Monday, June 9, 2003

Research Towards the Elimination of Health Disparities

Yvonne T. Maddox, Ph.D. [bio]

Abstract:

While the overall health of the Nation has improved over the last two decades, there continue to be striking disparities in the burden of illness and death experienced by various racial and ethnic populations. These disparities include shorter life expectancy as well as higher rates of cardiovascular disease, cancer, infant mortality, birth defects, asthma, diabetes, stroke, sexually transmitted disease, and mental illness. Complex interactions among biological factors, the environment, and specific health behaviors are believed to contribute to these disparities, along with inequalities in income and education. Biomedical research has an important role to play in eliminating health disparities through (1)advancing our understanding of the development and progression of disease and disabilities that contribute to health disparities in minority populations (2) developing new or improved approaches for detecting or diagnosing the onset or progression of diseases and disabilities that contribute to health disparities, and (3) developing new or improved treatment and approaches for preventing or delaying the onset of progression of life-altering diseases and conditions. Furthermore, establishing and maintaining a research infrastructure which focuses on issues of recruitment, support and retention of diverse medical and behavioral research investigators is crucial to this endeavor. Along with research and a culturally diverse research workforce, a plan to eliminate racial and ethnic health disparities requires that researchers translate research advances into clear, culturally relevant information that individuals can understand in order to improve their health and well-being.

Learning Objectives:

By the end of the presentation participants should be able to:

1. Define racial and ethnic health disparities
2. Identify some underlying factors which contribute to health disparities
3. Establish a role for biomedical and behavioral research in eliminating health disparities
4. Describe some of the NIH initiatives on the subject of health disparities

Links:

1. Addressing Health Disparities: The NIH Program of Action

Innovations in HIV Prevention with Latina and African American Women at High Risk

Hortensia Amaro, Ph.D. (Keynote) [bio]

Abstract:

While Latina and African American women in the U.S. are disproportionately affected by HIV/AIDS, there continues to be a dearth of effective evidence-based approaches to prevent the spread of HIV infection in these populations.

This presentation will:

• review the epidemiology of HIV among women of color
• discuss limitations of traditional HIV prevention approaches
• identify gender- and culturally-specific HIV risk factors
• describe how marginalization and disempowerment based on social status affect HIV risk
• present findings from two new intervention studies focusing on immigrant Latinas and Latina and African American women with co-occurring disorders of addiction, mental illness and a history of trauma, and
• discuss areas for future HIV prevention research with Latina and African American women.

Learning Objectives:

By the end of the presentation participants should be able to:

1. Participants will become familiar with the epidemiology of HIV risk among Latinas and African American women.
2. Participants will be able to describe gender- and culturally-specific factors related to HIV risk in women.
3. Participants will be able to discuss the role of addiction, mental illness and trauma in HIV risk among Latina and African American women.
4. Participants will become familiar with intervention approaches to reduce HIV risk among Latina and African American women

Selected Citations:

1. Amaro, H. (1995). Love, Sex and Power: Considering Women's Realities in HIV Prevention. American Psychologist, 50(6), 437-447.
2. Amaro, H. and Raj, A. (2000). On the Margin: The Realities of Power and Women's HIV Risk Reduction Strategies. Journal of Sex Roles. 42(7/8):723-749.
3. Amaro, H., Vega., R.R., and Valencia, D. (2001). Gender, Context, and HIV Prevention Among Latinos. In: M Aguirre-Molina, C. Molina and R. Zambrana (Eds). Health Issues in the Latino Community. (pp. 301-323). Josey- Bass Publishers, San Fransisco, CA.
4. Gomez, C.A. and VanOss Marin, B. (1996). Gender, Culture, and Power: Barriers to HIV-Prevention Strategies for Women. The Journal of Sex Research, 33(4), 355-362.
5. Raj, A., Amaro, H., and Reed, E. (2001). Culturally Tailoring HIV/AIDS Prevention Programs: Why, When and How. In S.S. Kazarian and David R. Evans (eds.) Handbook of Cultural Health Psychology (pp.195-239). Academic Press.
6. Wingood, G.M., and DiClemente, R.J. (1998). The Influence of Psychosocial Factors, Alcohol, Drug Use on African-American Women's High-Risk Sexual Behavior. American Journal of Preventive Medicine, 15(1), 54-59.
7. Wingood, G.M. and DiClemente, R.J. (2000). Application of the Theory of Gender and Power to Examine HIV-Related Exposures, Risk Factors, and Effective Interventions for Women. Health Education and Behavior, 27(5), 539-565.
8. Wyatt, G.W., Myers, H.F., Williams, J.K., Ramirez Kitchen, C., Loeb, T., Vargas Carmona, J., Wyatt, L.E. Chin, D., Presley, N. (2002). Does a History of Trauma Contribute to HIV Risk for Women of Color? Implications for Prevention and Policy. American Journal of Public Health, 92(4), 660-665.

Links:

1. The Institute on Urban Health Research (IUHR), Bouve College of Health Sciences, Northeastern University, Boston, MA.

Tuesday, June 10, 2003

Racial and Ethnic Data Issues for Epidemiologic Studies

Olivia Carter-Pokras, Ph.D. [bio]

Selected Citations:

1. American Anthropological Association. Statement on "Race". May 17, 1998. Available at: http://www.aaanet.org/stmts/racepp.htm
2. American Association of Physical Anthropologists. AAPA Statement on Biological Aspects of Race. American Journal of Physical Anthropology. 1996;101:569-570. Available at: http://www.physanth.org/positions/race.html
3. American Sociological Association. Statement of the American Sociological Association on the Importance of Collecting Data and Doing Social Scientific Research on Race. August 9, 2002. Available at: http://www.asanet.org/governance/racestmt.html
4. American Sociological Association. 2003. The Importance of Collecting Data and Doing Social Scientific Research on Race. Washington, DC: American Sociological Association. Available at: http://www.asanet.org/media/asa_race_statement.pdf
5. Bennett T, Bhopal R. US health journal editor's opinions and policies on research in race, ethnicity, and health. J Natl Med Assoc. 1998 Jul;90(7):401-8.
6. Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health 2003 Apr;57(4):254-8.
7. Carter-Pokras O, Baquet C. What is a "health disparity"? Public Health Rep 2002 Sep-Oct;117(5):426-34.
8. International Committee of Medical Journal Editors. Uniform Requirements for Manuscripts Submitted to Biomedical Journals. October 2001. Available at: http://www.icmje.org/
9. Jones CP, LaVeist TA, Lillie-Blanton M. "Race" in the epidemiologic literature: an examination of the American Journal of Epidemiology, 1921-1990.
10. Mays VM, Ponce NA, Washington DL, Cochran SD. Classification of race and ethnicity: implications for public health. Annu Rev Public Health 2003;24:83-110.
11. National Institutes of Health. NIH Policy On Reporting Race And Ethnicity Data: Subjects In Clinical Research. August 2001. Available at: http://grants1.nih.gov/grants/guide/notice-files/NOT-OD-01-053.html
12. Williams DR. The concept of race in Health Services Research: 1996 to 1990. Health Serv Res. 1994 Aug;29(3):261-74.
13. Kaplan JB, Bennett T. Use of Race and Ethnicity in Biomedical Publication. JAMA 2003; 289:2709-2716

Genomic Definition of Self and Group Identity: Implications for Biomedical Research [archived webcast]

Charles Rotimi, Ph.D. [bio]

Abstract:

Genomic science promises to have profound consequences on our understanding of issues surrounding self and group identity including ethnicity/tribalism and race/racism. The successful completion of the sequencing of the human genome has catapulted us into a brave new world, a world in which we are challenged "to think out of the box" and look at ourselves in ways we never before thought possible. We now have the tools to do whole genome analysis in our quest to describe the pattern of genetic variation and its relationship to the natural history of human origins and the differential distribution of diseases by groups, populations and geography. The new genomic tools will help us begin to answer the following questions: How does genomic variation inform the definition of "populations" used by geneticists and epidemiologists today? What is the relationship between genomic variation and race? What is the relationship between self-identity and the more complex notion of ancestry? Does group identity mean group ancestry? What does it mean to self identify as African American or Hispanic? This presentation will offer some suggestions that are likely to raise additional questions.

Learning Objectives:

By the end of the presentation participants should be able to:

1. Understand differences in genetic variations within and between groups and the implications of these variations in identifying racial groups in the US.
2. Become aware of new data from the Human Genome Project.
3. Discuss the biological, social, and environmental determinants of health disparities and their interactions.
4. Understand the implications of pharmacogenomics on health disparities

Selected Citations:

1. Stacey et al. The Structure of Haplotype Blocks in the Human Genome. Science Vol 296: 21 June 2002.
2. David Rotman. Genes, Medicine, and the new race debate. MIT Technology Review, June 2003.
3. Summary of the Symposium on Genetic Variation and Gene Environment Interaction in Human Health and Disease, April 16, 2003.
4. Charles N. Rotimi, PhD. Genomic Definition of Self and Group Identity: Implications for Biomedical Research.
5. Neil Risch, Esteban Burchard, Elad Ziv and Hua Tang. Categorization of humans in biomedical research: genes, race and disease. Genome Biology 2002, 3(7):comment 2007.1–2007.12 .
6. Rosenberg et al. Genetic Structure of Human Populations. Science Vol 298: 20 Dec 2002.
7. Wilson et al. Population genetic structure of variable drug response. Nature Genetics, Volume 29, November 2001, 268-269.
8. Braun L. Race, Ethnicity, And Health: Can Genes Explain Disparities? Perspectives in Biology and Medicine, vol 45, no 2 (Spring 2002: 159-74).
9. Pamela Sankar and Mildred K. Cho. Toward a New Vocabulary of Human Genetic Variation. Science VOL 298 15 November 2002.

Wednesday, June 11, 2003

Using Health and Family Data from the National Center for Health Statistics to Study Health Disparities

Anjani Chandra, Ph.D. [bio]

Abstract:

As the nation's principal health statistics agency, the National Center for Health Statistics provides statistical information to guide actions and policies to improve the health of the American people. With its roots in the National Vital Statistics System over 40 years ago, and its current organizational residence in the Centers for Disease Control and Prevention, NCHS's mission is clear - to monitor the nation's health by providing accurate, relevant, and timely data. NCHS provides mechanisms for obtaining consistent, uniform statistics that allow for:

• comparison across population groups, types of health care providers, and states and local areas
• planning, targeting, and assessing the effectiveness of public health programs
• identifying health problems, risk factors, and disease patterns.

As will be shown in the presentation, "health" data are defined in the broad sense, as it is recognized that a host of family and environmental factors are relevant for the achievement and maintenance of good health. We first provide an overview of the major data systems at NCHS, as well as some of the approaches used to ensure methodologically sound and culturally sensitive data collection mechanisms at the Center. We then showcase data systems related to reproductive and perinatal health, including the National Natality Dataset and the National Survey of Family Growth, in order to highlight the potential for research in health disparities offered by NCHS data.

Learning Objectives:

By the end of the presentation participants should be able to:

1. Familiar with the types of data collected by the National Center for Health Statistics (NCHS).
2. Able to describe approaches used by NCHS to ensure methodological soundness and cultural sensitivity in the data it collects.
3. Able to discuss the potential uses of NCHS reproductive and perinatal data to address health disparities.

Selected Citations:

Illustrative publications describing efforts to ensure methodologically sound and culturally sensitive data collection instruments at NCHS:

1. Loue S (1999). The Assessment of Immigration Status in Health Research. Vital and Health Statistics Series 2(127). Hyattsville, MD: National Center for Health Statistics.
2. Miller J (2001). Early Childhood Chronic Illness: Comparability of Maternal Reports and Medical Records. Vital and Health Statistics Series 2(131). Hyattsville, MD: National Center for Health Statistics.
3. Miller K. (2002). Cognitive Analysis of Sexual Identity, Attraction and Behavior Questions. Cognitive Methods Staff Working Paper Series, No. 32. Hyattsville, MD: National Center for Health Statistics.
4. Sirken M (2002). Integrating Measurements of Disability in Federal Surveys: Seminar Proceedings. Hyattsville, MD: National Center for Health Statistics.
5. Sudman S, Warnecke R, Johnson T, et al. (1994). Cognitive Aspects of Reporting Cancer Prevention Examinations and Tests. Vital and Health Statistics Series 6(7). Hyattsville, MD: National Center for Health Statistics.

Illustrative publications by NCHS researchers based on the major NCHS data systems; most of these are accessible from the NCHS webpage: www.cdc.gov/nchs:

1. Abma J, Chandra A, Mosher W, Peterson L, Piccinino L (1997). Fertility, Family Planning, and Women's Health: New Data from the 1995 National Survey of Family Growth. Vital and Health Statistics Series 23(19). Hyattsville, MD: National Center for Health Statistics.
2. Anderson R (2002). Deaths: Leading Causes for 2000. National Vital Statistics Reports 50(16). Hyattsville: National Center for Health Statistics.
3. Blackwell D, Tonthat L (2002). Summary Health Statistics for U.S. Children: National Health Interview Survey, 1998. Vital and Health Statistics Series 10(208). Hyattsville: National Center for Health Statistics.
4. Burt C, McCaig L (2001). Trends in hospital emergency department utilization: United States, 1992-99. Vital and Health Statistics Series 13(150). Hyattsville: National Center for Health Statistics. Cohen R, Ni H, Hao C. Trends in Health Insurance Coverage by Poverty Status among Persons Uunder 65 Years of Age: United States, 2002. Health e-stat available at http://www.cdc.gov/nchs/products/pubs/pubd/hestat/insurance.htm.
5. Flegal K, Carroll M, Ogden C, Johnson C (2002). Prevalence and Trends in Obesity among U.S. Adults, 1999-2000. JAMA 288:1723-7.
6. Hajat A, Lucas JB, Kington R (2000). Health Outcomes among Hispanic Subgroups: United States, 1992-1995. Advance Data from Vital and Health Statistics No. 310. Hyattsville, MD: National Center for Health Statistics.
7. Keppel K, Pearcy J, Wagener D (2002). Trends in Racial and Ethnic-Specific Rates for the Health Status Indicators: United States, 1990-98. Healthy People Statistical Notes #23. Hyattsville: National Center for Health Statistics.
8. Martin J, Hamilton B, Ventura S, Menacker F, Park M, Sutton P (2002). Births: Final Data for 2001. National Vital Statistics Report 51(2). Hyattsville: National Center for Health Statistics. Mosher W, Deang L, Bramlett M (2003). Community Environment and Women's Health Outcomes: Contextual Data. Vital and Health Statistics Series 23(23). Hyattsville, MD: National Center for Health Statistics.
9. Ventura S, Mosher W, Curtin S, Abma J, Henshaw S (2000). Trends in pregnancies and pregnancy rates by outcome: Estimates for the United States, 1976-96. Vital and Health Statistics Series 21(56). Hyattsville: National Center for Health Statistics.
   

African Americans and HIV: Context and Epidemiology

Adaora A. Adimora, M.D., M.P.H [bio]

Abstract:

Although the U.S. AIDS epidemic was originally perceived as an affliction of white, gay men, African Americans and Latinos have accounted for a majority of newly reported AIDS cases since 1991 and now comprise a majority of all AIDS cases reported to date. The African American and Latino preponderance is particularly striking among women and heterosexually-infected men. Neither differential access to anti-retroviral drugs nor known differences in the number of sexual partners or use of condoms explain the magnitude of the disparity. Recent work in the epidemiology of sexually transmitted infections (STI) points to the importance of sexual networks in influencing the dissemination of STI in populations. Mathematical models have shown that the prevalence of concurrent partnerships - an individual's having more than one sexual partership at a time - can have a powerful effect on dissemination even with the same average number of partners per year.

Data from the 1995 National Survey of Family Growth indicate that 21% of African American women had one or more concurrent partnerships between 1991 and 1995, about double the percentage for other women. Prevalence was lowest among married women, but only about 25% of African American women were married in 1995 - a percentage about half that of other women. In a study of African Americans in the general population of a 13-county region in Eastern North Carolina, we found a 5-year concurrency prevalence of 30% for women and 50% for men, and a one-year prevalence of nearly 20% for women and 30% for men. Men who were unmarried or who had a history of incarcertion were more likely to have had concurrent partnerships, as were women who had had a recent sexual partner who had been incarcerated. Respondents who had had concurrent partnerships also reported having had a nonmonogramous partner. Focus group interviews about community life and contextual factors affecting sexual behavior pointed to pervasive economic and racial oppression, boredom, substance abuse, and a shortage of black men due to high mortality and incarceration as factors responsible for widespread concurrency among unmarried persons. Contextual forces that interfere with stable marriage and long-term partnerships may contribute to African Americans' much higher rates of HIV and other STI.

Learning Objectives:

By the end of the presentation participants should be able to:

1. Describe the distribution of heterosexually-acquired HIV/AIDS among U.S. racial/ethnic minorities.
2. Discuss factors, including sexual network characteristics, that might be responsible for intensifying heterosexual transmission in population groups.
3. Describe the prevalance and correlates of concurrent sexual partnerships among U.S. women and among African Americans in the southeast U.S.
4. Discuss the role of contextual factors in influencing sexual network patterns that may be responsible for elevated heterosexual transmission of HIV in the African American population.

Selected Citations:

1. Adimora AA, Victor J. Schoenbach VJ. Contextual factors and the Black-White disparity in heterosexual HIV transmission. Epidemiology, 13:707-712.
2. Adimora AA, Schoenbach VJ, Bonas DM, Donaldson KH, Martinson FEA, Stancil TR. Concurrent sexual partnerships in the 1995 National Survey of Family Growth. Epidemiology 2002;13:320-327.
3. Adimora AA, Schoenbach VJ, Martinson FEA, Donaldson KH, Fullilove R, Samsa G, Cates W Jr., Aral SO. Effects of social context on sexual relationships among rural African Americans. Sex Trans Dis 2001;28:69-76.

Thursday, June 12, 2003

The Development, Implementation, and Assessment of a Culturally Innovative HIV/AIDS Intervention for Hispanic Drug Injectors.

Antonio Estrada, Ph.D. [bio]

Abstract:

The video presentation will highlight the development, implementation, and assessment of a culturally innovative HIV risk reduction model for Hispanic (Mexican American) injection drug users (IDUs). The behavioral model predicting behavioral intentions and self-efficacy to reduce HIV risk behaviors included specific demographic characteristics of the sample (i.e., age, education, employment status), cultural factors (i.e., familism, traditionalism, religiosity, and acculturation), ‘tecato’ - Mexican American drug injector sub-cultural factors (i.e., machismo, respeto), behavioral factors (STDs, sex risk, IDU risk) and psychosocial factors (self-esteem and social support), as well as other factors derived from the Theory of Reasoned Action (risk perception, peer influences, attitudes/beliefs, benefits of HIV risk reduction, HIV/AIDS knowledge, and intentions to reduce HIV risks). A two-staged methodology using both qualitative and quantitative data collection techniques was used to assess several of the above concepts, especially those related to culture. Results demonstrated that both cultural and psychosocial factors are predictive of behavioral intentions and self-efficacy to reduce HIV risk behaviors among Hispanic IDUs.

Learning Objectives:

By the end of the presentation participants should be able to:

1. Discuss the importance of HIV/AIDS risk reduction with at-risk groups.
2. Assess the extent to which models of behavior change include cultural concepts.
3. Identify Hispanic cultural strengths that could be used to motivate behavior change.
4. Examine the need to include cultural measures in research practice.

Selected Citations:

1. Ajzen, I., and Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice Hall.
2. Ajzen, I., and Madden, T. (1986). Prediction of goal-directed behavior: Attitudes, intentions, and perceived behavioral control. J Experimental Soc Psychol, 49, 453-474.
3. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211.
4. Bandura, A. (1994). Social cognitive theory and exercise of control over HIV infection. In R. DiClemente and J. Peterson (Eds.), Preventing AIDS: Theories and methods of behavioral interventions (pp. 25-59). New York: Plenum.
5. Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman. adolescents' HIV related sexual risk behavior. Health Education Quarterly, 19, 263-277.
6. Becker, M.H. and Joseph, J.G. (1988). AIDS and behavioral change to reduce risk: A review. American Journal of Public Health, 78, 394-410.
7. Becker, M.H.: "The Health Belief Model and Personal Health Behaviors," Health Ed. Mono. 2: 220-243, 1974.
8. Booth, R.E., Koester, S., Brewster, J.T., Weibel, W.W., and Fritz R. (1991). Intravenous drug users and AIDS: risk behaviors. American Journal of Drug and Alcohol Abuse, 17, 337-353.
9. Estrada, A.L. and Quintero, G.A.: "Redefining Categories of Risk and Identity: The Appropriation of AIDS Prevention Information and Constructions of Risk," in W. Elwood (Ed.), Power in The Blood: AIDS, Politics, And Communication, Ch. 11, pp. 133-147, 1999.
10. Fishbein, M. (1993). Introduction. In D.J. Terry, C. Gallois, and M. McCamish (Eds.), The theory of reasoned action: Its application to AIDS preventive behavior. Oxford, England: Pergamon Press.
11. Fisher, W.A., Fisher, J.D., and Rye, B.J. (1995). Understanding and promoting AIDS preventive behavior: Insights from the theory of reasoned action. Health Psychology, 14, 255-264.
12. Grund, J.P.C., Friedman, S.R., Stern, L.S., Jose, B., Neaigues, A., Curtis, R., Des Jarlais, D.C. (1996). Syringe mediated drug sharing among injecting drug users: patterns, social context and implications for transmission of blood-borne pathogens. Social Science and Medicine, 5, 691-703.
13. Marin, G. and Marin, B.V.: Research With Hispanic Populations. Applied Social Research Methods Series Vol. 23, Sage Publications, 1991.
14. Marin G. AIDS prevention among Hispanics: needs, risk behaviors and cultural values. Public Health Reports, 1989; 104 (5), 411-414.
15. Marin G. Defining culturally appropriate community interventions: Hispanics as a case study. Journal of Community Psychology, 1993; 21, 149-161.
16. Mikawa, J.K., et al.: "Cultural Practices of Hispanics: Implications for the Prevention of AIDS," Hisp J Beh Sci., 14(4): 421-433, 1992.
17. Quintero, G.A.and Estrada, A.L. (1998). Cultural models of masculinity and drug use: machismo, heroin, and street survival on the U.S.-Mexico border. Contemporary Drug Problems, 25, 147-168.
18. Singer, M.: "Confronting the AIDS Epidemic Among IV Drug Users: Does Ethnic Culture Matter?," AIDS Educ & Prev., 3(3): 258-283, 1991.

Roots of American Indian/Alaska Native: Indigenous Health Disparities

Michael Bird, MSW, MPH [bio]

This presentation will discuss the nature,extent and context of Health Disparities for American Indian and Alaska Native Populations as well as Indigenous Populations through out the world. It will offer an alternative to the myth of personal responsibility as the most significant factor as to why some communities are healthy and others are not.

Learning Objectives:

By the end of the presentation participants should be able to:

1. Understand the nature and extent the of Indigenous Health Disparities.
2. Understand the contextual nature of Indigenous Health Disparities.
3. Understand that this issue is an internationl issue for Indigenous Peoples in the internatinal community.

Selected Citations:

1. American Holocaust, David Stannard. Oxford Press, 1992.
2. I Rigoberta Menchu, An Indian Woman in Guatemala. Verso Press, 1984.
3. American Indian Holocaust/Survival A Population History Since 1492, Russell Thornton. University of Oklahoma Press. 1987.
4. From A Native Daughter:Colonalism/Sovreignty in Hawaii, Haunani Kay Trask. Common Courage Press,1993.

Links:

1. American Indian, Alaska Native, and Native Hawaiian Caucus (AIANNHC).
2. Michael Bird statement to the U.S. Commission on Civil Rights, 10/17/2003.

Friday, June 13, 2003

Racial Disparity in Infant Mortality Among African American Women: A Comparative Study

Fran T. Close, Ph.D. [bio]

Abstract:

Infant mortality is a tragedy that affects families across all racial and ethnic groups. In the United States and Florida, African American newborns die two-to-three times more often than White babies. Though the exact cause for the disparity of infant mortality among African Americans is not known, factors thought to contribute to the disparity include the health of the mother before and during pregnancy, high stress levels experienced by some women and cultural beliefs that result in at-risk behaviors. The Florida Racial and Ethnic Approaches to Community Health 2010 Project examined the root causes of the disparities in infant mortality rates in two Florida counties. Gadsden County and Hillsborough County represent a small rural community and a large urban community, respectively. These counties were chosen because they have racial disparities in infant mortality rates in excess of the state or other comparable Florida counties. Surveys were administered to African American women of childbearing age (18-44) in both counties. Focus groups were also conducted in various venues throughout the communities. The surveys and focus group protocols concentrated on the intergenerational health habits, psychological and socioeconomic factors that may contribute to adverse pregnancy outcomes in African American women. Based on the Periods of Risk Model, it was shown the contributing risk factors for infant mortality in both counties related to prematurity and Maternal Health. These factors include douching practices, maternal infections, women’s general health condition, stress and socioeconomic status. For example, women reported a high prevalence of douching at least once a month (Gadsden 88%; Hillsborough 47%). It is hoped that this study will raise awareness and provide information to African American women of childbearing age through community-driven activities that would improve the pregnancy outcomes of women of color.

Learning Objectives:

By the end of the presentation participants should be able to:

1. Have a greater understanding of the racial/ethnic disparity and the epidemiology of infant mortality in the US and Florida.
2. Be able to identify factors that contribute to racial/ethnic disparity of infant mortality in two Florida counties.
3. Understand the benefits of using both surveys and focus groups to obtain health data in an African American population.
4. Discuss how research findings should be used to create appropriate community-based interventions for African American women in two Florida counties.

Seat Belt Use Among African-Americans: Utilizing Key Stakeholders to Decrease the Disparity.

Otis Cosby, M.D., Ph.D. [bio]

Abstract:

Seat belt use among African Americans (AA) has been a focus area for research and outreach activities at Meharry Medical College since the release of its 1999 landmark report ‘Achieving a Credible Health and Safety Approach to Increasing Seat Belt Use among African Americans’. The report clearly documented that blacks were less likely to buckle up than whites, particularly among AA youth. Interest was stimulated to address this issue as a public health crisis from many federal, state, and private organizations, including the National Highway Traffic Safety Administration, General Motors Corporation, and State Farm Insurance Company. To further the research activities, enhance outreach efforts, and encourage states legislators to support primary seat belt laws, the Meharry-State Farm Alliance was created. This partnership’s key objective is to decrease morbidity and mortality associated with motor vehicle crashes by emphasizing primary prevention as a means to reduce the disparity among African Americans; this is the focus of this presentation.

Learning Objectives:

By the end of the presentation participants should be able to:

1. To discuss the rates of seat belt use among minority groups
2. To discuss mortality and morbidity data associated with motor vehicle crashes
3. To differentiate between seat belt use rates in primary versus secondary law states
4. To review the outcomes of research studies conducted by Meharry Medical College
5. To highlight the importance of partnerships to address this issue
6. To discuss the plan for addressing seat belt use by African Americans through the Meharry – State Farm Alliance
7. To highlight the role that every citizen must play to reduce morbidity/mortality through primary prevention

Selected Citations:

1. Ellis H, Nelson B, Cosby O, et. al., 2000; Achieving A Credible Health and Safety Approach to Increasing Seat Belt Use Among African Americans. Journal of Health Care for Poor and Underserved, 11(2), 145-149.
2. Achieving A Credible Health and Safety Approach to Increasing Seat Belt Use Among African Americans (Full Report), Department of Occupational and Preventive Medicine, Meharry Medical College, May 1999.
3. Blue Ribbon Panel to Increase Seat Belt Use Among African Americans: A Report to the Nation, December 2000, DOT H5809185
4. National Occupant Protection Use Survey, 2000. Controlled Intersection Study, National Highway Traffic Administration, DOT HS 809318
5. Motor Vehicle Traffic Crash Fatality and Injury Estimates for 2000, National Highway Traffic Safety Administration, November 2001.
6. Traffic Safety Facts, 2000, Occupant Protection, National Highway Traffic Safety Administration, DOT HS 809327
7. Seat Belts and African Americans – 2000 Report, The Facts (to Buckle Up America), DOT HS 808 866
8. Safety Belt Use by African Americans Registers Sharp Increase to Record Level, Latest NHTSA Belt Use Survey Shows, News Report, U.S. Department of Transportation, March 10, 2003; NHTSA 5-03.

Links for participants:
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   Continuing education credits
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Last Updated: 06/11/03 by Raj, 09/06/06, 12/30/2009 by Vic