Satcher Fellowships 2010-2011

The SNMA Satcher fellowship aims to provide medical student members of the SNMA opportunities to explore racial and ethnic health disparities in a research environment. Included in this article are abstracts from the four Satcher fellows for 2010-2011. The research of these fellows address how cultural and/or language barriers can affect the quality of care and were presented at the 2011 AMEC in Indianapolis.

Amy West, Edward Bittner2, Vilma E. Ortiz2

  1. Harvard Medical School, Boston, MA, United States. 2. Massachusetts General Hospital, Boston, MA, United States.



Introduction: The time preceding an operation is marked by uncertainty and angst, particularly when communication barriers exist between the patient and the healthcare professional. Language barriers can lead to miscommunication, mistrust, avoidance of medical care and heightened anxiety about the unknown. As medical interpreter services are scarce, patients who opt to use family members as interpreters may not receive the exact message that is intended from the medical team. Video instruction has proven to be effective in many aspects of health care (1). In studies where language barrier does not exist, it has been shown that the addition of video instruction to a pre-anesthesia interview increases patient knowledge about procedures and lowers pre-operative anxiety (2, 3). We studied the effect of an instructional video in Spanish on self-reported anxiety, knowledge about general anesthesia procedures and satisfaction with the preoperative anesthesia process in patients requiring a Spanish interpreter.

Twenty consecutive, Spanish-speaking patients scheduled to undergo surgery under general anesthesia were randomized to group V (video) or group NV (no video). Using a 1-10 scale, all patients were asked in Spanish to describe their anxiety associated with general anesthesia, knowledge about anesthetic procedures, and satisfaction with the information about general anesthesia they had received in the preoperative clinic. On the day of surgery, all patients had the routine pre-anesthesia interview involving use of a medical interpreter or family member. Prior to this interview, group V saw a three-minute educational video explaining in Spanish the procedures, risks and benefits accompanying a general anesthetic. Both groups were then asked the same questions about anxiety, knowledge, and satisfaction. Pre and Post- interview changes in anxiety, knowledge and satisfaction scores were compared between the V and NV groups using the Wilcoxon Rank Sum test. The level of significance was set at p <0.05.

The study included 20 patients; Median age 53.9 +/- 16.8; 65% female; 80% literate. There was a significant reduction in anxiety score in patients who viewed the video compared to those who did not (median reduction 2 vs 0, p=0.020). There was an increase in satisfaction score in the video group (median increase 2 vs 0, p=0.046). There was no difference in reported knowledge improvement score between the 2 groups (3.5 vs 4, p=0.908).

In Spanish speaking patients, the addition of an instructional video in Spanish to a pre-anesthesia interview decreases anxiety and increases satisfaction.

1. Nurs Clin N Am 2009;44:103-115
2. Anesth Analg 2005;100:1753-8
3. BJA 2010;104:369-74

Brian A. Freeman, MPH; Alton Hart, Jr., MD, MPH

Title: Determining How a Culturally Sensitive Booklet Affects Smoking Cessation Outcomes in an African-American male barbershop intervention.

Introduction: Though smoking prevalence rates are similar among African Americans and Whites, African-American men bear the greatest burden of tobacco-related disease compared to White men.  Limited research has focused on how to provide feasible smoking cessation information to African-American men that will empower them to modify smoking behavior.

Purpose: To conduct a pilot study exploring the acceptability, feasibility and potential effects of providing a culturally tailored smoking cessation booklet to adult African-American male smokers in urban barbershops.

Methods: Ten Richmond, VA urban barbershops were randomly assigned to either an intervention or a control group.  Control barbershops received the National Cancer Institutes’(NCI) Cancer Information Service (CIS) bookmarker “Want to Quit?” which included a number to a NCI telephone quitline.  Intervention barbershops received copies of the Pathways to Freedom smoking cessation booklet and the CIS bookmarker from December 2008-June 2009.  Post intervention surveys of 192 eligible customers were administered beginning November 2009 until June 2010.  Model 1 examined the association between barbershop group and quit attempts, while controlling for socio-demographic and smoking behavior covariates.  Model 2 examined the association between group and reduced cigarette consumption, while controlling for the same covariates in Model 1.

Results: In Model 1 the intervention barbershop group did not exhibit higher quit rates than in control shops adjusting for socio-demographic variables (OR = 1.61 95% CI = 0.76-3.36).  This result was repeated in Model 2 (OR = 2.03, 95% CI = 0.88-4.68).

Conclusion: This project was easy to conduct, well received, feasible, and could be administered in a salient population and community.  However, African American male smokers received no additional benefit by being exposed to the Pathways to Freedom booklet as compared with a non tailored CIS bookmarker.

Latrice G. Landry, Josiemer Mattei, Carmen Casteneda-Sceppa, Katherine L. Tucker

Title: The association between serum estrogen, homeostasis, dietary intake, obesity and diabetes in the Boston Puerto Rican Health Study

From the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Boston, MA; the Northeastern University Bouve college, Boston, MA

Background: Research on the effects of endogenous estrogen concentrations and homeostasis, adiposity and diabetes risk can provide insight into prevention and clinical management for populations suffering from those conditions. Current research on allostatic load provides an understanding to the relationship between the environment, homeostasis and chronic disease. Given the promise of this research, there is a paucity of literature on the effect of estrogen and allostatic load, adiposity and diabetes risk in Puerto Ricans. This study aims to identify the relationship between estrogen and allostatic load, diabetes risk and obesity in Puerto Rican participants in the Boston Puerto Rican Health Study.

Methods: Using SAS 9.2 we conducted a cross sectional investigation of the association between estrogen and caloric intake, allostatic load, diabetes status and body fat distribution (android and gynoid fat mass from dexa scan). In addition, we investigated the relationship between serum estrogen concentrations and BMI and waist-hip-ratio (WHR) in. Multiple linear regression models were adjusted for age and stratified by sex. BMI and android and gynoid fat mass were used as variables within the same model. Statistical significance was based on a p= 0.05 significance level.

Results: In a stratified analysis, allostatic load, diabetes status, energy intake and gynoid fat mass failed to show statistical significance in men. In men, BMI was the only statistically significant predictor of serum estrogen concentration (p=0.03), while android fat mass approached statistical significance (p=0.07).  In women, allostatic load, BMI and diabetes were not significantly associated with serum estrogen concentration in our models. Android (p= 0.04 ) and gynoid (p=0.02) fat mass, total energy intake (p=0.008) and age (p <.0001) were all significant predictors of serum estrogen concentration in women. Age and serum estrogen levels were significantly associated with waist hip ratio in women (p=  0.003 and 0.02 respectively), but not men. Serum estradiol and age were not significantly associated with BMI in men or women, although it approached significance in women (p=0.08).

Conclusion: Allostatic load and diabetes were not found to be significantly associated with serum estrogen in Puerto Rican men and women. Obesity was significantly associated with serum estrogen. In men, BMI was a significant, whereas in women gynoid and android fat mass (measures of adiposity) were significantly associated with serum estrogen levels.  These results suggest not only different effects of estrogen in men and women, but also differences in the relationship between estrogen and obesity by the measurement tool.

James C. Pendleton1,2,3 and John W. McDonald1,4,5

1International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA 2Medical Scientist Training Program, 3Graduate Program in Pathobiology, 4Department of Neurology, and 5Department of Physical Medicine and Rehabilitation, Johns Hopkins University Medical School, Baltimore, MD, USA

Title: The effect of activity-based restorative therapies (ABRT) on cardiovascular disease risk in African-Americans with spinal cord injury

Introduction: Cardiovascular disease (CVD) is a health dimension disproportionately effecting racial and ethnic minorities.  This disparity is compounded by the observation that the prevalence of CVD has been reported to be higher in individuals with spinal cord injury (SCI) compared to the general population.  Activity based restorative therapies (ABRT) have been shown to improve CV health among many other physiological measures.

Methods: This study was organized as a retrospective review of the clinical records of SCI patients (n=179) that had received a 1-year course of ABRT, specifically functional electrical stimulation (FES).  Mean arterial pressure (MAP), resting heart rate (HR), stroke volume (SV), and oxygen uptake (VO2) were measured during submaximal, steady-state leg cycling at three month increments. CVD risk factors including, BMI, fasting glucose (FG), HDL cholesterol (HDL), and total cholesterol (TC) were assessed at 6-month increments.

Results: African-Americans receiving FES training experienced a significantly decreased HR (24%±2.8, P<0.01) and MAP ((31%±2.7, P<0.001), and significantly increased SV (40%±2.9, P<0.001), VO2 (47%±1.6, P<0.001), and HDL (35%±2.9, P<0.001) compared to pre-training levels.  Additionally, decreases were experienced in BMI (7%±2.7, P<0.05) FG (42%±1.6, P<0.001), and TC (41%±1.4, P<0.001).  African-Americans experienced a greater reduction in MAP (14%±3.9, P<0.05), FG (38%±2.6, P<0.01), and TC (21%±2.4, P<0.01) and a greater increase in VO2 (10%±1.2, P<0.01) and HDL (15%±4.5, P<0.05) compared to their Caucasian counterparts experiencing the same interventions. There was no statistical difference between the groups along the BMI, HR, or SV measures.

Conclusion: ABRT appears to be a highly efficacious treatment as well as a reliable health disparity intervention.

Filed Under: Scientific Focus


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