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

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

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

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

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

Life Expectancy

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%)

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

Teen Pregnancy From , 30% decline among year olds Black teens decreased most (42%) In 2000, Black teens pregnancy rate higher than national average (153.3 vs per 1000) 57% of Black girls become pregnant at least once

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

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

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

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

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

Child Health I Obesity –From , obesity has tripled among children and teens aged 6-19 –Black girls have the highest prevalence of obesity among teens aged 12 to 19

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

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

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

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

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

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

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

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