Monday, July 21, 2008 thru Friday, July 25, 2008

• High TB Rates Among Immigrants to U.S. Highlight Need for Improved Screening, Study Says
  [Jul 23, 2008]

High TB Rates Among Immigrants to U.S. Highlight Need for Improved Screening, Study Says
[Jul 23, 2008]

      Immigrants arriving in the U.S. from Southeast Asia, sub-Saharan Africa and parts of Latin America have high rates of active or latent tuberculosis, highlighting a need for improved screening of the disease, according to a CDC study published Wednesday in the Journal of the American Medical Association, Reuters reports (Stern, Reuters, 7/22).

For the study, CDC researcher Kevin Cain and colleagues analyzed data on TB among U.S. immigrants from 2001 to 2006. The researchers found that immigrants from sub-Saharan Africa and Southeast Asia were at highest risk for the disease, with TB incidence of approximately 250 cases per 100,000 people among immigrants from countries such as Cambodia, Ethiopia, the Philippines, Somalia and Vietnam (Tanner, AP/Los Angeles Times, 7/23). According to the study, U.S. immigrants from sub-Saharan Africa and Southeast Asia account for 22% of the foreign-born population but make up more than half of the TB cases among people born outside the U.S. In addition, TB cases among immigrants to the U.S. increased by 5% from 1993 to 2006, accounting for 57% of all TB cases in the U.S. in 2006, the study found.

The researchers also found high rates of drug-resistant TB among immigrants from China, Peru, the Philippines and Vietnam (Reuters, 7/22). The study found that 20% of recent immigrants from Vietnam and 10% of foreign-born residents living with TB had drug-resistant TB, compared with about 4% of U.S.-born residents living with TB (AP/Los Angeles Times, 7/23).

The study called for improved efforts to screen people from high-risk countries for TB before they depart their home countries or to test them and begin treatment when they arrive in the U.S. (Reuters, 7/22). According to the researchers, a similar screening effort among immigrants and refugees from the Philippines and Vietnam would have detected almost half of the approximately 250 TB cases that were brought into the U.S. annually between 2001 and 2006 (Bloomberg/Long Island Newsday, 7/23).

Under a U.S. law, CDC conducts an overseas screening process to detect active TB cases among people immigrating to the U.S. However, according to Cain, approximately 30% of foreign-born people in the U.S. -- including temporary workers, tourists, students and undocumented immigrants -- do not undergo the screening process (Reuters, 7/22). In addition, although most TB cases develop within the first two years after arriving in the U.S., many latent TB cases do not become contagious until after immigrants have been living in the U.S. for several years. Identifying and treating latent TB would be another step to help curb the spread of the disease, Cain said. Cain added that screening immigrants who feel healthy would require sensitivity to cultural differences (Reuters, 7/22). Cain added that it "would be daunting" to screen the 37 million foreign-born residents for TB.

Henry Blumberg of the Emory University School of Medicine said the research demonstrates that "it's in the interest" of the U.S. to improve efforts to fight TB worldwide (AP/Los Angeles Times, 7/23). The "goal" of U.S. health officials "should be [to] address this serious health concern in the communities that need it most," Cain said, adding that "[a]s long as TB is out of control globally it will be a problem" in the U.S. (Reuters, 6/22).

An abstract of the study is available online.

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

Rural Alaska Natives Drink More Sugary Beverages Than Urban Residents
[Jul 21, 2008]

      Many rural Alaska Natives are drinking more soda and drinks high in sugar, increasing their risk for diabetes, obesity and cavities, Anchorage Daily News reports.

According to a 2006 Alaska Health Department and Social Services survey, about one-third of rural toddlers in Northern and Southwest Alaska on an average day drink two or more cups of a high-sugar beverage, compared with 3% of toddlers in the rest of the state. Rural adults drink about three times as much soda daily as adults living in Anchorage and Fairbanks, another state survey found.

In addition, a recent Alaska Native Tribal Health Consortium survey found that 30% of 200 households surveyed in three Yukon-Kuskokwim-area villages reported that they drink local treated water. Most said they did not like the taste, Daily News reports.

The consortium also reports that in about one out of five rural villages, fewer than 10% of the households have running water. State Rep. Mary Nelson (D) said, "Many of the villages that have highest soda pop consumption -- probably the majority -- don't have running water. Or if they do have running water, it's not drinkable." Nelson added that at some rural village stores, soda costs less than water.

Rex Wilhelm, president of rural retailer Alaska Commercial, said there has been a drop in soda sales as more people are choosing to buy energy drinks and flavored water -- which also are high in sugar. "People are trying to make more healthy choices," but the change is not coming quickly enough, he said.

Health officials have tried to encourage residents to drink more water and fewer sugary beverages to prevent the onset of certain diseases. In addition, the Alaska Native Tribal Health Consortium and the Alaska Native Health Board have asked schools to help reduce the sale of sodas and sugary drinks on campus. The consortium also launched a dental heath campaign, Daily News reports (Hopkins, Anchorage Daily News, 7/20).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

Washington Post Examines HIV/AIDS Among Hispanics in U.S.
[Jul 23, 2008]

      HIV/AIDS among the Hispanic community in the U.S. is reaching what some public health experts are calling a "simmering public health crisis," the Washington Post reports.

According to the Post, Hispanics account for about 14% of the U.S. population but represented 22% of new HIV/AIDS diagnoses in 2006. However, the 22% figure includes data from only 33 states and Puerto Rico, so the actual percentage could be higher, the Post reports (Connolly, Washington Post, 7/23). According to the Kaiser Family Foundation's statehealthfacts.org, Hispanics living in Washington, D.C., have the highest rate of new HIV/AIDS cases nationwide -- about 109.2 cases per every 100,000 people (Constable, Washington Post, 7/23). In addition, as many as one in four Hispanic men who have sex with men who live in major U.S. cities are HIV-positive.

According to the Post, language difficulties, cultural barriers and legal issues associated with immigration make the Hispanic community unique in terms of providing HIV prevention, education and treatment. Only two of 17 CDC programs target Hispanics, but the agency has implemented a Spanish-language hotline, confidential testing sites and other initiatives aimed at addressing HIV/AIDS among the Hispanic population. "Hispanics are overrepresented in this epidemic, and we need to target our efforts to them," CDC epidemiologist Kenneth Dominguez said.

Frank Galvan of the Charles Drew University of Medicine and Science said that the U.S. needs to "make a dent" in reducing HIV/AIDS among Hispanics or the epidemic "will continue to spread to other populations." Oscar De La O, president of the Hispanic service group Bienestar, said U.S. officials "need to stop downplaying or ignoring what's happening among" Hispanics. De La O added that he is concerned U.S. immigration policies toward HIV-positive people will create "another underground in which [HIV-positive] people cannot access treatment but will not leave the country."

According to the Post, the "nexus of AIDS and migration" will "gain fresh prominence" next month at the XVII International AIDS Conference in Mexico City. "Migrants tend to be lonely, separated from their family or partners," Dominguez said, adding, "They do not have health insurance. They may turn to drugs or alcohol. All of these put a migrant at higher risk."

This Post story also profiles Hispanics affected by HIV/AIDS in the U.S. The article was supported by a Kaiser Family Foundation mini reporting fellowship (Connolly, Washington Post, 7/23). In addition, a second Post article profiled the group La Clinica del Pueblo and its efforts to provide HIV education and prevention to Hispanics living in the district (Constable, Washington Post, 7/23).

Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference.

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

Cambridge, Mass., Studies Look at Racial, Gender Health Disparities
[Jul 22, 2008]

      The Cambridge, Mass., Public Health Department, in conjunction with several local community groups and organizations, recently released two reports that highlight health disparities among genders, races and ethnicities, the Boston Globe reports. The city has a high student population, as well as growing numbers of minorities and immigrants, which can make it more difficult to get an accurate picture of residents' health, according to the Globe.

One of the reports focused on the health issues of men. The report, among other issues, found that black men in Cambridge are hospitalized for diabetes at a rate 48% higher than that of white men. Claude-Alix Jacob, the city's chief public health officer, said the finding indicates a need for more community-based outreach efforts.

The second report focused on the health of women and young girls and found that 47% of women in Cambridge diagnosed with HIV progress to AIDS within three months, which is significantly higher than the statewide average and the average for men, Kimberly Sansoucy, head of the commission involved with the report, said.

Sansoucy said explaining the finding is complicated. "Are there immigrant women who come into the country with HIV who are not then treated once they arrive here? Is it because women with HIV are isolated within their communities, because they don't have access to health care, because of cultural differences where women do not have as much independence or are not allowed to seek treatment? Those are the questions we hope to spur with public health officials," she said.

Jacob added, "Part of this is figuring out how we tailor our outreach to not only the lower socioeconomic status, but also to some of the other immigrants that are here" (Cheng, Boston Globe, 7/20).

The men's health report is available online (.pdf). The report on women and girls also is available online (.pdf).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

Culturally Tailored Health Education Improves Clinical Outcomes Among Minorities With Type 2 Diabetes, Study Finds
[Jul 22, 2008]

      Culturally tailored health education appears to help improve some clinical outcomes in the short-term for minorities with type 2 diabetes, according to a study published in the Cochrane Database of Systematic Reviews, Reuters Health reports. The study noted that language and cultural barriers can serve as obstacles to quality diabetes health education for minorities.

For the study, author Yolanda Robles of United Kingdom-based Cardiff University analyzed results from 11 published studies that compared the efficacy of culturally tailored diabetes education with standard diabetes care. The studies included 1,603 minority participants from middle- or high-income nations.

Researchers found "clinically significant improvements" in blood sugar control among participants who received diabetes education in their native language that used culture-specific information. Participants receiving culturally tailored care also showed improved knowledge of diabetes and healthy lifestyles, according to Reuters Health. The improvements were noted three to six months after the participants received the care.

The findings support the idea "that health education should be couched in a learner-centered manner" and should consider religious aspects, as well as social and cultural values, researchers said.

Robles said that more research is needed to study the long-term effects of culturally tailored diabetes education (Hendry, Reuters Health, 7/21).

An abstract of the study is available online.

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

Increase in Breast Cancer Among Alaska Native Women Appears To Be Slowing, Researchers Say
[Jul 23, 2008]

      The 30-year increase in breast cancer rates among Alaska Native women appears to be leveling off, according to researchers making a presentation on Tuesday at a cancer symposium in Anchorage, Alaska, the Anchorage Daily News reports.

Breast cancer once was a rare occurrence among Alaska Native women, but the group's rate in Alaska now equals the rate of white women nationwide and is 50% higher than that of American Indians and Alaska Natives who live in other states, according to the Daily News.

According to new research, there were 40 breast cancer cases per 100,000 women among Alaska Natives from 1969 to 1973. That number increased to 138 cases per 100,000 women from 1994 to 1998, and then fell to 132 cases per 100,000 women from 1999 to 2004.

Janet Kelly, an epidemiologist with the Alaska Native Tribal Health Consortium, said that the findings might indicate that the increase is leveling off. However, she added, "I think you'd be hard-pressed to say there's anything (like a decline) going on yet."

A new report Kelly co-wrote with Anne Lanier, director of the consortium's research office, found that Alaska Native women's susceptibility to different types of cancer appears to vary by geographical region. The study looked at cancer in Alaska Natives from 1969 through 2003 and found that while breast cancer was the most prevalent type of cancer among Alaska Native women in Anchorage and the Interior, colorectal cancer was most prevalent among women in Barrow and coastal areas of western Alaska. The breast cancer rate in those areas was half the rate found in Anchorage.

Lanier said the small number of cancer cases in sparsely populated rural areas of Alaska makes it difficult to make statistically sound conclusions. She said, "This is a population that -- when I started working here 40-plus years ago -- we didn't even think cancer was a problem [in]," adding, "And what we have observed is a dramatic change ... particularly in lung cancer, but also in breast and prostate, which are also going up" (Bryson, Anchorage Daily News, 7/22).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

Southern U.S. Not Receiving Adequate Federal Funding To Provide HIV/AIDS Prevention, Support, Report Says
[Jul 22, 2008]

      The Southern U.S. is not receiving enough federal funding to provide adequate HIV prevention, treatment and support programs, according to a report released on Monday by the Southern AIDS Coalition, the Birmingham News reports.

An increasing number of new HIV cases in the South -- combined with "inadequate funding, resources and infrastructure" -- have "resulted in a catastrophic situation in our public health care systems in the South," the report says. The report added that public health workers should "act to correct funding and treatment disparities" to slow the spread of the virus in "isolated communities" in the region. Kathie Hiers, CEO of AIDS Alabama and a co-author of the report, said that HIV/AIDS is increasingly affecting remote areas of the South populated by blacks, who are at greatest risk of the disease. "The ruralness of the epidemic is what's becoming painfully clear," she said.

Although health officials for years knew that HIV was increasingly affecting the South, they believed the increase in new HIV cases was coming from large cities in Florida, according to Hiers. However, experts concentrated on the Deep South -- Alabama, Georgia, Louisiana, Mississippi, North Carolina and South Carolina -- and found HIV cases spreading in rural areas with large black populations with financial, health and social issues. "You don't think of the rural areas as driving the epidemic in the South, but that's clearly what's happening," Hiers said.

Federal Funding
According to the report, the distribution of federal funding does not reflect the path of the HIV epidemic nationwide, with the South receiving less funding for treatment, education and support despite a higher number of new HIV cases and an increasing number of AIDS-related deaths. Total deaths from AIDS-related causes increased to 190,000 in the South in 2001 through 2005, while the number of such deaths decreased in the rest of the nation during that time period, the report says.

According to the News, much of the funding issue "revolves around funding formulas devised early in the HIV/AIDS epidemic." These initial funding formulas were based on cumulative AIDS cases as opposed to HIV cases, giving "an advantage to large metropolitan areas where the epidemic started," according to the News. Last year, authorities adjusted Ryan White Program funding formulas, and the changes have helped, the News reports. However, the South still ranks No. 1 nationwide in the number of new HIV cases but ranks last out of four regions nationwide in overall federal funding. The federal government distributes about $6,565 annually for each person living with AIDS in the South, compared with $6,963 per person in the North, which has a higher percentage of AIDS cases, the News reports. "We're driving the epidemic, but we're still getting the least money," Hiers said.

Gary Puckrein, president and CEO of the National Minority Quality Forum, said that "one of the big misconceptions is it is big cities on the West Coast and East Coast that are really driving the disease," adding that the epidemic has "moved both in terms of geography and demography." Puckrein added, "It's really important for people in Southern states to know that because they're not getting their fair share of [federal] support."

Another report, released in May by Funders Concerned About AIDS, found that the South also receives less private funding to fight HIV/AIDS, the News reports. The report found that the South received only 19% of U.S. donations for HIV/AIDS in 2006 (Parks, Birmingham News, 7/20).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

California Medical Schools Continue To Have Low Enrollment Among Minority Students
[Jul 23, 2008]

      Minorities continue to be underrepresented at University of California medical schools, according to a report from the Greenlining Institute, New America Media reports.

According to Hector Javier Preciado, director of health policy at the Greenlining Institute, the report finds that Hispanics, African-Americans and American Indians account for 40% of California's population but comprise 20% of students at UC medical schools. He noted that while Asian-Americans as a whole are not underrepresented in the UC system, certain groups such as Hmongs and other Southeast Asians are underrepresented.

Even if UC admitted only students from the underrepresented racial and ethnic groups, Preciado said it would take 38 years for the physician population to match the diversity of the general population in California. He said, "The physician and patient relation is a very intimate one and as you would imagine one would feel more comfortable and more inclined to be honest about one's health if there was a rapport, and we know that cultural similarities help establish that."

Preciado said, "What happened is the steep decline in the number of the minorities getting in to the medical school. Proposition 209 punched the major hole in that pipeline. And a lot of people did not get to the point where they could be physicians, or where they could enter the medical school." Until 1996, when Proposition 209 was approved, schools employed affirmative action programs (Basilaia, New America Media, 7/22).

The report is available online.

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

Miami-Dade County, Fla., Town Hall Addresses Health Disparities Facing Black Residents
[Jul 23, 2008]

      Miami-Dade County, Fla., health officials on Monday held a town hall discussion that focused on addressing health care disparities among black residents, the Miami Herald reports. According to county health records, blacks are more than twice as likely to die of asthma, cancer, diabetes and other diseases than whites and Hispanics. They also are eight times more likely to die of HIV/AIDS, according to the Herald. County health officials maintain that while factors such as diet and stress may contribute to the disparities, racial issues likely are a larger contributor.

Many of the health issues that blacks face are linked to race, rather than income or socioeconomic status, Marsha Jenakovich, senior health and evaluation specialist for local not-for-profit Health Council of South Florida, said. Jenakovich said, "There's a problem when we're seeing that a No. 1 risk factor to one's health is being black."

To address the situation, officials plan to implement the Work Site Wellness Program, which encourages people to take lunchtime walks during work hours. In addition, Jenakovich said the council is developing a list of health care providers who have received cultural competency training to help better serve minority patients.

Karen Weller, director of community health and planning for the Miami-Dade County Department of Health, said, "We're trying to understand why neighborhoods in the county with people of primarily African and Caribbean descent suffer worse health outcomes than their counterparts," adding, "As we identify the reasons for the disparities we can reduce them" (Bailey, Miami Herald, 7/20).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

Column Discusses HIV/AIDS Risks for Black Women
[Jul 21, 2008]

      If the popular television series "Sex and the City" "chronicl[ed] the sexually liberated adventures of four black women" instead of white women, "one of the lead characters could credibly have tested positive for" HIV, Johnathon Briggs, director of communications at the AIDS Foundation of Chicago, writes in a Chicago Tribune opinion piece. According to federal health data, black women are nearly 23 times more likely to be diagnosed with AIDS than white women, Briggs writes.

Briggs says research has found that even though black women "engage in risky sex no more often than their white counterparts," they still are more susceptible to HIV/AIDS, which further underscores the "notion that behavior is not the sole contributing factor driving HIV transmission." While the public service message on HIV has been, "It's not who you are, it's what you do," that message is only partly true for black women, Briggs says.

He notes a recent study that found gene mutation is possibly what makes black people more susceptible to HIV/AIDS. Further, members of communities with high rates of poverty and incarceration have higher risks of HIV, Briggs writes. He quotes the Community HIV/AIDS Mobilization Project, which has said, "We have seen that social factors like lack of housing, less access to health care and being in a tough financial situation also can make people vulnerable to HIV/AIDS." Briggs continues, "In short, who you are, and where you live and, consequently, the sexual partners you choose, matters when it comes to HIV prevention."

He adds, "Though it is true that nearly every major character on 'Sex and the City' had [a sexually transmitted infection] scare, the most severe disease any of the four white Manhattan women ever got was chlamydia," which can be treated with antibiotics. He concludes that the "reality of sex in the inner city requires more than medicine. It also demands effective prevention programs and tools to change the environments that lead to disparities in disease," which is "far more worthy of our attention" than the "hard-candy gloss and glimmer of its pop-culture counterpart" (Briggs, Chicago Tribune, 7/20).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

Event Date: 7/23/2008
Host: CNN
Event: CNN Presents, "Black in America: The Black Woman and Family," to explore the experiences of black women, including statistics of single parenthood, racial disparities and the toll of HIV/AIDS
Location: Television Broadcast

Event Date: 7/23/2008
Host: Center for Health Care Strategies
Event: National Health Plan Collaborative Meeting to bring together 11 of the nation's largest health insurance plans to improve diabetes care and reduce health disparities, July 23-24
Location: Arlington, Va.
Event Contact: Jackye Santiago, 609-528-8400, ext. 124; e-mail, jsantiago@chcs.org. Please RSVP