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Open AccessEditorial The 2014 Minority Health and Health Disparities Grantees’ Conference

by Mark Edberg, Barbara E. Hayes, Valerie Montgomery-Rice and Paul B. Tchounwou

Int. J. Environ. Res. Public Health 2016, 13(1), 57; doi:10.3390/ijerph13010057

Received: 14 December 2015 / Accepted: 16 December 2015 / Published: 22 December 2015

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Abstract

Health disparities have been defined as a particular type of health difference closely linked with social, economic and/or environmental disadvantage. The National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health, has a comprehensive portfolio of grants that

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Health disparities have been defined as a particular type of health difference closely linked with social, economic and/or environmental disadvantage. The National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health, has a comprehensive portfolio of grants that fund scientific research to improve racial/ethnic minority health and eliminate health disparities. The 2014 Minority Health and Health Disparities Grantees’ Conference highlighted excellence and innovation in biological, environmental, sociocultural, clinical and behavioral research supported by NIMHD. This special issue of the International Journal of Environmental Research and Public Health includes peer-reviewed publications from investigators who participated in this conference. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Research

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Open AccessArticle Vulnerability of Coastal Communities from Storm Surge and Flood Disasters

by Jejal Reddy Bathi and Himangshu S. Das

Int. J. Environ. Res. Public Health 2016, 13(2), 239; doi:10.3390/ijerph13020239

Received: 14 August 2015 / Revised: 4 February 2016 / Accepted: 14 February 2016 / Published: 19 February 2016

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Abstract

Disasters in the form of coastal storms and hurricanes can be very destructive. Preparing for anticipated effects of such disasters can help reduce the public health and economic burden. Identifying vulnerable population groups can help prioritize resources for the most needed communities. This

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Disasters in the form of coastal storms and hurricanes can be very destructive. Preparing for anticipated effects of such disasters can help reduce the public health and economic burden. Identifying vulnerable population groups can help prioritize resources for the most needed communities. This paper presents a quantitative framework for vulnerability measurement that incorporates both socioeconomic and flood inundation vulnerability. The approach is demonstrated for three coastal communities in Mississippi with census tracts being the study unit. The vulnerability results are illustrated as thematic maps for easy usage by planners and emergency responders to assist in prioritizing their actions to vulnerable populations during storm surge and flood disasters. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Racial Differences in Length of Stay for Patients Who Leave Against Medical Advice from U.S. General Hospitals

by Rima Tawk and Matthew Dutton

Int. J. Environ. Res. Public Health 2016, 13(1), 95; doi:10.3390/ijerph13010095

Received: 17 August 2015 / Revised: 14 December 2015 / Accepted: 29 December 2015 / Published: 31 December 2015

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Abstract

There is a paucity of published literature on the length of hospital stays (LOS) for patients who leave against medical advice (AMA) and on the factors that predict their LOS. The purpose of the study is to examine the relationship between race and

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There is a paucity of published literature on the length of hospital stays (LOS) for patients who leave against medical advice (AMA) and on the factors that predict their LOS. The purpose of the study is to examine the relationship between race and the LOS for AMA patients after adjusting for patient and hospital characteristics. National Hospital Discharge Survey (NHDS) data were used to describe LOS for AMA patients aged 18 years or older. Patient characteristics included age, sex, race, marital status, insurance, and diagnosis (ICD-9-CM). Hospital characteristics consisted of ownership, region and bed size. LOS was the major outcome measure. Using data from all years 1988–2006, the expected time to AMA discharge was first examined as a function of race, then adjusting for year terms, patient and hospital characteristics, and major medical diagnoses and mental illness. The unadjusted effect of race on the expected time of leaving AMA was about twice the adjusted effect. After controlling for the other covariates, the expected time to AMA discharge is 20% shorter for Blacks than Whites. The most significant predictors included age, insurance coverage, mental illness, gender, and region. Factors identified in this study offer insights into directions for evidence based- health policy to reduce AMA discharges. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Racial and Ethnic Heterogeneity in the Association Between Total Cholesterol and Pediatric Obesity

by Laurens Holmes, Alex LaHurd, Emily Wasson, Lavisha McClarin and Kirk Dabney

Int. J. Environ. Res. Public Health 2016, 13(1), 19; doi:10.3390/ijerph13010019

Received: 14 August 2015 / Revised: 8 November 2015 / Accepted: 16 November 2015 / Published: 23 December 2015

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Abstract

Total cholesterol (TC) directly correlates with overweight/obesity, but it remains unclear if this association varies by race and ethnicity. We assessed the association as well as the racial/ethnic heterogeneity in this relationship. Data on 63,863 children were assessed using electronic medical records between

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Total cholesterol (TC) directly correlates with overweight/obesity, but it remains unclear if this association varies by race and ethnicity. We assessed the association as well as the racial/ethnic heterogeneity in this relationship. Data on 63,863 children were assessed using electronic medical records between 2010 and 2011. A cross-sectional design was utilized with log-binomial regression model and chi-squared statistic to examine the data. Overall, abnormal total cholesterol (ATC) was 7.5% (4812). Significant racial variability in ATC was observed: Black/African American (AA) (7.4%), White (7.0%), Asian (5.1%) and some other race (SOR) children (11.3%), χ² (5) = 141.5, p < 0.0001. Black/AA (34.7%) and SOR children (41.2%) were predominantly overweight/obese, unlike the Asian children, (25.8%), χ² (5) = 324.6, p < 0.0001. The BMI percentile was highest among SOR (69.0 ± 28.6) and Black/AA children (65.2 ± 29.1), but lowest among Asian children (55.7 ± 31.5). A significant racial variability was also observed in weight, with the highest mean among Black/AA children (36.8kg ± 23.0) and the lowest among Asian children (28.7kg ± 16.8), f = 7.2, p < 0.001. Relative to normal TC, children with ATC were 2.6 times as likely to have abnormal BMI, relative risk (RR) =2.60, 99% CI, 2.54–2.68). Compared to non-Hispanic (RR = 2.62, 99% CI, 2.54–2.69), the risk was lower among Hispanics (RR = 2.34, 99%, 2.21–2.48). Among children with ATC, risk for abnormal BMI was highest among Asians, adjusted RR = 2.91, 99% CI, 2.34–3.62), intermediate among AA (ARR = 2.68, 99% CI, 2.59–2.77), but lowest among Whites (ARR = 2.40, 99% CI, 2.39–2.64), and SOR (ARR = 2.33, 99% CI, 2.19–2.50). In a large sample of children, total cholesterol directly correlates with BMI, with an observed racial and ethnic heterogeneity. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Factors Associated with Providers’ Perceptions of Mental Health Care in Santa Luzia’s Family Health Strategy, Brazil

by Angela R. Ghesquiere, Rogerio M. Pinto, Rahbel Rahman and Anya Y. Spector

Int. J. Environ. Res. Public Health 2016, 13(1), 33; doi:10.3390/ijerph13010033

Received: 15 August 2015 / Revised: 2 November 2015 / Accepted: 5 November 2015 / Published: 23 December 2015

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Abstract

Brazil has a unique mental health care system, characterized by universal coverage delivered by interdisciplinary teams both in the community and in specialized centros de atenção psicossocial (CAPS—psychosocial care centers). Provision of patient-centered mental health care is an important principle of Brazilian mental

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Brazil has a unique mental health care system, characterized by universal coverage delivered by interdisciplinary teams both in the community and in specialized centros de atenção psicossocial (CAPS—psychosocial care centers). Provision of patient-centered mental health care is an important principle of Brazilian mental health care, but this topic has not been well-studied. We analyzed data from a cross-sectional survey of 151 community health workers (CHWs), nurses, and physicians in Santa Luzia, Minas Gerais State, Brazil. Chi-squares, t-tests and multivariate regression analyses examined differences in socio-demographics, caseload, engagement in evidence-based practices (EBPs), and transdisciplinary collaboration between providers who reported providing high levels of patient-centered mental health care and those who did not. In multivariate regression models, components of transdisciplinary collaboration were significantly associated with providers’ perceptions of patient-centered mental health care (p < 0.05). CHWs were also significantly more likely to report providing patient-centered care than physicians and nurses. EBP engagement and sociodemographics were not associated with perceptions. Results suggest that training efforts to improve patient-centered mental health care in Brazil could build upon CHWs’ skills and focus on transdisciplinary collaboration. Findings may inform practice in other countries with similar health care systems. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Beliefs and Behaviors about Breast Cancer Recurrence Risk Reduction among African American Breast Cancer Survivors

by Benjamin Ansa, Wonsuk Yoo, Mary Whitehead, Steven Coughlin and Selina Smith

Int. J. Environ. Res. Public Health 2016, 13(1), 46; doi:10.3390/ijerph13010046

Received: 11 August 2015 / Revised: 17 November 2015 / Accepted: 24 November 2015 / Published: 23 December 2015

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Abstract

A growing body of evidence suggests that breast cancer recurrence risk is linked to lifestyle behaviors. This study examined correlations between breast cancer recurrence, risk reduction beliefs, and related behaviors among African American breast cancer survivors (AA BCSs). Study participants included 191 AA

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A growing body of evidence suggests that breast cancer recurrence risk is linked to lifestyle behaviors. This study examined correlations between breast cancer recurrence, risk reduction beliefs, and related behaviors among African American breast cancer survivors (AA BCSs). Study participants included 191 AA BCSs, mean age = 56.3 years, who completed a lifestyle assessment tool. Most respondents believed that being overweight (52.7%), lack of physical activity (48.7%), and a high fat diet (63.2%) are associated with breast cancer recurrence. Over 65% considered themselves overweight; one third (33.5%) agreed that losing weight could prevent recurrence, 33.0% disagreed, while the remaining 33.5% did not know; and nearly half (47.9%) believed that recurrence could be prevented by increasing physical activity. Almost 90% survivors with BMI < 25 Kg/M² reported no recurrence compared to 75.7% with BMI ≥ 25 Kg/M² (p = 0.06); nearly all of the women (99.2%) answered “yes” to seeking professional help to lose weight, 79.7% of which were recurrence-free (p = 0.05). These results provide information about AA BCSs’ beliefs and behaviors protective against breast cancer recurrence. Additional research is warranted to determine the effectiveness of educational interventions for AA BCSs that promote consumption of a healthy diet and engaging in regular physical activity. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Depression, a Hidden Mental Health Disparity in an Asian Indian Immigrant Community

by Lisa R. Roberts, Semran K. Mann and Susanne B. Montgomery

Int. J. Environ. Res. Public Health 2016, 13(1), 27; doi:10.3390/ijerph13010027

Received: 17 August 2015 / Revised: 26 September 2015 / Accepted: 12 October 2015 / Published: 23 December 2015

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Abstract

Cultural influences are deeply rooted, and continue to affect the lives of Asian-Indian (AI) immigrants living in Western culture. Emerging literature suggests the powerful nature of traditions and culture on the lives, mental and physical health of AI immigrants, particularly women. The purpose

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Cultural influences are deeply rooted, and continue to affect the lives of Asian-Indian (AI) immigrants living in Western culture. Emerging literature suggests the powerful nature of traditions and culture on the lives, mental and physical health of AI immigrants, particularly women. The purpose of this study was to explore depression among AI women in Central California (CC). This mixed-methods research was conducted in collaboration with the CC Punjabi community and the support of local religious leaders. All interviews were conducted in Punjabi and English. Whenever possible we utilized validated scales aligned with emerging themes from the qualitative data, which also provided contextualization to survey responses. In all we conducted 11 key informant interviews, four focus groups (n = 47) and a rigorously developed anonymous survey (n = 350). Social dynamics and traditional expectations including gendered roles significantly affected mental health among women participants. Subgroups along the lines of language choice (Punjabi vs. English) experience and report depression differently in part due to the highly stigmatized nature of mental health issues in this model minority community. The findings of this study highlight the importance of utilizing mixed methods to access hard to reach populations regarding sensitive topics such as mental health. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle The Ala54Thr Polymorphism of the Fatty Acid Binding Protein 2 Gene Modulates HDL Cholesterol in Mexican-Americans with Type 2 Diabetes

by Lorena M. Salto, Liming Bu, W. Lawrence Beeson, Anthony Firek, Zaida Cordero-MacIntyre and Marino De Leon

Int. J. Environ. Res. Public Health 2016, 13(1), 52; doi:10.3390/ijerph13010052

Received: 15 August 2015 / Revised: 20 November 2015 / Accepted: 26 November 2015 / Published: 23 December 2015

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Abstract

The alanine to threonine amino acid substitution at codon 54 (Ala54Thr) of the intestinal fatty acid binding protein (FABP2) has been associated with elevated levels of insulin and blood glucose as well as with dyslipidemia. The aim of this study was

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The alanine to threonine amino acid substitution at codon 54 (Ala54Thr) of the intestinal fatty acid binding protein (FABP2) has been associated with elevated levels of insulin and blood glucose as well as with dyslipidemia. The aim of this study was to characterize the effect of this FABP2 polymorphism in Mexican-Americans with type 2 diabetes (T2D) in the context of a three-month intervention to determine if the polymorphism differentially modulates selected clinical outcomes. For this study, we genotyped 43 participant samples and performed post-hoc outcome analysis of the profile changes in fasting blood glucose, HbA1c, insulin, lipid panel and body composition, stratified by the Ala54Thr polymorphism. Our results show that the Thr54 allele carriers (those who were heterozygous or homozygous for the threonine-encoding allele) had lower HDL cholesterol and higher triglyceride levels at baseline compared to the Ala54 homozygotes (those who were homozygous for the alanine-encoding allele). Both groups made clinically important improvements in lipid profiles and glycemic control as a response to the intervention. Whereas the Ala54 homozygotes decreased HDL cholesterol in the context of an overall total cholesterol decrease, Thr54 allele carriers increased HDL cholesterol as part of an overall total cholesterol decrease. We conclude that the Ala54Thr polymorphism of FABP2 modulates HDL cholesterol in Mexican-Americans with T2D and that Thr54 allele carriers may be responsive in interventions that include dietary changes. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Local Health Departments’ Activities to Address Health Disparities and Inequities: Are We Moving in the Right Direction?

by Gulzar H. Shah and John P. Sheahan

Int. J. Environ. Res. Public Health 2016, 13(1), 44; doi:10.3390/ijerph13010044

Received: 15 August 2015 / Revised: 12 November 2015 / Accepted: 13 November 2015 / Published: 23 December 2015

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Abstract

Context: Health disparities are among the critical public health challenges. Objectives: To analyze the extent to which local health departments (LHDs) perform activities for addressing health disparities, changes in proportion of LHDs’ performing those activities since 2005, and factors associated with

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Context: Health disparities are among the critical public health challenges. Objectives: To analyze the extent to which local health departments (LHDs) perform activities for addressing health disparities, changes in proportion of LHDs’ performing those activities since 2005, and factors associated with variation in such engagement. Methods: We used the 2013 National Profile of LHDs Survey to perform Logistic Regression of activities LHDs performed to address health disparities. Results: About 20 percent of LHDs did not perform any activity to address health disparities. Significant decreases occurred since 2005 in the proportion of LHDs that performed health disparity reduction/elimination activities for four activities. LHD characteristics significantly associated (p≤0.05) with the increased likelihood of performing activities to address health disparities were: recent completion of community health assessment, community health improvement plan and agency wide strategic plan. Other significant positive impacts on such activities included per capita expenditures, local governance, having one or more local boards of health, larger population size and metropolitan status of the LHD jurisdiction. Conclusions: Reduced infrastructural capacity of LHDs has resulted in fewer LHDs addressing health disparities in their jurisdictions. LHD characteristics associated with higher performance of activities for health disparity reduction identified by this research have important policy implications. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle “That’s True Love:” Lived Experiences of Puerto Rican Perinatally HIV-Infected Youth within Their Families’ Context

by Georgina Silva-Suárez, Elena Bastida, Silvia E. Rabionet, Consuelo Beck-Sagué, Irma Febo and Carmen D. Zorrilla

Int. J. Environ. Res. Public Health 2016, 13(1), 7; doi:10.3390/ijerph13010007

Received: 5 August 2015 / Revised: 1 October 2015 / Accepted: 26 October 2015 / Published: 22 December 2015

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Abstract

The burden of HIV affects not only HIV-infected patients but also their families and caregivers. It is also known that family support is crucial for people living with HIV. A qualitative study was conducted to explore the life experiences, within the family context,

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The burden of HIV affects not only HIV-infected patients but also their families and caregivers. It is also known that family support is crucial for people living with HIV. A qualitative study was conducted to explore the life experiences, within the family context, of perinatally HIV-infected (pHIV-I) youth in Puerto Rico. Twenty in-depth interviews were performed and audio-recorded. Within the family context, study participants experienced acceptance, love and support but also stigma and discrimination. They reported that family is an essential component in their lives and treatment. Losing one or both parents at a young age was considered more difficult than having HIV. Most participants who lost their parents lived with other family members. This was a challenging situation for both pHIV-I youth and their caregivers. Participants described their healthcare providers as part of their families and would like to keep in touch as they transition to adult care. Despite the challenges, participants expressed a desire to have children. Services targeted to this population should stress social support, incorporate family members into the medical process, provide special guidance and support while transitioning to adult care, and provide them with the latest information regarding HIV and reproductive options. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Increasing Cervical Cancer Awareness and Screening in Jamaica: Effectiveness of a Theory-Based Educational Intervention

by Evelyn Coronado Interis, Chidinma P. Anakwenze, Maug Aung and Pauline E. Jolly

Int. J. Environ. Res. Public Health 2016, 13(1), 53; doi:10.3390/ijerph13010053

Received: 17 August 2015 / Revised: 23 November 2015 / Accepted: 1 December 2015 / Published: 22 December 2015

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Abstract

Despite declines in cervical cancer mortality in developed countries, cervical cancer incidence and mortality rates remain high in Jamaica due to low levels of screening. Effective interventions are needed to decrease barriers to preventive behaviors and increase adoption of behaviors and services to

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Despite declines in cervical cancer mortality in developed countries, cervical cancer incidence and mortality rates remain high in Jamaica due to low levels of screening. Effective interventions are needed to decrease barriers to preventive behaviors and increase adoption of behaviors and services to improve prospects of survival. We enrolled 225 women attending health facilities in an intervention consisting of a pre-test, educational presentation and post-test. The questionnaires assessed attitudes, knowledge, risk factors, and symptoms of cervical cancer among women. Changes in knowledge and intention to screen were assessed using paired t-tests and tests for correlated proportions. Participants were followed approximately six months post-intervention to determine cervical cancer screening rates. We found statistically significant increases from pre-test to post-test in the percentage of questions correctly answered and in participants’ intention to screen for cervical cancer. The greatest improvements were observed in responses to questions on knowledge, symptoms and prevention, with some items increasing up to 62% from pre-test to post-test. Of the 123 women reached for follow-up, 50 (40.7%) screened for cervical cancer. This theory-based education intervention significantly increased knowledge of and intention to screen for cervical cancer, and may be replicated in similar settings to promote awareness and increase screening rates. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Minority College Women’s Views on Condom Negotiation

by TyWanda McLaurin-Jones, Maudry-Beverly Lashley and Vanessa Marshall

Int. J. Environ. Res. Public Health 2016, 13(1), 40; doi:10.3390/ijerph13010040

Received: 16 August 2015 / Revised: 15 October 2015 / Accepted: 19 October 2015 / Published: 22 December 2015

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Abstract

This study utilized quantitative and qualitative methods to (1) investigate the relationship between frequency of condom use and negotiation strategies and (2) evaluate experiences with condom negotiations among sexually active, heterosexual, African American college women. One hundred female students from a Historically Black

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This study utilized quantitative and qualitative methods to (1) investigate the relationship between frequency of condom use and negotiation strategies and (2) evaluate experiences with condom negotiations among sexually active, heterosexual, African American college women. One hundred female students from a Historically Black Colleges and Universities (HBCU) completed a questionnaire that included the Condom Influence Strategies Scale (CIS) and participated in a focus group. An ANOVA was conducted to compare differences between never, inconsistent, and consistent condom users. Consistent condom users scored higher than never users on the “withholding sex” subscale of the CIS (4.88 vs. 3.55; p < 0.001) as well as endorsed items more strongly on the “direct request” subscale of the CIS (4.63 vs. 3.82, p < 0.05) than never users. A thematic analysis of open discussions identified overarching themes. Similarly, refusing sex and/or having direct communications with partner emerged as primary strategies. Threats to negotiation included deciding the “right timing” of discussion and having a previous history of sexual intercourse without a condom with their partner. Other key concepts that contribute to condom negotiation are the views that condoms are a male’s responsibility and stigma of women who carry condoms. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Beta-Arrestin1 Levels in Mononuclear Leukocytes Support Depression Scores for Women with Premenstrual Dysphoric Disorder

by Farzana Alam, Sanket Nayyar, William Richie, Anthony Archibong and Tultul Nayyar

Int. J. Environ. Res. Public Health 2016, 13(1), 43; doi:10.3390/ijerph13010043

Received: 29 August 2015 / Revised: 29 September 2015 / Accepted: 13 October 2015 / Published: 22 December 2015

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Abstract

Depression is very common in reproductive women particularly with premenstrual dysphoric disorder (PMDD), which is a severe form of premenstrual syndrome (PMS). Beta-arrestins were previously implicated in the pathophysiology, diagnosis and treatment for mood disorders. This study examined whether a measurement for beta-arrestin1

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Depression is very common in reproductive women particularly with premenstrual dysphoric disorder (PMDD), which is a severe form of premenstrual syndrome (PMS). Beta-arrestins were previously implicated in the pathophysiology, diagnosis and treatment for mood disorders. This study examined whether a measurement for beta-arrestin1 levels in peripheral blood mononuclear leukocytes (PBMC), could aid to distinguish between PMDD and PMS. Study participants (n = 25) were non-pregnant women between 18–42 years of age with the symptoms of PMS/PMDD, but not taking any antidepressants/therapy and at the luteal phase of menstruation. The levels of beta-arrestin1 protein in the PBMCs were determined by ELISA using human beta-arrestin1 kit. The beta-arrestin1 levels were compared with the Hamilton Depression Rating Scale scores among these women. The magnitude of the different parameters for Axis 1 mental disorders were significantly higher and beta arrestin1 protein levels in PBMCs were significantly lower in women with PMDD as compared to PMS women. The reduction in beta arrestin1 protein levels was significantly correlated with the severity of depressive symptoms. Beta-arrestin1 measurements in women may potentially serve for biochemical diagnostic purposes for PMDD and might be useful as evidence-based support for questionnaires. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle User-Friendly Data-Sharing Practices for Fostering Collaboration within a Research Network: Roles of a Vanguard Center for a Community-Based Study

by Jae Eun Lee, Jung Hye Sung, M. Edwina Barnett and Keith Norris

Int. J. Environ. Res. Public Health 2016, 13(1), 34; doi:10.3390/ijerph13010034

Received: 15 August 2015 / Revised: 27 October 2015 / Accepted: 9 November 2015 / Published: 22 December 2015

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Abstract

Although various attempts have been made to build collaborative cultures for data sharing, their effectiveness is still questionable. The Jackson Heart Study (JHS) Vanguard Center (JHSVC) at the NIH-funded Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN) Data Coordinating Center (DCC)

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Although various attempts have been made to build collaborative cultures for data sharing, their effectiveness is still questionable. The Jackson Heart Study (JHS) Vanguard Center (JHSVC) at the NIH-funded Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN) Data Coordinating Center (DCC) may be a new concept in that the data are being shared with a research network where a plethora of scientists/researchers are working together to achieve their common goal. This study describes the current practices to share the JHS data through the mechanism of JHSVC. The JHS is the largest single-site cohort study to prospectively investigate the determinants of cardiovascular disease among African-Americans. It has adopted a formal screened access method through a formalized JHSVC mechanism, in which only a qualified scientist(s) can access the data. The role of the DCC was to help RTRN researchers explore hypothesis-driven ideas to enhance the output and impact of JHS data through customized services, such as feasibility tests, data querying, manuscript proposal development and data analyses for publication. DCC has implemented these various programs to facilitate data utility. A total of 300 investigators attended workshops and/or received training booklets. DCC provided two online and five onsite workshops and developed/distributed more than 250 copies of the booklet to help potential data users understand the structure of and access to the data. Information on data use was also provided through the RTRN website. The DCC efforts led to the production of five active manuscript proposals, seven completed publications, 11 presentations and four NIH grant proposals. These outcomes resulted from activities during the first four years; over the last couple of years, there were few new requests. Our study suggested that DCC-customized services enhanced the accessibility of JHS data and their utility by RTRN researchers and helped to achieve the principal goal of JHSVC of scientific productivity. In order to achieve long-term success, the following, but not limited to these, should be addressed in the current data sharing practices: preparation of new promotional strategies in response to changes in technology and users’ needs, collaboration with the Network statisticians, harmonization of the JHS data with the other local-based heart datasets to meet the needs of the potential users from the broader geographical areas, adoption of the RTRN comprehensive data-sharing policy to broaden the variety of research topics and implementation of an ongoing monitoring program to evaluate its success. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Dietary Acculturation among Filipino Americans

by Persephone Vargas and Leo-Felix Jurado

Int. J. Environ. Res. Public Health 2016, 13(1), 16; doi:10.3390/ijerph13010016

Received: 14 August 2015 / Revised: 6 October 2015 / Accepted: 12 October 2015 / Published: 22 December 2015

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Abstract

Acculturation, the subsequent changes that occur in one culture after continuous first hand contact with another culture, impacts the dietary habits and health risks of individuals. This study examines the acculturation, dietary habits and anthropometric measurements in a sample of 210 first generation

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Acculturation, the subsequent changes that occur in one culture after continuous first hand contact with another culture, impacts the dietary habits and health risks of individuals. This study examines the acculturation, dietary habits and anthropometric measurements in a sample of 210 first generation Filipino American immigrants in New Jersey (NJ). Acculturation was measured using the Short Acculturation Scale for Filipino Americans (ASASFA). Dietary acculturation was measured using the Dietary Acculturation Questionnaire for Filipino Americans (DAQFA) and dietary intake was determined using the Block’s Brief Food Frequency Questionnaire (BFFQ). Anthropometric measurements were obtained including weight, height and waist circumference. Acculturation had a significant negative relationship with Filipino Dietary acculturation. Western dietary acculturation was significantly correlated with caloric intake (r(208) = 0.193, p < 0.01), percentage fat intake (r(208) = 0.154, p < 0.05), percentage carbohydrate intake (r(208) = −0.172, p < 0.05), Body Mass Index (BMI) (r(208) = 0.216, p < 0.01) and waist circumference (r(208) = 0.161, p < 0.01). There was no significant correlation between Filipino dietary acculturation, dietary intake and anthropometric measurements. The results showed that Filipino American immigrants have increased risks including increased BMI, waist circumference and increased fat intake. Over all, this research highlighted some dietary changes and their effects on dietary intake and health status. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessCommunication Reducing Health Disparities and Improving Health Equity in Saint Lucia

by Kisha Holden, Lisa Charles, Stephen King, Brian McGregor, David Satcher and Allyson Belton

Int. J. Environ. Res. Public Health 2016, 13(1), 37; doi:10.3390/ijerph13010037

Received: 15 August 2015 / Revised: 4 November 2015 / Accepted: 9 November 2015 / Published: 22 December 2015

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Abstract

St. Lucia is an island nation in the Eastern Caribbean, with a population of 179,000 people, where chronic health conditions, such as hypertension and diabetes, are significant. The purpose of this pilot study is to create a model for community health education, tracking,

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St. Lucia is an island nation in the Eastern Caribbean, with a population of 179,000 people, where chronic health conditions, such as hypertension and diabetes, are significant. The purpose of this pilot study is to create a model for community health education, tracking, and monitoring of these health conditions, research training, and policy interventions in St. Lucia, which may apply to other Caribbean populations, including those in the U.S. This paper reports on phase one of the study, which utilized a mixed method analytic approach. Adult clients at risk for, or diagnosed with, diabetes (n = 157), and health care providers/clinic administrators (n = 42), were recruited from five healthcare facilities in St. Lucia to assess their views on health status, health services, and improving health equity. Preliminary content analyses indicated that patients and providers acknowledge the relatively high prevalence of diabetes and other chronic illnesses, recognize the impact that socioeconomic status has on health outcomes, and desire improved access to healthcare and improvements to healthcare infrastructures. These findings could inform strategies, such as community education and workforce development, which may help improve health outcomes among St. Lucians with chronic health conditions, and inform similar efforts among other selected populations. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Glyceollin I Reverses Epithelial to Mesenchymal Transition in Letrozole Resistant Breast Cancer through ZEB1

Int. J. Environ. Res. Public Health 2016, 13(1), 10; doi:10.3390/ijerph13010010

Received: 7 August 2015 / Revised: 20 August 2015 / Accepted: 24 August 2015 / Published: 22 December 2015

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Abstract

Although aromatase inhibitors are standard endocrine therapy for postmenopausal women with early-stage metastatic estrogen-dependent breast cancer, they are limited by the development of drug resistance. A better understanding of this process is critical towards designing novel strategies for disease management. Previously, we demonstrated

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Although aromatase inhibitors are standard endocrine therapy for postmenopausal women with early-stage metastatic estrogen-dependent breast cancer, they are limited by the development of drug resistance. A better understanding of this process is critical towards designing novel strategies for disease management. Previously, we demonstrated a global proteomic signature of letrozole-resistance associated with hormone-independence, enhanced cell motility and implications of epithelial mesenchymal transition (EMT). Letrozole-resistant breast cancer cells (LTLT-Ca) were treated with a novel phytoalexin, glyceollin I, and exhibited morphological characteristics synonymous with an epithelial phenotype and decreased proliferation. Letrozole-resistance increased Zinc Finger E-Box Binding Homeobox 1 (ZEB1) expression (4.51-fold), while glyceollin I treatment caused a −3.39-fold reduction. Immunofluorescence analyses resulted of glyceollin I-induced increase and decrease in E-cadherin and ZEB1, respectively. In vivo studies performed in ovariectomized, female nude mice indicated that glyceollin treated tumors stained weakly for ZEB1 and N-cadherin and strongly for E-cadherin. Compared to letrozole-sensitive cells, LTLT-Ca cells displayed enhanced motility, however in the presence of glyceollin I, exhibited a 68% and 83% decrease in invasion and migration, respectively. These effects of glyceollin I were mediated in part by inhibition of ZEB1, thus indicating therapeutic potential of glyceollin I in targeting EMT in letrozole resistant breast cancer. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Epidemiologic, Racial and Healthographic Mapping of Delaware Pediatric Cancer: 2004–2014

by Laurens Holmes, Jonathan Vandenberg, Lavisha McClarin and Kirk Dabney

Int. J. Environ. Res. Public Health 2016, 13(1), 49; doi:10.3390/ijerph13010049

Received: 31 August 2015 / Revised: 6 November 2015 / Accepted: 24 November 2015 / Published: 22 December 2015

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Abstract

Childhood cancer remains the leading cause of disease-related death among children 0 to 14 years and incidence varies by race, ethnicity, sex, geographic locale, and age at onset. However, data are unavailable in some regions, indicative of a need for such information for

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Childhood cancer remains the leading cause of disease-related death among children 0 to 14 years and incidence varies by race, ethnicity, sex, geographic locale, and age at onset. However, data are unavailable in some regions, indicative of a need for such information for cancer awareness, education and prevention program. We utilized retrospective epidemiologic design to assess and characterize pediatric tumors in the Nemours Electronic Medical Records, between 2004 and 2014. Tumor frequency and children population size were used to determine the period prevalence as cumulative incidence (CI) proportion, as well as chi-square and Poisson Regression. The CI for overall childhood cancer in Delaware was 234 per 100,000 children, and varied by race, black (273 per 100,000), white (189 per 100,000). Similarly, sex variability was observed in CI, boys (237 per 100,000) and girls (230 per 100,000). The most commonly diagnosed malignancies were acute lymphoblastic leukemia (ALL), Central Nervous System (CNS)/brain and renal cancer. The geographic locales with relatively higher cancer CI in the state of DE were zip codes 19804 and 19960, but this does not imply cancer clustering. Differences in overall childhood cancer distribution occurred by race, sex, geography, and age. These findings are indicative of the need for cancer-specific health education, awareness and prevention programs in reducing the observed disparities in Delaware. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Differences in Colorectal Cancer Outcomes by Race and Insurance

by Rima Tawk, Adrian Abner, Alicestine Ashford and Clyde Perry Brown

Int. J. Environ. Res. Public Health 2016, 13(1), 48; doi:10.3390/ijerph13010048

Received: 4 September 2015 / Revised: 20 November 2015 / Accepted: 24 November 2015 / Published: 22 December 2015

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Abstract

Colorectal cancer (CRC) is the second most common cancer among African American women and the third most common cancer for African American men. The mortality rate from CRC is highest among African Americans compared to any other racial or ethnic group. Much of

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Colorectal cancer (CRC) is the second most common cancer among African American women and the third most common cancer for African American men. The mortality rate from CRC is highest among African Americans compared to any other racial or ethnic group. Much of the disparity in mortality is likely due to diagnosis at later stages of the disease, which could result from unequal access to screening. The purpose of this study is to determine the impact of race and insurance status on CRC outcomes among CRC patients. Data were drawn from the Surveillance, Epidemiology, and End Results database. Logistic regressions models were used to examine the odds of receiving treatment after adjusting for insurance, race, and other variables. Cox proportional hazard models were used to measure the risk of CRC death after adjusting for sociodemographic and tumor characteristics when associating race and insurance with CRC-related death. Blacks were diagnosed at more advanced stages of disease than whites and had an increased risk of death from both colon and rectal cancers. Lacking insurance was associated with an increase in CRC related-deaths. Findings from this study could help profile and target patients with the greatest disparities in CRC health outcomes. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Statistical Validation of a Web-Based GIS Application and Its Applicability to Cardiovascular-Related Studies

by Jae Eun Lee, Jung Hye Sung and Mohamad Malouhi

Int. J. Environ. Res. Public Health 2016, 13(1), 2; doi:10.3390/ijerph13010002

Received: 13 July 2015 / Revised: 30 September 2015 / Accepted: 14 October 2015 / Published: 22 December 2015

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Abstract

Purpose: There is abundant evidence that neighborhood characteristics are significantly linked to the health of the inhabitants of a given space within a given time frame. This study is to statistically validate a web-based GIS application designed to support cardiovascular-related research developed by

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Purpose: There is abundant evidence that neighborhood characteristics are significantly linked to the health of the inhabitants of a given space within a given time frame. This study is to statistically validate a web-based GIS application designed to support cardiovascular-related research developed by the NIH funded Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN) Data Coordinating Center (DCC) and discuss its applicability to cardiovascular studies. Methods: Geo-referencing, geocoding and geospatial analyses were conducted for 500 randomly selected home addresses in a U.S. southeastern Metropolitan area. The correlation coefficient, factor analysis and Cronbach’s alpha (α) were estimated to quantify measures of the internal consistency, reliability and construct/criterion/discriminant validity of the cardiovascular-related geospatial variables (walk score, number of hospitals, fast food restaurants, parks and sidewalks). Results: Cronbach’s α for CVD GEOSPATIAL variables was 95.5%, implying successful internal consistency. Walk scores were significantly correlated with number of hospitals (r = 0.715; p < 0.0001), fast food restaurants (r = 0.729; p < 0.0001), parks (r = 0.773; p < 0.0001) and sidewalks (r = 0.648; p < 0.0001) within a mile from homes. It was also significantly associated with diversity index (r = 0.138, p = 0.0023), median household incomes (r = −0.181; p < 0.0001), and owner occupied rates (r = −0.440; p < 0.0001). However, its non-significant correlation was found with median age, vulnerability, unemployment rate, labor force, and population growth rate. Conclusion: Our data demonstrates that geospatial data generated by the web-based application were internally consistent and demonstrated satisfactory validity. Therefore, the GIS application may be useful to apply to cardiovascular-related studies aimed to investigate potential impact of geospatial factors on diseases and/or the long-term effect of clinical trials. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Color It Real: A Program to Increase Condom Use and Reduce Substance Abuse and Perceived Stress

by Tiffany Zellner, Jennie Trotter, Shelia Lenoir, Kelvin Walston, L’dia Men-Na’a, Tabia Henry-Akintobi and Assia Miller

Int. J. Environ. Res. Public Health 2016, 13(1), 51; doi:10.3390/ijerph13010051

Received: 15 August 2015 / Revised: 31 October 2015 / Accepted: 26 November 2015 / Published: 22 December 2015

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Abstract

Few interventions have targeted perceived stress as a co-occurring construct central to substance use and subsequent HIV/AIDS risk reduction among African American urban young adults. The Color It Real Program was a seven session, weekly administered age-specific and culturally-tailored intervention designed to provide

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Few interventions have targeted perceived stress as a co-occurring construct central to substance use and subsequent HIV/AIDS risk reduction among African American urban young adults. The Color It Real Program was a seven session, weekly administered age-specific and culturally-tailored intervention designed to provide substance abuse and HIV education and reduce perceived stress among African Americans ages 18 to 24 in Atlanta, GA. Effectiveness was assessed through a quasi-experimental study design that consisted of intervention (n = 122) and comparison (n = 70) groups completing a pre- and post-intervention survey. A series of Analysis of Variance (ANOVA) tests were used to assess pre- to post-intervention changes between study groups. For intervention participants, perceived stress levels were significantly reduced by the end of the intervention (t(70) = 2.38, p = 0.020), condom use at last sexual encounter significantly increased (F = 4.43, p = 0.0360), intervention participants were significantly less likely to drink five or more alcoholic drinks in one sitting (F = 5.10, p = 0.0245), and to use clean needles when injecting the drug (F = 36.99, p = 0.0001). This study is among the first of its kind to incorporate stress management as an integral approach to HIV/SA prevention. The program has implications for the design of other community-based, holistic approaches to addressing substance use and risky behaviors for young adults. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle African American Women: Surviving Breast Cancer Mortality against the Highest Odds

by Shelley White-Means, Muriel Rice, Jill Dapremont, Barbara Davis and Judy Martin

Int. J. Environ. Res. Public Health 2016, 13(1), 6; doi:10.3390/ijerph13010006

Received: 29 July 2015 / Revised: 21 August 2015 / Accepted: 6 September 2015 / Published: 22 December 2015

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Abstract

Among the country’s 25 largest cities, the breast cancer mortality disparity is highest in Memphis, Tennessee, where African American women are twice as likely to die from breast cancer as White women. This qualitative study of African-American breast cancer survivors explores experiences during

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Among the country’s 25 largest cities, the breast cancer mortality disparity is highest in Memphis, Tennessee, where African American women are twice as likely to die from breast cancer as White women. This qualitative study of African-American breast cancer survivors explores experiences during and post treatment that contributed to their beating the high odds of mortality. Using a semi-structured interview guide, a focus group session was held in 2012 with 10 breast cancer survivors. Thematic analysis and a deductive a priori template of codes were used to analyze the data. Five main themes were identified: family history, breast/body awareness and preparedness to manage a breast cancer event, diagnosis experience and reaction to the diagnosis, family reactions, and impact on life. Prayer and family support were central to coping, and survivors voiced a cultural acceptance of racial disparities in health outcomes. They reported lack of provider sensitivity regarding pain, financial difficulties, negative responses from family/friends, and resiliency strategies for coping with physical and mental limitations. Our research suggested that a patient-centered approach of demystifying breast cancer (both in patient-provider communication and in community settings) would impact how women cope with breast cancer and respond to information about its diagnosis. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Black–White Latino Racial Disparities in HIV Survival, Florida, 2000–2011

by Diana M. Sheehan, Mary Jo Trepka, Kristopher P. Fennie, Guillermo Prado, Miguel Ángel Cano and Lorene M. Maddox

Int. J. Environ. Res. Public Health 2016, 13(1), 9; doi:10.3390/ijerph13010009

Received: 7 August 2015 / Revised: 20 September 2015 / Accepted: 23 September 2015 / Published: 22 December 2015

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Abstract

This research aimed to estimate Black/White racial disparities in all-cause mortality risk among HIV-positive Latinos. Florida surveillance data for Latinos diagnosed with HIV (2000–2008) were merged with 2007–2011 American Community Survey data. Crude and adjusted hazard ratios (aHR) were calculated using multi-level Cox

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This research aimed to estimate Black/White racial disparities in all-cause mortality risk among HIV-positive Latinos. Florida surveillance data for Latinos diagnosed with HIV (2000–2008) were merged with 2007–2011 American Community Survey data. Crude and adjusted hazard ratios (aHR) were calculated using multi-level Cox regression. Of 10,903 HIV-positive Latinos, 8.2% were Black and 91.9% White. Black Latinos were at increased mortality risk compared with White Latinos after controlling for individual and neighborhood factors (aHR 1.40, 95% confidence interval (CI) 1.21–1.62). In stratified analyses, risk factors for Black Latinos included: age ≥60 years compared with ages 13–19 (aHR 4.63, 95% CI 1.32–16.13); US birth compared with foreign birth (aHR 1.56, 95% CI 1.16–2.11); diagnosis of AIDS within three months of HIV diagnosis (aHR 3.53, 95% CI 2.64–4.74); residence in the 3rd (aHR 1.82, 95% CI 1.13–2.94) and 4th highest quartiles (aHR 1.79, 95% CI 1.12–2.86) of neighborhood poverty compared with the lowest quartile; and residence in neighborhood with 25%–49% (aHR 1.59, 95% CI 1.07–2.42) and ≥50% Latinos compared with <25% Latinos (aHR 1.58, 95% CI 1.03–2.42). Significant racial disparities in HIV survival exist among Latinos. Differential access to—and quality of—care and perceived/experienced racial discrimination may be possible explanations. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Improving the Neighborhood Environment for Urban Older Adults: Social Context and Self-Rated Health

by Arlesia Mathis, Ronica Rooks and Daniel Kruger

Int. J. Environ. Res. Public Health 2016, 13(1), 3; doi:10.3390/ijerph13010003

Received: 17 July 2015 / Revised: 16 October 2015 / Accepted: 11 November 2015 / Published: 22 December 2015

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Abstract

Objective: By 2030, older adults will account for 20% of the U.S. population. Over 80% of older adults live in urban areas. This study examines associations between neighborhood environment and self-rated health (SRH) among urban older adults. Methods: We selected 217

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Objective: By 2030, older adults will account for 20% of the U.S. population. Over 80% of older adults live in urban areas. This study examines associations between neighborhood environment and self-rated health (SRH) among urban older adults. Methods: We selected 217 individuals aged 65+ living in a deindustrialized Midwestern city who answered questions on the 2009 Speak to Your Health survey. The relationship between neighborhood environment and self-rated health (SRH) was analyzed using regression and GIS models. Neighborhood variables included social support and participation, perceived racism and crime. Additional models included actual crime indices to compare differences between perceived and actual crime. Results: Seniors who have poor SRH are 21% more likely to report fear of crime than seniors with excellent SRH (p = 0.01). Additional analyses revealed Black seniors are 7% less likely to participate in social activities (p = 0.005) and 4% more likely to report experiencing racism (p < 0.001). Discussion: Given the increasing numbers of older adults living in urban neighborhoods, studies such as this one are important for well-being among seniors. Mitigating environmental influences in the neighborhood which are associated with poor SRH may allow urban older adults to maintain health and reduce disability. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Community-Based Participatory Research Integrates Behavioral and Biological Research to Achieve Health Equity for Native Hawaiians

by Claire K. M. Townsend, Adrienne Dillard, Kelsea K. Hosoda, Gregory G. Maskarinec, Alika K. Maunakea, Sheryl R. Yoshimura, Claire Hughes, Donna-Marie Palakiko, Bridget Puni Kehauoha and Joseph Keawe‘aimoku Kaholokula

Int. J. Environ. Res. Public Health 2016, 13(1), 4; doi:10.3390/ijerph13010004

Received: 22 July 2015 / Revised: 11 September 2015 / Accepted: 18 September 2015 / Published: 22 December 2015

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Abstract

Native Hawaiians bear a disproportionate burden of type-2 diabetes and related complications compared to all other groups in Hawai‘i (e.g., Whites, Japanese, Korean). Distrust in these communities is a significant barrier to participation in epigenetic research studies seeking to better understand disease processes.

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Native Hawaiians bear a disproportionate burden of type-2 diabetes and related complications compared to all other groups in Hawai‘i (e.g., Whites, Japanese, Korean). Distrust in these communities is a significant barrier to participation in epigenetic research studies seeking to better understand disease processes. The purpose of this paper is to describe the community-based participatory research (CBPR) approach and research process we employed to integrate behavior and biological sciences with community health priorities. A CBPR approach was used to test a 3-month evidence-based, diabetes self-management intervention (N = 65). To investigate the molecular mechanisms linking inflammation with glucose homeostasis, a subset of participants (n = 16) provided peripheral blood mononuclear cells. Community and academic researchers collaborated on research design, assessment protocols, and participant recruitment, prioritizing participants’ convenience and education and strictly limiting the use of the data collected. Preliminary results indicate significant changes in DNA methylation at gene regions associated with inflammation and diabetes signaling pathways and significant improvements in hemoglobin A1c, self-care activities, and diabetes distress and understanding. This study integrates community, behavioral, and epigenomic expertise to better understand the outcomes of a diabetes self-management intervention. Key lessons learned suggest the studies requiring biospecimen collection in indigenous populations require community trust of the researchers, mutual benefits for the community and researchers, and for the researchers to prioritize the community’s needs. CBPR may be an important tool in providing communities the voice and protections to participate in studies requiring biospecimens. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessCommunication A Multidisciplinary Intervention Utilizing Virtual Communication Tools to Reduce Health Disparities: A Pilot Randomized Controlled Trial

by John F. Emerson, Madelyn Welch, Whitney E. Rossman, Stephen Carek, Thomas Ludden, Megan Templin, Charity G. Moore, Hazel Tapp, Michael Dulin and Andrew McWilliams

Int. J. Environ. Res. Public Health 2016, 13(1), 31; doi:10.3390/ijerph13010031

Received: 15 August 2015 / Revised: 27 October 2015 / Accepted: 17 November 2015 / Published: 22 December 2015

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Abstract

Advances in technology are likely to provide new approaches to address healthcare disparities for high-risk populations. This study explores the feasibility of a new approach to health disparities research using a multidisciplinary intervention and advanced communication technology to improve patient access to care

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Advances in technology are likely to provide new approaches to address healthcare disparities for high-risk populations. This study explores the feasibility of a new approach to health disparities research using a multidisciplinary intervention and advanced communication technology to improve patient access to care and chronic disease management. A high-risk cohort of uninsured, poorly-controlled diabetic patients was identified then randomized pre-consent with stratification by geographic region to receive either the intervention or usual care. Prior to enrollment, participants were screened for readiness to make a behavioral change. The primary outcome was the feasibility of protocol implementation, and secondary outcomes included the use of patient-centered medical home (PCMH) services and markers of chronic disease control. The intervention included a standardized needs assessment, individualized care plan, intensive management by a multidisciplinary team, including health coach-facilitated virtual visits, and the use of a cloud-based glucose monitoring system. One-hundred twenty-seven high-risk, potentially eligible participants were randomized. Sixty-one met eligibility criteria after an in-depth review. Due to limited resources and time for the pilot, we only attempted to contact 36 participants. Of these, we successfully reached 20 (32%) by phone and conducted a readiness to change screen. Ten participants screened in as ready to change and were enrolled, while the remaining 10 were not ready to change. Eight enrolled participants completed the final three-month follow-up. Intervention feasibility was demonstrated through successful implementation of 13 out of 14 health coach-facilitated virtual visits, and 100% of participants indicated that they would recommend the intervention to a friend. Protocol feasibility was demonstrated as eight of 10 participants completed the entire study protocol. At the end of the three-month intervention, participants had a median of nine total documented contacts with PCMH providers compared to four in the control group. Three intervention and two control participants had controlled diabetes (hemoglobin A1C <9%). Multidisciplinary care that utilizes health coach-facilitated virtual visits is an intervention that could increase access to intensive primary care services in a vulnerable population. The methods tested are feasible and should be tested in a pragmatic randomized controlled trial to evaluate the impact on patient-relevant outcomes across multiple chronic diseases. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle When Free Is Not for Me: Confronting the Barriers to Use of Free Quitline Telephone Counseling for Tobacco Dependence

by Christine Sheffer, Sharon Brackman, Charnette Lercara, Naomi Cottoms, Mary Olson, Luana Panissidi, Jami Pittman and Helen Stayna

Int. J. Environ. Res. Public Health 2016, 13(1), 15; doi:10.3390/ijerph13010015

Received: 14 August 2015 / Revised: 27 October 2015 / Accepted: 30 October 2015 / Published: 22 December 2015

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Abstract

Remarkable disparities in smoking rates in the United States contribute significantly to socioeconomic and minority health disparities. Access to treatment for tobacco use can help address these disparities, but quitlines, our most ubiquitous treatment resource, reach just 1%–2% of smokers. We used community-based

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Remarkable disparities in smoking rates in the United States contribute significantly to socioeconomic and minority health disparities. Access to treatment for tobacco use can help address these disparities, but quitlines, our most ubiquitous treatment resource, reach just 1%–2% of smokers. We used community-based participatory methods to develop a survey instrument to assess barriers to use of the quitline in the Arkansas Mississippi delta. Barriers were quitline specific and barriers to cessation more broadly. Over one-third (34.9%) of respondents (n = 799) did not have access to a telephone that they could use for the quitline. Respondents reported low levels of knowledge about the quitline, quitting, and trust in tobacco treatment programs as well as considerable ambivalence about quitting including significant concerns about getting sick if they quit and strong faith-based beliefs about quitting. These findings suggest quitlines are not accessible to all lower socioeconomic groups and that significant barriers to use include barriers to cessation. These findings suggest targets for providing accessible tobacco use treatment services and addressing concerns about cessation among lower income, ethnic minority, and rural groups. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle DNA Damage, Cell Cycle Arrest, and Apoptosis Induction Caused by Lead in Human Leukemia Cells

by Clement G. Yedjou, Hervey M. Tchounwou and Paul B. Tchounwou

Int. J. Environ. Res. Public Health 2016, 13(1), 56; doi:10.3390/ijerph13010056

Received: 16 August 2015 / Revised: 15 October 2015 / Accepted: 19 October 2015 / Published: 22 December 2015

Cited by 4 | PDF Full-text (2167 KB) | HTML Full-text | XML Full-text

Abstract

In recent years, the industrial use of lead has been significantly reduced from paints and ceramic products, caulking, and pipe solder. Despite this progress, lead exposure continues to be a significant public health concern. The main goal of this research was to determine

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In recent years, the industrial use of lead has been significantly reduced from paints and ceramic products, caulking, and pipe solder. Despite this progress, lead exposure continues to be a significant public health concern. The main goal of this research was to determine the in vitro mechanisms of lead nitrate [Pb(NO₃)₂] to induce DNA damage, apoptosis, and cell cycle arrest in human leukemia (HL-60) cells. To reach our goal, HL-60 cells were treated with different concentrations of Pb(NO₃)₂ for 24 h. Live cells and necrotic death cells were measured by the propidium idiode (PI) assay using the cellometer vision. Cell apoptosis was measured by the flow cytometry and DNA laddering. Cell cycle analysis was evaluated by the flow cytometry. The result of the PI demonstrated a significant (p < 0.05) increase of necrotic cell death in Pb(NO₃)₂-treated cells, indicative of membrane rupture by Pb(NO₃)₂ compared to the control. Data generated from the comet assay indicated a concentration-dependent increase in DNA damage, showing a significant increase (p < 0.05) in comet tail-length and percentages of DNA cleavage. Data generated from the flow cytometry assessment indicated that Pb(NO₃)₂ exposure significantly (p < 0.05) increased the proportion of caspase-3 positive cells (apoptotic cells) compared to the control. The flow cytometry assessment also indicated Pb(NO₃)₂ exposure caused cell cycle arrest at the G₀/G₁ checkpoint. The result of DNA laddering assay showed presence of DNA smear in the agarose gel with little presence of DNA fragments in the treated cells compared to the control. In summary, Pb(NO₃)₂ inhibits HL-60 cells proliferation by not only inducing DNA damage and cell cycle arrest at the G₀/G₁ checkpoint but also triggering the apoptosis through caspase-3 activation and nucleosomal DNA fragmentation accompanied by secondary necrosis. We believe that our study provides a new insight into the mechanisms of Pb(NO₃)₂ exposure and its associated adverse health effects. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Application of Citizen Science Risk Communication Tools in a Vulnerable Urban Community

by Yuqin Jiao, Julie K. Bower, Wansoo Im, Nicholas Basta, John Obrycki, Mohammad Z. Al-Hamdan, Allison Wilder, Claire E. Bollinger, Tongwen Zhang, Luddie Sr. Hatten, Jerrie Hatten and Darryl B. Hood

Int. J. Environ. Res. Public Health 2016, 13(1), 11; doi:10.3390/ijerph13010011

Received: 11 August 2015 / Revised: 2 October 2015 / Accepted: 9 October 2015 / Published: 22 December 2015

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Abstract

A public participatory geographical information systems (PPGIS) demographic, environmental, socioeconomic, health status portal was developed for the Stambaugh-Elwood (SE) community in Columbus, OH. We hypothesized that soil at SE residences would have metal concentrations above natural background levels. Three aims were developed that

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A public participatory geographical information systems (PPGIS) demographic, environmental, socioeconomic, health status portal was developed for the Stambaugh-Elwood (SE) community in Columbus, OH. We hypothesized that soil at SE residences would have metal concentrations above natural background levels. Three aims were developed that allowed testing of this hypothesis. Aim 1 focused on establishing partnerships between academia, state agencies and communities to assist in the development of a community voice. Aim 2 was to design and conduct soil sampling for residents of the SE community. Aim 3 was to utilize our interactive, customized portal as a risk communication tool by allowing residents to educate themselves as to the potential risks from industrial sources in close proximity to their community. Multiple comparisons of means were used to determine differences in soil element concentration by sampling location at p < 0.05. The results demonstrated that eight metals (As, Cd, Cu, Pb, Mo, Se, Tl, Zn) occurred at statistically-significantly greater levels than natural background levels, but most were below risk-based residential soil screening levels. Results were conveyed to residents via an educational, risk-communication informational card. This study demonstrates that community-led coalitions in collaboration with academic teams and state agencies can effectively address environmental concerns. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Harnessing Data to Assess Equity of Care by Race, Ethnicity and Language

by Amber Gracia, Jorge Cheirif, Juana Veliz, Melissa Reyna, Mara Vecchio and Subhash Aryal

Int. J. Environ. Res. Public Health 2016, 13(1), 45; doi:10.3390/ijerph13010045

Received: 1 August 2015 / Revised: 27 October 2015 / Accepted: 2 November 2015 / Published: 22 December 2015

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Abstract

Objective: Determine any disparities in care based on race, ethnicity and language (REaL) by utilizing inpatient (IP) core measures at Texas Health Resources, a large, faith-based, non-profit health care delivery system located in a large, ethnically diverse metropolitan area in Texas. These measures,

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Objective: Determine any disparities in care based on race, ethnicity and language (REaL) by utilizing inpatient (IP) core measures at Texas Health Resources, a large, faith-based, non-profit health care delivery system located in a large, ethnically diverse metropolitan area in Texas. These measures, which were established by the U.S. Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC), help to ensure better accountability for patient outcomes throughout the U.S. health care system. Methods: Sample analysis to understand the architecture of race, ethnicity and language (REaL) variables within the Texas Health clinical database, followed by development of the logic, method and framework for isolating populations and evaluating disparities by race (non-Hispanic White, non-Hispanic Black, Native American/Native Hawaiian/Pacific Islander, Asian and Other); ethnicity (Hispanic and non-Hispanic); and preferred language (English and Spanish). The study is based on use of existing clinical data for four inpatient (IP) core measures: Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), Pneumonia (PN) and Surgical Care (SCIP), representing 100% of the sample population. These comprise a high number of cases presenting in our acute care facilities. Findings are based on a sample of clinical data (N = 19,873 cases) for the four inpatient (IP) core measures derived from 13 of Texas Health’s wholly-owned facilities, formulating a set of baseline data. Results: Based on applied method, Texas Health facilities consistently scored high with no discernable race, ethnicity and language (REaL) disparities as evidenced by a low percentage difference to the reference point (non-Hispanic White) on IP core measures, including: AMI (0.3%–1.2%), CHF (0.7%–3.0%), PN (0.5%–3.7%), and SCIP (0–0.7%). Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle PVT1 Exon 9: A Potential Biomarker of Aggressive Prostate Cancer?

by Adeodat Ilboudo, Jyoti Chouhan, Brian K. McNeil, Joseph R. Osborne and Olorunseun O. Ogunwobi

Int. J. Environ. Res. Public Health 2016, 13(1), 12; doi:10.3390/ijerph13010012

Received: 12 August 2015 / Revised: 29 October 2015 / Accepted: 2 November 2015 / Published: 22 December 2015

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Abstract

Prostate cancer (PCa) is the most commonly diagnosed cancer as well as the greatest source of cancer-related mortality in males of African ancestry (MoAA). Interestingly, this has been shown to be associated with single nucleotide polymorphisms around regions 2 and 3 of the

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Prostate cancer (PCa) is the most commonly diagnosed cancer as well as the greatest source of cancer-related mortality in males of African ancestry (MoAA). Interestingly, this has been shown to be associated with single nucleotide polymorphisms around regions 2 and 3 of the 8q24 human chromosomal region. The non-protein coding gene locus Plasmacytoma Variant Translocation 1 (PVT1) is located at 8q24 and is overexpressed in PCa and, therefore, is also a candidate biomarker to explain the well-known disparity in this group. PVT1 has at least 12 exons that make separate transcripts which may have different functions, all of which are at present unknown in PCa. Our aim was to determine if any PVT1 transcripts play a role in aggressiveness and racial disparity in PCa. We used a panel of seven PCa cell lines including three derived from MoAA. Ribonucleic acid extraction, complementary deoxyribonucleic acid synthesis, and quantitative polymerase chain reaction (qPCR) were performed to evaluate expression of all 12 PVT1 exons. Each qPCR was performed in quadruplicates. At least four separate qPCR experiments were performed. Expression of PVT1 exons was inconsistent except for exon 9. There was no significant difference in exon 9 expression between cell lines derived from Caucasian males (CM), and an indolent cell line derived from MoAA. However, exon 9 expression in the aggressive MDA PCa 2b and E006AA-hT cell lines derived from MoAA was significantly higher than in other cell lines. Consequently, we observed differential expression of exon 9 of PVT1 in a manner that suggests that PVT1 exon 9 may be associated with aggressive PCa in MoAA. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Characterizing the HIV/AIDS Epidemic in the United States and China

by Ming-Bo Huang, Li Ye, Bing-Yu Liang, Chuan-Yi Ning, William W. Roth, Jun-Jun Jiang, Jie-Gang Huang, Bo Zhou, Ning Zang, Michael D. Powell, Hao Liang and Vincent C. Bond

Int. J. Environ. Res. Public Health 2016, 13(1), 30; doi:10.3390/ijerph13010030

Received: 17 August 2015 / Revised: 31 October 2015 / Accepted: 4 November 2015 / Published: 22 December 2015

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Abstract

The HIV/AIDS data from the national surveillance systems of China and the United States from 1985 to 2014 were compared to characterize the HIV/AIDS epidemic in both countries. The current estimated national HIV prevalence rate in China and the United States are 0.0598%

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The HIV/AIDS data from the national surveillance systems of China and the United States from 1985 to 2014 were compared to characterize the HIV/AIDS epidemic in both countries. The current estimated national HIV prevalence rate in China and the United States are 0.0598% and 0.348%, respectively. In the United States, the annual number of new HIV infections has remained relatively stable (~50,000 each year) and has shown a downward trend in recent years. The Chinese national HIV prevalence is still low, and new HIV infections have been contained at a low level (50,000–100,000 each year). However, the epidemic has showed an increasing trend since 2012. By risk group, in both countries, men who have sex with men (MSM), heterosexual sex, and injection drug use (IDU) are the most common modes of transmission of new HIV infections. However, in the United States, MSM is the dominant transmission route, accounting for >60% of new infections; whereas in China, heterosexual sex has now become the dominant route, also accounting for >60% of new infections. A rapid increase in the proportion of HIV cases that were attributed to MSM and an obvious decrease in the proportion of HIV cases attributed to IDU in China in recent years imply that the China’s epidemic is still evolving, to some extent, copying what was experienced in the United States. By age group, the proportions of HIV cases that were attributed to the age group 25–59 were comparable between the two countries. However, the United States had a higher proportion of cases that were attributed to age groups 15–19 and 20–24 than China, indicating that youth account for more infections in the United States. One other fact worth noting: in China there is a significant increase in the number of HIV new infections in individuals over 50 years of age, which results in much higher proportion of cases that were attributed to age groups 60–64 and over 65 in China than those in the United States. By race/ethnicity, in the United States, Blacks/African Americans continue to experience the most severe HIV burden, followed by Hispanics/Latinos. In China, no official data on race/ethnicity disparities are currently available. Thus, region, risk group, age are important factors in the HIV epidemics in both countries. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Nutrition and Health Disparities: The Role of Dairy in Improving Minority Health Outcomes

by Constance Brown-Riggs

Int. J. Environ. Res. Public Health 2016, 13(1), 28; doi:10.3390/ijerph13010028

Received: 15 August 2015 / Revised: 20 October 2015 / Accepted: 26 October 2015 / Published: 22 December 2015

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Abstract

Consuming a balanced diet, such as the food groups represented on MyPlate, is key to improving health disparities. Despite the best of intentions, however, the dietary guidelines can be culturally challenging, particularly when it comes to dairy consumption. Many African and Hispanic Americans

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Consuming a balanced diet, such as the food groups represented on MyPlate, is key to improving health disparities. Despite the best of intentions, however, the dietary guidelines can be culturally challenging, particularly when it comes to dairy consumption. Many African and Hispanic Americans avoid milk and dairy products—key contributors of three shortfall nutrients (calcium, potassium and vitamin D)—because many people in these populations believe they are lactose intolerant. However, avoiding dairy can have significant health effects. An emerging body of evidence suggests that yogurt and other dairy products may help support reduced risk of heart disease, hypertension, obesity, and type 2 diabetes—conditions that disproportionately impact people of color. For this reason, the National Medical Association and the National Hispanic Medical Association issued a joint consensus statement recommending African Americans consume three to four servings of low-fat dairy every day. Cultured dairy products could play an important role in addressing these recommendations. Because of the presence of lactase-producing cultures, yogurt is often a more easily digestible alternative to milk, and thus more palatable to people who experience symptoms of lactose intolerance. This was a key factor cited in the final rule to include yogurt in the Special Supplemental Nutrition Program for Women, Infants, and Children. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Hot Spot Mutation in TP53 (R248Q) Causes Oncogenic Gain-of-Function Phenotypes in a Breast Cancer Cell Line Derived from an African American patient

by Nataly Shtraizent, Hiroshi Matsui, Alla Polotskaia and Jill Bargonetti

Int. J. Environ. Res. Public Health 2016, 13(1), 22; doi:10.3390/ijerph13010022

Received: 15 August 2015 / Accepted: 2 October 2015 / Published: 22 December 2015

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Abstract

African American (AA) breast cancer patients often have triple negative breast cancer (TNBC) that contains mutations in the TP53 gene. The point mutations at amino acid residues R273 and R248 both result in oncogenic gain-of-function (GOF) phenotypes. Expression of mutant p53 (mtp53) R273H

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African American (AA) breast cancer patients often have triple negative breast cancer (TNBC) that contains mutations in the TP53 gene. The point mutations at amino acid residues R273 and R248 both result in oncogenic gain-of-function (GOF) phenotypes. Expression of mutant p53 (mtp53) R273H associates with increased cell elasticity, survival under serum deprivation conditions, and increased Poly (ADP ribose) polymerase 1 (PARP1) on the chromatin in the AA-derived TNBC breast cancer cell line MDA-MB-468. We hypothesized that GOF mtp53 R248Q expression could stimulate a similar phenotype in the AA-derived TNBC cell line HCC70. To test this hypothesis we depleted the R248Q protein in the HCC70 cell line using shRNA-mediated knockdown. Using impedance-based real-time analysis we correlated the expression of mtp53 R248Q with increased cell deformability. We also documented that depletion of mtp53 R248Q increased PARP1 in the cytoplasm and decreased PARP1 on the chromatin. We conclude that in the AA-derived TNBC HCC70 cells mtp53 R248Q expression results in a causative tumor associated phenotype. This study supports using the biological markers of high expression of mtp53 R273H or R248Q as additional diagnostics for TNBC resistant subtypes often found in the AA community. Each mtp53 protein must be considered separately and this work adds R248Q to the increasing list of p53 mutations that can be used for diagnostics and drug targeting. Here we report that when R248Q mtp53 proteins are expressed in TNBC, then targeting the gain-of-function pathways may improve treatment efficacy. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Results of a Community Randomized Study of a Faith-Based Education Program to Improve Clinical Trial Participation among African Americans

by Paula M. Frew, Jay T. Schamel, Kelli A. O’Connell, Laura A. Randall and Sahithi Boggavarapu

Int. J. Environ. Res. Public Health 2016, 13(1), 41; doi:10.3390/ijerph13010041

Received: 16 August 2015 / Revised: 20 October 2015 / Accepted: 23 October 2015 / Published: 22 December 2015

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Abstract

This is a report of a cluster randomized clinical trial evaluating the effectiveness of a church-based educational intervention aimed at improving African Americans’ (AA) participation in clinical trials. Two hundred and twenty-one AA subjects ages ≥50 years from six predominantly AA churches were

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This is a report of a cluster randomized clinical trial evaluating the effectiveness of a church-based educational intervention aimed at improving African Americans’ (AA) participation in clinical trials. Two hundred and twenty-one AA subjects ages ≥50 years from six predominantly AA churches were randomized to intervention or control condition. The intervention included three educational sessions about clinical trials and health disparities; control participants completed questionnaires. Primary endpoints of the study were differences in individual subjects' intentions to obtain clinical trial information and intention to join a clinical trial, as determined by 10 point scale items at baseline, three and six months. A statistically significant increase in the intention to obtain clinical trial information at the three and six month time points was observed in the intervention group, but not the control group. Older participants (65–95 years) were less likely than younger participants (50–64 years) to increase their motivation to seek clinical trial information by the three and six month time points. No significant increases were observed in intention to join clinical trials. This randomized trial shows that AA church-based educational interventions are likely to increase the motivation of AA subjects to obtain clinical trial information and are therefore potentially effective at ameliorating the underrepresentation of AA subjects in clinical trials. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Cultural Competence in Pediatrics: Health Care Provider Knowledge, Awareness, and Skills

by Kirk Dabney, Lavisha McClarin, Emily Romano, Diane Fitzgerald, Lynn Bayne, Patricia Oceanic, Arie L. Nettles and Laurens Holmes

Int. J. Environ. Res. Public Health 2016, 13(1), 14; doi:10.3390/ijerph13010014

Received: 12 August 2015 / Revised: 14 November 2015 / Accepted: 17 November 2015 / Published: 22 December 2015

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Abstract

The purpose of this study was to assess the effects of a cultural competence training (CCT) program on pediatric health care providers’ self-reported ability to provide culturally competent care to a diverse pediatric patient population. This quantitative, nested ecologic level study design used

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The purpose of this study was to assess the effects of a cultural competence training (CCT) program on pediatric health care providers’ self-reported ability to provide culturally competent care to a diverse pediatric patient population. This quantitative, nested ecologic level study design used a repeated measure in the form of pre-test and post-test data to assess percent change in providers’ cultural awareness, experience working or learning about different cultures, and preparedness and skills in working with different cultures before and after CCT. The study was conducted between 2011 and 2012 in a pediatric hospital and associated outpatient offices. The sample consisted of pediatric health care providers from various departments, mainly physicians and nurses (n = 69). Participants completed a pre-intervention cultural competence assessment and then were subjected to a cultural competence-training program, after which they completed the assessment a second time. The baseline and post-intervention data were collected in the form of Likert scales and transformed into a quintile or quartile scale as appropriate. Data were assessed using paired t-tests or Wilcoxon’s signed-rank tests. Providers indicated a 13% increase in knowledge (53.9% vs. 66.7%, t = 3.4, p = 0.001), 8.7% increase in awareness (46.7% vs. 55.4%, t = 3.0, p = 0.002), and 8% statistically marginal increase in skills (66.4% vs. 74.5%, z = 1.8, p = 0.06). Culturally competent training in a pediatric environment significantly enhances knowledge, awareness and to some extent skills in providing care to culturally diverse patient population. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Genistein and Glyceollin Effects on ABCC2 (MRP2) and ABCG2 (BCRP) in Caco-2 Cells

by Chandler Schexnayder and Robert E. Stratford

Int. J. Environ. Res. Public Health 2016, 13(1), 17; doi:10.3390/ijerph13010017

Received: 14 August 2015 / Revised: 14 September 2015 / Accepted: 23 September 2015 / Published: 22 December 2015

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Abstract

The goal of the present study was to determine the effects of glyceollins on intestinal ABCC2 (ATP Binding Cassette C2, multidrug resistance protein 2, MRP2) and ABCG2 (ATP Binding Cassette G2, breast cancer resistance protein, BCRP) function using the Caco-2 cell intestinal epithelial

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The goal of the present study was to determine the effects of glyceollins on intestinal ABCC2 (ATP Binding Cassette C2, multidrug resistance protein 2, MRP2) and ABCG2 (ATP Binding Cassette G2, breast cancer resistance protein, BCRP) function using the Caco-2 cell intestinal epithelial cell model. Glyceollins are soy-derived phytoestrogens that demonstrate anti-proliferative activity in several sources of cancer cells. 5 (and 6)-carboxy-2′,7′-dichloroflourescein (CDF) was used as a prototypical MRP2 substrate; whereas BODIPY-prazosin provided an indication of BCRP function. Comparison studies were conducted with genistein. Glyceollins were shown to inhibit MRP2-mediated CDF transport, with activity similar to the MRP2 inhibitor, MK-571. They also demonstrated concentration-dependent inhibition BCRP-mediated efflux of BODIPY-prazosin, with a potency similar to that of the recognized BCRP inhibitor, Ko143. In contrast, genistein did not appear to alter MRP2 activity and even provided a modest increase in BCRP efflux of BODIPY-prazosin. In particular, glyceollin inhibition of these two important intestinal efflux transporters suggests the potential for glyceollin to alter the absorption of other phytochemicals with which it might be co-administered as a dietary supplement, as well as alteration of the absorption of pharmaceuticals that may be administered concomitantly. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle A Pilot Study to Examine the Disparities in Water Quality between Predominantly Haitian Neighborhoods and Dominican Neighborhoods in Two Cities in the Dominican Republic

by Jessica Rogers-Brown, Ryan Johnson, Dominique Smith and Kim Ramsey-White

Int. J. Environ. Res. Public Health 2016, 13(1), 39; doi:10.3390/ijerph13010039

Received: 17 August 2015 / Revised: 23 September 2015 / Accepted: 24 September 2015 / Published: 22 December 2015

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Abstract

Worldwide, diarrheal disease is a leading cause of death affecting over 1.7 million individuals annually. Much of this can be attributed to lack of clean water, sanitation and hygiene. Nearly all of these deaths occur in countries with developing economies. This public health

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Worldwide, diarrheal disease is a leading cause of death affecting over 1.7 million individuals annually. Much of this can be attributed to lack of clean water, sanitation and hygiene. Nearly all of these deaths occur in countries with developing economies. This public health problem is apparent in the island of Hispaniola; the island that is shared by Haiti and the Dominican Republic. Significant gaps in income between the countries have resulted in Haitians migrating into the Dominican Republic. While there has been increased migration into the Dominican Republic, many of the neighborhoods remain segregated. A cross-sectional analysis was conducted at 49 sites in the Dominican Republic. Samples were classified as being from a Haitian neighborhood or Dominican neighborhood and analyzed for microbial contamination. Overall, Haitian neighborhoods were found to have statistically significantly higher levels of contamination of both coliform and E. coli. The odds of having E. coli contaminated water in Haitian neighborhoods are 4.25 times as high as Dominican neighborhoods. The odds of having coliform contaminated water in Haitian neighborhoods are 4.78 times as high as Dominican neighborhoods. This study provides evidence of the disparity in access to clean drinking water for Haitian immigrants and highlights the need for further investigation. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Barriers for Compliance to Breast, Colorectal, and Cervical Screening Cancer Tests among Hispanic Patients

by Christine Miranda-Diaz, Elba Betancourt, Yelitza Ruiz-Candelaria and Robert F. Hunter-Mellado

Int. J. Environ. Res. Public Health 2016, 13(1), 21; doi:10.3390/ijerph13010021

Received: 14 August 2015 / Revised: 13 October 2015 / Accepted: 15 October 2015 / Published: 22 December 2015

Cited by 6 | PDF Full-text (204 KB) | HTML Full-text | XML Full-text

Abstract

Hispanics are less likely to undergo screening tests for colorectal cancer and cervical cancer than non-Hispanic whites. Compliance with mammography, fecal occult blood testing (FOBT), colonoscopy, and cervical smears (PAP) and barriers for compliance were studied. A descriptive study was performed with 194

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Hispanics are less likely to undergo screening tests for colorectal cancer and cervical cancer than non-Hispanic whites. Compliance with mammography, fecal occult blood testing (FOBT), colonoscopy, and cervical smears (PAP) and barriers for compliance were studied. A descriptive study was performed with 194 ambulatory patients while they attended routine medical visits. Women are more likely than men to undergo a colonoscopy. Conversely, FOBT was most likely reported by men. Reasons for compliance with FOBT differed by gender. Men were most likely to avoid FOBT due to lack of knowledge whereas women reported that physicians do not recommend the procedure. Both men and women reported that lack of physician’s recommendation was their primary reason for not undergoing a colonoscopy. Men tend to report lack of knowledge about colonoscopy procedure. A higher mammogram utilization rate was reported by women older than 40 years. PAP smears were reported by 74% of women older than 21 years. The major reasons for avoiding mammography and PAP tests were having a busy schedule, fear, and feeling uncomfortable during the procedure. In a multivariate regression analysis, occupational status was found to be a predictor for compliance with FOBT and colonoscopy. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Computer Optimization of Biodegradable Nanoparticles Fabricated by Dispersion Polymerization

by Emmanuel O. Akala, Simeon Adesina and Oluwaseun Ogunwuyi

Int. J. Environ. Res. Public Health 2016, 13(1), 47; doi:10.3390/ijerph13010047

Received: 15 August 2015 / Revised: 4 November 2015 / Accepted: 12 November 2015 / Published: 22 December 2015

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Abstract

Quality by design (QbD) in the pharmaceutical industry involves designing and developing drug formulations and manufacturing processes which ensure predefined drug product specifications. QbD helps to understand how process and formulation variables affect product characteristics and subsequent optimization of these variables vis-à-vis final

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Quality by design (QbD) in the pharmaceutical industry involves designing and developing drug formulations and manufacturing processes which ensure predefined drug product specifications. QbD helps to understand how process and formulation variables affect product characteristics and subsequent optimization of these variables vis-à-vis final specifications. Statistical design of experiments (DoE) identifies important parameters in a pharmaceutical dosage form design followed by optimizing the parameters with respect to certain specifications. DoE establishes in mathematical form the relationships between critical process parameters together with critical material attributes and critical quality attributes. We focused on the fabrication of biodegradable nanoparticles by dispersion polymerization. Aided by a statistical software, d-optimal mixture design was used to vary the components (crosslinker, initiator, stabilizer, and macromonomers) to obtain twenty nanoparticle formulations (PLLA-based nanoparticles) and thirty formulations (poly-ɛ-caprolactone-based nanoparticles). Scheffe polynomial models were generated to predict particle size (nm), zeta potential, and yield (%) as functions of the composition of the formulations. Simultaneous optimizations were carried out on the response variables. Solutions were returned from simultaneous optimization of the response variables for component combinations to (1) minimize nanoparticle size; (2) maximize the surface negative zeta potential; and (3) maximize percent yield to make the nanoparticle fabrication an economic proposition. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

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Open AccessArticle Ethnic Differences in Maternal Adipokines during Normal Pregnancy

by Xinhua Chen and Theresa O. Scholl

Int. J. Environ. Res. Public Health 2016, 13(1), 8; doi:10.3390/ijerph13010008

Received: 6 August 2015 / Revised: 3 September 2015 / Accepted: 7 September 2015 / Published: 22 December 2015

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Abstract

Two adipokines (adiponectin and resistin) have opposite relations with insulin resistance and inflammation. Our major focus was to determine whether there were detectable ethnic differences in maternal adipokines during pregnancy. We also explored the correlation of the adipokines with maternal glucose homeostasis, blood

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Two adipokines (adiponectin and resistin) have opposite relations with insulin resistance and inflammation. Our major focus was to determine whether there were detectable ethnic differences in maternal adipokines during pregnancy. We also explored the correlation of the adipokines with maternal glucose homeostasis, blood pressure and anthropometric parameters. Pregnant women (n = 1634) were from a large prospective cohort study in Camden NJ (African-American 36.8%; Hispanic 47.6%; Caucasian 15.6%). Serum adiponectin and resistin were measured at entry (week 16.8) and the 3rd trimester (week 30.7) using the Luminex xMapTechnology. Significant differences were observed among ethnic groups, controlling for confounding variables. African American women were exceptional in that they had decreased adiponectin and increased resistin throughout the course of pregnancy (p < 0.05 to p < 0.0001) and a greater than two fold risk of simultaneously exhibiting low adiponectin (lowest tertile) and high resistin (highest tertile) compared to Caucasians and/or Hispanics. The cohort as a whole and each ethnic group showed similar negative correlations between adiponectin, and glucose homeostasis, blood pressure and anthropometric parameters but there was lesser correspondence with resistin. Our data underscore the need for further research on ethnic variation in adipokines and other physiologic biomarkers during complicated and uncomplicated pregnancy. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Building Collaborative Health Promotion Partnerships: The Jackson Heart Study

by Clifton C. Addison, Brenda W. Campbell Jenkins, Darcel Odom, Marty Fortenberry, Gregory Wilson, Lavon Young and Donna Antoine-LaVigne

Int. J. Environ. Res. Public Health 2016, 13(1), 25; doi:10.3390/ijerph13010025

Received: 15 August 2015 / Revised: 23 October 2015 / Accepted: 9 November 2015 / Published: 22 December 2015

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Abstract

Building Collaborative Health Promotion Partnerships: The Jackson Heart Study. Background: Building a collaborative health promotion partnership that effectively employs principles of community-based participatory research (CBPR) involves many dimensions. To ensure that changes would be long-lasting, it is imperative that partnerships be configured to

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Building Collaborative Health Promotion Partnerships: The Jackson Heart Study. Background: Building a collaborative health promotion partnership that effectively employs principles of community-based participatory research (CBPR) involves many dimensions. To ensure that changes would be long-lasting, it is imperative that partnerships be configured to include groups of diverse community representatives who can develop a vision for long-term change. This project sought to enumerate processes used by the Jackson Heart Study (JHS) Community Outreach Center (CORC) to create strong, viable partnerships that produce lasting change. Methods: JHS CORC joined with community representatives to initiate programs that evolved into comprehensive strategies for addressing health disparities and the high prevalence of cardiovascular disease (CVD). This collaboration was made possible by first promoting an understanding of the need for combined effort, the desire to interact with other community partners, and the vision to establish an effective governance structure. Results: The partnership between JHS CORC and the community has empowered and inspired community members to provide leadership to other health promotion projects. Conclusion: Academic institutions must reach out to local community groups and together address local health issues that affect the community. When a community understands the need for change to respond to negative health conditions, formalizing this type of collaboration is a step in the right direction. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Associations of Adiponectin with Adiposity, Insulin Sensitivity, and Diet in Young, Healthy, Mexican Americans and Non-Latino White Adults

by Rocio I. Pereira, Cecilia C. Low Wang, Pamela Wolfe, Edward P. Havranek, Carlin S. Long and Daniel H. Bessesen

Int. J. Environ. Res. Public Health 2016, 13(1), 54; doi:10.3390/ijerph13010054

Received: 15 August 2015 / Revised: 22 October 2015 / Accepted: 1 December 2015 / Published: 22 December 2015

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Abstract

Low circulating adiponectin levels may contribute to higher diabetes risk among Mexican Americans (MA) compared to non-Latino whites (NLW). Our objective was to determine if among young healthy adult MAs have lower adiponectin than NLWs, independent of differences in adiposity. In addition, we

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Low circulating adiponectin levels may contribute to higher diabetes risk among Mexican Americans (MA) compared to non-Latino whites (NLW). Our objective was to determine if among young healthy adult MAs have lower adiponectin than NLWs, independent of differences in adiposity. In addition, we explored associations between adiponectin and diet. This was an observational, cross-sectional study of healthy MA and NLW adults living in Colorado (U.S.A.). We measured plasma total adiponectin, adiposity (BMI, and visceral adipose tissue), insulin sensitivity (IVGTT), and self-reported dietary intake in 43 MA and NLW adults. Mean adiponectin levels were 40% lower among MA than NLW (5.8 ± 3.3 vs. 10.7 ± 4.2 µg/mL, p = 0.0003), and this difference persisted after controlling for age, sex, BMI, and visceral adiposity. Lower adiponectin in MA was associated with lower insulin sensitivity (R² = 0.42, p < 0.01). Lower adiponectin was also associated with higher dietary glycemic index, lower intake of vegetables, higher intake of trans fat, and higher intake of grains. Our findings confirm that ethnic differences in adiponectin reflect differences in insulin sensitivity, but suggest that these are not due to differences in adiposity. Observed associations between adiponectin and diet support the need for future studies exploring the regulation of adiponectin by diet and other environmental factors. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Fostering Social Determinants of Health Transdisciplinary Research: The Collaborative Research Center for American Indian Health

by Amy J. Elliott, Emily R. White Hat, Jyoti Angal, Victoria Grey Owl, Susan E. Puumala and DenYelle Baete Kenyon

Int. J. Environ. Res. Public Health 2016, 13(1), 24; doi:10.3390/ijerph13010024

Received: 15 August 2015 / Revised: 20 October 2015 / Accepted: 23 October 2015 / Published: 22 December 2015

Cited by 1 | PDF Full-text (503 KB) | HTML Full-text | XML Full-text

Abstract

The Collaborative Research Center for American Indian Health (CRCAIH) was established in September 2012 as a unifying structure to bring together tribal communities and health researchers across South Dakota, North Dakota and Minnesota to address American Indian/Alaska Native (AI/AN) health disparities. CRCAIH is

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The Collaborative Research Center for American Indian Health (CRCAIH) was established in September 2012 as a unifying structure to bring together tribal communities and health researchers across South Dakota, North Dakota and Minnesota to address American Indian/Alaska Native (AI/AN) health disparities. CRCAIH is based on the core values of transdisciplinary research, sustainability and tribal sovereignty. All CRCAIH resources and activities revolve around the central aim of assisting tribes with establishing and advancing their own research infrastructures and agendas, as well as increasing AI/AN health research. CRCAIH is comprised of three divisions (administrative; community engagement and innovation; research projects), three technical cores (culture, science and bioethics; regulatory knowledge; and methodology), six tribal partners and supports numerous multi-year and one-year pilot research projects. Under the ultimate goal of improving health for AI/AN, this paper describes the overarching vision and structure of CRCAIH, highlighting lessons learned in the first three years. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

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Open AccessArticle Inpatient Hospitalization Costs: A Comparative Study of Micronesians, Native Hawaiians, Japanese, and Whites in Hawai‘i

by Megan Hagiwara, Deborah Taira Juarez, Seiji Yamada, Jill Miyamura and Tetine Sentell

Int. J. Environ. Res. Public Health 2016, 13(1), 29; doi:10.3390/ijerph13010029

Received: 15 August 2015 / Revised: 1 October 2015 / Accepted: 9 October 2015 / Published: 22 December 2015

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Abstract

Considerable interest exists in health care costs for the growing Micronesian population in the United States (US) due to their significant health care needs, poor average socioeconomic status, and unique immigration status, which impacts their access to public health care coverage. Using Hawai‘i

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Considerable interest exists in health care costs for the growing Micronesian population in the United States (US) due to their significant health care needs, poor average socioeconomic status, and unique immigration status, which impacts their access to public health care coverage. Using Hawai‘i statewide impatient data from 2010 to 2012 for Micronesians, whites, Japanese, and Native Hawaiians (N = 162,152 hospitalizations), we compared inpatient hospital costs across racial/ethnic groups using multivariable models including age, gender, payer, residence location, and severity of illness (SOI). We also examined total inpatient hospital costs of Micronesians generally and for Medicaid specifically. Costs were estimated using standard cost-to-charge metrics overall and within nine major disease categories determined by All Patient Refined Diagnosis Related Groups. Micronesians had higher unadjusted hospitalization costs overall and specifically within several disease categories (including infectious and heart diseases). Higher SOI in Micronesians explained some, but not all, of these higher costs. The total cost of the 3486 Micronesian hospitalizations in the three-year study period was $58.1 million and 75% was covered by Medicaid; 23% of Native Hawaiian, 3% of Japanese, and 15% of white hospitalizations costs were covered by Medicaid. These findings may be of particular interests to hospitals, Medicaid programs, and policy makers. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle The Impact of Educational Attainment on Observed Race/Ethnic Disparities in Inflammatory Risk in the 2001–2008 National Health and Nutrition Examination Survey

by Gniesha Y. Dinwiddie, Ruth E. Zambrana, Lauren A. Doamekpor and Lenny Lopez

Int. J. Environ. Res. Public Health 2016, 13(1), 42; doi:10.3390/ijerph13010042

Received: 16 August 2015 / Revised: 8 October 2015 / Accepted: 26 October 2015 / Published: 22 December 2015

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Abstract

Inflammation has shown to be an independent predictor of cardiovascular disease (CVD) and growing evidence suggests Non-Hispanic Blacks (NHBs) and certain Hispanic subgroups have higher inflammation burden compared to Non-Hispanic Whites (NHWs). Socioeconomic status (SES) is a hypothesized pathway that may account for

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Inflammation has shown to be an independent predictor of cardiovascular disease (CVD) and growing evidence suggests Non-Hispanic Blacks (NHBs) and certain Hispanic subgroups have higher inflammation burden compared to Non-Hispanic Whites (NHWs). Socioeconomic status (SES) is a hypothesized pathway that may account for the higher inflammation burden for race/ethnic groups yet little is known about the biological processes by which SES “gets under the skin” to affect health and whether income and education have similar or distinct influences on elevated inflammation levels. The current study examines SES (income and education) associations with multiple levels of C-Reactive Protein (CRP), an important biomarker of inflammation, in a sample of 13,362 NHWs, 7696 NHBs and 4545 Mexican Americans (MAs) in the United States from the 2001 to 2008 National Health and Nutrition Examination Survey. After adjusting for age, sex, and statin use, NHBs and MAs had higher intermediate and high CRP levels compared to NHWs. Income lessened the magnitude of the association for both race/ethnic groups. The greater intermediate and high CRP burden for NHBs and MAs was strongly explained by educational attainment. MAs were more vulnerable to high CRP levels for the lowest (i.e., less than nine years) and post high school (i.e., associates degree) educational levels. After additional adjustment for smoking, heavy drinking, high waist circumference, high blood pressure, diabetes and statin use, the strength of the association between race/ethnicity and inflammation was reduced for NHBs with elevated intermediate (RR = 1.31; p ≤ 0.001) and high CRP levels (RR = 1.14; p ≤ 0.001) compared to NHWs but the effect attenuated for MAs for both intermediate (RR = 0.74; p ≤ 0.001) and high CRP levels (RR = 0.38; p ≤ 0.001). These findings suggest educational attainment is a powerful predictor of elevated CRP levels in race/ethnic populations and challenges studies to move beyond examining income as a better predictor in the SES-inflammation pathway. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Profile of HIV-Infected Hispanics with Pancytopenia

by Eduardo J. Santiago-Rodríguez, Angel M. Mayor, Diana M. Fernández-Santos and Robert F. Hunter-Mellado

Int. J. Environ. Res. Public Health 2016, 13(1), 38; doi:10.3390/ijerph13010038

Received: 15 August 2015 / Revised: 27 October 2015 / Accepted: 5 November 2015 / Published: 22 December 2015

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Abstract

Pancytopenia is seen in late HIV infection; it is associated with medical complications and with decreased survival. We determined the prevalence of pancytopenia at baseline in a cohort of HIV-positive Hispanics living in Puerto Rico, and compared their socio-demographic, immunological and clinical characteristics.

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Pancytopenia is seen in late HIV infection; it is associated with medical complications and with decreased survival. We determined the prevalence of pancytopenia at baseline in a cohort of HIV-positive Hispanics living in Puerto Rico, and compared their socio-demographic, immunological and clinical characteristics. A total of 1202 patients enrolled between 2000 and 2010 were included. They were grouped according to pancytopenia status, defined by having: platelets <150,000 μL, white cell count <4000 μL, and hemoglobin <12 g/dL (women) or <13 g/dL (men). Differences were evaluated using Student’s t-test, Chi-square test and Kaplan-Meier method. The prevalence of pancytopenia was 8.7%. Patients with pancytopenia had lower BMI and lower CD4 count, as well as higher HIV viral load and higher proportions of unemployment, clinical AIDS and antiretroviral treatment (ART) use (p < 0.05). One-year mortality rate was significantly higher in patients with pancytopenia (18.1% vs. 5.1%, p < 0.001). When stratifying for ART this association persisted for patients who did not receive ART (41.4% vs. 5.2%, p < 0.001), but it was not seen in patients who received treatment (9.2% vs. 5.6%, p = 0.196). Pancytopenia was associated with elements of advanced stages of HIV. ART could reduce the mortality of HIV-patients with pancytopenia to levels comparable to patients without the disorders. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Identification of Barriers to Stroke Awareness and Risk Factor Management Unique to Hispanics

by Marina Martinez, Nitin Prabhakar, Kendra Drake, Bruce Coull, Jenny Chong, Leslie Ritter and Chelsea Kidwell

Int. J. Environ. Res. Public Health 2016, 13(1), 23; doi:10.3390/ijerph13010023

Received: 15 August 2015 / Revised: 26 September 2015 / Accepted: 29 September 2015 / Published: 22 December 2015

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Abstract

Barriers to risk factor control may differ by race/ethnicity. The goal of this study was to identify barriers to stroke awareness and risk factor management unique to Hispanics as compared to non-Hispanic whites (NHWs). We performed a prospective study of stroke patients from

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Barriers to risk factor control may differ by race/ethnicity. The goal of this study was to identify barriers to stroke awareness and risk factor management unique to Hispanics as compared to non-Hispanic whites (NHWs). We performed a prospective study of stroke patients from an academic Stroke Center in Arizona and surveyed members of the general community. Questionnaires included: the Duke Social Support Index (DSSI), the Multidimensional Health Locus of Control (MHLC) Scale, a stroke barriers questionnaire, and a Stroke Awareness Test. Of 145 stroke patients surveyed (72 Hispanic; 73 NHW), Hispanics scored lower on the Stroke Awareness Test compared to NHWs (72.5% vs. 79.1%, p = 0.029). Hispanic stroke patients also reported greater barriers related to medical knowledge, medication adherence, and healthcare access (p < 0.05 for all). Hispanics scored higher on the “powerful others” sub-scale (11.3 vs. 10, p < 0.05) of the MHLC. Of 177 members of the general public surveyed, Hispanics had lower stroke awareness compared to NHWs and tended to have lower awareness than Hispanic stroke patients. These results suggest that Hispanic stroke patients perceive less control over their health, experience more healthcare barriers, and demonstrate lower rates of stroke literacy. Interventions for stroke prevention and education in Hispanics should address these racial/ethnic differences in stroke awareness and barriers to risk factor control. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Persistent HIV Viremia: Description of a Cohort of HIV Infected Individuals with ART Failure in Puerto Rico

by Gerónimo Maldonado-Martínez, Robert F. Hunter-Mellado, Diana Fernández-Santos and Eddy Ríos-Olivares

Int. J. Environ. Res. Public Health 2016, 13(1), 50; doi:10.3390/ijerph13010050

Received: 15 August 2015 / Revised: 16 November 2015 / Accepted: 24 November 2015 / Published: 22 December 2015

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Abstract

The introduction of antiretroviral therapy (ART) has allowed human immunodeficiency virus (HIV) suppression in patients. We present data of a cohort of Puerto Rican patients with HIV who were under treatment with a steady regime of ART across a time horizon of eleven

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The introduction of antiretroviral therapy (ART) has allowed human immunodeficiency virus (HIV) suppression in patients. We present data of a cohort of Puerto Rican patients with HIV who were under treatment with a steady regime of ART across a time horizon of eleven years. The time periods were categorized into four year stratums: 2000 to 2002; 2003 to 2005; 2006 to 2008 and 2009 to 2011. Socio-demographic profile, HIV risk factors, co-morbid conditions were included as study variables. One year mortality was defined. The p value was set at ≤0.05. The cohort consisted of 882 patients with 661 subjects presenting with persistent HIV viral load after a self-reported 12 month history of ART use. In this sub-cohort a higher viral load was seen across time (p < 0.05). Illicit drug use, IV drug use, alcohol use, loss of work were associated to having higher viral load means (p < 0.05). HIV viral load mean was lower as BMI increased (p < 0.001). It is imperative to readdress antiretroviral adherence protocols and further study ART tolerance and compliance. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Micro RNA in Exosomes from HIV-Infected Macrophages

by William W. Roth, Ming Bo Huang, Kateena Addae Konadu, Michael D. Powell and Vincent C. Bond

Int. J. Environ. Res. Public Health 2016, 13(1), 32; doi:10.3390/ijerph13010032

Received: 15 August 2015 / Revised: 9 October 2015 / Accepted: 15 October 2015 / Published: 22 December 2015

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Abstract

Exosomes are small membrane-bound vesicles secreted by cells that function to shuttle RNA and proteins between cells. To examine the role of exosomal micro RNA (miRNA) during the early stage of HIV-1 infection we characterized miRNA in exosomes from HIV-infected macrophages, compared with

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Exosomes are small membrane-bound vesicles secreted by cells that function to shuttle RNA and proteins between cells. To examine the role of exosomal micro RNA (miRNA) during the early stage of HIV-1 infection we characterized miRNA in exosomes from HIV-infected macrophages, compared with exosomes from non-infected macrophages. Primary human monocytes from uninfected donors were differentiated to macrophages (MDM) which were either mock-infected or infected with the macrophage-tropic HIV-1 BaL strain. Exosomes were recovered from culture media and separated from virus particles by centrifugation on iodixanol density gradients. The low molecular weight RNA fraction was prepared from purified exosomes. After pre-amplification, RNA was hybridized to microarrays containing probes for 1200 miRNA species of known and unknown function. We observed 48 miRNA species in both infected and uninfected MDM exosomes. Additionally, 38 miRNAs were present in infected-cell exosomes but not uninfected-cell exosomes. Of these, 13 miRNAs were upregulated in exosomes from HIV-infected cells, including 4 miRNA species that were increased by more than 10-fold. Though numerous miRNA species have been identified in HIV-infected cells, relatively little is known about miRNA content in exosomes from these cells. In the future, we plan to investigate whether the upregulated miRNA species we identified are increased in exosomes from HIV-1-positive patients. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Protein Kinase CK2 Expression Predicts Relapse Survival in ERα Dependent Breast Cancer, and Modulates ERα Expression in Vitro

by Marlon D. Williams, Thu Nguyen, Patrick P. Carriere, Syreeta L. Tilghman and Christopher Williams

Int. J. Environ. Res. Public Health 2016, 13(1), 36; doi:10.3390/ijerph13010036

Received: 15 August 2015 / Revised: 9 October 2015 / Accepted: 10 October 2015 / Published: 22 December 2015

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Abstract

The heterotetrameric protein kinase CK2 has been associated with oncogenic transformation, and our previous studies have shown that it may affect estrogenic signaling. Here, we investigate the role of the protein kinase CK2 in regulating ERα (estrogen receptor α) signaling in breast cancer.

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The heterotetrameric protein kinase CK2 has been associated with oncogenic transformation, and our previous studies have shown that it may affect estrogenic signaling. Here, we investigate the role of the protein kinase CK2 in regulating ERα (estrogen receptor α) signaling in breast cancer. We determined the correlation of CK2α expression with relapse free breast cancer patient survival utilizing Kaplan Meier Plotter (kmplot.com/analysis/) to mine breast cancer microarrays repositories. Patients were stratified according to ERα status, histological grade, and hormonal therapy. Luciferase reporter assays and flow cytometry were implemented to determine the impact of CK2 inhibition on ERE-mediated gene expression and expression of ERα protein. CK2α expression is associated with shorter relapse free survival among ERα (+) patients with grade 1 or 2 tumors, as well as among those patients receiving hormonal therapy. Biochemical inhibition of CK2 activity results in increased ER-transactivation as well as increased expression among ERα (+) and ERα (−) breast cancer cell lines. These findings suggest that CK2 may contribute to estrogen-independent cell proliferation and breast tumor progression, and may potentially serve as a biomarker and pharmacological target in breast cancer. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Implementing a Graduate Certificate Program in Cardiovascular Epidemiology: The Jackson Heart Study

by Brenda W. Campbell Jenkins, Clifton Addison, Gregory Wilson, Lavon Young, Regina Fields, Clevette Woodberry and Marinelle Payton

Int. J. Environ. Res. Public Health 2016, 13(1), 26; doi:10.3390/ijerph13010026

Received: 15 August 2015 / Revised: 5 November 2015 / Accepted: 5 November 2015 / Published: 22 December 2015

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Abstract

The Jackson Heart Study (JHS) is committed to providing opportunities for expanding the understanding of the epidemiology, diagnosis, prevention, and treatment of cardiovascular diseases. The JHS Graduate Training and Education Center (GTEC) has initiated the Daniel Hale Williams Scholar (DHWS) program where students

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The Jackson Heart Study (JHS) is committed to providing opportunities for expanding the understanding of the epidemiology, diagnosis, prevention, and treatment of cardiovascular diseases. The JHS Graduate Training and Education Center (GTEC) has initiated the Daniel Hale Williams Scholar (DHWS) program where students are afforded the opportunity to interact with epidemiologists and other biomedical scientists to learn to identify, predict, and prevent cardiovascular disease using the Jackson Heart Study data. This study describes the structured programs developed by JHS GTEC seeking to alleviate the shortage of trained professionals in cardiovascular epidemiology by training graduate students while they complete their academic degrees. The DHWS program provides: (1) an enrichment curriculum; (2) a learning community; (3) quarterly seminars; and (4) a Summer Institute. Students attend enrichment activities comprising: (1) Applied Biostatistics; (2) Cardiovascular Disease Epidemiology; (3) Social Epidemiology; (4) Emerging Topics; and (5) Research Writing. Training focuses on developing proficiency in cardiovascular health knowledge. The DHWS program is a unique strategy for incorporating rigorous academic and career-focused training to graduate students and has enabled the acquisition of competencies needed to impact cardiovascular disease management programs. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessArticle Using an External Exposome Framework to Examine Pregnancy-Related Morbidities and Mortalities: Implications for Health Disparities Research

by Tonny J. Oyana, Patricia Matthews-Juarez, Stephania A. Cormier, Xiaoran Xu and Paul D. Juarez

Int. J. Environ. Res. Public Health 2016, 13(1), 13; doi:10.3390/ijerph13010013

Received: 12 August 2015 / Revised: 13 November 2015 / Accepted: 17 November 2015 / Published: 22 December 2015

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Abstract

Objective: We have conducted a study to assess the role of environment on the burden of maternal morbidities and mortalities among women using an external exposome approach for the purpose of developing targeted public health interventions to decrease disparities. Methods: We

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Objective: We have conducted a study to assess the role of environment on the burden of maternal morbidities and mortalities among women using an external exposome approach for the purpose of developing targeted public health interventions to decrease disparities. Methods: We identified counties in the 48 contiguous USA where observed low birthweight (LBW) rates were higher than expected during a five-year study period. The identification was conducted using a retrospective space-time analysis scan for statistically significant clusters with high or low rates by a Discrete Poisson Model. Results: We observed statistically significant associations of LBW rate with a set of predictive variables. However, in one of the two spatiotemporal models we discovered LBW to be associated with five predictive variables (teen birth rate, adult obesity, uninsured adults, physically unhealthy days, and percent of adults who smoke) in two counties situated in Alabama after adjusting for location changes. Counties with higher than expected LBW rates were similarly associated with two environmental variables (ozone and fine particulate matter). Conclusions: The county-level predictive measures of LBW offer new insights into spatiotemporal patterns relative to key contributory factors. An external framework provides a promising place-based approach for identifying “hotspots” with implications for designing targeted interventions and control measures to reduce and eliminate health disparities. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Review

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Open AccessReview Health Policy Training: A Review of the Literature

by Harry J. Heiman, L. Lerissa Smith, Marissa McKool, Denise N. Mitchell and Carey Roth Bayer

Int. J. Environ. Res. Public Health 2016, 13(1), 20; doi:10.3390/ijerph13010020

Received: 14 August 2015 / Revised: 20 September 2015 / Accepted: 8 October 2015 / Published: 23 December 2015

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Abstract

The context within which health care and public health systems operate is framed by health policies. There is growing consensus about the need for increased health policy leadership and a health professional workforce prepared to assume these leadership roles. At the same time,

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The context within which health care and public health systems operate is framed by health policies. There is growing consensus about the need for increased health policy leadership and a health professional workforce prepared to assume these leadership roles. At the same time, there is strong evidence supporting the need for a broader policy lens and the need to intentionally target health disparities. We reviewed the published literature between 1983 and 2013 regarding health policy training. From 5124 articles identified, 33 met inclusion criteria. Articles varied across common themes including target audience, goal(s), health policy definition, and core curricular content. The majority of articles were directed to medical or nursing audiences. Most articles framed health policy as health care policy and only a small number adopted a broader health in all policies definition. Few articles specifically addressed vulnerable populations or health disparities. The need for more rigorous research and evaluation to inform health policy training is compelling. Providing health professionals with the knowledge and skills to engage and take leadership roles in health policy will require training programs to move beyond their limited health care-oriented health policy framework to adopt a broader health and health equity in all policies approach. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessReview Cellular Mechanisms of Action of Drug Abuse on Olfactory Neurons

by Thomas Heinbockel and Ze-Jun Wang

Int. J. Environ. Res. Public Health 2016, 13(1), 5; doi:10.3390/ijerph13010005

Received: 28 July 2015 / Revised: 24 September 2015 / Accepted: 9 October 2015 / Published: 22 December 2015

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Abstract

Cannabinoids (Δ9-tetrahydrocannabinol) are the active ingredient of marijuana (cannabis) which is the most commonly abused illicit drug in the USA. In addition to being known and used as recreational drugs, cannabinoids are produced endogenously by neurons in the brain (endocannabinoids) and serve as

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Cannabinoids (Δ9-tetrahydrocannabinol) are the active ingredient of marijuana (cannabis) which is the most commonly abused illicit drug in the USA. In addition to being known and used as recreational drugs, cannabinoids are produced endogenously by neurons in the brain (endocannabinoids) and serve as important signaling molecules in the nervous system and the rest of the body. Cannabinoids have been implicated in bodily processes both in health and disease. Recent pharmacological and physiological experiments have described novel aspects of classic brain signaling mechanisms or revealed unknown mechanisms of cellular communication involving the endocannabinoid system. While several forms of signaling have been described for endocannabinoids, the most distinguishing feature of endocannabinoids is their ability to act as retrograde messengers in neural circuits. Neurons in the main olfactory bulb express high levels of cannabinoid receptors. Here, we describe the cellular mechanisms and function of this novel brain signaling system in regulating neural activity at synapses in olfactory circuits. Results from basic research have the potential to provide the groundwork for translating the neurobiology of drug abuse to the realm of the pharmacotherapeutic treatment of addiction, specifically marijuana substance use disorder. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Other

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Open AccessErratum Erratum: Dinwiddie, G.; et al. The Impact of Educational Attainment on Observed Race/Ethnic Disparities in Inflammatory Risk in the 2001–2008 National Health and Nutrition Examination Survey. Int. J. Environ. Res. Public Health 2016, 13, 42

by International Journal of Environmental Research and Public Health Editorial Office

Int. J. Environ. Res. Public Health 2016, 13(4), 367; doi:10.3390/ijerph13040367

Received: 23 March 2016 / Accepted: 24 March 2016 / Published: 29 March 2016

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Abstract Due to an error during production, the legend of Figure 1 in the published paper [1] was incorrect. [...]
Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessBrief Report Impact of ASUMA Intervention on HIV Risk Behaviors among Puerto Rican Adolescents

by Diana M. Fernandez-Santos, Christine Miranda-Diaz, Wanda I. Figueroa-Cosme, Raul O. Ramon, Angel M. Mayor, Eddy Rios-Olivares and Robert F. Hunter-Mellado

Int. J. Environ. Res. Public Health 2016, 13(1), 60; doi:10.3390/ijerph13010060

Received: 15 August 2015 / Revised: 3 December 2015 / Accepted: 18 December 2015 / Published: 23 December 2015

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Abstract

The purpose of this manuscript is to assess and compare HIV risk behaviors among early adolescents after a three-year pilot study. A total of 135 public and private junior high schools students completed the intervention protocol. A self-administered questionnaire was given at baseline

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The purpose of this manuscript is to assess and compare HIV risk behaviors among early adolescents after a three-year pilot study. A total of 135 public and private junior high schools students completed the intervention protocol. A self-administered questionnaire was given at baseline and at the end of the third year (fourth measure). Descriptive and inferential analyses were performed using SPSS 20.0. About 60% of the students were 14 years old at the fourth measure. The proportion of students that did not report at least one HIV risk behavior at baseline and those that reported any risk behavior at the fourth measure was lower in the intervention group (45.0%) than in the control group (54.5%). The proportion of students that reported at least one HIV risk behavior at baseline and those that did not report any HIV risk behavior at the fourth measure was higher in the intervention group than in the control group (33.3% vs. 8.3%). The proportion of students engaging in HIV risk behaviors was higher in the control group than in the intervention group at the fourth measure, suggesting that A Supportive Model for HIV Risk Reduction in Early Adolescence (ASUMA) intervention might be a promising initiative to reduce adolescents’ engagement in HIV risk behaviors. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessBrief Report The Genetic Diversity and Evolution of HIV-1 Subtype B Epidemic in Puerto Rico

by Pablo López, Vanessa Rivera-Amill, Nayra Rodríguez, Freddie Vargas and Yasuhiro Yamamura

Int. J. Environ. Res. Public Health 2016, 13(1), 55; doi:10.3390/ijerph13010055

Received: 14 August 2015 / Revised: 20 November 2015 / Accepted: 24 November 2015 / Published: 23 December 2015

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Abstract

HIV-1 epidemics in Caribbean countries, including Puerto Rico, have been reported to be almost exclusively associated with the subtype B virus (HIV-1B). However, while HIV infections associated with other clades have been only sporadically reported, no organized data exist to accurately assess the

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HIV-1 epidemics in Caribbean countries, including Puerto Rico, have been reported to be almost exclusively associated with the subtype B virus (HIV-1B). However, while HIV infections associated with other clades have been only sporadically reported, no organized data exist to accurately assess the prevalence of non-subtype B HIV-1 infection. We analyzed the nucleotide sequence data of the HIV pol gene associated with HIV isolates from Puerto Rican patients. The sequences (n = 945) were obtained from our “HIV Genotyping” test file, which has been generated over a period of 14 years (2001–2014). REGA subtyping tool found the following subtypes: B (90%), B-like (3%), B/D recombinant (6%), and D/B recombinant (0.6%). Though there were fewer cases, the following subtypes were also found (in the given proportions): A1B (0.3%), BF1 (0.2%), subtype A (01-AE) (0.1%), subtype A (A2) (0.1%), subtype F (12BF) (0.1%), CRF-39 BF-like (0.1%), and others (0.1%). Some of the recombinants were identified as early as 2001. Although the HIV epidemic in Puerto Rico is primarily associated with HIV-1B virus, our analysis uncovered the presence of other subtypes. There was no indication of subtype C, which has been predominantly associated with heterosexual transmission in other parts of the world. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessConference Report The Oglala Sioux Tribe CHOICES Program: Modifying an Existing Alcohol-Exposed Pregnancy Intervention for Use in an American Indian Community

by Jessica D. Hanson and Susan Pourier

Int. J. Environ. Res. Public Health 2016, 13(1), 1; doi:10.3390/ijerph13010001

Received: 30 June 2015 / Revised: 16 July 2015 / Accepted: 23 July 2015 / Published: 22 December 2015

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Abstract

Alcohol-exposed pregnancies are a health issue for many American Indian communities. The goal of this manuscript is to outline how an existing alcohol-exposed pregnancy prevention program with non-pregnant women (Project CHOICES) was modified to fit the needs and norms of an American Indian

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Alcohol-exposed pregnancies are a health issue for many American Indian communities. The goal of this manuscript is to outline how an existing alcohol-exposed pregnancy prevention program with non-pregnant women (Project CHOICES) was modified to fit the needs and norms of an American Indian community. The Oglala Sioux Tribe CHOICES Program was developed and implemented using community feedback through initial meetings, reviewing materials, gathering input into recruitment and intervention logistics, and conducting interviews to evaluate the program. The intervention was implemented and has been enrolling non-pregnant American Indian women for the past several years. While data collection is ongoing, it has shown preliminary success in changing behaviors and in impacting how the community views the prevention of alcohol-exposed pregnancies. Overall, this study highlights the potential to expand this prevention program to other sites and with other populations, such as adolescents. By the end of this article, readers will comprehend the steps necessary to replicate such a program at other tribal and rural sites. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessProject Report Bringing Community and Academic Scholars Together to Facilitate and Conduct Authentic Community Based Participatory Research: Project UNITED

by Dwight Lewis, Lea Yerby, Melanie Tucker, Pamela Payne Foster, Kara C. Hamilton, Matthew M. Fifolt, Lisle Hites, Mary Katherine Shreves, Susan B. Page, Kimberly L. Bissell, Felecia L. Lucky and John C. Higginbotham

Int. J. Environ. Res. Public Health 2016, 13(1), 35; doi:10.3390/ijerph13010035

Received: 15 August 2015 / Revised: 14 September 2015 / Accepted: 14 September 2015 / Published: 22 December 2015

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Abstract

Cultural competency, trust, and research literacy can affect the planning and implementation of sustainable community-based participatory research (CBPR). The purpose of this manuscript is to highlight: (1) the development of a CBPR pilot grant request for application; and (2) a comprehensive program supporting

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Cultural competency, trust, and research literacy can affect the planning and implementation of sustainable community-based participatory research (CBPR). The purpose of this manuscript is to highlight: (1) the development of a CBPR pilot grant request for application; and (2) a comprehensive program supporting CBPR obesity-related grant proposals facilitated by activities designed to promote scholarly collaborations between academic researchers and the community. After a competitive application process, academic researchers and non-academic community leaders were selected to participate in activities where the final culminating project was the submission of a collaborative obesity-related CBPR grant application. Teams were comprised of a mix of academic researchers and non-academic community leaders, and each team submitted an application addressing obesity-disparities among rural predominantly African American communities in the US Deep South. Among four collaborative teams, three (75%) successfully submitted a grant application to fund an intervention addressing rural and minority obesity disparities. Among the three submitted grant applications, one was successfully funded by an internal CBPR grant, and another was funded by an institutional seed funding grant. Preliminary findings suggest that the collaborative activities were successful in developing productive scholarly relationships between researchers and community leaders. Future research will seek to understand the full-context of our findings. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Open AccessConference Report SalHUD—A Graphical Interface to Public Health Data in Puerto Rico

by Humberto G. Ortiz-Zuazaga, Roberto Arce-Corretjer, Juan M. Solá-Sloan and José G. Conde

Int. J. Environ. Res. Public Health 2016, 13(1), 18; doi:10.3390/ijerph13010018

Received: 14 August 2015 / Revised: 21 September 2015 / Accepted: 10 October 2015 / Published: 22 December 2015

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Abstract

Purpose: This paper describes SalHUD, a prototype web-based application for visualizing health data from Puerto Rico. Our initial focus was to provide interactive maps displaying years of potential life lost (YPLL). Methods: The public-use mortality file for year 2008 was downloaded from the

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Purpose: This paper describes SalHUD, a prototype web-based application for visualizing health data from Puerto Rico. Our initial focus was to provide interactive maps displaying years of potential life lost (YPLL). Methods: The public-use mortality file for year 2008 was downloaded from the Puerto Rico Institute of Statistics website. Data was processed with R, Python and EpiInfo to calculate years of potential life lost for the leading causes of death on each of the 78 municipalities in the island. Death records were classified according to ICD-10 codes. YPLL for each municipality was integrated into AtlasPR, a D3 Javascript map library. Additional Javascript, HTML and CSS programing was required to display maps as a web-based interface. Results: YPLL for all municipalities are displayed on a map of Puerto Rico for each of the ten leading causes of death and for all causes combined, so users may dynamically explore the impact of premature mortality. Discussion: This work is the first step in providing the general public in Puerto Rico with user-friendly, interactive, visual access to public health data that is usually published in numerical, text-based media. Full article

(This article belongs to the Special Issue Proceedings from the 2014 Minority Health & Health Disparities Grantees’ Conference (MHHDGC))

Guest Editor Dr. Mark Edberg Department of Anthropology, Columbian College of Arts & Science, 2110 G St. NW, Washington, DC 20052, USA Website \| E-Mail
Guest Editor Dr. Barbara E. Hayes College of Pharmacy and Health Sciences, Texas Southern University, Gray Hall, 3100 Cleburne Street, Houston, TX 77004, USA E-Mail
Guest Editor Dr. Valerie Montgomery Rice Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, USA Website \| E-Mail
Guest Editor Prof. Dr. Paul B. Tchounwou Molecular Toxicology Research Laboratory, Jackson State University, 1400 Lynch Street, Box 18750, Jackson, MI 39217, USA Website \| E-Mail Fax: +1 601 979 2349

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