Minority Health: Recent Findings
Using pedometers to set activity goals increases physical activity among native elders.
Researchers studied the use of pedometers to increase walking, physical activity, and fitness levels over a 6-week period among American Indian and Alaska Native primary care patients. Participants achieved significant improvements on most outcomes, which included step counts, self-reported physical activity and well-being, and a 6-minute walk test.
Source: Sawchuk, Russo, Charles, et al., Am Indian Alsk Native Ment Health Res 18(1):23-41, 2011. See also Sawchuk, Russo, Bogart, et al., Prev Chronic Dis 8(3):1-9, 2011; Sawchuk, Charles, Wen, et al., Prev Med 47:89-94, 2008; and Sawchuk, Bogart, Charles, et al, Am Indian Alsk Native Ment Health Res 15(1):1-17, 2008 (AHRQ grant HS108S4).
Study compares treatments to overcome phobia in Asian Americans.
Researchers compared a standard in vivo exposure treatment for phobia, including catastrophic thinking and general fear, in Asian Americans with a culturally adapted similar treatment. They found that Asian Americans with low acculturation benefitted more from the culturally adapted treatment, but the two treatments were equally effective for Asian Americans with high acculturation.
Source: Pan, Huey, and Hernandez, Cultur Divers Ethnic Minor Psychol 17(1):11-22, 2011 (AHRQ grant HS10870).
Twenty-seven percent of elementary school children living in Puerto Rico are obese.
According to this 2008 study, elementary school children in Puerto Rico have higher rates of obesity (27 percent) than same-age Hispanic children (25 percent) and non-Hispanic white or black children (19 percent) living in the United States. Another 11 percent of Puerto Rican elementary school children met the criteria for being overweight.
Source: Rivera-Soto, Rodriguez-Figueroa, and Calderon, Puerto Rico Health Sci J 29(4):357-363, 2010 (AHRQ grant HS14060).
Race is one of several factors in the Nation’s epidemic of childhood obesity.
According to this study, 2.7 million U.S. children are severely obese, an increase of more than 300 percent since 1976. Researchers examined data representing 71 million U.S. children and found that black and Mexican American boys aged 12 to 19 are most likely to be severely obese, and children from poor families are also at increased risk for severe obesity. As in adults, severe obesity in children and adolescents can lead to chronic health problems, such as diabetes and cardiovascular disease.
Source: Skelton, Cook, Auinger, et al., Acad Pediatr 9(5):322-329, 2009 (AHRQ grant HS13901).
Extrapulmonary TB occurs most often in black men.
Although tuberculosis most often affects the lungs, it can also infect other parts of the body such as the lymph nodes and various organs. This extrapulmonary type of TB most often signals a compromised immune system, such as from HIV disease. The researchers compiled data on all 2,142 TB cases reported in the State of Tennessee from 2000 to 2006 and found that more than one-fourth (26.1 percent) were extrapulmonary in nature. The rate of extrapulmonary TB was highest in black men (5.93 per 100,000, compared with black women (3.21), men of other races (1.01), and women of other races (0.58).
Source: Fiske, Griffin, Erin, et al., BMC Infect Dis 10(16):1-8, 2010 (AHRQ grant HS13833).
MRSA infections have increased among American Indian/Alaska Native individuals.
Researchers examined outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) infections among American Indians and Alaska Natives (AI/ANs) and found that nationwide hospitalization rates for MRSA infection in AI/ANs increased between 1996 and 2005 (from 4.6 to 50.6 per 100,000). Hospitalization rates were highest for young AI/AN children and nonelderly adults, and skin and soft tissue infections were the most commonly diagnosed. The highest prevalence of MRSA infections were in the Indian Health Service regions of Alaska and the Southwest.
Source: Byrd, Holman, Bruce, et al., Clin Infect Dis 49(7):1009-1015, 2009 (AHRQ Publication No. 10-R016)* (Intramural).
Poor blacks have the worst long-term outcomes from work-related back pain.
This review of outcomes among workmen's compensation (WC) claimants in Missouri found that more than 6 years after settlement of WC claims, lower socioeconomic status, black race, and poor early adjustment were associated with poorer long-term adjustment among claimants with low back pain. These individuals were found to have higher levels of pain, pain-related disability, and catastrophic thinking while in pain. Black claimants also had higher rates of occupational disability than other claimants, as evidenced by long-term unemployment and receipt of Social Security disability.
Source: Chibnall and Tait, Pain Med 10(8):1378-1388, 2009 (AHRQ grants HS13087 and HS14007). See also Bernstein, Gallagher, Cabral, and Bijur, Pain Med 10(1):106-110, 2009 (AHRQ grant HS13924).
Differences in socioeconomic status in childhood correlate with racial differences in disability in adulthood.
This researcher analyzed 1998-2006 data on community-dwelling blacks and whites, beginning at age 65 and continuing every 2 years. She looked at health conditions, behaviors, and disability at baseline in 1998 and compared adult socioeconomic status (SES) with childhood SES. Compared with white parents, black parents of study participants had fewer years of education, and black fathers were less likely to work in certain occupations, such as professional and sales jobs. Black fathers also were more likely to be absent or deceased when black participants were growing up. As adults, black participants had lower educational levels, income, and wealth compared with whites. Over the course of the study, blacks reported more disabilities than whites, and their disabilities increased over time.
Source: Bowen, Soc Sci Med 69:433-441, 2009 (AHRQ grant HS13819).
Perceived racism among black women is linked to socioeconomic position.
This study of 1,249 women, aged 40 to 79, living in Connecticut found that both individual and neighborhood socioeconomic position (SEP) may play a role in understanding how racial discrimination is perceived, measured, and processed. Black women who had higher levels of education reported more racial discrimination than those with less than 12 years of education. Interestingly, income and occupation were not associated with perceived racial discrimination among the women in this study.
Source: Dailey, Kasl, Holford, et al., Ethn Health 15(2):145-163, 2010 (AHRQ grant HS15686).
Older Mexican American men are more accepting than others of physician-assisted suicide.
In this study, Mexican Americans aged 60 to 89 reported stronger agreement with legalizing physician-assisted suicide (52.7 percent) than non-Hispanic whites (33.7 percent), and Mexican American men were more than twice as likely as Mexican American women to agree with it. High religiosity was not a predictor of opposition to legalizing physician-assisted suicide among Mexican Americans, but among non-Hispanic whites, those who were highly religious were much less likely to support its legalization.
Source: Espino, Macias, Wood, et al., J Am Geriatr Soc 58(7):1370-1375, 2010 (AHRQ grant HSl4064).
Minority pediatricians are more likely than white pediatricians to care for minority children.
This study found that minority pediatricians treated an average of 20 percent more minority children than white pediatricians; the percentage of minority patients was highest for Hispanic pediatricians (57.9 percent) and black pediatricians (57.6 percent), compared with 33.4 percent for white pediatricians and 40.6 percent for Asian pediatricians. Minority pediatricians also took care of many more publicly insured or uninsured patients than white pediatricians.
Source: Basco, Cull, O'Connor, and Shipman, Pediatrics 125(3):460-467, 2010 (AHRQ grant HS15679). See also Sabin, Nosek, Greenwald, and Rivara, J Health Care Poor Underserved 20:896-913, 2009 (AHRQ grant HS1S676).
Researchers examine patients’ general attitudes toward doctors’ race and ethnicity.
Using a telephone survey, researchers asked 695 whites and 510 blacks in Hamilton County, OH, how they felt about two dimensions of technical competence and interpersonal skills. They found that black patients were more likely than white patients to believe that same-race doctors would better understand their health problems (7 percent vs. 12 percent), and they expected to be more at ease with same race doctors than white patients (27 percent vs. 20 percent). Blacks also were more likely than whites to feel the same way about physicians born in the United States.
Source: Malat, van Ryan, and Purcell, J Natl Med Assoc 101(8):800-807, 2009 (AHRQ grant HS13280).
Health literacy test found valid for both English- and Spanish-speaking individuals.
These researchers developed and validated the Short Assessment of Health Literacy—Spanish and English and in a test with 201 Spanish-speaking and 202 English-speaking individuals, found it to have good reliability and validity.
Source: Lee, Stucky, Lee, et al., Health Serv Res 45(4):1105-1120, 2010 (AHRQ grant HS13233).
CAHPS survey instrument developed in collaboration with Choctaw Nation Health Services program.
Working together, representatives from AHRQ’s Consumer Assessment of Healthcare Providers and Systems (CAHPS) program and the Choctaw National Health Services program have developed the CAHPS American Indian Survey for use in evaluating Choctaw patient experiences at the tribe’s various Indian Health Service (IHS) clinics in Oklahoma. The survey has been field-tested and found to be valid; it will be used as the basis for developing additional survey instruments for the IHS to measure quality of care across various health care programs serving tribes in other parts of the country.
Source: Weidmer-Ocampo, Johansson, Dalpoas, et al., J Health Care Poor Underserved 20(3):695-712, 2009 (AHRQ grants HS09204 and HS16980).
Using a list of common surnames can help improve estimates of race/ethnicity in patient data.
According to this study, using a list of relatively common surnames from the 2000 Census can yield more accurate estimates of racial/ethnic disparities in care. The 151,671 surnames listed by at least 100 individuals represent nearly 90 percent of all individuals captured by the census. Using the self-reported racial/ethnic affiliations for each surname, together with geographical information, researchers can calculate a set of likelihoods for someone with a specific surname being white, black, Hispanic, or so on.
Source: Elliott, Morrison, Fremont, et al., Health Serv Outcomes Res Methodol 9:69-83, 2009 (AHRQ contract 282-00-0005).
Researchers can safely omit race and ethnicity from cesarean rate risk-adjustment models.
Perinatal outcomes such as infant and maternal death, prematurity, and cesarean delivery are used as a measure of the quality of obstetric care. These less desirable outcomes are known to be higher in the black population than in the white population. The objective of this study was to see if adding race and ethnicity to an otherwise identical model would improve the predictive impact of the model. Researchers tested two risk-adjustment models for primary cesarean rates and found that the two models did not differ substantially in predictive discrimination or in model calibration. They suggest that race and ethnicity can safely be left out of cesarean rate risk-adjustment models.
Source: Bailit and Love, Am J Obstet Gynecol 69:e1-e5, 2008 (AHRQ grant HS14352).
- Researchers examine risk of workplace injury and how racial/ethnic disparities in risk change over time.
The researcher estimated individual workplace injury and illness risk over time for a group of American workers who participated in a 10-year study (1988-1998) and found that white men had a high risk of injury relative to other groups (white women, black men and women, and Latino men and women). Among women, black women had the highest risk of injury.
Berdahl, J Public Health 98(12):2258-2263, 2008 (AHRQ Publication No. 09-R020)* (Intramural).
- Study results in culturally appropriate survey instruments for use with Hmong Americans.
Because of its history of refugee status, low proportion of English speakers, and cultural beliefs, the Asian Hmong population in central California has low involvement with health care institutions. The researchers worked with Hmong community leaders to develop and focus-group test a linguistically and culturally sensitive survey that can be used to assess knowledge about hypertension care in this population.
Source: Wong, Mouanoutoua, and Chen, J Cult Divers 15(1):30-36, 2008 (AHRQ grant HS10276).
Each year since 2001, AHRQ has published two national reports that present detailed information, including charts and updated trend information, on the quality of health care services and disparities (by race and income) in health care in the United States. Copies of the most recent reports are available from AHRQ.
National Healthcare Disparities Report, 2011 (AHRQ Publication No. 12-0006).*
National Healthcare Quality Report, 2011 (AHRQ Publication No. 12-0005).*
AHRQ’s State Snapshots, an interactive Web-based tool, show how each State is doing on specific health care quality measures, including trending information on whether States have shown improved or worsened care for racial/ethnic minorities and other populations. AHRQ’s 2011 State Snapshots are available at http://statesnapshots.ahrq.gov.
AHRQ is partnering with Hispanic-serving organizations to promote the Agency’s Spanish-language resources and to encourage consumers to become more active partners in their health care. The Agency now offers more than 30 publications in Spanish that compare treatments for heart and vascular system conditions, diabetes, cancer, bone and joint-related conditions, pregnancy, digestive system ailments, depression, and other conditions. These and their English-language companion guides were produced by AHRQ's Effective Health Care Program, which conducts patient-centered outcomes research and makes research results available to consumers, clinicians, policymakers, and others.
To learn more about these guides and other resources, visit the Agency's Web site at http://www.ahrq.gov/patient-consumers.
Other Minority Health Initiatives
To find out more about other initiatives related to minority health, including the Agency's minority health research agenda, visit http://www.ahrq.gov/research/findings/factsheets/minority/index.html.
Copies of items in this brief that are marked with an asterisk (*) are available from the AHRQ Publications Clearinghouse. To order a copy, call the clearinghouse toll-free at 1-800-358-9295 or send an e-mail to AHRQpubs@ahrq.gov. Please use the AHRQ publication number when ordering.
For additional information about AHRQ’s activities, funding for research, or other topics, please visit the AHRQ Web site at www.ahrq.gov.
For questions and comments regarding AHRQ’s priority populations research program, you may contact us at Prioritypops@ahrq.hhs.gov.