AJPH highlights the science of health disparities

Date: Apr 25 2015

EMBARGOED AJPH research: New supplement investigates the science of health disparities

EMBARGOED UNTIL April 23, 2015, 4 p.m. (EDT)

Contact: For copies of articles or full table of contents of an issue, contact Kimberly Short, 202-777-2511.

For this special American Journal of Public Health supplement, studies, commentaries and editorial pieces address the science behind eliminating health disparities. Find research addressing mortality variances by age and gender as it relates to alcohol consumption; instances of insurance-based discrimination; and spatial clustering of work-related injuries.

External funding support for this supplement was provided by the US National Institutes of Health and the US Food and Drug Administration, Office of Minority Health.

American Journal of Public Health highlights:
  1. Alcohol consumption’s relation to mortality varies by race and gender
  2. Insurance-based discrimination is associated with type of health insurance
  3. Work-related injuries occur among key ZIP codes in predictable ways 

Alcohol consumption’s relation to mortality varies by race and gender

According to new research from the American Journal of Public Health, risks and benefits of alcohol consumption in relation to risk of death varied by race and gender in a nationally representative sample of the US population.

Researchers analyzed data from the National Health Interview Survey with more than 150,000 participants 18 years or older who were non-Hispanic white or non-Hispanic black. Information was collected from respondents about alcohol consumption, socioeconomic status, race and ethnicity, health behaviors and medical conditions from 1997 to 2002. All-cause mortality was also assessed by linking the NHIS to the National Death Index up to 2006.

According to the findings, alcohol drinking patterns were associated with all-cause mortality by race and gender. The lowest mortality risk was observed among white men who consumed one to two drinks over a period of three to seven days per week, while black men were at a lowest risk when they did not drink alcohol at all. Further, for white women, mortality risk was at its lowest for those who drank one drink a day for three to seven days per week, while black women were at lowest risk when they consumed one drink, two or fewer days a week.

“Current dietary guidelines recommend moderate consumption for adult Americans who consume alcoholic beverages. Our study suggests that additional refinements based on race/ethnicity may be necessary. More research is needed.” the authors conclude.

[“Black-white differences in the relationship between alcohol drinking patterns and mortality among US men and women.” Contact: Chandra Jackson, Harvard Medical School, Boston, Massachusetts.]

Insurance-based discrimination is associated with type of health insurance
New research from the American Journal of Public Health finds that instances of insurance-based discrimination varies based on type of insurance. According to the study, uninsured and publicly insured adults experience greater discrimination than those privately insured.

The study used data from the 2013 Minnesota Health Access Survey, a telephone interview survey that captures information about access to health care, household insurance coverage, experience with health care, health status and socio-demographic information. Researchers reviewed interview responses from more than 4,000 participants in which they measured experiences of insurance-based discrimination, insurance type and details regarding access to care. Insurance-based discrimination was evaluated based on responses to questions about fair or unfair treatment by health care providers.

Results from the study indicate that insurance-based discrimination was higher among adults who were uninsured or publicly insured compared to adults who were privately insured. Rates of reported insurance-based discrimination were 25 percent for uninsured adults and 21 percent for adults who were publicly insured. Alternatively, 3 percent of privately insured adults experienced insurance-based discrimination.

“The ACA is designed to reduce health care disparities by expanding insurance coverage to millions of uninsured people. Yet it is still unclear whether the stigma of public program enrollment and reports of insurance-based discrimination will fade as public insurance becomes more common-place after the ACA’s full implementation, at the same time intensifying for uninsured people given the individual mandate,” the authors suggest.

[“Reports of insurance-based discrimination in health care and its association with access to care.” Contact: Xinxin Han, MS, University of Minnesota School of Public Health, Minneapolis, Minnesota.]

Work-related injuries occur among key ZIP codes in predictable ways
According to new research from the American Journal of Public Health, the majority of instances of work-related injury in Illinois occurred among workers living in 20 percent of the state’s ZIP codes, with key clusters in 10 locations.

Researchers captured data from the state of Illinois trauma registry and reviewed work-related traumatic injuries that took place between 2000 and 2009 among workers 15 years of age or older. Spatial clustering relationships were then determined based on the instances of injury and where the workers lived. The study also captured information regarding socio-demographics, employment and other features for the ZIP codes under review using Census data and data from the Federal Bureau of Investigations Uniform Crime Reports.

Results indicated that among the 23,200 Illinois work-related injuries, 80 percent took place among workers living within 20 percent of the ZIP codes, with 10 key spatial clusters. According to the findings, clusters in home ZIP codes of injured workers were positively correlated with proportion of immigrants and Hispanics; clusters were negatively correlated with “urban poverty.”

“Our investigation, which used existing health surveillance data, suggests that some neighborhoods might be disproportionately affected by traumatic occupational injuries,” the authors wrote.

“On a grander scale, the findings in our study should spur a greater appreciation of the relationship between work and health. There is flourishing interest in the relationship among neighborhood (place) and health, with race/ethnicity, gender, immigration status, income and poverty, social capital, food deserts, crime, housing, transportation availability, environmental justice, greenspace availability and other factors modifying this relationship,” they suggest.

[“Spatial clustering of occupational injuries in communities.” Contact: Linda Forst, MD, MPH, IC School of Public Health, Chicago, Illinois.]

Find a full list of papers to be published online on April 23, 2015, at 4 p.m. EDT below:

  • Letter to the Editor: Continued Disparities in Lesbian, Gay and Bisexual Research Funding at the National Institutes of Health 
  • Letter Response Invitation: Coulter et al respond 
  • Systematic Review: Racial/Ethnic and Socioeconomic Disparities in Endocrine Therapy Adherence in Breast Cancer: A systematic review 
  • Research Article: Disparity in Naloxone Administration by Emergency Medical Service Providers and the Burden of Drug Overdose in Rural Communities in the United States 
  • Research Article: Inequities in workplace secondhand smoke exposure among nonsmoking women of reproductive age 
  • Research Article: Racial/ethnic disparities in HIV risk and socio-economic factors among trans*female youth 
  • Research Article: State Constitutional Commitment to Health and Health Care and Population Health Outcomes: Evidence from Historical U.S. Data 
  • Editorial: Small Is Essential: Importance of Subpopulation Research in Cancer Control
  • Editorial: Calling for a Bold New Vision of Health Disparities Intervention Research 
  • Editorial: Beyond Health Equity: Achieving Wellness within American Indian and Alaska Native Communities 
  • Government, Law and Public Health Practice: Missed Policy Opportunities to Advance Health Equity by Recording Demographic Data in Electronic Health Records 
  • Government, Law and Public Health Practice: Review of State Legislative Approaches to Eliminating Racial and Ethnic Health Disparities, 2002-2011 
  • Framing Health Matters: Transdisciplinary Cardiovascular and Cancer Health Disparities Training: Experiences of the Centers for Population Health and Health Disparities 
  • Framing Health Matters: Cultural Reflexivity in Health Research and Practice 
  • Framing Health Matters: Intergenerational transmission of the effects of acculturation on health in Hispanic Americans: a fetal programming perspective 
  • Framing Health Matters: Moving the dial to advance population health equity in New York City Asian American populations
  • Framing Health Matters: The Adaption and Implementation of a Community-Based Participatory Research Curriculum to Build Tribal Research Capacity 
  • Field Action Report: Participatory Evaluation of a Community Mobilization Effort to Enroll Residents of Wyandotte County, Kansas through the Affordable Care Act 
  • Field Action Report: Eliminating Health Disparities: Innovative methods to improve cervical cancer screening in a medically underserved population 
  • Brief: Asian Americans in New York City Face Disparities in Diabetes Management Compared to Other Racial/Ethnic Minority Groups 
  • Brief: Increasing Disparities in Breast Cancer Mortality for Black Women Aged 20-49 in the U.S. from 1979-2010 
  • Brief: Self-Implemented HIV Testing: Perspectives on improving dissemination among urban African American youth 
  • Brief: Medicaid and racial and ethnic minorities with substance use disorders: Who falls into the expansion gap? 
  • Brief: Using Evidence-Based Policy, Systems and Environmental (EBPSE) Strategies to increase access to healthy food and/or opportunities for physical activity among Asian Americans, Native Hawaiians and Pacific Islanders 
  • Research Article: A community-based oral public health approach to promote health equity 
  • Research Article: Oral Health Equity and Unmet Dental Care Needs in a Population-Based Sample: Findings from the Survey of the Health of Wisconsin 
  • Research Article: A Multi-state Asian-language Tobacco Quitline: Addressing a Disparity in Access to Care 
  • Research Article: The Interaction of Depressive Symptoms and Substance Use to Predict Risky Sexual Behavior and STIs over 36 Months among African American Female Adolescents Seeking Sexual Health Care in Atlanta, GA 
  • Research Article: Addressing Health Disparities in the Mental Health of Refugee Children and Adolescents through Community Based Participatory Research: A Study in Two Communities 
  • Research Article: Comparing The Relative Efficacy Of Narrative Versus Non-narrative Health Messages In Reducing Health Disparities Using a Randomized Trial 
  • Research Article: Unequal burdens of loss: Examining the frequency and timing of homicide deaths experienced by Black men across the life course 
  • Research Article: Cause-of-death disparities in the African diaspora: exploring differences among shared-heritage populations 
  • Research Article: Healthcare Spending and Utilization under The ACA Expansion on Dependents' Coverage by Race/Ethnicity 
  • Research Article: Does Mandated Coverage of Preventive Care Reduce Disparities? Evidence from Colorectal Cancer Screening 
  • Research Article: Reports of Insurance-Based Discrimination in Health Care and Its Association with Access to Care 
  • Research Article: Spatial Clustering of Occupational Injuries in Communities 
  • Research Article: Nuevo Amanecer: Results of a RCT of a Community-based, Peer-delivered Stress Management Intervention to Improve Quality of Life in Latinas with Breast Cancer 
  • Research Article: Secular trends, race and geographic disparity of early-stage breast cancer incidence: 25 years of surveillance in Connecticut 
  • Research Article: Black-White Differences in the Relationship between Alcohol Drinking Patterns and Mortality among US Men and Women 
  • Research Article: Physical Activity, Fruit & Vegetable Intake, and Health Related Quality of Life among Older Chinese, Hispanics, and Blacks in New York City 

The articles were published online April 23, 2015, at 4 p.m. EDT by the American Journal of Public Health under “First Look.” First Look articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, www.apha.org, and is available at www.ajph.org.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to Kimberly Short at APHA, 202-777-2511, or email her. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions department. If you are not a member of the press, a member of APHA or a subscriber, online single issue access is $30 and online single article access is $22 at www.ajph.org or for direct customer service, call 202-777-2516, or email.

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The American Journal of Public Health is the monthly journal of the American Public Health Association. APHA champions the health of all people and all communities by strengthening the profession of public health, sharing the latest research and information, promoting best practices and advocating for public health issues and policies grounded in research. More information is available at www.apha.org.