This issue provides an array of useful and interesting articles that reflect the work of nurse researchers in the Center for the Advancement of Health Disparities Research (CAHDR). This center is a partnership between the University of Hawaii at Manoa School of Nursing and Dental Hygiene and the University of Washington School of Nursing. During the first 4 years of its existence, the CAHDR has focused on topics within 5 research areas1:
1. Research trends in disparities and best approaches
* Research development and methodology; evidence-based nursing interventions; community-based interventions
2. Determinants of health related to health disparities
* Socioeconomic, environmental, genetic, biological, and behavioral factors; racial and ethnic discrimination; gender discrimination
3. Effects on population health resulting from health disparities
* Chronic disease; mental health; cultural competency; ethnic considerations of families, groups, and communities (minority health)
4. Healthcare needs and costs resulting from health disparities
* Service delivery (diversification of workforce; access to care); symptom management; health promotion; lab analysis of biological indicators of health disparities
5. Policy and system supports for the elimination of health disparities
* Health status indicators; data sensitive to health disparities; quality indicators for health disparities
The articles in this supplement present the work of 8 of the center's 23 funded studies and focus on 3 of the 5 identified research areas.2-4 The articles discuss important health issues that confront people who because of their race, gender, health condition, or income are disadvantaged in regard to receiving quality, affordable, and accessible healthcare. The studies provide important data about the selected target group and also offer useful suggestions and recommendations for ways in which more effective care can be provided. Specifically, the articles discuss such important topics as (1) correlates of objectively and subjectively measured physical activity in adult wheelchair users; (2) factors influencing health research participation among women with imprisoned partners; (3) foster care stakeholders' perceptions of effects on foster children's health; (4) the relationship between maternal acceptance-rejection and children's social competence and the role that maternal acculturation plays in the relationships of Korean-American mothers; (5) breastfeeding patterns of native Hawaiian mothers participating in The Special Supplemental Nutrition Program for Women, Infants, and Children; (6) the lived experiences of men and women in Hawaii diagnosed with obsessive- compulsive disorder; (7) Chinese immigrant restaurant workers' occupational hazards and risks; and (8) decreasing organizational barriers and increasing access to immunizations for young children (6 months) to adolescents (21 years) by using a "walk-in" shot clinic.
What is most interesting about this set of articles is that most of the studies deal with important topics that are seldom discussed in the healthcare literature. While some offer solutions, all serve to open our eyes and minds to the obstacles people face because of their ethnicity and cultural practices, which may differ from those of the other cultural groups with whom they live and interact as well as from their health conditions, obstacles to getting healthcare, and their working situations.
Some of the most important findings in this supplement discuss the importance of (a) integrating scholarly research into the lives of people in communities experiencing health disparities; (b) encouraging researchers to rely on the knowledge, involvement, and assistance of community members to effectively study and implement strategies to reduce health disparities; (c) recognizing that subjectively measured activity correlates significantly with age, state of change, health, healthcare providers discussing exercise, and social support for exercise; (d) encouraging intervention planners to plan programs that place emphasis on modifying the social environment and removing attitudinal barriers; and (e) examining some of the factors that influence whether women choose to participate in research include knowledge of health-related research and the interview conditions. Furthermore, (f) themes emerging from content analysis of interview data focused on foster children's mental health and included coping strategies, perceptions of being different, problems faced within the foster care system, and, not surprisingly, (g) need for mutual support for foster care stakeholders. Also learned was that (h) low maternal acceptance-rejection was positively related to children's low social competence and that (i) a walk-in immunization clinic could improve the immunization status for all clients, not just children, who came to a community health center.
The findings of the studies reported in this issue are consistent with the data and conclusions reported in previous National Healthcare Disparity Reports (NHDR).2 The 2005 NHDR found that the American healthcare system faces serious disparities related to race, ethnicity, and socioeconomic status. Disparities such as quality of care, access to care, cost of care, settings in which care is provided, age, race, gender, and general health condition, and, in particular, the availability and willingness to engage in prevention strategies are seen in nearly every corner of our healthcare system.
One of the goals of Healthy People 2010 is to "eliminate health disparities among segments of the population, including differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation."3 The American Medical Association reports that racial and ethnic minorities face significant healthcare challenges despite the continued general improvement in health in the United States. For example, minorities "experience a lower quality of health services and are less likely to receive routine medical procedures and have higher rates of morbidity and mortality than non-minorities."4 What is more, disparities are evident even if gender, condition, age, and socioeconomic status are accounted for.4
Finally, the National Institute of Environmental Health Sciences (NIEHS) reports that low income and minority citizens in the United States face greater health risks than do wealthier citizens.5 For example, poor citizens have shorter life expectancies and "higher rates of cancer, birth defects, infant mortality, asthma, diabetes, and cardiovascular disease."5 Differences in community and work environments coupled with less access to quality healthcare account for much of the health disparities between America's rich and the poor. That is, residents of low-income communities are more likely to live and work in riskier and more polluted environments.5 More research on this important and timely topic of health disparities is needed.
I hope that each of you will enjoy reading these articles as much as I did.
Jeanette Lancaster, PhD, RN, FAAN
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