Predictors of successful telephone follow-up in a multicenter study of infants with severe bronchiolitis

PurposeTo identify the characteristics that predict successful telephone follow-up with parents of infants with severe bronchiolitis.MethodsWe analyzed data from a 17-center, prospective cohort study of infants (age <1 year) hospitalized with bronchiolitis during three consecutive fall/winter seasons. Participant contact information and clinical data were collected during the index hospitalization. Parents were called at 6-month intervals (based on the child's age) after discharge to assess respiratory problems. The primary outcome was age 12-month telephone interview status. Participants were classified as unreachable after 28 days of unsuccessful attempts.Results798 of 916 children (87%) completed the age 12-month telephone interview. In unadjusted analyses, factors associated with successful follow-up included: private health insurance, annual household income $60,000 or more, and residing in the Northeast, Midwest, or West. Follow-up was less common among non-Hispanic blacks, Hispanics, and households with 3 or more children. In multivariable analyses, follow-up was more likely among parents of females, and, compared with the South, in the Northeast and Midwest (all P < .05). Compared with non-Hispanic whites, non-Hispanic blacks and Hispanics remained less likely to complete the interview as did households with 3 or more children (all P < .05).ConclusionSociodemographic and geographic factors predict successful telephone follow-up, even among parents of infants with severe illness.     

Agreement between Self-Reported and Administrative Race and Ethnicity Data among Medicaid Enrollees in Minnesota

Objective. This paper measures agreement between survey and administrative measures of race/ethnicity for Medicaid enrollees. Level of agreement and the demographic and health-related characteristics associated with misclassification on the administrative measure are examined.
Data Sources. Minnesota Medicaid enrollee files matched to self-report information from a telephone/mail survey of 4,902 enrollees conducted in 2003.
Study Design. Measures of agreement between the two measures of race/ethnicity are computed. Using logistic regression, we also assess whether misclassification of race/ethnicity on administrative files is associated with demographic factors, health status, health care utilization, or ratings of quality of health care.
Data Extraction. Race/ethnicity fields from administrative Medicaid files were extracted and merged with self-report data.
Principal Findings. The administrative data correctly classified 94 percent of cases on race/ethnicity. Persons who self-identified as Hispanic and those whose home language was English had the greater odds (compared with persons who self-identified as white and those whose home language was not English) of being misclassified in administrative data. Persons classified as unknown/other on administrative data were more likely to self-identify as white.
Conclusions. In this case study in Minnesota, researchers can be reasonably confident that the racial designations on Medicaid administrative data comport with how enrollees self-identify. Moreover, misclassification is not associated with common measures of health status, utilization, and ratings of quality of care. Further replication is recommended given variation in how race information is collected and coded by Medicaid agencies in different states.     

Intact performance on an indirect measure of race bias following amygdala damage

Recent brain imaging and lesion studies provide converging evidence for amygdala involvement in judgments of fear and trust based on facial expression [Adolphs et al., Nature 393 (1998) 470; Adolphs et al., Neuropsychologia 37 (1999) 1111; Breiter et al., Neuron 17 (1996) 875; Winston et al., Nat. Neurosci. 5 (3) (2002) 277]. Another type of social information apparent in face stimuli is social group membership. Imaging studies have reported amygdala activation to face stimuli of different racial groups [Hart et al., NeuroReport 11 (11) (2000) 2351]. In White American subjects, amygdala activation to Black versus White faces was correlated with indirect, implicit measures of racial evaluation [Phelps et al., J. Cogn. Neurosci. 12 (5) (2000) 729]. To determine if the amygdala plays a critical role in indirect social group evaluation, as suggested by the imaging results, a patient with bilateral amygdala damage and control subjects were given two measures of race bias. All subjects were female, White Americans. The Modern Racism Scale (MRS) is a direct, self-report measure of race attitudes and beliefs. The Implicit Association Test (IAT) is an indirect, automatic evaluation task. Performance on the two tasks did not differ between the patient with amygdala damage and control subjects. All subjects showed a pro-Black bias on the direct, explicit measure of race beliefs, the MRS, and a negative evaluation towards Black faces on the indirect measure of race evaluation, the IAT. These results indicate that even though amygdala activation to Black versus White faces is correlated with performance on indirect measures of race bias [Phelps et al., J. Cogn. Neurosci. 12 (5) (2000) 729], the amygdala is not critical for normal performance on the IAT.     

Methodologic implications of allocating multiple-race data to single-race categories

OBJECTIVE: To illustrate methods for comparing race data collected under the 1977 Federal Office of Management and Budget (OMB) directive, known as OMB-15, with race data collected under the revised 1997 OMB standard. DATA SOURCES/STUDY SETTING: Secondary data from the 1993-95 National Health Interview Surveys. Multiple-race responses, available on in-house files, were analyzed. STUDY DESIGN: Race-specific estimates of employer-sponsored health insurance were calculated using proposed allocation methods from the OMB. Estimates were calculated overall and for three population subgroups: children, those in households below poverty, and Hispanics. PRINCIPAL FINDINGS: Although race distributions varied between the different methods, estimates of employer-sponsored health insurance were similar. Health insurance estimates for the American Indian/Alaska Native group varied the most. CONCLUSIONS: Employer-sponsored health insurance estimates for American Indian/Alaska Natives from data collected under the 1977 OMB directive will not be comparable with estimates from data collected under the 1997 standard. The selection of a method to distribute to the race categories used prior to the 1997 revision will likely have little impact on estimates of employer-sponsored health insurance for other groups. Additional research is needed to determine the effects of these methods for other health service measures.     

Relationship between Race/Ethnicity and Hysterectomy Outcomes for Benign Gynecologic Conditions

Study Objective

To examine the association between race/ethnicity, route of hysterectomy, and risk of inpatient surgical complications.

Smoking prevention for ethnically diverse adolescents: 2-year outcomes of a multicultural, school-based smoking prevention curriculum in Southern California

BACKGROUND: Effective school-based curricula are needed to prevent smoking among ethnically diverse adolescents. This study evaluated a multicultural smoking prevention curriculum in ethnically diverse Southern California middle schools. METHODS: Students in 24 middle schools (N = 3157 sixth graders) received the multicultural curriculum, a similar curriculum without references to cultural issues, or a control condition. Odds ratios for experimentation with smoking over a 2-year period were calculated. RESULTS: The multicultural program was associated with a lower risk of smoking between sixth and eighth grade, relative to the control group. Program effects varied according to the ethnic composition of the schools. In schools with predominantly Hispanic populations, the multicultural curriculum was more effective than the control, but the standard curriculum was not. In schools with predominantly Asian or multicultural populations, the standard curriculum was more effective than the control, but the multicultural curriculum was not. Analyses stratified by ethnicity within the schools revealed that the multicultural curriculum was effective among Hispanic students within predominantly Hispanic schools, but not among Hispanic students within predominantly Asian/multicultural schools. CONCLUSIONS: Smoking prevention for adolescents in culturally diverse school contexts is a challenge. In this study, a multicultural curriculum was most effective among Hispanic students in predominantly Hispanic schools. Further research is needed to determine the best ways to prevent smoking in predominantly Asian and multicultural schools.     

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.