A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care.

Over the past decade, researchers have shifted their focus from documenting health care disparities to identifying solutions to close the gap in care. Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation, is charged with identifying promising interventions to reduce disparities. Based on our work conducting systematic reviews of the literature, evaluating promising practices, and providing technical assistance to health care organizations, we present a roadmap for reducing racial and ethnic disparities in care. The roadmap outlines a dynamic process in which individual interventions are just one part. It highlights that organizations and providers need to take responsibility for reducing disparities, establish a general infrastructure and culture to improve quality, and integrate targeted disparities interventions into quality improvement efforts. Additionally, we summarize the major lessons learned through the Finding Answers program. We share best practices for implementing disparities interventions and synthesize cross-cutting themes from 12 systematic reviews of the literature. Our research shows that promising interventions frequently are culturally tailored to meet patients' needs, employ multidisciplinary teams of care providers, and target multiple leverage points along a patient's pathway of care. Health education that uses interactive techniques to deliver skills training appears to be more effective than traditional didactic approaches. Furthermore, patient navigation and engaging family and community members in the health care process may improve outcomes for minority patients. We anticipate that the roadmap and best practices will be useful for organizations, policymakers, and researchers striving to provide high-quality equitable care.

Impact of the food environment and physical activity environment on behaviors and weight status in rural U.S. communities.

OBJECTIVE: To examine the association between weight status and characteristics of the food and physical activity environments among adults in rural U.S. communities. METHOD: Cross-sectional telephone survey data from rural residents were used to examine the association between obesity (body mass index [BMI] >30 kg/m(2)) and perceived access to produce and low-fat foods, frequency and location of food shopping and restaurant dining, and environmental factors that support physical activity. Data were collected from July to September 2005 in Missouri, Arkansas, and Tennessee. Logistic regression models (N=826) adjusted for age, education and gender comparing normal weight to obese respondents. RESULTS: Eating out frequently, specifically at buffets, cafeterias, and fast food restaurants was associated with higher rates of obesity. Perceiving the community as unpleasant for physical activity was also associated with obesity. CONCLUSION: Adults in rural communities were less likely to be obese when perceived food and physical activity environments supported healthier behaviors. Additional environmental and behavioral factors relevant to rural adults should be examined in under-studied rural U.S. populations.