Suchergebnisse

Background: Little data exist to describe serial population-level trends in cognitive impairment– especially among minority communities. Because memory problems are among the first warning signs of cogni­tive impairment, they provide a potential method for monitoring changes in cogni­tive health at the population level. This exploratory study aimed to: 1) estimate prevalence of memory problems among US residents by race/ethnicity, age category; and 2) examine whether racial/ethnic dif­ferences in subjective cognitive concerns (memory problems) varied across recent time periods.Design and Setting: Serial cross-sectional analysis of self-reported data from the National Health and Examination Survey (NHANES), 1999-2014.Participants: 20,585 participants aged ≥45 years during 1999-2014, who reported race/ethnicity as non-Hispanic White (NHW), non-Hispanic Black (NHB), and Latino/Hispanic.Measurements: The outcome of interest was subjective cognitive concerns, identi­fied as self-reported memory problems. The frequencies of memory problems were examined for each 4-year period, across racial/ethnic groups.Results: In adjusted analyses, compared with older (aged ³65 years) NHWs, dispari­ties in subjective cognitive concerns were observed for older Latinos for most periods (range of AOR: 1.43 – 2.01, P<.05). Ad­ditionally, Latinos without a high school education had significantly higher odds of reporting memory problems than NHW in multiple periods (range of AOR: 1.95 – 2.17, P<.005), while Latino high school graduates did not. There were no significant changes in racial/ethnic differences in sub­jective cognitive concerns over time.Conclusions: The prevalence of sub­jective cognitive concerns across time periods points to a need to engage patients – particularly older and less-educated Latinos – about warning signs for cogni­tive impairment. The impact of education on subjective cognitive concerns in older Latinos may be related to acculturation and warrant further investigation. Ethn Dis. 2019;29(3):525-534; doi:10.18865/ ed.29.3.525

BackgroundDrug substitution is a promising approach to reducing medication costs.ObjectiveTo calculate the potential savings in a Medicare Part D plan from generic or therapeutic substitution for commonly prescribed drugs.DesignCross-sectional, simulation analysis.ParticipantsLow-income subsidy (LIS) beneficiaries (n = 145,056) and non low-income subsidy (non-LIS) beneficiaries (n = 1,040,030) enrolled in a large, national Part D health insurer in 2007 and eligible for a possible substitution.MeasurementsUsing administrative data from 2007, we identified claims filled for brand-name drugs for which a direct generic substitute was available. We also identified the 50 highest cost drugs separately for LIS and non-LIS beneficiaries, and reached consensus on which drugs had possible therapeutic substitutes (27 for LIS, 30 for non-LIS). For each possible substitution, we used average daily costs of the original and substitute drugs to calculate the potential out-of-pocket savings, health plan savings, and when applicable, savings for the government/LIS subsidy.ResultsOverall, 39 % of LIS beneficiaries and 51 % of non-LIS beneficiaries were eligible for a generic and/or therapeutic substitution. Generic substitutions resulted in an average annual savings of $160 in the case of LIS beneficiaries and $127 in the case of non-LIS beneficiaries. Therapeutic substitutions resulted in an average annual savings of $452 in the case of LIS beneficiaries and $389 in the case of non-LIS beneficiaries.ConclusionsOur findings indicate that drug substitution, particularly therapeutic substitution, could result in significant cost savings. There is a need for additional studies evaluating the acceptability of therapeutic substitution interventions within Medicare Part D.

Background: Electronic health (eHealth) literacy may affect telehealth uptake, yet few studies have evaluated eHealth literacy in underserved populations.Objective: The objective of this study was to describe technology access and use patterns as well as eHealth literacy levels among English-speaking and LEP patients in a Los Angeles safety net health system.Methods: Patients, aged ≥18 years with a diagnosis of diabetes mellitus and/or hyper­tension, and their caregivers were recruited from three primary care safety-net clinics in Los Angeles County (California) between June – July 2017. Participants' electronic health literacy was assessed by the eHealth Literacy Scale (eHEALS); participants were also asked about technology access and use. We examined these measures in English-speaking and limited English proficient (LEP) Spanish-speaking patients.Results: A total of 71 participants (62 pa­tients and 9 caregivers) completed the ques­tionnaire. The mean age of the respondents was 56 years old. More than half of partici­pants used a phone that could connect to the Internet (67%). The mean score for 10 eHEALS items was in the moderate range (26/50 points). There was no difference in mean eHEALS between language groups. However, 47% of Spanish-speaking partici­pants "agreed/strongly agreed" that they knew how to use the Internet to answer their health questions, compared to 68% of English-speaking participants (P<.05).Conclusions: In this sample of patients from a diverse safety net population, perceived skills and confidence in engaging with electronic health systems were low, particularly among LEP Spanish-speakers, despite moderate levels of electronic health literacy. More studies are needed among diverse patient populations to better assess eHealth literacy and patients' digital readi­ness, and to examine how these patient metrics directly impact telehealth utilization.Ethn Dis. 2022;32(1):21-30; doi:10.18865/ed.32.1.21

<p><strong>Objective:</strong> To examine variation by race and gender in the association between neighborhood socioeconomic status and walking among community-dwelling older adults.</p><p><strong>Design:</strong> Cross-sectional.</p><p><strong>Setting:</strong> Cardiovascular Health Study, a longitudinal population-based cohort.</p><p><strong>Participants:</strong> 4,849 adults aged &gt;65 years.</p><p><strong>Measurements:</strong> Participants reported number of city blocks walked in the prior week. Neighborhood socioeconomic status (NSES) measured at the level of the census tract. Negative binominal regression models were constructed to test the association between NSES and blocks walked. In the fully adjusted models, we included two-way and three-way interaction terms among race, gender, and NSES. </p><p><strong>Results</strong>: In adjusted analyses, among White residents in the lowest NSES quartile (most disadvantaged), men walked 64% more than women (<em></em>P&lt;.001), while in the highest NSES (most advantaged), men walked 43% more than women (<em></em>P&lt;.001). Among African American residents in the lowest NSES quartile, men walked 196% more blocks than women (<em></em>P&lt;.001), while in the highest NSES, men walked 43% more blocks than women, but this did not reach statistical significance (<em></em>P=.06). </p><p><strong>Conclusions:</strong> Female gender is more strongly associated with walking for African Americans than for Whites in low SES neighborhoods but had a similar association with walking for both African Americans and Whites in high SES neighborhoods. <em>Ethn Dis. </em>2016;26(1):17-26; doi:10.18665/ed.26.1.17</p>

Objective: To explore factors influencing COVID-19 vaccine decision-making among Black adults at high-risk for COVID-19 infection. Despite effective treatment and vaccination availability, Black Americans continue to be disproportionately impacted by COVID-19.Design, Setting, and Participants: Using community-engaged qualitative methods, we conducted virtual, semi-structured focus groups with Black residents in Los Angeles County before widespread vaccine rollout. Recruitment occurred through local com­munity partners.Methods: As part of a larger study exploring COVID-19 vaccine decision-making factors among multiethnic groups, two-hour virtual focus groups were conducted between December 15, 2020 and January 27, 2021. Transcripts were analyzed using reflexive thematic analysis.Main Outcome Measures: Themes and subthemes on factors for vaccine confi­dence and accessibility.Results: Three focus groups were con­ducted with 17 Black participants, who were primarily female (n=15), residents of high-poverty zip codes (n=11) and employed full-time (n=6). Black-specific considerations for vaccine confidence and accessibility include: 1) reduced confidence in COVID-19 vaccines due to historical gov­ernment inaction and racism (existing health inequities and disparities are rooted in rac­ism; historical unethical research practices); 2) misunderstanding of Black communities' vaccine concerns ("vaccine hesitancy" as an inaccurate label to describe vaccine skepti­cism; ignorance to root causes of vaccine skepticism); and 3) recognizing and building on resources (community agency to address COVID-19 vaccine needs adequately).Conclusions: Vaccination campaigns should improve understanding of underlying vac­cination concerns to improve vaccine out­reach effectiveness and should partner with, provide resources to, and invest in local, trusted Black community entities to improve COVID-19 vaccination disparities.Ethn Dis. 2022;32(4):341-350; doi:10.18865/ed.32.4.341

Lack of trust in biomedical research, government, and health care systems, especially among racial/ethnic minorities and under-resourced communities, is a longstanding issue rooted in social injustice. The COVID-19 pandemic has further highlighted existing health and socioeconomic inequities and increased the urgency for solutions to provide access to timely, culturally, and linguistically appropriate evidence-based information about COVID-19; and ultimately to promote vaccine uptake. California's statewide alliance STOP COVID-19 CA (comprising eleven sites), leverages long standing community partnerships to better understand concerns, misinformation, and address racial/ethnic inequities in vaccine hesitancy and uptake. Using data from the California CEAL Communication Working Group, we demonstrate the wide range of strategies, communication methods, languages, and trusted messengers that have been effective in reaching diverse communities across the state. We also showcase challenges and lessons learned, such as the importance of including trusted community partners to share information or provide vaccines. These approaches, rooted in community engagement, are crucial for addressing inequities and responding to future public health emergencies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10865-022-00284-8.

ImportanceThe COVID-19 pandemic has had disproportionate effects on racial and ethnic minority communities, where preexisting clinical and social conditions amplify health and social disparities. Many of these communities report lower vaccine confidence and lower receipt of the COVID-19 vaccine. Understanding factors that influence the multifaceted decision-making process for vaccine uptake is critical for narrowing COVID-19-related disparities.ObjectiveTo examine factors that members of multiethnic communities at high risk for COVID-19 infection and morbidity report as contributing to vaccine decision-making.Design, setting, and participantsThis qualitative study used community-engaged methods to conduct virtual focus groups from November 16, 2020, to January 28, 2021, with Los Angeles County residents. Potential participants were recruited through email, video, and telephone outreach to community partner networks. Focus groups were stratified by self-identified race and ethnicity as well as age. Transcripts were analyzed using reflexive thematic analysis.Main outcomes and measuresThemes were categorized by contextual, individual, and vaccine-specific influences using the World Health Organization's Vaccine Hesitancy Matrix categories.ResultsA total of 13 focus groups were conducted with 70 participants (50 [71.4%] female) who self-identified as American Indian (n = 17 [24.3%]), Black/African American (n = 17 [24.3%]), Filipino/Filipina (n = 11 [15.7%]), Latino/Latina (n = 15 [21.4%]), or Pacific Islander (n = 10 [14.3%]). A total of 39 participants (55.7%) were residents from high-poverty zip codes, and 34 (48.6%) were essential workers. The resulting themes included policy implications for equitable vaccine distribution: contextual influences (unclear and unreliable information, concern for inequitable access or differential treatment, references to mistrust from unethical research studies, accessibility and accommodation barriers, eligibility uncertainty, and fears of politicization or pharmaceutical industry influence); social and group influences (inadequate exposure to trusted messengers or information, altruistic motivations, medical mistrust, and desire for autonomy); and vaccination-specific influences (need for vaccine evidence by subpopulation, misconceptions on vaccine development, allocation ambiguity, vaccination safety preferences, the importance of perceiving vaccine equity, burden of vaccine scheduling, cost uncertainty, and desire for practitioner recommendation).Conclusions and relevanceIn this qualitative study, participants reported a number of factors that affected their vaccine decision-making, including concern for inequitable vaccine access. Participants endorsed policy recommendations and strategies to promote vaccine confidence. These results suggest that support of informed deliberation and attainment of vaccine equity will require multifaceted, multilevel policy approaches that improve COVID-19 vaccine knowledge, enhance trust, and address the complex interplay of sociocultural and structural barriers to vaccination.

Objective
To synthesize community and healthcare informants' perspectives on contextual considerations and tailoring recommendations for high-quality, sustainable implementation of evidence-based practices (EBPs) for managing hypertension (HTN) in a multiethnic safety-net population.


Design
Structured focus-group discussions and semistructured qualitative interviews.


Background
High-quality, sustainable implementation of HTN-related EBPs can promote equitable care. Implementation challenges extend beyond individual patients to span multiple levels of context. Few studies have systematically engaged community and healthcare perspectives to inform the design of HTN intervention trials.


Setting
A large safety-net healthcare system.


Participants/Methods
We conducted four structured discussions with each of five race- or ethnicity-specific community action boards (CABs) to understand community members' HTN-related norms, assets, needs, and experiences across local healthcare systems. We interviewed 41 personnel with diverse roles in our partnered healthcare system to understand the system's HTN-related strengths and needs. We solicited EBP tailoring recommendations from both groups. We summarized the findings using rapid content analysis.


Results
Participants identified contextual considerations spanning seven themes: social determinants, healthcare engagement, clinical interaction, system operations, standardization, patient education, and partnerships and funding. They offered tailoring recommendations spanning nine themes: addressing complex contexts, addressing social needs, system operations, healthcare system training and resources, linguistic and cultural tailoring, behavioral engagement, relational engagement, illness-course engagement, and community partnerships.


Conclusions
Engaging community and healthcare informants can ground implementation in the policy, community, healthcare system, clinical, and interpersonal contexts surrounding diverse patients at risk for disparities. Such grounding can reframe inequitable implementation as a multilevel social problem facing communities and healthcare systems, rather than individuals.

Lack of trust in biomedical research, government, and health care systems, especially among racial/ethnic minorities and under-resourced communities, is a longstanding issue rooted in social injustice. The COVID-19 pandemic has further highlighted existing health and socioeconomic inequities and increased the urgency for solutions to provide access to timely, culturally, and linguistically appropriate evidence-based information about COVID-19; and ultimately to promote vaccine uptake. California's statewide alliance STOP COVID-19 CA (comprising eleven sites), leverages long standing community partnerships to better understand concerns, misinformation, and address racial/ethnic inequities in vaccine hesitancy and uptake. Using data from the California CEAL Communication Working Group, we demonstrate the wide range of strategies, communication methods, languages, and trusted messengers that have been effective in reaching diverse communities across the state. We also showcase challenges and lessons learned, such as the importance of including trusted community partners to share information or provide vaccines. These approaches, rooted in community engagement, are crucial for addressing inequities and responding to future public health emergencies.

<p><strong>Objective</strong>: To describe the design and rationale of the Healthy Community Neighborhood Initiative (HCNI), a multicomponent<br />study to understand and document health risk and resources in a<br />low-income and minority community.</p><p><strong>Design</strong>: A community-partnered participatory research project.<br />Setting: A low-income, biethnic African American and Latino neighborhood in South Los Angeles.</p><p><strong>Participants</strong>: Adult community residents aged &gt;18 years.</p><p><strong>Main Outcome Measures</strong>: Household survey and clinical data collection; neighborhood characteristics; neighborhood observations; and community resources asset mapping.</p><p><strong>Results</strong>: We enrolled 206 participants (90% of those eligible), of whom 205 completed the household interview and examination,<br />and 199 provided laboratory samples. Among enrollees, 82 (40%) were aged &gt;50 years and participated in functional status<br />measurement. We completed neighborhood observations on 93 street segments; an average of 2.2 (SD=1.6) study participants<br />resided on each street segment observed. The community asset map identified 290 resources summarized in a Community Resource Guide given to all participants.</p><p><strong>Conclusions</strong>: The HCNI communityacademic partnership has built a framework to assess and document the individual, social, and community factors that may influence clinical and social outcomes in a community at high-risk for preventable chronic disease. Our project suggests that a community collaborative can use<br />culturally and scientifically sound strategies to identify community-centered health and social needs. Additional work is needed to<br />understand strategies for developing and implementing interventions to mitigate these disparities. <em>Ethn Dis</em>. 2016;26(1):123-132; doi:10.18865/ed.26.1.123</p>