Browsing by Subject "Inequality and Stratification"
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Item A Mixed Methods Approach to the Definition of Family Health Promotion Practices for Mexican Sonoran Mothers(2006-12-01) Montiel-Carbajal, Maria Martha; Sue LurieMontiel-Carbajal, Maria M., A Mixed Methods Approach to the Definition of Family Health Promotion Practices for Mexican Sonoran Mothers. Doctor of Public Health (Social and Behavioral Sciences), December 2006, 143 pp., 14 tables, 1 illustration, bibliography, 55 titles. The purpose of this research was to study the family health promotion practices of a sample of Mexican mothers living in the state of Sonora Mexico through a concurrent mixed method approach that included (1) a qualitative component with face to face and in-depth interviews, investigator observations, and analysis of content; (2) a quantitative component consisting of statistical analysis of data from selected selections of the National Survey for the Evaluation of Health Services 2002-2003. For the qualitative component 15 mothers, with mean age of 40 years, mean years of education of 10 years, living with their families were selected to form a purposive sample, and assigned to one of three groups: married working mothers, non-married working mothers, or married non-working mothers. The qualitative component was naturalistic and descriptive using semi-structured interviews with the mothers, and individual questionnaires to collect demographic and housing information. The quantitative component used the survey responses provided by the database of the National Survey for the Evaluation of Health Services 2002-2003, from 404 female adults age 18 and older, living in the urban zone of Sonora. The qualitative component showed that mothers conceptualize the health status of the family as a priority. The specific practices they use depend on the set of external resources and internal strengths of the family in order to overcome the physical, environmental, relational, or economic barriers they found to the promotion of health practices. The participants also reported being unsatisfied with the access and quality of the social health care system. The data from the quantitative component showed that Mexican Sonoran women living in the urban area reported having good health and felt satisfied with their health status; their satisfaction with the social health care system was fair. The group of non-married working mothers was detected to be more at risk for cardiovascular diseases due to a greater proportion of smokers and drinking paired with low amount of exercise. The results provided valuable information to formulate health promotion programs and future policies to be implemented with the target population.Item Access to Health and Social Services for Poverty Level Adults with Chronic Disease or Disability(2006-12-01) Reese, Sharon E.; Kristine Lykens; Sue Lurie; Richard ScotchReese, Sharon E., Access to Health and Social Services for Poverty Level Adults with Chronic Disease or Disability. Doctor of Public Health (Health Management and Policy), December, 2006, 79 pp., 7 tables, 51 references. This dissertation reports the results of research into the difficulties poverty level adults with disabilities have in accessing vital health and social services. Chapter one gives a background of the problem, a purpose of the research, the research question, limitations and constraints, and the importance of the study. Chapter two is a review of the literature concerning this population and access. Chapter three reviews the methodology used in the study, with chapters four and five presenting results, conclusions and recommendations. Qualitative methods using a focus group and individual interviews five major themes emerged: health issues, access or obtaining care, interactions with providers, obtaining medication, and transportation (table 6). A review of these themes and the particular responses of participants in these areas highlighted the need for policy change in the area of access to services for this special group. This dissertation also makes recommendations for policy changes and potential barriers to those changes.Item An Analysis of Texas Hospitals: Assessing the Association between Charity Care, Uncompensated Care, & Community Benefits(2007-05-01) Mitias, Marcus J.; Nuha Lackan; Jeff Talbert; Douglas MainsMitias, Marcus J. An Analysis of Texas Hospitals: Assessing the Association between Charity Care, Uncompensated Care, & Community Benefits. Master of Public Health (Health Management & Policy), May 2007, 47 pp., 5 tables, 11 illustrations, references, 45 titles. The question of whether not-for-profit hospitals are meeting their charitable obligations is once again starting to intensify. Congress is calling for increased scrutiny of not-for-profit hospitals. Similarly, pressure is mounting in Texas where the not-for-profit hospital sector struggles to justify the contributions they make to the community. This cross-sectional study examines the county level association between charity care, uncompensated care expenditures, and community benefits, and hospital structure, and the number of uninsured. Descriptive and multi-linear regression analyses are used to compare hospital charity care and uncompensated care expenditures in Texas. Results indicate the number of uninsured is significantly associated with charity care expenditures and uncompensated care expenditures.Item An Evaluation of the Impact of Continuity of Care on Cost of Services in New and Renewing CHIP Enrollees(2001-01-01) Montague, Brian; Kristine Lykens; Muriel Marshall; Karan SinghObjective. To assess the impact of continuity of care as measured by enrollment history on the cost of services in Colorado’s state insurance program for children in low-income families, the Child Health Plan Plus. Design. A retrospective cohort study using data extracted from the eligibility/enrollment system and the claims payment system for inpatient and specialty services. All children enrolled in the program for at least 90 days and managed under the state managed-care network from its inception to April 1st of 2000 were included in the analysis (n-11841). Enrollees were separated into three enrollment groups: new members, renewing members, and members transition from a prior outpatient services group. The odds by enrollment groups: new members, renewing members, and members transition from a prior outpatient services program. The odds by enrollment group an average monthly claims greater than the 75th percentile amongst those with claims (n-2661) and the odds of presence of any claim in the full data set were compared means of a logistic regression model. In order to permit inferences regarding the total cost of care, all models included age group as a cofactor. Presence of chronic or congenital disease, ethnicity, primary language, urban residence, and the presence of multiple parents or caretakers were tested using univariate chi-square analysis and significant factors (p [less than] 0.1) were included as effects in the models. Results. All cofactors with the exception of ethnicity were significant in both models. Chronic disease status was associated with an increased risk of all claims. (OR=4.961, p [less than] 0.0001) and high claims (OR=9.639, p [less than] 0.0001). Renewal status was associated with a decreased risk of any claim (OR=0.921, p [less than] 0.0936) while rollover status was associated with both an increased risk of any claim (OR=1.157, p=0.0034) and a decreased risk of high claims (OR=0.731, p=0.0033). Residence in rural counties increased the risk of any claim (OR=0.0428, p [less than] 0.0001) and an increased risk of high claims (OR=1.472, p=0.0376). Conclusions. Enrollment history had a modest, though significant, effect on the presence of any claim and the specific presence of high claims. Rollover status was protective increasing utilization of the system overall but reducing the risk of high claims whereas renewal status only reduced the risk of utilization overall. The absence of multiple adults in the household showed a pattern consistent with episodic use of the system. Relative to urban residents, residents of rural counties were more likely to have used any service and less likely to have incurred high claims. This effect may be attributable to the transition of patients to HMO networks in urban counties. Linguistic or cultural barriers as reflected in primary language strongly decreased utilization, suggesting that these may be important barriers to address in outreach and member education.Item Associations Between Socioeconomic Statuses and Behavioral Risk Factors and Self-Reported Health Status(2005-05-01) Wu, Gang; Daisha Cipher; Shande Chen; Sejong BaeWu, Gang, Association Between Socioeconomic Statuses and Behavioral Risk Factors and Self-Reported Health Status. Master of Public Health (Biostatistics), May 2005, 70pp., 5 figures, 4 tables, references, 58 titles. Socioeconomic statuses (SES) and behavioral risk factors determine more than 70% of overall health outcome of American population. The effects of SES and behavioral risk factors on self-reported health status (SRHS) were studied using binary logistic regression models. Age group, education level, ethnicity, physical activities, cholesterol intake, smoking status, and drinking status were identified as significant predictors (p [less than] 0.05) to SRHS based on overall model. Significant predictors for each ethnic group varied based on the same model separated by ethnicity: White (insurance coverage, physical activities, smoking status, and drinking status), Black (gender, vegetable intake, and Hispanic (cholesterol intake). Ethnic disparities in SES and behavioral risk factors were discussed. The findings may have potential importance in public health intervention.Item Barriers to Health Care Access Among Vietnamese Refugees in Tarrant County, Texas.(2004-05-01) Le, Tuan D.; Chiehwen Ed Hsu; Sue Lurie; Raghbir SandhuLe, Tuan D., Barriers to Health Care Access among Vietnamese Refugees in Tarrant County, Texas. Master of Public Health (Health Management & Policy), May 2004, 88 pp., 17 tables, 11 illustrations, bibliography, 56 titles. The refugee community is the most vulnerable community due to existing medical conditions without proper treatment and many barriers in accessing the health care system, including different language, cultural conflict, legal restrictions, and socioeconomic status. The purpose of this study is to determine the nature of these barriers that keep the Vietnamese refugees from accessing the health care system in Tarrant County. The study found that 45.8% have no health insurance, 17.4% received Medicaid, 53.7% have no primary care physician, and 57.14% of Vietnamese elderly refugees, who have been living in the U.S. between seven and ten years, and have lost SSI and Medicaid. These findings are significant at p [less than] .001. Vietnamese refugees perceived factors that kept them from accessing the health care system as major barriers, including language (14%), legal issues (17%), misunderstanding of the medical system (15%), lack of insurance (14%), and different culture (11%). These results may assist social service providers, health care providers, and policy activists to enhance their services and advocate for legal issues, in order to remove these barriers and help refugees to access health care better.Item Barriers to Medicaid Enrollment: A Study of the Texas Healthy Kids Corporation(2000-12-01) Barlow, Daphne J.; Doug A. Mains; Sally BlakleyBarlow, Daphne J., Barriers to Medicaid Enrollment: A Study of the Texas Healthy Kids Corporation. Masters of Public Health (Health Administration), December, 2000, 38 pp., 18 tables, References, 13 titles. Recently Medicaid eligibility was expanded to include more children than ever before in Texas. However, many Medicaid eligible families have not obtained benefits. This study concerns potentially Medicaid eligible families who applied to the Texas Health Kids Corporation. A random telephone survey of these applicants examined the outcome of Medicaid eligibility notification. Data was analyzed to determine the predictors of attempting or completing an application. No significant sensitivity to profilers such as primary language, race/ethnicity, education level or age was detected. Instead, having prior knowledge of Medicaid eligibility and being female were predictive factors to consider when engineering outreach programs. While these results indicated a statistical significance, further study of repeat notification and gender in order to conclusively recommend policy change. These results have implicated for the Texas CHIP program.Item Child Nutrition and Hygiene Practices Related to Dental Caries in Preschool Children(2006-08-01) Sterba, Jennifer A.; Urrutia-Rojas, Ximena; Coggin, ClaudiaSterba R.D.H., B.S., Jennifer A. Child Nutrition and Hygiene Practices Related to Dental Caries in Pre-School Children. Master of Public Health (Community Health), August 2006, 50 pp., bibliography, 22 titles. Dental caries is a significant public health issue among low income children. Head start is a child developmental program that provides education and health services for low income families. One hundred and thirty seven children, age’s three to six, and their parents/guardians enrolled in four sites at Head Start Greater Dallas, Inc. participated in this study. Fifty-three percent of all children had evidence of early childhood caries. In this study, parents/guardians reported adequate nutrition and hygiene practices of their child’s oral health, but children still show a high incidence of caries. Therefore, preventive educational services provided by a dental professional would be beneficial to the Head Start families to improve children’s oral health.Item Emergency Department Visits and Hospitalizations for Ambulatory Care Sensitive Conditions Among Uninsured Hispanics(2005-05-01) Trevino, Elizabeth; Mains, Doug A.; Rene, Antonio; Gonzales, AdelaTrevino, Elizabeth., Emergency Department Visits and Hospitalizations for Ambulatory Care Sensitive Conditions among Uninsured Hispanics. Doctor of Public Health (Health Management and Policy), May 2005, 83 pp., 10 tables, bibliography, 87 titles. Inequalities in access to health care persist in the US health care delivery system and as the number of uninsured patients in the United States continues to increase, emergency departments around the country are becoming inundated with people seeking non-acute, as well as acute medical care. This study explored whether there are differences of emergency department use and hospitalizations for ambulatory care sensitive (ACS) conditions among uninsured Hispanics as compared to other ethnicities using 2001-2002 National Hospital Ambulatory Medical Care Survey (NHAMCS) data. A weighted sample of 4,210,248 emergency department visits for years 2001-2002 was analyzed using frequencies, Pearson x2 tests, logistic regression and multiple logistic regression to determine whether Hispanics and uninsured Hispanic were visiting the emergency department more frequently than any other ethnic group; uninsured Hispanics were being hospitalized due to the severity of the disease; and determine the significant predictors for preventable hospitalizations. Significant differences among the ethnicities studied and emergency department visits during 2001-2002 were found. These differences resulted in favor of African-American. African-American had larger rates of ED visits as compared to Whites and Hispanics. Uninsured African-American were also found as the racial/ethnic group with greater visits for emergency departments. These findings changed when assessing preventable hospitalizations for ACS conditions. A similar direction was found for Whites. Uninsured Hispanics were hospitalized more frequently in triage category less than 15 minutes, indicating the severity of the disease. Age, gender, race/ethnicity and insurance status were found to be significant predictors for preventable hospitalizations. This study revealed a substantial national problem with hospitalizations among uninsured Hispanics that may be prevented with timely and appropriate ambulatory care. The significant finding in this study strongly suggests that although this group did not visit the emergency department as frequently when compared to other ethnicities between 2001-2002, they are doing so when their condition deteriorates to the point to which a visit to the emergency room and hospitalization has become inevitable.Item Epidemiology of Cholera in Malawi, 2002-2003(2004-08-01) Nkhoma, Ella; Sejong Bae; Antonio Rene; Raghbir SandhuNkhoma, Ella, Epidemiology of Cholera in Malawi, 2002-2003. Master of Public Health (Epidemiology), August 2004, 33pp., 4 tables, 3 figures, bibliography, 24 titles. The objective of the present study was to characterize epidemic cholera in Malawi from 2002-2003. National and district-level surveillance records were used for the analyses in this study. The study employed Poisson regression, log-linear analysis, epidemic curve analysis, curve-fitting procedures and epidemic model simulations. District-level determinants of cholera mortality included various sociodemographic indicators. Significant two-way interactions were observed for age and district, with the oldest age group (65+) experiencing the highest risk of symptomatic cholera and residents of Nkhatabay districts also experiencing the most increased risk. Temporal analysis revealed the existence of secondary outbreaks and demonstrated the contribution of preexisting immunity to epidemic dynamics.Item Examining the Relationship Between Relative Wellbeing & Health Disparities in the City of Dallas(2006-08-01) Byerly, Jerah J.; Urrutia-Rojas, XimenaByerly, Jerah J., Examining the Relationship between Relative Wellbeing & Health Disparities in the City of Dallas. Master of Public Health (Community Health), August 2006,43 pp., 8 tables, 6 illustration (figures), bibliography , 29 titles. Health disparities are studies across many diseases and demographic characteristics. This study examined health disparities in relation to geographic assets … a social determinant of health. The purpose of this project was to replicate the Relative Wellbeing Index model in Albrecht & Ramasubramanian’s 2004 study, “The Moving Target: A Geographic Index of Relative Wellbeing”. This study sought to measure well-being at the neighborhood level in Dallas. Data was collected from 2000 U.S. Census. Results indicated the presences of pockets of extreme concentration and social isolation. South Dallas and Fair Park, two of the lowest socioeconomic neighborhoods, had the lowest level of wellbeing. In conclusion, the study indicated Well being scores were not equally distributed across neighborhoods in the City of Dallas.Item Factors Associated with Multi-Drug Resistance among Patients with Streptoccus pneumoniae Ear Infections(2004-05-01) Mendoza, Belinda A.; Francisco Soto Mas; Chiehwen Ed Hsu; Antonio ReneMendoza, Belinda A., Factors Associated with Multi-Drug Resistance among Patients with Streptoccus pneumoniae Ear Infections. Master of Public Health (Social and Behavioral Sciences), May 2004, 27 pp., 6 tables, 1 figure, references, 9 titles. Clinical trials play an important role in the development of new medical treatments. The purpose of this study is to describe patients participating in a clinical trial and at analyze the socio-demographic characteristics of patients with susceptible and multi-drug resistant Streptococcus pneumoniae ear infections. At the conclusion of this study, a socio-demographic description of clinical trial participants was obtained and the results were slightly younger than patients with susceptible S. pneumoniae ear infections and were more likely to attend day care.Item Geographic Information System: A Targeted Approach to Syphilis Elimination(2000-08-01) Morrison-Jones, June; Urrutia-Rojas, Ximena; Lurie, Sue; Oppong, JosephMorrison-Jones, June, Geographic Information System: A Targeted Approach to Syphilis Elimination. Master of Public Health, August 2000, 55 pp., 3 tables, 3 appendices, reference list, 25 titles. Syphilis is a sexually transmitted disease that has long caused a heavy public health and economic burden in the United States. With syphilis rates reaching their lowest recorded levels in the United States, Health officials are calling for an increased effort to eliminate the disease. In the United States, syphilis is also now extremely concentrated geographically, facilitating effective intervention. Most syphilis cases disproportionately affect a small portion of the population. African Americans who live below the poverty level, have limited access to health care, and have a number of social problems are also affected. This study examines the geographic distribution of syphilis and factors associated with syphilis transmission in Dallas County. The study used the techniques of geographic information system, principles of epidemiology, sociocultural linkages (race, ethnicity, and gender) between demographic factors and syphilis, to gain insights into the geographic distribution of syphilis among the affected groups, and intervention strategies for syphilis elimination were developed. These suggestions should assist the Dallas County Health Department in launching an effective syphilis elimination program. Results showed that zip codes with high incidence of cases were generally adjacent to each other. In addition, statistically significant results confirmed that poverty, minority-race ethnicity and geographic core areas are factors associated with the transmission of syphilis.Item Health Care Access Patterns in Relation to Ethnic/Racial and Health Insurance Status at an Osteopathic Hospital for 1998 through 2001(2003-12-01) Mego, Charles B.W.; Lurie, Sue; Balcazar, Hector; TrevinoMego, III, Charles B.W., Health Care Access Patterns in Relation to Ethnic/Racial and Health Insurance Status at an Osteopathic Hospital for 998 through 2001. Doctor of Public Health (Social and Behavioral Sciences), December 2003, 106 p.p., 25 tables, 5 illustrations, references, 44 titles. The patient population of the Osteopathic Health System of Texas (OHST), an academic health center with a 256-bed teaching hospital, was analyzed for health care access as measured by health services utilization in 1998 through 2001. This study explored the question of whether there was less health care access among minorities than among the White non-Hispanic majority within the patient population at OHST. The Tarrant County population was compared to OHST’s population demographics. This assessment determined which Ethnic/Racial groups had the highest medical services utilization and their payment methods. Patient data obtained from the OHST’s Meditech database was analyzed using Epi-Info. White non-Hispanics made up over fifty percent of the Emergency Room (ER), Inpatient and Outpatient service utilization in 1998 through 2001. The Outpatient component made up just over fifty percent of the OHST’s patient. African-Americans were over represented in the ER, Inpatient, and Outpatient service components relative to the Tarrant County demographics for 1998 through 2001. The Hispanic ER Managed Care category increased 7% and confirmed a growth rate of 29% more ER Managed Care in 2001, as compared to 1998 (URR=1.29, [1.24-`.35], x2 = 142.49, p [less than] .01). The Hispanic ER Medicaid category decreased 4.1% and indicated a reduced growth rate of 17% less ER Medicaid in 2001 as compared to 1998 (URR = 0.83, [0.79-0/87], x2 = 57.69, p,.01). The Hispanic Inpatient Managed Care category increased 13.2% and revealed a positive growth rate with 52% more Inpatient Managed Care in 2001 as compared to 1998 (URR=1.52, [1.44-1.61]. x2 = 224.92, p [less than] .01). The Hispanic Inpatient Medicaid category decreased 14.4% and showed a reduced growth rate of 38% less Inpatient Medicaid in 2001 as compared to 1998 (URR=0.62, [0.59-0.66], x2=274.58, p [less than] .01). The Hispanic and the Other groups relied heavily upon ER Self Pay, with a general decrease in Medicaid coverage and an increase in Managed Care. The Hispanic and Other groups have medical needs that are being neglected at OHST, and may lead to serious health problems that could be more costly if still treatable.Item HIV Related Risk Behaviors: A Comparitive Study of Urban, Suburban, and Rural U.S. Adolescents(2006-08-01) Patil, Godavari D.; Karan Singh; Sejong Bae; Francise Soto MasGodavari D. Patil, HIV Related Risk Behaviors: A Comparative Study of Urban, Suburban, and Rural U.S. Adolescents. Masters of Public Health (Biostatistics), August 2006, 120 pp., 29 tables, References, 209 titles. This explorative study YRBS 2003 data provides the prevalence of HIV-related risky sexual behaviors and predictors of such behaviors across gender, race/ethnicity, and metro status (N=15, 214) during 2003. Overall, more urban male adolescents engaged in health-compromising behaviors. A significant association was found between gender, race/ethnicity, and metro status and sexual behaviors and associated risk behaviors such as alcohol, drug use, and mental health indicators. These associated risk behaviors were not only associated among themselves and with sexual behaviors variables but also turned out to be responsible predictor variables for HIV related sexual risk behaviors. Minority groups especially black adolescents were at higher risk of contracting HIV infection as having multiple sexual partners was highest (8 fold) among black adolescents compared to mixed & other race, and Hispanic adolescents. Suburban adolescents were nearly two times more likely that rural and urban adolescents to having multiple partners. Results indicated that younger the age more the involvement in sexual and other risky behaviors.Item Income Inequality and Racial Disparities in Infant Mortality in Texas Counties(2004-05-01) Jesmin, Syeda S.; Susan Eve; Kristine Lykens; Erma LawsonJesmin, Syeda S., Income Inequality and Racial Disparities in Infant Mortality in Texas Counties. Master of Public Health (Health Services Research), May, 2004, 63 pp., 7 tables, 2 figures, references, 74 titles. This study provides an initial examination of predictors of differences of infant mortality between African-Americans and Whites. Guided by Wilkinson’s theory, it was hypothesized that income inequality among the population is a significant predictor of infant mortality disparities. A number of socioeconomic and health services variables were used in this study to control for the effects of income inequality on the dependent variable. Findings suggest that income inequality of a county is not a direct predictor of higher infant mortality of African-Americans than Whites. However, the association of inequality and IMR gap varies based on the metropolitan status of the county. Insurance status was found to have a negative effect on IMR gap, which implies the importance of including variables other than related to access (such as, quality of care) in future research.Item Measurement of Health Care Professional Concordance with the National Asthma Education and Prevention Program Guidelines for the Management of Asthma(2007-05-01) Oshitoye, Jeannette AdetokunboAsthma is a widely prevalent chronic disease affecting children in the United States. Prior studies show that blacks are more likely to die from asthma than other racial groups. Despite this fact, blacks are less likely to receive the recommended medication to appropriately treat their asthma. Because of the disparity in treatment, this study was conducted to determine if minorities were receiving information recommended by the NAEPP Guidelines. Logistic regression was used to determine the receipt of instructional information. Results show that males are less likely; and those below the age of 17 are more likely to receive the information.Item Population Characteristics Suggest Modifications to Proposed Pediatric Asthma Intervention Program(1998-08-01) DeMoss, Margaret W.; Ramirez, Gilbert; Urrutia-Rojas, Ximena; Coggin, ClaudiaDeMoss, Margaret W., Population Characteristics Suggest Modifications to Proposed Pediatric Asthma Intervention Program. Master of Public Health, August, 1998, 57 pp., 4 tables, 1 illustration, 2 appendices, reference list, 46 titles. Asthma is the most common chronic childhood disease affecting almost 5 million children in this country. The children most as risk for developing asthma come from low income, minority, and urban families. This studies examines a proposed pediatric asthma intervention program targeting Tarrant County area Medicaid clients. The purpose of this study is to define different subgroups and preferences among those clients and to recommend modifications that are likely to improve program outcomes. Recommendations were based on information gathered from interviews with 70 families, all having at least one child with asthma. Specific interests in learning more about asthma as well as learning preferences are tested for association with a variety of family characteristics. Although no statistically significant results were determined for subgroups, descriptive findings reveal that a large minority of respondents are interested in more information about asthma, but not necessarily by the means proposed. The study also suggests special needs for families with very young children, for those with adult asthma, and for Hispanics.Item Public Opinion of the Uninsured: Who Are They? Can They Get Care? Should Insurance be Publically Provided(2001-07-01) Miller, Rachel; Kristine Lykens; Doug A. Mains; Karan SinghThe United States is at the pinnacle of medical expertise and exploration. Many people from around the world come here to receive that outstanding care. Unfortunately, many of our own citizens are unable to enjoy that same privilege. With mounting technological and research costs, Health Maintenance Organizations, State-funded health insurance, and federally funded programs, such as Medicaid, are struggling to meet the expanding numbers of uninsured. The public is the driving force behind the policy debate in this country, and the debate over the uninsured may be lacking some very important information. It was the aim of this study to evaluate the public’s view of the uninsured. Meta-analysis was used to evaluate three questions regarding the public’s opinions of the status of the uninsured in the country to better understand the true perception held.Item Racial and Ethnic Differences in Cardiovascular Disease Risk Factors in U.S. Older Women: Findings from the Behavioral Risk Factor Surveillance Survey(2006-08-01) Kurian, Anita K.; Sejong Bae; Karan Singh; Kristine LykensKurian, Anita K., Racial and Ethnic Differences in Cardiovasular Disease Risk Factors in U.S. Older Women: Findings from the Behavioral Risk Factor Surveillance Survey, 2003 & 2004. Doctor of Public Health (Clinical Research), August 2006, 118 pp., 55 tables, 14 illustrations, references, 69 titles. Objectives- The study sought to determine if there were any significant racial and ethnic differences in six modifiable cardiovascular disease risk factors in women aged 65 years and older. It also examined the dynamic relationships of race/ethnicity, socioeconomic status and cardiovascular risk factors. Methods- Data were extracted from the merged 2003 & 2004 Behavioral Risk Factors Surveillance Survey (BRFSS). Prevalence estimates and 95% of each of the six cardiovascular disease risk factors considered (Hypertension, Diabetes, Obesities, Hypercholesterolemia, Smoking, and No leisure-time physical activity) were calculated by race/ethnicity. Multinomial (for indicator outcomes) and multiple logistic regression analyses (for binary outcomes) were performed. Path analysis was performed to assess the complex pathways by which race/ethnicity and socioeconomic status (SES) were associated with cardiovascular disease risk factors. Results- Of the 77,492 survey respondents included in the sample, there were 68,251 whites, 4,912 blacks, 3,656 Hispanics and 673 AIANs. The odds of the cardiovascular risk factors were higher in race/ethnicity minority women (non-Hispanic black, Hispanic, American Indian Alaskan Native) compared to white women aged 65 years and older. Socioeconomic status was found to be a moderator rather than a mediator of the relationship between race/ethnicity and cardiovascular disease risk factors. The re-specified model with the behavioral risk factors (smoking and no leisure-time physical activity) as mediators was deemed a good fit to the data. Age, race/ethnicity, SES, smoking and leisure-time physical activity were found to have significant direct, indirect and total effects on cardiovascular disease risk factors. Conclusions- There is a need to find better ways to measure race/ethnicity, and future research should consider the impact of more fundamental determinants of CVD risk factors. Area-based measures, such as neighborhood conditions, should also be given consideration for influencing these risk factors. Identification of potential mediating and moderating factors in these pathways (for example, sense of personal control or social support) will help clinicians and public health professionals to develop culturally sensitive intervention or prevention programs specifically targeted toward risk burdens in each of these populations.