Kaiser Health Disparities Report: A Weekly Look at Race, Ethnicity and Health
Monday, June 30, 2008 thru Friday, July 04, 2008
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Politics & Policy
Science & Medicine
Coverage, Access and Quality
Health in the Community
Initiatives
Opinion
Recent Releases
Politics & Policy
Congressional Black Caucus Urges Lawmakers To Include Menthol Restriction in Tobacco Legislation
[Jul 01, 2008]
The Congressional Black Caucus is calling on lawmakers to add restrictions on menthol cigarettes to legislation (HR 1108, S 625) that would give FDA the authority to regulate tobacco and outlaw most flavor additives, the New York Times reports (Saul, New York Times, 7/1). Menthol flavoring was left out of the bill as a concession to the tobacco industry, without which the bill would not have a chance of passing. Three out of four black smokers use menthol-flavored cigarettes. Like other additives, menthol, which is derived from mint and is available in synthetic form, can help mask the harsh taste of tobacco. The additive is the most widely used flavoring in cigarettes (Kaiser Health Disparities Report, 6/18).
Virgin Islands Rep. Donna Christensen (D), head of the black caucus' health task force, said the caucus is working with Rep. Henry Waxman (D-Calif.), the sponsor of the House bill, to address concerns about menthol. In an e-mail, she wrote, "We are very aware and gravely concerned about the disproportionate incidence of lung cancer in the African-American community and, along with so many minority health experts, have long been concerned about the role menthol may play."
Christensen did not disclose the exact language of any proposed changes to the legislation, but she said the caucus is working to strengthen provisions on research and reporting about menthol and to allow FDA to ban menthol. Lorillard, the cigarette company that would stand to lose the most from a menthol ban, on June 22 sent e-mails to customers encouraging them to contact their congressional representatives "and tell them to oppose any amendment to ban menthol cigarettes." Michael Robinson, a spokesperson for Lorillard, said, "We think it's important that consumers know what's going on in Washington and have an opportunity to make their voices heard" (New York Times, 7/1).
DHS Inspector General Issues Recommendation on Reporting Procedures of Immigrant Detainee Deaths
[Jul 03, 2008]
The Immigration and Customs Enforcement bureau should promptly report all deaths of immigrants held at federal detention centers in the U.S. to the Department of Homeland Security, as well as to state authorities where required by law, according to recommendations in a report released Tuesday by the DHS Office of Inspector General, the New York Times reports. The 55-page report follows a "special review" of the deaths of two immigrant detainees. Although both detainees died of pre-existing medical conditions, the review found that the cases highlighted larger problems with oversight and medical care at immigration detention centers, including the failure to recognize or address serious health care deficiencies at the centers.
The review, conducted by the Office of the Federal Detention Trustee at the Department of Justice, involved the deaths of a 60-year-old South Korean woman with cancer in September 2006 at the Regional Correctional Center in Albuquerque, N.M., and a 30-year-old Ecuadorean woman with a severe brain infection caused by a parasite in April 2006 at the Ramsey County jail in St. Paul, Minn. According to the review, both women received inadequate medical treatment. In addition, a government investigation of the center in Albuquerque found detainees waited for up to one month for medical attention due to a nurse shortage.
The review also found that 11 of the 20 immigrant detainees with chronic health conditions were scheduled for regular visits at chronic care clinics and that centers were not adhering to requirements that they notify DOJ and DHS about detainee deaths.
The inspector general's report called on ICE and the detention trustee to pool information about the detention centers and recommended improved medical screening and education about the parasite. Kelly Nantel, a spokesperson for ICE, said that "as a result of the report," the agency has developed guidelines for all deaths to be reported to the appropriate state and federal authorities (Bernstein, New York Times, 7/3).
Science & Medicine
Study Looks at Risks Associated With Oral Contraceptives for Black Women
[Jul 02, 2008]
Black women taking low-dose oral contraceptives have a risk of side effects that can lead to heart disease and diabetes, according to a study published in the Journal of Clinical Endocrinology, Reuters Health reports.
For the study, NIH researcher Anne Summer and colleagues examined 104 healthy black women who did not have diabetes. Twenty-one of the women were taking oral contraceptives and 83 were not.
Researchers found that compared with the other participants, the women taking oral contraceptives had higher glucose levels after fasting for two hours and higher fasting triglyceride levels. They also were more insulin-resistant. In an analysis based on weight, researchers found that women taking oral contraceptives who were not considered obese were more insulin resistant and were more likely to be glucose intolerant.
According to the study, "Compared with white women, African-American women are more insulin resistant, have a higher prevalence of glucose intolerance and paradoxically lower triglyceride levels. Therefore, the metabolic effects of oral contraceptive pill observed in white women cannot be extrapolated to African-American women."
Researchers concluded, "Assessing the risks and benefits of oral contraceptive pill use is complex and requires careful consideration" in black women (Reuters Health, 6/30).
 An abstract of the study is available online.
Men, Blacks in Particular, Less Likely Than Women to Be Aware That They Have High Blood Pressure, Study Finds
[Jul 03, 2008]
Men are one-quarter less likely than women to know that they have high blood pressure and black men with high blood pressure, are particularly unlikely to know of their condition, according to study published in the Archives of Internal Medicine, Reuters Health reports. For the study, lead researcher Ronald Victor of the University of Texas' Southwestern Medical Center examined 1,514 black and white adults between the ages of 18 and 64 who participated in a heart health study that diagnosed them with high blood pressure.
One-third of the group said they had never been diagnosed with high blood pressure, with men being more likely than women to say they had not been diagnosed. The men also were less likely than women to have visited a doctor, and black men were more likely than both women and white men to say they have not seen a doctor because they believed they did not need to. Researchers said the findings are consistent with previous studies indicating that men, in particular "marginalized minority men," often avoid visiting a doctor.
In addition, the study found that those who had a regular physician were nearly four times more likely than those who did not to know they had high blood pressure and more than eight times more likely to be taking medication for it.
Victor said, "There is no such thing as a 'well-man exam,' and maybe that's the issue. In our society, women learn to become health conscious in terms of preventive health care, and men don't have that kind of emphasis from a young age." He added, "The explanation of the disparity, while not clear, isn't closely associated with perceived discrimination at the doctor's office, which is a good thing" (Reuters Health, 7/2).
An abstract of the study is available online.
Coverage, Access and Quality
Charleston Post and Courier Examines South Carolina Law's Effect on Immigrant Health Care
[Jul 01, 2008]
The Charleston Post and Courier on Sunday looked at how South Carolina's Illegal Immigration Reform Act has affected immigrants' health care. The law, which took effect in June, prohibits undocumented adult immigrants from receiving nonemergency medical care that is funded by the state. Prenatal care, immunizations and treatment for communicable diseases are excluded from the measure. In addition, clinics that are funded by membership dues, private donations and federal grants are not affected by the law.
The law requires that any adult seeking care at a state-funded health clinic or hospital provide an affidavit that states the individual is in the U.S. legally; however, the law does not require actual proof of citizenship. The affidavit would later be verified through the Department of Homeland Security's Systematic Alien Verification Entitlement program.
According to the Post and Courier, enforcing the law is complicated because federal law requires that all individuals receive emergency care, regardless of immigration status. Delaying care to screen an individual's legal status would be unlawful under federal rules. Further, "it might be impossible" to ensure that no state funds go toward providing care to undocumented immigrants, the Post and Courier reports. There is no agency responsible for enforcing the prohibition against the use of state funds, according to the Post and Courier.
Ultimately, "[W]hether the law has teeth or not might be irrelevant" because fear of being asked to identify themselves might "reduce the number of [undocumented] immigrants seeking health care," the Post and Courier reports. In addition, the law might result in additional spending on health care if undocumented immigrants delay seeking care until their conditions become very serious, according to the Post and Courier (Coley, Charleston Post and Courier, 6/29).
USA Today Looks at Counties' Response to Increase in Hispanic Population
[Jul 01, 2008]
A USA Today series on Monday examined a nationwide increase in the Hispanic population and how various parts of the country are responding to the population boom.
According to a study published in the June issue of Population and Development Review, the Hispanic population increased by 10.2 million between 2000 and 2007, and 58.6%, or 6.8 million, of the increase was because of births (Nasser [1], USA Today, 6/30).
Saline County, Kan., is offering more public services to account for an increase in its Hispanic population. According to USA Today, Hispanics made up 6% of the county's population in 2000 and almost 8% by 2006.
Yvonne Gibbons, director of Salina-Saline County Health Department, said, "We have noticed an increase in the WIC (Women, Infants and Children) immunization," adding, "There are younger babies. A lot of them are born here in the United States." In addition, some small clinics in the county have been "scrambling to hire bilingual staffs," according to USA Today (Nasser [2], USA Today, 6/30).
Bureau and Putnam counties in Illinois also are offering more public health services to Hispanics, USA Today reports. The dental clinic run by the counties' health department three years ago hired a Spanish-speaking dentist, after which the patient load increased from 3,000 to 8,000. Diana Rawlings, public health administrator for the counties, said, "The Hispanic community is getting more and more comfortable coming here, and that's the goal of public health."
In Grady County, Ga., the number of Hispanics has doubled in the last few years. Rusty Moye, the county's administrator, said, "It's put a strain on our emergency services," adding that many Hispanics are "using our emergency rooms as their health clinics because when they get sick, they have no doctor" (Nasser [3], USA Today, 6/30).
Los Angeles Daily News Examines Connection Between High Number of Minority Children in Foster Care System, Drug Tests Given to Minority Mothers in Hospitals
[Jun 30, 2008]
Some health care officials maintain that the high population of minority children in the foster care system can be attributed in part to hospitals and welfare agencies disproportionately administering drug tests to low-income, pregnant minority women who seek public health care, the Los Angeles Daily News reports. Nationwide, 58% of the 513,000 children in foster care are minorities, although they comprise only 42% of the U.S. child population, according to the Daily News.
A Journal of Women's Health study found black women and their newborns were 1.5 times more likely than other races and ethnicities to be tested for the presence of illicit drugs. The decision on which patients should be screened for illicit drug use, is up to individual hospital staff, the Daily News reports. In addition, poor and minority mothers who test positive for drug use are often unaware or unable to afford additional tests to confirm the first finding.
Dorothy Roberts, a professor at the Northwestern University School of Law and author of a book on welfare, said, "There is very strong evidence that hospital staff are more likely to suspect drug use on the part of black mothers and these mothers are more likely to have their children removed and put in foster care."
Barry Lester, a professor of pediatrics and psychiatry at Brown University who lobbied to develop a national policy on the issue, said, "Hospitals have different rules on how they decide who to drug test," adding, "Sometimes the rules are medically based. ... But a lot of times the decision is based on clinical suspicion" and as a result, "There is a tremendous imbalance of poor people and minorities who end up getting tested" (Anderson, Los Angeles Daily News, 6/29).
Health in the Community
California Summit Focuses on Diabetes, Obesity in Minority Communities
[Jul 01, 2008]
The California Legislative Black Caucus Foundation and Assembly member Sandre Swanson (D) on Friday sponsored a health care summit that focused on ways to address diabetes and obesity, particularly in minority communities, the Contra Costa Times reports.
At the summit held in Oakland, Calif., Alameda County Health Director Anthony Iton said other issues, such as poverty and root causes of the diseases, need to be addressed. He noted that blacks and Hispanics, who are disproportionately affected by diabetes and obesity, often have few opportunities or power in their communities, which can cause them to lose hope and not take care of their health. "We have to invest in people," he said, adding, "There are all of these populations that have essentially been oppressed."
Gary Puckrein, president and CEO of the National Minority Quality Forum, said health care officials need to increase more resources to communities in the most need. Puckrein discussed a Web-based program that maps diabetes prevalence by neighborhood and ZIP code. The program was developed with funding from Amylin Pharmaceuticals and Eli Lilly.
Using the mapping system and CDC data, Puckrein said his organization has found that available resources are not going to the communities that need them the most. "We can begin to move resources where the problem is," he said. Puckrein added that he hopes to make the program available to advocacy groups and lawmakers to help make policy decisions (Kleffman, Contra Costa Times, 6/27).
Initiatives
Program Seeks To Promote End-of-Life Care Among Blacks
[Jul 02, 2008]
The Dallas Morning News recently examined a two-day program that aims to address the "discrimination, cultural and economic barriers, and lingering distrust of the health care system" that contributes to blacks' minimal use of end-of-life care. According to 2006 data from the National Hospice and Palliative Care Organization, less than 9% of hospice patients are black. Blacks make up nearly 14% of the U.S. population, the Morning News reports. Blacks are more likely than whites to seek aggressive life-saving treatments for terminally ill family members, and less likely to feel comfortable making the decision to end such treatment or to have living wills or documents designating a family member to make medical decisions for them when they are unable to make them on their own, according to the Morning News.
Dallas is the first Southwest city to host the program, called A Progressive Palliative Care Educational Curriculum for the Care of African-Americans at Life's End, which was developed by Duke University. A coalition of Dallas hospitals, hospices and other care providers is co-sponsoring the program. Sessions will address cultural and spiritual concerns, seek to improve communication with involved parties and develop strategies for patient-centered care. In addition, participants will develop action plans based on what they learned and how they plan to inform others about end-of-life care.
Robert Fine, head of the local APPEAL program and internist at Baylor University Medical Center, said, "The hope is rallying our community of health care providers and African-American churches around the goal of improving treatment and care at the end of life for a group of people who haven't had the best care at the end of life."
Richard Payne -- director of Duke University Medical Center's Institute on Care at the End of Life, who will facilitate the program -- said, "Minority families and African-Americans in particular have to cope with thoughts of, 'Would I be in this fix if I had better access to care?' or, 'Can I trust this system that hasn't treated me very well?' or, 'Are they treating me well, or is it a cost-saving measure?'" He added, "Just to acknowledge these questions is a big step" toward improving end-of-life care for blacks (Hancock, Dallas Morning News, 6/28).
Efforts, Grant Seek To Promote Healthy Living in Underserved Communities, Medical Services to Asian-Americans, Improve Health Quality for Minorities, Others
[Jul 03, 2008]
The following summarizes efforts that seek to improve health among minorities.
- Chicago: The Chicago Tribune on Monday featured the Kitchen Table Interventions Program, which trains local community members to be health care advocates and researchers to promote better health in urban and underserved communities. The program was launched in January as a pilot project by Northwestern University and Westside Health Authority. Funding comes from a $380,000 NIH National Center on Minority Health and Health Disparities grant awarded to the Community Healthy Lifestyles Partnership Project. As part of the program, eight trained residents of the Austin neighborhood randomly surveyed households to determine the most prevalent medical issues and health behaviors. The neighborhood was selected because of its higher rates of asthma, heart disease, hypertension and other conditions. The advocates then facilitated weekly informational sessions on nutrition, exercise, emotional wellness, HIV/AIDS, breast cancer and other topics. Researchers now are analyzing the information collected by the trained advocates and will use it to develop intervention programs that target urban neighborhoods (Shelton, Chicago Tribune, 7/1).
- Department of Defense: At a four-day meeting last week, the department's Breast Cancer Research Program presented a variety of data on the disease, including racial disparities. The conference -- Era of Hope -- included presentations on the latest breast cancer developments and research. Abstracts from several studies related directly to minorities were presented. Such studies included: "A New Paradigm for African-American Breast Cancer Involving Stem Cell Differentiation in a Breast Tissue Engineering System," by Jean Latimer of the University of Pittsburgh; "Diabetes, Physical Activity, and Breast Cancer Among Hispanic Women," by Maureen Sanderson of the University of Texas Health Science Center at Houston; and "Body Composition and Postmenopausal Breast Cancer in Hispanic Women," by Gerson Peltz of the University of Texas at Brownsville (BCRP release, 6/26).
- Los Angeles: The Pasadena Star News recently featured the Chinatown Service Center, the largest Chinese-American health and human service organization in Southern California, which is expected to reopen in 2010 in Los Angeles after being closed for nearly 10 years. The Board of Supervisors in May approved a 40-year lease agreement with the center, which provides preventive health and dental services to low-income residents. The center expects to rely on donations and grants to operate and cover the costs of $8 million in upgrades to the county building. In addition to English, services are provided in Cambodian, multiple dialects of Chinese, Vietnamese and Spanish (McLain, Pasadena Star News, 6/29).
- Pennsylvania: The Robert Wood Johnson Foundation has awarded Pennsylvania State University with a three-year, $4 million grant to expand its evaluation of a health quality reform project that aims to reduce racial disparities and take on other initiatives, United Press International reports. The $300 million national project, called Aligning Forces for Quality, involves 14 community-based programs across the U.S. that help physicians improve quality of care for patients and ensure that patients receive adequate information to make better health decisions. AF4Q also seeks to improve nursing in hospitals and reduce health care inequality based on race or ethnicity (UPI, 7/1).
Opinion
Black AIDS Institute HIV/AIDS Card Could Help Stop the Spread of the Disease in the Community, Columnist Says
[Jul 03, 2008]
The Black AIDS Institute "may have come up with a strategy that could make a difference" and "help stop the spread of HIV/AIDS" in the black community, Chicago Sun-Times columnist Mary Mitchell writes. As part of BAI's "Test 1 Million" initiative, the institute has developed a card that certifies that an individual has been tested for HIV in the last six months.
After a consent form from BAI's Web site is signed, a testing facility can send the individual's information to an online database. The individual then receives a card stating his or her HIV status and the date of the test. Phill Wilson, BAI's founder and executive director, said the information will be confidential and each person is identified by a PIN number. The card expires after six months. The organization is working to allow participants to also include their sexual history and have access to their data by cell phone or e-mail, according to Mitchell.
Wilson said he would like people to use the card as an incentive to practice safer sex and not as a verification that a person has tested negative, because the card does not reflect the person's behavior since the test was taken.
Mitchell writes, "Instead of women feeling pressured to consent to unprotected sex on the strength of 'Baby, I've been tested and I'm clean,' they can ask for tangible proof." She adds, "Black women, particularly, have to find creative ways to protect themselves against the disease, and an HIV/AIDS testing card is a step in that direction.
"If nothing else, the existence of this system may help those of us who think we aren't at risk for the disease have the conversation," Mitchell writes, concluding, "Just as the unseemly violence playing out in too many black communities can touch the lives of the law-abiding, HIV/AIDS is a threat to us all" (Mitchell, Chicago Sun-Times, 7/1).
Recent Releases
Study Looks at Asthma Prevalence by Race/Ethnicity, Connection With Housing Conditions
[Jul 01, 2008]
"Racial/Ethnic Differences in Asthma Prevalence: The Role of Housing and Neighborhood Environments," Journal of Health and Social Behavior: The study looks at the prevalence of asthma among 10 racial and ethnic groups in New York City and how housing and neighborhood conditions can contribute to a disparity in prevalence. Researchers found that Puerto Rican-Americans, other Hispanics and blacks had the highest levels of asthma, while Mexican-Americans, Chinese-Americans and Asian/Indians had the lowest levels. They also found that reducing minorities' exposure to deteriorated housing conditions and increasing levels of community unity, as well making improvements in other household factors, reduce asthma rates among blacks and Puerto Rican-Americans. However, even after such interventions, asthma rates among those two groups still remain significantly higher than those among whites (Rosenbaum, JHSB, June 2008).
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