We used the intersectionality framework to examine impact of racial/ethnic, immigration, and insurance differences on the timing of initiation of prenatal care (PNC) and subsequent adherence. In this ...cross sectional study
independent variables
were women’s race/ethnicity; nativity; age; education; and insurance.
The dependent variables
were late initiation and non-adherence to recommended number of PNC visits. We used multivariate analysis to evaluate the impact of the independent variables on late initiation and non-adherence. Analysis revealed that race/ethnicity/nativity (RE-N) was more consistently associated with late initiation and non-adherence for privately insured than publicly insured persons. While private insurance had a positive impact on initiation and adherence overall, its impact was greater for White women. Having private insurance coverage was most beneficial to White women. We contend that the intersectional approach provides promising avenues for expanding our knowledge of health disparities and of identifying new ways of going about eliminating the persistent and pervasive social inequalities and informing efforts to reduce them.
Racial, ethnic, (R/E) and gender disparities in access to health services in the United States and their relationship to adverse health outcomes are well established. Despite an increase in ...evidence-based cardiovascular treatment, gender, racial, and ethnic disparities in coronary artery disease (CAD) treatment persist. There is neither currently a comprehensive framework for understanding why disparities occur in cardiovascular disease care, nor viable solutions for intervention. This article synthesizes the literature on disparities in coronary artery disease with a conceptual model for understanding chronic disease disparities. This article follows the natural history of disease to observe where differences arise, beginning with health risk management, screening, diagnosis, treatment, and rehabilitation. Racial, ethnic, and gender differences were found at every step of this continuum, including a higher burden of risk factors and a less likelihood of receiving needed lifesaving cardiac procedures. Unfortunately, there is a dearth of intervention strategies to reduce racial, ethnic, and gender disparities in coronary artery disease. Comprehensive solutions will require addressing the barriers at the system, the provider, and the patient level. An early intervention approach that addresses multiple risk factors should be a high priority.
The goals of the Central California Regional Obesity Prevention Program (CCROPP) are to promote safe places for physical activity, increase access to fresh fruits and vegetables, and support ...community and youth engagement in local and regional efforts to change nutrition and physical activity environments for obesity prevention. CCROPP has created a community-driven policy and environmental change model for obesity prevention with local and regional elements in low-income, disadvantaged ethnic and rural communities in a climate of poor resources and inadequate infrastructure. Evaluation data collected from 2005-2009 demonstrate that CCROPP has made progress in changing nutrition and physical activity environments by mobilizing community members, engaging and influencing policymakers, and forming organizational partnerships.
To evaluate costs and effectiveness of ambulatory care provided by specialists, nonspecialists (general internists), and both specialists and nonspecialists (co-care) to patients with knee ...osteoarthritis (OA) and/or chronic low back pain (LBP).
We studied Veterans Health Administration (VHA) outpatients from the Veterans Health Study with LBP and/or OA followed for at least 6 months between August 1993 and December 1995, who completed the Medical Outcomes Study Short Form 36-item (SF-36) functional status questionnaires at both baseline and followup. We obtained costs of VHA outpatient utilization and medications for these patients during the followup period. We compared costs and effectiveness of the ambulatory care provided by specialists, nonspecialists, and co-care. We also compared specialty care with nonspecialty care using an incremental cost effectiveness ratio (ICER) of annualized cost difference divided by annualized SF-36 based Physical Component Summary (PCS) improvement difference. ICER stability was assessed using bootstrap sampling.
Among 398 patients, followed an average of 14 months, 155 received only nonspecialty care, 49 specialty-only care, and 192 co-care. After regression analysis, adjusted for age, disease characteristics, and baseline health status, PCS improvements per year were 1.66 (SD 8.22) for nonspecialty care, 3.48 (SD 7.91) for specialty care, and 0.65 (SD 8.08) for co-care; while costs of care per year were $1099 (SD $1681), $1376 (SD $1503), and $2517 (SD $1644), respectively (all data US dollars). A standardized ICER of $152 per PCS unit indicated specialty care to be cost effective compared with nonspecialty care.
Specialist-only ambulatory care for OA or LBP was associated with improvement in functional status at slightly higher costs compared with nonspecialty care. Co-care, however, was substantially more costly and was associated with little improvement in functional status.
This meta-analysis compares California to 13 states with regard to adequacy of prenatal care in the context of the major Medicaid expansion. It shows a reduction in prenatal care inadequacy after ...1992, especially in California. It also shows persistent racial ethnic disparities. By examining how California differed from other states, this study provides not only benchmarks for attaining the Healthy People 2010 goal of 90% adequacy but also possible strategies for achieving this goal. Attaining the Healthy People 2010 objective for prenatal care for California as a whole will require further efforts to understand and address racial/ethnic and insurance-related inequalities.
Efforts to prohibit the sales of tobacco and alcohol products to minors are widespread. Electronic Age Verification (EAV) devices are one possible means to improve compliance with sales to minors ...laws. The purpose of this study was to evaluate the implementation and effectiveness of EAV devices in terms of the frequency and accuracy of age verification, as well as to examine the impact of EAV's on the retailer environment. Two study locations were selected: Tallahassee, Florida and Iowa City, Iowa. Retail stores were invited to participate in the study, producing a self-selected experimental group. Stores that did not elect to test the EAV's comprised the comparison group. The data sources included: 1) mystery shopper inspections: two pre- and five post-EAV installation mystery shopper inspections of tobacco and alcohol retailers; 2) retail clerk and manager interviews; and 3) customer interviews. The study found that installing EAV devices with minimal training and encouragement did not increase age verification and underage sales refusal. Surveyed clerks reported positive experiences using the electronic ID readers and customers reported almost no discomfort about being asked to swipe their IDs. Observations from this study support the need for a more comprehensive system for responsible retailing.
Introduction. Most accounts of breast cancer burden inequalities emphasize (a) the cost benefit/cost utility of seeking care or (b) equity, including insurance status and other determinants of ...access. However, these factors do not fully explain racial/ethnic disparities. The purpose of this study was to explore the utility of an alternative explanatory framework---the 'cultural-explanatory model' of illness and health proposed by Kleinman (1978) in predicting appropriate mammography initiation (uptake) and timely continuous use (adherence). This study examines: (1) major themes, differences in cancer concepts between racial/ethnic groups and how these themes differed or paralleled professional concepts particularly the biomedical and (2) the marginal impact of self-reported knowledge on mammography uptake and adherence controlling for health insurance type, provider factors and other structural access barriers. Design. A multi-ethnic group of 750 women from Eastern Massachusetts: Caucasian (143), Haitian (284), African-American (163) and Caribbean/Latina (160), comprised the sample. The main independent variables were (1) race/ethnicity and (2) measures of self-reported knowledge derived from qualitative analysis of open-ended questions addressing the nature of cancer, its causes, and potential cures. The covariate of interest was health insurance type. The dependent variables were multiple measures of appropriate mammography use, defined as: age at first mammogram (<=40 years vs. over 40 years), annual or biennial mammography rate and number of mammograms per decade of life (5 or more). Racial/ethnic group differences in breast cancer knowledge were described using bivariate tests and multivariate logistic regression analyses that explored the main effects of knowledge measures and their interactions in explaining mammography use. Findings. Important racial/ethnic differences were revealed in major themes about what is cancer, what can cause cancer, and what can cure cancer. Self-reported knowledge of cause remained a significant predictor of mammography adherence and uptake in a multivariate adjustment. In construct health insurance was only a significant predictor of uptake and not adherence. Conclusion. The Cultural Explanatory Model can improve understanding of racial/ethnic patterns in mammography uptake and adherence. Future studies should explore other knowledge structures, other than the explanatory framework.
Letter to the Editors: A Reply Krevor, Brad S.; Capitman, John A.; Ruwe, Mathilda ...
Journal of public health policy,
01/2004, Letnik:
25, Številka:
3/4
Journal Article
Recenzirano
Author's Reply: "Preventing Illegal Tobacco and Alcohol Sales to Minors Through Electronic Age-Verification Devices: A Field Effectiveness Study"
Caregiver workshops were offered to members by a group practice HMO as part of a larger demonstration of adding community care to HMO services. Of 1,200 members indicating interest at four sites, 532 ...participated in workshops and 320 completed pre- and post-questionnaires on effectiveness. Analyses showed improvements in caregiving preparedness and reductions in sadness and depression. Engagement in the workshops (completing 3 or more sessions) and improvements were more likely for individuals with more independent lives and social capital. Alternative helping strategies are recommended for caregivers who are less likely to engage in classes due to burden or lack of respite or transportation.
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