Source: LaVeist et al. [26]. © 2011, The People‐to‐People Health Foundation, Inc.
| Health‐related outcome | EHDIC‐SWB | National survey | |||
|---|---|---|---|---|---|
| Odds ratioa | 95% CI | Odds ratioa | 95% CI | Major finding | |
| Hypertension | 1.42 | 1.09, 1.86 | 2.01 | 1.63, 2.48 | Racial disparity related to hypertension prevalence smaller in EHDIC‐SWB than in NHANES, but statistically significant |
| Diabetes | 1.07 | 0.71, 1.58 | 1.61 | 1.26, 2.04 | Racial disparity related to diabetes found in NHIS, but not in EHDIC‐SWB |
| Obesity | 1.25 | 0.90, 1.75 | 1.99 | 1.71, 2.32 | Racial disparity related to obesity found in NHIS, but not in EHDIC‐SWB |
| Cigarette smoking | Blacks have lower odds of being current smokers and smoke fewer cigarettes per day compared to Whites in EHDIC‐SWB, but no racial disparity in smoking in NHIS | ||||
| Lifetime smoker | 0.55 | 0.41, 0.72 | 0.62 | 0.49, 0.79 | |
| Current smoker | 0.71 | 0.56, 0.90 | 0.93 | 0.72, 1.21 | |
| Cigarettes smoked per day | 0.68 | 0.61, 0.75 | 0.86 | 0.74, 1.01 | |
| Use of health services | 1.44 | 1.00, 1.87 | 0.74 | 0.51, 1.07 | No disparity in having a medical care visit in MEPS, but more likely to have a visit in EHDIC‐SWB |
CI = confidence interval, NHANES = National Health and Nutrition Examination Survey, NHIS = National Health Interview Survey, MEPS = Medical Expenditure Panel Survey.
a All odds ratios are for the odds of the health‐related outcome among Blacks compared to the odds of the health‐related outcome among Whites [26].
Though the EHDIC study advances our understanding of health disparities, the study was conducted in only two census tracts in an urban population. As a result, the generalizability of the study findings is limited. Conducting this study in nonurban environments or higher SES communities may yield different results. Future studies plan to examine health disparities in different environments.
3.5.2 Hispanic Community Health Study/Study of Latinos
The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), colloquially referred to as SOL, is a multisite, community‐based, longitudinal study of the health of Latino populations in the United States. Participants were selected to be representative of the target population in four communities: the Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA. The study enrolled participants from diverse national backgrounds, including Cuban, Dominican, Puerto Rican, Mexican, Central American, and South American.
Using data from HCHS/SOL, Kershaw and colleagues used two easily assessable measures of acculturation to investigate the relationship between acculturation level and favorable levels of cardiovascular risk factors [28]. They used nativity and years lived in the United States to derive a three‐level acculturation variable: (i) low acculturation: foreign‐born and lived in the United States less than 10 years, (ii) moderate acculturation: foreign‐born and lived in the United States equal to or more than 10 years, and (iii) high acculturation: US‐born. Among cardiovascular risk factors, the study assessed cholesterol levels, systolic and diastolic blood pressure, fasting plasma glucose, current smoking, electrocardiograph abnormalities, and stress due to ethnic discrimination.
Results from multivariable‐adjusted models showed that low‐acculturated women had significantly higher odds of favorable levels of cardiovascular risk factors compared to moderate‐ or high‐acculturated women. Further, favorable levels of cardiovascular risk factors differed significantly among men by their national background. For example, moderate‐acculturated Dominican men had significantly higher odds of favorable levels of cardiovascular risk factors compared to their low‐acculturated counterparts.
One of the limitations of this study is its cross‐sectional design and, therefore, inability to examine changes in health behaviors over time and determine temporality. The HCHS/SOL study has longitudinal follow‐up and will eventually be able to assess these factors over time. Another limitation is that the study may have overadjusted for covariates that may be on the causal pathway between acculturation level and favorable levels of cardiovascular risk factors.
Despite these limitations, the present study exhibits how acculturation level can influence established risk factors for chronic health conditions and how that relationship can differ among subpopulations of immigrants.
3.5.3 Pittsburgh Hill/Homewood Research on Neighborhoods and Health Study
The Pittsburgh Hill/Homewood Research on Neighborhoods and Health (PHRESH) study evaluates a natural experiment of neighborhood revitalization on health in Black communities. To reduce inequalities in food access, policy solutions have concentrated on addressing the issue of “food deserts,” or neighborhoods with inadequate access to healthy, affordable foods. One proposal has been to place full‐service supermarkets in neighborhoods with limited access to healthy food. To better understand how this solution may lead to changes in diet, Dubowitz and colleagues conducted a rigorous study in Pittsburgh, PA that surveyed two predominately Black sociodemographically similar neighborhoods. The PHRESH study uses a quasi‐experimental longitudinal design. One of the study neighborhoods received a new supermarket, and the other acted as a control in order to understand if the introduction of the supermarket led to improved dietary outcomes. Data were collected using surveys with randomly selected residents, which included two 24‐hour dietary recalls administered between seven to fourteen days apart [29].
The study results showed net positive changes in overall dietary quality; average daily intakes of kilocalories and added sugars; and percentage of kilocalories from solid fats, added sugars, and alcohol in the neighborhood that received a full‐service supermarket [29]. However, the only positive outcome in the recipient neighborhood specifically associated with regular use of the new supermarket