Plasma selenium biomarkers in low income black and white americans from the southeastern United States.

Biomarkers of selenium are necessary for assessing selenium status in humans, since soil variation hinders estimation of selenium intake from foods. In this study, we measured the concentration of plasma selenium, selenoprotein P (SEPP1), and glutathione peroxidase (GPX3) activity and their interindividual differences in 383 low-income blacks and whites selected from a stratified random sample of adults aged 40-79 years, who were participating in a long-term cohort study in the southeastern United States (US). We assessed the utility of these biomarkers to determine differences in selenium status and their association with demographic, socio-economic, dietary, and other indicators. Dietary selenium intake was assessed using a validated food frequency questionnaire designed for the cohort, matched with region-specific food selenium content, and compared with the US Recommended Dietary Allowances (RDA) set at 55 µg/day. We found that SEPP1, a sensitive biomarker of selenium nutritional status, was significantly lower among blacks than whites (mean 4.4 ± 1.1 vs. 4.7 ± 1.0 mg/L, p = 0.006), with blacks less than half as likely to have highest vs. lowest quartile SEPP1 concentration (Odds Ratio (OR) 0.4, 95% Confidence Interval (CI) 0.2-0.8). The trend in a similar direction was observed for plasma selenium among blacks and whites, (mean 115 ± 15.1 vs. 118 ± 17.7 µg/L, p = 0.08), while GPX3 activity did not differ between blacks and whites (136 ± 33.3 vs. 132 ± 33.5 U/L, p = 0.320). Levels of the three biomarkers were not correlated with estimated dietary selenium intake, except for SEPP1 among 10% of participants with the lowest selenium intake (≤ 57 µg/day). The findings suggest that SEPP1 may be an effective biomarker of selenium status and disease risk in adults and that low selenium status may disproportionately affect black and white cohort participants.

Challenges and strategies in serving the uninsured in Nashville, Tennessee.

This study identified challenges faced by a healthcare safety net system. Surveys of safety net outpatient clinic and hospital emergency department (ED) facilities and key informant interviews ascertained barriers to providing necessary client services and strategies to overcome them. About 60% of key informants responded that Medicaid cuts greatly increased the numbers of uninsured clients. The outpatient clinic and ED personnel reported that the capacity of providers to care for these increasing numbers of uninsured was primarily strained by limited referral resources for needed specialty care. The most commonly cited successful coping strategies for clinics were networking and partnering. [corrected].

Parity and breastfeeding in relation to obesity among black and white women in the southern community cohort study.

OBJECTIVE: This research sought to describe associations among parity, breastfeeding, and adult obesity in black and white women in the southeastern United States. METHODS: Cross-sectional data from 7,986 white women and 23,198 black women (age 40-79 years) living in the southeastern United States and enrolled in the Southern Community Cohort Study during 2002-2006 were used to examine self-reported body mass index (BMI) and weight change since age 21 in association with parity and breastfeeding. Multiple linear regression and logistic regression with adjustment for demographic and lifestyle factors were used. RESULTS: At all levels of parity and breastfeeding, black women had higher BMI and weight gain since age 21 than white women. Compared to nulliparity, five or more live births was associated with increased odds of obesity in white women (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.08-1.74) and, to a lesser extent, in black women (OR = 1.22, 95% CI = 1.07-1.38). In white women, breastfeeding for more than 12 months compared to none was associated with decreased odds of obesity (OR = 0.68, 95% CI = 0.56-0.82), whereas in black women, no association between obesity and breastfeeding was seen. CONCLUSIONS: The associations between childbearing factors and measures of adult obesity appear to be larger in white women compared to black women but relatively small overall. However, when considered as part of the constellation of factors that lead to obesity, even these small associations may be important in an overall obesity prevention strategy.

Trends in smoking among African-Americans: a description of Nashville's REACH 2010 initiative.

African Americans bear a disproportionate burden of tobacco related morbidity and mortality despite smoking less than their Caucasian counterparts. Nashville's REACH 2010 initiative developed community partnerships to promote awareness, education and participatory programs to prevent and decrease smoking among residents of the northern geographic area of Nashville, TN, a majority African American community. A social-ecological model provided the framework for interventions used during a 5 year period that included: (a) community level strategies to increase awareness and knowledge about the effects of smoking; (b) individual level strategies to enlist and train community members to become advocates, lead smoking cessation classes and encourage current smokers in quit attempts; and (c) strategies directed to changing policy through education and partnership building. Smoking prevalence among residents was examined from 2001 through 2005 based on data from the Nashville CDC REACH 2010 Risk Factor Survey and the Tennessee CDC Behavioral Risk Factor Survey. Tests for linear trends indicated a significant decreasing trend (P < .02) of daily smoking and smoking uptake (P < .03) in North Nashville. In contrast to our community an increasing trend was observed in quitting smoking (P < .01). No trends were significant for African Americans in Tennessee. This study suggests that consistent, multiple and multi-level strategies targeted to an African American community may impact smokers who are not ready to quit but willing to reduce their level of smoking. This study underscores the importance of developing and implementing community wide campaigns to address the needs of African Americans.

Validity of the SF-12 for use in a low-income African American community-based research initiative (REACH 2010).

INTRODUCTION: The objective of our study was to assess the psychometric properties of the Medical Outcomes Study's 12-Item Short Form Survey Instrument (SF-12) for use in a low-income African American community. The SF-12, a commonly used functional health status assessment, was developed based on responses of an ethnically homogeneous sample of whites. Our assessment addressed the appropriateness of the instrument for establishing baseline indicators for mental and physical health status as part of Nashville, Tennessee's, Racial and Ethnic Approaches to Community Health (REACH) 2010 initiative, a community-based participatory research study. METHODS: A cross-sectional random residential sample of 1721 African Americans responded to a telephone survey that included the SF-12 survey items and other indicators of mental and physical health status. The SF-12 was assessed by examining item-level characteristics, estimates of scale reliability (internal consistency), and construct validity. RESULTS: Construct validity assessed by the method of extreme groups determined that SF-12 summary scores varied for individuals who differed in self-reported medical conditions. Convergent and discriminate validity assessed by multitrait analysis yielded satisfactory coefficients. Concurrent validity was also shown to be satisfactory, assessed by correlating SF-12 summary scores with independent measures of physical and mental health status. CONCLUSION: The SF-12 appears to be a valid measure for assessing health status of low-income African Americans.

Disparities in perceptions of healthcare access in a community sample.

Disparities in health status persist for many sociodemographic groups in the United States. An understanding of barriers to healthcare access and utilization can assist community-based initiatives in developing strategies to improve the health of minority and low-income populations. Using self-reported information from 3014 community residents, a factor analysis was conducted that defined barriers to healthcare by 4 dimensions: (1) time and competing priorities, (2) convenience and availability, (3) healthcare utilization, and (4) healthcare affordability. Differential effects of demographics were observed on all factors. Racial disparities were found where African Americans experienced more problems based on the convenience and availability of services (P < .02) than did whites, after controlling for income, education, age, and marital status. In addition, gender differences showed that women experienced greater difficulty with time and competing priorities than men (P < .001); however, women experienced fewer problems related to utilization (P < .001). Of the covariates, income was significant (P < .01) on 3 of the 4 indicators. This study points to the need to develop interventions that address the unique challenges faced by different population groups to ensure timely healthcare. In addition, the reduction of economic disparities should be considered as an important strategy to improve public health.

Diabetes management among low-income African Americans: a description of a pilot strategy for empowerment.

Incidence of type II diabetes is increasing in the United States and is most prevalent among low-income African Americans. Community health initiatives supported by partnerships of community leaders and health professionals can contribute to the elimination of inequalities in health status. The focus of Racial and Ethnic Approaches to Community Health (REACH) 2010, an initiative sponsored by the Centers for Disease Control and Prevention, is to facilitate the initiation of community-wide changes as well as increase individual empowerment to reduce disparities in diabetes, cardiovascular disease, and cancer. A pilot program developed by REACH health educators and community health partners to improve disease self-management among low-income African American diabetic patients was implemented at a community health center in Nashville, Tenn. The program's major components included health education, individual counseling, screenings, and outreach. The program shows promise of improving patient care and outcomes.

Use of the SF-12 instrument for measuring the health of homeless persons.

OBJECTIVE: To evaluate the construct validity of the Short Form 12-item Survey (SF-12) among users of a homeless day shelter. Adding brief health assessments has potential to provide information regarding the effect that programs have upon the health status and functioning of homeless persons. STUDY SETTING: A convenience sample of 145 homeless persons at a day shelter in an urban setting. STUDY DESIGN: Participants were verbally administered the SF-12 that provides information on mental and physical health status and the Dartmouth Improve Your Medical Care Survey (IYMC) that provides information on functional health, clinical symptoms, medical conditions, and health risk. The IYMC survey system has been widely used in clinical settings to assess health status and the outcomes of care. DATA COLLECTION/EXTRACTION METHODS: Construct validity was assessed by the following approaches: (a) the method of extreme groups was used where multivariate analysis of variance determined if SF-12 summary scores varied for individuals who differed in self-reported clinical symptoms and medical conditions, and (b) convergent validity was assessed by correlating SF-12 summary scores with the subscales. PRINCIPAL FINDINGS: Four to 10 point differences in physical health (PCS12) and 5-11 point differences in mental health (MCS12) were found between those who reported acute symptoms and medical conditions and those who did not. A 13-point difference in PCS12 scores and a 7-16-point difference in MCS12 scores were found for those who reported none or few to several symptoms or conditions. The summary scores and subscales yielded satisfactory convergent validity coefficients that ranged from 0.62 to 0.88 with one exception. CONCLUSIONS: The SF-12 shows promise as a valid outcome indicator for assessing and monitoring health status among the homeless. Its strengths include brevity and availability of norms for specific medical conditions.