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Churches, academic institutions, and public health: partnerships to eliminate health disparities.

The four principles represent a framework for improving the process of establishing sustainable partnerships between research, public health, and faith-based institutions that seek to eliminate health disparities. To improve the efficacy of partnerships with churches identification of potential partner churches must be deliberate, trusting relationships must be built, divergent perspectives must be communicated and reconciled, and some tangible power should be transferred to church and community leaders where feasible. We applaud the National Institutes of Health, through the National Center on Minority Health and Health Disparities', efforts to "promote coordination and collaboration among the agencies conducting or supporting minority health or other health disparities research." We recommend that the North Carolina Office of Minority Health and Health Disparities be charged with and provided adequate resources to facilitate this type of coordination and collaboration among North Carolina Department of Health and Human Services agencies that are disparities conducting or supporting minority health and health research. A special emphasis should be placed on partnerships that seek to engage communities of faith.

Community Participation↗
PubMed2005

Improving health, eliminating disparities: finding solutions for better health care for all populations.

The Fourth Annual Primary Care and Prevention Conference was held October 25-27, 2004 in Atlanta, Georgia to address inequalities in primary care health outcomes and to develop strategies to improve the health status among under-served communities throughout the country. The Ninth Annual HeLa Women's Health Conference was conducted concurrently during the conference's Tuesday, October 26 sessions and were designed for those in obstetrics/gynecology. The reports herein provide a sample of the rich presentations and scientific knowledge imparted by a faculty of more than 100 who addressed disparities across disease states (heart disease and stroke; cancer; diabetes, chronic kidney disease, and obesity; infectious disease; mental health and mental disorders; environmental health/injury and violence; respiratory diseases; and substance abuse, tobacco use) and within focused areas (adult health; maternal, child and adolescent health; health policy and practice; and social and community health).

Community Health Planning↗
PubMed2005

Visual impairment and use of eye-care services and protective eyewear among children--United States, 2002.

Visual impairment is an important cause of developmental disability among children. Ocular conditions, if undetected or untreated, can have substantial long-term implications for the quality of life of the child and the family and can place a burden on public health resources. For these reasons, the national health objectives for 2010 now include three vision objectives for children: 1) reducing visual impairment and blindness, 2) increasing the proportion of preschool children who receive vision screening, and 3) increasing the use of protective eyewear in recreational activities and hazardous situations around the home (objective nos. 28-2, 28-4, and 28-9a). When these objectives were published in November 2000, baseline data were available for only one objective, that of reducing visual impairment and blindness among children. To address all three childhood vision objectives, CDC analyzed data from the 2002 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which indicated that the prevalence of visual impairment and the use of eye-care services were significantly higher among children aged >6 years, compared with younger children, and varied by race/ethnicity and family income. As a result of that analysis, national baselines are now available for all three objectives. Collaborative efforts of all relevant agencies, health professionals, educators, and the public are needed to achieve the national childhood vision objectives for 2010.

Adolescent↗
PubMed2005

Monitoring progress in arthritis management--United States and 25 states, 2003.

Arthritis is a chronic disease affecting an estimated 43 million (20.8%) U.S. adults and is the leading cause of disability in the United States. Arthritis results in activity and work limitations, decreased quality of life, and substantial burden to the U.S. health-care system. Promotion of arthritis self-management through weight counseling, physical activity counseling, and arthritis education can reduce pain, improve function and quality of life, and delay disability among persons with arthritis. To encourage arthritis self-management, three objectives were added to the national health objectives for 2010. To monitor progress toward achieving these objectives and assess that progress by selected characteristics, CDC analyzed data from the 2003 National Health Interview Survey (NHIS) and the state-based 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of those analyses, which indicated no statistically significant progress toward reaching the targets for weight counseling, physical activity counseling, and arthritis education. To meet these targets by 2010, public health and health-care agencies should increase efforts to improve awareness of these three factors among both health-care providers and patients. Such interventions will enable persons with arthritis to better self-manage their disease.

Adult↗
PubMed2005

Behavioral interventions and the role of television in the growing epidemic of adolescent obesity--data from the 2001 Youth Risk Behavioral Survey.

OBJECTIVE: To test television exposure's contribution to overweight (BMI > 95th percentile /age) status in 11.3% of 2001 YRBS respondents, when controlling for moderate/vigorous activity, and eating habits. METHODS: Controlling for age, ethnicity, smoking, moderate/vigorous activity, and diet habits, gender-specific SUDAAN models estimate likelihood (O.R.) for overweight in teens watching 2+ hours of TV/day. RESULTS: TV exposure independently increases odds of overweight by 50% for both genders (boys: OR 1.5 [1.2-1.8]; girls: OR 1.6 [1.2-2.0]), when other covariates are controlled. Low vigorous activity rate (1.39 [1.1-1.86]) and smoking independently promote obesity in girls, while boys with fewer fruit/vegetable servings are less likely to be overweight (.76 [.60-.96]). CONCLUSION: Current school-based interventions promote environmental and curricular changes for healthier diets and increased activity rates. TV exposure, however, is rarely targeted as a separate risk factor, and requires attention at the individual, family, and community levels.

Adolescent↗
PubMed2005

Adult immunization disparities: a challenge for the public health/primary care partnership.

Vaccine preventable pneumonias account for 5% of all the years of potential life lost (YPLL) attributable to racial and ethnic health disparities. Eliminating disparities in influenza and pneumococcal vaccination rates could eliminate many of these pneumonia deaths and hospitalizations among at-risk individuals. This represents one of the most focused and achievable targets within the broader agenda of eliminating racial and ethnic health disparities, which is one of two major health goals for the nation outlined in Healthy People 2010. A broad, three-dimensional conceptual framework guiding a strong public health/primary care partnership will be required to achieve this goal.

Adult↗
PubMed2005

Are older adults up-to-date with cancer screening and vaccinations?

INTRODUCTION: Public health organizations in the United States emphasize the importance of providing routine screening for breast cancer, cervical cancer, and colorectal cancer, as well as vaccinations against influenza and pneumococcal disease among older adults. We report a composite measure of adults aged 50 years and older who receive recommended cancer screening services and vaccinations. METHODS: We analyzed state data from the 2002 Behavioral Risk Factor Surveillance System, which included 105,860 respondents aged 50 and older. We created a composite measure that included colonoscopy or sigmoidoscopy within 10 years or a fecal occult blood test in the past year, an influenza vaccination in the past year, a Papanicolaou test within 3 years for women with an intact cervix, a mammogram, and for adults aged 65 and older, a pneumonia vaccination during their lifetime. We performed separate analyses for four age and sex groups: men aged 50 to 64, women aged 50 to 64, men aged 65 and older, and women aged 65 and older. RESULTS: The percentage of each age and sex group that was up-to-date according to our composite measure ranged from 21.1% of women aged 50 to 64 (four tests) to 39.6% of men aged 65 and older (three tests). For each group, results varied by income, education, race/ethnicity, insurance status, and whether the respondent had a personal physician. CONCLUSION: These results suggest the need to improve the delivery of cancer screenings and vaccinations among adults aged 50 and older. We propose continued efforts to measure use of clinical preventive services.

Aged↗
PubMed2005

Methodological issues in measuring health disparities.

OBJECTIVES: This report discusses six issues that affect the measurement of disparities in health between groups in a population: Selecting a reference point from which to measure disparity. Measuring disparity in absolute or in relative terms. Measuring in terms of favorable or adverse events. Measuring in pair-wise or in summary fashion. Choosing whether to weight groups according to group size. Deciding whether to consider any inherent ordering of the groups. These issues represent choices that are made when disparities are measured. METHODS: Examples are used to highlight how these choices affect specific measures of disparity. RESULTS: These choices can affect the size and direction of disparities measured at a point in time and conclusions about the size and direction of changes in disparity over time. Eleven guidelines for measuring disparities are presented. CONCLUSIONS: Choices concerning the measurement of disparity should be made deliberately, recognizing that each choice will affect the results. When results are presented, the choices on which the measurements are based should be described clearly and justified appropriately.

Data Collection↗
PubMed2005

Trends in cholesterol screening and awareness of high blood cholesterol--United States, 1991-2003.

High blood cholesterol (HBC) (i.e., total cholesterol > or =240 mg/dL) is a major risk factor for heart disease, the leading cause of death in the United States. As a result, public health agencies and their partners have attempted to reduce the prevalence of HBC through screening and by increasing public awareness of HBC and strategies for reducing it. A national health objectives of Healthy People 2010 is to increase to 80% the proportion of adults aged > or =20 years who have been screened for HBC within the preceding 5 years. For this report, data from the Behavioral Risk Factor Surveillance System (BRFSS) collected during 1991-2003 were analyzed to examine trends in the percentage of adults screened for HBC and the percentage of those screened who were told they had HBC. The findings indicated that both percentages increased during 1991-2003 but that few states had achieved the national health objective for screening. Further emphasis on cholesterol screening is needed, particularly among Hispanic and Asian/Pacific Islander populations and young adults.

Behavioral Risk Factor Surveillance System↗
PubMed2005

Trends in walking for transportation in the United States, 1995 and 2001.

INTRODUCTION: The purpose of this study was to examine trends in walking for transportation among U.S. adults and youth for Healthy People 2010 objective 22-14. The objective calls for increasing the proportion of trips of 1 mile or less made by walking to 25% for adults and 50% for youth. National transportation surveys are used to track national health objectives, but data interpretation and caveats to use have not been discussed in the public health literature to date. METHODS: Cross-sectional analyses at two time points used data from the 1995 Nationwide Personal Transportation Survey and the subsequent 2001 National Household Travel Survey. The populations of interest were U.S. civilian noninstitutionalized adults (aged 18 years and older) and youth (aged 5 to 15 years). Trends were reported for the percentage of walking trips of 1 mile or less for transportation (adults) and walking trips of 1 mile or less to school (youth) using 86,286 trips (1995) and 119,462 trips (2001) made by adults and 3114 trips (1995) and 4073 trips (2001) made by youth. RESULTS: Of trips of 1 mile or less, adults reported more walking in 2001 (21.2%; 95% confidence interval [CI], 20.5-21.9) than in 1995 (16.7%; CI, 15.9-17.5). For trips to school of 1 mile or less, youths also increased walking from 1995 (31.3%; CI, 27.9-34.4) to 2001 (35.9%; CI, 33.0-38.8). Changes in survey methodology affected the interpretation of the Healthy People 2010 trends. CONCLUSION: In spite of small increases in walking between 1995 and 2001 accompanying a change in survey methodology, U.S. adults and youth fall short of meeting Healthy People 2010 walking objectives for trips of 1 mile or less.

Adolescent↗