Preparing racially and ethnically diverse communities for public health emergencies

The tragedy of Hurricane Katrina in New Orleans confirmed that effective implementation of public health preparedness programs and policies will require compliance from all racial and ethnic populations. This study reviews current resources and limitations and suggests future directions for integrating diverse communities into related strategies. It documents research and interventions, including promising models and practices that address preparedness for minorities. However, findings reveal a general lack of focus on diversity and suggest that future preparedness efforts need to fully integrate factors related to race, culture, and language into risk communication, public health training, measurement, coordination, and policy at all levels.     

Improving care and interactions with racially and ethnically diverse populations in healthcare organizations

The need for healthcare managers to develop strategies that address culturally appropriate care for racial and ethnic populations continues to grow in importance. Healthcare organizations within the United States serve a range of diverse people, but they are not adequately meeting the needs of specific populations. Cultural and linguistic barriers are posing problems for an industry that is already financially strained. If strategies to provide more culturally appropriate care are not implemented, financial pressures will continue to rise and quality of care will suffer. Healthcare organizations can and should promote cultural competence among their physicians and employees. This article attempts to define the scope of the problem through literature and case studies. It also offers healthcare managers strategies for improving cultural understanding and competency within their organization.     

Contributors to self-reported health in a racially and ethnically diverse population: focus on Hispanics

PurposeTo understand if Hispanics report health differently than other racial and ethnic groups after controlling for demographics and risk factors for poor health.MethodsThe sample (N = 5502) included 3201 women, 1767 black, 1859 white, and 1876 Hispanic subjects from the Boston Area Community Health Survey, a population-based survey of English- and Spanish-speaking residents of Boston, Massachusetts, United States, aged 30–79 years in 2002–2005. Multiple logistic regression models were used to examine the association between race/ethnicity (including interview language for Hispanics) and fair/poor self-reported health (F/P SRH) adjusting for gender, age, socioeconomic status, depression, nativity, and comorbidities.ResultsCompared with whites, Hispanics interviewed in Spanish were seven times as likely to report F/P SRH (odds ratio, 7.7; 95% confidence interval, 4.9–12.2) after adjusting for potential confounders and those interviewed in English were twice as likely. In analyses stratified by depression and nativity, we observed stronger associations with Hispanic ethnicity in immigrants and nondepressed individuals interviewed in Spanish.ConclusionsIncreased odds of F/P SRH persisted in the Hispanic group even when accounting for interview language and controlling for socioeconomic status, age, depression, and nativity, with interview language mitigating the association. These findings have methodological implications for epidemiologists using SRH across diverse populations.     

Practical recommendations for ethnically and racially sensitive hospice services

Hospice providers have long understood that hospice services are disproportionately utilized by Caucasians compared with racial and ethnic minorities. In fact, it is clear that this disparity is increasing with time despite the development of literature that recommends making services more culturally sensitive and accessible to minority groups. This suggests a need for more concrete and practical recommendations to make hospice services accessible and amenable to minority groups. For implementation in hospice service organizations, standard recommendations require enhancement to increase outreach, improve understanding of cultural issues related to death and dying, improve communication with non-English speaking populations, and implement cross-cultural training programs. In addition, the self-awareness and ethnic identity of hospice workers themselves are elements of culturally sensitive care that frequently are overlooked when discussing hospice organizations. This article outlines some specific objectives for meeting the goal of improving hospice services for ethnic and racial minorities.     

Prevalence of and risk factors for urine leakage in a racially and ethnically diverse population of adults: the Boston Area Community Health (BACH) Survey

Most epidemiologic studies of urine leakage in the United States report on women and White populations. In this study, the authors determined the prevalence of urine leakage across genders and racial/ethnic groups in a population-based sample of 5,506 adults aged 30-79 years and identified factors related to leakage within genders and racial/ethnic groups. The prevalence of weekly urine leakage was 8% overall, 10.4% in women, and 5.3% in men. White women (11.7%) were more likely than Black (9.4%) and Hispanic (7.3%) women to report weekly leakage and to report stress-type (35.4% vs. 9.4% and 14.5%, respectively) and urge-type (13.4% vs. 3.3% and 10.8%, respectively) leakage. Rates and leakage types for men did not vary by race/ethnicity. For women, central obesity, asthma, and arthritis increased the odds of weekly leakage. For men, the odds of leakage increased for Blacks and Whites at ages 50 and 60 years, respectively, and for Hispanics of higher social class. For both genders, various comorbid conditions, including heart disease, asthma, and depression, increased the odds of leakage in varying racial/ethnic groups. The authors conclude that types of and risk factors for urine leakage vary by gender and racial/ethnic group.     

The relation between perceived unfair treatment and blood pressure in a racially/ethnically diverse sample of women

Elevated blood pressure is an important public health problem in midlife women, especially among minority groups. Few studies have examined the impact of perceived unfair treatment due to different factors such as racism, sexism, or ageism on blood pressure. By use of a racially/ethnically diverse community sample of nearly 3,300 midlife women enrolled in the longitudinal, multisite Study of Women's Health across the Nation between 1995 and 1997, this study examined whether perceived unfair treatment varied by race/ethnicity and whether it was associated with blood pressure levels. Overall, unfair treatment was reported by 65% of African-American women, 60% of Chinese women, 36% of Japanese women, 47% of White women, and 27% of Hispanic women. Although racial/ethnic differences in blood pressure were evident, high levels of perceived unfair treatment were not a correlate of elevated blood pressure.     

Coping with asthma in racially and ethnically diverse urban children: The role of emotional problems in disease control

This study examined cross-sectional associations among coping, mental health, and asthma outcomes in racially/ethnically diverse urban children. Children (N = 42; 65% female) ages 9 to 17 (M = 11.9) years old and their parents reported on the child’s coping, emotional and conduct problems, asthma control, and school missed due to asthma. Higher child and parent reported secondary control coping was correlated with fewer mental health problems and better child reported asthma control. Child reported emotional problems partially accounted for associations between child and parent reported secondary control coping and child reported asthma control. Secondary control coping may improve asthma by reducing emotional difficulties.     

Unraveling the ecology of risks for early childhood asthma among ethnically diverse families in the southwest

OBJECTIVES: We describe the prevalence of asthma risk factors within racial/ethnic and language groups of infants participating in an intervention study for reducing chronic asthma. METHODS: Low-income children aged 9 to 24 months with 3 or more episodes of wheezing illness were enrolled. Baseline information included family and medical histories, allergic status, environmental exposures, emotional environment, and caregiver psychosocial resources. RESULTS: Racial/ethnic and language groups-European Americans, African Americans, high-acculturated Hispanics, and low-acculturated Hispanics-showed different patterns of risk factors for childhood asthma, with low-acculturated Hispanics showing the most distinctive pattern. CONCLUSIONS: Patterns of covariation of biological and psychosocial risk factors for childhood asthma were associated with racial/ethnic and language status among urban, low-income children.     

Valuing health in a racially and ethnically diverse community sample: an analysis using the valuation metrics of money and time

Purpose  

Limited research in health valuation analyzes samples with high proportions of racial/ethnic minorities within the United States. The primary objective was to explore patterns of health valuation across race/ethnicity using the Collaborative Psychiatric Epidemiology Surveys. A secondary objective was to analyze whether mental health disorder and immigrant status were associated with these estimates.     

Indigency, ethnicity, and hospital viability. The growth of racially diverse communities challenges Catholic providers and sponsors

A Catholic Health Association study analyzes correlations between the ethnic and racial composition of communities served by Catholic hospitals and these hospitals' viability and capacity to serve their communities. It also describes the extent to which Catholic hospitals serve racially homogeneous communities, on the one hand, and racially and ethnically diverse communities, on the other. For comparison, the study focuses on hospitals in two groups. Group A consists of hospitals in the top quartile based on their proportion of care for the poor and top-quartile percentages of black and Hispanic residents in their local communities. Group B consists of hospitals with bottom-quartile levels of care for the poor and bottom-quartile percentages of black and Hispanic residents. The study found that, from 1985 to 1990, group A hospitals continued to provide high levels of care for the poor (between 28 percent and 32 percent on average) while average margins fell from about 4 percent to below 1 percent. During the same period, the amount of care group B hospitals provided to the poor remained between 5 percent and 6 percent; although their margins declined, these hospitals were significantly more profitable than group A hospitals. The financial stress currently being experienced by many hospitals that serve communities with relatively high percentages of ethnic and racial minorities is troubling. Without basic reform of the healthcare system, many of these facilities may have to close, leaving many in their communities without access to adequate healthcare.     

Disordered eating,socio-cultural media influencers,body image,and psychological factors among a racially/ethnically diverse population of college women

This study examined disordered eating, socio-cultural media influencers, body image, and psychological factors among a large, racially/ethnically diverse sample of college women (n = 1445; 58% White, 21% Asian, 11% Hispanic, 11% Black) who completed an online survey. Black women were significantly more satisfied with their weight and shape and had lower eating concerns, disinhibited eating, and emotional eating than all other racial/ethnic groups. Black women tended to have significantly higher levels of self-esteem, were less likely to compare their body to those of people in the media, felt less pressured to attain the physical appearance standard set by the media, and had less awareness of the societal appearance norms set by the media than other racial groups. Findings suggest that Black college women, independent of weight status, may be protected from disordered eating, negative body image, and societal media pressures.