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OBJECTIVE: This study determined rates of breastfeeding advice given to African American and white women by medical providers and WIC nutrition counselors, and sought to determine whether racial differences in advice contributed to racial differences in rates of breastfeeding. METHODS: The study used data from the 1988 National Maternal and Infant Health Survey, a cross-sectional survey of a nationally representative sample of mothers with a live birth, infant death, or fetal death in 1988. The authors compared white women (n=3,966) and African American women (n=4,791) with a live birth in 1988 on self-reported rates of medical provider and WIC advice to breastfeed, WIC advice to bottlefeed, and breastfeeding. RESULTS: Self-reported racial identification did not predict medical provider advice. However, being African American was associated with less likelihood of breastfeeding advice and greater likelihood of bottlefeeding advice from WIC nutrition counselors. In multivariate analyses controlling for differences in advice, being African American was independently associated with lower breastfeeding rates (odds ratio [OR] = 0.41, 95% CI 0.32, 0.52). CONCLUSIONS: African American women were less likely than white women to report having received breastfeeding advice from WIC counselors and more likely to report having received bottlefeeding advice from WIC counselors. However, African American and white women were equally likely to report having received breastfeeding advice from medical providers. Lower rates of breastfeeding advice from medical or nutritional professionals do not account for lower rates of breastfeeding among African American women.
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Health literacy-"the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions"-has been identified as a cross-cutting quality-of-care issue by the Institute of Medicine. This article defines the scope of the health literacy problem, discusses the literacy demands of critical care, and offers strategies for nurses to improve the quality of health communication with patients and families in the critical care environment.
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BACKGROUND: For a number of reasons, it has been difficult to garner public interest in the need to improve the quality of care delivered nationally. One possible reason for this is that the concept of quality has different meanings for different stakeholders. To make the problems of suboptimal quality more concrete and potential solutions more compelling, the Strategic Framework Board (SFB) recommended developing a set of national goals for quality improvement. OBJECTIVES: To describe the criteria by which national goals should be selected, illustrate the analytic methods that should be used to support the development of such goals, and describe and illustrate a process by which national goals could be formulated. RESEARCH DESIGN: Targeted review of literature and discussions among members of the SFB. FINDINGS: National goals have played a key role in making progress under the Healthy People 2000 and Health People 2010 initiatives. The recommended process will involve assembling key evidence as well as engaging in a consensus process. CONCLUSIONS: Developing a set of national goals for quality improvement is a key activity for a national quality measurement and reporting system to undertake. The steps outlined here represent a feasible and productive method for accomplishing this objective.
The authors detail a Writing Across the Curriculum (WAC) exercise that combines the Department of Health and Human Services' Secretary's Award for Innovations in Health Promotion and Disease Prevention (Secretary's Award) and the DHHS document Healthy People 2010. The authors discuss the writing competition as a way to encourage innovative problem solving and provide curricular instructions for using Healthy People 2010 and the Secretary's Award as a WAC exercise.
This article examines to what extent data are typically available at the state and local level to track the Healthy People 2010 (HP 2010) objectives. It is estimated that there is a data source to track 56 percent of the relevant HP 2010 objectives at the state level and only 33 percent of the objectives can be tracked at the county level. The main solution for tracking more objectives at the state and county level is to expand the number of questions and coverage of the BRFSS and YRBS.
Healthy People 2010 national objectives seek to engage public health systems in health improvement. Focusing on "healthy communities," the article describes the readiness of U.S. counties to meet targets and the technical assistance that may be needed. Using rate comparisons and trends, four readiness-to-improve health categories are calculated for nine mortality rates. Greatest readiness for improvement was found for coronary heart disease mortality, where the fewest jurisdictions (35%) were static, having neither met targets nor improved; least readiness (65%) was observed for colon and rectum cancer and suicide. Nevertheless, some counties (50-1,050) were exemplary, already meeting the target and still improving.
OBJECTIVES: To compare relative measures of disparity in rates of favorable events with those in rates of adverse events. METHODS: Relative measures of disparity are applied to four health indicators to demonstrate how the size of a disparity between groups, and changes in disparity over time, depend on whether indicators are expressed in terms of favorable or adverse events. RESULTS: The size of an absolute measure of disparity is the same whether favorable or adverse events are studied. The size of a relative measure of disparity depends on the rate for each group and the reference point from which the disparity is measured. The rates for each group and for the reference point depend on whether the indicator is expressed in terms of favorable or adverse events. Relative measures of disparity, and conclusions about changes in relative measures of disparity, depend on whether indicators are expressed in terms of favorable or adverse events. CONCLUSIONS: When relative measures of disparity are used to monitor changes in disparity over time or to compare disparities across different indicators, disparities should be measured in terms of adverse events.
OBJECTIVES: One overarching goal of Healthy People 2010 is to eliminate health disparities. Reducing disparities improves the overall health status of a population but is a lengthy process. The disparity change score (DCS) is a method for tracking health disparities over time. METHODS: Rates, rate ratios, and DCSs were calculated to track disparities during two time periods by sex, race/ethnicity, education, and income for key health indicators. Time periods were 10 years apart for all death indicators; length between time periods varied for other indicators depending on data collection systems. RESULTS: Sex-, race/ethnicity-, education-, and income-based disparities and disparity changes for New Mexico were identified. In general, males, American Indians, and those with the lowest income and education experienced the greatest health disparities. Five disparities that are worsening were identified for targeted interventions, mainly for males (firearm-related death and suicide) and American Indians (diabetes death and influenza/pneumonia death), but also for white non-Hispanics (drug-related death). CONCLUSIONS: Examining disparities at one point in time discounts disparity change over time. The DCS can help identify large disparities that are worsening and toward which resources for targeted interventions can be redirected. New Mexico should consider interventions for the five key disparities identified in this study.
In 2001, the Office of Disease Prevention and Health Promotion in the US Department of Health and Human Services announced its intention to (1) identify innovative ways to increase public awareness and focus on Healthy People 2010 objectives and (2) broaden the participation of community-based organizations, including agencies new to public health. The mechanism selected, microfinancing, was modeled after small venture loans for economic stimulus in developing countries. The Office of Disease Prevention and Health Promotion selected one state health department and one academic research organization from 80 applicants to test models of awarding "microgrants" of 2,010 dollars to community agencies. This article describes the two models, the types of agencies that were funded, the primary Healthy People 2010 objectives targeted, examples of how the monies were used and leveraged by grantees, and the implications of microgrants for public health practice and policy.
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OBJECTIVE: To analyze healthy life expectancy (HLE) for major racial and gender subgroups, based on the diverse population of Tennessee and compared with the United States. MATERIALS AND METHODS: We use life table methodology and the HLE calculation model of the National Center for Health Statistics (NCHS), using two databases for 2001: NCHS National Vital Statistics Reports life tables and CDC Behavioral Risk Factor Surveillance System (BRFSS) survey. RESULTS: For Tennessee, although average total life expectancy (TLE) is 73.6 years at birth, only 61.1 years of "good" health are expected. Substantial racial and gender differences are found in both TLEs and HLEs with black males having the lowest and white females the highest. Although females have longer TLE, they spend more years in an unhealthy state than males. CONCLUSIONS: The findings raise new challenges for researchers and health policy makers for accomplishing the dual goals of longer life expectancy and elimination of health disparities among population subgroups.
Health policy in both the United States and the United Kingdom has recently shifted toward a much greater concern with disparities and inequalities in health and health care. As evidence for these disparities and inequalities mounts, the different approaches in each country present specific challenges for policy and practice. These differences are most apparent in the mechanisms by which the progress of such policies is measured. This article compares the United States' and United Kingdom's strategies to gauge the challenges for policymakers in order to inform policy and practice. A cross-national comparison of selected measurement mechanisms identifies lessons for policy and practice in both countries.
OBJECTIVE: To explore three potential causes of racial/ethnic differences in influenza vaccination rates in the elderly: (1) resistant attitudes and beliefs regarding vaccination by African-American and Hispanic Medicare beneficiaries, (2) poor access to care during influenza vaccination weeks, and (3) discriminatory behavior by providers. DATA SOURCES: Medicare beneficiaries who responded to both the 1995 and 1996 Medicare Current Beneficiary Survey (MCBS) (n=6,746). STUDY DESIGN: We combined survey information from the MCBS with Medicare claims. We measured resistance to vaccination by self-reported reasons for not receiving vaccination, access to care by claims submitted during vaccination weeks, and discrimination by racial differences in vaccinations among beneficiaries who visited the same providers during vaccination weeks. PRINCIPAL FINDINGS: White beneficiaries (66.6 percent) were more likely to self-report having received vaccination than were African Americans (43.3 percent) or Hispanics (52.5 percent). Resistance to vaccination plays a role in low vaccination rates of African-American (-11.8 percentage points), but not Hispanic beneficiaries. Unequal access accounts for <2 percent of the disparity. Minority beneficiaries remained unvaccinated despite having medical encounters with their usual providers on days when those same providers were administering vaccinations to white beneficiaries. This disparity is attributable not to provider discrimination but to a 1.6-5 x higher likelihood of white beneficiaries initiating encounters for the purpose of receiving vaccination. CONCLUSION: Disparities in access to care and provider discrimination play little role in explaining racial/ethnic disparities in influenza vaccination. Eliminating missed opportunities for vaccination in 1995 would have raised vaccination rates in three racial/ethnic groups to the Healthy People 2000 goal of 60 percent vaccination.
PURPOSE: To identify aggregate-specific cancer risk factors of Vietnamese Americans in south Alabama and present a comparison with available national data and Healthy People 2010 targets. DESIGN: Cross-sectional survey. METHODS: A convenience sample of 284 Vietnamese community residents 18 years and over completed an investigator-designed questionnaire. Data were analyzed using descriptive correlational analysis. FINDINGS: Aggregate-specific cancer risk factors included high prevalence of hepatitis, high smoking and drinking rates in men, extended sun exposure without protection, knowledge deficit of cancer and cancer screenings, and low cancer screening rates. Educational level was significantly related to many cancer risk factors. CONCLUSIONS: Significant cancer risk factors exist in the target population in comparison to available national data and Healthy People 2010 targets. More focused cancer prevention and early detection efforts should be initiated for this underserved population. Future research is needed to (a) determine the effect of acculturation on cancer risk factors and (b) develop culturally appropriate interventions to improve the effectiveness of cancer prevention and early detection interventions in this subgroup of Asian Americans.