Resource List - UC Davis Health Disparities Research

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A Procedure to Characterize Geographic Distributions of Rare Disorders in Cohorts
This study focused on improved techniques for finding statistical significance for clusters of individual point data.  By eliminating false positives (which would incorrectly correlate individual data points as significant clusters), resultant clusters can thus be analyzed for demographic risk factors because confounding evidence is significantly reduced.

Asian Americans and Cancer Clinical Trials. A Mixed-Methods Approach to Understanding Awareness and Experience
Barriers to recruitment of minority populations affect the generalizability and impact of clinical trial findings for those populations.  A survey was administered to new cancer patients.  Comparison of survey results for Asian-American respondents and non-Asian respondents indicated that Asians were less likely to have heard the term "clinical trial" and were more likely to define a clinical trial as "an experiment" or "a test procedure in a clinic" than non-Asians.  Multiple strategies will be necessary to enhance awareness of and experience with accrual to cancer clinical trials for Asians.

Overcoming Barriers to Cancer Clinical Trial Accrual. Impact of Mass Media Campaign. The object of this study was to increase awareness of cancer clinical trials and SB 37 through a mass multi-media campaign.  Awareness level predicted willingness to participate.  Blacks, Asians, and lowest income groups were the least willing to participate.  Awareness increased significantly at UCD versus the UCSD cohort.  It was unclear whether this increase was attributable entirely to the multi-media campaign or to varying demographic variables.

Persistent Racial and Ethnic Disparities in Up-to-Date Colorectal Cancer Testing in Medicare Enrollees. 
The object of this study was to assess whether there is greater colonoscopy use among white as compared with nonwhite Medicare enrollees since Medicare established coverage for colorectal cancer screening has been associated with a widening in white versus nonwhite disparities in up-to-date colorectal cancer screening testing status.  Although white versus nonwhite disparities in up-to-date status via colonoscopy widened, this was counterbalanced by narrowing white versus nonwhite disparities in up-to-date status via fecal occult blood test and sigmoidoscopy.

Trends in Colorectal Cancer Testing Among Medicare Subpopulations. 
In 1998, Medicare initiated universal coverage for colorectal cancer screening via fecal occult blood testing and sigmoidoscopy. In mid-2001, universal coverage was advanced to screening colonoscopy. This study sought to determine whether trends in colorectal cancer testing differed among racial/ethnic, age, or gender subgroups of the Medicare population.  The study found that colonoscopy is supplanting sigmoidoscopy as a colorectal cancer test among Medicare enrollees, while fecal occult blood testing use is in decline. The transition from sigmoidoscopy to colonoscopy has occurred more quickly among white than nonwhite Medicare enrollees.

Determinants of Racial/Ethnic Colorectal Cancer Screening Disparities. 
This study found that determinants of racial/ethnic colorectal cancer screening disparities vary among minority groups, suggesting the need for different interventions to mitigate those disparities.  Whereas socioeconomic, access, and language barriers seem to drive the colorectal cancer screening disparities experienced by blacks and Hispanics, additional factors may exacerbate the disparities experienced by Asians.

Factors Associated with Hispanic/non-Hispanic White Colorectal Cancer Screening Disparities. 
In the United States, Hispanics are less likely to undergo colorectal cancer (CRC) screening than non-Hispanic whites (whites).  Factors associated with CRC screening disparities between Hispanics and non-Hispanic whites appear similar among Hispanic sub-groups. However, the relative contribution of these factors to disparities varies by Hispanic national origin group, suggesting a need for differing approaches to increasing screening for each group (Mexican, Cuban, Puerto Rican, or Dominican).

Can Patient Coaching Reduce Racial/Ethnic Disparities in Cancer Pain Control? Secondary Analysis of a Randomized Control Trial.
Minority patients with cancer experience worse control of their pain than do their white counterparts. This disparity may reflect more miscommunication between minority patients and their physicians. Therefore, we examined whether patient coaching could reduce disparities in pain control in a secondary analysis of a randomized controlled trial.  At enrollment, minority patients had significantly more pain than their white counterparts.  At follow-up, minorities in the control group continued to have more pain, whereas in the experimental group, disparities were eliminated.  The effect of the intervention on reducing disparities was significant.  Patient coaching offers promise as a means of reducing racial/ethnic disparities in pain control. Larger studies are needed to validate these findings and to explore possible mechanisms.

Engaging the Underserved: Personal Accounts of Communities on Mental Health Needs for Prevention and Early Intervention Strategies.
UC Davis Center for Reducing Health Disparities.

The findings in this report are a result of 30 focus groups conducted in 10 counties across California.  There were common concerns from historically underserved communities in regards to accessing and utilizing the existing mental health care system.  The most common concerns among focus group participants were violence and trauma, illicit drugs, depression, stress, and suicide.  There is also limited or no access to mental health care and other social services due to a variety of barriers.  Social determinants, such as poverty and discrimination, were identified as major factors affecting mental health in communities.  Focus groups also cited social exclusion and isolation as a barrier to accessing mental health care.  Focus groups also emphasized that mental health services need to build on existing community resources to help improve the existing mental health care system.  Several recommendations from the CRHD and the focus groups are outlined in this report.

Building Partnerships: Key Considerations When Engaging Underserved Communities Under the Mental Health Services Act.
UC Davis Center for Reducing Health Disparities.

Key informant interviews and focus groups were used to gather information on the needs, priorities, community assets and views on services provided by County Mental Health Departments.  Key considerations for County Mental Health Departments were discussed for successfully reaching out to underserved communities.  Departments need to first identify historically unserved and underserved communities.  Second, Departments need to engage communities based on mutual respect and power sharing.  Lastly, Departments should follow 7 principles of community engagement: 1) pay attention to histories of marginalization and mistrust; 2) have transparent discussions of power; 3) build on community strengths and local knowledge; 4) encourage cooperation; 5) identify opportunities for co-learning; 6) make important efforts towards sustainability, systems development, and capacity building; and 7) make important efforts to protect the well-being, interests, and rights of communities.