African American adolescent males' views on doctors and the health care system.

OBJECTIVE: African American adolescent males have disproportionately high rates of morbidity and mortality and low levels of primary care use. To optimize health care for this group, there is a need to understand their views on doctors and health care, reasons for foregone care, and preferences regarding provision of health care. METHODS: This was a pilot survey of African American adolescent males attending community groups in Chicago. RESULTS: A majority of respondents agreed with declarative statements about doctors being considerate, truthful, and respectful (63%, 80%, and 80%, respectively). A majority also indicated that the health care system informs them of ways to stay healthy (65%), but fewer agreed that it meets the needs of adolescents and minorities (44% and 33%, respectively). Race/gender concordance with physicians did not seem to be a high priority. Significant reasons for foregone care included conflict with school hours, parents not having time, and lack of transportation. Despite access issues, only a minority of participants wanted health care services co-located with other aspects of their daily lives (school, community centers, church, and barbershops). CONCLUSION: African American adolescent males may view doctors and the health care system positively. Eliminating barriers to care and ensuring positive interactions may create opportunities to improve health issues afflicting these at-risk adolescents.

Cultural leverage: interventions using culture to narrow racial disparities in health care.

The authors reviewed interventions using cultural leverage to narrow racial disparities in health care. Thirty-eight interventions of three types were identified: interventions that modified the health behaviors of individual patients of color, that increased the access of communities of color to the existing health care system, and that modified the health care system to better serve patients of color and their communities. Individual-level interventions typically tapped community members' expertise to shape programs. Access interventions largely involved screening programs, incorporating patient navigators and lay educators. Health care interventions focused on the roles of nurses, counselors, and community health workers to deliver culturally tailored health information. These interventions increased patients' knowledge for self-care, decreased barriers to access, and improved providers' cultural competence. The delivery of processes of care or intermediate health outcomes was significantly improved in 23 interventions. Interventions using cultural leverage show tremendous promise in reducing health disparities, but more research is needed to understand their health effects in combination with other interventions.

Sexual health after spinal cord injury: a longitudinal study.

OBJECTIVES: To clarify sexuality issues after spinal cord injury (SCI) and to identify the appropriate timing of sexual health interventions. DESIGN: Longitudinal analysis of the survey responses of persons with SCI at 4 intervals between initial inpatient rehabilitation and 18 months postdischarge. SETTING: Spinal Cord Injury Model Systems inpatient center and home-based setting. PATIENTS: A volunteer sample of 40 individuals (32 men, 8 women) from a consecutive population of persons with recent SCI admitted for initial inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Responses to the Sexual Health Needs Survey. RESULTS: By 6 months postdischarge, individuals in the study group had made the significant changes in sexual activity and sexual interest that they would achieve during the study period. The respondents' greatest concerns remained their partners' and their own sexual satisfaction. A more realistic recognition of decline in their sexual activity, function, and interest corresponded with more requests for sexual health interventions during the interval from inpatient rehabilitation and 6 months postdischarge. CONCLUSIONS: The interval between inpatient rehabilitation to 6 months postdischarge appeared to be the critical period for function and realization about sexuality. Readily accessible sexual health interventions at about 6 months after inpatient rehabilitation and the inclusion of sexual partners in the intervention process appear warranted.