Discerning Disparities: The Data Gap.

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

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

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

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

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

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

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

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

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

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

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

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

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

The importance of location for tobacco cessation: rural-urban disparities in quit success in underserved West Virginia Counties.

CONTEXT: Adults who live in rural areas of the United States have among the highest smoking rates in the country. Rural populations, including Appalachian adults, have been historically underserved by tobacco control programs and policies and little is known about their effectiveness. PURPOSE: To examine the end-of-class quit success of participants in A Tobacco Cessation Project for Disadvantaged West Virginia Communities by place of residence (rural West Virginia and the urban area of Greater Charleston). METHODS: This collaborative program was implemented in 5 underserved rural counties in West Virginia and consisted of 4 intervention approaches: (1) a medical examination; (2) an 8-session educational and behavioral modification program; (3) an 8-week supply of pharmacotherapy; and (4) follow-up support group meetings. FINDINGS: Of the 725 program participants, 385 (53.1%) had successfully quit using tobacco at the last group cessation class they attended. Participants who lived in rural West Virginia counties had a lower end-of-class quit success rate than those who lived in the urban area of Greater Charleston (unadjusted odds ratio [OR]= 0.69, 95% confidence interval [CI]= 0.48, 0.99), even after taking into account other characteristics known to influence quit success (adjusted OR = 0.58, 95% CI = 0.35, 0.94). CONCLUSIONS: Tobacco control programs in rural West Virginia would do well to build upon the positive aspects of rural life while addressing the infrastructure and economic needs of the region. End-of-class quit success may usefully be viewed as a stage on the continuum of change toward long-term quit success.

Oral health is the measure of a just society.

Former Surgeon General David Satcher's report, Oral Health in America, documents the higher burden of oral diseases and conditions borne by those with relatively low social standing at each stage of life. When an entire community suffers from a health concern, that concern becomes a social justice issue. Racial and ethnic minorities, prisoners, and seniors suffer disproportionately from oral diseases and conditions due to societal prejudices that place them at risk over and above any risk associated with their economic means. Community-based delivery models that involve the community in planning and implementation, build upon the existing health safety net to link oral health services with primary care, and change public or institutional policy to support the financing and delivery of oral health care have proven successful. Here we champion the need for a national health plan that includes oral health care to promote social justice and oral health for all.

Confronting racism and sexism to improve men's health.

Two fundamental determinants of men's health are confronted-racism and sexism-that the authors believe underlie many of the health disparities documented between women and men and place men of color at particular disadvantage in U.S. society. In doing so, the authors contend that race and gender, as well as racism and sexism, are social constructs and, therefore, amenable to change. They hope to allay concerns that gains in the health of men will come at the expense of continued advances in the health of women. Instead, by better understanding how the harsh intersections of racism and sexism have contorted roles for men of color and damaged their social ties, a healing process in intimate relationships, extended families, and entire communities may be fostered. Only by reforming historical injustices and reuniting men with their partners, families, and communities will sustained improvements in their health and well-being be realized.

Perspectives from the front lines of tobacco control.

This research is designed to share valuable experiences and transferable principles from program staff of the Legacy/Community Voices initiative who have been involved in planning, implementing, evaluating, and sustaining tobacco control activities in underserved communities. Interviews were conducted with 13 front line staff from 9 sites: Alameda County, California; Detroit, Michigan; El Paso, Texas; Ingham County, Michigan; Miami, Florida; New Mexico; North Carolina; Northern Manhattan; and West Virginia. A model emerged from these interviews that places the life cycle of a program in a central position, with many of the identified themes (working with local champions, obtaining support from multiple partners, increasing organizational capacity) repeated throughout, albeit in different forms at different stages. Reflecting upon wisdom gained and identifying best processes for such work may help ensure that tobacco control programs are developed that are culturally safe and effective in meeting the needs of diverse communities throughout the United States.