Larrell L. Wilkinson

Disparities in access to care among asthmatic children in relation to race and socioeconomic status.

Asthma is one of the leading chronic illnesses among children in the United States. International epidemiological studies have also shown asthma prevalence is an increasing problem. The objective of this study was to examine the correlates of access to care among asthmatic children age 0—17 in the United States. This is a retrospective study and secondary data analysis of the 2000 National Health Interview Survey. Parametric testing using univariate, bivariate, and multivariate analyses were performed to examine health care utilization among children with asthma in the United States. It was found that Black children were highly associated with not visiting a general doctor in the past 12 months (OR 0.47; 95% CI 0.30, 0.75). Uninsured asthmatic children were associated with the risk of not seeing a general doctor in the past 12 months (OR 0.40; 95% CI 0.23, 0.69). Our study findings indicate disparities among Black children with asthma and their ability to access appropriate health care services. Additional studies are required to identify factors that contribute to the temporal trends in asthma and country of origin.

The Role of Perceived Discrimination in Obesity Among African Americans

INTRODUCTION African Americans, especially those in the South, suffer a disproportionate burden of obesity and are at high risk for perceived discrimination (PD). This study investigates the association between PD and weight status among African Americans and clarifies the role of perceived stress and health behaviors in this relationship. METHODS Data came from the Jackson Heart Study, Examination 1 (2000-2004; analyses conducted in 2016 using Stata, version 14). African Americans from Jackson, Mississippi, aged 21-95 years were recruited (N=5,301). Weight status was measured using anthropometric data with BMI; waist circumference (in centimeters); and obesity class (I, II, III). Survey instruments were used to measure PD, perceived global stress, and health behaviors. Multivariate regression was used to model weight status outcomes as a function of PD, perceived stress, and health behaviors. RESULTS After controlling for sociodemographic factors and health status, perceived everyday discrimination was associated with higher BMI (b=0.33, p<0.01); higher waist circumference (b=0.70, p<0.01); and higher relative risk of Class III obesity versus non-obesity (relative risk ratio, 1.18; p<0.001). Global perceived stress was linked to higher BMI (b=0.42, p<0.05) and higher waist circumference (b=1.18; p<0.01) and partially mediated the relationships between PD and these weight status outcomes. Health behaviors led to suppression rather than mediation between PD and weight status and between stress and weight status. CONCLUSIONS PD and perceived stress are potential risk factors for higher weight status. They should be considered as a part of a comprehensive approach to reduce obesity among African Americans.

Dietary, Physical Activity, and Lifestyle Behaviors of Rural African American South Carolina Children

Overweight and obese children continue to be a growing problem, and differences exist, especially among racial and ethnic groups. Even though a poor diet and lack of physical activity are attributable factors to being overweight among children, indications exists that geographic location may also be important. In rural areas in the United States, childhood obesity is often higher than the national average. This study analyzed dietary, physical, activity, and lifestyle behaviors of rural African American children and their risk for becoming overweight. This study is a cross-sectional convenience sample of 98 students from a rural county in South Carolina in 2002. Findings showed rural female children were significantly more likely than rural male children to engage in physical activity for at least 20 minutes per day (odds ratio, 5.57; p = .0056). Given the increase in the prevalence of obesity especially among minority populations, the need exists to develop culturally appropriate nutrition and exercise interventions to assistchildren in a healthy weight loss attempt. Increased prevalence of obesity and other diseases among African Americans warrants aggressive interventions to reduce risk factors in this vulnerable population.

An Examination of Lower Extremity Function and Its Correlates in Older African American and White Men

OBJECTIVE Maintaining functional status and reducing/eliminating health disparities in late life are key priorities. Older African Americans have been found to have worse lower extremity functioning than Whites, but little is known about potential differences in correlates between African American and White men. The goal of this investigation was to examine measures that could explain this racial difference and to identify race-specific correlates of lower extremity function. METHODS Data were analyzed for a sample of community-dwelling men. Linear regression models examined demographics, medical conditions, health behaviors, and perceived discrimination and mental health as correlates of an objective measure of lower extremity function, the Short Physical Performance Battery (SPPB). Scores on the SPPB have a potential range of 0 to 12 with higher scores corresponding to better functioning. RESULTS The mean age of all men was 74.9 years (SD=6.5), and the sample was 50% African American and 53% rural. African American men had scores on the SPPB that were significantly lower than White men after adjusting for age, rural residence, marital status, education, and income difficulty (P<.01). Racial differences in cognitive functioning accounted for approximately 41% of the race effect on physical function. Additional models stratified by race revealed a pattern of similar correlates of the SPPB among African American and White men. CONCLUSIONS The results of this investigation can be helpful for researchers and clinicians to aid in identifying older men who are at-risk for poor lower extremity function and in planning targeted interventions to help reduce disparities.

The females against cancer educational series: a qualitative evaluation of mother/daughter knowledge and perceptions of human papillomavirus and its related cancers.

OBJECTIVE To evaluate the knowledge, perceptions, and effectiveness of an human papillomavirus (HPV)/cervical cancer education/prevention program. METHODS Approximately 50 middle and high school girls and their mothers participated in the 7-part educational series. Qualitative pre-evaluations and postevaluations were completed for every session, followed by culminating focus groups with mothers and daughters separately. RESULTS Common themes included lack of basic knowledge about HPV and its related cancers. Additionally, mothers and daughters expressed difficulty in communicating with one another about healthy relationships; however, during the focus groups, both mothers and daughters discussed how they had utilized effective communication tools to discuss sensitive topics and make informed decisions together. CONCLUSIONS Despite recent HPV prevention campaigns, more innovative strategies must be implemented to educate more mothers and daughters of HPV and its dangers. Additionally, in educating communities about HPV and associated cancers, more innovative strategies should be mobilized to trigger discussions regarding protective behaviors against HPV.

Development of the Soldier Health Promotion to Examine and Reduce Health Disparities (SHPERHD) Project Coordinating Center: Challenges and Opportunities Within a University/Community Partnership

The Soldier Health Promotion to Examine and Reduce Health Disparities (SHPERHD) Project was designed to be a partnership between the Institute for Partnerships to Eliminate Health Disparities at the University of South Carolina and the Fort Jackson United States Army Base located in Columbia, South Carolina. SHPERHD Project researchers are studying problems related to obesity and weight management, musculoskeletal injuries and infection, and mental health issues during recruitment, basic training, and post-deployment. In order to successfully develop targeted interventions to prevent and lower the incidence of injury, promote healthy nutrition, and decrease mental health issues, at the same time also reducing disparity gaps, the SHPERHD Project comprises a professional, technical, and administrative staff with specific competence in the operation of a Coordinating Center to handle the wide variety of areas related to military studies. This article discusses the procedures and processes that were implemented in the development of the SHPERHD Project Coordinating Center.

HIV Testing Among Deep South Residents With Serious Psychological Distress

OBJECTIVE To describe the prevalence of serious psychological distress among Deep South residents and human immunodeficiency virus (HIV) testing among Deep South residents with serious psychological distress. METHODS Data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey from Georgia, Louisiana, Mississippi, and South Carolina were used for this study. Andersens behavioral model of health care use provided the conceptual framework for the study. The Kessler 6 was used to dichotomize the sample as having or not having serious psychological distress. chi2 Test and multivariate logistic regression analyses were performed on the weighted data. RESULTS Only 5.7% of our sample had experienced serious psychological distress in the past 30 days. A majority proportion of persons with serious psychological distress (54.9%) had been tested for HIV. HIV testing was slightly more prevalent among males with serious psychological distress (63%) than females with serious psychological distress (60%). Predisposing factors (age, race/ethnicity, and urbanization) were confounders of HIV testing among both males and females with serious psychological distress. Enabling factors (income, health care access) were only confounders of HIV testing among males with serious psychological distress. CONCLUSION Future HIV prevention and management efforts should consider the potential role of concurrent serious psychological distress in impacting an individuals daily life and health activities such as self-care, caring for family, and maintaining employment.

Psychological Distress and Health Insurance Coverage among Formerly Incarcerated Young Adults in the United States

The United States incarcerates more people per capita than any other nation. Studies have consistently demonstrated higher prevalence of serious mental illness among the incarcerated. Although health care may be available to individuals while incarcerated, research is needed to understand the context of health care coverage and mental health after incarceration. The purpose of this study is to estimate the point prevalence of psychological distress (PD) among young adults with incarceration experience, while comparing the prevalence to that of young adults in the general population. Additionally, this study characterizes the relationship between incarceration experience and PD, while also examining this association given an individuals health insurance coverage status among young adults. Lastly, we examine if other individual, contextual, and behavioral factors influences the relationship between incarceration experience and PD, in addition to their health insurance coverage status. This study utilizes data from the 2008 panel of the National Longitudinal Survey of Youth 97, a population based survey dataset from the U.S. Department of Labor. Andersens Behavioral Model of Health Services Use provided the conceptual framework for the study. The Mental Health Index 5 (MHI-5) was used to determine PD or normal mental health. Chi-square testing and multivariate logistic regression were performed to examine incarceration experience in association to PD. The sample with incarceration experience reported almost double the proportion of PD (21%) compared to those without an incarceration experience (11%). Young adults who have been incarcerated reported greater odds of PD than those with no incarceration experience (COR 2.18; 95% CI, 1.68–2.83) and the association was diminished in the presence of health insurance status and model covariates. Future health prevention and health management efforts should consider the impact of health insurance coverage status, health behaviors, and life satisfaction on mental health status among young adults with incarceration experience.

Psychological health and discrimination experience among graduate students: findings from the Stress Coping Obstruction Prevention & Education (SCOPE) Study

Purpose – African-Americans historically report greater exposure to discrimination and also experience unfavorable outcomes associated with physical health, poverty concentration, residential segregation, and poorer education. The effects of discrimination are particularly harmful on mental health as discriminatory experiences contribute significantly to diminished mental health status and psychological distress. African-Americans pursuing graduate education may experience additional stressors, increasing the risk for poorer mental health. The purpose of this paper is to examine the association of psychological health and discrimination experiences among black and white graduate students at a southeastern university. Design/methodology/approach – Participants were 505 graduate students at a predominantly white southeastern institution. Researchers collected data via self-administered online and paper questionnaires during the spring 2010 semester. Graduate students were asked questions pertaining to indiv...