health disparities

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Exporting The Couch Potato Lifestyle (And Obesity) Via TV, Computers, Cars

(Aaron Escobar/Wikimedia Commons)

(Aaron Escobar/Wikimedia Commons)

A new study finds that the luxuries of modern life come at an extremely high cost: a greater chance of becoming obese or developing diabetes.

Researchers report that in lower-income countries, ownership of a household device — including a car, computer or TV — significantly “increased the likelihood of obesity and diabetes.”  Specifically, owning these items was “associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference.” Of the three “devices,” owning a TV had the strongest association with the bad health outcomes.

In poorer countries, such big-ticket items are clearly less prevalent than in rich countries, however they are fast becoming more ubiquitous. And so, apparently, are the ills associated with sitting around watching TV, typing on a computer and driving.

Here’s more from the news release:

The spread of obesity and type-2 diabetes could become epidemic in low-income countries, as more individuals are able to own higher priced items such as TVs, computers and cars. The findings of an international study, led by Simon Fraser University health sciences professor Scott Lear, are published today in the Canadian Medical Association Journal.

Lear headed an international research team that analyzed data on more than 150,000 adults from 17 countries, ranging from high and middle income to low-income nations.

Researchers, who questioned participants about ownership as well as physical activity and diet, found a 400 per cent increase in obesity and a 250 per cent increase in diabetes among owners of these items in low-income countries.

The study also showed that owning all three devices was associated with a 31 per cent decrease in physical activity, 21 per cent increase in sitting and a 9 cm increase in waist size compared with those who owned no devices. Continue reading

Insights On Why Some Girls Are Skirting The HPV Vaccine

Public health officials have been somewhat puzzled by low rates of HPV vaccination: only 54% of adolescent girls receive the first dose of the 3-part vaccine series, and only 33% complete it.

What gives? Doctors recommend it. It’s safe and effective. It has the potential to save thousands of lives every year. So why aren’t more people getting the HPV vaccine?

A young girl after getting the HPV vaccine

A young girl after getting the HPV vaccine

A new study by doctors and public health researchers at the University of Colorado sheds light on who remains unvaccinated and why. (While the full article has not yet been released, the authors recently presented their research with an abstract and poster.) It builds on previous findings that deserve mention: women of low socioeconomic status have the highest risk of developing cervical cancer because of their limited access to other preventative measures, like annual exams and pap smears. In other words, poor women need the HPV vaccine the most. But among the girls who begin the vaccine series, minorities and the impoverished are much less likely to complete it.

To find out why, the researchers, led by Sean O’Leary, MD, MPH, interviewed the parents of girls with an incomplete HPV vaccination. They recruited both English-speaking and Spanish-speaking parents for the study to see if there were any major differences in reasoning or access to care.

As it turns out, two big issues appear to be at play here: parents don’t understand the importance of completing the vaccine series, and healthcare providers aren’t following up about scheduling doses 2 and 3. Spanish-speaking parents had particular trouble with the latter; one parent reported that their provider was “not clear on when to get the next [shot in the series],” even though they wanted their daughter to complete the series “because we are responsible.”

What we’re looking at, it seems, is a bit of a break-down in doctor-patient communication. Continue reading

Menthol Perils: ‘Health Enemy #1 For African-Americans’

By Karen Weintraub
Guest Contributor

The FDA this week issued a “preliminary” report after more than two years of study, concluding that menthol isn’t inherently dangerous in cigarettes, but that by masking the harsh flavor, it induces more people to start smoking and makes it harder for them to stop. The report was seen as a step toward an eventual ban on menthol in cigarettes – the one flavoring not already prohibited by federal law.

Now, public health experts say, it’s time to take menthol out of cigarettes.

cigarettes

“It makes smoking a blowtorch taste like rice pudding,” says Harvard School of Public Health Professor Gregory Connolly, director of the school’s Center for Global Tobacco Control. “And unfortunately, what’s in that rice pudding is very heavy toxins that go right to the lungs and you wind up with lung cancer, heart disease, stroke, emphysema, and so forth.”

Connolly, and several other local public health experts, says there’s no scientific doubt that menthol in cigarettes is a problem. And it’s one that disproportionately harms African-Americans and young people – who have a marked preference for menthol.

“If you ask me what is Public Health Enemy #1 for the African-American community in terms cancer: it’s Newport cigarettes – the menthol in cigarettes,” Connolly says. Continue reading

Mass. Teen Birth Rate Hits Record Low; Black Infant Mortality Tops Whites

WBUR’s Martha Bebinger reports on new data released by the state Department of Public Health:

Seventeen out of 1000 teenagers in Massachusetts had a baby in 2010. That’s half the national average. Patricia Quinn, director of the Massachusetts Alliance on Teen Pregnancy, says teenagers today do a better job with contraception than did their parents.

 (kristaguenin/flickr)

(kristaguenin/flickr)

“That’s not a message that adults wrap their heads around on a regular basis that young people could be doing more right than we did when we were teens and that is definitely the case when it comes to teen pregnancy and sexual behavior,” Quinn said.

Quinn says state figures out today also shows that teen abortion rates have declined 68% since a peak in 1989. And teen births rates are at a record low.

Black babies continue to a have much greater chance of dying before their first birthday in Massachusetts as compared to white infants….

The Public Health report says the black infant mortality rate is almost two and half times that of white infants. The gap has been higher, but health leaders say the numbers are still unacceptable. Department of Public Health interim commissioner Lauren Smith.

“This just remains a call to us to focus even more intensely on the health of women of childbearing age before they even become pregnant,” Smith said.

Barriers Block Disabled Patients From Specialty Care, Study Finds

If you’re disabled and in a wheelchair, gaining full access to basic medical care can still be elusive, a new report finds.

The study, published online in the journal Annals of Internal Medicine, focuses on speciality care and concludes that even in our high-tech environment, something that seems fairly low-tech — getting a patient on to an exam table — doesn’t happen in many doctor’s offices. “Many sub-specialists could not accommodate a patient with mobility impairment because they could not transfer the patient to an examination table,” the report states.

It’s widely known — and a huge problem — that adults who use wheelchairs often face difficulties getting a complete physical examination because they have trouble getting on the exam table, says Dr. Lisa I. Iezzoni, director of the Mongan Institute for Health Policy at Massachusetts General Hospital. (Iezzoni, who has used a wheelchair for nearly 25 years because of multiple sclerosis, recently authored a report that found people with disabilities face major obstacles accessing a range of health services, from cancer screening to various medical treatments.) As a result, the study authors note, this patient population receives “less preventive care than their able-bodied counterparts.”

Dr. Tara Lagu, an internist at Baystate Medical Center

Dr. Tara Lagu, an internist at Baystate Medical Center

To investigate the problem further, researchers led by Dr. Tara Lagu, an internist at Baystate Medical Center in Springfield, enlisted medical students and residents to make appointments for a fictional obese (219 pounds), wheelchair-using patient with a recent stroke. They called doctors in four states (Massachusetts, Georgia, Oregon and Texas) and included a range of specialists — endocrinologists, gynecologists, orthopedic surgeons, ophthalmologists and psychiatrists, among others.

“We wanted a real-life snapshot of accessibility,” Lagu said. The callers would say: “I’m an internal medical resident trying to make an appointment for my patient — they had a specific script they had to adhere to.”

Shockingly, many of the office staff flat out refused to make an appointment, the researchers report. When asked why, some of these office staffers were quite direct and said it was not possible to get the disabled person on to the exam table.

You can listen to Lagu discuss the research here. But the bottom line (from the abstract) is this:

Of 256 practices, 56 (22%) reported that they could not accommodate the patient, 9 (4%) reported that the building was inaccessible, 47 (18%) reported inability to transfer a patient from a wheelchair to an examination table, and 22 (9%) reported use of height-adjustable tables or a lift for transfer. Gynecology was the subspecialty with the highest rate of inaccessible practices (44%).

Lagu said the study tracks with her “real life experience,” after 10 years as a doctor. “Pretty much everywhere I’ve been in my career, I’ve encountered this or a similar problem,” she said. Continue reading

Why Are 4 Out Of 5 Black Women Obese, Overweight?

This statistic, from a BU Today report on fighting obesity, is enough to ruin your morning: “No population in the United States has a higher obesity rate than African American women, four out of five of whom are overweight or obese, according to a 2012 study by the Centers for Disease Control and Prevention.”

No population has a higher overweight and obesity rate than African-American women (Spree2010/flickr)

The causes of this alarming obesity rate are various and complex and range from genes and diet to socioeconomic status and the environment, according to Julie Palmer, a senior epidemiologist at Boston University’s Slone Epidemiology Center who has coordinated the Black Women’s Health Study since 1995. In the BU piece, Palmer details some of these causes and potential fixes:

On Diet

“…when the women were asked how often they ate out and what type of fast food they chose—burgers, pizza, Mexican, Chinese, fried chicken, or fried fish—those who frequently chose the first option had the most consequences. “We found that eating burgers from fast food or other restaurants definitely increased risk for obesity,” Continue reading

Report: Mass. Among Most Unequal States On Income Gap

Center On Budget and Policy Priorities

Here in Massachusetts we often crow about how great things are — our premier health care and education systems, for instance. But it’s worth noting that not everything is so hot, and some things are pretty miserable. Here’s some evidence: A new report by the Center on Budget and Policy Priorities has found that across all states the gap between the richest and poorest households are wide and growing. The states with the largest gaps: New Mexico, Arizona, California, Georgia, New York, Louisiana, Texas, Massachusetts, Illinois, and Mississippi.

According to a statement on the group’s website, the 2000′s were a “lost decade” for low and middle-income households:

“Prolonged growth in income inequality undermines the basic American belief that hard work should pay off,” said Elizabeth McNichol, co-author of the report and senior fellow at the Center. “Anyone who contributes to the nation’s economic growth should reap the benefits of that growth. But for decades now, those benefits have been skewed in favor of the wealthiest members of society.”

The long-standing trend of growing income inequality continued between the late 1990s and the mid-2000s.

Incomes fell by close to 6 percent among the bottom fifth of households, on average, while rising by 8.6 percent among the top fifth, during this period. Incomes grew even faster — 14 percent — among the top 5 percent of households. For the middle fifth of households, incomes grew by just 1.2 percent.

In 45 states and the District of Columbia, gaps between the richest and the poorest households widened during this period and narrowed in none. Average incomes grew more quickly among the top fifth of households than among the bottom fifth in most states.

“For low- and middle-income families, the 2000s were a lost decade of falling incomes and economic insecurity,” said Doug Hall, co-author of the report and Director of the Economic Analysis and Research Network (EARN) at the Economic Policy Institute.

“That’s not only harmful to these families, but it also threatens our future economic growth.”

How does this relate to health care? Quite directly, says Nancy Turnbull, Senior Lecturer on Health Policy and Associate Dean for Educational Programs at the Harvard School of Public Health: Continue reading

Report: People With Disabilities Still Face Major Disparities In Health Care

Dr. Lisa Iezzoni, Massachusetts General Hospital, reports that people with disabilities were less likely to get standard treatment for breast and lung cancer, and more likely to die from their cancers.

Twenty-years after the Americans With Disabilities Act took effect, people with disabiliites continue to face major obstacles getting a range of health services, from preventive care such as cancer screening to various treatments for disease.

This bleak analysis comes from Lisa Iezzoni, MD, director of the Mongan Institute for Health Policy at Massachusetts General Hospital and is published in the October edition of the journal Health Affairs.

According to the MGH press release:

Iezzoni, who has used a wheelchair for nearly 25 years because of multiple sclerosis, explains, “An analogy I use to illustrate how disparities among racial and ethnic minorities differ from those affecting people with disabilities is that Rosa Parks made progress towards civil rights when she could get onto that bus and sit anywhere she wanted to. I can’t even get onto a bus unless it is adapted for my needs, the bus driver notices me, recognizes my disability, and reacts to it. That kind of need for proactive accommodation applies to health care facilities as well.”

The 2010 census found that 54 million Americans — nearly 20 percent of the population — were then living with disabilities. Less than half of adults with disabilities were employed, and 27 percent of those with severe disabilities fell below the poverty rate, compared with 9 percent of those without disabilities. Iezzoni’s review of several broad-based surveys found that people with disabilities were significantly more likely to report being in fair or poor health than were those without disabilities. Continue reading

Investigating Breast Cancer Disparities Among African-American Women

The National Cancer Institute just awarded $19.3 million to several medical teams, including one at Boston University, to investigate the disparities in breast cancer among African-American women.

Here’s the BU press release:

Why are African-American women more likely than those of European descent to be diagnosed with breast cancer at a young age, and with poor prognoses? It’s a provocative question, and one that a multidisciplinary team from the Slone Epidemiology Center at Boston University (BU), the University of North Carolina Lineberger Comprehensive Cancer Center (UNC) and Roswell Park Cancer Institute (RPCI) are coming together to address, supported by a five-year, $19.3 million award from the National Cancer Institute (NCI).

This “team science” effort to better understand a significant health disparity will be led by Co-Principal Investigators Julie Palmer, ScD, from BU, Robert Millikan, PhD, from UNC’s Lineberger Comprehensive Cancer Center and Christine Ambrosone, PhD, from RPCI. They will collaborate with a team of researchers in a national study investigating the causes of breast cancer among African-American women. For reasons that are not clear, African-American women are more likely than women of European descent to be diagnosed before age 45, and are also more likely to be diagnosed with aggressive types of breast cancer that are linked to more deaths. Continue reading

Health Report: Stark Racial Disparities Persist

Don McNeil of The New York Times digs in to the first-ever report by the CDC on racial disparities in health and health care and finds some troubling surprises, among them that, “Blacks are hit proportionately harder by AIDS, strokes and heart disease. And American Indians tend to die in car crashes.”

Some of the other striking health gaps he details include:

–Babies born to black women are up to three times as likely to die in infancy as those born to women of other races.

–More than 80 percent of all suicides are committed by whites, but young American Indian adults have the highest suicide rates by far — 25 per 100,000 population at age 21, compared with 14 for whites, 10 for blacks and 8 for Asians and Hispanics.

–Overdoses of prescription drugs now kill more Americans than overdoses of illegal drugs, the opposite of the pattern 20 years ago. Overdose death rates are now higher among whites than blacks; that trend switched in 2002, after doctors began prescribing more powerful painkillers, antidepressants and antipsychotics — more easily obtained by people with health insurance.

–High blood pressure is twice as common among blacks as whites, but the group with the least success in controlling it is Mexican-Americans.

–Compared with whites, blacks have double the rate of “preventable hospitalizations,” which cost about $7 billion a year.

–Blacks, Hispanics and American Indians, whether gay or straight, all have higher rates of new infection with the AIDS virus than whites, and the situation is getting worse for blacks and Indians. Asians have the lowest rate.

–Binge drinking — defined as five drinks for men and four for women — is increasing. In a switch from the norm for health problems, it is more common among the better-educated and more affluent, including college students. But poor people, and especially American Indians, drink much more heavily when on binges.

–Teenage pregnancy is holding steady or falling for all ethnic groups, but is still three times as common among Hispanic girls as among white girls, and more than twice as common among black girls as among whites.