Health Disparities
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/32549
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Browsing Health Disparities by Author "Fulda, Kimberly"
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Item Addressing Disparities in Treatment for Substance Use Disorder Among Individuals with Developmental Disabilities: Perspectives from Treatment Facility Employees(2024-03-21) Yip, Maggie; Phan, Cong-Bao; Espinoza, Anna; Walters, Scott; Barnett, Tracey E.; Bednar, Hannah; Garcia, Lizbeth; Taha, Suha; Miller, Jackson; Lopez, Cindy; Fulda, KimberlyPurpose Research on substance use disorder (SUD) among individuals with developmental disabilities (DD) is limited. The extant literature suggests that people with DD are less likely to use substances overall compared to people without a disability; however, they are more susceptible to SUD if they do use substances. Among facilities in the United States that provide aid for individuals with DD and treatment facilities for individuals with SUD, there are currently no interdisciplinary practice guidelines or training materials available for providers treating those with a co-diagnosis of DD and SUD. Our project aims to reduce the disparities between treatment guidelines and materials available for people with a co-diagnosis of both SUD and DD. The purpose of this analysis was to gauge overall awareness of providing treatment for individuals with SUD/DD co-diagnosis and reflect on current protocols regarding this population. Methods In this project, interviews were conducted with workers at facilities that primarily provide SUD services. Relevant facilities were identified and selected through systematic internet searches. In this study, 11 questions were asked to workers at facilities through 15-30 minute phone interviews. Questions that were used for this analysis revolved around themes of workers’ perspectives on the importance of integrating SUD/DD services, their current practices, and their future recommendations for integrating care for individuals with both SUD/DD. Results We conducted a total of 12 interviews. Responses came from the South and Midwest United States geographical regions. From these interviews, we found that most programs aim to individualize their approaches to treating this specific population. However, there is no standardized approach to how they individualize these cases. Furthermore, many programs expressed that they rarely refer individuals with a co-diagnosis of SUD/DD outside of their agency and feel inadequately prepared to treat individuals with SUD/DD co-diagnosis, which further emphasizes the need for accessible standardized guidelines. Overall, many workers expressed a need for improved access to screenings, assessment tools, specific guidelines, knowledge, training, and specialized programs for the variety of specific types of DDs. Conclusions People with DD that experience SUD are a vulnerable population with few resources. To meet the needs of this vulnerable population, standardized guidelines and training materials should be developed to address the specific needs of this patient population and equip healthcare providers and stakeholders with the tools necessary to ensure this population has proper and equitable access to treatment.Item Do sociodemographic, health behaviors, and clinical factors predict levels of hs-CRP stratified by race and ethnicity?(2024-03-21) Modisette, Rebecca; Yockey, R. Andrew; Fulda, KimberlyPurpose: Health disparities between different racial and ethnic groups exist for many preventable chronic conditions, such as cardiovascular disease and diabetes. High- sensitivity C- reactive protein (hs-CRP) is a marker of systemic inflammation, and it is known that inflammation is one of the many components associated with physiologic deterioration, or chronic illness. Research has shown disparities in elevations of hs-CRP within different races and ethnicities. Furthermore, research has also demonstrated which factors can lead to elevations in hs-CRP within the general population. However, there is a need to determine factors and clarify relationships predictive of elevated HS-CRP for different racial and ethnic groups. The purpose of this analysis was to identify sociodemographic, health behavior, and clinical factors that predict hs-CRP by race / ethnicity. Methods: A secondary analysis of the 2017-2020 National Health and Nutrition Examination Survey (NHANES) was conducted. Briefly, the NHANES is a nationally representative survey assessing physical activity, chronic disease, and other health behaviors among adults 18 years of age and older in the United States. The outcome variable was hs-CRP levels, which was log-transformed due to non-normal distributions. Covariates included demographics (e.g., age, biological sex, education, marital status), insurance, BMI, sleep, depression, alcohol drinks, physical activity, and number of chronic conditions. Due to missing data, 5 datasets were imputed and combined in a multivariate manner using Rubin’s rules. Regression analyses were conducted stratified by race/ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Mexican American, Other Hispanic, and Other/Multi-Racial) to determine significant risk factors. Analyses were weighted to be representative of the U.S. population. Results: The analytic sample consisted of 15,476 adults ages 18 years or older (M= 38.5,SE =0.19). Diverging patterns emerged regarding hs-CRP levels, such that significant risk factors included BMI, biological sex (female), and health status. For white individuals, identifying as female (b = 0.13), increased BMI (b = 0.07), and poor sleep (b = 0.07) were significant predictors of inflammation. Regarding Black individuals, increased age (b = 0.01), identifying as female (b = 0.19), and increased BMI (b = 0.07) were significant predictors of inflammation. Pertaining to Mexican American individuals, identifying as female (b = 0.44), reporting good/fair/poor health (b = 0.28), and increased BMI(b = 0.08) were significant predictors of inflammation. Good/fair/poor health (b = 0.33) and increased BMI (b = 0.07) were significant predictors of inflammation for Other Hispanic individuals, while never being married decreased the risk for inflammation (b = -0.45). For Asian individuals, increased poverty (b= 0.08) and increased BMI (b = 0.09) were significant predictors. Finally, for multi-racial individuals, identifying as female (b = 0.37) and increased BMI (b = 0.04) were significant predictors of inflammation. Conclusion: This study identified racial/ethnic differences in sociodemographic, health behavior, and clinical factors that predict hs-CRP. Understanding disparities in risks for elevated hs-CRP could help clinicians identify potential biomarkers and intervene to reduce the impact of elevated inflammation among racial/ethnic minorities. Future research should include other social determinants of health such as environment, shift work, and nutrition.Item The ethical implications of gender bias in clinical research: a Narrative Review(2024-03-21) Quinn, Quincey; Tucker, Zachary; Yockey, Andrew; Fulda, KimberlyIntroduction: Sex bias in clinical research emerged in the 1960s after the 'thalidomide babies' incident, causing ethical concerns and a culture of abundance of caution. This led to the systematic exclusion of females, contributing to the exclusion of women as a gender identity. While sex bias has been extensively explored, gender bias merits separate consideration as gender bias affects the healthcare of an expanded group of individuals. Purpose: The purpose of this study was to conduct a narrative review on the ethical implications of gender bias in research with the following questions in mind: What are the implications of sex and gender bias in clinical research? What is the current landscape of gender bias in clinical research? Where can we improve consideration of sex and gender in clinical research to increase healthcare outcomes for women and those assigned female at birth? What are the participation differences in research by gender? What are barriers (social, economic, practical) to research by gender? Are there ethical implications to the inclusion/exclusion criteria for research participants by gender identity? Methods: A narrative review utilizing 8 databases (PUBMED, Scopus, CINAHL Complete, EBSCO host, APA Psych Info, Families Studies Abstract, MEDLINE Complete) from 2013 to August 2023 was performed. Search terms: “women OR woman OR female,” “research OR clinical research,” “sex bias or gender bias” and “underrepresent OR ethic OR equity.” 90 articles were reviewed by 3 researchers and evaluated for inclusion. A total of 45 articles were utilized for the final review. Results: In the analysis of five key questions, gender-related discussions were limited. The ethical implications of sex and gender bias in clinical research were acknowledged, emphasizing the need for ethical considerations related to sex bias, including varied safe doses, potential risks to pregnant individuals, and the impact on patient outcomes. The current landscape of gender bias in clinical research remained largely unaddressed, but insights into sex bias were provided, highlighting recent guidelines, disparities in representation, and the pervasive issue of sex bias across different specialties. Participation differences and barriers in research by gender were explored, with a focus on social, economic, and practical aspects. Barriers included education, economic stability, practical challenges, and researcher-imposed biases, affecting recruitment and retention. In addressing the ethical implications of inclusion/exclusion criteria based on gender identity, the study touched on the utility of studying transgender individuals due to hormone profiles, with one author recognizing the importance of the question. Conclusion: There is a need for education of the scientific community on the difference between gender and sex. The dataset gathered yielded limited information due to the inconsistent use of gendered and sex terms. More women need to be included in research both as participants and as authors to address gaps in professional development in academia and address the underpinnings of bias in the workforce. Further strategies to work towards equity include enforcing pre-existing guidelines, utilizing the participation-to-prevalence ratio, combating misinformation, and modifying inclusion criteria for greater inclusivity.