TAG: "Health disparities"

UC Davis personalizing outreach to address Asian cancer health disparities


National Minority Cancer Awareness Week is April 13-19.

In an effort to reduce cancer health disparities among Asian-Americans, UC Davis Comprehensive Cancer Center now offers individual, in-language education and culturally sensitive materials for every Asian-American cancer patient.

Debuting during the National Minority Cancer Awareness Week April 13-19, the new brochures and five-minute videos are designed to inform Asian-Americans about the importance of engaging in cancer research. The educational efforts also are part of the Asian-American Cancer Education Study (AACES), a UC Davis program aimed at increasing awareness of clinical trials and the importance of donation of biospecimens such as blood, saliva or tissue.

Asian-Americans’ involvement in clinical trials and biospecimen donation is crucial because Asian-Americans are consistently underrepresented in cancer research. Studies show that language barriers, mistrust of the medical system and cultural differences often create misunderstandings about the nature and purpose of clinical trials and biospecimen donation, discouraging participation.

“Asian-Americans are the only racial group for whom cancer is the leading cause of death, so we are highly motivated to increase their involvement,” said professor Moon Chen, the cancer center’s associate director for cancer control.

UC Davis researchers have found that less than five percent of all clinical trials participants in the U.S. include minorities, less than two percent of clinical cancer research studies focus on non-white ethnic or racial groups, and biospecimen collection among diverse populations lags far behind that of non-Hispanic whites.

The Asian American Network for Cancer Awareness and Training (AANCART), headquartered at the UC Davis Comprehensive Cancer Center, developed the brochures and DVDs based on extensive research using ethnically specific community outreach programs in Honolulu, Los Angeles, Sacramento and San Francisco. Through community focus groups and surveys conducted in Vietnamese, Chinese, Korean, Tagalog and Hmong, AANCART sought to understand existing cultural barriers and misconceptions about participation in cancer research. They found many causes of confusion, from pervasive cultural beliefs to language problems such as inaccurate translation of certain terms and phrases.

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Higher social class linked to fewer bone fractures among non-white women


UCLA findings help shed light on importance of social class in fracture risk of midlife women.

If you are a middle-aged African-American or Asian woman, your social class may play a significant role in how likely you are to suffer bone fracutres, a UCLA-led study suggests.

The study, published in the current issue of Osteoporosis International, is unique in that it followed Asian, African-American and white women for a period of nine years during midlife; most previous studies on socioeconomic status and osteoporosis risk had focused solely on older white women and often had not collected information on fractures over time.

The new findings help shed light on the importance of social class — and particularly education levels — in the fracture risk of midlife women from different racial and ethnic groups, the researchers said.

Osteoporosis is a public health concern for a wide variety of individuals. About half of post-menopausal women and 20 percent of older men will suffer an osteoporosis-linked fracture, said the study’s lead author, Dr. Carolyn Crandall, a professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.

“The traditional paradigm of assessing fracture risk does not include consideration of socioeconomic factors, such as education and income,” she said. “Examining the associations of socioeconomic status with fracture risk could help the targeting of individuals at risk of future fracture and inform the development of preventive strategies.”

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Joint cancer center study finds barriers to minority clinical trial participation


New strategies for data collection recommended.

Moon Chen, UC Davis

A new study involving researchers from UC Davis and four other National Cancer Institute-designated cancer centers reveals important barriers that limit minority group participation in cancer clinical trials, findings that will be used to refine and launch more effective strategies to assure that more minorities benefit from clinical trials.

The study, published online today (March 18) in Cancer, found variations in how the cancer centers gather patient demographic information and other relevant data. The research was part of a national effort to recruit more racial/ethnic minorities into therapeutic clinical trials and, ultimately, to reduce the disproportional incidence of many cancers among those populations.

UC Davis is one of five National Cancer Institute-designated comprehensive cancer centers united in the endeavor, known as EMPaCT – Enhancing Minority Participation in Clinical Trials. Funded by the National Institute of Minority Health and Health Disparities, the consortium is in the second phase of its work to address barriers that limit the representation of minorities in therapeutic trials.

“Racial and ethnic minorities make up more than half the nation’s population, but language, culture, and other barriers historically have suppressed their involvement in clinical trials,” said UC Davis professor Moon Chen, who leads the UC Davis EMPaCT team. “Clinical trials are critical to our development of effective cancer therapies, and we must have participation by meaningful numbers from all racial/ethnic groups to ensure those therapies are based on specific characteristics of these populations.”’

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Study to examine social adversity, early puberty, risk-taking by teens


Researchers will work with a group of more than 600 youth and their parents in Salinas.

How does social adversity affect the timing of puberty? How do social adversity and early puberty influence risk-taking behavior in teens?

Julianna Deardorff, assistant professor in the UC Berkeley School of Public Health’s Maternal and Child Health program, recently received a $2.5 million grant from the National Institutes of Health to find out.

Deardorff and her team (which will include an M.P.H. student and a postdoctoral fellow) will work with a group of more than 600 youth and their parents in Salinas. The research will include analyzing pubertal hormones, stress hormones and cultural factors that may exacerbate or protect against the negative effects of stressful circumstances.

“My goal has always been to understand how stress gets under the skin and can lead potentially to earlier and faster puberty and to sexual risk-taking behaviors in Latino youth who are growing up in adverse circumstances,” says Deardorff, who will start working with this migrant farming community in April.

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Study finds 125K immigrant youth with ‘deferred action’ may be eligible for Medi-Cal


UC reports indicate need, potential for health coverage among undocumented.

Laurel Lucia, UC Berkeley

University of California researchers today (Feb. 25) released two reports that indicate high need and potential for health coverage among undocumented teens and young adults in the Golden State. The findings trail a bill recently introduced in the California Legislature that calls for health care coverage for all Californians regardless of their immigration status.

Up to 125,000 young immigrants are estimated to be Medi-Cal (the state’s Medicaid program) eligible under state policy, according to a new report, Realizing the Dream for Californians Eligible for DACA: Demographics and Health Coverage released by the UC Berkeley Labor Center, the UC San Francisco Philip R. Lee Institute for Health Policy Studies and the UCLA Center for Health Policy Research. DACA, or Deferred Action for Childhood Arrivals, provides temporary work authorization and relief from deportation for undocumented immigrants who came to the U.S. as children. In California policy, unlike that of most other states, low-income individuals granted deferred action are eligible for Medi-Cal.

“This state policy could significantly improve health coverage rates among these young immigrants, increase access to the care they need and reduce the burden on safety net providers,” says Laurel Lucia, a policy analyst with the UC Berkeley Labor Center. “However, immigrant youth may still face barriers to enrolling because they lack information on the program or fear deportation for themselves or family members.”

Out of the 300,000 undocumented Californians estimated to be eligible the DACA program, approximately 150,000 have applied and been granted deferred action. Despite being considered “lawfully present” by the U.S. Department of Homeland Security, DACA youth are not eligible for federally subsidized health programs, such as Medicaid or the new programs created under the Affordable Care Act.

A high need for coverage exists, according the UCLA Labor Center’s Undocumented and Uninsured: Immigrant Youth and the Struggle to Access Health Care in California, the first statewide study about and by immigrant youth on health care access. Researchers surveyed 550 immigrant youth throughout the state, including DACA-eligible and undocumented youth.

The UCLA Labor Center researchers found that 69 percent of immigrant youth did not have health insurance, while half delayed getting the medical care they felt they needed in the past year. Nearly all (96 percent) of those delaying care cited cost or lack of insurance as reasons.

“Without health care, immigrant youth and their families must rely on Band-Aid solutions,” says Imelda Plascencia, one of the report authors.

“They wait for hours at free clinics for partial care or find ways to pool resources with friends and family,” says Plascencia, who also is undocumented. “Whenever they interact with the formal medical system, the fear of deportation is present. These experiences are inhumane.”

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Home makeovers for health


UCLA public health experts part of effort to help at-risk families in East L.A.

During a home visit, registered dietitian Brenda Robles talks to a study participant about healthy food choices. Promotora Rosalba Cain (middle) is part of the study team.

Home is where more than just the heart is — it’s where the risk of obesity-related conditions such as diabetes and heart disease lurks.

It’s where countless people spend hours sitting on the sofa watching television instead of being physically active. And it’s where they will reach for conveniently packaged processed foods rather than spend the time and energy preparing a healthier meal from scratch.

To help residents change their home environment and reduce these risks, a group of public health experts from the Fielding School of Public Health led by professor William McCarthy, in partnership with researchers at USC and leaders from the East Los Angeles community, has devised a hands-on strategy that goes far beyond merely sitting down with residents to advise them about their diet and the benefits of physical activity.

With the cooperation of residents, they are going into the homes of at-risk families in East Los Angeles to work together to transform their living environment. Call it a home makeover for health.

For the population of East Los Angeles, which is overwhelmingly Mexican American, the risk of obesity-related conditions such as diabetes and heart disease is markedly higher than for most other populations. So community health workers and a registered dietitian with the Cardiovascular Disease Risk Reduction Study are working one-on-one with families to change the “choice architecture” of their homes.

With the permission of residents, they will move the healthiest foods to the front of the family’s refrigerator and pantry. They will confine the television to parts of the home where it’s less likely to be used during meal times. And they will strategically place athletic shoes and exercise equipment so that they are accessible and in plain sight — and thus never out of mind.

It’s an approach that takes its cue from the field of behavioral economics, which says that people’s moment-to-moment choices are heavily influenced by what’s immediately in front of them.

“Our goal is to create a home and neighborhood environment where the healthier option becomes the easy choice, and the less healthy option becomes the more difficult choice,” McCarthy explained.

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How information consumption impacts health behaviors


Misconceptions can have serious implications on a person’s overall health.

Susana Ramirez, UC Merced

Susana Ramirez, UC Merced

From sunrise to sunset, people consume all kinds of information from television, online and from other sources.

UC Merced public health professor A. Susana Ramirez wants to know how that influences people’s health decisions and behaviors. Quite often, misconceptions about leading a healthy life can have serious implications on a person’s overall health.

For example, one paper she led shows that people who got health information from the media made healthier choices, including exercising more and eating more fruits and vegetables. There may be several explanations for this finding, including that people who sought information resolved to be healthier, or that information seeking reinforced an existing commitment to engage in healthy behaviors.

Before coming to UC Merced in 2013, Ramirez was a postdoctoral research fellow at the National Cancer Institute, which is based in Bethesda, Md. She earned a master’s in public health from Harvard University and a Ph.D. in communications from the University of Pennsylvania.

Ramirez, who is particularly interested in Latino health, plans to partner with San Joaquin Valley communities in her research, as well as using the findings to improve residents’ health.

“The San Joaquin Valley has a diverse Latino population, in terms of generation and language,” she said. “There’s a compelling case and need for the kind of research I’m doing.”

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Minorities and poor have more advanced thyroid cancers when diagnoses


UCLA study shows black patients fare worst; Asians, Hispanics survive longest with disease.

Avital Harari, UCLA

Avital Harari, UCLA

UCLA researchers have found that minority patients and those of lower socioeconomic status are far more likely to have advanced thyroid cancer when they are diagnosed with the disease than white patients and those in higher economic brackets.

In one of the most comprehensive studies of its kind, the UCLA team looked at nearly 26,000 patients with well-differentiated thyroid cancer and analyzed the impact of race and socioeconomic factors on the stage of presentation, as well as patient survival rates.

Their findings are published in the January issue of the Journal of Endocrinology and Metabolism.

“Race, social status, wealth and health insurance coverage make a difference in how far a thyroid cancer has advanced by the time a patient first sees a doctor,” said lead study author Dr. Avital Harari, an assistant professor of general surgery in the endocrine surgery unit at the David Geffen School of Medicine at UCLA.

Researchers hope the study will lead to strategies aimed at increasing access to health care and help make doctors who treat thyroid cancer patients more aware of how aggressive this cancer can be in certain socioeconomic and racial groups.

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Men don’t seek obesity surgery as soon as they should


Obese women more likely to seek weight-loss surgery.

Mohamed Ali, UC Davis

Mohamed Ali, UC Davis

Even though obesity affects women and men equally, a UC Davis study shows that obese women are four times more likely than obese men to seek weight-loss surgery. When they do see a bariatric surgeon, male patients tend to be older, more obese and sicker than women.

“It is important for men to realize that obesity poses a serious threat to their health and lifespans,” said Mohamed Ali, senior author of the study and chief of bariatric surgery at UC Davis. “A patient who is 100 pounds or more above his ideal body weight poses a therapeutic dilemma and should be referred to a surgeon.”

For the study, published in the December issue of Surgical Endoscopy, Ali and his colleagues collected information from 1,368 patients who were evaluated for bariatric surgery at UC Davis between 2002 and 2006.

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Minorities’ health would benefit most from beverage sugar tax


UCSF research team concludes that tax would result in lower rates of diabetes, heart disease.

Kirsten Bibbins-Domingo, UC San Francisco

Kirsten Bibbins-Domingo, UC San Francisco

Taxing sugar-sweetened beverages is likely to decrease consumption, resulting in lower rates of diabetes and heart disease, and these health benefits are expected to be greatest for the low-income, Hispanic and African-American Californians who are at highest risk of diabetes, according to a new analysis led by researchers at UC San Francisco.

Over the course of the next decade, lowered incidence of these diseases would save over half a billion dollars in medical costs, concluded the research team, which includes members from Oregon State University and the Mailman School of Public Health at Columbia University.

The researchers previously modeled the national health effects of a penny-per-ounce tax over the course of 10 years and found that it would reduce consumption among adults by 15 percent, modestly lower the prevalence of diabetes and obesity and prevent tens of thousands of coronary heart events, strokes and premature deaths. The new study considered a range of reductions in sugary beverage consumption among Californians.

In the new study, assuming a decline of 10 to 20 percent in the consumption of soda and other sugary beverages from the tax, researchers concluded that new cases of diabetes and coronary heart disease would drop statewide, and those health benefits would be greatest in poor and minority communities. The analysis, published Dec. 11 in the online journal PLOS ONE, predicted that overall, one in 20,000 Californians would avoid diabetes. This estimate would double for Hispanics and poor Californians and triple for African Americans.

”Poor and minority communities in California and nationally have very high rates of diabetes, a chronic condition with potentially devastating health complications,” said Kirsten Bibbins-Domingo, M.D., Ph.D., UCSF professor of medicine and director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center. “Although many steps are needed to reverse the rising diabetes trends in the state, our study suggests that efforts to curb sugary beverage consumption can have a significant positive impact, particularly in those most likely to be affected.”

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UCLA helping change the way a community eats, one store at a time


Euclid Market is latest store to be transformed.

Transformation of Euclid Market's exterior

Transformation of Euclid Market's exterior

Big chain grocery stores, farmers markets and other sources of healthy foods are usually in short supply in low-income communities. Public health experts refer to these areas as “food swamps” for their lack of available nutritious foods.

One such area is in the Boyle Heights neighborhood of East Los Angeles, where fast food reigns and meals are frequently purchased at corner markets. These small stores tend to be rundown, uninviting and focused on selling the bane of healthy eating — junk food.

At noon on Saturday, Dec. 14, the UCLA–USC Center for Population Health and Health Disparities (CPHHD) and the UCLA Fielding School of Public Health will join with local community members in Boyle Heights to celebrate the grand reopening of the neighborhood’s Euclid Market, which has been transformed into the opposite of what most corner markets are.

Instead of drab, there is fresh paint. Instead of the prominent placement of junk food and beer, the front of the store now highlights healthy foods like fresh fruits and vegetables, bottled water and nutritious snacks.

The Euclid Market is the third store in the East Los Angeles–Boyle Heights area to undergo a CPHHD-supported transformation. The first opened in November 2011, the second in February 2012.

The latest conversion, funded by the National Heart, Lung and Blood Institute of the National Institutes of Health and led by the UCLA Fielding School of Public Health, is part of a collaborative strategy with community members to change eating habits and reduce disease risk among the area’s dominant Latino population, which is plagued by high rates of obesity-related chronic diseases. Obesity stands as one of the nation’s most significant public health problems.

“Both of the existing transformed stores in the East L.A. area are reporting increased profits and greater foot traffic, so that’s good news for the small business owner,” said Alex Ortega, the director of the CPHHD and a professor of public health at the Fielding School.

“But it’s even better news for the people in those areas because having access to nutritious food that’s convenient to buy will help folks change their bad eating habits,” he added. “The goal, of course, is to see improvements in the overall health of our underserved communities.”

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U.S. ranks low in efficiency of health care spending


UCLA, McGill study also shows women fare worse than men in most countries.

Stethoscope on mapA new study by researchers at the UCLA Fielding School of Public Health and McGill University in Montreal reveals that the United States health care system ranks 22nd out of 27 high-income nations when analyzed for its efficiency of turning dollars spent into extending lives.

The study, which appears online today (Dec. 12) in the “First Look” section of the American Journal of Public Health, illuminates stark differences in countries’ efficiency of spending on health care, and the U.S.’s inferior ranking reflects a high price paid and a low return on investment.

For example, every additional hundred dollars spent on health care by the United States translated into a gain of less than half a month of life expectancy. In Germany, every additional hundred dollars spent translated into more than four months of increased life expectancy.

The researchers also discovered significant gender disparities within countries.

“Out of the 27 high-income nations we studied, the United States ranks 25th when it comes to reducing women’s deaths,” said Dr. Jody Heymann, senior author of the study and dean of the UCLA Fielding School of Public Health. “The country’s efficiency of investments in reducing men’s deaths is only slightly better, ranking 18th.”

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UC Davis: Investigating liver cancer disparities

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