Patterns of informal care among Puerto Rican,African American,and white stroke survivors

Background. There has been an increase in the number of non-institutionalized stroke survivors over the past few decades leading to larger numbers of family caregivers. Less is known about the patterns of informal caregiving within racially and ethnically diverse families even though there is greater post-stroke morbidity and mortality for these groups.

Research aims. The purpose of our research is to examine the informal caregiving networks of white, African American, and Puerto Rican caregivers.

Methodology. We examine data collected from 118 stroke survivors and caregivers to explore the dynamics of caregiving. Data are drawn from a diverse group of whites, African Americans, and Puerto Ricans living on the US Mainland and Puerto Rico at three different time points over the course of 12 months.

Analysis. We examine the size, stability, change, and family dynamics of informal caregiving networks.

Findings and implications. We find that whites, African Americans, and Puerto Ricans each have differing caregiving structures highlighted by expansion and contraction across time, size of network, and relationship to the stroke survivor. Greater cultural awareness among health professionals can lead to improved coordination of information or formal care services. These findings may also be used as a baseline for understanding the caregiving patterns of other Spanish-speaking Caribbean nations.     

Ethnicity is associated with alterations in oxytocin relationships to pain sensitivity in women

It is well established that African Americans (AA) experience greater pain associated with a variety of clinical conditions, and greater pain sensitivity to experimental pain tasks relative to non-Hispanic Whites (W). Notably, African Americans do not show the same relationships involving endogenous pain regulatory mechanisms and pain sensitivity documented in Caucasians, including positive associations between blood pressure, norepinephrine, cortisol and greater pain tolerance.

Objectives. The purpose of this study was to examine the relationship between plasma oxytocin (OT) and pain sensitivity and to explore the relation of OT to other factors known to influence pain perception.

Design. OT concentration and sensitivity to ischemic, cold pressor, and thermal pain tasks were assessed in African American (n=25) and non-Hispanic White (n=23) pre-menopausal women.

Results. African American women demonstrated significantly lower pain tolerance across tasks compared with Whites (F _1,46=6.31, p=0.0156) and also exhibited lower plasma OT levels (AA: 3.90, W: 7.05 pg/mL; p=0.0014). Greater OT levels were correlated with greater tolerance to ischemic pain (r=0.36, p=0.013) and accounted for a marginally significant portion of the ethnic difference in ischemic pain tolerance (B=+0.29, p=0.06). Greater OT was also correlated with greater tolerance of cold pressor pain (r=0.31, p=0.03); however, this association was no longer seen after the variance due to ethnicity was accounted for.

Conclusion. These data suggest that reduced oxytocinergic function may be one of multiple biological factors contributing to the greater sensitivity to experimental ischemic pain, and to the greater burden of some types of clinical pain experienced by African Americans compared with Whites.     

The portrayal of depression in the three most popular English-language Black-American magazines in the USA: Ebony,Essence, and Jet

Objective. To examine how depression is portrayed within a specific racialized group.

Design. Manifest and latent content analysis of the three highest circulating magazines directed toward Black-American readers, Essence, Ebony, and Jet, from 2000 to 2007.

Results. The findings demonstrate ambiguity and contradictions about depression's meaning and incidence, as well as the availability, accessibility, and suitability of medical treatment. All of these are linked to racialized identities among Black Americans.

Conclusion. Magazine portrayal of depression in these magazines can only be understood in the context of experienced racism, oppression, and ethnic identity among Blacks.     

Exploring differences in self-rated health among Blacks,Whites, Mexicans,and Puerto Ricans

Objectives. Self-rated health (SRH) is a robust predictor of subsequent health and mortality. Although age, gender, and race differences in SRH have been explored, less work has examined ethnic differences, particularly in the US.

Design. The current study uses representative data from six Chicago communities to compare levels and determinants of fair–poor health for Blacks, Whites, Mexicans, and Puerto Ricans (n=1311).

Results. Mexicans and Puerto Ricans were at least three times more likely to report fair or poor health than Whites, while African-Americans were over twice as likely. In adjusted logistic regression models, only Mexicans remain significantly more likely to report fair–poor health than Whites (OR = 4.3, CI = 1.8–9.8). However, this effect disappears when controlling for acculturation. No variable predicted poor subjective health for all groups, though depression was associated with poor health for most.

Conclusion. Together, these analyses suggest that the single item measure of SRH might not be appropriate for comparing health status across members of different race/ethnic groups. More research is needed to understand what factors influence how an individual perceives his or her health.     

Assessing the effects of race and ethnicity on use of complementary and alternative therapies in the USA

Objective To investigate the use of alternative therapies among different racial/ethnic groups in the USA. Specifically, we examined whether alternative medicine use differs for working aged whites, Asian Americans, African Americans, and Hispanics.

Design Using the 1996 Medical Expenditure Panel Survey, racial differences in utilization were investigated at two levels: (1) the bivariate level with no controls for other factors and (2) at the multivariate level with controls for age, sex, region, marital status, education, income, health status, satisfaction with conventional healthcare, and access measures.

Results Americans in this sample population used alternative and complementary therapies at a fairly low rate (6.5%). This 6.5%, however, was not consistent across all groups. African Americans and Hispanics were less likely than whites to utilize alternative therapies, whereas Asian Americans did not differ significantly from whites.

Conclusions The use of alternative and complementary therapies varied across racial/ethnic groups. Evidence showed that individuals who were dissatisfied with the availability of conventional healthcare, who were in poor health, but very satisfied with their conventional provider were more likely to use complementary and alternative medicine (CAM) therapies. The addition of these variables to a logistic regression model did not change the findings for differential use by ethnicity, the relative ranking of groups, or the overall strength of the relationship.     

Why are African Americans under‐represented in medical research studies? Impediments to participation

Objectives. In accordance with the NIH Revitalization Act of 1993, the National Institutes of Health and the Alcohol, Drug and Mental Health Administration require grant applicants and cooperative agreement participants to include minorities in human subject research. In an environment characterized by diminishing research dollars, this mandate has increased the pressure on investigators to determine factors that impede minority participation and to develop strategies to overcome these impediments.

Methods. An extensive review of the literature was conducted to identify the factors possibly responsible for the low participation levels of African Americans in medical research studies and to highlight areas for further research. The items examined included the historical relationship between African Americans and medical researchers and the attitudes, perceptions and beliefs of potential participants and researchers as they relate to the low representation of African Americans in medical research.

Results. The factors identified as possible impediments to African American participation included distrust of the medical/scientific community, poor access to primary medical care, the failure of researchers to recruit African Americans actively, the alienation of minority health professionals, lack of knowledge about clinical trials, language and cultural barriers.

Conclusions. Well‐designed, relevant, ethical research in conjunction with an appreciation of the many barriers to participation are paramount to increasing African American presence in clinical research.     

Patient–provider race-concordance: does it matter in improving minority patients’ health outcomes?

Objective. To understand if patient–provider race-concordance is associated with improved health outcomes for minorities.

Design. A comprehensive review of published research literature (1980–2008) using MEDLINE, HealthSTAR, and CINAHL databases were conducted. Studies were included if they had at least one research question examining the effect of patient–provider race-concordance on minority patients’ health outcomes and pertained to minorities in the USA. The database search and data analysis were each independently conducted by two authors. The review was limited to data analysis in tabular and text format. A meta-analysis was not possible due to the discrepancy in methods and outcomes across studies.

Results. Twenty-seven studies met the inclusion criteria. Combined, the studies were based on data from 56,276 patients and only 1,756 providers. Whites/Caucasians (37.6%) and Blacks/African Americans (31.5%), followed by Hispanics/Latinos (13.3%), and Asians/Pacific Islanders (4.3%) comprised the majority of the patient sample. The median sample of providers was only 16 for African Americans, 10 for Asians and two for Hispanics. The review presented mixed results. Of the 27 studies, patient–provider race-concordance was associated with positive health outcomes for minorities in only nine studies (33%), while eight studies (30%) found no association of race-concordance with the outcomes studied and 10 (37%) presented mixed findings. Analysis suggested that having a provider of same race did not improve ‘receipt of services’ for minorities. No clear pattern of findings emerged in the domains of healthcare utilization, patient–provider communication, preference, satisfaction, or perception of respect.

Conclusions. There is inconclusive evidence to support that patient–provider race-concordance is associated with positive health outcomes for minorities. Studies were limited to four racial/ethnic groups and generally employed small samples of minorities. Further research is needed to understand what health outcomes may be more sensitive to cultural proximity between patients and providers, and what patient, provider and setting-level variables may moderate or mediate these outcomes.     

Race, ethnicity and hospitalization for six chronic ambulatory care sensitive conditions in the USA

Objectives. Hospitalization for ambulatory care sensitive conditions, also called preventable hospitalization, has been widely accepted as an indicator of access to primary health care, and of the overall success of the primary health care system. Our objective is to examine associations between preventable hospitalization and race and ethnicity in the USA, separately for six major chronic diseases: angina, asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes and hypertension.

Design. We used the 1997 Nationwide Inpatient Sample, 1997 Current Population Survey and 1997 National Health Interview Survey, to calculate rates of preventable hospitalization, and the prevalence of ambulatory care sensitive conditions, for African Americans, Hispanics and non-Hispanic whites. Rates were calculated for ages 19–64, and 65 and over. Preventable hospitalization rates that accounted for underlying hospitalization patterns were also estimated. A final set of estimations adjusted the preventable hospitalization rates for disease prevalence.

Results. Preventable hospitalization rates were notably higher for African Americans and Hispanics than for non-Hispanic whites for almost all of the conditions, both for women and men and for both age groups. Rates adjusted for underlying hospitalization patterns showed a similar pattern. Adjusted for disease prevalence, rate differences remained notably large for both women and men, and for both age groups. Particularly great, for both African Americans and Hispanics of both sexes, are the risks of preventable hospitalization for asthma, diabetes and hypertension.

Conclusion. African Americans and Hispanics have high preventable hospitalization rates for major chronic conditions, even after disease prevalence and underlying hospital utilization patterns are considered. These rates are particularly high for asthma, diabetes and hypertension, which are amenable to prevention and management interventions. Our results suggest a need to improve access to quality primary health care for African Americans and Hispanics in the USA, and for enhanced support of targeted prevention efforts.     

Ethnic differences in the reliability and validity of a Panic Disorder Screen

Purpose. The purpose of this study was to compare the reliability and validity of the Brief Panic Disorder Screen (BPDS) in samples of African American and Caucasian American primary care patients.

Methods. The BPDS was administered to 295 patients scheduled to visit a primary care clinic for medical reasons. The presence or absence of a panic disorder diagnosis was established during a clinical interview with a psychiatrist. Measures of reliability (internal consistency) and validity (criterion validity) were compared between the two ethnic subgroups.

Findings. The BPDS demonstrated greater reliability and validity for Caucasians than African Americans. This effect was maintained even after controlling for group differences in key demographic variables. Differences between ethnic groups were apparent in both those with and those without panic disorder (PD). BPDS responses of African Americans with PD demonstrated very low internal consistency whereas a high rate of false positive PD diagnoses was related to higher than expected BPDS scores among African Americans without PD, particularly on the level of fear felt when experiencing shortness of breath or heart palpitations.

Discussion. These findings support the notion that cultural differences in the language and meaning associated with anxiety disorders contribute to the difficulty of accurately diagnosing PD in primary care populations. Additional research is needed to provide a better understanding of the cultural aspects of the anxiety experience. Such research would facilitate the development of better screening tools for panic and other anxiety disorders for ethnic minority primary care populations.     

Internalized racism and mental health among African-Americans,US-born Caribbean Blacks,and foreign-born Caribbean Blacks

Objectives. The tripartite model of racism includes personally mediated racism, institutionalized racism, and the less-oft studied internalized racism. Internalized racism – or negative beliefs about one’s racial group – results from cultural racism that is endemic in American society. In this project, we studied whether these negative stereotypes are associated with mental health among African-Americans and Caribbean Blacks.

Design. Using secondary data from the National Survey of American Life, we investigated the association between internalized racism and mental health (measured by depressive symptoms and serious psychological distress (SPD)) among these two groups. We also explored whether ethnicity/nativity and mastery moderate the association between internalized racism and mental health among African-Americans and Caribbean Blacks.

Results. Internalized racism was positively associated with depressive symptoms and SPD among all Black subgroups. However, internalized racism was a weaker predictor of SPD among foreign-born Caribbean Blacks than US-born Caribbean Blacks and US-born African-Americans. Additionally, higher mastery was protective against distress associated with internalized racism.

Conclusion. Internalized racism is an important yet understudied determinant of mental health among Blacks. Future studies should take into account additional heterogeneity within the Black population (e.g. African-born individuals) and other potential protective mechanisms in addition to mastery (e.g. self-esteem and racial identity).     

Race,psychiatric comorbidity,and headache characteristics in patients in headache subspecialty treatment clinics

Objective. This research examined how race, psychiatric comorbidity, and headache characteristics are inter-related in patients with severe headache disorders.

Design. This study used a naturalistic cohort design and assessed 114 Black and 173 White patients receiving treatment in headache subspecialty clinics in Cincinnati, Cleveland, Columbus, and Toledo, OH. Face-to-face interviews yielded headache and psychiatric diagnoses; 30-day daily diaries collected data on headache frequency, severity, and disability; and self-administered surveys obtained data on headache management self-efficacy, headache locus of control, and quality of life.

Results. Compared with Whites, Blacks reported more frequent and severe headaches, were more likely to be diagnosed with depressive disorders, and were more likely to be diagnosed with chronic headaches. White and Black patients diagnosed with both depression and anxiety reported the most frequent headache days per month and the lowest levels of life quality and headache management self-efficacy.

Conclusions. Additional research on race, psychiatric comorbidity, and headache characteristics is needed that can inform culturally contextualized interventions for persons with severe headache disorders.     

Investigating the mental abilities of rural Zulu primary school children in South Africa

Introduction. Maximising the full potential of health and educational interventions in South African schools requires assessment of the current level of mental abilities of the school children as measured by cognitive and scholastic tests and the identification of any barriers to improved performance.

Objectives. This study reports on the application and interpretation of a selected battery of mental ability tests among Zulu school children and the methodological and analytical issues that need to be addressed.

Design The test scores of 806 primary school children from a rural community are presented, based on four tests: Raven's Coloured Progressive Matrices (CPM), an Auditory Verbal Learning Test (AVLT), the Symbol Digit Modalities Test (SDMT) and Young's Group Mathematics Test (GMT).

Results. Significant gender differences were found in the test scores, and the mean scores of Zulu children in this study were lower than those reported in other studies. The results of this selected test battery provide data for the further development of appropriate test instruments for South African conditions.

Conclusion. These results can contribute towards the development of a test battery for South African children that can be used to assess and improve their school performance.     

Gender and ethnic differences in the co-occurrence of adolescent risk behaviors

Design

Results

Conclusion

We consider gender and ethnic differences in the co-occurrence of adolescent behaviors related to health and well-being.

Using a nationally representative sample of adolescents in the National Longitudinal Survey of Youth (1997–2000), we examine behavior among students as well as school drop-outs. We use latent class models (LCMs) to identify subpopulations of adolescents with similar patterns of co-occurring behaviors. The generalizability of the findings for African American adolescents in the 1970s is considered using a sample of inner-city youth from the Pathways to Adulthood Survey.

For all ethnic groups, we find a subpopulation with ‘problem behavior’ characteristics (in which early sexual initiation, alcohol use, smoking, marijuana use, and truancy are all highly prevalent). This cluster is most common among European American adolescents and among young men. A subpopulation characterized by behaviors often leading to poor social outcomes (e.g. truancy, early sexual initiation and fighting) is most common for African American adolescents, especially young African American men.

Our findings suggest that multi-factorial interventions which address the interrelationships between all of the behaviors are relevant regardless of gender or ethnicity. However, the ethnic and gender differences in the likelihood of specific patterns of interrelationships highlight the importance of considering the ethnic and gender composition of a population when developing future research and interventions.     

A review of recent literature on materialist and psychosocial models for racial and ethnic disparities in birth outcomes in the US, 2000–2014

Objective: Material and psychosocial factors exacerbate racial disparities in health outcomes. This review sought to ascertain recent knowledge of the effects of materialist and psychosocial factors on differences in low birthweight (LBW) and preterm delivery (PTD) outcomes between Black and White mothers.

Design: Search and review was conducted for studies that examined: (a) neighborhood-level deprivation as an indicator of material conditions, and (b) racial discrimination or occupational stressors as indicators of psychosocial stress. The outcomes of interest were LBW and PTD.

Results: Material and psychosocial factors significantly and negatively affected Blacks more than Whites, and were associated with increased adverse outcomes. Of five studies with a homogeneous Black study sample, three reported no effect on outcomes in women exposed to material or psychosocial factors.

Conclusion: Through this review we find that in comparison to White women, Black women are at higher risk of adverse outcomes due to both psychosocial stress and meso-level deprivation, after accounting for personal factors. A better understanding of effects on health outcomes of material and psychosocial factors in Black women is needed. Further investigation into materialist and psychosocial factors, will allow us to better understand the factors driving PTD and LBW disparities in the US.     

Posttraumatic stress symptomology in parents of children with cancer: Implications related to criterion changes in DSM-IV-TR to DSM-5

Objective: This preliminary study compared a DSM-IV-TR screening tool for posttraumatic stress symptoms (PTSS) with a modified DSM-5 version for parents of children diagnosed with cancer.

Methods: Caregivers (n = 101) completed the Brief Symptom Inventory (BSI) and Impact of Event Scale-Revised (IES-R). Five BSI items were added to the IES-R to assess whether caregivers met DSM-5 specific posttraumatic stress disorder criteria.

Results: Chi-square analysis revealed three groups: caregivers who (1) did not meet screening criteria for DSM-IV-TR or DSM-5; (2) only met DSM-IV-TR criteria; and (3) met criteria for DSM-IV-TR and DSM-5, X²(1, n = 101) = 64.47, p < 0.001. Subgroup 2 had lower overall PTSS than subgroup 3 (p < 0.001), but more than Subgroup 1 (p < 0.001).

Conclusions: A “gap group” evidenced elevated PTSS but did not meet DSM-5 screening criteria. Further research is needed to clarify the prevalence and composition of PTSS among caregivers, and evaluate the clinical implications of the changes in diagnostic criteria.     

Understanding the role of clergy in African American organ and tissue donation decision-making

Objectives. To describe and understand the attitudes, beliefs, and experiences towards organ and tissue donation among African American clergy in Atlanta, Georgia, USA. The secondary objective is to understand what messages clergy are providing to their parishioners relative to organ and tissue donation, and what their perceived role is in donation education.

Design. A qualitative study in which African American clergy (n=26) participated in four focus groups.

Results. African American clergy, though generally supportive of organ and tissue donation in principle, have serious reservations about donation due to perceived inequalities in the donation and transplantation system. The clergy did not personally hold religious concerns about donation, but expressed that these concerns were a major barrier to donation among their parishioners. None of the clergy knew the written position that their religion took on donation; they acknowledged the need for more education for them and their parishioners on this topic. They also felt that as religious leaders, they could play an important role in promoting organ and tissue donation among African American parishioners.

Conclusions. African American clergy and religious leaders may play an important role towards improving willingness to donate among African American parishioners, but more education and advocacy is needed to prepare them for this role.     

Obesity in Inner‐city African Americans

Objective. Obesity, a risk factor for chronic diseases, has a high prevalence in African Americans and low‐income individuals. However, little is known about perceptions of overweight, attempts to lose weight, and strategies used to lose weight among African Americans in inner cities.

Design. A 1990 cross‐sectional telephone survey (n = 1445) of north St Louis and central Kansas City, USA.

Results. Obesity was common (44%) in this sample of inner‐city African Americans. The obese perceived themselves as overweight (70%) and were trying to lose weight (66%). The majority of the obese (68%) were both dieting and exercising to lose weight. Smoking prevalence was not higher among the obese or those trying to lose weight. Many of the obese had received medical advice recently on low‐fat diets (51%) and had been advised to lose weight (40%). Factors independently associated with perception, attempts to lose weight and medical advice differed, but included degree of obesity.

Conclusions. These results corroborate US national data that obesity is a public health problem in this population and that obese inner‐city African Americans perceive themselves as overweight and are trying to lose weight, especially as degree of obesity increases. It also appears that smoking is not being used as a weight loss strategy and that the obese, as a group, are receiving some medical advice on low‐fat diets. This information is critical for designing culturally sensitive weight‐control programmes.     

The influence of ethnicity on patient satisfaction

Methods

Results

Conclusion

To investigate the influence of ethnicity on patient satisfaction with hospitalization care.

We conducted a random selection, cross-sectional study. Data were collected by telephone interviews over a three-year period utilizing a 16-question survey. Patients were excluded from the study if they were admitted for an obstetric visit, physical rehabilitation, or psychiatric illness or if we were unable to reach them by telephone. We used logistic regression to compare ethnicity with the responses for each of the 16 questions while controlling for three confounders (age, gender, and insurance status). For each question, patient responses of excellent and very good were considered satisfied. Patient responses of good, fair, and poor were considered not satisfied.

We surveyed 7,795 patients. Compared to African-Americans, non-Hispanic white Americans were significantly older, included more males, and were insured by Medicaid less often (p?

African-Americans reported significantly lower rates of satisfaction compared to non-Hispanic white Americans for six of 16 questions regarding satisfaction during hospitalization care.     

‘It means everyone should know their status’: exploring lay conceptions of sickle cell trait and sickle cell trait screening among African Americans within middle reproductive age

Objective: This study examined the meaning of sickle cell trait and sickle cell trait screening from the lay perspective of African Americans.

Design and Methods: African Americans (N?=?300), ages 18–35 and unaware of their sickle cell trait status, completed two open-ended questions from a larger survey. One question asked for their understanding of sickle cell trait; the other asked for their understanding of sickle cell trait screening. Content analysis occurred in two phases: (1) In vivo and holistic coding; and (2) focused coding.

Results: Four categories emerged illustrating lay conceptions of sickle cell trait; (1) Perceived as an illness; (2) Perceived recognition of the inheritance pattern of sickle cell trait; (3) Perceived lack of knowledge of sickle cell trait; and (4) Perceived importance of sickle cell trait. Five categories emerged illustrating lay conceptions for sickle cell trait screening: (1) Perceived recognition that screening means getting tested for sickle cell trait; (2) Perceived lack of knowledge of sickle cell trait screening; (3) Perceived health benefit of sickle cell trait screening; (4) Perceived importance of sickle cell trait screening; and (5) Perceived barriers to sickle cell trait screening.

Conclusions: Sickle cell trait and sickle cell trait screening are concepts that are both regarded as important among this high-risk population. However, there is still misunderstanding concerning the hereditary nature and reproductive implications of sickle cell trait. Interventions seeking to improve communication on the need for sickle cell trait screening should begin by identifying what the population at large understands, knows and/or believes to improve their ability to make informed health decisions.