National Black Family Promotions Coalition: Methodological Approach

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National Black Family Promotions Coalition
Methodological Approach

• Carolyn M. Springer, Ph.D.
• September 23, 2005

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Secondary Data

• Cull and synthesize data
• Multiple Sources
• Interdisciplinary
• Health of Black Families
• Maternal and Infant Health
• Family wellness
• A Critical Eye
• Identify Strengths
• Identify Existing Gaps

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Secondary Data

• Provide Conceptual Frameworks
• Ecological Model
• User Friendly
• Interpret data for different audiences
• Recommendations
• Inform audiences
• Inform practice
• Inform policy

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Black Americans

• 36 million 12 of US population
• Race and Ethnicity as major determinants of
  health
• Poverty
• Increased morbidity
• Increased mortality
• Inadequate health insurance
• Limited access to health care

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Poverty

• 52 poor or near poor (24 Whites)
• Twice as likely to be unemployed (10.3 vs. 4.7)
• In 2002, 33 of Blacks had income less than
  15,260 (vs. 11 Whites)
• Black Children lt18 years
• 3x as likely to be living in poverty
• 62 single parent households
• 56 households headed by women

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Life Expectancy
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Adult Health

• Black males higher incidence of prostate,
  lung/bronchus, colon/rectal and stomach cancer
• Black females lower incidence of breast cancer
  but higher fatality higher incidence of
  colon/rectal, pancreatic and stomach cancer
• Higher rates of hypertension
• Higher rates of STDs
• AIDS cases Black males (42) Black Females (65)

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Maternal and Child Health

• IMR 13.3 for Blacks 5.7 for Whites
• Black infants are twice as likely
• to die in infancy
• to be born pre-term
• to be low birth weight
• Black women
• More than 2x likely to receive late or no
  pre-natal care
• 3 to 4x as likely to die from pregnancy and
  related complications

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Teen Pregnancy

• From 1991-2002, 30 decline among 15-19 year olds
• Black teens decreased most (42)
• In 2000, Black teens pregnancy rate higher than
  national average (153.3 vs. 83.6 per 1000)
• 57 of Black girls become pregnant at least once

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Postpartum Depression

• Similar rates by race/ethnicity
• Individual, community and systemic barriers may
  heighten risk
• Identification
• Treatment
• Misperceptions about tx
• Fears
• Lack of insurance

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Tobacco Use

• 22 Blacks use tobacco (27 men, 22 women)
• 45,000 tobacco related deaths among Black adults
• Smoke less and smoke later in life but more
  likely to die
• About 15 of Black teens smoke
• Smoke cigarettes with high menthol content
• 10 of pregnant women smoked

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Other Drugs

• Alcohol
• Drink less
• More alcohol-related medical problems
• Higher rates of mortality
• Illicit Drug Use
• Blacks 1 in 13 vs. 1 in 16 for Whites

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Domestic Violence

• Black women
• 35 higher than Whites
• 22 higher than other ethnic groups
• About 12 in every 1000
• Escalates during pregnancy
• 23 of women who seek prenatal acre
• 17 of abused women indicate first abuse during
  pregnancy

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Access to Health Care

• Immunization rates similar
• Less likely to have primary care provider
• Less likely to access medical care
• Long travel times
• Long waits
• Twice as likely to have asthma and 6x as likely
  to die

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Child Health I

• Obesity
• From 1988-2002, obesity has tripled among
  children and teens aged 6-19
• Black girls have the highest prevalence of
  obesity among teens aged 12 to 19

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Child Health II

• 13 of Black children aged 0-17 have special
  Health Care Needs
• Sickle cell anemia
• 61 of pediatric AIDS cases
• Learning Disabilities
• 17 specific disabilities, 21 SED 35 mild
  retardation
• Lack of mental health tx leads to incarceration

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Barriers to Care I

• Access
• Uninsured and underinsured
• About 25 uninsured
• Geography
• Remote or rural areas

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Barriers to Care II

• Relationship with health care providers
• 23 report poor communication with providers
• Leave without asking questions
• Leave without understanding
• Negative experiences
• Looked down upon
• Disrespected

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Qualitative Data

• Give voice to those who are silent or who have
  been silenced
• Insider perspective
• Use their frames of reference and language
• Begin with general question or problem
• Hypotheses emerge from research
• Samples small have identified characteristics
• Close, personal relationship to subjects
• Allow for participant input
• Less structured measures
• Descriptive analysis- identify key themes

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Qualitative Methods

• Focus Groups
• Focused dialogue with 8-10 participants
• Can be used to further explore an issue
• Can be used to develop measures
• Town Hall Meetings
• Moderated conversation for larger groups
• Allow different perspectives to be heard
• Members of the community can reflect on issues
  and make recommendations

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The Demon Plague

• Semi-structured interviews with 37 APIs living
  with HIV (Kang, Rapkin, Springer and Kim, 2003)
• 16 interviews with undocumented immigrants
  (Chinese, Japanese, East Indian, Bengali,
  Burmese, Other)
• Lack of Knowledge and Misperceptions
• Self, Community Members
• Stigma and Discrimination
• Immigration-Related Stressors
• Difficulty Navigating Service Systems

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Caribbean Women Speak Out

• TCC and NYC Dept. of Heath (2001)
• Gather information about high IMR in Central and
  South Brooklyn to inform practice and
  interventions
• Role of cultural traditions and practices in
  accessing care
• 8 Focus Groups with women from Jamaica, Trinidad
  and Tobago, Haiti and Guyana
• 62 participants who lived in US from 2-15 years
  and had a live or still birth in the last 5 years

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Caribbean Women Speak Out

• Womens knowledge and awareness of IM
• Behavioral and Cultural Factors During
  Preconception and Pregnancy
• Social and Environmental Barriers to obtaining
  optimal care
• Similarities and Differences