Development of a Multicomponent Intervention to Decrease Racial Bias Among Healthcare Staff.

Background: Real or perceived discrimination contributes to lower quality of care for Black compared to white patients. Some forms of discrimination come from non-physician and non-nursing (non-MD/RN) staff members (e.g.

Exploring the Association of Healthcare Worker Race and Occupation with Implicit and Explicit Racial Bias.

Background: Racial bias is associated with suboptimal healthcare treatment for minorities. Research focuses on bias among physicians rather than non-physician healthcare staff (e.g.

Blood Pressure Measurement Biases in Clinical Settings, Alabama, 2010-2011.

Introduction: Blood pressure measurement in clinical care settings seldom follows the protocol recommended by national guidelines, potentially leading to overestimates or underestimates of blood pressure control. We evaluated blood pressure measurement methods as a source of bias in determining blood pressure control among community-dwelling adults with diabetes.

Methods: In a community-based trial of patients with diabetes, we measured both "clinical blood pressure" (clinical BP) (taken by a community nurse or medical assistant instructed to "take the participant's blood pressure like you do in your own clinic") and "research blood pressure" (research BP) (research staff followed a guideline-concordant protocol).

Peer Coaches to Improve Diabetes Outcomes in Rural Alabama: A Cluster Randomized Trial.

Purpose: It is unclear whether peer coaching is effective in minority populations living with diabetes in hard-to-reach, under-resourced areas such as the rural South. We examined the effect of an innovative peer-coaching intervention plus brief education vs brief education alone on diabetes outcomes.

Methods: This was a community-engaged, cluster-randomized, controlled trial with primary care practices and their surrounding communities serving as clusters.

"We'll Get to You When We Get to You": Exploring Potential Contributions of Health Care Staff Behaviors to Patient Perceptions of Discrimination and Satisfaction.

Objectives: We qualitatively assessed patients' perceptions of discrimination and patient satisfaction in the health care setting specific to interactions with nonphysician health care staff.

Methods: We conducted 12 focus-group interviews with African American and European American participants, stratified by race and gender, from June to November 2008. We used a topic guide to facilitate discussion and identify factors contributing to perceived discrimination and analyzed transcripts for relevant themes using a codebook.

Depressive symptoms are associated with incident coronary heart disease or revascularization among blacks but not among whites in the Reasons for Geographical and Racial Differences in Stroke study.

Purpose: To examine the association of depressive symptoms with coronary heart disease (CHD) end points by race and income.

Methods: Study participants were blacks and whites (n = 24,443) without CHD at baseline from the national Reasons for Geographical and Racial Differences in Stroke cohort. Outcomes included acute CHD and CHD or revascularization.

Assessing peer advisor intervention fidelity using video skits in a peer support implementation trial.

In community-based interventions involving lay health workers, or "community health workers," peer-client interactions are not typically observed by investigators, creating challenges in assessing intervention fidelity. In the context of a community-based randomized controlled trial of the effectiveness of peer support on diabetes outcomes of people with diabetes in rural Alabama, a region characterized by poverty and low literacy, we developed a video assessment tool that assessed participant perceptions of peer-client interactions. The video assessment consisted of four short skits on areas of emphasis during peer training: directive versus nondirective counseling style and setting a specific versus a more general goal.

The relationship between coping styles in response to unfair treatment and understanding of diabetes self-care.

Purpose: This study examined the relationship between coping style and understanding of diabetes self-care among African American and white elders in a southern Medicare-managed care plan.

Methods: Participants were identified through a diabetes-related pharmacy claim or ICD-9 code and completed a computer-assisted telephone survey in 2006-2007. Understanding of diabetes self-care was assessed using the Diabetes Care Profile Understanding (DCP-U) scale.

Hospital laboratory reporting may be a barrier to detection of 'microsize' myocardial infarction in the US: an observational study.

Background: International guidelines recommend that the decision threshold for troponin should be the 99th percentile of a normal population, or, if the laboratory assay is not sufficiently precise at this low level, the level at which the assay achieves a 10% or better coefficient of variation (CV). Our objectives were to examine US hospital laboratory troponin reports to determine whether either the 99th percentile or the 10% CV level were clearly indicated, and whether nonconcordance with these guidelines was a potential barrier to detecting clinically important microscopic or 'microsize' myocardial infarctions (MIs). To confirm past reports of the clinical importance of microsize MIs, we also contrasted in-hospital, 28-day and 1-year mortality among those with microsize and nonmicrosize MI.

Perceived weight discrimination in the CARDIA study: differences by race, sex, and weight status.

Objective: To examine self-reported weight discrimination and differences based on race, sex, and BMI in a biracial cohort of community-based middle-aged adults.

Design And Methods: Participants (3,466, mean age = 50 years, mean BMI = 30 kg/m²) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study who completed the 25-year examination of this epidemiological investigation in 2010-2011 were reported. The sample included normal weight, overweight, and obese participants.

Association of race and sex with risk of incident acute coronary heart disease events.

Context: It is unknown whether long-standing disparities in incidence of coronary heart disease (CHD) among US blacks and whites persist.

Objective: To examine incident CHD by black and white race and by sex.

Design, Setting, And Participants: Prospective cohort study of 24,443 participants without CHD at baseline from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, who resided in the continental United States and were enrolled between 2003 and 2007 with follow-up through December 31, 2009.

Awareness and management of chronic disease, insurance status, and health professional shortage areas in the REasons for Geographic And Racial Differences in Stroke (REGARDS): a cross-sectional study.

Background: Limited financial and geographic access to primary care can adversely influence chronic disease outcomes. We examined variation in awareness, treatment, and control of hypertension, diabetes, and hyperlipidemia according to both geographic and financial access to care.

Methods: We analyzed data on 17,458 participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study with either hypertension, hyperlipidemia, or diabetes and living in either complete Health Professional Shortage Area (HPSA) counties or non-HPSA counties in the U.

Awareness, treatment and control of hypertension, diabetes and hyperlipidemia and area-level mortality regions in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Background: Health Professional Shortage Areas (HPSA) receive extra federal resources, but recent reports suggest that HPSA may not consistently identify areas of need.

Purpose: To assess areas of need based on county-level ischemic heart disease (IHD) and stroke mortality regions.

Methods: Need was defined by lack of awareness, treatment, or control of hypertension, diabetes, or hyperlipidemia.

Recruitment of a rural, southern, predominantly African-American population into a diabetes self-management trial.

We are conducting a community-based cluster-randomized trial in rural Alabama, testing a peer-support intervention designed to improve diabetes self-care behaviors. We describe recruitment and data collection approaches used, focusing on strategies that created community partnerships and facilitated recruitment in underserved, rural, largely minority communities. Key recruitment and data collection strategies included early community engagement; pilot testing of procedures; inclusion of community members as study team members, recruiters, and data collectors; data collection at community venues to minimize participant travel requirements; and provision of a multi-disciplinary diabetes education program to both intervention and control participants.

Sexual health knowledge of male and female Latino immigrants.

To explore sexual health knowledge among Latino immigrants in a Southern U.S. city, we conducted 20 qualitative interviews, (10 Women and 10 Men).

Intervention mapping as a guide for the development of a diabetes peer support intervention in rural Alabama.

Introduction: Peer support is a promising strategy for the reduction of diabetes-related health disparities; however, few studies describe the development of such strategies in enough detail to allow for replication. The objective of this article is to describe the development of a 1-year peer support intervention to improve diabetes self-management among African American adults with diabetes in Alabama's Black Belt.

Methods: We used principles of intervention mapping, including literature review, interviews with key informants, and a discussion group with community health workers, to guide intervention development.

Health Professional Shortage Areas, insurance status, and cardiovascular disease prevention in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

Individuals with cardiovascular disease (CVD) living in Health Professional Shortage Areas (HPSA) may receive less preventive care than others. The Reasons for Geographic And Racial Differences in Stroke Study (REGARDS) surveyed 30,239 African American (AA) and White individuals older than 45 years of age between 2003-2007. We compared medication use for CVD prevention by HPSA and insurance status, adjusting for sociodemographic factors, health behaviors, and health status.

Low medication adherence and the incidence of stroke symptoms among individuals with hypertension: the REGARDS study.

The authors analyzed data on 9950 participants taking antihypertensive medications in the nationwide Reasons for Geographic and Racial Differences in Stroke (REGARDS) study to determine the association between medication adherence and incident stroke symptoms. Medication adherence was assessed using a validated 4-item self-report scale and participants were categorized into 4 groups (scores of 0, 1, 2, and 3 or 4, with higher scores indicating worse adherence). The incidence of 6 stroke symptoms (sudden weakness on one side of the body, numbness, painless loss of vision in one or both eyes, loss of half vision, losing the ability to understand people, and losing the ability to express oneself verbally or in writing) was assessed via telephone interviews every 6 months.

The association between income, education, and experiences of discrimination in older African American and European American patients.

Objective: Racial/ethnic discrimination has adverse effects on health outcomes, as does low income and education, but the relationship between discrimination, income, and education is not well characterized. In this study, we describe the associations of discrimination with income and education in elderly African Americans (AA) and European Americans (EA).

Design: Cross-sectional observational study involving computer-assisted telephone survey.

Racial and regional differences in age at menopause in the United States: findings from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Objective: We sought to examine regional and black-white differences in mean age at self-reported menopause among community-dwelling women in the United States.

Study Design: This was a cross-sectional survey conducted in the context of the REasons for Geographic And Racial Differences in Stroke and Myocardial Infarction study.

Results: We studied 22,484 menopausal women.

Heavy drinking is associated with poor blood pressure control in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Alcohol intake has been shown to have a J-shaped association with blood pressure (BP). However, this association has not been examined in mixed race populations or in people with diabetes where tighter blood pressure control is recommended. Participants in the REGARDS study who were 45 years or older (n = 30,239) were included.

Agreement on cause of death between proxies, death certificates, and clinician adjudicators in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Death certificates may lack accuracy and misclassify the cause of death. The validity of proxy-reported cause of death is not well established. The authors examined death records on 336 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a national cohort study of 30,239 community-dwelling US adults (2003-2010).

Prehypertension, racial prevalence and its association with risk factors: Analysis of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Background: There are few available data on the epidemiology of prehypertension (preHTN). To determine racial, clinical, and demographic differences in the prevalence of preHTN and its cross-sectional association with vascular risk factors.

Methods: Cross-sectional analysis of 5,553 prehypertensives, 20,351 hypertensive's, and 4,246 nonhypertensive participants (age ≥45), from a population-based national cohort study (REasons for Geographic And Racial Differences in Stroke (REGARDS) total population 30,239, of whom 30,150 had adequate blood pressure (BP) measurements) enrolled from January 2003-October 2007 with oversampling from the southeastern stroke belt, and black individuals.

Trust in physicians and blood pressure control in blacks and whites being treated for hypertension in the REGARDS study.

Objectives: Among persons treated for hypertension, Blacks are more likely to have uncontrolled blood pressure compared to Whites. Few studies have focused on trust in physicians as a potential contributor to this disparity in blood pressure (BP) control. The primary objective of this study was to assess the relationship between trust in physicians and blood pressure control among Blacks and Whites being treated for hypertension.