Monday, January 05, 2009 thru Friday, January 09, 2009

• Teen Birth Rate Increased in 26 States in 2006; Highest Rates in States With Large Hispanic, Black Populations
  [Jan 08, 2009]

 

Teen Birth Rate Increased in 26 States in 2006; Highest Rates in States With Large Hispanic, Black Populations
[Jan 08, 2009]

      Teen birth rates increased in 26 states in 2006, according to CDC's National Center for Health Statistics data released on Wednesday that provide a state-by-state breakdown, USA Today reports. The data show that the birth rate in 2006 among women ages 15 to 19 increased 3% to 41.9 births per 1,000 women. The new report updates previously released data from NCHS showing that 2006 marked the end of a 34% decline in births among women ages 15 to 19 from 1991 to 2005.

According to the new report, the South and Southwest regions had the highest rates of teen births, with Mississippi reporting 68.4 births per 1,000 young women, followed by New Mexico with a rate of 64.1 and Texas with 63.1. Teen birth rates were lowest in the Northeast, and New Hampshire had the lowest rate with 18.7 births per 1,000 young women. Teen birth rates declined in New York, North Dakota, Rhode Island and Washington, D.C. (Jayson, USA Today, 1/8).

The states with the highest birth rates for teens ages 15 to 19 have large proportions of black and Hispanic teens, groups that traditionally have higher birth rates, experts said.

A number of factors can contribute to teen birth rates, including culture, poverty and racial demographics, the AP/Tucson Citizen reports. Other factors include the increasing cost of and lack of available birth control and the portrayal of pregnancy in the media, said Stephanie Birch, director of maternal and child health programs at the Alaska Department of Health and Social Services. Some experts also say that a lack of funding for comprehensive sexual education and an increase in funding for abstinence-only programs also contributed to the increase (AP/Tucson Citizen, 1/8).

The report is available online (.pdf).

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California Law Requiring Private Health Plans To Cover Interpretation Services Takes Effect
[Jan 05, 2009]

      A law requiring California health, dental and specialty insurers to provide members with interpreters took effect Jan. 1, the Sacramento Bee reports. Of the 37 million people living in California, more than 40% speak a language other than English, and one-fifth of the population say they cannot speak English "very well," according to the Bee. Federal law requires health plans to provide interpreters for beneficiaries of Medi-Cal and Healthy Families, the state's Medicaid and SCHIP programs, and many hospitals offer interpreters. However, until the law took effect, many patients lacked guaranteed access to an interpreter.

The legislation (SB 853) was signed into law in 2003, but Gov. Arnold Schwarzenegger (R) imposed a moratorium on it when he took office. Insurers had expressed concern about how to balance the need for access to care with cost. Insurers estimate that the law will cost about $25 million. Many insurers plan to contract out for interpretation services.

Anthony Wright, executive director of California Health Access, said, "This law has been a long time coming. Our big concern now is whether people have adequate notice of their rights and can actually use them." The state intends to launch a campaign in the next few weeks to publicize the law.

Cindy Ehnes -- director of the state Department of Managed Health Care, which will oversee implementation of the new law -- said that testimony given at hearings on the issue "was an incredible eye-opener to me." She added, "Often these people who can't speak English are told to go home unless they bring somebody who can. It was like being treated by a system as if they had no consequence" (Caina Calvan, Sacramento Bee, 1/3).

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New York State Web Site Lists Hospital Admission Rates by ZIP Code, Race, Ethnicity
[Jan 06, 2009]

      Where a person lives, combined with race and ethnicity, can influence the kind of care they receive, according to a new Web site from the New York State Health Department, the Syracuse Post-Standard reports. The Web site uses 2005 and 2006 hospital discharge data from New York's Statewide Planning and Research Cooperative System and lists hospital admission rates by ZIP code for 12 preventable conditions, including high blood pressure, diabetes, asthma and pneumonia.

The site also lists "avoidable hospitalizations" based on race and ethnicity. In one Syracuse ZIP code, hospitalization rates are one-and-a-half times higher for Hispanics and four times higher for blacks than for whites, according to the Web site. The highest hospital admission rates occurred in rural ZIP codes.

The data aims to help state health officials quickly pinpoint which areas have gaps in primary and preventive health care and will better direct services as needed and plan for community health services in the coming year.

Richard Daines, the state's health commissioner, said that racial health disparities are a problem nationwide. "What's really troubling is that even at the same socioeconomic level, African-American populations have worse health outcomes than white populations," he added. Cynthia Morrow, health commissioner of Onondaga County, said, "We live in a society where health outcomes are largely associated with income status, educational status and race," adding, "It very graphically shows us the unforgivable disparities that exist." Dennis Norfleet, Oswego County's interim public health director, said, "If people do not understand health and illness, then they are more likely to let illnesses go further to the point where they will require hospitalization" (Mulder, Syracuse Post-Standard, 1/2).

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Height of Black Women Declining; Obesity Might be Related to Cause, Study Finds
[Jan 06, 2009]

      A yet-to-be-released study has found shorter heights among black women born around 1980 compared with those born in the mid-1960s, a disparity that might be linked to obesity among black women, the Washington Post reports. The study -- conducted by John Komlos, a professor at the University of Munich -- looks at the relationship between standards of living and human health and body size.

Komlos analyzed data recently released by CDC's National Health and Nutrition Examination Survey and found that in the U.S., black women born around 1980 are on average a little shorter than 5-feet-4 inches today, while black women born in the mid-1960s are on average a little more than one-half an inch taller. By comparison, white women born around 1980 are more than three-fourths an inch taller than black women of the same age, according to the Post.

According to the Post, the finding of shorter heights among younger black women is "a surprising development, since Americans in general have gotten taller from one generation to the next." Komlos said that it "is more or less unprecedented in modern times, except in dire circumstances" for any group in the developed world to become shorter over time.

Komlos noted that there is a relationship between the decline in height and obesity, which disproportionately affects black women. According to a 2007 National Center for Health Statistics report, 23.8% of black girls ages 12 to 19 are overweight, compared with 14.6% of white girls the same age. The report also found that 51.6% of black women ages 20 to 74 are considered obese, compared with 31.5% of white women. Komlos said obesity can affect a young person's growth potential.

According to Alan Rogol, a professor of clinical pediatrics at the University of Virginia and Indianapolis, Ind.-based Riley Hospital for Children, obesity causes an acceleration of the onset of puberty in young people, and in women, "the female hormone estrogen is what leads to closure of the ends of long bones, where you grow from. If that is done more quickly on average, you are at risk for being ... smaller as an adult."

The study notes that while genetics have a significant role in determining an individual's ultimate height, nutrition, and lifestyle and access to health care also contribute. The study also found that growth differences in black women were particularly evident among those at the lower end of the socioeconomic spectrum, where diets tend to be less healthy and access to care is lower (Minnema, Washington Post, 1/6).

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Folic Acid Supplements Help To Prevent Certain Birth Defects for Which Hispanic Women Have Increased Risk
[Jan 08, 2009]

      Twenty-one percent of Hispanic women are consuming enough folic acid to prevent certain birth defects before becoming pregnant, compared with more than 40% of white women, the North Denver News reports. Consuming adequate amounts of the dietary supplement before becoming pregnant can help prevent neural tube birth defects -- serious defects of the spine and brain. According to the News, roughly 3,000 infants are born with neural tube birth defects annually. The effects of the conditions occur within the first few weeks of pregnancy, often before a woman is aware that she is pregnant.

Alina Flores, a health education specialist at CDC's National Center on Birth Defects and Developmental Disabilities, said, "It is crucial for every woman, but especially for Hispanics, to take folic acid every day even before getting pregnant, so that we can continue to decrease the number of children born with neural tube defects." Hispanic women have a 30% to 40% increased risk for having children with neural tube birth defects.

Folic acid has been found to prevent up to 70% of such birth defects and can easily be consumed by taking daily supplements. Flores said, "Many Hispanic women believe that vitamins with folic acid are just for pregnant women, that they make you gain weight, that they are very costly or that you need a prescription." She added, "None of these myths is true" (North Denver News, 1/7).

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Newsweek Opinion Pieces Examines Race-Based Medicine
[Jan 06, 2009]

      Jerry Adler, senior editor for Newsweek, examines research into the genetic differences between racial groups in a recent opinion piece for the magazine. According to Adler, the question of "what, if any, are the significant genetic differences between racial groups ... that we use to define 'race'" was "virtually a closed question in academia" for decades. However, medical researchers lately have been collecting data on differences in health risks and drug responses for various groups, according to Adler. In addition to BiDil -- the first FDA-approved drug to treat heart failure specifically for blacks -- a recent Pharmacogenomics Journal study "counted up nine clinical trials around the world studying diseases or treatments in groups defined by race or gender or both, including chronic hepatitis B in blacks and Hispanics and respiratory syncytial virus in Native American infants," Adler writes.

A report of a conference attended by medical ethicists, geneticists and legal scholars "urges researchers to tread carefully in designing, carrying out and reporting studies that involve racial categories," Adler writes. Timothy Caulfield -- a professor of health law at the University of Alberta, who convened the conference -- believes that race as a social construct is not very useful biologically. For instance, according to Caulfield, descendents of Nigeria are very different from those of Kenya, even though they are both physically categorized as black, Adler writes. Caulfield also is concerned that even if such distinctions are made in research, once that research "gets in the hands of drug manufacturers, there's going to be slippage ... marketers want to sell to the broadest possible categories."

However, Adler says "that very tendency runs counter to another significant trend in medicine." He writes, "The research that has allowed us to parcel out racial differences by ancestry will eventually outstrip even those categories, and identify specific vulnerabilities and drug reactions in the genomes of individuals." Adler says, "We will no longer be white or Asian or African, or even Northern European, Ashkenazi, Japanese or East African; we will be who we are, each one of us," concluding, "And the sooner we reach that point, the better" (Adler, Newsweek, 1/12).

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Tennessean Editorial, Opinion Piece Address Language Barriers in Health Care
[Jan 05, 2009]

      The Tennessean on Friday published an editorial and an opinion piece that addressed issues related to language barriers in health care. Summaries appear below.

• Tennessean: Language barriers can complicate the relationship between physicians and patients, but "most medical providers, especially those who serve large numbers of immigrants, understand the importance of finding interpreters to help solve this problem," a Tennessean editorial states. In health care, "no one should want situations where providers say the patient must be fluent in English if the patient expects care," the editorial states, adding, "Everyone should agree that that's not an ideal approach to medicine." According to the editorial, health clinics should "spread the word that interpreters are needed," as volunteers who "can interpret can be priceless to many of those who give care." The editorial states that, "as diversity in any community grows, languages and customs bring challenges that can complicate matters," adding that the "answer is to find ways to bridge those lines of communication" (Tennessean, 1/2).
  
  
• Mary Bufwack, Tennessean: "Language barriers have resulted in the wrong diagnosis, the wrong medications, unnecessary hospitalizations and in one emergency case, permanent disability," Bufwack, CEO of the United Neighborhood Health Services in Nashville, Tenn., writes in a Tennessean opinion piece. However, the "danger of a lack of language services does not only result in poor health care and harm to the individual unable to speak English," she writes, adding, "Entire communities can be put at risk." Bufwack writes, "The need for interpreters will continue to grow" adding, "Rather than waiting for each practice and organization to solve the problem, we should be designing and implementing effective systems that can be available to all health care providers at reasonable costs" because current "models are partial, expensive and inefficient." According to Bufwack, by "purchasing language services in bulk, all providers, no matter how large or small the volume, have access to high quality services at affordable rates." She concludes, "Language services are essential for an effective and high quality public health and health-care delivery system" (Bufwack, Tennessean, 1/2).

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Studies Look at High Blood Pressure Control Among Blacks, Weight-Loss Methods
[Jan 07, 2009]

      The following summarizes studies published in the January issue of the Journal of the National Medical Association.

• "A Proposed New Model of Hypertensive Treatment Behavior in African-Americans" (.pdf): In the report, Jennifer Middleton, assistant medical director of the University of Pittsburgh Medical Center's St. Margaret Bloomfield-Garfield Family Health Center, suggests that the reason why blacks have poorer high blood pressure control than whites is related to insufficient adoption of treatment regimens, not because of differences in education levels, general knowledge of the condition or access to care. Low treatment adherence among blacks with high blood pressure in turn could be related to beliefs among blacks "that are inconsistent with the biomedical disease model of hypertension," the report says. According to the report, some blacks think of the condition as an "episodic and symptomatic disease" rather than a "chronically progressive and silent condition." In addition, some blacks think the main cause of high blood pressure is stress or is related to "being black" and experiencing racism or other cultural pressures, the report says. The report suggests that public health workers and care providers should identify such health beliefs in an effort to improve blood pressure control among blacks (Middleton, Journal of the National Medical Association, January 2009).
  
  
• "Disparities by Ethnicity and Socioeconomic: Status in the Use of Weight Loss Treatments"(.pdf): The study examines the differences in weight-loss practices between whites and ethnic minorities and lower- and higher-socioeconomic status individuals. A telephone survey conducted from November 2005 to January 2006 asked 3,500 U.S. adults about their weight-loss practices and beliefs. Seven methods of weight loss were examined, including medically supervised weight-loss programs, commercial programs and the use of over-the-counter diet pills. Blacks and Hispanics were more likely than whites to report using over-the-counter weight-loss pills and less likely than whites to report use of commercial weight-loss programs. Blacks also were more likely than whites to report use of medically supervised programs. In addition, individuals of a higher socioeconomic status were more likely to report self-directed weight-loss attempts than those of a lower socioeconomic status. Higher-socioeconomic status individuals also were more likely than their counterparts to report using commercial programs and less likely to use over-the-counter diet pills (Gilden Tsai et al., Journal of the National Medical Association, January 2009).
  

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