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Caribbean Exploratory (NCMHD) Research
Center UpdateGloria B. Callwood, PhD, RN
Presented at Caribbean Exploratory Research Center
2nd ANNUAL HEALTH DISPARITIES INSTITUTEOctober 15, 2009
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ObjectivesThis presentation will: Describe the organizational structure of the
Caribbean Exploratory Research Center on Health Disparities
Provide an overview of significant health issues and health care barriers in the Virgin Islands
Identify key self reported health related concerns of residents
Share information on Center activities and overview of data emerging from the Center’s efforts
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Caribbean Exploratory Research Center on Health Disparities
Where we are located
Who we are
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Caribbean Exploratory Research Center
on Health Disparities US Virgin Islands
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St. Croix Campus
St. Thomas Campus
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Who are Virgin Islands Residents?
The Virgin Islands is a blended multiculturalSociety with a direct affect on the cultureand health of the population Black 76.2%, White 13.1%, Asian 1.1%, Other 6.1%, Mixed 3.5% (2000 census)
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Caribbean Exploratory Research Center on Health
Disparities (CERC) A National Center for Minority and Health
Disparities funded Project (#1P20MD002286-03) Organized into four cores
Administrative Research Research Education and Training Community Engagement/Outreach
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Caribbean Exploratory Research Center on Health
Disparities (CERC) Organized to:
Conduct research on health disparities Provide mentoring and training opportunities
for students, junior faculty and researchers Provide health screening, health promotion
and health information dissemination activities
Establish partnerships with community based organizations
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Significance of Exploratory Center for the Virgin Islands
Health disparities among African American, African Caribbean and Hispanic population sub-groups in the US Virgin Islands have been well documented in national and territorial reports
There is a paucity of research focused on factors that interact to create health disparities in the US Virgin Islands.
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Significance of Exploratory Center for the Virgin Islands
Research is needed to: Generate sources of reliable data Identify, develop, and evaluate
intervention strategies that will most effectively reduce or eliminate health disparities in the Virgin Islands.
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Mortality
Leading causes of deathCardiovascular DiseaseCancer
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Morbidity Diabetes #4 in US at 9%*
High blood pressure #28 in US at 24.8%*
High Cholesterol # 37 in US at 31.5%*
Rated #2 in nation per 100,000 for HIV/AIDS** (DC #1)
TB-10.83 per 100,000 (2005)* Treatment success only 50 % 1995 (
World Development Indicators database )
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data, 2004*
CDC HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States and Dependent Areas,
2007,**
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Barriers Contributing to Disparities
Three potential sources of Unequal Treatment Health systems-level factors – financing,
structure of care; cultural and linguistic barriers
Patient-level factors – including patient preferences, refusal of treatment, poor adherence, biological differences
Disparities arising from the clinical encounter
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Health systems-level factors Large percentage of uninsured 18-64
years 32.7% (BRFSS, 2006)
Large immigrant population Limited translation capability
Access Fragmented services Poor public transportation Hours of service
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Patient-level factors Low percentage preventive screening
Colorectal Cancer Screening 14.8 %
Women aged 40+ who have had a mammogram within the past two years 61.3%
Visited the dentist or dental clinic within the past year for any reason 61%
(BRFSS 2006)
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Patient-level factors Patient preferences
Level of confidence in the health care system
Adherence Cannot be separated from cost/insurance
issues Health literacy
Hesitancy to question provider
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Clinical Encounter
Waiting time for service Time spent with provider Level of explanation of
condition/treatment Requirement to pay provider out of
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Insights From Focus Groups
Ranked health issues in the Virgin Islands1. Disease and disease management2. Financial concerns3. Services
Facilities Personnel Customer services
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Center Research Activities Begun under Capacity building EXPORT
Center Grant (Studies completed or in progress) A church based diabetes survey for St. Thomas
in the US Virgin Islands Focus study of patient/provider breast cancer
risk communication and breast cancer risk management
Factors and life experiences affecting self management among a population of type 2 diabetic patients in the United States Virgin Islands
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Center Research Activities cont.
Health Status and Access to healthcare among African American and African Caribbean Women
Knowledge, attitudes, perceptions and decision making of pregnant and parenting women of African heritage at risk for or living with HIV/AIDS: an international perspective
Abuse status and health consequences for African Caribbean and African American women Study (ACAAWS)
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One Study Key Results Focus study of patient/provider breast
cancer risk communication and breast cancer risk management N-178 aged 30-74 12.1% projected to be at moderate to high risk
for breast cancer Historical information relative to personal and
family health was not routinely collected from subjects
The majority of subjects did not comply with recommended breast cancer screening guidelines
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Key Study Results Women reporting having had discussions with
health care providers about their personal breast cancer risk were more likely to express an interest in medical strategies for the management of breast cancer risk
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Implications for Research, Practice and Education
Need for the development of more focused programs of research, education and outreach to promote breast health among women in the USVI
Need to enhance systems responsible for monitoring and reporting cancer trends relative to cancer incidence, mortality and survival within the territory
Need for forums for investigators, faculty, students and the community to discuss the breast health needs and concerns of women across the territory
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Implications for Research, Practice and Education
cont. Need for educational programming for women in
the community that focuses on breast cancer, breast cancer risk, breast cancer screening, and breast cancer risk management
Need for educational programming for women in the community that enhance communication with health care providers
Need for educational programming for women in the community that focus on the relationship between personal health and family health
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Implications for Research, Practice and Education
cont. Need for training of health care providers
(i.e., physicians, nurse practitioners, oncology nurse specialists, etc.) relative to the assessment and communication of breast cancer risk
Need for the development of programs of research to address issues relevant to breast cancer detection and control among women in the USVI across the care continuum.
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Caribbean Exploratory Research Center Next Steps
Follow up on recommendations from reported studies
Facilitate the completion of ongoing studies through presentation to peers, publication and implementation of relevant interventions to reduce disparities
Host conferences aimed at garnering involvement in community based participatory, and culturally relevant research
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Next Steps cont. Provide support for pilot studies
addressing health disparities Mentor students, faculty and community
researchers in evidenced based approaches to address disparities
Engage the community through CBOs in educational, wellness and preventative activities
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Next Steps Cont. Seek additional funding sources
Three grant applications submitted through the Center in response to the American Recovery and Reinvestment Act call for proposals
Thousands of applications submitted from across the nation
One of the three submitted proposals funded for $600,000 over a two year period.
We will continue to seek opportunities for additional support of what we consider vital work to improve the health of Virgin Islanders.
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Resources
CDC National Center for Chronic Disease Prevention and Health Promotion Behavioral Risk Factor Surveillance System (2004, 2006)
CDC HIV/AIDS Surveillance report , 2007 HEALTHY VIRGIN ISLANDS 2010: Improving Health For
All(2003) Virgin Islands Department of Health Underwood, S., Ramsay-Johnson, E., Callwood, G., Evans, E.
(2007) Promoting Breast Health among Women in the U.S. Virgin Islands: A Focused Study of the Needs of Caribbean Women, JNBNA Vol. 18 (2)
Unequal Treatment: Confronting Racial and Ethnic
Disparities in Healthcare (2003) Institute of Medicine U S Census Bureau (2000)
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Thank YouQuestions?
Supported by a grant from NIH NCMH-HD #1P20MD002286-03