Assessing Health Issues in States with Large Minority Populations.

Health care spending is often addressed in discussions of budgeting and deficits in the United States. It is important to many Americans that funds allocated for health care spending be allocated and spent in the most efficient and effective manner, leading to improved health outcomes, particularly for underserved populations. Many studies address health care spending, but few address the issue of spending as it relates to societal well-being, or certain health outcomes that adversely impact communities. This study seeks to expand the available literature by analyzing data from national sources at the state level.

Moving toward cultural competency: DREAMWork online summer program.

This article describes the origination and implementation of an online, interactive summer component of the Diversity Recruitment and Education to Advance Minorities in the Nursing Workforce Program (DREAMWork) at University of Tennessee at Chattanooga (UTC). The summer course was designed as a strategy to help prepare baccalaureate nursing students to provide both culturally sensitive and competent care through online learning. Sixteen baccalaureate nursing students participated in the four week online summer program. Course objectives were framed using Campinha-Bacote's (2002) model of cultural competence (Figure 1). Analysis revealed at the end of the four week summer program, students were more comfortable discussing their own prejudices and biases and were left with a deeper appreciation of what it meant to provide culturally sensitive care. The results of this summer program suggest the need to expand the online course to allow DREAMWork pre-nursing students to address the issue of becoming culturally competent prior to admission into upper division nursing clinical courses. This project was supported by funds from the Division of Nursing (DN), Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under grant # D19HP08214.

Complementary and alternative medicine (CAM) use among men with a history of prostate cancer.

Complementary and alternative medicine (CAM) has been commonly used among Americans; however, less is known about its use among men with a history of prostate cancer. This study used the 2002 National Health Interview Survey (NHIS) to explore the amount and type of CAM use among 218 Black and White men with a history of prostate cancer. Over 90% of men reported having ever used any form of CAM and most men used biologically-based and mind-body therapies. Nurses are in a unique position to discuss, to assess needs and practices, and perhaps, to act as intermediaries for physicians and other healthcare professionals and prostate cancer survivors who use CAM.

Assessing knowledge of Sudden Infant Death Syndrome among African American women in two Mississippi communities.

PURPOSE: Sudden Infant Death Syndrome (SIDS) is the third leading cause of Mississippi infant mortality with nonwhite infants dying of SIDS at two to three times the rate of white infants. The purpose of this study was to assess the level of SIDS related knowledge among African American women in two geographical areas of Mississippi and gain insight on improving methods for SIDS education and outreach. DESIGN: An African American faculty was contracted to conduct six focus groups among African American women (n = 57) in two geographical areas of the state. FINDINGS: Themes were common among participants from both the metropolitan and rural Delta communities. Participants in both geographical areas were familiar with [or at least had previously heard] the term SIDS. Unfortunately, there was inconsistency among participants as to the source of information. Given the inconsistencies, it is not surprising that overall knowledge related to SIDS was incomplete and in some cases inaccurate. DISCUSSION/CONCLUSION: Some information regarding SIDS is available in the various communities. Unfortunately, the information is not fully understood and is not consistently distributed resulting in a lack of knowledge among these women and thus, a continued risk for high rates of SIDS events in Mississippi.

Race, stability of health insurance coverage, and prescription medication use.

OBJECTIVE: To determine the effects of health insurance and race on prescription medication use and expense. METHODS: An observational, non-experimental design was used. Multivariable regression analyses were conducted to evaluate the independent effects of health insurance status and race on prescription medication use and expense while controlling for sociodemographic, geographic, and health status characteristics. The sample consisted of 19,035 participants in the 1996 through 2003 Medical Expenditure Panel Survey. FINDINGS: European Americans spent about $300 to $400 more and used three to four more prescriptions annually compared to other racial groups. Prescription medication expenses increased as time spent uninsured increased. Participants with part-year coverage filled four fewer prescriptions than those with full-year health insurance coverage. Participants with private coverage spent less on prescription medications compared to those with public and those with dual public and private coverage ($1,194 vs. $1,931 and $2,076, respectively; p < or = 0.001). CONCLUSIONS: Significant racial and health insurance status disparities in prescription medication use and expenses exist after controlling for sociodemographic, geographic, and health status characteristics.

Stemming the tide of childhood obesity in an underserved urban African American population: a pilot study.

Recent data indicate that Americans are gaining weight at an alarming rate. It is estimated that over 12 million American children ages 2-19 years are overweight, with African American (AA) children comprising 20% of this cohort. The problem of obesity appears to be more prominent in some southern states. According to a new report by the Trust for America's Health, Mississippi has the 1st highest rate of adult obesity and the 8th highest rate of overweight youth ages 10-17 nationwide. The Kids for Healthy Eating and Exercising (KHEE) club was a model developed in the North Midtown area of Jackson, Mississippi. The purpose of this project was to develop the first weight control program and model specifically designed for AA children in the North Midtown area of the city of Jackson. This program devised measures to effectively enhance the lifestyle changes of selected obese children representing the target population. Results of the pilot project revealed the following changes among all participants: a decrease in body mass index (BMI); a decrease in waist girth of greater than 4 inches; and positive behavioral changes as documented in the daily entries of the participants' food journal.

Obesity in America.

Recent data indicate that Americans are gaining weight at an alarming rate. In fact, data from the CDC indicate that the U.S. obesity average was 12% in 1990 and had grown to 23% by 2005. In recent years, this problem appears to be more prominent in some southern states than in other states. The purpose of this study was to determine what factors were associated with increased levels of obesity. Do demographic, educational, healthcare, or economic factors correlate with this trend? Using state level data in a fixed effects regression model we examined obesity rates for the period 1990-2003. We also used cross tabulation tables to compare obesity rates to several independent variables. Our analysis revealed that obesity was related to several health, demographic, and economic factors. As a result, we argue that policy makers as well as health officials should take a comprehensive look at obesity as well as other social ills, health care conditions, and related issues prior to creating a plan to improve health in this country.

Disparities in health care: minority elders at risk.

Minority elders are at great risk for missed diagnoses, greater disabilities, and higher death rates unless health care providers acknowledge that disparities in healthcare do exist and adjust their way of providing care. In the next 30 years, the current elderly population of 35 million is predicted to increase to 72 million. Minority elders are expected to account for 50% of this population. Research has shown that minority elders have a higher incidence of certain diseases but do not receive the same care as their white counterparts (Baldwin, 2003). Differences in the incidence, prevalence, mortality, and burden of disease among minority elders indicate that disparities in healthcare are consistently found in a variety of settings (Jett, 2006). Poor communication and distrust in the health care system have been found to be major factors affecting the quality of healthcare for these individuals. This article discusses healthcare disparities experienced by minority elders and suggests ways to curtail this problem. Culturally sensitive care is suggested to save lives and improve quality of life for these vulnerable individuals. Understanding the cultural practices of minority elders and negotiating a plan of care that respects their beliefs will increase patient compliance, improve care, improve outcomes, and decrease healthcare disparities among minority elders.

Factors influencing HIV-risk behaviors among HIV-positive urban African Americans.

Urban African Americans are disproportionately affected by HIV, the virus associated with AIDS. Although incidence and mortality appear to be decreasing in some populations, they continue to remain steady among inner-city African Americans. A major concern is the number of HIV-positive individuals who continue to practice high-risk behaviors. Understanding factors that increase risks is essential for the development and implementation of effective prevention initiatives. Following a constructionist epistemology, this study used ethnography to explore social and cultural factors that influence high-risk behaviors among inner-city HIV-positive African Americans. Leininger's culture care diversity and universality theory guided the study. Individual qualitative interviews were conducted with HIV-positive African Americans in the community to explore social and cultural factors that increase HIV-risky behaviors. For this study, family/kinship, economic, and education factors played a significant role in risky behaviors. Reducing HIV disparity among African Americans is dependent on designing appropriate interventions that enhance protective factors. Clinicians providing care to HIV-positive individuals can play a key role in reducing transmission by recognizing and incorporating these factors when designing effective prevention interventions.

The State Children's Health Insurance Program: has it reduced the percentage of uninsured children?

Recent data indicate that the percentage of children in the United States who are uninsured is declining. Although many factors have contributed to that decline, this study assesses the role of public health insurance, specifically the State Children's Health Insurance Program (SCHIP), in reducing the percentage of uninsured children without health insurance from 1998-2000 and whether Medicaid and SCHIP crowd out exists. While this research confirms a significant decline in the percentage of uninsured children since SCHIP began enrolling children in 1998, other factors, including the poverty rate, the percentage of children on Medicaid, geographic region and race had a greater impact in explaining that result than SCHIP. Lastly, the data findings are consistent with research suggesting crowd out does exist.

Cytopathological changes associated with continuous and intermittent exposure to glucocorticoids using raw cell line as a model.

In a world of pathogens, the ability to detect an incipient infection and to respond rapidly and appropriately to it, is a decisive part of our survival strategy. The innate immune system provides the first response to an infection by initiating an inflammatory response. The monocyte surface of the molecule CD14 is a key element in this response system. Over activation of the inflammatory response can lead to systemic inflammation and septic shock. Glucocorticoids are anti-inflammatory and immunosuppressive agents that act on many cells of the body, including monocytes/macrophages. The specific aim of this investigation was to compare the role of conventional versus sustained delivery of Cortisol on the viability and morphology of RAW 264.7 macrophages. RAW cells were obtained from American Type Culture Collection. Standard laboratory protocols were followed in cell plating (10(4) cells/well), phase terminating, and morphological evaluation. The experimental design consisted of two phases. Each phase had non-treated control groups and experimental groups. The results of this investigation yielded that: (i) TCP drug delivery system was capable of providing sustained and continuous release of Cortisol as evidenced by survival of cells in all experimental wells, and (ii) regardless of the Cortisol concentration, RAW cells were viable throughout the experimental periods. Overall, the results of this study provide a comparative analysis of the modes of actions of steriods; and, the results document the effects of the susceptibility of infection based on route.

Recruitment, retention and matriculation of ethnic minority nursing students: a University of Mississippi School of Nursing approach.

According to Bednash (2000), the future of health care pivots on an adequate supply of appropriately educated and skilled professional registered nurses. Recognizing the long history of and the struggles by African-American (AA) nurses for education and equality in the nursing profession, it is essential that more African-American students be recruited, retained, and matriculated into the profession of nursing. African-American nurses have always contributed to the care of the poor and the sick and played a decisive role in the improvement of the health of their communities. The Bureau of Health Professions Division of nursing (March 2000) reported that 86.6 percent of the registered nurse population were white while 12.3 percent represented racial and ethnic minority groups. Given the current racial/ethnic background of the registered nurse population in the United States, there is an obvious disparity in the representation of minorities in the nursing profession, in spite of the increasing number of minorities represented in the general population. Thus, the purpose of this paper is to document strategies that are used to actively recruit, retain, and graduate ethnic minority students from the University of Mississippi Medical Center (UMMC) School of Nursing (SON).