Dissertations / Theses: 'Racial health care disparities'

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Slade, Catherine Putnam. "Does Patient-Centered Care affect Racial Disparities in Health?" Digital Archive @ GSU, 2007. http://digitalarchive.gsu.edu/pmap_diss/24.

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This thesis presents a challenge to policy initiatives that presume that patient-centered care will reduce racial disparities in health. Data from the Medical Expenditure Panel Survey were used to test patient assessment of provider behavior defined as patient-centered care according to the National Health Disparities Report of the Agency for Healthcare Research and Quality of the Department of Health and Human Services. Results indicated patient-centered care improves self-rated health status, but blacks still report worse health status than whites experiencing comparable patient-centered care. Further, black-white differences in patient-centered care had no affect on health status. Rival theories of black-white differences in health, including social class and health literacy, provided better explanations of disparities than assessment of provider behaviors. These findings suggest that policies designed to financially incentivize patient-centered care practices by providers should be considered with caution. While patient-centered care is better quality care, financial incentives could have a negative effect on minority health if providers are deterred from practices that serve disproportionate numbers of poor and less literate patients and their families. Measurement of the concept of patient-centered care in future health disparities research was also discussed.

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Slade, Catherine Putnam. "Does patient-centered care affect racial disparities in health?" Diss., Atlanta, Ga. : Georgia Institute of Technology, 2008. http://hdl.handle.net/1853/22569.

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Thesis (Ph. D.)--Public Policy, Georgia Institute of Technology, 2008.
Committee Chair: Robert J. Eger III, Ph.D.; Committee Member: Christopher M. Weible, Ph.D.; Committee Member: Gregory B. Lewis, Ph.D.; Committee Member: Monica M. Gaughan, Ph.D.; Committee Member: Valerie A. Hepburn, Ph.D.

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Grover, Simran. "Racial disparities in dental care provided at community health center clinics." Thesis, Boston University, 2008. https://hdl.handle.net/2144/37812.

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Thesis (MSD)--Boston University, Henry M. Goldman School of Dental Medicine, 2008 (Dept. of Health Policy and Health Services Research).
Includes bibliography: leaves 44-48.
0bjective: The objective of this study is to detemine if there are differences by race or ethnicity in dental care provided at community health center clinics resulting in oral health disparities. This study also provides detailed information about the types of dental procedures received by patients at community health center clinics. Methods: This was a retrospective observational study design, consisting of a convenience sample of patients seen and care provided by senior dental students during their ten-week externship at twenty one Boston University Goldman School of Dental Medicine affiliated community health center clinics. The data collected was analyzed SAS version 9.1. Frequencies for categorical variables, means for continuous variable, bivariate analyses and generalized models of logistic regression analysis were performed with the main dependent variable of interest being patient’s race/ethnicity. Results: The total sample was 62,112 observations, of which 56% were females. Regression analysis found that Blacks were 1.23 times and Asians and others were 1.09 times more likely to get diagnostic procedures than Whites. Hispanics were just as likely to receive diagnostic procedures as Whites. Blacks, Hispanics, Asians and others were more likely to get preventive procedures when compared to Whites (p[less than or equal to]0.0001 ). Blacks were less likely to get restorative procedures than Whites (p[less than or equal to]0.0001) whereas Hispanics were as likely to get restorative procedures as Whites. Further generalized logistic regression models to predict specific procedures were performed which indicates that Blacks were 1.99 times, Hispanics were 1.72 times, Asians and others were 1.21 times more likely to get amalgam restorations compared to composite restorations than Whites. However, Blacks were as likely to get root canal therapy compared to extractions as Whites whereas Hispanics were 27% and Asians and others were 37% more likely to get root canal therapy versus extractions than Whites (p[less than or equal to]0.0001). Blacks were 0.55 times, Asians and others were 0.37 times less likely to receive fixed partial dentures compared to removable partial dentures than Whites (p[less than or equal to]0.0001) whereas Hispanics were just as likely to receive fixed Partial dentures as Whites. Conclusion: Disparities were seen in the receipt of dental services provided such as diagnostic, preventive, and restorative procedures based on race at community health center clinics. This surprising finding related to community health center clinics indicate the need for future research focused on reasons for these disparities as community health center clinics are primary care providers for underserved populations.

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Victor, Elise C. "Pediatric asthma care in the emergency department| An examination of racial disparities." Thesis, California State University, Long Beach, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1524129.

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This study is an examination of the prevalence of asthma in adolescents, and it seeks to identify associations that may exist among individuals from different racial and socioeconomic backgrounds. The primary areas of focus were defined by the two research questions posed; these explored the differences among individuals in the study population who had a primary diagnosis of asthma and those who did not. The population consisted of children from birth to 17 years old treated in an emergency department during 2009. The National Hospital Ambulatory Medical Care Survey dataset from 2009 was used as the secondary data source for this retrospective study. After conducting a statistical analysis using a Chi-Squared test, it was determined that race has a statistically significant relationship to pediatric asthma. The factors for this correlation can be attributed to a number of theories that are discussed in detail throughout this research.

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Smith, Caroline Kristine. "Racial Disparities in a State Based Workers' Compensation System." PDXScholar, 2019. https://pdxscholar.library.pdx.edu/open_access_etds/4831.

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Racial, ethnic, and linguistic minority workers suffer higher rates of work-related injuries and illnesses in the United States compared to their White counterparts. Explanations for these higher rates include potential socioeconomic causes (education, income, and wealth) and occupational segregation into more dangerous occupations. What is less studied are the post-injury sequelae for minority workers, which is their experiences in the workers' compensation system, as well as their health and return to paid employment. What is known comes primarily from qualitative literature, which includes themes of racial discrimination (from employers, health care providers, and workers' compensation employees), a lack of information on how to navigate the workers' compensation system, and linguistically inappropriate communication with those whose first language is not the majority language. In addition, qualitative studies have found differences in the treatment of minority workers, delays in receiving partial wage payments, and worse health outcomes. Most studies examining minority workers in the workers' compensation system have not provided a theoretical framework from which to test hypotheses as to why differences exist in a social insurance system based on race, ethnicity, and language. The purpose of this dissertation was to test the role of racial discrimination in creating worse post-injury workers' compensation outcomes for minorities, compared to English speaking Whites. This dissertation utilized fundamental cause theory to frame the hypotheses and analyses in a cross-sectional investigation of differences in workers' compensation system outcomes, using both administrative data from the workers' compensation agency, as well as survey responses from a sample of 488 injured workers in Washington State. The survey, conducted by Washington State University Social and Economic Science Research Center (SESRC), provided many variables not available in the WC administrative data including measures of perceived racial discrimination to test the hypotheses that racial discrimination is a fundamental cause of worse workers' compensation outcomes for minorities. Fundamental cause theory suggests that there are basic or fundamental reasons for health disparities that are not caused by mechanisms linking the fundamental cause with a health outcome; in fact, these mechanisms can and do change, but the relationship between the primary cause and the health disparity outcome will remain. In addition, a fundamental cause affects multiple outcomes via multiple mechanisms. Access to resources such as income, wealth, prestige, knowledge, and beneficial social connections can reduce the impact of a disease once it occurs. The analytic chapters in this dissertation are organized first, to address racial discrimination in health care provider outcomes; second, to address racial discrimination in workers' compensation agency outcomes; and third, to address the role of pre-injury racial discrimination in post-injury return to work outcomes. Racial discrimination was tested in this dissertation as the fundamental cause of health-care provider disparities in timeliness of follow-up care, adequacy of care, and patient satisfaction. Racial discrimination was tested in the workers' compensation agency as the fundamental cause of administrative delays and difficulties: delays in diagnostic approval and wage replacement payments, as well as language appropriate communication, and higher counts of independent medical exams. Racial discrimination was also tested as the fundamental cause of poor return-to-work outcomes (feeling a worker returned to work too early and overall general health). Workplace support, as a possible resource (social connection), was tested as a mediator in the relationship between racial discrimination and workplace outcomes. Due to the survey nature of the study design, replicate weights were calculated based upon information available in both the surveyed and not-surveyed population to account for non-response bias, and all analyses were bootstrapped using Stata survey software. The results support the role of racial discrimination as a fundamental cause of outcomes for hypotheses in the workers' compensation agency with clear differences in delays for diagnostic services, a higher number of independent medical exams, as well as linguistically inappropriate communication for language minorities. Racial discrimination (prior to injury) was found to be significant in overall general health for minority workers, and for feeling they had returned to work too early. Workplace support (a potential social resource), was found to mitigate the role of racial discrimination in the workplace return-to-work outcomes. This study is an initial effort to examine racial discrimination as a fundamental cause of disparities in occupational health after an injury. As the majority of adults will spend one-fifth to one-third of their lives in paid employment, the ability to heal and return to full and active employment after a work-related injury is critical to ones' self-worth, as well as to the economic stability of individuals, families, and societies. If racial, ethnic, and language minorities suffer worse outcomes in their post-injury sequelae, these results will have long-lasting implications in any quest for a more equitable society.

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McGriff, Aisha Kamilah. "Healthy Bodies Matter: Analysis of the Disclosure of Race and Health Care on WebMD.com." Bowling Green State University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1447584802.

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Eyongherok, Arrey Irenee. "Mental Health Disparities Among Minority Populations." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7639.

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Despite the existence of effective treatments, mental health care disparities exist in the availability, accessibility, and quality of services for racial and ethnic minority groups. People living with serious mental complaints often resist engaging in treatments and experience high rates of dropout; poor engagement can lead to worse clinical outcomes. Addressing the complex mental health care needs of racial and ethnic minorities warrants considering evidence-based strategies to help reduce disparities. This systematic review sought to provide an analysis of published literature about the barriers and effective strategies in identifying and treating minority patients with mental health disorders. The practice-focused question of this systematic review was: What are the barriers and effective strategies to identification and treatment of mental health disorders among minority populations. This project was guided by PRISMA and SQUIRE guidelines and Fineout-Overholt and Melnyk’s appraisal form, comprising 11 studies published between 2014 and 2019, identified through Thoreau, Cochrane, CINAHL with Medline, EBSCO, and ProQuest, SAMHSA and PubMed databases. The systematic review results recommend intervention strategies such as integrated/collaborative care, workforce diversity, providers in minority neighborhoods, improving providers’ cultural skills, and stigma reduction to help reduce mental health care disparities. These findings are significant to lowering the gap in practice and can be used by the entire health care system to improve mental health care, thereby leading to a positive social change. Implementing these strategies would benefit patients, families, their communities, and the entire health care delivery system.

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Jourdain, Angela Rosa. "Racial Disparities, Fragmentation of Care, and Adverse Outcomes Associated with Ectopic Pregnancy." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7673.

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Ectopic pregnancy (EP) is a rare condition that occurs in 1% of all pregnancies. However, women of lower socioeconomic status (SES) and ethnic minority groups are at greater risk of adverse outcomes associated with EP than White women. The purpose of this study was to examine data from the 2014 National Inpatient Sample to identify predictors of complications from EP in 2,626 females ages 15-44 in the United States. The theoretical framework used to guide this study was the theory of fundamental causes to explain why the association between SES and mortality has persisted despite progressive advances in the diseases and risk factors that are believed to explain it. Independent t-tests were conducted to determine whether significant differences in patient outcomes existed between EP participants who required one medical intervention during hospitalization and those with two or more medical interventions. Multiple linear regression analyses were used to examine the association between race, primary expected payer, income, number of procedure codes on record, number of diagnoses on record, and length of stay. The key findings were that for every increase in number of procedures (β = 0.13, p <.001) the length of stay also increased by 0.13 units; for every increase in number of diagnoses (β = 0.37, p <.001) length of stay increased by .37 units, and within the Black racial/ethnicity (β = 0.05, p < .05) length of stay increased by 0.05 units. Finally, for females within a higher income quartile of $45,000 or more (β = .08, p < .001), length of stay decreased by -0.08 units. Positive social change implications may include assistance to public health professionals in identifying individual factors that place women at increased risk for EP and the ability to increase EP prevention activity in populations that may be more susceptible to the condition and complications.

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Kong, Meg C. "Racial disparities in antiretroviral therapy adherence and related outcomes in low-income populations with HIV/AIDS." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1276213307.

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Zhang, Yanjun. "Racial and Ethnic Disparities in Quality of Health Care among Adults with Diabetes in the United States." University of Toledo / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1242473857.

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OTUATA, Althea Michelle. "Cultural Competence of Public Health Nurses Who Care for Diverse Populations." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6800.

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Despite advances in health, science, and technology, U.S. healthcare lags in providing access to care and quality care to racial and ethnic minorities. Cultural competence has been noted as a strategy to improve access and quality. The purpose of this project was to assess public health nurses' cultural competence before and after participating in cultural competence informational modules. Two conceptual models were used in this project for theoretical guidance: Leininger's cultural care diversity and universality theory and Campinha-Bacote's process of cultural competence. To assess the nurses' cultural competence, the Cultural Competence Self-Assessment Checklist questionnaire was e-mailed to 57 public health nurses at a local health department. Survey participants remained anonymous. Data were collected on demographics. A paired t test was conducted to compare the statistical significance of the results. A quantitative software tool was used to analyze the data. Study results showed a confidence interval of 95% at p = 0.15, indicating that cultural competence informational modules made a significant difference between the pretest and the posttest of the Cultural Competence Self-Assessment Checklist. Thus, cultural competence informational modules make a difference in public health nurses' awareness, knowledge, and skills, which can enhance their ability to provide culturally competent care to racial and ethnic minorities. The implications of this project for social change include supporting health care professionals' ability to promote and implement cultural competence practices for all populations to decrease health disparities

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Zhang, Yan-Jun. "Racial and ethnic disparities in quality of health care among adults with diabetes in the United States /." Connect to full text in OhioLINK ETD Center, 2009. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=toledo1242473857.

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Thesis (M.S.)--University of Toledo, 2009.
Typescript. "Submitted as partial fulfillment of the requirements for The Master of Science in Pharmaceutical Sciences degree, Administrative Pharmacy option." "A thesis entitled"--at head of title. Bibliography: leaves 66-70.

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Valencia, Alejandra. "Racial and ethnic disparities in access and utilization of dental services among children in Iowa:." Thesis, University of Iowa, 2010. https://ir.uiowa.edu/etd/754.

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Even though the oral health of Americans has improved greatly in the last 50 years, some specific groups of the population have been left behind. Latinos, children and adults, bear a disproportionate burden of oral diseases. Latino children, the fastest growing minority group of children in the US, are affected disproportionately by oral diseases like dental caries compared to other groups. Understanding the difficulties and barriers that these children have to utilize dental care will help us in the future to develop effective programs to reduce health disparities in this segment of the population. The purpose of this study is to identify the factors that determine dental services access and utilization by children in the state of Iowa. Emphasis will be given to differences in utilization of dental services among different racial/ethnic groups. Additionally, the study will describe and compare difficulties in utilization of care among Latino children whose parents answered the survey in English (LE) and those who answered it in Spanish (LS). In order to address these objectives existing data from the Iowa Child and Family Household Health Survey 2005 (HHS) were analyzed. The dependent variable for the study was utilization of dental services. This outcome variable was dichotomized as whether or not the child had a dental visit in the last year. Characteristics of study subjects were first analyzed through descriptive statistics. Bivariate analyses were conducted to assess associations between the dependent variable and independent variables. Multiple logistic regression was used to identify factors associated with utilization of dental services in Iowa's children, and for each different racial and ethnic group. Seven factors were related to the time of the last dental visit for Iowa children: Having a regular source of dental care, dental insurance status, having a dental need in the past 12 months, brushing habits, the age of the children, and family income. The same seven factors were correlated to having a dental visit for white children. For African-American children, having a regular source of dental care, dental insurance status, and having a dental need in the last 12 months were the factors that were found associated to the time of the last dental check-up. For the Latino Spanish children, having a regular source of dental care and the age of the children were factors associated to dental utilization. Finally, for the Latino English children, the only factor associated with having a dental visit was having a regular source of dental care. Information from this research gives policy makers, public health workers, and clinicians an overview of oral health disparities affecting children in the state. For those agencies in Iowa interested in the improvement of access and utilization of dental services for minority children, this project gives important inside about the factors related to the use of services for different racial/ethnic groups in the state.

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Popa, Mihaela A. "Modifiable factors for disability : is there potential for reducing racial disparities in disability in older age?" [Tampa, Fla.] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0002054.

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Karimi, E. Asl Madjid MJ. "Exploration of racial and ethnic disparities in health care transition and quality for youth with intellectual and developmental disabilities| Analysis of 2009--2010 National Survey of Children with Special Health Care Needs." Thesis, TUI University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3586992.

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BACKGROUND: Children with Special Health Care Needs (CSHCN) increasingly live into adulthood, and every year approximately 500,000 American youth transition from pediatric to adult health care system. Health Care Transition (HCT) for Youth with Special Health Care Needs (YSHCN) has emerged as a significant event in the life course of this population. The overarching goal for HCT is to provide high quality, coordinated, uninterrupted health care which is responsive to the needs and desires of the patient. Although improvements have been seen in health care quality of the general population, differences still persist in health care quality among CSHCN in racial and ethnic minority groups. Children with Intellectual and Developmental Disabilities (ID-DD) are an important subpopulation of CSHCN because of their increasing prevalence due to autism and attention deficit hyperactivity disorder, high service needs, cost, and societal impact. A few researchers have focused on transition preparation for all YSHCN, but not on racial and ethnic (e.g., African American, Latino) disparities in health care transition and quality for youth ages 12-17 with ID-DD. OBJECTIVE: The purpose of this study was to explore the racial and ethnic disparities in transition to adult health care and quality of care for youth ages 12-17 with ID-DD. METHODS: The 2009–2010 National Survey of Children with Special Health Care Needs is a nationally representative sample with 17, 114 respondents (parents of CSHCN) ranging in age from 12 to 17 years old. They were asked about transitioning to an adult provider, changing health care needs, maintaining insurance needs, and increasing responsibility for self-care. They were also asked about having a personal doctor or nurse, doctors spending enough time with them, doctors listening carefully to the parent, providers showing sensitivity about family values; the parent receiving enough information from the doctor, and the doctor making the parent feel like a partner. The researcher analyzed the association of selected characteristics with successful transition and quality of health care for White, Black, and Latino children ages 12-17 with ID-DD. The study was guided by Andersen’s (1995) Behavioral Model of Health Care Use. Bivariate analyses were conducted and consisted of seven chi-square analyses. For each chi-square analysis, the data split to include only children with ID-DD. RESULTS: The study was comprised of youth with ID-DD ranging in age from 12 to 17 years old, with an average mean age of 14.55 years old (M=14.55, SD=1.74). Results of the chi-square analysis indicated the proportions of children transitioning to adult health care for each ethnic group were not significantly different than expected (χ²(3) = 5.41, p = 0.144). Results also indicated that only four percent of children with ID-DD successfully transitioned to adult health care. Four of the six chi-square analyses related to the quality of health care were indicative of significant deviations from expected responses (doctors and other health care providers spending enough time with the child χ²(12) = 79.74, p < 0.001; listening carefully (χ²(15) = 63.42, p < 0.001); showing sensitivity to family values (χ²(15) = 34.44, p = 0.003); and making the family feel like a partner in care (χ²(12) = 33.89, p <0 .001). A multiple linear regression was conducted to determine the relationship between the occurrence of an intellectual or developmental disability and the transition to adult health care, while controlling for predisposing (e.g., race and ethnicity, gender, parents education, and family structure), enabling factors (e.g., family income, health insurance status, and patient-centered medical home). A preliminary F test on the regression indicated a significant model fit (F(12, 10,387) = 67.76, p < 0.001). Furthermore, a multiple linear regression was conducted to determine the relationship between the occurrence of a disability and the quality of health care, while controlling for predisposing and enabling factors. The preliminary F test indicated a significant model (F(12, 17,101) = 328.62, p < .001). CONCLUSIONS: Youth with ID-DD, particularly those who are Latino and Black, face greater challenges in transitioning to adult health care and receiving a quality of care compared to other children with special health care needs in the United States. Addressing specific medical home components might reduce racial and ethnic disparities. Future research that examines the association between the HCT and family/professional partnerships in family-to-family health information centers (ACA 5507(b)) will be needed to ensure quality outcomes for youth with ID-DD.

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Phillips, Karon L. "Cultural Competence in Health Care: A Client-Based Perspective." Scholar Commons, 2009. http://scholarcommons.usf.edu/etd/3681.

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In response to the presence of health disparities among a diverse population of older adults, creating culturally competent health care services has emerged as a possible method to help reduce and eventually eliminate inequalities in health care. However, little information exists concerning the effectiveness of cultural competence, and even less is known about how culturally competent clients perceive their providers to be. This dissertation examined a number of indicators related to cultural competence, including the predictors of client-provider racial/ethnic concordance, client perceptions of the interpersonal sensitivity of their health care providers, and the overall satisfaction with care reported by older Non-Hispanic White, African American/Black, Hispanic/Latino, and Asian American adults. In order to accomplish these aims, three related studies were conducted, all drawing on data from the Commonwealth Fund 2001 Health Care Quality Survey. The first study focused on the factors that predicted racial/ethnic concordance between clients and their health care providers. The second study examined several factors that can affect the clients’ perception of their providers’ interpersonal sensitivity, including client-provider racial/ethnic concordance. The third and final analysis utilized the outcome variables from the two previous studies, in addition to the client-level variables, to determine which factors predicted satisfaction with care received. The results show that the factors that predicted client-provider racial/ethnic concordance and perceived interpersonal sensitivity varied across the four groups. In addition, perceived interpersonal sensitivity was a significant predictor of satisfaction with care for all four of the groups. The findings from this dissertation contribute to a broader understanding of racial/ethnic differences in client-provider racial/ethnic concordance, perceptions of interpersonal sensitivity, and overall satisfaction with care among older adults from racially and ethnically diverse backgrounds.

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Ma, Sai. "A good start in life revisiting racial and ethnic disparities in health outcomes at and after birth /." Santa Monica, CA : RAND, 2007. http://www.rand.org/pubs/rgs_dissertations/RGSD220/.

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Fahey, Nisha. "Epidemiology and Characteristics of Pediatric COVID-19 Cases Among UMass Memorial Health Care Patients." eScholarship@UMMS, 2021. https://escholarship.umassmed.edu/gsbs_diss/1140.

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Background: The epidemiology of SARS-CoV-2 infection in the pediatric population, with a focus on racial and ethnic disparities and impact of societal public health measures, remains poorly understood. Methods: This large observational study used electronically abstracted data from pediatric (≤ 19 years of age) patients who received a molecular test for SARS-CoV-2 at a UMass Memorial Health Care (UMMHC) site between March 8, 2020 and April 3, 2021 which was further supplemented by manual chart review of a subset of pediatric SARS-CoV-2 cases. Multivariable logistic regression models with interaction terms were used to identify risk factors for SARS-CoV-2 infection. Segmented regression analysis using Poisson models was used to estimate the effect of public health measures on the weekly incidence of SARS-CoV-2 infection. Results: A total of 25,426 unique pediatric patients were tested for SARS-CoV-2 among whom 2,920 (11.5%) tested positive. The average age of those who tested positive was 10.8 years (SD: 5.8) and 48.1% were female. In the subset analysis, nearly three-quarters (75.9%) of SARS-CoV-2 diagnoses occurred through a telephone encounter, meaning that the child was not physically examined by a provider prior diagnosis and only 2.0% were admitted for inpatient care at diagnosis. Results of multivariable regression revealed that children or parents who self-reported Black race, Hispanic ethnicity, and non-English primary language were associated with approximately twice the odds of testing positive in comparison with White or English-speaking patients. Furthermore, increasing age was associated with increased odds of testing positive for SARS-CoV-2 (aOR: 1.1 (1-4 years), 1.2 (5-9 years), 1.4 (10-14 years), 1.6 (15-17 years), 1.7 (18-19 years)). However, this association between age and positivity rate, varies by race/ethnicity and primary language such that Non-Hispanic Black, Hispanic, and non-English speaking children had markedly greater odds of testing positive during adolescence in comparison to Non-Hispanic White and English-speaking counterparts. Results from segmented regression analysis demonstrated a decline in weekly incidence of cases 9.9% (95% CI: 7.8 – 11.9) after the Massachusetts state mask mandate was implemented. During the winter holidays, the rate of increase in the weekly incidence of cases was 12.1% (95% CI: 11.9 – 12.3) in this pediatric population. Conclusions: Many SARS-CoV-2 cases have been diagnosed at UMMHC sites and notable racial/ethnic disparities exist that vary based on patient age. Public health measures are effective at preventing transmission of SARS-CoV-2 among children.

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Sayre, Sara N. "Perceived Racism and Trust in Health Care." University of Akron / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=akron1382601437.

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Withers, Elizabeth Melissa. "Black/White Health Disparities in the U.S. The Effect of Education over the Life-Course." PDXScholar, 2011. https://pdxscholar.library.pdx.edu/open_access_etds/42.

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In the United States there exists a clear and disconcerting racial disparity in the distribution of good health, which can be seen in differential levels of morbidity and mortality affecting blacks and whites. Previous research has examined the role of SES in shaping racial health disparities and recent studies have looked specifically at the effect of education on health to explain the racial disparity in health. Higher levels of education are robustly associated with good overall health for both blacks and whites and this association has been examined over the life-course. This research explores racial differences in the effect of education on health in general as well as over the life-course. Specifically, this paper examines race differences in the effects of education on health over the life-course. Pooled data from the National Health Interview Survey were analyzed using multivariate logistic regression to estimate the effects of race, education and age on health. The results of these analyses indicate that blacks receive lower education returns on their health than whites. The effect of education on health was shown to grow in the beginning of the life-course and diminish at the end of the life course in accordance with the mortality-as-leveler hypothesis. The black white health disparity was shown to grow over the life-course among the highly educated, whereas the disparity was consistent over the life-course for the poorly educated.

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Nearns, Jodi. "The contribution of the neighborhood context to social disparities in access to health care among sexually experienced adolescent females." [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001645.

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McAfee, Colette. "A National Study of Racial/Ethnic Differences in End-of-Life Care Planning: An Application of the Integrated Behavioral Model." University of Toledo / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1438047807.

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Boag, William (William George). "Quantifying racial disparities in end-of-life care." Thesis, Massachusetts Institute of Technology, 2018. http://hdl.handle.net/1721.1/118063.

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Thesis: S.M., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2018.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 75-80).
There are established racial disparities in healthcare, particularly during end-of-life care when poor communication and historical inequities can lead to suboptimal options and outcomes for patients and their families. Previous work has suggested that medical disparities can reflect higher rates of mistrust for the healthcare system among black patients. When the doctor-patient relationship lacks trust, patients may believe that limiting any intensive treatment is unjustly motivated, and demand higher levels of aggressive care. While there are clinical examples of exemplary end-of-life care, studies have highlighted that aggressive care can lead to painful final moments, and may not improve patient outcomes. In this thesis, I demonstrate that racial disparities which have been reported previously are also present in two public databases. I explore the notion that one underlying cause of this disparity is due to mistrust between patient and caregivers, and develop a multiple trust metric proxies to measure such mistrust more directly. These metric demonstrate even stronger disparities in end-of-life care than race does and statistically significant higher levels of mistrust for black populations. I hope that this work will serve as a useful view for bias and fairness in clinical data, and that future work can better understand mistrust so that its underlying factors (e.g. poor communication and perceived discrimination) can be addressed.
by William Boag.
S.M.

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Dryfhout-Ferguson, Vicki L. "Racial Disparities in Pregnancy Outcomes." University of Cincinnati / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1273167016.

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Sawaqdeh, Abere. "Racial disparities within a mental health court." Tallahassee, Fla. : Florida State University, 2009. http://purl.fcla.edu/fsu/lib/digcoll/undergraduate/honors-theses/sawaqdeh.

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Thesis (Honors paper)--Florida State University, 2009.
Advisor: Dr. Joyce Carbonell, Florida State University, College of Arts and Sciences, Dept. of Psychology. Includes bibliographical references.

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Brown, Jacqueline. "Oral Health Disparities Across Racial/Ethnic Groups." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/honors/37.

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Oral health disparities persist across various sociodemographic groups in the United States. Data were obtained from the 2007-2008 National Health and Nutrition Examination Survey(NHANES)to investigate differences in tooth count, self-rated condition of teeth, decay in at least one tooth, and ownership of dentures across racial/ethnic groups.

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Del, Rio Jassmin. "Racial Disparities in Maternal Mortality Rates in the United States." Scholarship @ Claremont, 2019. https://scholarship.claremont.edu/cmc_theses/2153.

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Introduction: The Center for Disease Control (CDC) reports that the maternal mortality ratio (MMR) in 1987 was 7.2 deaths per 100,000 live births compared to 18.0 deaths in 2015. This increase in MMR has occurred disproportionately. The same report demonstrates that black women are more than 3 times as likely to die of pregnancy-related causes than non-Hispanic white women. The present study explores how structural differences in the economy, education system, and public policy affect the health of black, pregnant women in the U.S. Methods: This research examined epidemiological studies of maternal mortality in the U.S. Data from previous studies was used to investigate the relationship between the racial disparity in MMR and societal, economic, and political factors that contribute to said relationship. Data from the Center for Disease Control (CDC), the U.S. Census Bureau, the United Nations (UN), and the Claremont Colleges Library network was examined. Results: Studies show that between 2008-2012, black women were found to have the greatest prevalence of preexisting conditions prior to pregnancy. Furthermore, white women are more likely to have their labor induced than black, Asian, and Hispanic women. The increased prevalence of preexisting conditions among black women can be greatly attributed to factors stemming from institutional racism. These factors include less access to health care, education, and equal economic opportunities. Conclusion: Implicit bias among practicing health professionals must be addressed via multiethnic education. It is necessary to create an equally safe environment for women of all races. Additionally, health care providers should take on the responsibility of educating pregnant women about any possible preexisting chronic conditions to properly care for themselves. Prenatal health education must be made readily available and accessible to all demographics. Reports demonstrate that the creation of standardized, disease-specific procedures that target chronic conditions may reduce the U.S. MMR. For black women to overcome the current rates of comorbidity, U.S. public policy must change in a way that decreases the disparity in the socioeconomic status of all Americans.

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Boettner, Bethany L. "The Role of Residential Segregation in Racial Health Disparities during Childhood." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1316546212.

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Koehlmoos, Tracey Lynn. "Racial Disparities in Breast Cancer Surgical Treatment and Radiation Therapy Use." Scholar Commons, 2005. https://scholarcommons.usf.edu/etd/728.

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This study explores the relationship between race and surgical treatment and radiation therapy use for localized breast cancer patients in the state of Florida in 2001. The study will be useful in raising awareness of the relationship between Black race and appropriate breast cancer treatment within the Florida Cancer Data System. The Healthy People 2010 initiatives call to eliminate racial disparities and the high placement of breast cancer on the national research agenda make this study timely and insightful for health policymakers, clinicians and other health researchers. Also, the study evaluates the effect of other health system and patient related factors such as insurance provider and rural versus urban residence, to the appropriate use of cancer therapy in order to present an up-to-date and accurate picture of the quality of breast cancer care for women in the state of Florida. The study used multivariate logistic regression modeling and chi-square distribution to compare models in order to disentangle the effects of age, rural residence, marital status and primary health insurance provider from race and to determine how these factors influenced breast conserving surgery versus mastectomy use. Further, the second research question exclusively focused on the population that received breast conserving surgery in order to examine the impact of race and the other covariates as explanatory measures of appropriate receipt of radiation therapy. The first hypothesis found that there was no statistically significant difference between Black and White women in terms of receipt of breast conserving surgery for treatment of localized breast cancer. The second hypothesis, which focused on appropriate receipt of radiation therapy following breast conserving surgery, found that there was a statistically significant interaction between Black race and Medicaid as primary health insurance provider. The study concludes by examining possible areas of improvement in data collection in the State of Florida. Also, the study contains recommendations as to previously unexplored facets of breast cancer research and breast cancer health policy that could be beneficial in the reduction of health and healthcare disparities in other geographic areas and in other diseases.

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Vedom, Julia. "Health care access and regional disparities in China." Thesis, University of Ottawa (Canada), 2008. http://hdl.handle.net/10393/25483.

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This thesis examines the access of health care facilities in nine provinces of China between the years 1989 and 2004, evaluating the effect of demographic, financial and geographic factors. Equity in social welfare has long played a major role in shaping China's national policies. However, continued pursuit of the GDP-led development orientation in China since the late 1970s has resulted in increasing urban-rural and intra- and inter-regional socio-economic disparities, raising multiple causes for concern from an equity perspective and suggesting the trends that should be closely monitored. While there is a consensus about the need and importance of access equity, little geographic research has been conducted in this area. In light of these issues, using China Health and Nutrition Survey this study addressed the following two objectives: (1) to describe the geographic and financial disparities in access to clinics and hospitals in nine provinces of China during the 1989-2004 period, and (2) to explore the demographic, socio-economic and geographic factors affecting access to health care. Results of the analysis show that between 1989 and 2004 the accessibility gap between hospitals and clinics in terms of geographic indicators has decreased, while the gap in financial accessibility has increased, making urban hospitals the least accessible facilities. Access to both hospitals and clinics in urban and rural areas is mostly conditioned by geographic factors, namely the travel method, region of residence and the availability of health care facilities. Patients who were able to reach the facilities on foot were more likely to enjoy better access than those who were not able to do so. Similarly, residents of western China (Guangxi and Guizhou) along with the provinces with higher availability of health care facilities also tended to have better potential access than their counterparts. Several important contributions essential for informing public decision- and policymaking stem from this thesis, leading to a better understanding of issues related to the accessibility of health care in nine provinces of China. While, typically, the determinants of accessibility have been attributed to the financial or demographic characteristics of patients, this research has identified geographic factors as being of the foremost importance in the accessibility of health care. This important finding provides grounds for further geographic research on accessibility issues in China. While our conceptual framework was designed for studying the accessibility of health care in China, it can be potentially applied to any country with regional, provincial or neighborhood disparities in access.

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Sirjoosingh, Candace. "Racial and socioeconomic disparities in cervical cancer survival in the United States." Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=97130.

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Within the United States, cervical cancer morbidity, mortality and survival are experienced differently among women of varying races and socioeconomic status. Non-Hispanic black women have higher rates of incidence and mortality, as compared to non-Hispanic white women.Using the Surveillance Epidemiology and End Results database, United States Census data and Area Resource Files, a survival analysis was conducted to identify socioeconomic factors related to cervical cancer survival, as well as factors that mediated the racial disparities in survival.Socioeconomic factors, measured at the US county level, that were associated with cervical cancer survival included unemployment rates, poverty level, percentage of white collar individuals, and educational attainment. An empirical search for confounders of the relationship between race and survival was conducted, and after adjustment for these confounders, non-Hispanic black women were found to have significantly poorer survival than non-Hispanic white women, with a 17% increased risk of death.
Aux États-Unis, les femmes noires non hispaniques ont des taux plus élevés d'incidence et de mortalité que les femmes blanches non hispaniques. En utilisant la base des données "Surveillance, Epidemiology and End Results," une analyse a été réalisée pour identifier les facteurs socio-économiques liés à la survie du cancer du col de l'utérus, ainsi que les facteurs qui affectent les disparités raciales en matière de survie. Les facteurs socioéconomiques communautaires qui ont été associés à la survie au cancer du col utérin incluent le taux de chômage, le niveau de pauvreté, le pourcentage d'individuels professionnels, et le niveau de scolarité. Une recherche empirique des facteurs de relation entre la race et la survie a été effectuée. Après l'ajustement de ces facteurs, les femmes noires d'origine non hispanique ont été retrouvées à avoir une risque de mortalité qui était 17% plus haut que celles des femmes blanches d'origine non hispaniques.

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Yan, Fengxia. "Racial Disparities Study in Diabetes-Related Complication Using National Health Survey Data." Digital Archive @ GSU, 2010. http://digitalarchive.gsu.edu/math_theses/90.

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The main aim of this study is to compare the prevalence of diabetes-related complications in white to the prevalence in other racial and ethnic groups in United States using 2009 Behavioral Risk Factor Surveillance System (BRFSS). By constructing the logistic regression model, odds ratios (OR) were calculated to compare the prevalence of diabetes complications in white and other groups. Compared to white, the prevalence of hypertension and stroke in African Americans were higher, while the prevalence of heart attack and coronary heart disease were lower. The Asian Americans or Pacific Islanders, African Americans and Hispanics were more likely to develop retinopathy compared to white. The prevalence of hypertension, hypercholesterolemia, heart attack, coronary heart disease, Stroke in Native Americans and “other” group were not significantly different from the prevalence in white. Asian or Pacific Islanders were less likely to experience stroke.

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Pro, George. "Racial/ethnic disparities in treatment initiation and completion among offenders with alcohol problems." Diss., University of Iowa, 2018. https://ir.uiowa.edu/etd/6626.

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Alcohol abuse is positively associated with incarceration and is the most common substance abuse problem among offenders. However, most prisons and jails do not offer alcohol treatment and only 10% of offenders who need treatment receive it. Among those who do receive treatment, alcohol-related problems following release and recidivism are drastically reduced. Guided by the Socio-Cultural Framework for Health Services Disparities, this dissertation sought to describe past and future trends of treatment utilization in correctional settings, as well as identify predictors of treatment completion among offenders with alcohol as their primary substance of abuse. Racial/ethnic disparities have been identified repeatedly throughout the criminal justice system (CJS) and include the underrepresentation of racial/ethnic minorities in treatment in prisons and jails. Therefore, racial/ethnic disparities were a primary focus of this research. Study 1 used the Treatment Episode Dataset – Admissions (1992-2014) to compare racial/ethnic differences in treatment utilized in a correctional setting (versus non-correctional settings) among treatment-seekers with alcohol as their primary substance of abuse (n=5,565,884). A higher within-group proportion of African Americans (2.4%) received treatment in a prison or jail, versus 1.2% of Whites and 1.1% of Hispanics. Using forecasted estimates from a generalized linear model (2015-2025), African American men had significantly higher odds of utilizing treatment in a correctional setting in 2025, compared to White men (adjusted odds ratio [aOR] = 1.52, 95% confidence interval [95% CI] = 1.45-1.60). No significant difference between Hispanics and Whites was identified. Study 2 used the Treatment Episode Dataset – Discharges (TEDS-D) (2006-2014) to model treatment completion with individual and system-level factors among offenders with alcohol as their primary substance of abuse (n=23,655). African Americans had 29% lower odds of treatment completion compared to Whites (aOR = 0.71, 95% CI = 0.65-0.76). African Americans and Hispanics referred to treatment by the CJS demonstrated lower odds of treatment completion, compared to Whites also referred by the CJS (aOR = 0.63, 95% CI = 0.57-0.70; and aOR = 0.85, 95% CI = 0.74-0.98, respectively). African Americans and Hispanics referred by the CJS demonstrated even lower odds of treatment completion, compared to Whites referred by any non-CJS source (aOR = 0.50, 95% CI = 0.41, 0.61; aOR = 0.74, 95% CI = 0.57-0.97, respectively). Study 3 used a reduced TEDS-D dataset (2013-2014) to investigate state-level characteristics and treatment completion (n=3,798). Whites and Hispanics were largely unaffected by state-level factors. Among African Americans, those in states where the level of alcohol consumption was high (versus low) and in states which spent a higher percent of their budget on corrections (versus lower) were less likely to complete treatment (aOR = 0.11, 95% CI = 0.02-0.55; and aOR = 0.24, 95% CI = 0.08-0.75, respectively). African Americans in states where the incarceration disparity was high between Hispanics and Whites (versus low) and in states with a high percentage of Republican legislators (versus low) were more likely to complete treatment (aOR = 4.39, 95% CI = 1.10, 17.50; and aOR = 3.88, 95% CI = 1.21, 12.44, respectively). African Americans experienced disparities in treatment services utilization and completion on multiple ecological levels. Few differences between Hispanics and Whites were identified throughout all three studies. A comprehensive outlook of future trends in treatment utilization in correctional settings provides needed perspective on the scope and size of the challenge ahead. Better understanding predictors of treatment completion among offenders may inform interventions aimed at reforming the CJS, improving correctional health services, and promoting evidence-based state legislative priorities.

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Mellerson, Michelle Nicole. "Socioeconomic disparities and asthma treatments." Thesis, TUI University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3584789.

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Asthma is the most prevalent chronic illness in the United States. Disparities in asthma treatment in the emergency department prognosticate asthma outcomes in children and adult asthma patients. The purpose of this study was to investigate the relationship between socio-economic/demographic factors (i.e., ethnicity, income level, insurance type, and location) of asthma patients and receipt of asthma treatment, evaluation, and management in emergency departments in Maryland. Methods: This study was a non-experimental research design. The representative population consisted of 146 adults and children with asthma in Maryland. One-hundred-forty-six cases with codes for management, evaluation, and treatment of mild, moderate, and severe persistent asthma symptoms were extracted from the 2009 State Emergency Department Databases (SEDD). Frequency distribution of the population by marital status, length of stay, gender, ethnicity, admission source, and admission type was displayed. The significance of ethnicity, income level, location, insurance type and management, evaluation, and treatment of mild, moderate, and severe persistent asthma was tested. Results: The number of African Americans presenting themselves to the emergency department for evaluation and management for mild persistent asthma was significantly higher than expected, X² (6, n = 107) = 17.213, p = .009. This was inconsistent with the literature which stated that African Americans and Hispanics used the emergency department more than any other ethnicity. No significance was found between location and asthma treatment, management, and evaluation; health insurance status and asthma treatment, management, and evaluation; income and asthma treatment, management, and evaluation. Gender was independent from age at admission, length of stay, number of procedures, and total charges. Conclusion: Inconsistent with the literature review the results of this study did not show significance the study variables except for relationship for ethnicity and asthma treatment, evaluation, and management.

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Lee, Jae Chul. "Health disparities in access to health care for older people with disabilities." Diss., Connect to online resource - MSU authorized users, 2008.

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Thesis (Ph.D.)--Michigan State University. Rehabilitation Counselor Education , 2008.
Title from PDF t.p. (viewed on July 2, 2009) Includes bibliographical references (p. 128-144). Also issued in print.

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Kuang, Xiaoxin, Kiana R. Johnson, Karen Schetzina, Claudia Kozinetz, and David L. Wood. "An Ecological Model of Health Care Access Disparities for Children." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5139.

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Isong, Inyang. "Early Childhood Obesity in the United States: An Assessment of Racial/Ethnic Disparities and Risk Factors." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:27201738.

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This dissertation focused on childhood obesity among preschool aged children in the United States, using data from the Early Childhood Longitudinal Study Birth Cohort. Chapter 1 examined racial/ethnic differences in preschool-aged children’s weight trajectories and identified sensitive periods at which disparities emerge, using mixed growth models and nonparametric LOESS curves. Racial/ethnic disparities in US children’s weight-status and growth trajectories emerge at different ages for different racial groups, but they are generally well established by kindergarten age. Our findings indicate that interventions designed to prevent early childhood overweight/obesity should be implemented early in the life-course. Chapter 2 assessed the contribution of behavioral and environmental risk factors to racial/ethnic disparities in preschool children’s weight status, using decomposition analyses to estimate the percent of disparity explained by individual obesity risk factors. Gaps in the prevalence of socio-economic-status (SES) accounted for a substantial part (ranging from 24.4% to 63.3%) of the explained disparities in BMI z-scores between racial/ethnic minority children and their white peers. Apart from SES and its correlates, infant weight gain during the first 9-months of life, lack of breastfeeding, early introduction of solids, and sugar sweetened beverage consumption were additional factors that played important roles in explaining racial/ethnic differences. Interventions implemented early in the life-course that target these key contributory risk factors could potentially help reduce the magnitude of racial/ethnic disparities in early childhood obesity Chapter 3 examined the effect of attending childcare on children’s BMI z-scores, employing OLS regression, as well as two quasi-experimental approaches designed to minimize the effect of selection bias and unmeasured confounding. In linear regression models, compared to children in parental care, children in non-parental childcare at 24 months had higher BMI z-scores at kindergarten entry. However, both quasi-experimental approaches revealed no significant effect of childcare attendance on children’s BMI z-score, suggesting that the link between non-parental childcare and obesity may not be causal. Previously reported associations may be confounded by unobserved family circumstances resulting in selection into different types of childcare arrangement.

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Curry, Andrea Nicole. "The Evaluation of the Relationship between Racial Health Disparities and the Patient-Provider Relationship." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6005.

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African Americans are adversely affected by health disparities due to the complexities of the patient-provider relationship. The behavioral model of health services was used as the theoretical framework to understand how individuals make healthcare utilization decisions. The purpose of the research was to evaluate how the patient-provider relationship influences inconsistent doctor visits by African American patients despite the prevalence of chronic conditions. 45 African Americans located in Shelby County, Tennessee were included in this study. A cross-sectional quantitative design was used to collect the data via an online survey. The 45 collected responses were analyzed by performing multiple linear regression, Pearson correlation, and Cronbach's ï?¡. Results of the analyses were statistically significant in proving that education level, income, gender of African Americans, and having health insurance affect the patient-provider relationship. It was determined by the statistically significant results that the patient-provider relationship had an effect on African American patients' decision to seek healthcare services and medication compliance and follow-up medical care. This information may guide the conversation within the Shelby County, Tennessee African American community regarding what role the patient-provider relationship has when addressing health disparities among African Americans.

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Okombo, Florence A. "Racial Ethnic Health Disparities: A Phenomenological Exploration of African American Adults with Diabetes Complications." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3572.

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Racial/ethnic minority groups experience a higher mortality rate, a lower life expectancy, and worse mental health outcomes than non-Hispanic in the United States. There is a scarcity of qualitative studies on racial/ethnic health disparities. The purpose of this hermeneutic phenomenological study was to explore the personal experiences, attitudes, and perspectives of 6 African American adults with chronic health issues related to diabetes through a face-to-face interview. Social cognitive theory and health belief model guided the study. The participants were recruited through purposeful sampling. The data were coded using axial and thematic coding and subsequently analyzed through phenomenological interpretive inquiry. The participants' perceived experiences were summarized in 7 themes (Beliefs and perceptions, denial, attitudes, treatment cost, neighborhood effect, juggling work and family related stress, and need for positive motivation and support). The participants' experiences with their health outcomes were influenced by internal and some external factors that were beyond their control. Social change implications include public policy makers integrating health policies that are designed for socioeconomic inequality in the neighborhood and improving health insurance company policies on treatment copays. Public health and other human services professionals can develop health intervention to assist minorities with chronic health issues to manage their disease and overcome barriers related to the disease.

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Obot, Stella S. "Health Care Disparities and Chronic Disease Burden: Policy Implications for NGOs." Digital Archive @ GSU, 2010. http://digitalarchive.gsu.edu/iph_theses/88.

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The purpose of this capstone is to develop a program to address health literacy among African American adults. The social cognitive theory and the health belief model was used to create a model of an age appropriate, culturally sensitive program with a pre and post test to improve the health literacy in this population. The Community Health Literacy Improvement Program (CHIP) is a pilot program that will consist of a four week didactic intervention focused on combating prose, document, and quantitative health illiteracy. This program will be implemented through a community based nonprofit organization. Participants who complete the CHIP program will be able to identify risk factors for chronic diseases, assess their ability to avoid chronic diseases, and be able to locate community health resources. This proposed intervention will show that community based nonprofit organizations have an important role to play in building community buy in and establishing the agency necessary for community based, culturally sensitive programs such as CHIP to succeed.

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O'Neill, Amy E. "Pathophysiology and Racial/Ethnic Disparities in the Progression of Metabolic Syndrome." Thesis, University of North Texas, 2006. https://digital.library.unt.edu/ark:/67531/metadc5310/.

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Disparities exist in the U.S. between the health status of African American and Hispanic individuals and the health status of non-Hispanic Caucasian individuals across all age groups. Those minority individuals age 55 and over are more likely to suffer from specific health disparities in areas such as diabetes, heart disease, and cancer than their white majority counterparts. Among the most common chronic disorders experienced within this age group are obesity, type II diabetes and cardiovascular disease, all three of which collectively form what has recently become known as metabolic syndrome. As of 2004, metabolic syndrome is diagnosable once criteria are clinically significant for a variety of different risk factors designated by the World Health Organization. However, like many syndromes these criteria are not stable across individuals, and leaves variability between individuals being diagnosed. It has been seen that each of the above mentioned racial/ethnic groups experience the individual risk factors at disproportionate rates, making it plausible that metabolic syndrome could be experienced in distinctly different ways depending upon racial/ethnic background. Using two nationally representative data sets, it is first largely evident that African American and Hispanic individuals are reaching higher peak rates of diabetes and cardiovascular disease much earlier in age than are non-Hispanic Caucasian individuals. The study goes on to reveals that the metabolic syndrome appears to follow one underlying progressive syndrome that begins with obesity and progresses towards heart disease. Each of the racial/ethnic groups experience significantly different progressions of the syndrome across time. Behavioral analysis found significant differences in health behaviors across the three groups; however a more pervasive lack of initiative in practicing preventive health behaviors is also present. The study achieved a higher understanding of individual differences within metabolic syndrome and insight into how and at what time in the lifespan health services can be most beneficial in providing preventive services to culturally diverse populations.

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Williams, Faustine, Nancy Zoellner, Maisha Flannel, L. Noel, J. Habif, P. Hovmand, and Sarah Gehlert. "Addressing Racial Disparities in Breast Cancer Treatment Delays: An Application of Group Model Building (GMB)." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/66.

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Jones, DeShauna D. "Habitus and Heart Health: Using Bourdieu to Interpret Socioeconomic and Racial Disparities in Physical Activity Participation." The Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=osu1254257684.

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Siegel, Sari. "Health care disparities in Maryland in the "Contract with America" era." College Park, Md. : University of Maryland, 2007. http://hdl.handle.net/1903/6887.

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Thesis (Ph. D.) -- University of Maryland, College Park, 2007.
Thesis research directed by: Public Policy. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.

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Burger, Andrew E. "A Modern Plague: U.S. Racial and Ethnic Vaccination Disparities During the 2009 H1N1 Influenza Pandemic." DigitalCommons@USU, 2018. https://digitalcommons.usu.edu/etd/7279.

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On June 11, 2009 the World Health Organization announced that a novel strain of H1N1 influenza was being classified a Phase 6 pandemic, the highest level of alarm indicating that the disease was present worldwide and its spread was inevitable. While seasonal influenza epidemics occur annually, the 2009 H1N1 strain was the first novel pandemic influenza since the 1968 Hong Kong flu. The 2009 H1N1 pandemic provides a case study of how the U.S. population responded to an emergent and potentially lethal infectious disease. The richness and variety of public health data presents an opportunity to examine predictors of vaccination among men and women from different racial/ethnic groups. Because vaccination is often the most effective way to prevent influenza, it is important to understand the predictors of low vaccination uptake during the H1N1 pandemic to better prepare for future novel outbreaks of influenza. Through a series of three research papers, my dissertation provides a comprehensive examination of the ways that race, ethnicity and gender affected H1N1 vaccination behavior. Paper 1 explores the diversity of the U.S. Hispanic population by estimating H1N1 vaccination uptake among U.S-born and foreign-born Hispanics. In Paper 2, I shift my focus to H1N1 vaccination disparities between non-Hispanic whites and non-Hispanic blacks in the U.S. This paper further explores racial disparities in vaccination by examining intersections with gender and analyzing the influence of attitudes and beliefs about the H1N1 vaccine. In Paper 3, I provide a more detailed account of the socioeconomic and attitudinal mechanisms through which race, ethnicity and gender influence H1N1 vaccination. My research confirms large racial/ethnic disparities in H1N1 vaccination and identifies mechanisms amenable to policy change that could reduce the disease burden of a future influenza pandemic.

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Kim, Uriel. "Health Services Access and Cancer Disparities Among Low-Income Ohioans." Case Western Reserve University School of Graduate Studies / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=case1586799590015602.

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Villarreal, Cesar. "Health Disparities among Sexual Minorities: Trends of Health Care and Prevalence of Disease in LGB Individuals." Thesis, University of North Texas, 2018. https://digital.library.unt.edu/ark:/67531/metadc1248527/.

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The primary focus of the current study was to identify health disparities between sexual minority subgroups by examining differences of health indicators in lesbians, gay men, and bisexual individuals, and compare these to their heterosexual counterparts. Data was drawn from the National Health and Nutrition Examination Survey (NHANES), and variables examined in sexual minorities were related to health care access and utilization, risky health behaviors, and overall disease prevalence and outcomes. Findings suggest there are still some current health disparities in terms of insurance coverage, access to medical care, substance use, and prevalence of certain health conditions. However, a trend analysis conducted to examine three NHANES panels, suggests a mild improvement in some of these areas. Further findings, discussion, limitations of the study, current implications, and future directions are addressed.

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Reiter, E. Miranda. "The Impact of Social Support, Psychosocial Characteristics, and Contextual Factors on Racial Disparities in Hypertension." Thesis, Utah State University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3683497.

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Hypertension is a serious medical condition. Although men and women of all racial groups in the US suffer from high blood pressure, black women have the highest rates of hypertension. For instance, the age-adjusted prevalence of hypertension among black women ages 20 and over is 44.3, compared to 28.1 among white women, 40.5 among black men, and 31.1 among white men.

Past research has focused on SES and behavioral factors as potential explanations for blood pressure disparities between black and white women. But, even after controlling for such factors, considerable disparities remain. The goal of this research is to examine cultural and social factors that have been shown to increase blood pressure. Specifically, I examine social support, psychosocial characteristics, and contextual factors associated with race/ethnicity and hypertension, in hopes of explaining some of the disparities in high blood pressure between black and white women.

Using data from Waves I, III, and IV of the National Longitudinal Study of Adolescent Health (Add Health), I estimated a sequence of multinomial logistic regression models predicting prehypertension and hypertension in young adulthood. Cross-sectional models show that racial disparities in hypertension remain after controlling for social support, psychosocial characteristics, and contextual factors. In fact, the only covariate that substantially reduced the racial disparity in hypertension was body mass index (BMI), a fairly reliable measure of body fatness for most people. I also estimated a set of multinomial logistic regression models predicting odds of prehypertension and hypertension by adolescent and cumulative social support, as well as psychosocial, contextual, and behavioral factors. These models were included to determine if early life and/or cumulative factors and conditions would help explain racial blood pressure disparities not explained by adulthood factors. Findings show that none of the early life or cumulative social support, psychosocial, contextual, or behavioral factors helped to explain racial differences in prehypertension or hypertension. Even after controlling for these factors, black women are still 1.18 times more likely than white women to have prehypertension and over two times more likely to suffer hypertension.

Indeed, my findings indicate that, of the factors included in all these models, only race, age, and BMI were significant predictors of blood pressure. Also, BMI was the only factor to explain some of the disparities between black and white women. These results are similar to other studies that have examined racial health disparities, suggesting that simply being a black woman in US society may be unhealthy. The health effects of racism, discrimination, and other sources of stress faced disproportionately by black women are not easily measured by social science research, which is possibly why racial disparities in blood pressure have yet to be explained. Future research should also explore possible epigenetic effects introduced by the health conditions experienced by previous generations, as well as the influence of prenatal and early life environments.

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James, Tiffany. "Assessing Racial Differences in U.S. Prenatal Care, Gestational Weight Gain, and Low Birthweight." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5205.

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The benefits of prenatal care (PNC) are extensively documented; however, controversy surrounds the extent to which benefits are experienced among different racial groups. Determining whether PNC influences positive birth outcomes and if advantages differ by race is pertinent to attaining positive health outcomes. The purpose of this study was to examine the relationship between gestational weight gain (GWG), low birthweight (LBW), and PNC while weighing racial differences. The theoretical foundation was the motivation-facilitation theory of PNC access. Research questions were designed to (a) determine if there was a significant association between GWG and LBW, (b) determine if PNC had a mediating role if GWG was found to be associated with LBW, and (c) determine if PNC was a mediator and if that role differed between races. A quantitative, deductive correlational analysis was carried out using a retrospective observational approach. Spearman correlation showed that the relationship between GWG and LBW was significant (rs = 0.14, p < .001). Binary logistic regression was used for analysis and showed that the overall model was significant, Ï?2(12) = 50.29, p < .001, and that maternal age, race, marital status, GWG, education, body mass index (BMI), cigarette use, and gestational diabetes significantly affected the chances of LBW. Baron and Kenny's mediation analysis supported partial mediation for American Indian or Alaskan Native and Asian or Pacific Islander races and showed that PNC was significantly associated with birthweight. Based on these findings, providers can aim to implement motivational factors to increase the facilitation and use of PNC to decrease adverse birth outcomes and increase population health.

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Pande, Aakanksha. "With or Without: Empirical Analyses of Disparities in Health Care Access and Quality." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10117.

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The existence of unfair differences or disparities in access to and quality of health care is well known. However, the nature of disparities at different stages of the health seeking pathway and interventions to reduce them are less clear. Applying the tools of statistics and quasi experimental design-- interrupted time series, propensity score matching, hierarchical models---we can analyze how care is accessed in low, middle and high income countries and assess for disparities. The results are sometimes surprising and underscore the need to generate context specific evidence to ensure targeting of programs. My first paper evaluates the impact of a controversial policy, mandating of health insurance, on reducing disparities in health care access and affordability. Using longitudinal survey data from five states in USA (2002-2009), I show that living in MA, where health insurance is mandated, results in a higher probability of being insured and having a personal doctor and lower probability in forgoing care due to costs as compared to similar border states. The beneficial effect of the mandate is greatest in traditionally "disadvantaged" groups defined by race, income, education or employment status. My second paper examines gender disparities in access to medicines in sub Saharan Africa--Uganda, Kenya, Nigeria, Ghana, Gambia. Using medicines specific survey data, I construct a novel seven stage access to medicines pathway and assess gender disparities along it applying the Institute of Medicine framework. Contrary to prevailing belief, I find few gender differences in unadjusted outcomes which cease to be significant on controlling for health status and country characteristics. My third paper assesses disparities by educational attainment in process and outcomes of care. I use unique data extracted from an electronic medical record of diabetic patients in Mexico City. Using a matching algorithm, I control for only differences in health need and find few significant differences in processes and outcomes of care. The unmatched traditional regression based risk adjustments tend to overestimate the significance and magnitude of the association. The three papers demonstrate the need to use more sophisticated statistical tools to appropriately measure disparities and ensure the effectiveness of health programs.

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Dissertations / Theses on the topic 'Racial health care disparities'

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