Shelley I. White-Means

Exploring Mediators of Food Insecurity and Obesity: A Review of Recent Literature

One in seven American households experience food insecurity at times during the year, lack of money and other resources hinder their ability to maintain consistent access to nutritious foods. Low-income, ethnic minority, and female-headed households exhibit the greatest risk for food insecurity, which often results in higher prevalence of diet-related disease. The food insecurity-obesity paradox is one that researchers have explored to understand the factors that influence food insecurity and its impact on weight change. The aim of this inquiry was to explore new evidence in associations of food insecurity and obesity in youth, adult, and elderly populations. A literature search of publication databases was conducted, using various criteria to identify relevant articles. Among 65 results, 19 studies conducted since 2005 were selected for review. Overall, the review confirmed that food insecurity and obesity continue to be strongly and positively associated in women. Growing evidence of this association was found in adolescents; but among children, results remain mixed. Few studies supported a linear relationship between food insecurity and weight outcomes, as suggested by an earlier review. New mediators were revealed (gender, marital status, stressors, and food stamp participation) that alter the association; in fact, newer studies suggest that food stamp participation may exacerbate obesity outcomes. Continued examination through longitudinal studies, development of tools to distinguish acute and chronic food insecurity, and greater inclusion of food security measurement tools in regional and local studies are warranted.

Cultural Competency, Race, and Skin Tone Bias Among Pharmacy, Nursing, and Medical Students Implications for Addressing Health Disparities

The Institute of Medicine report, Unequal Treatment, asserts that conscious and unconscious bias of providers may affect treatments delivered and contribute to health disparities. The primary study objective is to measure, compare, and contrast objective and subjective cognitive processes among pharmacy, nursing, and medical students to discern potential implications for health disparities. Data were collected using a cultural competency questionnaire and two implicit association tests (IATs). Race and skin tone IATs measure unconscious bias. Cultural competency scores were significantly higher for non-Hispanic Blacks and Hispanics in medicine and pharmacy compared with non-Hispanic Whites. Multiracial nursing students also had significantly higher cultural competency scores than non-Hispanic Whites. The IAT results indicate that these health care preprofessionals exhibit implicit race and skin tone biases: preferences for Whites versus Blacks and light skin versus dark skin. Cultural competency curricula and disparities research will be advanced by understanding the factors contributing to cultural competence and bias.

Informal caregivers' leisure time and stress

This article explores the disruption informal caregiving creates in the caregivers family life and the relationship between leisure and stress caused by caregiving. The study finds that the caregiving setting, caregivers sociodemographic characteristics, and economic variables (i.e., wage rate, nonwage income, and Medicaid coverage) significantly affect the caregivers leisure. Additionally, reducing leisure leads to emotional and physical stress and less satisfaction with life overall. The article concludes with implications for public policy.

The economic implications of the racial and ethnic disparities in the use of selective serotonin reuptake inhibitors

ABSTRACT Objectives: Previous studies have examined racial and ethnic disparities in the use of selective serotonin reuptake inhibitors (SSRI). This study aims to examine the economic implications of these disparities. Research design and methods: In this retrospective observational study, the study sample was adult survey respondents with a diagnosis of depression from the Medical Expenditure Panel Survey (2002–2003). SSRI use was measured as the number of times when SSRIs were obtained. The racial and ethnic disparities in SSRI use were examined employing a negative binomial model. The economic implications of disparities were explored using a linear regression with SSRI use as an independent variable. Interaction terms between the variable for SSRI use and dummy variables for racial and ethnic groups were included to explore whether the relationships between SSRI use and health expenditures differ across racial and ethnic groups. Results: The mean number of times of SSRI use was higher for non-Hispanic whites than non-Hispanic blacks (3.02 vs. 1.79; p < 0.05) and Hispanic whites (3.02 vs. 1.68; p < 0.05). These differences were still significant after adjusting for covariates ( p < 0.05). In the multivariate analysis, each time of SSRI use was associated with health expenditures of

Race, disability and assistive devices: sociodemographics or discrimination

301 higher. Neither dummy variables for racial and ethnic groups nor the interaction terms between these dummy variables and the variable for SSRI use were significant. Conclusions: The lower use of SSRIs among minorities compared to non-Hispanic whites is associated with lower health expenditures among minorities. SSRI may be a proxy for improved access to health care due to under-treatment of depression in general. The main limitation of this study is that its observational nature does not allow the researchers to determine whether the association between SSRI use and the increase in health expenditures is a causal effect.

Race versus ethnic heritage in models of family economic decisions

This research provides empirically‐based, detailed information on race as a determinant of the relationship between chronic illness/disability and assistive device use by elderly persons. The database is the 1994 wave of the National Long Term Care Survey. The important findings are: whites are more likely to use home modification devices and blacks are more likely to use portable devices; chronic conditions vary in their influence on the use of assistive devices; the joint presence of diabetes, heart conditions or hypertension with ADLs and IADLs motivates greater assistive device use; the relationships between chronic health conditions and assistive device use vary by race; for blacks, income has the largest impact on assistive device purchases; half of the racial differences in the probability of using assistive devices is explained by differences in sociodemographic characteristics and the rest is explained, in part, by discrimination.

Labour supply of informal caregivers

Race is an important dimension which survey researchers use to examine a number of social phenomena. Despite its importance, few researchers realize the measurement implications of using race as a proxy for experience and culture in statistical modeling. Particularly problematic is the tendency to use race and ethnic heritage interchangeably. This article proposes that one cannot use race and ethnic heritage interchangeably without impacting the results and interpretation. Through a case study, measurement errors in models that use race and ethnic heritage interchangeably to examine family decisions are explored. Results using race are different from results when ethnic heritage is used. This article concludes with a proposed framework for research that contrasts the utility of race and ethnic heritage in statistical models.

Do working mothers have healthy children

This paper contributes to the informal caregiving literature by investigating the relationship between caregiving and the caregivers labour market decisions. Its main interest is in determining the factors that affect the caregivers decisions to remain in the work force and the amount of time he/she chooses to work. A major finding is that non-wage income, wage rate, education, the make-up of the caregiving network, and a host of identifiable sociodemo-graphic factors influence the caregivers labour market decisions. Another finding is that some of the sociodemographic factors, e.g., gender and living arrangements, affect the decision to work but not the number of hours of work, and vice versa. The paper concludes with a discussion of future studies and public policy implications.

African American women: Surviving breast cancer mortality against the highest odds

This paper examines the effects of maternal employment on childrens physical and mental health. The data used are from the Health Interview Survey 1981, Child Health Supplement. A health production model is developed on the basis of Beckers household production theory. The results reveal that a mothers employment is a significant factor affecting her childs physical health. Use of physician services, prices (i.e., CPI used as a proxy variable), sex of the child, receipt of Medicaid, the number of relocations, the mothers education, the mothers health status, breast-feeding practices, and the birth weight of the child are other important variables explaining the health status of children. The role of each of these factors varies according to the marital status of the mother.

Medical Expenditure Panel Survey: A valuable database for studying racial and ethnic disparities in prescription drug use

Among the country’s 25 largest cities, the breast cancer mortality disparity is highest in Memphis, Tennessee, where African American women are twice as likely to die from breast cancer as White women. This qualitative study of African-American breast cancer survivors explores experiences during and post treatment that contributed to their beating the high odds of mortality. Using a semi-structured interview guide, a focus group session was held in 2012 with 10 breast cancer survivors. Thematic analysis and a deductive a priori template of codes were used to analyze the data. Five main themes were identified: family history, breast/body awareness and preparedness to manage a breast cancer event, diagnosis experience and reaction to the diagnosis, family reactions, and impact on life. Prayer and family support were central to coping, and survivors voiced a cultural acceptance of racial disparities in health outcomes. They reported lack of provider sensitivity regarding pain, financial difficulties, negative responses from family/friends, and resiliency strategies for coping with physical and mental limitations. Our research suggested that a patient-centered approach of demystifying breast cancer (both in patient-provider communication and in community settings) would impact how women cope with breast cancer and respond to information about its diagnosis.