The influence of provider sex on neurologists' annual incomes

OBJECTIVE: We sought to determine the influence of provider sex on neurologists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. METHODS: We used survey responses collected throughout the 1990s from 216 actively practicing neurologists and linear regression modeling to determine the independent influence of provider sex on neurologists' annual incomes. RESULTS: White female neurologists reported seeing 11% fewer visits and working 6% fewer annual hours than their white male counterparts. White female neurologists had practiced medicine for fewer years than white males (p = 0.01). In addition, females were less likely to be employees, as opposed to having an ownership interest in the practice, and were more likely to be board certified, though not statistically significantly so. After adjustment for work effort, provider characteristics, and practice characteristics, white female neurologists' mean annual income was 165,321 dollars, or 47,854 dollars (22%) lower than that for white males (95% CI: 82,710 dollars lower to 12,997 dollars lower, p = 0.007). CONCLUSION: During the 1990s, female sex was associated with lower annual incomes among neurologists. Just as policymakers are exploring sex differences in access to and outcomes health care, they should further explore these findings to ensure that income differences among physicians who provide that care are not unjustly driven by provider sex.     

Disparities in underserved white populations: the case of cancer-related disparities in Appalachia

There are meaningful cancer-related disparities in the Appalachian region of the U.S. To address these disparities, the Appalachia Community Cancer Network (ACCN), a collaboration of investigators and community partners in five states (Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia), is involved in increasing cancer education and awareness, conducting community-based participatory research (CBPR), and creating mentorship and training opportunities. The primary objective of this paper is to describe cancer-related disparities in the Appalachian region of the U.S. as an example of the disparities experienced by underserved, predominantly white, rural populations, and to describe ACCN activities designed to intervene regarding these disparities. An ACCN overview/history and the diverse activities of ACCN-participating states are presented in an effort to suggest potential useful strategies for working to reduce health-related disparities in underserved white populations. Strengths that have emerged from the ACCN approach (e.g., innovative collaborations, long-standing established networks) and remaining challenges (e.g., difficulties with continually changing communities, scarce resources) are described. Important recommendations that have emerged from the ACCN are also presented, including the value of allowing communities to lead CBPR efforts. Characteristics of the community-based work of the ACCN provide a framework for reducing health-related disparities in Appalachia and in other underserved white and rural populations.     

Patient navigator programs, cancer disparities, and the patient protection and affordable care act

Patients in vulnerable population groups suffer disproportionately from cancer. The elimination of cancer disparities is critically important for lessening the burden of cancer. Patient navigator programs have been shown to improve clinical outcomes. Among its provisions relevant to disparities in cancer care, The Patient Protection and Affordability Care Act authorizes continued funding of patient navigator programs. However, given the current economic and political environment, this funding is in jeopardy. This article describes patient navigator programs and summarizes the elements of the health care law that are relevant to these programs. It is vital that the entire oncology community remain committed to leading efforts toward the improvement of cancer care among our most vulnerable patients.     

A communication inequalities approach to disparities in fruit and vegetable consumption: Findings from a national survey with U.S. adults

ObjectivesThis study assessed whether socioeconomic disparities in fruit and vegetable consumption and its differences by social capital are accounted for by exposure to media information about fruits and vegetables and reflective integration of that information.MethodsOnline survey data were collected in July 2014 from 572 U.S. adults from a nationally representative online panel. Path analysis was employed to test our models.ResultsEducation and social capital were positively associated with media exposure, which was in turn positively related to reflective integration and finally led to fruit and vegetable consumption. Education and income were positively associated with social capital.ConclusionDifferences in fruit and vegetable consumption across social groups are at least partly explained by exposure to information about fruits and vegetables from the media, and by reflective integration of that information.Practice ImplicationsHealthcare professionals and health educators should create health messages delivered via the media that are easy to understand with an appropriate level of health literacy. Also, health interventions that aim to build social capital may promote health media use and its reasoning processes, thereby reducing communication inequalities by SES as well as disparities in fruit and vegetable consumption.     

Factors contributing to racial differences in gait mechanics differ by sex

BackgroundRacial differences in gait mechanics have been recently reported, but we don’t know what factors may drive differences in gait and whether these factors are innate or modifiable. The answers to those questions will inform both basic research and clinical interventions and outcomes.Research questionDo anthropometric, strength, and health status measures explain racial differences in gait between African Americans (AA) and white Americans (WA)?MethodsVenous blood samples, anthropometric measures, lower extremity strength, and an assessment of health status were collected from 92 participants (18–30 years old) as part of an Institutional Review Board-approved study. 3D motion capture and force plate data were recorded during 7 walking trials at set regular (1.35 m/s) and fast (1.6 m/s) speeds. Racial differences in gait were identified at both speeds. Correlations between anthropometric, strength, and health status independent variables and outcome measures were computed after stratifying data by sex. Stepwise linear regression models evaluated whether the inclusion of anthropometric, strength, and health status independent variables explained racial effects.ResultsIn males, no racial differences in gait were explained by independent variables. Q-angle and ankle dorsiflexion strength accounted for racial differences in self-selected walking speed in females. Racial differences in ankle plantarflexion angle were explained by ankle plantarflexion strength differences.SignificanceFactors that explain racial differences in gait in females were both innate and modifiable. These data make clear that it is important to include racially diverse normative gait databases in research studies. These results also identify potential intervention targets aimed at reducing racial health disparities.     

Which young women are not being vaccinated against HPV? Cross-sectional analysis of a UK national cohort study

ObjectivesHPV vaccination is highly effective in preventing HPV-associated disease, including cervical cancer, which disproportionately affects women from disadvantaged and minority ethnic backgrounds. We examined inequalities in initiation of the HPV vaccination schedule among young women in the UK and reasons given by their parents for non-initiation.DesignCross sectional analyses of a prospective nationally representative cohort study.SettingFour UK countries.Participants5,695 young women (39.9% from households in lowest income quintiles, 5.1% ever excluded from school, 0.5% not attending school) whose parents (14.3% from minority ethnic backgrounds; 54.1% with no stated religious faith) took part in interviews conducted when their daughters were 14 years old.Main outcome measuresParent-reported initiation of HPV vaccination and reasons for non-initiation. The adjusted odds (aORs) and 95% Confidence Intervals (CI) of initiating HPV vaccination were estimated using logistic regression after mutual adjustment for household income, school exclusion, school attendance and parental ethnic background and religious faith.Results92.3% (5265) had initiated HPV vaccination at time of interview. Initiation was less likely among those living in the poorest households (aOR; 95% CI: 0.44; 0.30 to 0.64 for those in lowest household income quintile), who did not attend school (0.11; 0.04 to 0.33), had ever been excluded from school (0.47; 0.29 to 0.76), or whose parents were from Black African (0.49; 0.26 to 0.95) or Any Other (0.34; 0.17 to 0.66) ethnic backgrounds. A reason consistent with a conscious or practical decision was reported by 53.3% (219) and 24.1% (90) parents respectively.ConclusionsAlthough most young women are immunised, marked social inequalities in access to HPV vaccination initiation remain. Practical steps to address this are possible and should be implemented to reduce inequalities in primary prevention of cancers and to ensure equitable access to this important public health intervention.