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Hopkins Center for Health Disparities Solutions Projects

Exploring Health Disparities in Integrated Communities Project

PI: Thomas A. LaVeist, PhD

Click here to read "Exploring Health Disparities in Integrated Communities: Overview of the EHDIC Study"

Research Questions
Methods
Questionnaires

Researchers who specialize in minority health have to traverse a series of compromises in conducting their research. These compromises stem primarily from the problem of determining whether to use a race comparative or race specific study design. Race/ethnic comparative data sources often have small numbers of minority respondents compared to whites, and usually do not include the range of variables that are of greatest interest to understanding social and behavioral aspects of minority health. However, race/ethnic specific data sources (such as the National Panel of Black Americans, the Three Generation Study of Mexican Americans, Cardiovascular Disease in American Indians, or Honolulu-Asia Aging Study) lack comparison groups that aid in the assessment of the generalizability of findings.

Additionally, in either case, data sources often do not contain sufficient numbers of low-income urban Caucasians or middle income African Americans and other minorities to make true racial comparisons. As a result, much of what is published on race disparities in health are based on samples of low-income African Americans compared with middle-income whites.

There is a long history of conducting large-scale epidemiologic longitudinal studies. Some of the best-known studies of this type are: Framingham, MA; Alameda County, CA Study; the Tecumseh, MI; and the Washington County, MD study. These large-scale epidemiologic studies have produced much of what health researchers understand about risk factors for disease and premature death. Yet, these very influential studies tend to be located in rural areas or small towns and do not include African Americans. Or, if African Americans are included, the numbers of respondents are typically insufficient to report in most analyses.

The Jackson Heart Study, supported by the National Heart Lung and Blood Institute is a large-scale study of African Americans, but here again the lack of a comparison group makes it impossible to examine racial disparities (Sempos et al. 1999). Other studies (such as the North Manhattan Study, Texas Community Surveillance, Greater Cincinnati/North Kentucky Stroke Study) have a better racial distribution, but their focus on specific health conditions and lack of social and community indicators make them less useful for the study of racial disparities.

The Principal Investigator of our application conducted an assessment (LaVeist1995) of federal data sets to determine the ability of the federal data portfolio to conduct research on minority health. This study found that few data sources were able to support the type of studies that are needed to explore the etiology of race disparities in health. As a result of inadequate data sources many published studies suffer mischaracterizations race associated differences in health outcomes as resulting from biological factors without specifying such differences, or confound race with socioeconomic status (LaVeist 1994).

Advancing minority health research will require the creation of new data sources that have the following characteristics: longitudinal, socio-economically equivalent across ethnic groups, set in an urban and/or suburban area (which is where most Americans live), allows for racial comparisons, and includes a wide range of behavioral, social and community as well as biological variables.

To address these limitations, we propose to do a comprehensive study of southwest Baltimore. Southwest Baltimore is a racially integrated community where blacks and whites share the same environment and a low socio-economic status. This study should be able to address health disparities without the confounding factors of class, income, and environment. This study will serve as an important resource that can be used to develop sub-studies conducted by faculty, fellows and students of the Hopkins Center for Health disparities Solutions. This multi-disciplinary study would combine behavioral, social and biological measures to assess their combined and individual effects on morbidity and mortality.

Research Questions

The purpose of this study is to investigate the level and cause of health disparities in a racially integrated community in southwest Baltimore. This community is comprised U.S. Census tracts 1902 and 1903.

  1. To determine hypertension prevalence among adult residents of these census tracts.
  2. To determine healthcare utilization patterns and to correlate psycho-social factors.
  3. To conduct a community health needs assessment.

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Methods

Study Design

We will attempt to enroll every adult (3,555) resident of the two census tracts into the study. We estimate that we will be able to successfully enroll 40% (1,422) of the targeted adults after adjusting for refusals and those who we cannot locate. The field period will begin with a health fair to “kick-off” the new initiative and introduce it to the community. The health fair will take place on a weekend in April, which is National Minority Health Month.  To promote awareness of the project, we will distribute flyers, T-shirts, and maintain a website devoted to the project.  To accomplish the goal of enrolling, screening and interviewing respondents within a six-month field period we will use three methods of recruitment. We will:

  1. Maintain a centralized location with “drop-in” hours for residents to drop-in and participate in the study.
  2. Conduct door-to-door screenings, setting up appointments if necessary, and
  3. Conduct one health fair per month to promote awareness of the project and conduct patient enrollment on-site. 

We estimate that these strategies will allow us to reach up to 90% of the adults in the census tract.

Weekend

Walk-in

Mini-Health

Weekday

Fairs

Days

Appointments

Interviews per day

75

16

32

Days per week

1

3

4

Total Weeks

5

12

18

Interviewers needed

4

2

8

Interviewer yield

375

576

2304

Population 

As we are attempting to obtain a census of the adults in the two target tracts, we will not be sampling. All adults, age 18 and above, are eligible to participate. There will be no exclusions for gender, race, ethnicity, etc. According to the 2000 US Census, there are 3,555 adults living in the target area. We will attempt to enroll every adult. However, we anticipate obtaining a 40% completion rate.

Procedures

Respondents enrolled in the study will be screened for blood pressure and reply to a structured questionnaire. These activities will be conducted using the following format:

  1. Blood pressure will be measured while the respondent is seated and will occur after the respondent has consented and before the questionnaire is administered. 
  2. Questionnaire administration will occur after blood pressure is taken. Respondents will be asked to complete a questionnaire consisting of validated questions designed to assess health behavior, health services utilization, attitudes values and beliefs, quality of life, mental health (including depression), demographic variables, a medical history and utilization of over-the-counter and prescription drugs. The questionnaire will be administered in a private location – either in the respondent’s home, at the “drop-in” location (space we will rent within the community) or some other appropriate and discrete location if the respondent would prefer. We will catalogue all medications the patient is taking; we will request that patients bring all of the medications they are taking along with them. The interviewer will record the names of each medication. That list will, then be coded to determine the class of each drug.

The entire encounter is estimated to average 45 minutes. We believe that study participants will tolerate a 45-minute interview. This is not out of line with previous studies conducted by the PI. We will not conduct proxy interviews.

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Questionnaires

The questionnaire consists of established batteries. The only sensitive questions are those regarding use of alcohol. 

Click here for the Participant Questionnaire (Adobe document)

Click here for the Street Assessment Questionnaire (Adobe document)

Click here for House Assessment Questionnaire (Adobe document)

Click here for the Community report (Adobe document)

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