Joel Emery McCullough

Disparities in adult African American women's knowledge of heart attack and stroke symptomatology: an analysis of 2003-2005 Behavioral Risk Factor Surveillance Survey data.

BACKGROUND Heart disease and stroke are the first and third leading causes of death of American women, respectively. African American women experience a disproportionate burden of these diseases compared with Caucasian women and are also more likely to delay seeking treatment for acute symptoms. As knowledge is a first step in seeking care, this study examined the knowledge of heart attack and stroke symptoms among African American women. METHODS This was a cross-sectional study analyzing 2003-2005 Behavioral Risk Factor Surveillance Survey (BRFSS) data. A composite heart attack and stroke knowledge score was computed for each respondent from the 13 heart attack and stroke symptom knowledge questions. Multivariate logistic regression was performed using low scores on the heart attack and stroke knowledge questions as the dependent variable. RESULTS Twenty percent of the respondents were low scorers, and 23.8% were high scorers. Logistic regression analysis showed that adult African American women who earned low scores on the composite heart attack and stroke knowledge questions (range 0-8 points) were more likely to be aged 18-34 (OR = 1.36, CI 1.35, 1.37), be uninsured (OR = 1.32, CI 1.31, 1.33), have an annual household income <

Rurality as a Root or Fundamental Social Determinant of Health

35,000 (OR = 1.46, CI 1.45, 1.47), and have a primary healthcare provider (OR = 1.22, CI 1.20, 1.23). CONCLUSIONS The findings indicated that knowledge of heart attack and stroke symptoms varied significantly among African American women, depending on socioeconomic variables. Targeting interventions to African American women, particularly those in lower socioeconomic groups, may increase knowledge of heart attack and stroke symptoms, subsequently improving preventive action taken in response to these conditions.

Adequacy of diabetes care for older U.S. rural adults: a cross-sectional population based study using 2009 BRFSS data

lace matters; it contextualizes health. When examining the influence of ommunity, neighborhood, and social space, researchers from multiple isciplines found that geography matters when assessing health status, ealth service use, health service deficits, adequacy of health care, and ealth-related behaviors. Where people live, work, and play protects and romotes their health and/or contributes to the health risks they experince. Koh et al advocate that all individuals should have an equal pportunity to maximize their health. However, some might experience a ealth disparity because of where they live. Such disparities, though, are ot fixed. Once identified, changes to improve health outcomes and educe disparities are possible. A health disparity or health inequity refers to differences in health or ealth outcomes related to factors such as gender, race, ethnicity, ocioeconomic status, or sexual orientation. As government reports such s Healthy People 2020 advocate for the fundamental human justice of ddressing avoidable health-related inequities, it is important to recognize he extensive body of public health-related research associating place or eographic locale as a significant factor in identifying populations ulnerable to health disparities. Although there is long-standing awareess of the health inequities for people living in the inner city, there is an merging body of research acknowledging the importance of rurality in ocial epidemiology, as well as the vulnerability of this specific opulation.

A Population-Based Study of Health Service Deficits for US Adults with Asthma

BackgroundIn the U.S. diabetes prevalence estimates for adults ≥ 65 years exceed 20%. Rural communities have higher proportions of older individuals and health disparities associated with rural residency place rural communities at risk for a higher burden from diabetes. This study examined the adequacy of care received by older rural adults for their diabetes to determine if older rural adults differed in the receipt of adequate diabetes care when compared to their non-rural counterparts.MethodsCross-sectional data from the 2009 Behavioral Risk Factor Surveillance Survey were examined using bivariate and multivariate analytical techniques.ResultsLogistic regression analysis revealed that older rural adults with diabetes were more likely to receive less than adequate care when compared to their non-rural counterparts (OR = 1.465, 95% CI: 1.454-1.475). Older rural adults receiving less than adequate care for their diabetes were more likely to be: male, non-Caucasian, less educated, unmarried, economically poorer, inactive, a smoker. They were also more likely to: have deferred medical care because of cost, not have a personal health care provider, and not have had a routine medical check-up within the last 12 months.ConclusionThere are gaps between what is recommended for diabetes management and the management that older individuals receive. Older adults with diabetes living in rural communities are at greater risk for less than adequate care when compared to their non-rural counterparts. These results suggest the need to develop strategies to improve diabetes care for older adults with diabetes and to target those at highest risk.

Exposure assessment of young children living in Chicago communities with historic reports of ritualistic use of mercury.

Objective. Asthma prevalence in the United States is higher than it is in many other countries and its impact in terms of healthcare expenditures and morbidity and mortality is staggering. In the United States, many groups bear a disproportionate burden of asthma. Understanding the epidemiology of adult asthma and deficits in health care can identify opportunities for improving care and effectively managing resources. Methods. The computed dependent variable, health service deficits, entails a lack of health insurance, not having a healthcare provider, deferring medical care because of cost, and having had no routine medical exam. Bivariate and multivariate analyses were performed on 2005 Behavioral Risk Factor Surveillance Survey data to examine the relationship between health service deficits experienced by adults with asthma and socioeconomic status (SES), race and ethnicity, and geographic locale. The variable was also calculated for each US state. Results. Hispanic (OR = 1.594, 95% CI = 1.588–1.599) and Other/Multiracial (OR = 1.447, 95% CI = 1.441–1.452) adults with current asthma had greater odds of having a health service deficit. Rural adults with current asthma had greater odds of having a health service deficit (OR = 1.086, 95% CI = 1.083–1.089) when compared with non-rural adult residents. Low-SES (OR = 1.976, 95% CI = 1.971–1.982) and middle-SES (OR = 1.596, 95% CI = 1.592–1.600) adults with current asthma had greater odds of having a health service deficit. The percentage of current asthma adults experiencing at least one health service deficit by state ranged from a low of 28.5% (Delaware) to a high of 58.8% (Wyoming). Conclusion. There are clear patterns of disparity associated with health services and asthma that can help target interventions.

Determining an association between having a medical home and uncontrolled asthma in US school-aged children: a population-based study using data from the National Survey of Children's Health.

Objective. According to a 1997 finding, mercury was available for sale in several Chicago communities for use in spiritual or medicinal practice. Mercury used this way may impact the health of children. The Chicago Department of Public Health (CDPH) and the Centers for Disease Control and Prevention conducted a study to 1) quantify mercury exposure in biological specimens collected from a pediatric clinic or home visit in selected neighborhoods in Chicago, and 2) investigate possible sources of mercury exposure in homes. Methods. An exposure assessment study design was chosen to determine whether children living in Chicago communities that historically sold mercury were exposed to mercury vapor. We enrolled and collected biological samples from 306 children aged 2–10 years. In addition, we enrolled 42 children during a door-to-door survey of community residents. All the urine samples were analyzed for elemental or inorganic mercury. We also analyzed 43 blood samples to assess dietary mercury. Results. Overall geometric mean urine mercury was 0.26μg/L. Urine mercury levels did not differ among the three clinics or between the various participant groups. We did not find any association between ritualistic mercury use and exposure to mercury. Conclusions. Although pediatric mercury exposure does not appear to be problematic among our study population, mercury remains a potential health threat as long as it is readily available in communities. Healthcare providers should be aware of the potential for mercury exposure. Physicians and patients may call the National Poison Control Centers (1-800-222-1222) for information about diagnosis, testing, and treatment for all types of exposures, including exposure to mercury. Professionals are available 24 hours a day.

Health Service Deficits and School-Aged Children With Asthma: A Population-Based Study Using Data From the 2007-2008 National Survey of Child Health

Abstract Introduction: The American Academy of Pediatrics and the American Academy of Family Physicians believe that infants, children, and adolescents benefit from having a medical home, characterized by accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. Several studies suggest that patients with asthma benefit from having a medical home. However, no national study has been conducted examining the relationships between having a medical home and asthma control in school-aged children with asthma. The purpose of this study was to examine the hypothesis that having an adequate medical home is protective against uncontrolled asthma in children. Methods: To test this hypothesis, cross-sectional data from the 2003–2004 National Survey of Childrens Health were analyzed. Analyses entailed creating the variables “medical home” as well as “uncontrolled asthma” from multiple variables. Multivariate analysis was performed using children with uncontrolled asthma as the dependent variable. Results: The logistic regression model performed yielded that school-aged children with uncontrolled asthma were more likely to: speak a primary language other than English (OR, 1.069; 95% CI, 1.045-1.093); live in households with incomes < 100% of the federal poverty level (FPL) (OR, 1.826; 95% CI, 1.810-1.842); not have health insurance (OR, 2.296; 95% CI, 2.263-2.330); live in rural rather than metropolitan areas (OR, 1.275; 95% CI, 1.262-1.287); and be non-Caucasian (OR, 2.067; 95% CI, 2.050-2.085). Multivariate analysis also yielded that children with uncontrolled asthma were more likely to have a medical home (OR, 1.138; 95% CI, 1.128-1.148). Conclusions: After controlling for possible confounding variables, this study did not detect an association between having a medical home and asthma control for children with asthma aged 5 to 17 years. Additional research should examine the relationship between variables, such as poverty, place of residence, health insurance status, and the medical home, not only in the instance of uncontrolled asthma, but for other childhood health conditions.

Who is providing and who is getting asthma patient education: an analysis of 2001 National Ambulatory Medical Care Survey data

BACKGROUND Asthma is one of the most common and costly illnesses of childhood. This study addresses health services deficits experienced by school-aged children with asthma. METHODS Analyzing data from the 2007-2008 National Survey of Child Health, this cross-sectional study used household income, race/ethnicity, and geographic residency as the primary independent variables and health service deficits as the dependent variable. RESULTS Multivariate analysis yielded that other/multiracial (odds ratio [OR], 1.234; 95% confidence interval [CI], 1.226-1.242) and Hispanic (OR, 2.207; 95% CI, 1.226-1.242) school-aged children with asthma had greater odds of having health services deficits as did both urban (OR, 1.106; 95% CI, 1.099-1.113) and rural (OR, 1.133; 95% CI, 1.124-1.142) school-aged children with asthma. Children with either moderate (OR, 1.195; 95% CI, 1.184-1.207) or mild (OR, 1.445; 95% CI, 1.431-1.459) asthma had greater odds of having a health services deficit than those with severe asthma. Low-income school-aged children with asthma had greater odds of having a health services deficit than high-income children (OR, 1.031; 95% CI, 1.026-1.036). At lesser odds of having a health service deficit were those who were African American, of middle-range income, male, or who were school-aged children with asthma in good to excellent health. CONCLUSION Both African American and other/multiracial school-aged children were at greater risk of having asthma than either Caucasian or Hispanic children. Three vulnerable subgroups of school-aged children with asthma-rural, Hispanic, and those of low income were the most likely to have health service deficits.