Patient provider communication about the health effects of obesity

Objective

We assessed the influence of race/ethnicity and provider communication on overweight and obese patients’ perceptions of the damage weight causes to their health.

Methods

The study included 1071 overweight and obese patients who completed the 2002 Community Health Center (CHC) User survey. We used logistic regression analyses to examine determinants of patients’ perceptions of the impact of their weight on their health. Models were adjusted for covariates and weighting was used to account for the sampling design.

Results

Forty-one percent of respondents were overweight and 59% were obese. Non-Hispanic Blacks and Hispanics were half as likely as non-Hispanic Whites to believe weight was damaging to their health while controlling for covariates. Overweight/obese CHC patients who were told they were overweight by healthcare providers were almost nine times more likely to perceive that weight was damaging to their health compared to those not told.

Conclusions

We observed large racial/ethnic disparities in the perception that overweight is unhealthful but provider communication may be a powerful tool for helping patients understand that overweight is damaging to health.

Practice implications

Given obesity is a national epidemic, further attention to the role of patient provider communication in illness is essential with important implications for both health professional training and health care provision.     

Examining Racial/Ethnic Minority Treatment Experiences with Specialty Behavioral Health Service Providers

This study investigated whether satisfaction and helpfulness of treatment by mental health service provider is related to race/ethnicity and psychosocial factors. Data from the National Co morbidity Survey-Replication study, which administered mental health service use questions for the past 12-months (1332), was analyzed. Data were stratified by service provider and analyzed with multiple logistic regressions. Racial/ethnic minorities were generally more likely to be satisfied with services provided by specialty mental health providers compared to white respondents. Racial/ethnic minorities generally perceived the services provided by specialty mental health providers as more helpful than did other racial/ethnic groups. Those who reported high cultural identity were more likely to find their treatment experience less satisfying and less helpful. Greater attention to specialty referrals for racial/ethnic minority groups may fruitfully contribute to improve help-seeking for these groups. The role culture plays in shaping the mental health treatment experience needs to be further investigated.     

Education differentials by race and ethnicity in the diagnosis and management of hypercholesterolemia: a national sample of U.S. adults (NHANES 1999–2002)

Objectives:  To examine education differentials in screening, awareness, treatment and control of hypercholesterolemia overall and in 3 race/ethnic groups. Methods:  We analyzed data for a nationally representative sample of 8,429 men and women ages 20 to 85 years, self-reported as white, black, Mexican American, or other race/ethnicity, who participated in the National Health and Nutrition Examination Survey from 1999–2002. Results:  Participants with < high school education were 2.5 times less likely than participants with ≥ high school education to have been screened for hypercholesterolemia, after adjusting for age and gender (odds ratio: 0.4, 95 % confidence interval: 0.3–0.5, and similar across race/ethnic group). Multivariable models for awareness, treatment and control showed no significant trends associated with education after adjusting for age, gender, race and comorbidities. Conclusions:  Higher education significantly increased the odds of being screened for hypercholesterolemia overall and within each race/ethnic group. Education differentials were strongest for hypercholesterolemia screening, and weak or no longer apparent for subsequent steps of awareness, treatment and control. Focusing public health policy on increasing screening for individuals with low education might greatly improve their chances of preventing or mitigating morbidity related to hypercholesterolemia and subsequent cardiovascular disease. Submitted: 31 March 2007; revised: 27 March 2008, 09 September 2008; accepted: 29 September 2008     

Race differences in factors relating to smoking initiation

To investigate race differences in retrospectively-reported early smoking experiences, we studied African-American (n = 48) and Caucasian (n = 155) current smokers who participated in a study designed to identify phenotypic and genotypic factors associated with smoking. Compared with Caucasian smokers, African-American smokers were less educated (mean ± s.e.m.: 13.3 ± 0.25 vs. 14.3 ± 0.16; p < .01), had higher BMI (28.9 ± 1.06 vs. 26.7 ± 0.52; p < .05), and smoked significantly fewer cigarettes/day (14.1 ± 1.00 vs. 18.4 ± 0.74; p < .01). Ninety percent of African-American smokers consumed menthol cigarettes, as opposed to 25% of Caucasian smokers. African-American smokers were significantly older than Caucasian smokers upon initial smoking experimentation (17.4 ± 1.1 vs. 14.7 ± 0.3; p < .05) and onset of regular smoking (19.7 ± 0.9 vs. 17.4 ± 0.4; p < .05). African-American smokers were significantly more likely than Caucasian smokers to endorse global pleasurable sensations (48% vs. 30%; p < .05), “pleasurable rush or buzz” (62% vs. 43%; p < .05), and “relaxing” (45% vs. 27%; p < .05) as early experiences with smoking, whereas Caucasian smokers were marginally more likely to report dizziness and difficulty inhaling (61% vs. 45%; p < .10 and 48% vs. 31%; p < .10, respectively). Caucasian smokers were significantly more likely to endorse friends (6.9 ± 0.2 vs. 4.8 ± 0.4; p < .0001) and “perk me up” (4.2 ± 0.3 vs. 3.1 ± 0.4; p < .05) and marginally more likely to endorse buzz (4.2 ± 0.2 vs. 3.4 ± 0.5; p < .10) as reasons for starting to smoke. Further research is needed to determine the relative contributions of genetic, developmental, and socio-cultural factors to these findings.     

The Black–White difference in age trajectories of functional health over the life course

This study examines whether the racial disparity in functional health grows unabated over the adult life course – the cumulative disadvantage hypothesis – or shrinks among the oldest old – the age-as-leveler hypothesis. Special emphasis is placed on the role of socioeconomic status (SES), which is highly associated with race. The analysis uses latent growth-curve modeling to examine differences in age trajectories of functional health between Black and White Americans and is based on nationally representative panel data of 3497 adults. Results cautiously support the age-as-leveler hypothesis. Net of functional health at baseline, Black adults experience a growing disadvantage in functional health over time until the oldest ages, when the gap in functional health begins to shrink. Results indicate that the potential leveling mechanisms of age may be specific to women. SES including financial assets explains the divergence in functional health across young and middle-aged Black and White adults, but not the later-life convergence. This study reveals the life-course pattern of racial disparity in functional health and suggests that more theoretical development is needed in this field to explain why the age-as-leveler and cumulative disadvantage processes are different for functional health than for other outcomes.     

Neighborhood racial composition,social capital and black all-cause mortality in Philadelphia

Neighborhood characteristics such as racial composition and social capital have been widely linked to health outcomes, but the direction of the relationship between these characteristics and health of minority populations is controversial. Given this uncertainty, we examined the relationship between neighborhood racial composition, social capital, and black all-cause mortality between 1997 and 2000 in 68 Philadelphia neighborhoods. Data from the U.S. Census, the Philadelphia Health Management Corporation's 2004 Southeast Pennsylvania Community Health Survey, and city vital statistics were linked by census tract and then aggregated into neighborhoods, which served as the unit of analysis. Neighborhood social capital was measured by a summative score of respondent assessments of: the livability of their community, the likelihood of neighbors helping one another, their sense of belonging, and the trustworthiness of their neighbors. After adjustment for the sociodemographic characteristics of neighborhood residents, black age-adjusted all-cause mortality was significantly higher in neighborhoods that had lower proportion of black residents. Neighborhood social capital was also associated with lower black mortality, with the strongest relationship seen for neighborhoods in the top half of social capital scores. There was a significant interaction between racial composition and social capital, so that the effect of social capital on mortality was greatest in neighborhoods with a higher proportion of black residents and the effect of racial composition was greatest in neighborhoods with high social capital. These results demonstrate that age-adjusted all-cause black mortality is lowest in mostly black neighborhoods with high levels of social capital in Philadelphia.     

Disparate use of minimally invasive surgery in benign surgical conditions

Background  Disparities in outcome across race and ethnicity have been consistently described for medical and surgical care. Given that surgery is a rapidly evolving field, we hypothesized that racial disparities exist in access to minimally invasive surgery (MIS), which importantly influences outcome. Methods  Cohort analysis of all patients who underwent appendectomy, gastric fundoplication, and gastric bypass in the Nationwide Inpatient Sample, a 20% stratified random sample of US hospital discharge abstracts. To determine the effect of race on the use of MIS techniques and morbidity and mortality, we controlled for patient characteristics, comorbidity, and hospital characteristics including surgical volume and MIS conversion to open surgery. Results  Blacks were consistently less likely to be treated with MIS despite adjustment for socioeconomic status, comorbidity, and treatment setting. In addition, in-hospital mortality and complications such as pneumonia, heart disease, infections, and surgical misadventures were higher in black than white patients. These outcomes differences remained despite adjustment for hospital volume, the use of MIS, and MIS conversion to open surgery. Conclusions  We demonstrate evidence of racial disparities in the use of MIS for benign surgical conditions and worse outcomes for patients of black race. Although, the racial differences in outcome were attenuated with adjustment for MIS, further studies are needed to help resolve remaining differences in outcomes across race. Presented at the 2008 SAGES Annual Meeting.