied to schools with the highest percentages of minority students and students who reside in high-crime areas compared to schools with the lowest percentages of minority students and students who reside in high-crime areas. Conversely, the results also reveal that the average use of school security measures (e.g., metal detectors, access controls, security guards, etc.) are more likely to be used in schools with the lowest percentages of minority students than schools with the highest percentages of minorities over time. These results are discussed in detail, and recommendations for changes in school policies and practices are offered, while being mindful of evidence-based best practices that may serve as viable alternatives to the zero-tolerance policies currently being used. Avenues for future research and theory development are also outlined.

No description available.

<p>Over the last century, developed countries have been successful in enhancing maternal health and reducing Maternal Mortality Ratio (MMR). By 2018, MMR across OECD countries and World Bank Group Regions have converged towards very low levels, averaging more than 5 deaths per 100,000 live births. The United States has become an outlier among the developed countries in maternal deaths and compares unfavorably to a number of poorer countries where the ratio has declined. In 2017, the US ranked worst in MMR among the 39 industrialized nations. United States has experienced almost a 142 percent increase in MMR from 1987-2018. According to the Centers for Disease Control and Prevention (CDC), every year in the US, more than 700 women die due to the pregnancy or childbirth-related complications, with 60 percent of these deaths being preventable. Within the US, MMR varies considerably, leaving large disparities across states as well as between all racial groups. This research study aims to understand the interplay of spatial and racial impacts on the variation of maternal mortality ratios within the US. The paper estimates Ordinary Least Squares (OLS) and Spatial Lag Models for MMR using cross-sectional US state data for 2012-2017, taken from CDC. The results show that the dominant root causes of high maternal mortality differ between black and white women. </p> <p> </p>

Thesis (MSD)--Boston University, Henry M. Goldman School of Dental Medicine, 2008 (Dept. of Health Policy and Health Services Research). / Includes bibliography: leaves 44-48. / 0bjective: The objective of this study is to detemine if there are differences by race or ethnicity in dental care provided at community health center clinics resulting in oral health disparities. This study also provides detailed information about the types of dental procedures received by patients at community health center clinics. Methods: This was a retrospective observational study design, consisting of a convenience sample of patients seen and care provided by senior dental students during their ten-week externship at twenty one Boston University Goldman School of Dental Medicine affiliated community health center clinics. The data collected was analyzed SAS version 9.1. Frequencies for categorical variables, means for continuous variable, bivariate analyses and generalized models of logistic regression analysis were performed with the main dependent variable of interest being patient’s race/ethnicity. Results: The total sample was 62,112 observations, of which 56% were females. Regression analysis found that Blacks were 1.23 times and Asians and others were 1.09 times more likely to get diagnostic procedures than Whites. Hispanics were just as likely to receive diagnostic procedures as Whites. Blacks, Hispanics, Asians and others were more likely to get preventive procedures when compared to Whites (p[less than or equal to]0.0001 ). Blacks were less likely to get restorative procedures than Whites (p[less than or equal to]0.0001) whereas Hispanics were as likely to get restorative procedures as Whites. Further generalized logistic regression models to predict specific procedures were performed which indicates that Blacks were 1.99 times, Hispanics were 1.72 times, Asians and others were 1.21 times more likely to get amalgam restorations compared to composite restorations than Whites. However, Blacks were as likely to get root canal therapy compared to extractions as Whites whereas Hispanics were 27% and Asians and others were 37% more likely to get root canal therapy versus extractions than Whites (p[less than or equal to]0.0001). Blacks were 0.55 times, Asians and others were 0.37 times less likely to receive fixed partial dentures compared to removable partial dentures than Whites (p[less than or equal to]0.0001) whereas Hispanics were just as likely to receive fixed Partial dentures as Whites. Conclusion: Disparities were seen in the receipt of dental services provided such as diagnostic, preventive, and restorative procedures based on race at community health center clinics. This surprising finding related to community health center clinics indicate the need for future research focused on reasons for these disparities as community health center clinics are primary care providers for underserved populations.

TITLE: Race, gender, and mental health outcomes in Tennessee AUTHOR INFO Eugene Annor Manik Ahuja PhD, MA1 Author Affiliations: 1College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States Background: Tennessee has been disproportionally burdened with high levels of mental health disorders. Over the last decade, Tennessee has consistently ranked in the bottom 10 U.S. states in prevalence of mental health disorders. While it is known that Tennessee ranks lower in mental health status, less is known of how these differences vary across race. Methods: We used cross-sectional data from the 2019 Behavioral Risk Factor Surveillance System, a nationally representative U.S. telephone-based survey of adults aged 18 years or older for the State of Tennessee (n=6,242). Chi-square tests were conducted to assess differences across race. Logistic regression analyses were conducted to test the association between gender and past month mentally unhealthy days, stratified by race. We coded mentally unhealthy days binary, at 15 or more mentally unhealthy days in the past month, and less than 15 days. We controlled for income, educational attainment, health insurance, and age. Results: Overall, 22.9% of American Indian/Alaska Natives, followed by White (14.8%), Black (13.6%) and Hispanic (12.0%) reported 15 or more mentally unhealthy days in the past month. Among Blacks, there were no significant differences between males (13.2%) and females (13.9%) for 15 or more past month mentally unhealthy days (p=.76), as well as among Hispanics (p=.17) Among Whites, females (16.6) reported a significantly higher (p Conclusions: Our findings reveal that among Blacks and Hispanics in Tennessee, there were no significant gender differences in mental health outcomes. White among Whites and American Indian/Alaska Natives, females reported a significantly higher rate of past month mentally unhealthy days. The current study reports that the gap among males and females in report of poorer mental health has narrowed, particularly among Blacks and Hispanics in Tennessee. Further efforts towards providing equitable access to mental health services across race and gender in Tennessee, is essential.

African Americans have lower vitamin D levels and reduced health outcomes compared to white Americans. Vitamin D deficiency may contribute to adverse health outcomes in African Americans. We hypothesized that race would be associated with vitamin D status and testing in African Americans veterans, and that vitamin D status is a major contributor to health care costs in African American veterans compared to white veterans. A retrospective analysis of the medical data in the Veterans Integrated Service Network 9 (southeastern United States) was performed, and 14 148 male veterans were identified. Race was designated by the patient and its relationship to vitamin D levels/status and costs was assessed. Vitamin D levels were significantly lower and the percent of patients with vitamin D deficiency was significantly higher in African American veterans. This difference was independent of latitude and seasonality. Vitamin D testing was done significantly more in white veterans compared to African American veterans (5.4% vs 3.8%). While follow-up testing was 42% more likely if a patient was found to be vitamin D deficient, white veterans were 34% more likely than African American veterans to have at least 1 follow-up 25-hydroxyvitamin D performed. African American veterans had significantly higher health care costs, which were linked to lower vitamin D levels; however, the cost differential persisted even after adjusting for vitamin D status. Vitamin D deficiency is highly prevalent in African American veterans and needs improved management within the Veteran Administration system. Vitamin D status appears not to be the sole contributor to increased health care costs in African American veterans.

Racial disparities in cardiovascular disease (CVD) have become a matter of national concern. We investigated racial disparities and trends in glycosylated hemoglobin, high-density lipoprotein (HDL), C-reactive protein, plasma homocysteine, albuminuria, and other risk factors among 4758 diagnosed hypertensive subjects age 18 years or older from the National Health and Nutrition Examination Survey, 1999-2006. Compared with non-Hispanic whites, Hispanics, and non-Hispanic blacks were more likely to have uncontrolled blood pressure (BP) (Hispanics odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.21-2.07; blacks OR: 1.42, 95% CI: 0.21-1.67), elevated glycosylated hemoglobin (Hispanics OR: 2.70, 95% CI: 1.89-3.87; blacks OR: 2.17, 95% CI: 1.70-2.77), albuminuria (Hispanics OR: 2.36, 95% CI: 1.71-3.27; blacks OR: 1.80, 95% CI: 1.47-2.20), and less likely to have central obesity (Hispanics OR: 0.68, 95% CI: 0.51-0.91; blacks OR: 0.70, 95% CI: 0.58-0.84). Blacks had lower risks of elevated serum cholesterol (OR: 0.81, 95% CI: 0.67-0.98) and low HDL (OR: 0.76, 95% CI: 0.61-0.94) than whites. The risk of high serum homocysteine was lower in Hispanics and higher in blacks compared with whites (Hispanics OR: 0.64, 95% CI: 0.46-0.90; blacks OR: 1.36, 95% CI: 1.14-1.63). These results highlight the need for targeted interventions to aggressively treat uncontrolled BP, elevated glycosylated hemoglobin in Hispanic and black hypertensive subjects, and high serum homocysteine in blacks, to reduce disparities in CVD risk factors and CVD-associated morbidity and mortality.

Breast cancer affects over three million women in the United States, but this disease burden is not shared equally across all races. Black women, in particular, are diagnosed with more advanced cancer at a younger age and experience a disproportionately high mortality rate compared to white women. Factors that contribute to such disparity include socioeconomic status, tumor biology, age, insurance status, comorbidities, obesity, patients’ reproductive history and barriers to quality care. These factors alone, however, do not account for all the racial differences in mortality and outcomes experienced by black women. There is a growing body of literature that indicates black women are not receiving the same treatment and care as white women. Black women are less likely to receive surgery, radiation therapy, hormone therapy and targeted therapy than white women. Black women are also more likely to experience delays in the initiation of treatment, early discontinuation of treatment and overall guideline non-concordant care. The current literature has presented widespread racial disparities in the treatment of black women with breast cancer. Future research needs to focus on tangible interventions such as physician bias training and patient navigators to mitigate the inequity of care in the treatment of breast cancer.

The benefits of prenatal care (PNC) are extensively documented; however, controversy surrounds the extent to which benefits are experienced among different racial groups. Determining whether PNC influences positive birth outcomes and if advantages differ by race is pertinent to attaining positive health outcomes. The purpose of this study was to examine the relationship between gestational weight gain (GWG), low birthweight (LBW), and PNC while weighing racial differences. The theoretical foundation was the motivation-facilitation theory of PNC access. Research questions were designed to (a) determine if there was a significant association between GWG and LBW, (b) determine if PNC had a mediating role if GWG was found to be associated with LBW, and (c) determine if PNC was a mediator and if that role differed between races. A quantitative, deductive correlational analysis was carried out using a retrospective observational approach. Spearman correlation showed that the relationship between GWG and LBW was significant (rs = 0.14, p < .001). Binary logistic regression was used for analysis and showed that the overall model was significant, Ï?2(12) = 50.29, p < .001, and that maternal age, race, marital status, GWG, education, body mass index (BMI), cigarette use, and gestational diabetes significantly affected the chances of LBW. Baron and Kenny's mediation analysis supported partial mediation for American Indian or Alaskan Native and Asian or Pacific Islander races and showed that PNC was significantly associated with birthweight. Based on these findings, providers can aim to implement motivational factors to increase the facilitation and use of PNC to decrease adverse birth outcomes and increase population health.