Discerning Disparities: The Data Gap.

Health disparities that focus on gender and on the ancillary dependent variables of race and ethnicity reflect continually early illness, compromised quality of life, and often premature and preventable deaths. The inability of the nation to eliminate disparities also track along race and gender in communities where a limited number of health-care providers and policymakers identify as being from these traditionally underserved and marginalized population groups. Epidemiologists and other researchers and analysts have traditionally failed to integrate the social determinants of health and other variables known to support upward mobility in their predictive analyses of health status. The poor, and poor men of color particularly, begin a descent to invisibility and separation that has been witnessed since the early days of this nation. This history has the majority of men of color mired in poverty or near poverty and has more substantively and explicitly affected both American Indians and Africans forced into immigration into the United States and into slavery. Other racial and ethnic groups including large distinct ethnic groups of Asian Americans and Hispanics/Latinx do not have their treatment by systems fully reported from a health and social justice perspective simply because the systems do not disaggregate by race and ethnicity. It is axiomatic that examining disparities through the lens of race, ethnicity, and gender provides a unique opportunity to reflect upon what is known about boys' and men's health, particularly men from communities of color, and about payment systems. Integration of all populations into the enumeration of morbidity, mortality, and disparity indices is a dynamic reflection of the vision and exclusive actions of decision makers.

Community Engaged Lifestyle Modification Research: Engaging Diabetic and Prediabetic African American Women in Community-Based Interventions.

Purpose. The I Am Woman (IAW) Program is a community-based, culturally responsive, and gender-specific nutrition, obesity, and diabetes educational prevention program designed for African American women (AAW). Chronic nutrition-related health conditions such as excess body weight, diabetes mellitus, cardiovascular disease, and some forms of cancer are common among many African American women. Methods. IAW engaged AAW at risk for such deleterious health conditions by developing a health education intervention that aimed to support weight loss and management, improve knowledge about healthy lifestyle behavioral choices, and facilitate increased access to comprehensive healthcare. This Community Health Worker- (CHW-) led program enrolled 79 AAW aged 18 and older in a 7-week group health education intervention. Results. Following the intervention, results indicated that participants had greater knowledge about nutrition and health, strategies for prevention and management of obesity and diabetes, increased engagement in exercise and fitness activities, and decreased blood pressure, weight, body, and mass index. Cholesterol levels remained relatively unchanged. Additionally, AAW visited a primary care doctor more frequently and indicated greater interest in addressing their health concerns. Conclusion. This model of prevention appears to be a promising approach for increasing awareness about ways to improve the health and well-being of AAW.

"I Want a Second Chance": Experiences of African American Fathers in Reentry.

With over 700,000 people on average released from prison each year to communities, greater attention is warranted on the experiences and needs of those who are parents and seeking to develop healthy relationships with their children and families. This study seeks to explore the experiences of African American fathers in reentry. Qualitative data from 16 African American men enrolled in a fellowship program for fathers were collected from a focus group and analyzed for common themes and using standpoint theory. Four themes emerged that focused on fathers' commitment toward healthy and successful reintegration postincarceration: redemption, employment, health care, and social support. Focus group participants actively strive to develop and rebuild healthy relationships with their children through seeking gainful employment and through bonding with like-minded peers. Barriers in accessing health care are also discussed. Research findings may inform future programs and policies related to supporting fathers and their children in reentry.

Implications for Improving Oral Health Care Among Female Prisoners in Georgia's Correctional System.

Georgia has the eighth-highest state rate of incarceration and fourth-highest number of prisoners in the country. Aside from receiving a dental examination at intake to assess oral health needs, there are no efforts to determine the barriers and determinants that contribute to the presenting oral health status of Georgia's state prisoners. Also, there is no prerelease planning to establish a health care home for prisoners being released back into the community to continue oral health care services in an effort to support successful reentry.This study assessed the barriers that impact N=98 female inmates' access to oral health care, prior to incarceration, within Georgia's prison system using a 21-item survey developed by a division of an academic institution and administered by the staff of a state department. Majority of the survey respondents reported that they do not have a regular dental provider (83%), lack insurance coverage (66%), and had their last dental visit more than a year ago because they did not have money for service or treatment (64%). The data collected from this study will be utilized to inform future project efforts to both reduce costs and increase access to oral health care for Georgia's uninsured and underinsured, and especially the incarcerated and reentry populations.

Psychosocial and sociocultural correlates of depressive symptoms among diverse African American women.

African American women are faced with many challenges regarding their historical, cultural, and social structural position in the United States that may heighten their vulnerability for depression, one of the most prevalent disorders that can engender poor functionality. The purpose of this cross-sectional pilot study was to foster greater understanding about the occurrence and correlates of depressive symptoms among a diverse convenience sample of 63 African American women recruited from a comprehensive primary health care clinic (n = 23), a small private academic institution (n = 25), and an urban community setting (n = 15). Self-report data concerning selected psychological, sociocultural, and biological factors were collected. Descriptive statistics, Pearson product moment correlation, and analysis of variance were used to analyze data. Results indicated several similarities and differences among the 3 groups of women concerning levels of depressive symptoms and their correlates. Among the total sample, symptoms of depression were mild among 65% of the women. Depressive symptoms were significant and positively associated with negative and ruminative thinking (r = 0.79, p < .01), low self-esteem (r = 0.58, p < .01), stressful life events (r = 0.43, p < .05), low social support (r = 0.46, p <.01), depression stigma (r = 0.36, p < 01), and indication of chronic diseases (r = 0.34, p < .01). Depressive symptoms were significant and negatively associated with resiliency (r = -0.48, p < .01) and spiritual well-being (r = -.47, p < .01). This research adds to the empirical data concerning contributors to depressive symptoms for African American women.

Addressing obesity and diabetes among African American men: examination of a community-based model of prevention.

The Save Our Sons study is a community-based, culturally responsive, and gender-specific intervention aimed at reducing obesity and diabetes among a small sample (n = 42) of African American men. The goals of the study were to: (1) test the feasibility of implementing a group health education and intervention model to reduce the incidence of diabetes and obesity among African American men; (2) improve regular access to and utilization of health care services and community supportive resources to promote healthy lifestyles among African American men; and (3) build community networks and capacity for advocacy and addressing some of the health needs of African American men residing in Lorain County, Ohio. Trained community health workers facilitated activities to achieve program aims. Following the 6-week intervention, results indicated that participant's had greater knowledge about strategies for prevention and management of obesity and diabetes; increased engagement in exercise and fitness activities; decreased blood pressure, weight, and body mass index levels; and visited a primary care doctor more frequently. Also, local residents elevated African American men's health and identified it as a priority in their community. This model of prevention appears to be a substantial, robust, and replicable approach for improving the health and wellbeing of African American men.

Vulnerable populations, prison, and federal and state Medicaid policies: avoiding the loss of a right to care.

Unknown numbers of incarcerated people are losing public benefits. Instead of suspending these until the prisoner or detainee is released into society, some states are simply terminating benefits upon incarceration. Although there is evidence to suggest that this policy is having negative consequences for those who are reentering society and on their communities and systems of care, the precise impact is not clear because a systematic monitoring of these actions is nonexistent. A more efficient system would (a) suspend benefits and automatically reinstate the same to those eligible upon release and (b) establish a monitoring mechanism that would provide an accurate accounting of how these benefits are being applied.

The Dental Pipeline program's impact on access disparities and student diversity.

BACKGROUND: The Robert Wood Johnson Foundation, Princeton, N.J., the W.K. Kellogg Foundation, Battle Creek, Mich., and The California Endowment, Los Angeles, collaborated in funding a five-year (2002-2007) national demonstration program (Pipeline, Profession & Practice: Community-Based Dental Education [Dental Pipeline]) to reduce dental care access disparities. Fifteen dental schools were selected to participate in the Dental Pipeline program. The goals were to have senior students spend more time in community sites providing care to underserved patients; to prepare students to treat diverse, low-income patients; and to increase enrollment of underrepresented minority (URM) students. METHODS: A national program office at Columbia University in New York City administered the Dental Pipeline program. The participating dental schools developed networks of community clinics and practices for student rotations, established courses in cultural competency and public health and implemented new programs to recruit URM students. RESULTS: The average time senior students spent in community clinics and practices increased from 10 to 50 days; all schools developed courses in cultural competency and public health; and enrollment of UMR students increased 54.4 percent (excluding two of the schools) versus 16 percent in non-Dental Pipeline schools. CONCLUSIONS: On average, the participating dental schools were successful in meeting program goals.

Leadership development for health researchers at historically Black colleges and universities.

Historically Black colleges and universities (HBCUs) have traditionally been a magnet for Black students at all levels nationwide and have been an exemplar of mentorship models for preparing leaders in many fields. A research career development program for junior faculty scholars that leverages the unique strengths of HBCUs has the potential to promote diverse leadership in health research and advance practical understanding of how to address HIV/AIDS and related health challenges that ravage vulnerable communities. A program that creates institutional bonds between HBCUs and other academic institutions can create a groundbreaking framework for more-effective community-based participatory research. We present a rationale for supporting an HBCU-led collaborative research program, one that both advances junior faculty and explores the interrelationship between HIV/AIDS, mental health, and substance abuse through research in correctional facilities.

Determining what we stand for will guide what we do: community priorities, ethical research paradigms, and research with vulnerable populations.

Prisoners, ex-offenders, and the communities they belong to constitute a distinct and highly vulnerable population, and research must be sensitive to their priorities. In light of recent suggestions that scientific experimentation involving prisoners be reconsidered, community-based participatory research can be a valuable tool for determining the immediate concerns of prisoners, such as the receipt of high-quality and dignified health care inside and outside prisons. In building research agendas, more must be done to ensure the participation of communities affected by the resulting policies.

On inspiration and leadership: a conversation with Barbara Sabol, MA, RN, and Henrie M. Treadwell, PhD. Interview by Kathleen M. Nelson.

This article began with Barbara Sabol and Henrie Treadwell's conversations about public health leadership and their assertion that today's leaders must take bolder steps to ensure health care for the underserved. They discuss a number of characteristics that they consider essential if leaders are to reach beyond the status quo and create change in their hospitals, health systems, and communities.