Hortensia Amaro, Ph.D.  - Keynote Lecturer - 9th Annual Summer Public Health Research Institute and Videoconference on Minority Health - June 9-13, 2003
9th Annual SPHRIMH

The University of North Carolina at Chapel Hill
Program for Ethnicity, Culture, and Health Outcomes (ECHO)
Oscar A. Barbarin, III, Ph.D.  - Keynote Lecturer - 8th Annual Summer Public Health Research Institute and Videoconference on Minority Health - June 17-21, 2002
8th Annual
 Your guide to minority health-related activities at UNC-CH
and elsewhere 

10th Annual Summer Public Health Research Institute and Videoconference on Minority Health

Suggested readings, abstracts, bibliography, citations, links
Click on the instructor's name to view the corresponding materials

Monday, June 21, 2004
Congressional Minority Caucus Panel
Tuesday, June 22, 2004

Bill Jenkins, Ph.D, M.P.H. [bio]   [slides]
Jennie R. Joe, Ph.D., M.P.H., M.A [bio]  [slides]
Wednesday, June 23, 2004

Gilbert C. Gee, Ph.D. [bio] [slides]
Judith B. Bradford, Ph.D.  [slides]
Thursday, June 24, 2004

Ana F. Abraido-Lanza, Ph.D.[bio]  [slides]
Jerome Wilson, M.A, Ph.D [bio]  [slides]

Monday, June 21, 2004

Congressional Minority Caucus Panel

Hon. Donna M. Christensen [bio]
Hon. Michael Honda
Hon. Frank Pallone [bio]
Hon. Hilda L. Solis [bio]

Suggested Readings :

  1. Press Release from the Office of the V.I. Congressional Delegate: Democrats Announce Health Care Equality and Accountability Act of 2003 (Word document; 31KB)
  2. House and Senate Democrats announce principles for addressing racial and ethnic health disparities (Word document; 28KB)
  3. Short detailed summary of the Healthcare Equality and Accountability Act HR 3459/ S 1833 (Word document; 2 pages; 35KB)
  4. Statements by Senator Tom Daschle (South Dakota) (link), Representative Nancy Pelosi (California) (press release 10/21/2003) (press release 4/4/2004)
  5. Summary of the Healthcare Equality and Accountability Act HR 3459/ S 1833 (Word document; 33 pages; 156KB)
  6. List of Institute of Medicine Reports on Minority Health
  7. Health Care Equality and Accountability Act of 2003 (pdf; 432 pages; 779 KB)
  8. Congressional Research Service Memorandum to Hon. Donna M. Christensen: The Healthcare Equality and Accountability Act and the Closing the Health Care Gap Act of 2004 (Word document; 300KB)
  9. Letter to Honorable Bill Frist, MD and Honorable Tom Daschle
  10. Organizations Supporting HR 3459 (Rep. Cummings)/ S 1833 (Sen. Daschle) The Healthcare Equality and Accountability Act of 2004 (Word document; 34KB)

Tuesday, June 22, 2004

Is Health Care Entitlement a Solution to the Problem of Health Disparities for American Indians/Alaska Natives?

Jennie R. Joe, Ph.D., M.P.H., M.A [bio]

Abstract :

The evidence for various racial and ethnic health disparities continues to grow while promising innovative solutions to eliminate these disparities continue to be defined. While the progress toward implementing these solutions is slow, there appears to be consensus that any sustainable solution to eliminating health disparities requires building alliances and strengthening partnerships with the racial and ethnic communities experiencing these problems.

The need to improve the health status of American Indians/Alaska Natives has been a longstanding goal pursued by tribal communities, their advocates, and the federal Indian Health Service. One objective to achieve this goal has involved the realization of self-determination, a policy change that has encouraged tribes to take over management of their own health care delivery systems. Unlike other minority populations in the United States, American Indians and Alaska Natives have a unique government-to-government relationship with the federal government, an arrangement that often serves as the only mechanism to bring about policy change and/or to bring additional resources to help create change. At the present, tribes are supporting the reauthorization of key health legislation that includes a provision to initiate a study to examine health care entitlement. It is against this backdrop that this presentation will discuss the key health disparities faced by American Indians/Alaska Natives, the funding of health care, and the congressional route advocated for resolving some of these health disparities.

Learning Objectives:

  1. Gain an understanding of how American Indians/Alaska Natives receive their health care as well as the role of the federal government
  2. Gain some knowledge about the historical and political history that has impacted the health disparities faced by American Indians/Alaska Natives.
  3. Gain some insight into solutions being tried to target some specific preventable health problems

Bibliographic Citations :

  1. Dixon, Mim and Yvette Roubideaux (eds). (2001). Promises to Keep: Public Health Policy for American Indians and Alaska Natives in the 21st Century. Washington, DC: American Public Health Association. For updates on the reauthorization progress for the Indian Health Care Improvement Act, (H.R. 2440), go to the website of the National Indian Health Board: www.nihb.org
  2. Joe, Jennie R. (2003). The Rationing Healthcare and Health Disparity for American Indians/Alaska Natives. Pp.528-551 in Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: Institute of Medicine. National Academy Press.
  3. Indian Health Service (2000-2001). Trends in Indian Health. Rockville, Md: USDHHS. USPHS, Indian Health Service.
  4. Meriam, Lewis (1928). The Problem of Indian Administration: A Survey made at the Request of the Honorable Hubert Work, Secretary of Interior. Baltimore, MD: Johns Hopkins University Press (published for the Brookings Institution). February 21.
  5. Office of Technology Assessment (OTA). (1986). Indian Health Care. Washington, DC: US Government Printing Office.
  6. Rhodes, Everett R. (ed). (2000). American Indian Health: Innovations in Health Care, Promotion, and Policy. Baltimore: Johns Hopkins University Press.

Wednesday, June 23, 2004

Neighborhoods and Health Disparities
[slides] (will be posted at about 12:30pm EDT)

Gilbert C. Gee, Ph.D. [bio]

Abstract :

The goal of this presentation is to provide a framework for understanding how neighborhoods may explain ethnic disparities in health. We begin with a brief overview of the patterns of residence and settlement by ethnicity, including a discussion of the major concepts related to these patterns (segregation, ethnic enclaves) and the processes that may have led to their development (e.g. institutionalized racism). We then examine the relationship between residence and health, focusing in particular on the neighborhood processes that may lead to differential outcomes by ethnicity. In particular, we will focus on neighborhood resources, community stressors, and environmental justice. Finally, we will consider the extent to community redevelopment provides a potential avenue to shape the health of all communities and a way to eliminate health disparities.

Learning Objectives:

  1. Understand how the psychosocial conditions of neighborhoods may contribute to health.
  2. Examine how patterns of residential location vary by race.
  3. Articulate the relationship between residential segregation, neighborhood risk and resiliency, and health.

Bibliographic Citations :

  1. Acevedo-Garcia,D. (2003) Future directions in residential segregation and health research: a multilevel approach. American Journal of Public Health, 93, 215-221.
  2. Diez-Roux,A.V. (2000) Multilevel analysis in public health research. Annual Review of Public Health, 21, 171-192.
  3. Gee GC. (2002) A Multilevel analysis of the relationship between institutional and individual racial Discrimination and health status. American Journal of Public Health. 92, 615-623
  4. Geronimus,A.T. (2000) To mitigate, resist, or under: addressing structural influences on the health of urban populations. American Journal of Public Health, 90, 867-872.
  5. LaVeist,T.A. (1993) Segregation, poverty, and empowerment: health consequences for African Americans. Milbank Quarterly, 71, 41-64.
  6. Massey,D. & Denton,N.A. (1993) American Apartheid: Segregation and the Making of the Underclass. Harvard University Press, Cambridge.
  7. Northridge ME, Sclar ED, Biswas P. (2003) Sorting out the connections between the built environment and health: a conceptual framework for navigating pathways and planning healthy cities. Journal of Urban Affairs, 80, 556-568.
  8. Pastor,M., Sadd,J. & Hipp,J. (2001) Which came first? Toxic facilities, minority move-in, and environmental justice. Journal of Urban Affairs, 23, 1-21.
  9. Schulz, A.J., Williams, D.R., Israel, B.A., Lempert, L.B. (2002). Racial and spatial relations as social determinants of health in Detroit. Milbank Quarterly, 80(4), 677-707.
  10. Williams,D.R. & Collins,C.A. (2001) Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Reports, 116, 404-416.

Foundations for Sexual Minority Health
 [slides] (will be posted at about 12:30pm EDT)

Judith C. Bradford, M.A., Ph.D. [bio]

Abstract :

The health of sexual minority individuals and communities became a concern for public health in the United States when “persons defined by sexual orientation” were included in Healthy People 2010 as one of six groups experiencing health disparities and barriers to healthcare access. LGBT professional organizations and researchers worked with local, state, and federal government representatives to develop a common understanding of the health concerns and needs of sexual minorities, resulting in the initiation of the emerging field of lesbian, gay, bisexual, and transgender (LGBT) health. Remarkable progress has been made during the past five years to establish a unifying conceptual framework for this work and to develop an organizational infrastructure to address the multi-level challenges that must be overcome in order sexual minorities to have access to quality healthcare. The purpose of this presentation is to provide a framework for tackling several big questions: who are sexual minority persons and what are their healthcare needs? what factors influence the health of sexual minorities? how can public health respond? how do we set priorities, and what are the most important opportunities and challenges?

Learning Objectives:

  1. Describe the estimated number and distribution of sexual minorities in the United States, how these estimates are derived, and how to critically assess their utility.
  2. Identify the most significant health concerns and barriers to healthcare access of LGBT persons, within the context of health disparities.
  3. Use a social ecology model to discuss social, institutional, and policy-related contexts influencing the quality of life that sexual minorities can expect to achieve.
  4. Describe the initiation and ongoing development of a public health response to the healthcare needs of lesbian, gay, bisexual, transgender (LGBT) and intersex persons.
  5. Identify opportunities and challenges in sexual minority public health

Thursday, June 24, 2004

The Latino mortality paradox revisited: Is acculturation bad for your health? 

Ana Abraido-Lanza, Ph.D. [bio]

Abstract :

There is a great body of evidence on the inverse relationship between socioeconomic status and morbidity and mortality. Relative to non- Latino whites, Latinos in the United States have a worse socioeconomic status profile, but a lower all-cause mortality rate. This paradox has stimulated various hypotheses, such as selective migration of healthier individuals. This presentation will provide a general overview of hypotheses proposed to explain the Latino mortality paradox, as well as research findings concerning the paradox. Particular emphasis will be placed on the health behaviors and acculturation hypotheses, which posit that: (1) Latinos have more favorable health behaviors and risk factor profiles than non-Latino whites, and (2) Health behaviors and risk factors become more unfavorable with greater acculturation. An overview of concepts and theories on acculturation and health will be provided. Research findings will be highlighted from studies that test theoretical models concerning the association between acculturation and various health behaviors (e.g., breast cancer screening).

Learning Objectives:

  1. Discuss the main hypothesis concerning the Latino mortality paradox
  2. Analyze evidence concerning the paradox
  3. Describe key issues in acculturation theory as it concerns the health of Latinos

Bibliographic Citations :

  1. Abraído-Lanza, A.F., Dohrenwend, B.P., Ng-Mak, D.S., & Turner, J.B. (1999). The Latino mortality paradox: A test of the "salmon bias" and healthy migrant hypotheses. American Journal of Public Health, 89, 1543-1548.
  2. Clark L, Hofsess L. (1998). Acculturation. In S. Loue (Ed.), Handbook of Immigrant Health. New York, NY: Plenum Press; 1998,37-59.
  3. LaFromboise, T., Coleman, H.L.K., & Gerton, J. (1993). Psychological impact of biculturalism: Evidence and theory. Psychological Bulletin, 114, 395-412.
  4. Chun, K.M., Balls Organista, P. & Marín, G. (2003). Acculturation: Advances in theory, measurement and applied research. Washington, DC: American Psychological Association.

Racial Disparities in Prescription Drug Utilization: An Analysis of Beta-Blocker and Statin Use Following Hospitalization for Acute Myocardial Infarction  [slides]

Jerome Wilson, M.A., Ph.D. [bio]

Abstract :

OBJECTIVE: To assess the whether the use of beta-blockers and statins following hospitalization for an acute myocardial infarction (MI) varies by race/ethnicity among Medicaid recipients.

METHODS: This retrospective study used administrative claims and eligibility information from a 20% random sample of California Medicaid recipients. We selected adult patients who were hospitalized for acute MI between January 1, 1998 and December 31, 2000. Study patients were required to be eligible for medical and pharmacy benefits for six months prior to their MI to three months following the event. Patients were excluded if they did not have a known race/ethnicity (i.e., white, African American, Hispanic, Asian) recorded. Medical claims were used to assess the burden of comorbidity in the six months prior to hospitalization. Pharmaceutical claims were used to identify beta-blocker and statin drugs dispensed following the MI hospitalization. Logistic regression was used to assess the relation between race/ethnicity and the likelihood of use of beta-blockers and statins, respectively, adjusting for other potential differences in patient characteristics and comorbidity.

RESULTS: We identified 2,069 patients who were hospitalized for MI who met the cohort inclusion criteria. They had a mean age of 71 years and 54% were female. Fifty-eight percent were white, 23% were Asian, 14% were African American, and 5% were Hispanic. The average Charlson comorbidity score (excluding MI) was 1.8 (±1.3). Approximately one-half of patients were dispensed beta-blockers and one-third received statins in the 90 days following hospitalization. Compared with whites, African-American patients were significantly less likely to receive either beta-blockers (adjusted odds ratio 0.71; 95% CI 0.55 to 0.93) or statin therapy (OR: 0.66; 0.49 to 0.88), and hispanics were less likely to be dispensed statins (OR: 0.52; 0.32 to 0.85). Asian patients did not differ from whites in the likelihood of receiving either type of therapy.

CONCLUSIONS: In this Medicaid population, a relatively low proportion of patients were dispensed beta-blocker or statin drugs following an MI hospitalization. African-Americans, and to a lesser extent, Hispanics, were the least likely to receive treatment.

Learning Objectives:

  1. Recognize that differential dispensing of prescription drugs for certain acute and chronic conditions may contribute to observed health disparities.
  2. List the two classes of drugs that should be dispensed to patients after hospitalization for an acute myocardial infarction.
  3. Articulate which race/ethnic groups are more or less likely to receive beta-blocker and/or statin therapy following a hospitalization for an acute myocardial infarction.
  4. Identify the top four comorbidities that are likely to be associated with Medicaid patients who have been hospitalized with an acute myocardial infarction.
  5. List the factors that are associated with decreased likelihood of receiving a bata-blocker or statin after an inpatient stay for an acute myocardial infarction.

Bibliographic Citations :

  1. Ding J, Diez Roux AV, Nieto FJ, et al. Racial disparity in long-term mortality rate after hospitalization for myocardial infarction: the Atherosclerosis Risk in Communities study. Am Heart J 2003 Sep;146(3):459-64.
  2. Giles WH, Anda RF, Casper ML, Escobedo LG, Taylor HA. Race and sex differences in rates of invasive cardiac procedures in US hospitals: Data from the National Hospital Discharge survey. Arch Intern Med 1995 Feb;155(3):318-24.
  3. Peterson ED, Wright, SM, Daley J, Thibault GE. Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veterans Affairs. JAMA 1994 Apr;271(15);1175-80.
  4. Qureshi AI, Suri MF, Guterman LR, Hopkins LN. Ineffective secondary prevention in survivors of cardiovascular events in the US population: Report from the Third National Health and Nutrition Examination Survey. Arch Intern Med 2001 Jul;161(13):1621-8.
  5. Ryan TJ, Antman EM, Brooks NH, et al. 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infraction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infraction). Available at: http://www.acc.org. (Accessed April 2004).

Links for participants:
 *  Abstracts, readings, learning objectives
 *  Agenda
Attending the conference at UNC-CH

 *  Credits and acknowledgements

 *  Find a viewing site near you
 *  Participant evaluation
 *  Webcast of the Congressional Minority Caucus Panel

 Links for site facilitators:
  *  Register to be a satellite downlink site
*  Site facilitator information
  *  Attendance sheet for signing-in participants
  *  Color publicity flyer
  *  Site facilitator evaluation

Miscellaneous links:

*  Previous Videoconferences in this series
*  Back to the top

  Return to the videoconference home page 

Minority Health Project| Department of Maternal and Child Health
Campus Box 7445 | UNC School of Public Health | Chapel Hill, NC 27599-7445
Phone 919-843-6758 | Fax 919-966-0458| E-mail Minority_Health@unc.edu
Last Updated: 07/15/04 by Raj