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Native American Health Issues, Lessons Learned from Community-based Interventions, and Overview of Native Cancer Projects
Linda Burhansstipanov, MSPH, DrPH, CHES
This presentation will provide a brief overview of Native American health problems and issues which affect access to quality care. A very brief overview of the health care systems will be followed by a description of common data problems which affect local communities' health program development. Cultural issues and perceptions will be described as they relate to health care and specifically to cancer care. A summary of the types of lessons Native American Cancer Research Initiatives (NACRI) staff have learned from previous and on-going community-driven interventions will be shared with the participants. An excerpt of on-going nationally-funded Native American cancer projects will also be described, followed by two NACRI projects: National Native American Cancer Survivors' Support Network and Genetic Education for Native Americans. Those two projects will be used to illustrate how interventions must be modified to be culturally relevant and effective. Participants will be invited to raise questions and comments throughout the presentation (time limitations will be in effect).
The Impacts of Racism on Health
Camara P. Jones, M.D., M.P.H., Ph.D.
This presentation starts by examining the use of the variable "race" by health researchers, including the dangers of routinely documenting "race"-associated differences without vigorously investigating the basis of those differences. The variable "race" is critiqued as a rough proxy for socioeconomic status, culture, and genes but a precise measure of the social classification of people in a "race"-conscious society. This implies that racism may account for the marked "race"-associated differences in health outcomes observed in the United States.
Three levels of racism (institutionalized, personally-mediated, and internalized) are described, each of which has impacts on health. An allegory "Levels of Racism: A Gardener's Tale" is used to illustrate these three levels of racism and the relationships between them. Approaches to measuring each of these three levels of racism are briefly outlined. The question "How often do you think about your race?" is proposed as a summary measure of the psychological impact of chronic racial stigmatization. Data are presented on the distributions of this "race"-consciousness measure in two large surveys. In addition, plots of health status by socioeconomic status, stratified by "race", are proposed as another way to isolate various impacts of racism.
Comparison of systolic blood pressure distributions by "race" suggest accelerated aging of the "black" population compared to the "white" population. These data are the basis of the author's Accelerated Aging Hypothesis, that a) "black"-"white" differences in health outcomes in the United States are due to accelerated aging of the "black" population compared to the "white" population, and b) accelerated aging of the "black" population in the United States is due to racism.
Race and Ethnicity: Categories and the Influence of SES on Health
Olivia Carter-Pokras M.H.S., Ph.D.
Sampling Racial and Ethnic Minorities
William D. Kalsbeek, Ph.D.
This presentation considers the challenges of sampling important racial and ethnic minority subgroups of the population. Probability sampling and the nature of barriers to producing statistically effective samples of these race/ethnic minorities through targeted selection and oversampling are examined. Most barriers are tied to features or limitations of the list or lists that serve as sampling frames for selection. The selection process, estimation requirements, and implications of several remedies to sampling minorities are described and illustrated.
Minority Health Research: Application of Epidemiologic Methods
Elena E.S. Yu, Ph.D., M.P.H.
Qualitative Approaches to Questionnaire Design: Methods and Applications
Richard B. Warnecke, Ph.D.
This presentation reviews the cognitive processes which influence how respondents understand survey questions, retrieve information to respond to the questions, form a judgment about the information (including interpret the response scales) and then edit the response they make. We review these processes with attention to ethnic/cultural variation. Recommendations about how these process influence questionnaire design are then made.
Issues and Challenges in Reducing Health Disparities among Hispanics/Latinos in the U.S.
Aida L. Giachello, Ph.D.
This presentation will provide an overview and practical perspectives on the major issues, challenges and opportunities in reducing health disparities among Hispanics/Latinos. Specifically, it will briefly a) describe some of the major sociodemographic, economic and cultural characteristics of this population; b) summarize the major health disparities; c) discuss the barriers and challenges to increasing access to health care; d) describe theoretical frameworks and models for public health interventions and research; and e) present policy, program and research strategies and recommendations to reduce disparities and to deliver culturally competent health and mental health services for the year 2000 and beyond.
Assumptions in Community Based Research and Assessment
Robert E. Fullilove, III, Ed.D.
This presentation focuses on the use of both quantitative and qualitative research methods in the conduct of public health research in urban African American communities. Of particular interest are strategies for identifying the social and family networks in such communities. Additionally, the need to understand the historical forces that shape community life will also be highlighted. A central assumption in the work of the presenter has been that language, socialization patterns, and intergroup relationships must be understood prior to the development of community surveys and community based public health interventions. Although race is a significant factor in determining who lives where in the United States, the argument will be made that poor communities of color differ from one another along a number of very important dimensions. To know one such community, in other words, is not to know all such communities. Determining how to understand the sources of this "within and between community variation' and developing appropriate strategies for studying them will be the central theme of this presentation.
The Detroit Community-Academic Urban Research Center: Principles, Rationale, Challenges and Lessons Learned Through a Community-Based Participatory Research Partnership
Barbara A. Israel, Dr. P.H.
This presentation will review the literature concerning the social and environmental stressors (e.g., poverty, inadequate housing, air pollution, income inequalities, racism, and lack of employment opportunities) and health, and the key principles of and rationale for community-based participatory research. The process of establishing, implementing and evaluating the Detroit Community-Academic Urban Research Center (URC) will be described and analyzed. The URC is a community-based participatory research partnership involving the University of Michigan School of Public Health, the Detroit Health Department, six community-based organizations (Butzel Family Center, Community Health and Social Services, Friends of Parkside, Kettering Butzel Health Initiative, Latino Family Services, and Warren/Conner Development Coalition), and the Henry Ford Health System. The Center began in 1995, and receives core funding from the Centers for Disease Control and Preventionís Urban Centers for Applied Research in Public Health Initiative. The major processes that occurred during the early development and maintenance of the Center and the URC Board (composed of representatives of all of the partner organizations and a research scientist assignee from the CDC) will be presented. Based upon the results of the data collected as part of the evaluation of the Board (e.g., in-depth interviews, closed-ended annual surveys, meeting field notes), key facilitating factors and challenges faced in implementing the partnership will be provided, and lessons learned and recommendations will be presented for creating effective community-based participatory research partnerships.
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