The Science of Health Disparities

The MHRC generates new knowledge on the social, behavioral, and biological mechanisms of health disparities, with an emphasis on developing and testing interventions to reduce these disparities. The Research Program links investigators of various disciplines and scientific backgrounds to conduct multidisciplinary health disparities research. It identifies research priorities and funding opportunities, provides investigators with scientific expertise during the research process, and funds pilot research projects.

Contributions to UAB's Research Enterprise
By fostering interdisciplinary research collaborations and facilitating P-, U-, and R-series grants with emphasis on health disparities, the MHRC has secured significant extramural funding to UAB schools. Since 2012, the Center was instrumental in obtaining three major U54 health disparities grants of only seven such funded throughout the country. These three U54 Centers  underscore MHRC’s critical role as a national leader in the study of health disparities.
 They also extend MHRC’s reach and influence throughout the South and the nation.

Advancing the Knowledge

The publications below exemplify recent advancements of knowledge facilitated by the MHRC through the funding of pilot research. Only the findings of projects funded by the Center since 2012 are listed.

Fouad, M.N., Oates, G. R., Scarinci, I.C., Demark-Wahnefried, W, Hamby, B.W., Bateman, L.B., Estrada, J.J., Payton, M., Sims, M., Miele, L., Partridge, E.E. (2016). Supplement to American Journal of Preventive Medicine.

The Mid-South Transdisciplinary Collaborative Center published its findings to date, using a conceptual framework that considers the social context in which people live in order to understand the pathways and mechanisms that generate different health outcomes in obesity and related chronic diseases for people in vulnerable populations.

Selected findings include:

  • A study of the relationship between street connectivity – a measure of walkability for the local environment – and obesity risk, using electronic health records. Linking electronic health records with social determinants of health and environmental measures could help researchers understand the causes of obesity and chronic disease and suggest strategies for addressing the disparities in these conditions.
  • A study of the association between perceived discrimination and obesity among African-Americans, clarifying the role of perceived stress and health behaviors. The authors report that health behaviors lead to suppression, rather than mediation, between perceived discrimination and weight status and between stress and weight gain.
  • A study which provided clarification of the contributions of race, income, education, and perceived discrimination to systemic inflammation measured by four biomarkers. The findings suggest that inflammation-reducing interventions should focus on African-Americans and individuals facing socioeconomic disadvantages, especially low education levels.

Tabatabai, M.A., Kengwoung-Keumo, J-J, Oates, G.R., Guemmegne, J.T., Akinlawon, A., Ekadi, G., Fouad, M.N., and Singh, K.P. (2016) Racial and Gender Disparities in Incidence of Lung and Bronchus Cancer in the United States: A Longitudinal Analysis. PLoS ONE 11(9): e0162949. PMID:27685944

Certain population groups in the United States carry a disproportionate burden of cancer. This work models and analyzes the dynamics of lung and bronchus cancer age-adjusted incidence rates by race (White and Black), gender (male and female), and prevalence of daily smoking in 38 U.S. states, the District of Columbia, and across eight U.S. geographic regions from 1999 to 2012.

Findings:

  • Between 1999 and 2012, age-adjusted incidence rates in lung cancer have decreased in all states and regions. However, racial and gender disparities remain. Whites continue to have lower age-adjusted incidence rates for this cancer than Blacks in all states and in five of the eight U.S. geographic regions.
  • Disparities in incidence rates between Black and White men are significantly larger than those between Black and White women, with Black men having the highest incidence rate of all subgroups.
  • Assuming that lung cancer incidence rates remain within reasonable range, the model predicts that the gender gap in the incidence rate for Whites would disappear by mid-2018, and for Blacks by 2026. However, the racial gap in lung cancer incidence rates among Black and White males will remain.
  • Among all geographic regions, the Mid-South has the highest overall lung cancer incidence rate and the highest incidence rate for Whites, while the Midwest has the highest incidence rate for Blacks.
  • Between 1999 and 2012, there was a downward trend in the prevalence of daily smokers in both genders. However, males have significantly higher rates of cigarette smoking than females at all time points. The highest and lowest prevalence of daily smoking are found in the Mid-South and New England, respectively.
  • There was a significant correlation between lung cancer incidence rates and smoking prevalence in all geographic regions, indicating a strong influence of cigarette smoking on regional lung cancer incidence rates.

Scarinci, I.C., Moore, A., Benjamin, R., Vickers, S., Shikany, J., Fouad, M. (2016). A Participatory Evaluation Framework in the Establishment and Implementation of Transdisciplinary Collaborative Centers for Health Disparities Research. Evaluation and Program Planning.

This paper describes the formulation and implementation of a participatory evaluation plan for three Transdisciplinary Collaborative Centers for Health Disparities Research funded by the National Institute of Minority Health and Health Disparities.

Findings:

  • Significant engagement, participation, and commitment of all involved is critical for the evaluation process;
  • Having a "roadmap" (logic model) and "directions" (evaluation worksheets) are instrumental in getting members from different backgrounds to follow the same path; and
  • Participation of the evaluator in the leadership and core meetings facilitates continuous feedback.

Baker, E. H. & Altman, C. E. (2014). Maternal ratings of child health and child obesity, variations by 
          mother's r
ace/ethnicity and nativity. Maternal and Child Health Journal, 1-10.

Drs. Baker and Altman examined whether obesity-related indicators of child health are associated with maternal ratings of child health (MRCH) and its variation by mother's ethnicity/nativity, focusing on Hispanics.

Findings:

    • Less-acculturated foreign-born Hispanic mothers are less likely to associate child obesity with poor child health.
    • Cultural orientations that prefer heavier children or are unlikely to associate child obesity with poor child health may contribute to the higher levels of obesity found among their children.

Carson, T. L., Hardy, C. M., Greene, E., Carter, P. L., James, G., Partridge, E. E., Baskin, M. L. (2014).
          Considerations for bio-specimen collection among Black women residing in the rural Deep South
          participating in a cancer prevention study. J. Community Genet, 5, 257-263.
          DOI 10.1007/s12687-013-0178-5. PMCID: PMC4059851.

Minority and rural populations are poorly represented in bio-specimen, bio-banking, and cancer research. Drs. Carson, Partridge, Baskin and their team, used an approach underpinned by CPBR to recruit participants in a research study that included bio-specimens among a subsample of participants (Black women in the rural Deep South) in a large randomized weight loss/cancer prevention intervention.

Findings:

    • The feasibility of obtaining a specific bio-specimen sample, saliva, from Black women who were community volunteers in a research study using the CMPR model was determined.
    • Community health advisors, patient navigators, and other community networks such as DSN can play an important role in engaging members of the community to provide bio-specimen samples. 
    • Community buy-in garnered through full disclosure and empowerment steps described in this report are vital parts of efforts to increase minority participation in research trials with a bio-specimen collection component.
    • The research highlights best practices and recommendations for increasing the successful enrollment of minorities and rural populations in future bio-specimen research.

Durant, R. W., Wenzel, J. A., Scarinci, I. C., Paterniti, D. A., Fouad, M. N., Hurd, T. C., Martin, M. Y.
          (2014).  
Perspectives on barriers and facilitators to minority recruitment for clinical trials 
          among cancer center l
eaders, investigators, research staff, and referring clinicians:
          Enhancing Minority Participation in Clinical 
Trials (EMPaCT). Cancer, 120(Suppl 7), 1097-105.

This study of disparities in minority recruitment to cancer clinical trials has focused primarily on inquiries among minority populations. Yet very little is known about the perceptions of individuals actively involved in minority recruitment to clinical trials within cancer centers. Therefore, these MHRC-affiliated authors assessed the perspectives of cancer center clinical and research personnel on barriers and facilitators to minority recruitment.

Findings:

    • Multilevel approaches are needed to address barriers and optimize facilitators within cancer centers to enhance minority recruitment for cancer clinical trials.

Milner, A., Baker, E., Sisiopiku, V. (2013). Motivations and barriers to utilizing adult walking buses: An
          examination of demographic correlates of willingness to participate in a community-based   
          walking program. Open Journal of Preventive Medicine, 3(9,) 517-525.
          http://dx.doi.org/10.4236/ojpm.2013.39070

Walking buses are a way to increase physical activity by encouraging people to walk rather than rely on motorized forms of transportation. Several communities support walking school buses as an alternative mode of pupil transportation to schools. A possible extension of this concept is the introduction of adult walking buses. Given the novelty of the concept, very little is currently known about the public's perceptions regarding adult walking buses and their potential effectiveness to increase physical activity and decrease obesity among adults. To bridge this gap, this study examined motivations and barriers to participation in an adult walking bus program in Birmingham, Alabama using a comprehensive questionnaire survey.

Findings:

    • The most significant barrier to willingness to participate in a walking bus program is limited time.
    • The significance of demographic variables (obesity, race/ethnicity, and age) as predictors of willingness to participate is reduced once motivations and barriers are controlled.
    • The positive response to the program among the sample is encouraging and suggests that adult walking buses should be explored further as an active alternative transportation option with a potential to improve health and well-being.

Redman, N., Richman, J., Gamboa, C. M., Albert, M. A., Sims, M., Durant, R. W., Glasser, S. P., Safford, 
          M. A. 
(2013). Perceived stress is associated with incident coronary heart disease and all-cause 
          mortality in lo
w- but not high-income participants in the Reasons for Geographic and Racial
          Differences in Stroke 
Study. Journal of the American Heart Association, 19, 2 (6), e000447.                   PMCID: PMC3886761.

Perceived stress may increase risk for coronary heart disease (CHD) and death, but few studies have examined these relationships longitudinally. These authors sought to determine the association of perceived stress with incident CHD and all-cause mortality.

Findings:

    • Compared with reporting no stress, those reporting the highest stress had higher risk for incident CHD if they reported low income (sociodemographic-adjusted HR 1.36, 95% CI: 1.04, 1.78) but not high income (sociodemographic-adjusted HR 0.82, 95% CI: 0.57. 1.16).
    • The findings in low-income individuals attenuated with adjustment for clinical and behavioral factors (HR 1.29, 95% CI: 0.99, 1.69, P=0.06).
    • After full adjustment, the highest stress category was associated with higher risk for death among those with low income (HR 1.55. 95% CI: 1.31, 1.82) but not high income (HR 1.13, 95% CI 0.88, 1.46).
    • Conclusions: High stress was associated with greater risk of CHD and death for individuals with low but not high income.

White, K., Yeager, V. A., Menachemi, N., Scarinci, I. Impact of Alabama's immigration law on access
          to health c
are among Latina immigrants and children: Implications for national reform.
          American Journal of Public Health, 104
(3), 397-405.


In-depth interviews were conducted from May-July in 2012 to evaluate the effect of Alabama's 2011 omnibus immigration law on Latina immigrants and their US- and foreign-born children's access to and use of health services.

Findings:

    • The predominant effect of the law on access was reduction in service availability.
    • Affordability and acceptability of care were adversely affected because of economic insecurity and women's increased sense of discrimination.
    • Non pregnant women and foreign-born children experienced the greatest barriers, but pregnant women and mothers of U.S.-born children also had concerns about accessing care. 
    • Conclusion: The implications of restricting access to health services and the potential impact this has on public health should be considered in local and national immigration reform discussions.

Bovell, L. C., Shanmugan, C., Putcha B. D., Katkoori, V. R., Zhang, B., Bae, S., Singh, K. P., Grizzle, W.
          E., Manne, U. (2013). The prognostic value of miRNAs in colorectal cancers varies with patient
          race/ethnicity and stage of colorectal cancer. Clinical Cancer Research, 19(14), 3955-65. PMCID: PMC3746330.

In this study, Dr. Upender Manne, an active MHRC member, aimed to determine the prognostic value of five miRNAs with increased expression in colorectal cancers of Black and White patients.

Findings:

    • High expression of miR-203 was associated with poor survival of Whites with stage IV colorectal cancers, but in Blacks it was an indicator of poor survival of patients with stages I and II colorectal cancers.
    • Increased miR-21 expression correlated with poor prognosis for White stage IV patients. High miR-181b expression correlated with poor survival of only Blacks with stage III colorectal cancers.

 DuBay, D., Redden, D., Haque, A., Gray, S., Fouad, M., Siminoff, L., Holt, C., Kohler, C., Eckhoff, D. 

          (2012). Is decedent race an independent predictor of organ donor consent or merely a surrogate
          marker of socioeconomic status? Transplantation, 94(8), 873-8. doi:
          10.1097/TP.0b013e31826604d5. PMCID: PMC3566527.

In this retrospective study, the research team of an MHRC pilot grantee and MHRC leaders explored if the relationship between African American race and organ non-donation would be eliminated when controlling for socioeconomic status, education, and access to health care.

Findings:

    • Household income was a predictor of organ donor consent only in Whites.
    • Education, urban residence, and shorter distance between the decedent’s residence and donor hospital were significantly associated with consent for organ donation.
    • The odds ratio of donor consent in Whites compared with African Americans was 2.76; but when controlling for socioeconomic status and access to health care variables, the odds ratio of donor consent increased to 4.36.
    • The authors concluded that there is an unknown but important factor(s) associated with both race and obtaining organ donor consent.

Fouad, M. N., Johnson, R. E., Nagy, M. C., Person, S. D., Partridge, E. E. (2014). Adherence and
          retention in clinical trials: a community-based approach. Cancer, 120 (Suppl 7), 1106-12. doi:
          10.1002/cncr.28572


This work of MHRC leaders evaluated the effectiveness of using the Community Health Advisor model to promote retention and adherence of rural and low-income, mostly African American, women participating in the Atypical Squamous Cells of Undetermined Significance-Low-Grade Squamous Intraepithelial Lesion (ASCUS-LSIL) Triage Study (ALTS), a multicenter, randomized clinical trial.

Findings:

    • Adherence rates for scheduled clinic visits were significantly higher in the intervention group compared with the control group, leading the authors to conclude that volunteer CHAs can be trained to be effective in improving the retention and adherence of minority and low-income women in clinical trials.

Cockerham, W. C., Dingwall, R. & Quah, S. R. (2014). The Wiley-Blackwell encyclopedia of health,
          illness, behavior, and society. Wiley-Blackwell.


Dr. William Cockerham, a lead member of the MHRC, led the effort to produce the first comprehensive, interdisciplinary, and international reference work on the social scientific study of health and illness. This landmark five-volume work brings together 580 nationally and internationally known contributors who represent a variety of health-related disciplines.

Selected Publications of Health Disparities-Related Papers by MHRC Members 2011-2014