health disparities

Introducing the Language Access Portal

By Kelli Carrington, M.A.
Director, Office of Communications and Public Liaison
National Institute on Minority Health and Health Disparities

NIMHD Office of Communications and Public Liaison Director Kelli Carrington

Kelli Carrington, M.A.

Many of us know what it’s like to feel overwhelmed during a doctor’s visit by information about health conditions, medicines, and behavior recommendations. For patients who don’t speak or understand English fluently, the situation can be more than overwhelming—it can be dangerous. Patients with limited English proficiency (LEP) are nearly three times more likely to have an adverse medical outcome.1

Language is one of the most significant barriers to health literacy, the ability to understand the basic health information needed to make good health decisions. Patients who lack health literacy are often unable to read or understand written health information or to speak with their healthcare providers about their symptoms or concerns. These patients are less likely to follow important health recommendations or be able to give informed consent.2

According to the U.S. Census Bureau, more than 1 in 5 U.S. residents don’t speak English at home. Of that group, about 4 in 10, or 25 million people, have limited English proficiency.3 Many people with limited proficiency also live in households where no one speaks English well, meaning there isn’t a translator readily available to accompany them to doctor’s visits.

The National Institute on Minority Health and Health Disparities (NIMHD) is committed to addressing these language barriers and to improving the health literacy and lives of everyone living in America. We’re excited to announce a new tool, the Language Access Portal, as a resource for the NIMHD research community, public and community health professionals, healthcare providers, and others who work with health disparity populations with LEP. The portal improves access to cross-cultural and linguistically appropriate health information produced by the National Institutes of Health (NIH), NIMHD, and other federal agencies.

The Language Access Portal pulls together health resources from across NIH in selected languages, particularly those languages spoken by populations experiencing significant health disparities. As we launch, the portal includes information in Spanish, Hindi, Tagalog, Korean, Chinese, Japanese, and Vietnamese. The portal currently has language resources for the following areas where health disparities have been identified:

The Language Access Portal is an important tool to help people working with LEP populations provide the information necessary for patients to make important health decisions. The portal will continue to evolve and incorporate new resources from NIMHD, NIH and other government agencies as they become available, so keep checking back. By working together and using tools like the Language Access Portal, we can begin to tackle these communication barriers and improve the health of every resident of this country.

 

References

  1. Divi, C., Koss, R.G., Schmaltz, S.P., Loeb, J.M. (2007) Language Proficiency and Adverse Events in US Hospitals: a pilot study. Int J Qual Health Care. 19 (2): 60-67.
  2. Lee, J.S., Pérez-Stable, E.J., Gregorich, S.E. et al. (2017). Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English ProficiencyJ GEN INTERN MED. doi:10.1007/s11606-017-3983-4
  3. U.S. Census Bureau. Table S1601: 2011-2015 American Community Survey 5-Year Estimates.

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Addressing Mental Health in African Americans Through FAITH

By Dr. Tiffany Haynes, Ph.D.
Assistant Professor, Department of Health Behavior and Health Education
Fay W. Boozman College of Public Health
University of Arkansas for Medical Sciences, Little Rock, AR

Rural African Americans are disproportionately exposed to numerous stressors, such as poverty, racism, and discrimination,1–that place them at risk for experiencing elevated levels of depressive symptoms.6 Elevated levels of depressive symptoms can lead to a host of negative outcomes, including poor management of chronic illnesses (e.g., hypertension, diabetes), poor social and occupational functioning, and development of clinical depression.7 Although effective treatments for decreasing depressive symptoms exist, structural barriers (e.g., lack of available services, transportation) and perceptual barriers (e.g., stigma, fear of misdiagnosis) impede the use of traditional mental health services within these communities, resulting in a significant unmet psychiatric need. Failure to develop culturally appropriate strategies to provide adequate, timely care to rural African Americans can result in a significant public health crisis.

Dr. Tiffany Haynes, Ph.D.

Dr. Tiffany Haynes, Ph.D.

African American churches have been identified as potential venues for providing depression education and treatment for rural African Americans.8 Within the African American rural community, churches represent a key portal through which as much as 85% of the community can be reached.9 Churches have been used to address physical health outcomes in those communities, but few have focused primarily on addressing mental health outcomes10-11. Through the NIMHD-funded project entitled “Faith Academic Initiatives to Transform Health (FAITH) in the Delta,” our partnership, consisting of faith community leaders and University of Arkansas for Medical Science researchers, conducted formative work in the Arkansas Delta. Data suggested that community members consider elevated depressive symptoms to be a significant unmet need. Furthermore, community members suggested that attempts to improve depressive symptoms should do the following:

  1. Provide education about depressive symptoms. Recognizing when depressive symptoms become a clinical problem is the first step toward receiving adequate treatment. However, rural African Americans report difficulties in differentiating between normal sadness and clinically significant depressive symptoms. Providing education about depressive symptoms allows rural African Americans to make informed treatment decisions.
  2. Address the role that stress from social inequities plays in the development and maintenance of depressive symptoms. Rural African Americans correctly realize that prolonged exposure to stress caused by social inequities is a significant factor in the development and maintenance of depressive symptoms. Treatments that conceptualize depressive symptoms as normal reactions to stress are more culturally acceptable in rural African American communities.
  3. Find ways to increase social support for those experiencing depressive symptoms. Stigma is a significant concern in rural communities. Rural African Americans experiencing depressive symptoms tend to socially isolate themselves, which, in turn, can worsen depressive symptoms.
  4. Provide mental health interventions in community-based settings. Residents suggest that offering mental health services in community settings, such as churches, would allow residents to receive treatment in less stigmatizing places and improve access to mental health care.

    (from left to right): Pastor Johnny Smith, Community PI; Dr. Tiffany Haynes, Academic PI; Dr. Karen K. Yeary, PhD, Academic Co-PI; and Pastor Jerome Turner, Community PI.

    From left to right: Pastor Johnny Smith, Community PI; Dr. Tiffany Haynes, Academic PI; Dr. Karen K. Yeary, PhD, Academic Co-PI; and Pastor Jerome Turner, Community PI

Using this data as a base, researchers worked closely with the faith community to culturally adapt an evidence-based behavioral activation intervention for use with rural African American churches. This eight-session behavioral activation intervention, REJOICE (Renewed and Empowered for the Journey to Overcome in Christ Everyday), was adapted to include faith-based themes, scripture, and other aspects of the rural African American faith culture (e.g., Bible studies, interweaving faith-based messages throughout the intervention materials).

Currently, we are testing the effectiveness of REJOICE and obtaining pilot data about the best ways to implement this intervention in rural African American churches. Collecting data from this project is the first step in providing timely and appropriate care to high-need and underserved communities.

 

References

  1. Harris, R. P., & Worthen, D. (2003). African Americans in rural America. In D. L. Brown & L. E. Swanson (Eds.), Challenges for rural America in the twenty-first century (pp. 32-42). University Park, PA: The Pennsylvania State University Press.
  2. U.S. Department of Agriculture, Economic Research Service (2016). Rural Poverty and Well-Being: Geography of Poverty. Retrieved from https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/
  3. Fitchen, J. M. (1992). On the edge of homelessness: rural poverty and housing insecurity. Rural Sociology, 57, 173-193.
  4. Kusmin, L. (Ed.). (2012). Rural America at a glance, 2012 edition. Washington, DC: U.S. Department of Agriculture, Economic Research Service.
  5. Odom, E. C., & Vernon-Feagans, L. (2010). Buffers of racial discrimination: links with depression among rural African American mothers. Journal of Marriage and the Family, 72, 346-359.
  6. Kusmin, L. (Ed.). (2011). . Rural America at a glance, 2011 edition. Washington, DC: U.S. Department of Agriculture, Economic Research Service.
  7. Mays, V. M., Cochran, S. D., & Barnes, N. W. (2007). Race, race-based discrimination, and health outcomes among African Americans. Annual Review of Psychology, 58, 201-225.
  8. Taylor RJ, Chatters LM, Levin J. Religion in the Lives of African Americans: Social, Psychological, and Health Perspectives. Thousand Oaks, CA: Sage Publications, 2004.
  9. Reeves RR, Adams CE, Dubbert PM, Hickson DA, Wyatt SB. Are Religiosity and Spirituality Associated with Obesity Among African Americans in the Southeastern United States (the Jackson Heart Study)? J Relig Health. 2011.
  10. DeHaven MJ, Hunter IB, Wilder L, Walton JW, Berry J. Health programs in faith-based organizations are they effective? Am J Public Health. 2004; 94(6): 1030-6. 1448385
  11. Hankerson, Sidney H., and Myrna M. Weissman. “Church-based health programs for mental disorders among African Americans: a review.” Psychiatric Services 63.3 (2012): 243-249.
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Apply Now to the 2017–2018 NIH Medical Research Scholars Program

By Eliseo J. Pérez-Stable, M.D.
Director, National Institute on Minority Health and Health Disparities

The National Institutes of Health (NIH) Medical Research Scholars Program (MRSP) is an excellent research enrichment opportunity for promising students from diverse backgrounds to gain real-life experience in NIH laboratories and patient care areas. NIMHD is proud to participate with other NIH Institutes and Centers in the MRSP. Our goal is to introduce the MRSP to medical, dental, and veterinary students from diverse racial and ethnic backgrounds and encourage them to consider biomedical research as a career.

A medical researcher at work.

A medical researcher at work.

The U.S. population continues to increase in diversity, and there is an urgent need to ensure that the scientific talent which is key to our nation’s success is nurtured, recognized, and supported across all demographic groups. We need more researchers from diverse backgrounds to contribute minority perspectives and priorities to the research agenda, and advance the likelihood that underserved or health disparity populations participate in and benefit from health research.

However, minorities are seriously underrepresented in the biomedical workforce. In a recent study of U.S. citizens applying for investigator-initiated NIH research funding, African Americans were 13 percentage points less likely to receive awards, compared with Whites. African Americans/Blacks, American Indians and Alaska Natives, Hispanics/Latinos, and Native Hawaiians and other Pacific Islanders make up a disproportionately small component of the NIH Principal Investigator (PI) pool.

MRSP works to address this deficit in the research workforce by providing a comprehensive, year-long residential program designed to attract the most creative, research-oriented medical, dental, and veterinary students to the NIH intramural campus in Bethesda, Maryland. Student scholars in their second, third, or fourth year of study engage in a closely mentored basic, clinical, or translational research project that matches their research interests and career goals.

150930_dr_perez-stable_ps2_032_medIn addition to pursuing a rigorous research agenda, MRSP scholars participate in career development activities, lectures, journal club seminars, patient rounds, and clinical research coursework. They also highlight their research in formal presentations to the NIH community and at professional conferences. Each scholar is assigned an advisor who provides guidance in defining a well-articulated career development plan and selecting a dedicated NIH research mentor. Mentors are full-time NIH investigators with established and successful basic, translational, or clinical research programs.

The mentorship of students and early-career scientists is essential to professional success and the future of the biomedical research enterprise as a whole. The availability and quality of mentoring support for graduate students and newly graduated doctorates is important to increasing the proportion of underrepresented minority students who will ultimately obtain an independent position in a research university, medical school, or independent research institute, and finally, successfully compete for R01 grants.

As part of NIH’s mission to train the next generation of clinician-scientists and biomedical researchers, this program is designed for U.S. citizens and permanent residents currently enrolled in an accredited medical, dental, or veterinary program who have completed their core clinical rotations. This does not preclude students with strong research interests from applying before they complete their clinical rotations. Medical and osteopathic students may participate after completing their first year of clinical rotations (i.e., third year of medical school). Dental and veterinary students may participate in the MRSP after completing their second or fourth year of study, due to the integrated nature of the third and fourth (clinical) years.

MRSP scholars experience the full continuum of biomedical research—the bench, the bedside, between the two, and beyond. So this is a comprehensive, integrated, rich opportunity for students ready to build a solid foundation for their careers in biomedical research.  I encourage students who are ready to take this competitive, yet rewarding next step to apply.

Applications for the 2017–2018 program will be accepted from October 1, 2016, through January 13, 2017. Interviews will be held in early March 2017, and selections will be announced in mid-March.

Visit the NIH MRSP website at http://cc.nih.gov/training/mrsp/index.html to learn more and submit your online application.

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Health Disparities Among American Indians and Alaska Natives: Enormous Hurdles and Opportunities to Advance Health Status

By Linda Burhansstipanov, M.S.P.H., Dr.P.H.
Founder, Native American Cancer Research Corporation and President, Native American Cancer Initiatives, Inc., Pine, Colorado

Linda U. Krebs, RN, Ph.D., AOCN, FAAN
Associate Professor (retired), College of Nursing, University of Colorado at Denver, Anschutz Medical Campus

American Indians and Alaska Natives (AI/ANs) have long experienced lower health status than other U.S. populations do. AI/ANs born in 2011 have a lower life expectancy than all other U.S. populations (73.7 years vs. 78.1 years).[1] The poverty level among AI/ANs is nearly twice that of the overall U.S. population, and only half as many AI/ANs have health insurance.

linda-b-1

Dr. Linda Burhansstipanov

The socioeconomic conditions where people live and work have a substantial influence on health, and effects are cumulative over a lifetime.[2],[3] In the United States, educational attainment and income are the indicators most commonly used to measure the effect of socioeconomic status on health.3 Compared with other populations, AI/ANs are more likely to have lower socioeconomic status and to live in poverty, leading to less access to cancer prevention and screening and other healthcare services. Additionally, 20 percent of AI/ANs have not completed high school, compared with 8 percent of non-Hispanic Whites. Not completing high school has been associated with unhealthy and risk-taking behaviors.

Adult AI/ANs have behaviors and co-morbidities that increase their risk for cancer and other chronic conditions. They are more likely to be obese, use commercial tobacco, and have diabetes or high blood pressure.[4] Centers for Disease Control and Prevention (CDC) data reported that more than ¼ (29.5 percent) of AI/ANs reported having no healthcare provider, compared with 18.9 percent for whites and 24.2% of AI/ANs report having no healthcare coverage as compared with 12.5 percent for whites.[5]

 

Dr. Linda U. Krebs

Frequently, AI/ANs are also physically inactive. For example, one third of participants in the Education and Research Towards Health Study did not meet current physical activity recommendations; a high proportion were completely sedentary during leisure time.[6]

The Indian Health Service (IHS) reported that AIAN cancer screening rates were significantly lower than in the overall population, with only 59 percent receiving cervical screening, 48 percent breast screening, and 37 percent completing colorectal screening, leading to increased risk of late diagnosis and decreased survival from cancer.[7]

 What does this mean for AI/ANs? These data tell us we need:

  • Tobacco prevention programs and interventions, starting early with pregnant mothers as well as elementary school students
  • Tobacco control and cessation programs targeting adolescents and adults
  • Physical activity/exercise programs, starting with pregnant mothers
  • Environmental safety programs (e.g., safe well water, pollution and contamination reduction)
  • Cancer screening programs
  • Cancer survivorship programs, including resources that are culturally relevant for AI/AN cancer survivorship plans
  • Palliative care and end-of-life programs that are culturally and geographically relevant
  • Genetic studies on molecular markers or alleles that may contribute to or interfere with cancer medicines and treatments
  • Clinical trial recruitment and retention protocols that address barriers to participation (e.g., high blood pressure, cost of medications, lengthy travel to in-person clinic sessions)

Although AI/ANs continue to struggle with health inequities, they have many strengths. AI/ANs need interventions that build upon these strengths rather than repeatedly focusing on weaknesses. This community has survived hundreds of years of invasion and has the potential to continue to thrive as strong Native Peoples. Their traditions honor and respect their elders and families (despite historical trauma and community dysfunction). Their communities have strong foundations and emphasize the need to be healthy again like their ancestors by continuing to use native languages, consuming traditional foods, reserving tobacco for ceremonial uses only, and taking part in daily prayers, healing rituals (e.g., sweat lodges), and formal ceremonies (e.g., Green Corn, Stomp Dance, Sun Dance) as part of organized religions. These strengths affect AI/AN spirits, minds, emotions, bodies, and social interactions and contribute to the balance of these for health and wellness.

References

[1]     IHS. IHS fact sheets. Indian Health Service website. https://www.ihs.gov/newsroom/factsheets/disparities/ Published 2016.

[2]     Beckles GL, Truman BI, CDC. Education and income—United States, 2009 and 2011. MMWR Suppl. 2013; 62(3): 9-19.

[3]     CDC. CDC health disparities and inequalities report—United States, 2013. MMWR Suppl. 2013; 62(3): 1-187. http://www.cdc.gov/MMWR/pdf/other/su6203.pdf

[4]     Yurgalevitch SM, Kriska AM, Welty TK, Go O, Robbins DC, Howard BV. Physical activity and lipids and lipoproteins in American Indians ages 45-74. Med Sci Sports Exerc. 1998; 30(4): 543-549.

[5]     Cobb N, Espey D, King J. Health behaviors and risk factors among American Indians and Alaska Natives, 2000-2010 [published online April 22, 2014]. Am J Public Health. 2014; e1-e9. doi:10.2105/AJPH.2014.301879.

[6]     Duncan Glen E, Goldberg, Jack, Buchwald, Dedra, Wen, Yang and Henderson, Jeffrey A. Henderson. Epidemiology of Physical Activity in American Indians in the Education and Research Towards Health Cohort. American Journal Preventive Medicine, 2009. December 37(6): 488-494. Doi: 10.1016/j.amerpre.2009.07.13

[7]     https://www.ihs.gov/default/assets/File/GPRA/2010_12AreaReport_FINAL.pdf (cited   11/21/2016)

 

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Welcome to NIMHD Insights, the New NIMHD Blog

By Eliseo J. Pérez-Stable, M.D.
Director, NIMHD

At the one-year anniversary of my appointment as director of NIMHD, I’m excited to welcome you to our new blog, NIMHD Insights.

NIMHD leads scientific research in two distinct but overlapping areas: minority health and health disparities. But first of all, what do these terms mean?

Minority health concerns the health of the five U.S. racial and ethnic minorities who have historically faced discrimination and social disadvantage. These groups are defined by the U.S. Census and include African Americans/Blacks, Latinos/Hispanics, Asians, American Indians/Alaska Natives, and Native Hawaiians/other Pacific Islanders. All of these populations are usually not included as participants of all types of biomedical research and most are also underrepresented as members of the scientific workforce. At NIMHD, we are committed to addressing health issues within each of the minority groups independent of whether the outcome is worse, better or similar to that of the White comparison group. We value research that emphasizes mechanisms by which health differs within these race/ethnic groups, as well as comparisons to each other and Whites.

Health disparities are differences in health outcomes that negatively affect racial and ethnic minorities, persons of less privileged socioeconomic status, and underserved rural populations. All of these persons have historically been subjected to system and individual discrimination that results in social disadvantage and leads to worse health outcomes. NIMHD is focusing on outcomes that reflect a higher incidence/prevalence of diseases, higher or premature mortality from specific causes, a higher burden of illness as reflected by global measures such as disability-adjusted life years (DALYs) and worse results on standardized measures of function, well-being or symptoms. NIMHD postulates that the mechanisms that lead to these health disparities have determinants in the behavioral, biological, social, environmental, and clinical health care system that results in these worse outcomes. Understanding these mechanisms is precisely what will lead to development of interventions to reduce health disparities.

Although social disadvantage is at the core of factors that result in health disparities, it is not the only cause. Behavior and lifestyle affect individual and social outcomes especially in interactions with the biological factors of each person. For example, stress associated with early life adverse events may trigger biological mechanisms that may lead to chronic diseases in adults and this has great implications of how we attend to the health of children. Known carcinogen exposure such as tobacco smoke has an increased risk of causing lung cancer in some populations by race/ethnic category and may help us understand different factors that cause cancer, which would not be possible if only one race/ethnic group was included. Poor persons living in one urban environment appear to live an average of four years more than poor people in a different urban environment and this emphasizes the importance of place and systems in the wellbeing of the most vulnerable members of society. Treatment outcomes for persons with diabetes varies by socioeconomic status, race/ethnicity, and health literacy; interventions need to be attentive to these differences. Understanding the factors that explain these observations will advance our knowledge of minority health and health disparities. Health disparities research seeks to understand the causes and effects of these differences and to use this knowledge to determine the best approaches to improve health outcomes in affected populations.

NIMHD shares and interprets minority health and health disparities research findings, fosters innovative collaborations and partnerships, spearheads NIH’s efforts to increase the racial and ethnic diversity of the scientific workforce, and promotes the inclusion of minorities in clinical trials and registries. “Inclusion” of minorities in and of itself is not an issue of minority health or health disparities. Rather, it is an issue of social justice and good science that clinical studies need to have diverse populations that represent today’s American demographics.

This blog will feature posts by me and NIMHD research and program staff, along with guest contributors from within and outside NIH who represent the many disciplines that contribute to minority health and health disparities. Topics will look at the Institute’s research priorities and programs, scientific discoveries, and research policies and practices that impact program operations, among other related areas.

I look forward to engaging with you to share new insights and raise intriguing questions that encourage scientific discussion as we work to build an America in which all populations will have an equal opportunity to live long, healthy, productive lives.

Visit www.nimhd.nih.gov to learn more about NIMHD and subscribe to our blog.

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