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1.
J Immigr Minor Health ; 26(3): 554-568, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38180583

RESUMO

Racial and ethnic minority populations experience poorer cancer outcomes compared to non-Hispanic White populations, but qualitative studies have typically focused on single subpopulations. We explored experiences, perceptions, and attitudes toward cancer care services across the care continuum from screening through treatment among African American and Hispanic residents of Nebraska to identify unique needs for education, community outreach, and quality improvement. We conducted four focus groups (N = 19), April-August 2021 with people who were aged 30 or older and who self-identified as African American or Hispanic and as cancer survivors or caregivers. Sessions followed a structured facilitation guide, were audio recorded and transcribed, and were analyzed with a directed content analysis approach. Historical, cultural, and socioeconomic factors often led to delayed cancer care, such as general disuse of healthcare until symptoms were severe due to mistrust and cost of missing work. Obstacles to care included financial barriers, transportation, lack of support groups, and language-appropriate services (for Hispanic groups). Knowledge of cancer and cancer prevention varied widely; we identified a need for better community education about cancer within the urban Hispanic community. Participants had positive experiences and a sense of hope from the cancer care team. African American and Hispanic participants shared many similar perspectives about cancer care. Our results are being used in collaboration with national and regional cancer support organizations to expand their reach in communities of color, but structural and cultural barriers still need to be addressed.


Assuntos
Negro ou Afro-Americano , Sobreviventes de Câncer , Cuidadores , Grupos Focais , Hispânico ou Latino , Humanos , Nebraska , Hispânico ou Latino/psicologia , Masculino , Feminino , Negro ou Afro-Americano/psicologia , Pessoa de Meia-Idade , Sobreviventes de Câncer/psicologia , Cuidadores/psicologia , Adulto , Idoso , Fatores Socioeconômicos , Neoplasias/etnologia , Neoplasias/terapia , Pesquisa Qualitativa , Acessibilidade aos Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde/etnologia
3.
J Cancer Educ ; 38(5): 1767-1776, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37466902

RESUMO

Nationally and in Nebraska, African Americans (AA) and Hispanics have lower colorectal cancer (CRC) screening rates compared to non-Hispanic Whites. We aimed to obtain perspectives from AA and Hispanic cancer survivors and caregivers in Nebraska about CRC screening to improve outreach efforts. Data from four virtual focus groups (AA female, AA male, Hispanic rural, and Hispanic urban) conducted between April-August 2021 were analyzed using a directed content approach based on the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model. Most of the 19 participants were female (84%) and survivors (58%). Across groups, awareness of colonoscopy was high, but awareness of fecal testing needed to be higher, with confusion about different types of fecal tests. Predisposing factors were trust in the health system; awareness of CRC screening; machismo; fear of cancer; embarrassment with screening methods; and negative perceptions of CRC screening. Enabling factors included provider recommendations, healthcare access, and insurance. Reinforcing factors included prioritizing personal health and having a support system. Suggestions to improve screening included increasing healthcare access (free or low-cost care), increasing provider diversity, health education using various methods and media, and enhancing grassroots health promotion efforts. Lack of awareness, accessibility issues, attitudes and perceptions of CRC and CRC screening, trust, and cultural and linguistic concerns are major issues that need to be addressed to reduce CRC screening disparities among AA and Hispanic adults.


Assuntos
Negro ou Afro-Americano , Neoplasias Colorretais , Adulto , Feminino , Humanos , Masculino , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento , Nebraska , Hispânico ou Latino
4.
Tob Prev Cessat ; 9: 20, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37342229

RESUMO

INTRODUCTION: As a part of a priority-setting stakeholder engagement project to strengthen the impact of the federal Tobacco 21 (T21) law, we conducted a qualitative study to solicit input from a nationwide sample of tobacco control stakeholders regarding the implementation, enforcement, and equity implications of the T21 law. METHODS: Following the T21 policy evaluation guidance developed by the Centers for Disease Control (CDC), we identified T21 experts in four domains: policy, evaluation, subject matter, and implementation from a national search of stakeholders (invitations, n=1279) to account for geographical variation. This study presents results from five focus groups conducted in December 2021 among stakeholders (n=31) with experience in T21 policy, evaluation, subject matter, and implementation. RESULTS: Participating T21 stakeholders reported on eight themes from four main topic areas: 1) Implementation, 2) Enforcement, 3) Equity outcomes, and 4) Recommended changes from stakeholders. Stakeholders shared insights on both passive and active implementation methods used in their communities, and highlighted major barriers such as the absence of a standardized tobacco retail licensing mandate and insufficient resources. Regarding T21 enforcement, stakeholders believed that current deterrents for retail violations might not be effective. They noted that vape and tobacco shops and online sales of tobacco products are emerging major challenges in T21 enforcement. Stakeholders also discussed possible health inequities that may be exacerbated by heterogenous implementation of the T21 law. CONCLUSIONS: To strengthen T21 and mitigate potential exacerbation of existing health inequities, greater alignment of federal, state, and local efforts to reduce heterogeneity of implementation and enforcement of the T21 law is recommended.

5.
J Natl Med Assoc ; 115(2): 101-118, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36775786

RESUMO

The purpose of our study is to examine the barriers and facilitators for urban African American students interested in pursuing health professions careers in the Midwest. In our analysis of the key informant interviews and focus groups, we identified four barriers (lack of preparation, lack of funding, lack of support/isolation, and perceived discrimination) and three facilitators (early preparation, support/mentorship, funding). We provide recommendations for how to leverage these facilitators and address the barriers to increase the representation of African Americans in the healthcare workforce. Novel future directions for this work should include comprehensive interventions tailored to URM students that span the health professions education pipeline and begin as early as elementary school. Interventions that engage mentors should take place at high school, undergraduate, and graduate health professions school levels.


Assuntos
Negro ou Afro-Americano , Escolha da Profissão , Diversidade, Equidade, Inclusão , Ocupações em Saúde , Estudantes , Humanos , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Ocupações em Saúde/educação , Ocupações em Saúde/estatística & dados numéricos , Grupos Minoritários/educação , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Estudantes/psicologia , Estudantes/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Meio-Oeste dos Estados Unidos/epidemiologia
6.
Health Equity ; 6(1): 554-563, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36081888

RESUMO

Purpose: Despite escalating racism in the United States during COVID-19, few studies have identified correlates of racism experience among Americans using nationally representative data. This study seeks to quantitatively identify correlates of racism experience and qualitatively categorize racism experience and its coping using nationally representative survey data. Methods: Based on data from the "Health, Ethnicity and Pandemic Survey" (N=2,506), a nationally representative survey conducted in October 2020, multivariable logistic regression was estimated to examine the association between self-reported racism experience and selected correlates. Thematic analysis was conducted to qualitatively classify types of racism experience and related coping strategies. Results: When asked whether they had been discriminated or unfairly treated during COVID-19 because of their racial/ethnic background, 19% non-Hispanic Asian and Black respondents said yes, followed by 15% among Hispanics and 3% among non-Hispanic Whites. Besides significant correlates of racism experience identified at the individual and household level, three contextual factors at the neighborhood or state level were associated with lower odds of racism experience, including living in a blue state (adjusted odds ratio [AOR]=0.69, 95% confidence interval [CI]: 0.50-0.95; reference category: red state), living in the top third of the neighborhoods in the sample in terms of racial diversity (AOR=0.65%, 95% CI: 0.42-0.99; reference: bottom third), and coming from neighborhoods with a median population age of 35-39 (AOR=0.67, 95% CI: 0.46-0.98; reference: younger than 35). Prevailing coping strategies against experienced racism included social avoidance, direct confrontation, seeking social and religious support, resorting to hobbies for relief, and taking legal actions. Conclusion: Racism experience is not only correlated with factors at individual level, it is also associated with contextual factors such as political climate, neighborhood diversity, and population age structure. Future efforts in supporting victims of racism might be more cost-effective by focusing on the identified vulnerable groups and related contextual factors.

7.
Am J Prev Med ; 63(5): 852-860, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35931617

RESUMO

INTRODUCTION: Exposure to E-cigarette marketing and media advertisements is prevalent among adolescents. A validated vaping media literacy scale is needed to inform effective vaping prevention programs. METHODS: A 6-item vaping media literacy scale was adapted from validated smoking and general media literacy scales with an emphasis on marketing influences. A school-based survey (N=856) was conducted to assess the reliability of vaping media literacy and 3 subscales (i.e., authors and audiences [vaping Authors and Audiences], messages and meanings [vaping Messages and Meanings], and representation and reality [vaping Representation and Reality]). Multivariable logistic regression models were performed to examine the associations of vaping media literacy with perceived harmfulness of E-cigarette use and susceptibility to use E-cigarettes. Analyses were conducted in 2021. RESULTS: The mean vaping media literacy among students was 2.6 (range=0-6). There were significant disparities with lower vaping media literacy among middle-school (versus high-school, p=0.03) students, males (versus females, p=0.003), and racial/ethnic minority students (Blacks, Hispanics, others versus Whites, p=0.0009). A higher vaping media literacy was significantly associated with increased perceived harmfulness of E-cigarette use (AOR=1.2; 95% CI=1.1, 1.2; p<0.0001). All subscales were also associated with E-cigarette harm perception. Among never E-cigarette users, students with a higher (versus those with a lower) vaping media literacy had lower susceptibility to initiating E-cigarettes (AOR=0.90; 95% CI=0.83, 0.97; p=0.005). Both vaping Messages and Meanings and vaping Representation and Reality subscales were adversely associated with susceptibility to vaping. CONCLUSIONS: The vaping media literacy scale may gauge the influence of E-cigarette marketing on adolescents with high reliability and validity. Racial minorities, younger adolescents, and males appear relatively vulnerable to vaping marketing influence. Efforts to increase vaping media literacy are needed to curb youth E-cigarette use.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Vaping , Masculino , Feminino , Adolescente , Humanos , Vaping/efeitos adversos , Etnicidade , Alfabetização , Reprodutibilidade dos Testes , Grupos Minoritários , Percepção
8.
AMA J Ethics ; 24(7): E599-610, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35838388

RESUMO

Background: Omaha, Nebraska, has a lead-contaminated superfund site and substandard housing that pose risks for childhood lead exposure. Healthy Housing Omaha (formerly, Omaha Healthy Kids Alliance), an environmental health nonprofit, partnered with the fourth author, an artist, and a newspaper to raise awareness about lead poisoning by publishing portraits and stories of affected community members. Methods: The authors analyzed an interview with the artist, photographs of portraits published in a local newspaper, and quotations from portrait sitters. Results: Shared stories of lead exposure and poisoning conveyed in the portraiture and printmaking processes revealed structural racism as an emergent theme. Conclusions: Arts-based research methods, such as portraiture, can be scaled and applied to support national and international community engagement efforts to advocate for environmental justice and public health.


Assuntos
Intoxicação por Chumbo , Chumbo , Criança , Saúde Ambiental , Habitação , Humanos , Chumbo/toxicidade , Saúde Pública
9.
Prev Med ; 162: 107141, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35809822

RESUMO

The reach (i.e., enrollment, engagement, and retention) of health promotion evidence-based programs (EBPs) at the participant level has been challenging. Incentives based on behavioral economics may be used to improve EBP reach. We aimed to systematically review and synthesize the evidence of the effectiveness of incentives as a dissemination strategy to increase EBP reach. We conducted a literature search in PubMed, SCOPUS, EMBASE, Cochrane Review and Cochrane CENTRAL for articles published between January 2000 and March 2020 to identify incentive strategies used to increase program reach among health promotion EBPs. Inclusion criteria included studies published in English, experimental or quasi-experimental designs, comparison of incentive to non-incentive or control strategies, and reported on reach (n = 35 health promotion studies). Monetary incentives using cash and a fixed schedule of reinforcement were the most used incentive schemes (71%). Incentives alone or combined with other strategies as a multicomponent approach were effective in improving program enrollment, engagement, and retention. Specifically, incentive strategies were associated with higher odds of program enrollment (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.82-4.24; n = 10) and retention (OR, 2.54, 95% CI, 1.34-4.85; n = 9) with considerable heterogeneity (I2 = 94% and 91%, respectively). Incentives are a promising individual-level dissemination strategy to improve the reach of health promotion EBPs. However, understanding the optimal amount, type, frequency, and target of incentives, and how incentives fit in a multicomponent approach in different contexts requires further research.


Assuntos
Promoção da Saúde , Motivação , Economia Comportamental , Humanos
10.
Am J Mens Health ; 16(3): 15579883221097801, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35549937

RESUMO

Black men experience higher levels of chronic stress, life stressors, and discrimination due to oppressive social and economic conditions. Black men are at greater risk of depression, but most published research on stress and depression has focused on Black people in general, Black women, or older Black men. We sought to determine whether discrimination, perceived stress, major life stress, daily hassles, and social capital were associated with depressive symptoms in young Black men. Survey data were collected from April 2010 to March 2012 in Southern California from a convenience sample of Black men (N = 201). We used two-sample t tests and one-way analysis of variance (ANOVA) to examine the association of stress correlates with depressive symptoms. Logistic regression was conducted to estimate the likelihood of reporting depressive symptoms for each significant correlate. Over half of the sample reported depressive symptoms. Health status, perceived discrimination, urban hassles, perceived stress, and neighborhood trust and safety were significantly related to depressive symptoms. Those who reported higher perceived stress had higher odds of reporting depressive symptoms, whereas lower everyday discrimination experiences were associated with lower odds of depressive symptoms. Future studies should consider examining the effectiveness of embedding coping mechanisms for stress, including perceived discrimination, in health interventions for young Black men to prevent or reduce depression.


Assuntos
Racismo , Negro ou Afro-Americano , População Negra , California/epidemiologia , Depressão/epidemiologia , Feminino , Humanos , Masculino
11.
Womens Health (Lond) ; 18: 17455057221092267, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35435055

RESUMO

INTRODUCTION: Women account for 23% of new human immunodeficiency virus diagnoses in the United States, yet remain understudied. Adherence to antiretroviral therapy and consequent viral suppression are keys to preventing human immunodeficiency virus transmission, reducing risk of drug resistance, and improving health outcomes. OBJECTIVES: This review identified and synthesized peer-reviewed studies in the United States describing factors associated with viral suppression among cisgender women living with human immunodeficiency virus. METHODS: We searched five databases: Cumulative Index to Nursing and Allied Health (CINAHL), PubMed, Embase, Scopus, and PsycINFO, and reported the findings using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eligible studies included: (1) peer-reviewed English-language articles published since 2010; (2) includes only cisgender women; (3) participants were at least 18 years of age; (4) reported metrics on viral loads; and (5) conducted in the United States. RESULTS: Fourteen studies in total were reviewed. Eight studies had adult women living with human immunodeficiency virus, four recruited only pregnant women, and two included only racial minority women. The most commonly reported factors negatively associated with viral suppression were substance use (n = 4), followed by availability of health insurance, financial constraint, complexity of human immunodeficiency virus treatment regimen (n = 3), and intimate partner violence (n = 2). Other factors were depression, race, and age. In addition, all four studies that included only pregnant women reported early human immunodeficiency virus care engagement as a significant predictor of low viral loads pre- and post-partum. CONCLUSION: Substance use, financial constraint, lack of health insurance, human immunodeficiency virus treatment regimen type, intimate partner violence, and late human immunodeficiency virus care pre-post pregnancy were the most common factors negatively associated with viral suppression. There is a paucity of data on viral suppression factors related to transgender and rural populations. More human immunodeficiency virus research is needed to explore factors associated with human immunodeficiency virus treatment outcomes in transgender women and cisgender women in rural U.S. regions.


Assuntos
Infecções por HIV , Transtornos Relacionados ao Uso de Substâncias , Pessoas Transgênero , Adulto , Feminino , HIV , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Gravidez , Transtornos Relacionados ao Uso de Substâncias/complicações , Estados Unidos/epidemiologia , Carga Viral
12.
J Gen Intern Med ; 37(10): 2496-2504, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35411530

RESUMO

BACKGROUND: While hate crimes rose during the COVID-19 pandemic, few studies examined whether this pandemic-time racial discrimination has led to negative health consequences at the population level. OBJECTIVE: We examined whether experienced and perceived racial discrimination were associated with mental or behavioral health outcomes during the pandemic. DESIGN: In October 2020, we conducted a national survey with minorities oversampled that covered respondents' sociodemographic background and health-related information. PARTICIPANTS: A total of 2709 participants responded to the survey (response rate: 4.2%). MAIN MEASURES: The exposure variables included (1) experienced and encountered racial discrimination, (2) experienced racial and ethnic cyberbullying, and (3) perceived racial bias. Mental health outcomes were measured by psychological distress and self-rated happiness. Measures for behavioral health included sleep quality, change in cigarette smoking, and change in alcohol consumption. Weighted logistic regressions were performed to estimate the associations between the exposure variables and the outcomes, controlling for age, gender, race and ethnicity, educational attainment, household income, eligibility to vote, political party, COVID-19 infection, and geographic region. Separate regressions were performed in the six racial and ethnic subgroups: non-Hispanic White, non-Hispanic Black, Hispanic, East Asian, South Asian, and Southeast Asian respondents. KEY RESULTS: Experienced racial discrimination was associated with higher likelihood of psychological distress (adjusted odds ratio [AOR] = 2.18, 95% confidence interval [95% CI]: 1.34-3.55). Experienced racial discrimination (AOR = 2.31, 95% CI: 1.34-3.99) and perceived racial bias (AOR = 1.05, 95% CI: 1.00-1.09) were both associated with increased cigarette smoking. The associations between racial discrimination and mental distress and substance use were most salient among Black, East Asian, South Asian, and Hispanic respondents. CONCLUSIONS: Racial discrimination may be associated with higher likelihood of distress, and cigarette smoking among racial and ethnic minorities. Addressing racial discrimination is important for mitigating negative mental and behavioral health ramifications of the pandemic.


Assuntos
COVID-19 , Racismo , Humanos , Saúde Mental , Pandemias , Grupos Raciais , Estados Unidos/epidemiologia
13.
J STEM Outreach ; 5(2)2022.
Artigo em Inglês | MEDLINE | ID: mdl-38895651

RESUMO

The Youth Enjoy Science program at the University of Nebraska Medical Center has engaged American Indian/Alaska Native youth in mentored cancer research internships from 2017 to 2022. The primary purpose of this study was to examine mentor and mentee lived experiences of participation in Youth Enjoy Science research education internships and to provide insights that can inform mentorship practices in research education programs for American Indians/Alaska Natives. We conducted semi-structured interviews with current and former Youth Enjoy Science mentees (n=8) and mentors (n=8). Following a narrative inquiry research approach, we analyzed interview transcripts and collectively re-storied interview data. Participants described program characters, settings, problems, actions to address the problems identified, and resolutions that led to various recommendations for ways to raise contextual awareness between mentees and mentors.

14.
Am J Mens Health ; 15(3): 15579883211018418, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34027740

RESUMO

African Americans (AAs) are 20% more likely to develop serious psychological distress compared to Whites but are less likely to use mental health services. The study objective was to evaluate the effectiveness of recruitment strategies to engage AA fathers in a mental health intervention.Using the community-based participatory research (CBPR) approach, a community-academic partnership (CAP) developed and implemented direct and indirect referral strategies to engage AA fathers in a mental health intervention. Direct referral strategies focused on community partner identification of potentially eligible participants, providing information about the study (i.e., study flyer), and referring potential participants to the study. Indirect referrals included posting flyers in local businesses frequented by AA men, radio advertisements, and social media posts from community organizations.From January to October 2019, 50 direct and 1388 indirect referrals were documented, yielding 24 participants screened and 15 enrolled. Of all participants screened, 58% were referred through indirect referral, 38% were referred directly by community partners, and 4% of the participants were referred through both direct and indirect referrals. Twenty percent of those exposed to the direct referral methods and 1% of those exposed to the indirect referral methods were enrolled. The indirect referrals accounted for 60% of enrollment, whereas the direct referrals accounted for 33.3% of enrollment.Collaborating with the community partners to engage hard-to-reach populations in mental health studies allowed for broad dissemination of recruitment methods, but still resulted in low participant accrual. Additional focus on increasing direct referral methods appears to be a fruitful area of CBPR.


Assuntos
Negro ou Afro-Americano , Pesquisa Participativa Baseada na Comunidade , Estudos de Viabilidade , Humanos , Masculino , Saúde Mental , Seleção de Pacientes
15.
J Cancer Educ ; 36(5): 996-1004, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-32162283

RESUMO

American Indians residing in the Northern Plains region of the Indian Health Service experience some of the most severe cancer-related health disparities. We investigated ways in which the community climate among an American Indian population in an urban community in the Northern Plains region influences community readiness to address cancer. A Community Readiness Assessment, following the Community Readiness Model, conducted semi-structured interviews with eight educators, eight students, and eight community leaders from the American Indian community in Omaha's urban American Indian population and established the Northern Plains region community at a low level of readiness to address cancer. This study reports on a subsequent qualitative study that analyzed all 24 interview transcriptions for emergent themes to help understand the prevailing attitude of the community toward cancer. A synthesis of six emergent themes revealed that the community's perceptions of high levels of severity and barriers, paired with perceptions of low levels of susceptibility and benefits, lead to low levels of self-efficacy, all of which are reflected in minimal cues to action and little effort to address cancer. These findings, interpreted through the lens of the Health Belief Model, can inform the development of more community-based, comprehensive, and culturally appropriate approaches to address the multilevel determinants of health behaviors in relation to cancer among American Indians in the Northern Plains region.


Assuntos
Indígenas Norte-Americanos , Neoplasias , Comportamentos Relacionados com a Saúde , Humanos , Saúde Pública , Indígena Americano ou Nativo do Alasca
16.
J Racial Ethn Health Disparities ; 8(4): 879-891, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32839896

RESUMO

BACKGROUND: The primary function of the patient portal is to give patients greater access to their personal health information. Granting patients electronic access allows them to make well-informed health care decisions. OBJECTIVE: This study aimed to identify sociodemographic differences in patient portal use and examine factors affecting patient portal utilization following the final stage of the Meaningful Use program which aimed to promote the use of certified electronic health record (EHR) technology. RESEARCH DESIGN: Survey data from Health Information National Trends Survey (HINTS) 5, cycles 1, 2, and 3 were analyzed. The sample included 8291 completed surveys. Multivariable logistic regression on a selected response for each surveyed question was used to assess the racial and ethnic difference after controlling for age, sex, income, and education. SUBJECTS: Subjects included English and Spanish speaking adults in the USA. MEASURES: Measures included assessment of patient portal use, patient portal access, understanding health information, usefulness of health records, and privacy and security. RESULTS: After adjusting for age, sex, income, and education, there was a significant association between race/ethnicity and patient portal non-users responding, "no need to use online medical record" as the reason for not using the patient portal (P = 0.005). Among the portal users, there were significant associations between race/ethnicity and health care provider maintaining an EHR (P = 0.006), being offered access to their portal (P < 0.001), understanding health information in the portal (P = 0.004), finding the portal useful for health monitoring (P < 0.001), reporting concern about unauthorized access (P = 0.017), and keeping information from health care providers (P = 0.012). CONCLUSIONS: Race/ethnicity affects perceptions on the need for the patient portal, being offered access to a portal, and the reasons to access information online. Understanding the factors affecting patient portal use can inform future strategies aimed at increasing adoption.


Assuntos
Portais do Paciente/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sociodemográficos , Fatores Socioeconômicos , Inquéritos e Questionários
17.
Diabetes Res Clin Pract ; 159: 107944, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31765684

RESUMO

AIMS: To examine gender differences in program completion and glycemic outcomes for patients with type 2 diabetes (T2D) in a remote patient monitoring (RPM) program for diabetes management. METHODS: Based on data from an RPM program that enrolled post-discharge T2D patients (n = 1645) in 2014-2017, logistic regression models were estimated to assess gender difference in the likelihood of completing the three-month RPM program; whereas ordinary least squares (OLS) regression models were used to examine gender difference in post-RPM hemoglobin A1c (HbA1c), controlling for demographics, baseline health status, including HbA1c, patient activation scores, and physiological data upload frequency for patients who had completed the program. RESULTS: Among enrolled participants, men had lower odds of completing the three-month RPM program than women (adjusted odds ratio, 0.61; 95% confidence interval [CI], 0.39-0.95). However, among those who completed the program, men had lower post-RPM HbA1c than women (-0.18; 95% CI, -0.33, -0.03) after controlling for baseline HbA1c and other covariates. CONCLUSIONS: While female patients with T2D were more likely to complete the RPM program, they showed a higher glycemic level at the end of the program compared to male patients. To close gender disparities in health, interventions through telemedicine tailored towards women's diabetes outcomes and men's engagement level are warranted.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Identidade de Gênero , Hemoglobinas Glicadas/metabolismo , Monitorização Fisiológica/métodos , Telemedicina/métodos , Feminino , Hemoglobinas Glicadas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
J Racial Ethn Health Disparities ; 6(5): 883-891, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31004290

RESUMO

OBJECTIVE: To examine how the effect of race (Black versus White) on meeting physical activity (PA) guidelines varies by sex, income, education, and region of residence. METHODS: We pooled data from 10 consecutive years (2008 to 2017) of the National Health Interview Survey. We used logistic regression to assess the extent to which the effect of race on meeting the U.S. federal guidelines for PA varies by sex, income, education, and region, after controlling for several health-related variables. The analysis sample size was 225,600 (102,348 men and 123,252 women). RESULTS: Race and most of the other covariates interacted with sex in their effect on meeting PA guidelines; therefore, separate models for men and women were estimated. In each model, race interacted with income and region, but not with education. Among men, Blacks were more likely to meet PA guidelines than Whites in nearly all income categories and regions. The race effect was weakest among the poor and in the Northeast region. Among women, Blacks were generally less likely than Whites to meet the guidelines and the race effect was largest among the poor and in the Northeast region. CONCLUSION: This study showed that the difference between Blacks and Whites in the extent to which they adhere to federal PA guidelines varies by sex, income, and region of residence. Black women whole live below the poverty threshold are less likely than other demographic groups to meet the PA guidelines. Targeted interventions to promote PA among this population group are warranted.


Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Exercício Físico , Fidelidade a Diretrizes/estatística & dados numéricos , População Branca/estatística & dados numéricos , Adolescente , Adulto , Idoso , Escolaridade , Feminino , Guias como Assunto , Inquéritos Epidemiológicos , Humanos , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pobreza/etnologia , Características de Residência/estatística & dados numéricos , Fatores Sexuais , Estados Unidos , Adulto Jovem
19.
Ethn Dis ; 26(1): 123-32, 2016 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-26843805

RESUMO

OBJECTIVE: To describe the design and rationale of the Healthy Community Neighborhood Initiative (HCNI), a multi-component study to understand and document health risk and resources in a low-income and minority community. DESIGN: A community-partnered participatory research project. SETTING: A low-income, biethnic African American and Latino neighborhood in South Los Angeles. PARTICIPANTS: Adult community residents aged >18 years. MAIN OUTCOME MEASURES: Household survey and clinical data collection; neighborhood characteristics; neighborhood observations; and community resources asset mapping. RESULTS: We enrolled 206 participants (90% of those eligible), of whom 205 completed the household interview and examination, and 199 provided laboratory samples. Among enrollees, 82 (40%) were aged >50 years and participated in functional status measurement. We completed neighborhood observations on 93 street segments; an average of 2.2 (SD=1.6) study participants resided on each street segment observed. The community asset map identified 290 resources summarized in a Community Resource Guide given to all participants. CONCLUSIONS: The HCNI community-academic partnership has built a framework to assess and document the individual, social, and community factors that may influence clinical and social outcomes in a community at high-risk for preventable chronic disease. Our project suggests that a community collaborative can use culturally and scientifically sound strategies to identify community-centered health and social needs. Additional work is needed to understand strategies for developing and implementing interventions to mitigate these disparities.


Assuntos
Nível de Saúde , Pobreza , Características de Residência , Adulto , Negro ou Afro-Americano , Doença Crônica , Centros Comunitários de Saúde , Planejamento Ambiental , Feminino , Hispânico ou Latino , Humanos , Los Angeles , Masculino , Pessoa de Meia-Idade
20.
Clin Transl Sci ; 8(5): 573-8, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26365589

RESUMO

Grant writing is an essential skill necessary to secure financial support for community programs and research projects. Increasingly, funding opportunities for translational biomedical research require studies to engage community partners, patients, or other stakeholders in the research process to address their concerns. However, there is little evidence on strategies to prepare teams of academic and community partners to collaborate on grants. This paper presents the description and formative evaluation of a two-part community-academic partnered grant writing series designed to help community organizations and academic institutions build infrastructure for collaborative research projects using a partnered approach. The first phase of the series was a half-day workshop on grant readiness, which was open to all interested community partners. The second phase, open only to community-academic teams that met eligibility criteria, was a 12-week session that covered partnered grant writing for foundation grants and National Institutes of Health grants. Participants in both phases reported an increase in knowledge and self-efficacy for writing partnered proposals. At 1-year follow-up, participants in Phase 2 had secured approximately $1.87 million in funding. This community-academic partnered grant writing series helped participants obtain proposal development skills and helped community-academic teams successfully compete for funding.


Assuntos
Autoria , Pesquisa Biomédica/métodos , Fortalecimento Institucional/métodos , Relações Comunidade-Instituição , Educação Profissionalizante/métodos , Revisão da Pesquisa por Pares/métodos , Pesquisadores , Apoio à Pesquisa como Assunto , Redação , Pesquisa Biomédica/economia , Pesquisa Biomédica/educação , Fortalecimento Institucional/economia , Pesquisa Participativa Baseada na Comunidade , Comportamento Cooperativo , Currículo , Humanos , Comunicação Interdisciplinar , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Pesquisadores/economia , Pesquisadores/educação , Pesquisadores/psicologia , Apoio à Pesquisa como Assunto/economia
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