Assessing the Cost of Health Disparities among Black and White Adults with Diabetes Mellitus

The burden of diabetes is greater for ethnic minority populations than for whites. Additionally, there are racial/ethnic differences in diabetes related outcomes. Unclear are the underlying causal factors that influence these outcomes.

Since complications of diabetes can be managed through testing, Drs. Shelley White-Means and Robert Mayberry (Morehouse School of Medicine) explored whether there are racial differences in ADA recommended diabetes testing. They examined whether racial differences in testing account for racial differences in one outcome measure: new diabetes-related hospitalizations, a costly health care treatment. Finally, they examined how new hospitalizations and race influence medical expenditure patterns. This project was funded by a sub-contract with Morehouse Medical School.

Is There Equity in the Home Health Care Market?

Older blacks are less likely to use nursing homes and more likely to live in the community with chronic conditions and disabilities that exceed those of older whites. Older disabled blacks also are less likely to use community based services such physician services, prescription medications, and in-home assistive devices. Lack of close geographical proximity to services, segregation in the use of services, lack of knowledge about available services, limited referrals to auxiliary services, and patient dissatisfaction, culturally insensitive care, and unfavorable provider-patient interactions are factors that explain racial differences and disparities in care.

In this project Drs. Shelley White-Means and Rose Rubin explored whether the formal home health care market was equitable or manifested unexplained racial disparities in use, as found in other community-based care settings for older persons seeking health care. This research was funded by University of Memphis.

Social Capital and Institutional Support Systems: Neighborhood Effects on the Well-Being of Women and Girls

Phyllis Betts and Nancy Hardt (former director, Institute for Women's Health at the University of Tennessee Health Sciences Center), in conjunction with the Shelby County Health Department,  explored the link between neighborhood characteristics and teen birth rate. The project included a participatory research protocol and was linked to an action agenda (reducing teen births and leveraging neighborhood-based support systems for teen mothers/parents.)

The project team is part of a six-city collaborative, selected by the American Public Health Association's Maternal and Child Health Leadership Institute, for action-oriented technical assistance. The emphasis on neighborhood effects follows from Betts' earlier work on sexual assault, and her position with the School of Urban Affairs and Public Policy, where she is developing a neighborhood indicators schematic and database for the Memphis and Shelby County area.

The State of the Heart

The goal of this project was to describe the disparities in, and cost and implications of heart disease and stroke in Tennessee. Researchers also developed strategies and methods that can be used to assess and monitor at-risk populations and program outcomes. The Baqar Husaini Center for Health Research, Tennessee State University and Dr. Shelley White-Means were the project directors of the study, funded by the State of Tennessee.

Welfare, Children and Families: A Three City Study

Jane Henrici is a Research Scientist on this longitudinal, interdisciplinary, and multi-methodological investigation of low-income families and their neighborhood resources in Boston, Chicago, and San Antonio. While a CROW Affiliate, Henrici edited a book that combines material from all three cities with a focus on the experiences of poorer women in a range of topics, including the prevalence of domestic violence and of disabilities among them, and the inadequacy of most employment available to them to financially support their families.

A book contracted by Cambridge University Press was completed in August 2004 concerning health care for low-income urban families in the United States based on data from the study; many of these families lived in female-headed households and appeared to differentially suffer within the current health care system along lines of race, ethnicity, and national origin despite citizenship. For a list of the sources that provided funding support for, and of already published texts from, "Welfare, Children and Families: A Three City Study", please go to www.jhu.edu/~welfare.

Women, Development, and Food Security in Less Industrialized Societies

Dr. Stephen Scanlan examined food security and child mortality in a cross-national sample of less industrialized societies. Introducing important new measures for the "proximity of gender equality" constructed from the United Nations gender-related development index and human development index findings indicate that societies that incorporate gender into their policy and development plans are more likely to reap benefits in the form of decreased child hunger and child mortality.

The project also examined various indicators for female empowerment including average age at first marriage, educational attainment, women's employment in the non-agricultural labor sector, the United Nations gender empowerment index, and female contraceptive prevalence. Female empowerment benefits not only women as a group bearing the burdens of inequality but importantly carries over to improve the well-being of society as a whole-an essential goal of the women in development perspective.

Women's Experience with Violence

Supported by a grant from the National Institute of Justice, this project involved in-depth interviews with 150 local survivors of sexual assault. It was a follow-up to an earlier study supported by the Department of Justice that created a database with more than 5000 cases of sexual assault reported in Memphis between 1995 and 1998. Together, these projects endeavored to (1) document and theorize concerning the relationship between "victim characteristics" and the situational contexts in which assaults occur; and (2) chart the course of sexual assault cases in the law enforcement and victim advocacy systems.

In both projects, the researchers participated in "researcher-practitioner" collaborations that conceptualized and implemented interventions to enhance prosecution and support systems and to prevent further assaults. The Co-Principal Investigators, Phyllis Betts and Martha Schmidt, have contributed to our understanding of how the experience of African American women and low income women differs from that of more thoroughly studied groups, typically white college students. In particular, Drs. Betts and Schmidt questioned the primacy of the "date rape" paradigm, which fails to capture the range of relationship and situational contexts typical of the Memphis population.

Based on an analysis of 500 cases, Dr. Betts presented a working typology constructed from relationship and situational dimensions to the first annual Sexual Assault Prevention Conference sponsored by the National Institute of Justice, the Department of Health and Human Services, and the National Centers for Disease Control and Prevention, in May 2000.