Health of Black Families: Identifying Strengths and Gaps

1. National Black Family Promotions Coalition: Methodological Approach Carolyn M. Springer, Ph.D. September 23, 2005

2. 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

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

4. 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

5. 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 <18 years • 3x as likely to be living in poverty • 62% single parent households • 56% households headed by women

6. Life Expectancy

7. 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%)

8. 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

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. Barriers to Care I • Access • Uninsured and underinsured • About 25% uninsured • Geography • Remote or rural areas

18. 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

19. 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

20. 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

21. 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

22. 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

23. Caribbean Women “Speak Out” • Women’s knowledge and awareness of IM • Behavioral and Cultural Factors During Preconception and Pregnancy • Social and Environmental Barriers to obtaining optimal care • Similarities and Differences