Deanna Wathington

An ecological approach to understanding black-white disparities in perinatal mortality.

Despite appreciable improvement in the overall reduction of infant mortality in the United States, black infants are twice as likely to die within the first year of life as white infants, even after controlling for socioeconomic factors. There is consensus in the literature that a complex web of factors contributes to racial health disparities. This paper presents these factors utilizing the socioecological framework to underscore the importance of their interaction and its impact on birth outcomes of Black women. Based on a review of evidence-based research on Black–White disparities in infant mortality, we describe in this paper a missing potent ingredient in the application of the ecological model to understanding Black–White disparities in infant mortality: the historical context of the Black woman in the United States. The ecological model suggests that birth outcomes are impacted by maternal and family characteristics, which are in turn strongly influenced by the larger community and society. In addition to infant, maternal, family, community and societal characteristics, we present research linking racism to negative birth outcomes and describe how it permeates and is embedded in every aspect of the lives of African American women. Understanding the contribution of history to the various factors of life of Black women in the United States will aid in developing more effective policies and programs to reduce Black infant mortality.

Designing a Community-Based Lay Health Advisor Training Curriculum to Address Cancer Health Disparities

Introduction. Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. Approach and Strategies. Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic–community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Discussion and Conclusions. Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.

The superobese mother and ethnic disparities in preterm birth.

OBJECTIVES We assessed the association between preterm birth and obesity subtypes across racial/ethnic groups. METHODS We analyzed data on 540981 women from birth cohort files for the State of Florida from 2004 to 2007. Obese women were categorized using body mass index (BMI) values as class I obese (30.0 < or = BMI < or = 34.9), class II obese (35.0 < or = BMI < or = 39.9), class III or extremely obese (40 < or = BMI < or = 49.9), and superobese (BMI > or = 50.0). Logistic regression was used to obtain adjusted estimates. RESULTS About 28% of women were obese, with the highest rate (40.9%) registered among black gravidas, while whites and Hispanics had comparable rates (24.3% vs 25.5%, respectively). Superobesity was also most prevalent in blacks (1.3%). Among obese women, the risk for preterm birth was greatest among blacks (OR, 1.71; 95% CI, 1.65-1.77), while whites (OR, 1.15; 95% CI, 1.12-1.19) and Hispanics (OR, 1.22; 95% CI, 1.18-1.27) had significantly lower and comparable risk levels. CONCLUSIONS Extremely obese and superobese women are emerging high-risk groups for adverse birth outcomes, and black women appear to bear the heaviest burden. The disproportionately rising trend in extreme forms of obesity among black women is of utmost concern and represents a clarion call for infusion of more resources into obesity prevention programs in black communities.

Patterns and success of fetal programming among women with low and extremely low pre-pregnancy BMI.

PurposeTo estimate the frequency of fetal programming phenotypes among women with low BMI and the success of these programming patterns-to determine if small for gestational age (SGA) is a biologically adaptive mechanism to improve chances for infant survival.MethodsWe examined the frequency of fetal programming phenotypes: SGA, large for gestational age (LGA), and adequate for gestational age (AGA) among 1,063,888 singleton live births from 1978 to 1997. We also estimated the success of fetal programming phenotypes using neonatal death as the primary study outcome.ResultsUnderweight gravidas with AGA and LGA babies had elevated risk of neonatal mortality when compared to normal weight mothers, while the risk for neonatal mortality among mothers with SGA babies was reduced.ConclusionsThe variation in relative degrees of fetal programming patterns and success observed suggests that underweight mothers are more likely to succeed in programming SGA fetuses rather than any other phenotype.

Maternal prepregnancy underweight and risk of early and late stillbirth in black and white gravidas.

OBJECTIVE The association between underweight and stillbirth remains poorly defined, especially across racial/ethnic sub-populations. We investigate the association of pre-pregnancy underweight on the risk for early and late stillbirth among black and white mothers. METHODS We conducted analysis on the Missouri maternally linked data files covering the period 1989-1997 inclusive. Using body mass index (BMI), we categorized mothers as underweight (BMI <18.5) and normal weight (BMI = 18.5-24.9). By applying logistic regression modeling with adjustment for intracluster correlation, we estimated the risk for total, early (-28 weeks of gestation), and late stillbirth (>28 weeks of gestation) among black and white mothers. RESULTS A total of 1808 cases of stillbirth were registered. The rate of stillbirth among white mothers was 3.7 per 1000, while the rate among blacks was 7.1 per 1000. Underweight black mothers had comparable risk for total (OR, 0.9; 95% CI, 0.7-1.2), early (OR, 1.1; 95% CI, 0.8-1.5), and late stillbirth (OR, 0.8; 95% CI, 0.5-1.2) as compared to their normal-weight counterparts. By contrast, underweight white gravidas had a 30% reduced likelihood (OR, 0.7; 95% CI, 0.6-0.9) for late stillbirth as compared to normal-weight white mothers. However, the risks for total and early stillbirth among underweight white mothers were similar to those of normal-weight white mothers. CONCLUSION Low prepregnancy BMI has similar effects on fetal survival in both blacks and whites except for late stillbirth. The underweight white survival advantage over blacks in late pregnancy could probably be due to greater access for identified white at-risk groups to effective obstetrical interventions as previously reported.

Photonovels: An Innovative Approach to Address Health Disparities and Sustainability

Medically underserved and underrepresented communities have high rates of health disparities. In the greater Tampa Bay area, communities of color are disproportionately affected by chronic diseases such as cancer. In response to these concerns and as part of a lay health advisory program being implemented by the Center for Equal Health, a University of South Florida/H. Lee Moffitt Cancer Center & Research Institute partnership, our group created a photonovel, an educational tool which explains topics using a graphic novel style. The photonovel was designed to educate community members about prostate cancer and was compared to standard cancer educational materials currently used for cancer outreach. We found that our photonovel served as an effective health education tool to address cancer health disparities in medically underserved and underrepresented populations in Tampa Bay.

Abstract A13: Closing the gap with podcast communication: Reducing health disparities through video podcasts utilization of breast and prostate cancer messages in the Tampa Bay community.

Two learning objectives: 1) To disseminate research and cancer education using novel delivery methods in consideration of culture, language and literacy. 2) To gather demographical data and perceptions of cancer prevention and screening from viewers in the Tampa Bay Community. Podcasting may provide an effective approach to disseminating educational and empowering cancer survivorship messages to underserved populations. The Community Engagement and Outreach Core (CEOC) of the Center for Equal Health (CEH) is currently utilizing podcasts to address health disparities in the Tampa Bay Community, Florida and beyond. As a tool of community-based participatory research (CBPR), the CEH podcasts aim to distribute key cancer prevention and research messages while utilizing innovative delivery methods, taking into account culture, language and literacy. The podcasts include seven, 5-minute individual interviews with local breast and prostate cancer survivors from diverse backgrounds, and they are available to any user through iPad and computer access. YouTube, Facebook, along with the CEH web site are current online media outlets as of 2012, where visitors can choose which interview(s) they wish to view. A short questionnaire designed via SurveyMonkey follows each interview, gathering demographical data and perceptions from viewers, including thoughts on cancer and screening options. Podcasts are also designed to be added to the USF Health iTunesU repertoire. Target populations include selected medically underserved areas (MUAs), including white, African American, Hispanic and Caribbean populations in the 3-county metropolitan area. Additionally, bilingual messages are incorporated, taking into account language and literacy. The innovative design and portability of the CEH podcasts allow them to be utilized via IPad by CEOC Community Health Advisors when conducting community talking circles and health fairs within the diverse settings. Quantitative and qualitative research data will be highlighted during the presentation. These data are collected for viewer feedback and to analyze the strategic placement of this newly implemented community cancer resource. Citation Format: Mezelle Moore, Maisha Standifer, Julie Baldwin, Deanna Wathington, Kevin Sneed, Kaylynn Brown. Closing the gap with podcast communication: Reducing health disparities through video podcasts utilization of breast and prostate cancer messages in the Tampa Bay community. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A13.

Abstract B2: Applying audience response systems in community-based research

Background: Community-based participatory research methods allow for community engagement in the effort to reduce cancer health disparities. Community engagement involves health professionals becoming a part of the community in order to build trust, share their expertise, learn from the community and empower them to reduce disparities through their own initiatives and ideas. Audience response systems (ARS) are an innovative and engaging way to involve the community and obtain data for research purposes. ARS is an interactive-polling device that uses keypads to report live results via power point. The use of ARS within communities, specifically with underserved populations, unfortunately is very limited. These limitations serve to widen the disparity gap by not delivering new advances in medical knowledge and technology among all population groups. Applying ARS: ARS was proven successful at the Gathering of Neighborhood Voices Town Hall, sponsored by the Center for Equal Health (CEH). CEH, a National Institute on Minority Health and Health Disparities Exploratory Center of Excellence, is a collaborative approach between the University of South Florida and Moffitt Cancer Center to address and reduce cancer health disparities within minority and underserved populations. The Town Hall included a panel of experts and community members engaging in a dialogue about cancer health disparities. The purpose of the Town Hall was to increase community members’ knowledge and awareness of cancer health disparities; obtain feedback from the community about their needs and their views of cancer; and build a partnership and trust with the community. Results: Participants responded favorably toward the ARS and enjoyed the added interactions that resulted from this approach. They appreciated being able to “see how everyone else answered” and felt the event was “very helpful and informative.” About 93% of the audience responded they either liked or loved using the system. Importantly, participants stated that they “felt included in the research process.” About 78% of participants agreed or strongly agreed that they felt comfortable sharing their thoughts and opinions during the event. About 63% of participants had never heard of or knew very little about health disparities at the beginning; however, after the discussion, 97% of the audience felt health disparities existed within their community. Benefits: ARS lets the community answer truthfully, with anonymity, and without fear of repercussion. It allows audience members the ability to easily engage during an event. ARS also gives the community instant research results, which addresses the ethical concerns of returning data to community participants. Health researchers can collect large amounts of data quickly, in a non-threatening way while tracking individual responses anonymously. ARS creates a participatory learning environment by stimulating discussions with community members. Lessons Learned: Some questions were unable to be captured due to technology challenges so it is important that researchers become familiar with the system before initial use. Implementing an ARS-training for the researchers prior to the event and to pilot-test at the actual event location is ideal. Researchers should make sure to understand what an appropriate literacy level is for the specific questions they ask. Conclusion: ARS is beneficial to get feedback from the community on cancer health disparities and issues that are important to them. The use of ARS solved the ethical dilemma that the researchers face when trying to ensure that community members see the results of the research in which they contribute. ARS proved to be an effective tool for successfully accomplishing community-based participatory research. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B2.