Michael M. McKee

Deaf Epistemology: Deafhood and Deafness

Deaf epistemology constitutes the nature and extent of the knowledge that deaf individuals acquire growing up in a society that relies primarily on audition to navigate life. Deafness creates beings who are more visually oriented compared to their auditorily oriented peers. How hearing individuals interact with deaf individuals shapes how deaf individuals acquire knowledge and how they learn. Aspects of the Deaf episteme, not caused by deafness but by Deafhood, have a positive impact on how deaf individuals learn, resist audism, stay healthy, and navigate the world. Research on psychology, health, and education are reviewed to illustrate how visually oriented beings think and view the world differently from the majority. The article provides support to the theory of multiple epistemologies, and has implications for families, teachers, and researchers.

Impact of Communication on Preventive Services Among Deaf American Sign Language Users

BACKGROUND Deaf American Sign Language (ASL) users face communication and language barriers that limit healthcare communication with their providers. Prior research has not examined preventive services with ASL-skilled clinicians. PURPOSE The goal of this study was to determine whether provider language concordance is associated with improved receipt of preventive services among deaf respondents. METHODS This cross-sectional study included 89 deaf respondents aged 50-75 years from the Deaf Health Survey (2008), a Behavioral Risk Factor Surveillance System survey adapted for use with deaf ASL users. Association between the respondents communication method with the provider (i.e., categorized as either concordant-doctor signs or discordant-other) and preventive services use was assessed using logistic regression adjusting for race, gender, income, health status, health insurance, and education. Analyses were conducted in 2010. RESULTS Deaf respondents who reported having a concordant provider were more likely to report a greater number of preventive services (OR=3.42, 95% CI=1.31, 8.93, p=0.0122) when compared to deaf respondents who reported having a discordant provider even after adjusting for race, gender, income, health status, health insurance, and education. In unadjusted analyses, deaf respondents who reported having a concordant provider were more likely to receive an influenza vaccination in the past year (OR=4.55, p=0.016) when compared to respondents who had a discordant provider. CONCLUSIONS Language-concordant patient-provider communication is associated with higher appropriate use of preventive services by deaf ASL users.

Assessing Health Literacy in Deaf American Sign Language Users

Communication and language barriers isolate Deaf American Sign Language (ASL) users from mass media, health care messages, and health care communication, which, when coupled with social marginalization, places them at a high risk for inadequate health literacy. Our objectives were to translate, adapt, and develop an accessible health literacy instrument in ASL and to assess the prevalence and correlates of inadequate health literacy among Deaf ASL users and hearing English speakers using a cross-sectional design. A total of 405 participants (166 Deaf and 239 hearing) were enrolled in the study. The Newest Vital Sign was adapted, translated, and developed into an ASL version (ASL-NVS). We found that 48% of Deaf participants had inadequate health literacy, and Deaf individuals were 6.9 times more likely than hearing participants to have inadequate health literacy. The new ASL-NVS, available on a self-administered computer platform, demonstrated good correlation with reading literacy. The prevalence of Deaf ASL users with inadequate health literacy is substantial, warranting further interventions and research.

Health Literacy and the Disenfranchised: The Importance of Collaboration Between Limited English Proficiency and Health Literacy Researchers

Inadequate health literacy and limited English proficiency are associated with poor health care access and outcomes. Despite what appears to be an interaction phenomenon—whereby the rate of inadequate health literacy is particularly high among limited English proficiency populations—researchers in health literacy and limited English proficiency rarely collaborate. As a result, few health literacy instruments and interventions have been developed or validated for smaller linguistic populations. Interventions to improve health outcomes for people with low health literacy and limited English proficiency show great potential to alleviate many of the health disparities currently experienced by some of the most disenfranchised individuals in our health care system, those from smaller linguistic minority groups, including Deaf American Sign Language users. It is critical for health literacy and limited English proficiency researchers to work together to understand how culture, language, literacy, education, and disabilities influence health disparities and health outcomes. It is important to ensure that research is collaborative and inclusive in order to broaden the reach of future interventions to smaller linguistic minority populations.

Children With Hearing Loss and Increased Risk of Injury

PURPOSE Few studies have tested the hypothesis that children with sensory disabilities such as deafness may be at increased risk of injuries. To test this hypothesis, this study compared rates of emergency department or hospital treatment for injury among Medicaid-insured South Carolina children with and without a diagnosis of hearing loss. METHODS Medicaid billing data for 2002–2003 were obtained from the South Carolina Office of Research and Statistics. International Classification of Diseases, Ninth Revision, Clinical Modification billing codes were used to identify children with and without hearing loss, and episodes of injury-related emergency department or hospital treatment were compared for the 2 groups. RESULTS Rates of injury treatment in children with hearing loss were more than twice that of the control group (17.72 vs 8.58 per 100, respectively). The relative rate (RR) remained significantly higher (RR = 1.51, 95% confidence interval, 1.30–1.75) after adjusting for age, race, sex, and the number of hospital or emergency department encounters for treatment of non–injury-related conditions. Children with hearing loss had significantly higher treatment rates for every injury type, bodily location, and external cause, with a cell size sufficient for valid comparison. CONCLUSIONS Children with hearing loss may be at increased risk of injury. Additional study is needed to determine whether children with hearing loss are at increased risk (as opposed to simply seeking hospital care for injuries more often). If so, targeted injury prevention efforts for these children and their families would be warranted.

Engaging the Deaf American Sign Language Community: Lessons From a Community-Based Participatory Research Center

Background: Numerous publications demonstrate the importance of community-based participatory research (CBPR) in community health research, but few target the Deaf community. The Deaf community is understudied and underrepresented in health research despite suspected health disparities and communication barriers.Objectives: The goal of this paper is to share the lessons learned from the implementation of CBPR in an understudied community of Deaf American Sign Language (ASL) users in the greater Rochester, New York, area.Methods: We review the process of CBPR in a Deaf ASL community and identify the lessons learned.Results: Key CBPR lessons include the importance of engaging and educating the community about research, ensuring that research benefits the community, using peer-based recruitment strategies, and sustaining community partnerships. These lessons informed subsequent research activities.Conclusions: This report focuses on the use of CBPR principles in a Deaf ASL population; lessons learned can be applied to research with other challenging-to-reach populations.

Ethical issues in conducting research with deaf populations.

Deaf American Sign Language (ASL) users represent a small population at risk for marginalization from research and surveillance activities resulting from cultural, language, and ethical challenges. The Deaf communitys view of deafness as a cultural identity, rather than a disability, contradicts the medical communitys perception of deafness as a disease or deficiency in need of correction or elimination. These differences continue to have significant cultural and social implications within the Deaf community, resulting in mistrust of research opportunities. Two particularly contentious ethical topics for the Deaf community are the absence of community representation in genetic research and the lack of accessible informed consents and research materials. This article outlines a series of innovative strategies and solutions to these issues, including the importance of community representation and collaboration with researchers studying deaf populations.

Birth Outcomes Among U.S. Women With Hearing Loss

INTRODUCTION The purpose of this study is to estimate the national occurrence of deliveries in women with hearing loss and to compare their birth outcomes to women without hearing loss. METHODS This study examined the 2008-2011 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project in 2015 to compare birth outcomes in women with hearing loss and without. Birth outcomes included preterm birth and low birth weight. Multivariate regression analyses compared birth outcomes between women with and without hearing loss, controlling for maternal age, racial and ethnic identity, type of health insurance, comorbidity, region of hospital, location and teaching status of the hospital, ownership of the hospital, and median household income for mothers ZIP code. RESULTS Of an estimated 17.9 million deliveries, 10,462 occurred in women with hearing loss. In adjusted regression analyses controlling for demographic characteristics, women with hearing loss were significantly more likely than those without hearing loss to have preterm birth (OR=1.28, 95% CI=1.08, 1.52, p<0.001) and low birth weight (OR=1.43, 95% CI=1.09, 1.90, p<0.05). CONCLUSIONS This study provides a first examination of the pregnancy outcomes among women with hearing loss in the U.S. This analysis demonstrates significant disparities in birth outcomes between women with and without hearing loss. Understanding and addressing the causes of these disparities is critical to improving pregnancy outcomes among women with hearing loss.

Higher educational attainment but not higher income is protective for cardiovascular risk in Deaf American Sign Language (ASL) users

BACKGROUND Higher educational attainment and income provide cardiovascular protection in the general population. It is unknown if the same effect is seen among Deaf American Sign Language (ASL) users who face communication barriers in health care settings. OBJECTIVE We sought to examine whether educational attainment and/or annual household income were inversely associated with cardiovascular risk in a sample of Deaf ASL users. METHODS This cross-sectional study included 302 Deaf respondents aged 18-88 years from the Deaf Health Survey (2008), an adapted and translated Behavioral Risk Factor Surveillance System (BRFSS) administered in sign language. Associations between the self-reported cardiovascular disease equivalents (CVDE; any of the following: diabetes, myocardial infarction (MI), cerebral vascular attack (CVA), and angina) with educational attainment (≤high school [low education], some college, and ≥4 year college degree [referent]), and annual household income (<

Emergency Department utilization among Deaf American Sign Language users

25,000,