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Osakwe ZT, Calixte R, Peterson ML, Young SG, Ikhapoh I, Pierre K, McIntosh JT, Senteio C, Girardin JL. Association of Hospice Agency Location and Neighborhood Socioeconomic Disadvantage in the U.S. Am J Hosp Palliat Care 2024; 41:309-317. [PMID: 37644697 DOI: 10.1177/10499091231195319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Despite the growing increase in the utilization of hospice in the U.S, disparities exist in the utilization of hospice. Accumulating evidence has shown that neighborhood characteristics have an impact on availability of hospice agencies. OBJECTIVE To assess the association between neighborhood social vulnerability and hospice agency availability. METHODS Using the Medicare Post-Acute Care and Hospice Provider Utilization and Payment Public Use Files (PAC PUF) for 2019. Hospice agency addresses were geocoded to the census tract level. Multivariable Poisson regression models were used to assess the association between socioeconomic status SVI theme and hospice agency availability adjusting for number of home health agencies, primary care health profession shortage, per cent Black, and Percent Hispanic at the census tract level and rurality. RESULTS The socioeconomic status SVI subtheme was associated with decreased likelihood of hospice agency availability (adjusted IRR (aIRR), .56; 95% CI, .50- .63; P < .001). Predominantly Black, and predominantly Hispanic neighborhoods had lower rates of hospice agency availability (aIRR, .48; 95% CI, .39-.59; P < .001 and aIRR, .29; 95% CI, .24-.36; P < .001), respectively. CONCLUSION Neighborhood socioeconomic disadvantage was associated with lower availability of hospice agencies. Policies aimed at increasing access to hospice should be cognizant of neighborhood socioeconomic disadvantage.
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Affiliation(s)
- Zainab Toteh Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
| | - Rose Calixte
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Mandi-Leigh Peterson
- North Dakota Healthcare Workforce Group, University of North Dakota, Grand Forks, ND, USA
| | - Sean G Young
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Izuagie Ikhapoh
- School of Engineering and Applies Sciences, University of Buffalo, Buffalo, NY, USA
| | - Kaydeen Pierre
- College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
| | - Jennifer T McIntosh
- College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
- Yale University School of Nursing, Orange, CT, USA
| | - Charles Senteio
- Department of Library and Information Science, School of Communication and Information, Rutgers University, New Brunswick, NJ, USA
| | - Jean-Louis Girardin
- Department of Psychiatry and Neurology at the Miller School of Medicine, University of Miami, Miami, FL, USA
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Alberto IRI, Alberto NRI, Altinel Y, Blacker S, Binotti WW, Celi LA, Chua T, Fiske A, Griffin M, Karaca G, Mokolo N, Naawu DKN, Patscheider J, Petushkov A, Quion JM, Senteio C, Taisbak S, Tırnova İ, Tokashiki H, Velasquez A, Yaghy A, Yap K. A scientometric analysis of fairness in health AI literature. PLOS Glob Public Health 2024; 4:e0002513. [PMID: 38241250 PMCID: PMC10798451 DOI: 10.1371/journal.pgph.0002513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 12/07/2023] [Indexed: 01/21/2024]
Abstract
Artificial intelligence (AI) and machine learning are central components of today's medical environment. The fairness of AI, i.e. the ability of AI to be free from bias, has repeatedly come into question. This study investigates the diversity of members of academia whose scholarship poses questions about the fairness of AI. The articles that combine the topics of fairness, artificial intelligence, and medicine were selected from Pubmed, Google Scholar, and Embase using keywords. Eligibility and data extraction from the articles were done manually and cross-checked by another author for accuracy. Articles were selected for further analysis, cleaned, and organized in Microsoft Excel; spatial diagrams were generated using Public Tableau. Additional graphs were generated using Matplotlib and Seaborn. Linear and logistic regressions were conducted using Python to measure the relationship between funding status, number of citations, and the gender demographics of the authorship team. We identified 375 eligible publications, including research and review articles concerning AI and fairness in healthcare. Analysis of the bibliographic data revealed that there is an overrepresentation of authors that are white, male, and are from high-income countries, especially in the roles of first and last author. Additionally, analysis showed that papers whose authors are based in higher-income countries were more likely to be cited more often and published in higher impact journals. These findings highlight the lack of diversity among the authors in the AI fairness community whose work gains the largest readership, potentially compromising the very impartiality that the AI fairness community is working towards.
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Affiliation(s)
| | | | - Yuksel Altinel
- Bagcilar Research and Training Hospital, General Surgery Department, University of Health Sciences, Istanbul, Turkey
| | - Sarah Blacker
- Department of Social Science, York University, Toronto, Ontario, Canada
| | - William Warr Binotti
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Leo Anthony Celi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Tiffany Chua
- University of San Francisco, San Francisco, California, United States of America
| | - Amelia Fiske
- Institute for History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Molly Griffin
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Gulce Karaca
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Nkiruka Mokolo
- Meharry Medical College School of Medicine, Nashville, Tennessee, United States of America
| | - David Kojo N Naawu
- Meharry Medical College School of Medicine, Nashville, Tennessee, United States of America
| | | | - Anton Petushkov
- University of Michigan, Ann Arbor, Michigan, United States of America
| | - Justin Michael Quion
- University of the East Ramon Magsaysay Memorial Medical Center Inc, Quezon City, Philippines
| | - Charles Senteio
- Department of Library and Information Science, Rutgers University School of Communication and Information, New Brunswick, New Jersey, United States of America
| | | | - İsmail Tırnova
- Department of General Surgery, Baskent University School of Medicine, Istanbul, Turkey
| | - Harumi Tokashiki
- Department of Medicine, Carney Hospital, Boston, Massachusetts, United States of America
| | - Adrian Velasquez
- Department of Medicine, Carney Hospital, Boston, Massachusetts, United States of America
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, United States of America
| | - Antonio Yaghy
- New England Eye Center, Boston, Massachusetts, United States of America
| | - Keagan Yap
- Harvard College, Cambridge, Massachusetts, United States of America
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Senteio C, Murdock PJ. The Efficacy of Health Information Technology in Supporting Health Equity for Black and Hispanic Patients With Chronic Diseases: Systematic Review. J Med Internet Res 2022; 24:e22124. [PMID: 35377331 PMCID: PMC9016513 DOI: 10.2196/22124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/25/2020] [Accepted: 01/23/2022] [Indexed: 12/26/2022] Open
Abstract
Background Racial inequity persists for chronic disease outcomes amid the proliferation of health information technology (HIT) designed to support patients in following recommended chronic disease self-management behaviors (ie, medication behavior, physical activity, and dietary behavior and attending follow-up appointments). Numerous interventions that use consumer-oriented HIT to support self-management have been evaluated, and some of the related literature has focused on racial minorities who experience disparate chronic disease outcomes. However, little is known about the efficacy of these interventions. Objective This study aims to conduct a systematic review of the literature that describes the efficacy of consumer-oriented HIT interventions designed to support self-management involving African American and Hispanic patients with chronic diseases. Methods We followed an a priori protocol using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-Equity 2012 Extension guidelines for systematic reviews that focus on health equity. Themes of interest included the inclusion and exclusion criteria. We identified 7 electronic databases, created search strings, and conducted the searches. We initially screened results based on titles and abstracts and then performed full-text screening. We then resolved conflicts and extracted relevant data from the included articles. Results In total, there were 27 included articles. The mean sample size was 640 (SD 209.5), and 52% (14/27) of the articles focused on African American participants, 15% (4/27) of the articles focused on Hispanic participants, and 33% (9/27) included both. Most articles addressed 3 of the 4 self-management behaviors: medication (17/27, 63%), physical activity (17/27, 63%), and diet (16/27, 59%). Only 15% (4/27) of the studies focused on follow-up appointment attendance. All the articles investigated HIT for use at home, whereas 7% (2/27) included use in the hospital. Conclusions This study addresses a key gap in research that has not sufficiently examined what technology designs and capabilities may be effective for underserved populations in promoting health behavior in concordance with recommendations.
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Affiliation(s)
- Charles Senteio
- Department of Library and Information Science, School of Communication and Information, Rutgers University, New Brunswick, NJ, United States
| | - Paul Joseph Murdock
- Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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Osakwe ZT, Senteio C, Bubu OM, Obioha C, Turner AD, Thawani S, Saint Fleur-Calixte R, Jean-Louis G. Sleep Disturbance and Strain Among Caregivers of Persons Living With Dementia. Front Aging Neurosci 2022; 13:734382. [PMID: 35185513 PMCID: PMC8851235 DOI: 10.3389/fnagi.2021.734382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe study objective was to examine predictors of sleep disturbance and strain among caregivers of persons living with dementia (PLWD).MethodsThis cross-sectional study utilized a sample of community-dwelling older adults and their family caregivers drawn from the 2017 National Health and Aging Trends Study and National Study of Caregiving. Multivariable logistic regression was used to assess the association between caregiver and PLWD characteristics and a composite measure of caregiving strain. High caregiving strain was defined as a total score of ≥ 5 on the 6 caregiving strain items (e.g., emotional difficulty, no time for self). We used multivariable proportional odds models to examine predictors of caregiver sleep-related outcomes (trouble falling back to sleep and interrupted sleep), after adjusting for other caregiver and PLWD factors.ResultsOf the 1,142 family caregivers, 65.2% were female, 15% were Black, and 14% were Hispanic. Average age was 60 years old. Female caregivers were more likely to report high level of strain compared to male caregivers (OR: 2.61, 95% CI = 1.56, 4.39). Compared to non-Hispanic Whites, non-Hispanic Black and Hispanic caregivers had reduced odds of reporting greater trouble falling back asleep [OR = 0.55, CI (0.36, 0.82) and OR = 0.56, CI (0.34, 0.91), respectively]. The odds of reporting greater trouble falling back asleep was significantly greater among caregivers with high blood pressure vs. caregivers without high blood pressure [OR = 1.62, CI (1.12, 2.33)].ConclusionIn this cross-sectional study, caregivers with greater sleep difficulty (trouble falling back asleep) were more likely to report having high blood pressure. We found no racial/ethnic differences in interrupted sleep among caregivers to PLWD. These results suggest that interventions to improve sleep among caregivers to PLWD may decrease poor cardiovascular outcomes in this group.
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Affiliation(s)
- Zainab Toteh Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, NY, United States
- *Correspondence: Zainab Toteh Osakwe,
| | - Charles Senteio
- School of Communication and Information, Rutgers University, New Brunswick, NJ, United States
| | - Omonigho Michael Bubu
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, United States
| | - Chinedu Obioha
- College of Nursing and Public Health, Adelphi University, Garden City, NY, United States
| | - Arlener D. Turner
- Department of Psychiatry and Behavioral Sciences and Neurology, University of Miami, Miami, FL, United States
| | - Sujata Thawani
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | | | - Girardin Jean-Louis
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, United States
- Department of Psychiatry and Behavioral Sciences and Neurology, University of Miami, Miami, FL, United States
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Hotez E, Hudson S, Cho A, Senteio C, White J, Slaughter D, Hotez P, Chipley Q. Addressing Disparities for Intersectional BIPOC Communities: The Hood Medicine Initiative Case Study. EClinicalMedicine 2021; 42:101199. [PMID: 34825151 PMCID: PMC8605207 DOI: 10.1016/j.eclinm.2021.101199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Emily Hotez
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), 911 Broxton Ave, Los Angeles, CA, 90024
- Corresponding author: Emily Hotez, Ph.D., David Geffen School of Medicine, University of California, Los Angeles (UCLA), 911 Broxton Ave, Los Angeles, CA, 90024, 301-9225516
| | - Shanice Hudson
- Hood Medicine Initiative, Inc, P.O. Box 55458, Indianapolis, IN 46205
| | - Anchuen Cho
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), 911 Broxton Ave, Los Angeles, CA, 90024
- Hood Medicine Initiative, Inc, P.O. Box 55458, Indianapolis, IN 46205
| | - Charles Senteio
- Hood Medicine Initiative, Inc, P.O. Box 55458, Indianapolis, IN 46205
- Rutgers University School of Communication and Information, 4 Huntington Street, New Brunswick, NJ 08901
| | - Jonathan White
- Hood Medicine Initiative, Inc, P.O. Box 55458, Indianapolis, IN 46205
| | - Doug Slaughter
- Hood Medicine Initiative, Inc, P.O. Box 55458, Indianapolis, IN 46205
| | - Peter Hotez
- National School of Tropical Medicine, Baylor College of Medicine (BCM), One Baylor Plaza, Houston, Texas 77030
| | - Quinn Chipley
- Hood Medicine Initiative, Inc, P.O. Box 55458, Indianapolis, IN 46205
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Senteio C, Adler-Milstein J, Richardson C, Veinot T. Psychosocial information use for clinical decisions in diabetes care. J Am Med Inform Assoc 2021; 26:813-824. [PMID: 31329894 DOI: 10.1093/jamia/ocz053] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/26/2019] [Accepted: 03/31/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE There are increasing efforts to capture psychosocial information in outpatient care in order to enhance health equity. To advance clinical decision support systems (CDSS), this study investigated which psychosocial information clinicians value, who values it, and when and how clinicians use this information for clinical decision-making in outpatient type 2 diabetes care. MATERIALS AND METHODS This mixed methods study involved physician interviews (n = 17) and a survey of physicians, nurse practitioners (NPs), and diabetes educators (n = 198). We used the grounded theory approach to analyze interview data and descriptive statistics and tests of difference by clinician type for survey data. RESULTS Participants viewed financial strain, mental health status, and life stressors as most important. NPs and diabetes educators perceived psychosocial information to be more important, and used it significantly more often for 1 decision, than did physicians. While some clinicians always used psychosocial information, others did so when patients were not doing well. Physicians used psychosocial information to judge patient capabilities, understanding, and needs; this informed assessment of the risks and the feasibility of options and patient needs. These assessments influenced 4 key clinical decisions. DISCUSSION Triggers for psychosocially informed CDSS should include psychosocial screening results, new or newly diagnosed patients, and changes in patient status. CDSS should support cost-sensitive medication prescribing, and psychosocially based assessment of hypoglycemia risk. Electronic health records should capture rationales for care that do not conform to guidelines for panel management. NPs and diabetes educators are key stakeholders in psychosocially informed CDSS. CONCLUSION Findings highlight opportunities for psychosocially informed CDSS-a vital next step for improving health equity.
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Affiliation(s)
- Charles Senteio
- Department of Library and Information Science, Rutgers School of Communication and Information, New Brunswick, New Jersey, USA
| | - Julia Adler-Milstein
- Department of Medicine, University of California San Francisco, San Francisco, California USA
| | - Caroline Richardson
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan USA
| | - Tiffany Veinot
- School of Information, School of Public Health, University of Michigan, Ann Arbor, Michigan USA
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Senteio C, Veinot T, Adler-Milstein J, Richardson C. Physicians’ perceptions of the impact of the EHR on the collection and retrieval of psychosocial information in outpatient diabetes care. Int J Med Inform 2018; 113:9-16. [DOI: 10.1016/j.ijmedinf.2018.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/25/2018] [Accepted: 02/03/2018] [Indexed: 11/25/2022]
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Senteio C, Hershey D, Campbell T. DIABETES EDUCATION AND INTERGENERATIONAL TECHNOLOGY TRANSFER. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C. Senteio
- Library and Information Science, Rutgers University School of Communication and Information, New Brunswick, New Jersey,
- Michigan State University, East Lansing, Michigan,
| | - D. Hershey
- Michigan State University, East Lansing, Michigan,
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Senteio C, Hershey D, Campbell T. DIABETES EDUCATION AND INTERGENERATIONAL TECHNOLOGY TRANSFER. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C. Senteio
- Library and Information Science, Rutgers University School of Communication and Information, New Brunswick, New Jersey,
- Michigan State University, East Lansing, Michigan,
| | - D. Hershey
- Michigan State University, East Lansing, Michigan,
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Unertl KM, Schaefbauer CL, Campbell TR, Senteio C, Siek KA, Bakken S, Veinot TC. Integrating community-based participatory research and informatics approaches to improve the engagement and health of underserved populations. J Am Med Inform Assoc 2015; 23:60-73. [PMID: 26228766 PMCID: PMC4713901 DOI: 10.1093/jamia/ocv094] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/26/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE We compare 5 health informatics research projects that applied community-based participatory research (CBPR) approaches with the goal of extending existing CBPR principles to address issues specific to health informatics research. MATERIALS AND METHODS We conducted a cross-case analysis of 5 diverse case studies with 1 common element: integration of CBPR approaches into health informatics research. After reviewing publications and other case-related materials, all coauthors engaged in collaborative discussions focused on CBPR. Researchers mapped each case to an existing CBPR framework, examined each case individually for success factors and barriers, and identified common patterns across cases. RESULTS Benefits of applying CBPR approaches to health informatics research across the cases included the following: developing more relevant research with wider impact, greater engagement with diverse populations, improved internal validity, more rapid translation of research into action, and the development of people. Challenges of applying CBPR to health informatics research included requirements to develop strong, sustainable academic-community partnerships and mismatches related to cultural and temporal factors. Several technology-related challenges, including needs to define ownership of technology outputs and to build technical capacity with community partners, also emerged from our analysis. Finally, we created several principles that extended an existing CBPR framework to specifically address health informatics research requirements. CONCLUSIONS Our cross-case analysis yielded valuable insights regarding CBPR implementation in health informatics research and identified valuable lessons useful for future CBPR-based research. The benefits of applying CBPR approaches can be significant, particularly in engaging populations that are typically underserved by health care and in designing patient-facing technology.
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Affiliation(s)
- Kim M Unertl
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Chris L Schaefbauer
- Department of Computer Science, University of Colorado Boulder, Boulder, Colorado, USA
| | | | - Charles Senteio
- School of Information, University of Michigan, Ann Arbor, Michigan, USA
| | - Katie A Siek
- Informatics Division, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Suzanne Bakken
- School of Nursing and Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Tiffany C Veinot
- School of Information and School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
Adherence to treatment recommendations for chronic diseases is notoriously low across all patient populations. But African American patients, who are more likely to live in low-income neighborhoods and to have multiple chronic conditions, are even less likely to follow medical recommendations. Yet we know little about their contextually embedded, adherence-related experiences. We interviewed individuals (n = 37) with at least two of the following conditions: hypertension, diabetes, and chronic kidney disease. Using an "invisible work" theoretical framework, we outline the adherence work that arose in patients' common life circumstances. We found five types: constantly searching for better care, stretching medications, eating what I know, keeping myself alive, and trying to make it right. Adherence work was effortful, challenging, and addressed external contingencies present in high-poverty African American neighborhoods. This work was invisible within the health care system because participants lacked ongoing, trusting relationships with providers and rarely discussed challenges with them.
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Zhang S, Senteio C, Felizzola J, Rust G. Racial/ethnic disparities in antiretroviral treatment among HIV-infected pregnant Medicaid enrollees, 2005-2007. Am J Public Health 2013; 103:e46-53. [PMID: 24134365 DOI: 10.2105/ajph.2013.301328] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined racial/ethnic differences in prenatal antiretroviral (ARV) treatment among 3259 HIV-infected pregnant Medicaid enrollees. METHODS We analyzed 2005-2007 Medicaid claims data from 14 southern states, comparing rates of not receiving ARVs and suboptimal versus optimal ARV therapy. RESULTS More than one third (37.3%) had zero claims for ARV drugs. Three quarters (73.4%) of 346 Hispanic women received no prenatal ARVs. After we adjusted for covariates, Hispanic women had 3.89 (95% confidence interval = 2.58, 5.87) times the risk of not receiving ARVs compared with Whites. Hispanic women often had only 1 or 2 months of Medicaid eligibility, perhaps associated with barriers for immigrants. Less than 3 months of eligibility was strongly associated with nontreatment (adjusted odds ratio = 29.0; 95% confidence interval = 13.4, 62.7). CONCLUSIONS Optimal HIV treatment rates in pregnancy are a public health priority, especially for preventing transmission to infants. Medicaid has the surveillance and drug coverage to ensure that all HIV-infected pregnant women are offered treatment. States that offer emergency Medicaid coverage for only delivery services to pregnant immigrants are missing an opportunity to screen, diagnose, and treat pregnant women with HIV, and to prevent HIV in children.
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Affiliation(s)
- Shun Zhang
- Shun Zhang and George Rust are with the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA. Charles Senteio is with the University of Michigan, School of Information, Ann Arbor. Jesus Felizzola is with the AIDS Education and Training Center, National Center for HIV Care in Minority Communities, HealthHIV, Washington, DC
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Cardarelli K, Jackson R, Martin M, Linnear K, Lopez R, Senteio C, Weaver P, Hill A, Banda J, Epperson-Brown M, Morrison J, Parrish D, Newton JR, Royster M, Haley S, Lafayette C, Harris P, Vishwanatha JK, Johnson ES. Community-based participatory approach to reduce breast cancer disparities in south Dallas. Prog Community Health Partnersh 2011; 5:375-385. [PMID: 22616205 PMCID: PMC4238068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND South Dallas experiences significant disparities in breast cancer mortality, with a high proportion of stage III and IV diagnoses. To address these rates, the Dallas Cancer Disparities Community Research Coalition created an educational intervention to promote breast health and early detection efforts. OBJECTIVES The goals of the intervention were to increase (a) knowledge regarding the chief contributing factors for breast cancer, (b) awareness of the importance of screening for early detection, and (c) the proportion of women who have engaged in appropriate breast cancer screening practices. METHODS Eligibility criteria for this nonrandomized, controlled trial included women age 40 and older, English-speaking, and having no personal history of cancer. Control participants received written breast health educational materials. Intervention participants attended 8 weekly sessions that included interactive educational materials, cooking demonstrations, and discussions emphasizing primary and secondary breast cancer prevention. All study participants completed a 1-hour survey at baseline and 4 months later. RESULTS There were 59 women were enrolled in the intervention and 60 in the control group. At follow-up, after controlling for baseline mammography status, women in the intervention group were 10.4 times more likely (95% confidence interval [CI], 2.9-36.4) to have received a screening mammogram in the last year compared with the control group. Intervention participants demonstrated statistically significantly higher rates of breast self-examination (odds ratio [OR], 3.0; 95% CI, 1.0-8.6) and breast cancer knowledge (p=.003). CONCLUSION Lessons learned from this community-based participatory research (CBPR) study can be used to create sustainable cancer disparity reduction models that can be replicated in similar communities.
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Affiliation(s)
- Kathryn Cardarelli
- School of Public Health, University of North Texas Health Science Center, and Parkland Health and Hospital System, Dallas, TX, USA
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Cardarelli KM, Haley S, Linnear K, Jackson R, Martin M, Lopez R, Senteio C, Weaver P, Hill A, Banda J, Epperson-Brown M, Morrison J, Parrish D, Newton J, Royster M, Lafayette C, Harris P, Vishwanatha JK, Johnson ES. Abstract B2: Educational intervention to reduce breast cancer disparities: The Dallas Cancer Disparities Community Research Coalition. Cancer Epidemiol Biomarkers Prev 2010. [DOI: 10.1158/1055-9965.disp-10-b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: South Dallas experiences significant disparities in breast cancer mortality, with a high proportion of stage III and IV diagnoses. In an effort to address these rates, the Dallas Cancer Disparities Community Research Coalition created an educational intervention in 2009 to promote breast health and early detection efforts. The goals of the intervention were to increase: (1) knowledge regarding the chief contributing factors for breast cancer and steps to reduce breast cancer risk; (2) awareness of the importance of screening for early detection; and (3) the proportion of women who have engaged in appropriate breast cancer screening practices. The innovation of the project lies in the community-based participatory research (CBPR) approach, which brings together scientists and community representatives.
Methods: This study was approved by the UNT Health Science Center IRB. Women residing in South Dallas were recruited for the intervention, and West Dallas was chosen as the control group. In addition to residence in one of these two communities, eligibility criteria included age 40 and older, English-speaking, and no personal history of cancer. Participants were recruited through community partnerships, posting flyers throughout the community in high-traffic areas, and door-to-door visits in the targeted areas. Participants in the control group received only written breast health educational materials. Intervention participants attended 8 weekly sessions that included written educational materials, cooking demonstrations and discussions with clinicians from the Dallas/Fort Worth area. All study participants completed a one-hour survey at baseline and 4 months later to assess the outcome variables as well as a variety of possible intervening variables.
Results: A total of 59 women were enrolled in the intervention and 60 in the control group. Retention for the 8-week intervention was 71 %. After controlling for baseline mammography status, women in the intervention group were 10.4 times more likely (95% CI: 2.9-36.4) to report having had a screening mammogram in the last year compared to the control group. Intervention participants demonstrated statistically significantly higher rates of breast self examination (OR: 3.0,95% CI: 1.0-8.6) and breast cancer knowledge (p=.003). Conclusion: Lessons learned from this study can be used to create sustainable cancer disparity reduction models that can be replicated in similar communities across the United States.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B2.
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Affiliation(s)
| | | | | | | | | | - Roy Lopez
- 1UNT Health Science Center, Fort Worth, TX
| | | | | | - Anna Hill
- 1UNT Health Science Center, Fort Worth, TX
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Senteio C, Marshall KJ, Ritzen EK, Grant J. Preventing Homelessness: An Examination of the Transition Resource Action Center. J Prev Interv Community 2009; 37:100-11. [PMID: 19363771 DOI: 10.1080/10852350902735601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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