Diversity in Health Disparities and Health Equity Research in Family and Community Health

Family and Community Health has taken up the mantle of health disparities and health equity as primary foci in an effort to advance the science of health disparities leading to health equity with a focus on families and communities in the Unites States and across the globe. As championed by the National Center for Minority Health and Health Disparities, health disparities research "is a multidisciplinary field of study devoted to gaining greater scientific knowledge about the influence of health determinants and defining mechanisms that lead to disparities and how this knowledge is translated into interventions to reduce or eliminate adverse health differences." Health equity has been defined as not only the absence of systematic disparities in health and the determinants of health1 but also "the principle underlying a commitment to reduce-and, ultimately, eliminate-disparities in health and in its determinants, including social determinants."2 The editors of this issue of Family and Community Health present a collection of peer-reviewed articles that provide a glimpse of the diversity in health disparities and health equity work.

In particular, these articles highlight the diversity of social determinants of health that contextualize and shape the distinctive health characteristics and attributes of populations that tend to have worse health outcomes due to factors that are modifiable and unjust. Collectively, these articles highlight a range of contextual factors that are included among the broader social determinants of health. Examining and considering the heterogeneity among these factors are an important foundation of efforts to more precisely identify magnitude of forces that shape health disparities within and across families and communities that lead to insights into achieving health equity. These studies not only highlight the array of forces that influence, exacerbate, and maintain the poor health of particular groups but also emphasize the need to illuminate the unique mechanisms and pathways that connect these factors to specific family and community practices that affect and pattern health outcomes.

O'Neal and colleagues open this issue with a study examining the impact of individual, social, and environmental factors on obesity-related behaviors among African American community members from 3 cities in the southeastern United States. Their results demonstrate how factors at multiple levels of analysis have implications for physical activity among urban African Americans in the South.

The next article by Fakunle and colleagues reports findings from a study on e-cigarette availability in alcohol outlets in a metropolitan city in the mid-Atlantic region of the United States. While the literature on e-cigarette is sparse, the authors present results from analysis of data from field surveys of alcohol outlets along with area socioeconomic data to demonstrate distribution patterns in Baltimore, Maryland. Findings indicate that e-cigarettes were available in outlets where cigarettes, cigars, or hookah paraphernalia were sold-low-income, nonwhite neighborhoods.

Exposure to nicotine delivery systems such as cigarettes and e-cigarettes poses a risk to child health. Teixeira and Zuberi present a study of asthma, a condition often linked to and aggravated by air impurities. The authors analyze data from more than 3000 children from low-income neighborhoods and present evidence suggesting that family characteristics can mitigate the direct impact of community-level poverty on childhood asthma, suggesting that the macro-level factors have implication for individual health outcomes through entities more proximate to individuals.

The fourth article in this issue is salient for the current political climate, given its focus on immigration status. Held and Lindley analyze data from more than 4000 unauthorized immigrants from Mexico or Guatemala who needed prenatal care. The results indicated that Guatemalan participants were more likely to have inadequate prenatal care and have fewer prenatal visits than their Mexican peers. This study demonstrates some of the significant variation within immigrant groups entering the United States and highlights the challenge of categorization without context.

The article by Yue and colleagues is the only contribution in this issue focusing on a population outside of the United States. The authors report data from a study of 1383 infants between 18 and 30 months in rural China designed to provide insight into feeding practices between mothers and grandmothers. The results indicate that both groups do not regularly engage in positive feeding practices; however, mothers tend to be better than grandmothers. The authors note that the feeding practices of grandmothers were better with their grandchildren than their own children, suggesting that greater access to educational opportunities and access to reliable information could be ways to improve infant feeding practices by women in rural parts of China.

Rurality is also an important theme in the remaining articles in the issue. Hege and colleagues report findings from focus groups comprising members from 2 Appalachia communities in North Carolina. Focus groups participants were asked to share their insights into barriers to health and well-being in rural areas. Poverty was a central them, as participants cited limited economic opportunities as being an obstacle to access to resources such as food and health care. The voices of participants provided a rich context for consideration of social, economic, and health challenges facing individuals in rural and remote areas of the United States.

Fawcett and colleagues report results from an evaluation of a managed care program for underserved individuals who lived in rural areas and were diagnosed with heart failure and/or diabetes. The study of 277 patients enrolled in the program based on a nurse/community health worker team model produced results indicating that managed care could be used in rural settings. Participants in this study had fewer hospital admissions, fewer inpatient days when they were hospitalized, and had an overall positive return on investment.

The final article in this issue also highlights the significance of population health approaches for rural populations. Lin, Ortiz, and Boor conducted a study designed to examine the impact of Medicare Shared Savings Program Accountable Care Organizations (ACO) for diabetes-related hospitalization rates for rural black and white older adults. The authors did not find that ACO affiliation had a significant impact on the outcome of interest; however, this study was important because it sets the baseline for patient outcomes during the early years of ACO formation and development.

Family and Community Health has a rich tradition and global impact, and we believe this tradition was upheld in the current issue. We were honored to edit this issue. We reviewed a number of manuscripts and learned a great deal about the current thinking about the intersection between family health, community health, health disparities, and health equity. We could not publish all of the manuscripts that were submitted, and we had to make difficult decisions about which papers to include in this issue. We thank all authors for submitting their work for consideration, and we wish the editorial board, the Editor-in-Chief, and the publishers the best in their effort to impact health disparities and health equity research.

-Marino A. Bruce, PhD, MSRC, MDiv

-Derek M. Griffith, PhD

-Roland J. Thorpe, Jr, PhD

Issue Editors

REFERENCES