In the United States, health disparities continue to be a significant and growing problem for different sectors of the population. Although there are several definitions of health disparities, one accepted definition is that health disparities are "differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographical attributes."1,2 The Institute of Medicine report Unequal Treatment3 provided sufficient evidence that certain racial/ethnic groups, particularly African Americans, American Indians (AI), and Latinos, have higher incidence of chronic diseases, higher mortality, and poorer health outcomes, and are more likely to receive worse health care than whites. The reasons for health disparities are complex and have resulted from an intricate interaction among factors such as biology, the environment, a shortage of minority health care professionals, certain behaviors, and inequities in income, education, and access to health care. Biologic and genetic factors alone do not account for the health disparities that are experienced by minority populations. There is national consensus that the health disparities gap must be closed, and multidimensional approaches are required to mitigate them. This issue of Family and Community Health presents articles addressing strategies for dealing with health disparities.
The issue's first article brings focus to the link between a culturally diverse nursing workforce and the ability to provide quality, culturally competent patient care as a means of assuaging the health disparity gap between minority and nonminority populations. Degazon and Mancha report on findings from a Nursing Diversity Workforce grant, BEST (Becoming Excellent Students in Transition to Nursing), designed to assist students from minority and educationally disadvantaged backgrounds to become culturally competent registered nurses. They describe the strategies that were used, the outcomes derived, and the potential for closing the health disparity gap between segments of the population. The authors underscore the need for a nursing workforce that is culturally and linguistically attuned to the humaneness of all persons, particularly those who are underserved.
The second article provides results of a quasi-experimental study designed to address the low levels of awareness and use of a Cancer Information Service among African Americans and Hispanics. Kreuter et al tested the feasibility of promoting use of 1-800-4-CANCER through partnerships with community-based organizations that serve African American and Hispanic populations. Specifically, researchers and community partners jointly developed 16 types of small-media and client reminders that promoted information seeking about HPV vaccination. The authors reported that evidence-based cancer control resources can be effectively distributed though networks of community organizations and can increase health-related information seeking among constituents.
The third article in this issue focuses on the reduction of cancer disparities among Central Appalachian residents. Schoenberg et al conducted focus groups and key informant interviews to identify strategies to address the elevated rates of cancer disparities in Appalachian Kentucky residents. Residents identified cancer-screening challenges and strategies. Insights gleaned from the results informed a community-based participatory research intervention and offered strategies to others working in Appalachia, rural locales, and other traditionally underserved areas.
The fourth article describes how the Comprehensive Participatory Planning and Evaluation (CPPE) process was utilized within a community-based participatory research initiative aimed at addressing obesity in the health disparate Dan River Region. Zoellner et al detail how the community-academic partnership executed each step of the CPPE process to advance from the needs assessment phase to the action-oriented phases. As a result of the CPPE process, a collaborative community coalition is well positioned in the Dan River Region and empowered to make collective steps toward obesity reduction and improved community health.
The fifth article communicates how an evidence-based depression treatment was adapted to prevent depression among low-income mothers with vulnerable children. Feinberg et al adopted the principles of Problem-Solving Treatment into an intervention to prevent depression among low-income, culturally diverse mothers who have children who are at risk for developmental disability or school failure. The intervention adaptations spanned 3 domains. The feasibility of adaptations was assessed through 2 pilot-randomized trials, which demonstrated high participant adherence, satisfaction, and retention, demonstrating the feasibility of the adaptations.
The sixth article examines the relationship between AI parents' health and support behaviors, and their children's weight, physical activity, and dietary intake as a means of addressing the high overweight and obesity rates among AI youth. Ricci et al conducted a cross-sectional study to compare AI parents' report of their own diet, physical activity, and support for their child to engage in healthy diet and activity behaviors with their children's weight status. Their study may be the first to address such comparisons, with findings pointing to future research to more fully understand familial or societal factors that contribute to AI youth overweight and obesity.
The final article in this issue highlights the health care challenges posed by the recent growth of Latino immigrants, particularly in "emerging Latino states." McGuire et al describe the development, implementation, and evaluation of an educational DVD titled "A Guide to Working With Latino Patients in Alabama" used to reach health care professionals in a state that has recently received a large influx of Latino immigrants. Understanding common cultural beliefs and health care-seeking behaviors among the Latino immigrant population is an important aspect in facilitating competent care and reducing health disparities. Knowledge and confidence were assessed through pre- and posttest assessments among health care professionals nationwide. Results indicated significant increase in overall knowledge and confidence levels, indicating that multimedia training may be a promising approach to improving health care with Latino immigrants in the United States.
Overall, the articles presented in this issue offer promising collaborative strategies for addressing health disparities. Health statistics show that many racial and ethnic minorities, especially those in African American and Hispanic communities, are not aware of their disease or other health conditions until it is too late to start effective treatment,4 which further exacerbates the problems experienced in these minority groups. While regular physician visits can help minority patients stay in control of their health, many of these patients do not have access to adequate health care. One potentially good source for health information is the media; however, mainstream media focuses more on a business model that places much emphasis on entertainment news versus issues that truly matter to the general public.5 Since racial/ethnic audiences tend to get much of their health news through television and radio first,6 using mass media to bring more awareness to racial and ethnic communities regarding health issues could prove effective in the overall fight to reduce and ultimately eliminate health disparities.
We thank each author for sharing his or her work related to the theme of this issue. We also thank all reviewers whose critiques and recommendations helped to shape and refine the content in this issue.
-Veronica G. Parker, PhD
Professor/Biostatistician, School of Nursing
Director, Center for Research on Health
Disparities
Clemson University, Clemson,
South Carolina
[email protected]
-Charlton J. Coles, PhD
Behavioral Scientist
Agency for Toxic Substances and Disease
Registry
Division of Toxicology and Environmental
Medicine
Centers for Disease Control and Prevention
Atlanta, Georgia
[email protected]
-Valerie W. Black, MA
Instructor, Communication Arts
Johnson C. Smith University
Charlotte, North Carolina
[email protected]
REFERENCES