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Vaccinations are reported at the state level, but services are delivered at the county level through health departments (HD). This research contributes statistical models to predict county level HPV vaccination.Using a cross sectional study design, secondary data were analyzed for the years 2016-2018 for all counties of GA. Study population was male and female adolescents aged 13-17 who received the tetanus, diphtheria and pertussis (Tdap) vaccine. The number of administered HPV vaccine doses and HPV vaccination coverage rate were modeled using indicators of HD clinic access, age, sex, race/ethnicity, socioeconomic status, education, median household income, health insurance, and urban/rural residence.By county the number of administered HPV vaccine doses showed a statistically significant positive association with indicators of HD clinic access: public transit and the number of HD private clinics. HPV vaccination coverage showed a statistically significant negative association with White race and rural residency.Examining Tdap vaccinated adolescents conservatively predicted HPV vaccination and controlled for multiple confounders such as vaccination ineligibility, vaccine exemption, and vaccine opposition. Within this population, public health professionals and clinicians could use these statistical models to target HPV vaccination efforts among non-Hispanic whites and rural communities at the county level.

To characterize counties in GA by quantifying administered doses of the HPV and Tdap vaccines collected by the state health department immunization registry and indicators of Health Department (HD) clinic access.Using a cross sectional study design, secondary data were collected from public health data sources for the years 2016 to 2018 for 159 counties of Georgia. The study population was male and female adolescents aged 13-17. The number of administered HPV and Tdap vaccine doses were modeled in relation to number of private and public HD clinics, number of HD clinics registered in the VFC program and the availability of public transportation using Poisson regression, negative binomial regression, and Bayesian spatial analysis.Choropleth maps showed similar clustering patterns between administered doses of the HPV vaccine and Tdap vaccine and increased counts of administered vaccine doses in counties with both public and private clinics. Administered doses of HPV and Tdap vaccines were found to exhibit spatial dependence across counties. Accounting for spatial dependence, the availability of public transit had a significant positive effect on administered HPV vaccine doses, while the number of private HD clinics had a significant positive effect on administered Tdap vaccine doses.Maps at the county level show vaccination variability, clustering patterns and provide additional insights on the access to health care. Bayesian spatial models are needed to accurately identify and estimate factors associated with administering doses of the HPV and Tdap vaccines. Future work is needed to further examine the utilization of HPV vaccination services among urban groupings.

IntroductionDespite the disproportional impact of SLE on historically marginalised communities, the individual and sociocultural factors underlying these health disparities remain elusive. We report the design and methods for a study aimed at identifying epigenetic biomarkers associated with racism and resiliency that affect gene function and thereby influence SLE in a health disparity population.Methods and analysisThe Social Factors, Epigenomics and Lupus in African American Women (SELA) Study is a cross-sectional, case–control study. A total of 600 self-reported African American women will be invited to participate. All participants will respond to questionnaires that capture detailed sociodemographic and medical history, validated measures of racial discrimination, social support, as well as disease activity and damage for cases. Participants who wish will receive their genetic ancestry estimates and be involved in research. Blood samples are required to provide peripheral blood mononuclear cell counts, DNA and RNA. The primary goals of SELA are to identify variation in DNA methylation (DNAm) associated with self-reported exposure to racial discrimination and social support, to evaluate whether social DNAm sites affect gene expression, to identify the synergistic effects of social factors on DNAm changes on SLE and to develop a social factors-DNAm predictive model for disease outcomes. This study is conducted in cooperation with the Sea Island Families Project Citizen Advisory Committee.Discussion and disseminationSELA will respond to the pressing need to clarify the interplay and regulatory mechanism by which various positive and negative social exposures influence SLE. Results will be published and shared with patients and the community. Knowledge of the biological impact of social exposures on SLE, as informed by the results of this study, can be leveraged by advocacy efforts to develop psychosocial interventions that prevent or mitigate risk exposures, and services or interventions that promote positive exposures. Implementation of such interventions is paramount to the closure of the health disparities gap.

Background: People living with lupus may experience poor access to primary care and delayed specialty care. Purpose: To identify characteristics that lead to increased odds of poor access to primary care for minorities hospitalized with lupus. Methods: Cross-sectional design with 2011-2012 hospitalization data from South Carolina, North Carolina, and Florida. We used ICD-9 codes to identify lupus hospi­talizations. Ambulatory care sensitive condi­tions were used to identify preventable lupus hospitalizations and measure access to primary care. Logistic regression was used to estimate the odds ratio for the association between predictors and having poor access to primary care. Sensitivity analysis excluded patients aged >65 years. Results: There were 23,154 total lupus hospitalizations, and 2,094 (9.04%) were preventable. An adjusted model showed minorities aged ≥65 years (OR 2.501, CI 1.501, 4.169), minorities aged 40-64 years (OR 2.248, CI: 1.394, 3.627), minori­ties with Medicare insurance (OR 1.669, CI:1.353,2.059) and minorities with Medicaid (OR 1.662,CI:1.321, 2.092) had the highest odds for a preventable lupus hospitalization. Minorities with Medicare had significantly higher odds for ≥3 hospital days (OR 1.275, CI: 1.149, 1.415). Whites with Medicare (OR 1.291, CI: 1.164, 1.432) had the highest odds for ≥3 days. Conclusions: Our data show that middle-aged minorities living with lupus and on public health insurance have a higher likelihood of poor access to primary care. Health care workers and policymakers should develop plans to identify patients, explore issues affecting access, and place patients with a community health worker or social worker to promote better access to primary care. Ethn Dis. 2020;30(4):611- 620; doi:10.18865/ed.30.4.611

Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease in which the immune system attacks healthy tissues. While pharmaceutical therapies are an important part of disease management, behavioral interventions have been implemented to increase patients’ disease self-management skills, provide social support, and encourage patients to take a more active role in their care.Methods: Three interventions are considered in this study; peer-to-peer methodology, patient support group, and a patient navigator program that were implemented among largely African American women with SLE at the Medical University of South Carolina (MUSC). Outcomes of interest were patient activation and lupus self-efficacy. We used a Least Squares Means model to analyze change in total patient activation and lupus self-efficacy independently in each cohort. We adjusted for demographic variables of age, education, income, employment, and insurance.Results: In both unadjusted and adjusted models for patient activation, there were no statistically significant differences among the three intervention methodologies when comparing changes from baseline to post intervention. Differences in total coping score from baseline to post intervention in the patient navigator group (−101.23, p-value 0.04) and differences in scores comparing the patient navigator with the support group were statistically significant (116.96, p-value 0.038). However, only the difference in total coping from baseline to post intervention for the patient navigator program remained statistically significant (−98.78, p-value 0.04) in the adjusted model.Conclusion: Tailored interventions are a critical pathway toward improving disease self-management among SLE patients. Interventions should consider including patient navigation because this method was shown to be superior in improving self-efficacy (coping scores).

Objective The Peer Approaches to Lupus Self-management (PALS) program was developed as a peer mentoring tool to improve health behaviors, beliefs, and outcomes in African American women with systemic lupus erythematosus (SLE). This study aims to assess the cost of the PALS intervention and determine its effectiveness when compared to existing treatments. Methods Peer mentors and mentees were paired on shared criteria such as life stage, marital status, or whether they were mothers. This 12-week program consisted of a weekly peer mentoring session by telephone. Cost of healthcare utilization was evaluated by assessing the healthcare costs pre- and post-intervention. Validated measures of quality of life, self-management, disease activity, depression, and anxiety were collected. Total direct program costs per participant were totaled and used to determine average per unit improvement in outcome measures. The benefit-cost ratio and pre- versus post-intervention hospital charges were examined. Results A total of 20 mentees and 7 mentors were enrolled in the PALS program. All PALS pairs completed 12 sessions lasting an average of 54 minutes. Mentees reported statistically significant decreases in patient-reported disease activity, depression, and anxiety, with improved trends in patient activation or patient engagement in their disease and management. The total cost per patient was $1291.50, which was $107.62 per patient per week. There was a savings of $23,417 per individual receiving the intervention with a benefit-cost ratio of 18.13 per patient. Conclusion These findings suggest that the PALS intervention was effective in improving patient-level factors and was cost-effective. Future research will need to validate these findings in a larger sample.

ObjectiveThe Care-coordination Approach to Learning Lupus Self-Management (CALLS) study was designed to improve SLE disease self-management. This study aims to assess the benefits of the intervention compared with existing lupus care.MethodsParticipants were randomly assigned to participate in 12-weekly phone sessions with the patient navigator that included structured educational content, care coordination and patient-centred support services, or a usual care control condition. Validated measures of health literacy, self-efficacy, patient activation and disease activity were collected. We used least squares means and linear mixed-effects regression models for each outcome variable to assess the changes in outcome, from baseline to postintervention and to estimate the difference in these changes between the intervention and control group.ResultsThirty participants were enrolled and 14 were randomised to the treatment group. For perceived lupus self-efficacy, there was a significant increase in mean score for the intervention group, but not for the control group. With regard to disease activity, the experimental group experienced a slight decrease in mean flare score in the previous 3 months, whereas the control group experienced a slight increase, but this finding did not reach statistical significance. Trends were similar in self-reported global disease activity, but none of the findings were significant. Health literacy and patient activation measure scores remained largely unchanged throughout the study for the two groups.ConclusionThese findings suggest that the CALLS intervention may work to improve aspects of SLE disease self-management. Future research will be needed to validate these findings long-term.Trial registration numberNCT04400240.

OBJECTIVE To examine the feasibility and potential benefits of peer mentoring to improve the disease self-management and quality of life of individuals with systemic lupus erythematosus (SLE). METHODS Peer mentors were trained and paired with up to 3 mentees to receive self-management education and support by telephone over 12 weeks. This study took place at an academic teaching hospital in Charleston, South Carolina. Seven quads consisting of 1 peer mentor and 3 mentees were matched, based on factors such as age, area of residence, and marital and work status. Mentee outcomes of self-management, health-related quality of life, and disease activity were measured using validated tools at baseline, mid-intervention, and post-intervention. Descriptive statistics and effect sizes were calculated to determine clinically important (>0.3) changes from baseline. RESULTS Mentees showed trends toward lower disease activity (P = 0.004) and improved health-related quality of life, in the form of decreased anxiety (P = 0.018) and decreased depression (P = 0.057). Other improvements in health-related quality of life were observed with effect sizes >0.3, but did not reach statistical significance. In addition, both mentees and mentors gave very high scores for perceived treatment credibility and service delivery. CONCLUSION The intervention was well received. Training, the peer-mentoring program, and outcome measures were demonstrated to be feasible with modifications. This result provides preliminary support for the efficacy, acceptability, and perceived credibility of a peer-mentoring approach to improve disease self-management and health-related quality of life in African American women with SLE. Peer mentoring may augment current rheumatologic care.

Systemic lupus erythematosus (SLE) is associated with significant mortality, morbidity and cost for the individual patient and society. In the United States, African Americans (AAs) have 3-4 times greater prevalence of lupus, risk of developing lupus at an earlier age and lupus-related disease activity, organ damage and mortality compared with whites. Evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function and delayed disability among patients with lupus. However, AAs and women are still disproportionately affected by lupus. This article presents the argument that peer mentoring may be an especially effective intervention approach for AA women with SLE. SLE peers with a track record of success in lupus management and have a personal perspective that clinicians often lack. This commonality and credibility can establish trust, increase communication and, in turn, decrease disparities in healthcare outcomes.

Shrimp baiting is a fishing technique used by many South Carolinians and has been regulated in the state since the late 1980s. A postcard survey was developed and included with 400 South Carolina Department of Natural Resources (SCDNR) annual surveys of registered shrimp baiters over a two-year period. The survey contained questions concerning frequency, portion size, baiting locations, and preparation techniques for shrimp as well as other species consumed and demographic information. An overall response rate of 37% was received. The majority of respondents were men over the age of 55 years. Charleston and Beaufort counties were the most common locations for shrimp baiting. Almost half (45.9%) of respondents reported eating locally caught shrimp at least 2-3 times per month. The most common portion size was ½ pound (8 oz. or 277 g), with 44.8% of respondents reporting this as their typical amount of shrimp ingested at one meal. Only 3.7% of respondents reported typically eating the whole shrimp, while all other respondents ingested shrimp with the head removed. The most commonly consumed species besides shrimp were blue crab, oysters, and flounder. According to the US Food and Drug Administration mercury (Hg) guidelines, the majority (97%) of our respondents were not at risk for consuming unsafe levels of Hg from locally caught shrimp. However, this does not take into account other local seafood eaten or other contaminants of concern. These consumption results may be used in conjunction with data on contaminant levels in shrimp to determine potential adverse health risks associated with consumption of locally caught shrimp.

OBJECTIVE: We sought to examine the impact of the Affordable Care Act on preventable hospitalizations and associated charges for patients living with systemic lupus erythematosus (SLE), before and after Medicaid expansion. METHODS: A retrospective, quasi-experimental study, using an Interrupted Time Series (ITS) research design, was used to analyze data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for eight states. Lupus hospitalizations with a principal diagnosis of pre-determined ambulatory care sensitive (ACS) conditions were the unit of primary analysis. The primary outcome variable was access to care measured by preventable hospitalizations caused by an ACS condition. RESULTS: There were 204,150 lupus hospitalizations in the final analysis with the majority (53.5%) of lupus hospitalizations in states that did not expand Medicaid. In unadjusted analysis, Medicaid expansion states had significantly lower odds of having preventable lupus hospitalizations (OR 0.958); however, after adjusting for several covariates, Medicaid expansion states had increased odds of having preventable lupus hospitalizations (OR 1.302). Adjusted analysis showed that those with increased age, public insurance (Medicare or Medicaid), no health insurance, rural residence, or low income had significantly higher odds of having a preventable lupus hospitalization. States that expanded Medicaid had $523 significantly more charges than states that did not expand Medicaid. Older age and rural residence were associated with significantly higher charges. CONCLUSION: Our findings suggest that while Medicaid expansion increased health insurance coverage, it did not address other issues related to access to care that could reduce the number of preventable hospitalizations.

Background The annual medical costs for systemic lupus erythematosus (SLE) patients can reach up to $62 651 due to complex care needs. This presents a major challenge for all SLE patients, but it is compounded in African American women who experience the disease at a disproportionate rate and severity compared to other demographic cohorts. Peer mentoring interventions are one method examined in other chronic disease populations that has conferred self-management improvements for those patients. The Peer Approaches to Lupus Self-Management (PALS) is one such program, tailored for African American women with SLE,that could lead to cost-effective reductions in disease severity, flares, and subsequent resource utilization and medical costs. Methods Validated measures of quality of life, disease self-management, disease activity, depression, and anxiety were collected pre- (0 weeks) and post- (12 weeks) intervention. Total direct program costs per-participant were totaled and used to determine average per-unit improvement in programmatic outcome measures. Additionally, the benefit cost ratio and pre- versus post- intervention hospital charges were examined. Results Twenty mentees completed the study. Statistically significant reductions in disease activity, anxiety, and depression, were observed post-intervention. Patient self-management also improved, however did not reach statistical significance. Total cost per patient was $1,882.83 or $91.14 per week. This yielded a cost benefit ratio of $3423 per 1 unit decrease in the Generalized Anxiety Disorder score, $818 per 1 unit decrease in the PHQ-8 (depression) score, and $85.74 per 1 unit decrease in the SLAQ (disease activity) score. There was a statistically significant difference in pre-intervention hospital charges ($24,289, 95% CI: $55, $48,524) and post- hospital charges ($872, 95% CI: -$324, $2,070) (p=0.047), representing a substantial mean charge savings of $23 426 per individual. The benefit cost ratio was 12.44 per patient which implies that benefits were over 12 times higher than the cost per patient. Conclusions These findings indicate that the PALS intervention was not only effective in improving patient-level factors such as depression, anxiety, and self-reported disease activity, but the program was also highly cost-effective. These findings suggest that if adopted on a larger scale, this approach could significantly reduce financial burden on patients and medical facilities, as well as improve the quality of life of a high-risk patient population. Future research will need to validate these findings in a larger sample. Funding Source(s): This project was supported by NIH/NCATS Grant Number UL1, the Rheumatology and Immunology MCRC NIH/NIAMS Grant Number AR062755, NIH/NIAMS K23 AR052364, and NIH/NCRR UL1 RR029882.

Background Systemic lupus erythematosus (SLE or lupus) is a chronic autoimmune disease that is associated with increased morbidity, mortality, healthcare costs and decreased quality of life. African Americans in the USA have three to four times greater prevalence of SLE, risk of developing SLE at an earlier age, and SLE-related disease activity, damage, and mortality compared with Caucasians, with the highest rates experienced by African American women. There is strong evidence that patient-level factors are associated with outcomes, which justifies targeting them with intervention. While evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function, and delayed disability among patients with SLE, African Americans and women are still disproportionately impacted by SLE. Peer mentoring interventions are effective in other chronic conditions that disproportionately affect minorities, such as diabetes mellitus, HIV, and kidney disease, but there is currently no empirically tested peer mentoring intervention developed for patients with SLE. Preliminary data from our group suggest that peer mentoring improves self-management, reduces disease activity, and improves health-related quality of life (HRQOL) in African American women with SLE. Methods This study will test an innovative, manualized peer mentorship program designed to provide modeling and reinforcement by peers (mentors) to other African American women with SLE (mentees) to encourage them to engage in activities that promote disease self-management. Through a randomized, “mentored” or “support group” controlled design, we will assess the efficacy and mechanism(s) of this intervention in self-management, disease activity, and HRQOL. Discussion This is the first study to test peer mentorship as an alternative strategy to improve outcomes in African American women with SLE. This could result in a model for other programs that aim to improve disease self-management, disease activity, and HRQOL in African American women suffering from chronic illness. The peer mentoring approach is uniquely fitted to African Americans, and this intervention has the potential to lead to health improvements for African American women with SLE that have not been attainable with other interventions. This would significantly reduce disparities and have considerable public health impact. Trial registration ClinicalTrials.gov, NCT03734055. Registered on 27 November 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3580-4) contains supplementary material, which is available to authorized users.

Introduction: Over 400,000 slaves were taken from Africa and brought to Charleston, South Carolina, as part of the transatlantic slave trade during the 18th and 19th centuries. Due to these negative historical events, the healthcare of African Americans in Charleston may be compromised in regard to chronic illnesses and other conditions affecting minorities, such as lupus. Materials and Methods: The current study used an ethnographic approach to obtain the perspectives of lupus patients with the goal of identifying gaps within current research. In addition to patient perspectives, the geographical location of Charleston, South Carolina was considered through inquiries around culture, community, advocacy, and client/patient interaction to establish a narrative for the themes that emerged. Results: The eleven major themes identified were connectedness, knowledge, experience with lupus, compliance, clinical trial participation, career and planning for the future, visits, access to resources, lifestyle, transition from child to adult care, and an overarching theme of self-management. Conclusion: Understanding healthcare perceptions and decision-making among culturally diverse populations, particularly those who have been defined by centuries of substandard care, marginalization, exploitation, and distrust, is critical to the development of culturally tailored interventions designed to improve patient outcomes and reduce health disparities.

ObjectiveThe current article seeks to examine the ways in which African-American women with systemic lupus erythematosus (SLE) describe their disease experience and how they cope with their disease. This qualitative study provides deeper insight into whether experiences of African-American women with SLE differ from previous qualitative study findings.MethodsQualitative data were gathered using interviews and a focus group, from participants in the Peer Approaches to Lupus Self-management (PALS) programme. Data were analysed for themes related to disease experience and how participants cope with their disease. Twenty-seven African-American women with SLE were recruited into the peer mentoring programme, of which 7 served as mentors and 20 served as mentees. A 12-week peer mentoring intervention delivered by phone and based on the Chronic Disease Self-Management and Arthritis Self-Management Programs.ResultsThree categories encompassing a total of 10 subcategories emerged from analyses: (A) interpersonal, familialandromantic relationships; (B) individual experiences of living with SLE; and (C) physician–patient relationships.ConclusionWe gained insight on several issues related to patient perspectives of African-American women with SLE, and the context surrounding their thoughts and feelings related to lupus, including their providers, families and other social support networks. Additional research efforts could explore and address the thematic domains and respective subthemes identified here. Although limited due to the preliminary nature of the study, this information can be used to create future evidence-based interventions to decrease the impact of SLE on African-American patients.

Dorcey L Applyrs,1 Edith M Williams,2 Trevor D Faith,2 Diane L Kamen,3 Elizabeth Vazques,4 Janine M Jurkowski5 1School of Health Sciences, Excelsior College, Albany, NY, USA; 2Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; 3Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, SC, USA; 4Department of Epidemiology and Biostatistics, State University of New York at Albany, One University Place, Rensselaer, NY, USA; 5Department of Health Policy, Management, and Behavior, State University of New York at Albany, One University Place, Rensselaer, NY, USA Objective: This study investigated the association among corticosteroids, emotional health, physical health, and work/regular activities of daily living in an ethnically diverse sample of women with systemic lupus erythematosus.Methods: A secondary analysis of data from the Medical University of South Carolina Lupus Database was conducted between confirmed cases of lupus (n = 224) and controls (n = 60). The sample comprised 57 Caucasian Americans, 141 Gullah African Americans (a subpopulation of African Americans from the Sea Islands of South Carolina and Georgia), and 86 non-Gullah African Americans.Results: Emotional health outcomes were better for women with systemic lupus erythematosus compared with controls. High emotional health scores may be influenced by cultural factors such as masking emotion, disease-coping mechanisms, religion, and strong familial and social support. Although a significant association was not detected between emotional health and work/regular activities of daily living, relationships were significant after adjusting for corticosteroid use.Conclusion: These findings suggest corticosteroid use does influence the strength of the association between emotional health and work/regular activities of daily living. Keywords: systemic lupus erythematosus, emotional health, physical health, Gullah, corticosteroids, quality of life

Background: Systemic lupus erythematosus is a complex autoimmune disorder with heterogeneous presentation. Behavioral interventions have had mixed effects among this population, particularly among African American women, whom are disproportionately affected. The present study investigates predictors of individual responsiveness to a peer mentoring program designed to provide modeling and reinforcement by peers to African American women with systemic lupus erythematosus. Methods and findings: Potential predictors of outcome in the analyses include sociodemographic variables, psychosocial variables, and self-reported disease symptoms. Changes in patient reported outcomes were calculated between pre- and post-intervention time points. To categorize patients into groups based on level of improvement, a cluster analysis using the Ward’s Minimum Variance method was performed. Statistical comparisons of groups for demographics and patient reported outcomes were performed using Fisher’s exact test or Wilcoxon rank-sum tests. Two disease activity variables significantly predicted individual improvement, whereas other factors assessed had no statistically significant effect. Those mentees with worse self-reported baseline symptom severity (SLAQ2) and disease activity ratings (SLAQ3) had the highest likelihood of improvement. Conclusion: While other factors may influence individual response to the intervention, this analysis stems from a pilot study and may be underpowered to detect them. This subject warrants further study to determine the characteristics of individuals more or less likely to benefit from an intervention so that it can be tailored to their needs. The present data show that individuals with the most severe and active disease may benefit more from an intervention providing social support and targeting their self-management practices.

Aims Explorations of travel impediments among patients suffering from rheumatic diseases have been very limited. Research has consistently indicated a shortage of rheumatologists, resulting in patients potentially having to travel long distances for care. The purpose of our study was to explore how systemic lupus erythematosus (SLE) patients experience travel issues differentially by race and socio-economic status. Methods We conducted semi-structured interviews and a brief demographic survey with 10 patients diagnosed with SLE. Interview transcripts were coded and analyzed using NVivo Analysis Software to facilitate the reporting of recurrent themes and supporting quotations, and an initial codebook was independently developed by two researchers on the study team and then verified together. Results Patients described three major areas of concern with respect to travel burden in accessing their rheumatologists: reliance on caregivers; meeting financial priorities; and pain and physical limitations. Conclusions Our data suggest general traveling challenges interfering with medical appointment compliance for several participants and the importance of socio-economic issues when considering travel issues. This study highlights an important area with implications for adherence to medical appointments and participation in research among patients with SLE.

The Peer Approaches to Lupus Self-Management program sought to address the disparate impact of systemic lupus erythematosus (SLE) on African American women through a peer mentoring intervention with aims of reducing stress, anxiety, and depression. Given the association between psychological health and immune function this study examines the relationship between patient reported outcomes (PROs) in these domains and immunologic indicators of disease activity. Twenty-three African American women with SLE served as mentees in the intervention from whom PRO measures were collected at the outset, midpoint, and end of the 12 week pilot study. Blood samples were collected pre- and post-intervention. Plasma was collected from the samples and cryopreserved for subsequent analyses. The strongest correlations were between the Generalized Anxiety Disorder measure and Th1/Th2 cytokine balance. Weaker correlations existed between depression and the Th1/Th2 cytokine balance. Assessment of fresh versus cryopreserved samples revealed that changes in Th1/Th2 cytokine balance within the intervention were generally equivalent, regardless of sample type. The PALS intervention resulted in significant improvements to anxiety and depression levels which were significantly associated with positive changes in Th1/Th2 cytokine balance indicating a possible underlying mechanism of action. The nature of this relationship warrants further study.

Background Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder with significant disparate impact on African American women. The current study sought to highlight how the Peer Approaches to Lupus Self-management (PALS) intervention worked bi-directionally wherein both women with SLE leading the disease self-management program (mentors), and those participants who served as mentees, were empowered toward greater disease self-efficacy. Methods Data was captured for this study in two formats from the seven mentors participating in the pilot study: 1) mentor logs and 2) mentor interviews with the principle investigator. This information was then analyzed for themes relating to their experience within the study. Results We found that empowerment was facilitated by mentors taking their mentorship responsibilities seriously and seeking several avenues for collaboratively developing success with their mentees. Mentors reported that although challenges arose, their desire for success resulted in multiple approaches to be flexible and responsive to the needs of their mentees. Additionally, reciprocity was found to be a vital element of the program. Conclusions Key thematic areas supported our ability to demonstrate the usefulness of a peer mentoring program for SLE disease self-management on evoking empowerment through reciprocal relationships among mentors and mentees within our study population. Furthermore the feedback from PALS participants yielded very rich and contextual information that can be used as a thematic guide for developing and refining evidence-based interventions that seek to incorporate empowerment into disease self-management efforts for women suffering from SLE.

Purpose – African-Americans historically report greater exposure to discrimination and also experience unfavorable outcomes associated with physical health, poverty concentration, residential segregation, and poorer education. The effects of discrimination are particularly harmful on mental health as discriminatory experiences contribute significantly to diminished mental health status and psychological distress. African-Americans pursuing graduate education may experience additional stressors, increasing the risk for poorer mental health. The purpose of this paper is to examine the association of psychological health and discrimination experiences among black and white graduate students at a southeastern university. Design/methodology/approach – Participants were 505 graduate students at a predominantly white southeastern institution. Researchers collected data via self-administered online and paper questionnaires during the spring 2010 semester. Graduate students were asked questions pertaining to individual demographics, discrimination, and psychosocial concerns. Findings – Approximately 15 percent of the graduate students reported psychological distress. Additionally, black graduate students reported significantly higher levels of day-to-day and lifetime discrimination when compared to white graduate students. In addition to the proportions of psychological distress differing by race, African-American graduate students reported better psychological well-being when exposed to both day-to-day and lifetime discrimination than whites with similar exposure. Practical implications – Resilience factors and coping strategies should be examined further among African-American graduate students for greater understanding. Moreover, it is important to develop applications to improve mental health outcomes for all graduate students. Originality/value – This is one of the few studies to focus on the mental health and discrimination experiences among a graduate student population. The sample is drawn from the southeastern USA where there are long vestiges of discrimination and a sizable sampling of African-Americans who live in the USA.

Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that disproportionately affects African Americans and other minorities in the USA. Public health attention to SLE has been predominantly epidemiological. To better understand the effects of this cumulative disadvantage and ultimately improve the delivery of care, specifically in the context of SLE, we propose that more research attention to the social determinants of SLE is warranted and more transdisciplinary approaches are necessary to appropriately address identified social determinants of SLE. Further, we suggest drawing from the chronic care model (CCM) for an understanding of how community-level factors may exacerbate disparities explored within social determinant frameworks or facilitate better delivery of care for SLE patients. Grounded in social determinants of health (SDH) frameworks and the CCM, this paper presents issues relative to accessibility to suggest that more transdisciplinary research focused on the role of place could improve care for SLE patients, particularly the most vulnerable patients. It is our hope that this paper will serve as a springboard for future studies to more effectively connect social determinants of health with the chronic care model and thus more comprehensively address adverse health trajectories in SLE and other chronic conditions.

Very little is known about the impact of psychosocial stress on underlying biological mechanisms in African American lupus patients, although African American women display the highest rates of lupus. Due to the exposure of African Americans to a unique trajectory of stressors throughout the life course, it may be critical to understand the relationship between psychosocial stress and underlying biological mechanisms that influence disease activity and pathology in this high risk group. To begin to fill this research void, an evidence-based self-management program was piloted among a cohort of African American lupus patients participating in a SLE database project at the Medical University of South Carolina (MUSC). To assess disease activity, during each clinic visit, a history is obtained, and physical examination, phlebotomy, and urine collection are performed. SLE Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) scores are assessed at each visit. Disease data corresponding with data collection timeframes for each participant were extracted from the MUSC SLE Database to assess the effectiveness of the program. Several differences were observed between the intervention and control groups on symptoms pertaining to lupus activity, and many of these differences had large effect sizes. Our findings can be rapidly translated into improved delivery of health care and targeted trials/interventions with relevance to health disparities, and if widely implemented, morbidities and mortality related to lupus could be drastically reduced in African-Americans.

There are approximately 590,000 underground storage tanks (USTs) nationwide that store petroleum or hazardous substances. Many of these tanks are leaking, which may increase the risk of exposure to contaminants that promote health problems in host neighborhoods. Within this study, we assessed disparities in the spatial distribution of leaking underground storage tanks (LUSTs) based on socioeconomic status (SES) and race/ethnicity in South Carolina (SC). Chi-square tests were used to evaluate the difference in the proportion of populations who host a LUST compared to those not hosting a LUST for all sociodemographic factors. Linear regression models were applied to examine the association of distance to the nearest LUST with relevant sociodemographic measures. As percent black increased, the distance (both in kilometers and miles) to the nearest LUST decreased. Similar results were observed for percent poverty, unemployment, persons with less than a high school education, blacks in poverty, and whites in poverty. Furthermore, chi-square tests indicated that blacks or non-whites or people with low SES were more likely to live in LUST host areas than in non-host areas. As buffer distance increased, percent black and non-white decreased. SES variables demonstrated a similar inverse relationship. Overall, burden disparities exist in the distribution of LUSTs based on race/ethnicity and SES in SC.

Purpose.The study uses qualitative research to gain a better understanding of what occurs after low-income women receive an abnormal breast screening and the factors that influence their decisions and behavior. A heuristic model is presented for understanding this complexity.Design.Qualitative research methods used to elicited social and cultural themes related to breast cancer screening follow-up.Setting.Individual telephone interviews were conducted with 16 women with confirmed breast anomaly.Participants.Low-income women screened through a national breast cancer early detection program.Method.Grounded theory using selective coding was employed to elicit factors that influenced the understanding and follow-up of an abnormal breast screening result. Interviews were digitally recorded, transcribed, and uploaded into NVivo 8, a qualitative management and analysis software package.Results.For women (16, or 72% of case management referrals) below 250% of the poverty level, the impact of social and economic inequities creates a psychosocial context underlined by structural and cultural barriers to treatment that forecasts the mechanism that generates differences in health outcomes. The absence of insurance due to underemployment and unemployment and inadequate public infrastructure intensified emotional stress impacting participants' health decisions.Conclusion.The findings that emerged offer explanations of how consistent patterns of social injustice impact treatment decisions in a high-risk vulnerable population that have implications for health promotion research and systems-level program improvement and development.

The need for more enrichment programs for underrepresented groups in the health sciences particularly the environmental health sciences is considerable. The implications of chronic racial/ethnic differences in scientific training are best illustrated by the disproportionate number of health professionals from underrepresented groups. For example, African Americans comprise 13% of the total U.S. population but only account for 4% of U.S. physicians and in 2006, only 7.2% of all bachelor's degrees and 8.6% of all master's degrees awarded to African American were in the health sciences field. In an effort to increase the representation of persons of color in the health sciences, we used our existing community university partnership between the Low Country Alliance for Model Communities, the University of South Carolina, and the University of Maryland-College Park as the basis for a summer enrichment pilot project. The major aim was to provide academic experiences for underrepresented undergraduate a...

Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder that can cause significant morbidity and mortality. A large body of evidence has shown that African-Americans experience the disease more severely than other racial-ethnic groups. Relevant literature for the years 2000 to August 2015 were obtained from systematic searches of PubMed, Scopus, and the EBSCOHost platform that includes MEDLINE, CINAHL, etc. to evaluate research focused on SLE in African-Americans. Thirty-six of the 1502 articles were classified according to their level of evidence. The systematic review of the literature reported a wide range of adverse outcomes in African-American SLE patients and risk factors observed in other mono and multi-ethnic investigations. Studies limited to African-Americans with SLE identified novel methods for more precise ascertainment of risk and observed novel findings that hadn't been previously reported in African-Americans with SLE. Both environmental and genetic studies included in this review have highlighted unique African-American populations in an attempt to isolate risk attributable to African ancestry and observed increased genetic influence on overall disease in this cohort. The review also revealed emerging research in areas of quality of life, race-tailored interventions, and self-management. This review reemphasizes the importance of additional studies to better elucidate the natural history of SLE in African-Americans and optimize therapeutic strategies for those who are identified as being at high risk.

Purpose To assess women's attitudes, beliefs, characteristics, the perception of risks, and their relationships with not utilizing human immunodeficiency virus (HIV) testing services. Methods This study is a retrospective study and secondary data analysis of the 2006 National Health Interview Survey. Parametric testing using univariate, bivariate, and multivariate analyses was performed to examine perception of HIV acquisition and the relationship with not utilizing HIV testing services among women in the United States. Results More than half of the women in this study had never been tested for HIV (52.26%). In the multivariate analysis, using SAS callable SUDAAN, women who had not been tested for HIV that believed they had no risk of getting HIV were more likely to have never been married (odds ratio [OR], 0.37; 95% CI, 0.31-28.73; p = .0013). In addition, women who had never been tested for HIV that believed they had no risk of getting HIV were more likely to have less than a high school diploma (OR, 0.35; 95% CI, 0.15-0.78; p = .0022). Conclusions Findings from this study can lend themselves to the development of more efficient and sustainable interventions to prevent HIV infection and decrease high-risk behaviors among more susceptible populations and for the development of HIV testing policy.

A current research trajectory within environmental justice literature has been to explore various measures of proximity to environmental hazards which may contribute to exposure and health risks for vulnerable populations. Research has shown that many low-income residential areas, which often are predominantly comprised of people of color, are located in close proximity to hazardous waste sites. Public health researchers have documented that these inequities in residential patterns can be linked to negative health impacts, resulting in health disparities. The purpose of this article is to evaluate spatial distributions of leaking underground storage tanks (LUSTs) in the Charleston Metropolitan Statistical area (MSA). Furthermore, we aim to use various geographic information system (GIS) techniques that could provide local policymakers and community groups with knowledge to make better decisions for revitalization, planning, and community development efforts. Three GIS techniques were used in this...

Electronic medical records (EMRs) are at the forefront of the national healthcare agenda and this paper examines EMR implementation and usage based on data from the 2009 Commonwealth Fund National Survey of Federally Qualified Health Centers (FQHC). Chi-square analysis was used to examine differences in EMR implementation and usage. Logistic regression analysis was used to understand the adjusted associations between EMR implementation and usage. A significant finding of this study was that simple EMRs were implemented in more than half of FQHCs in the Northeast, Southern, and Western regions of the United States and EMRs in more than half of the FQHCs in the Southern and Western regions are not even utilized. These findings indicate simple EMR usage and full EMR implementation need improvement to meet the requirements of the American Recovery and Reinvestment Act by 2014, or face reduction in Medicare and Medicaid reimbursements.

Systemic Lupus Erythematosus (lupus) is a chronic autoimmune disease that can impact any organ system and result in life-threatening complications. African-Americans are at increased risk for morbidity and mortality from lupus. Self-management programs have demonstrated significant improvements in health distress, self-reported global health, and activity limitation among people with lupus. Despite benefits, arthritis self-management education has reached only a limited number of people. Self-selection of program could improve such trends. The aim of the current study is to test a novel intervention to improve quality of life, decrease indicators of depression, and reduce perceived and biological indicators of stress in African-American lupus patients in South Carolina. In a three armed randomized, wait list controlled trial, we will evaluate the effectiveness of a patient-centered ‘a–la-carte’ approach that offers subjects a variety of modes of interaction from which they can choose as many or few as they wish, compared to a ‘set menu’ approach and usual care. This unique ‘a-la-carte’ self-management program will be offered to 50 African-American lupus patients participating in a longitudinal observational web-based SLE Database at the Medical University of South Carolina. Each individualized intervention plan will include 1–4 options, including a mail-delivered arthritis kit, addition and access to an online message board, participation in a support group, and enrollment in a local self-management program. A ‘set menu’ control group of 50 lupus patients will be offered a standardized chronic disease self-management program only, and a control group of 50 lupus patients will receive usual care. Outcomes will include changes in (a) health behaviors, (b) health status, (c) health care utilization, and (d) biological markers (urinary catecholamines). Such a culturally sensitive educational intervention which includes self-selection of program components has the potential to improve disparate trends in quality of life, disease activity, depression, and stress among African-American lupus patients, as better outcomes have been documented when participants are able to choose/dictate the content and/or pace of the respective treatment/intervention program. Since there is currently no “gold standard” self-management program specifically for lupus, this project may have a considerable impact on future research and policy decisions. NCT01837875 ; April 18, 2013

BACKGROUND: Although much has been done to examine those factors associated with higher mortality among African American women, there is a paucity of literature that examines disparities among rural African Americans in South Carolina. The purpose of this investigation was to examine the association of race and mortality among breast cancer patients in a large cohort residing in South Carolina for which treatment regimens are standardized for all patients. METHODS: Subjects included 1209 women diagnosed with breast cancer between 2000 and 2002 at a large, local hospital containing a comprehensive breast center. Kaplan-Meier survival curves were calculated to determine survival rates among African American and European American women, stratified by disease stage or other prognostic characteristics. Adjusting for various characteristics, Cox multivariate survival models were used to estimate the hazard ratio (HR). RESULTS: The 5-year overall all-cause mortality survival proportion was ∼78% for African American women and ∼89% for European American women, P < 0.01. In analyses of subpopulations of women with identical disease characteristics, African American women had significantly higher mortality than European American women for the same type of breast cancer disease. In multivariate models, African American women had significantly higher mortality than European American women for both breast cancer-specific death (HR, 2.41; 95% confidence interval [CI], 1.21-4.79) and all-cause mortality (HR, 1.42; 95% CI, 1.06-1.89). CONCLUSIONS: African American women residing in rural South Carolina had lower survival for breast cancer even after adjustment for disease-related prognostic characteristics. These findings support health interventions among African American breast cancer patients aimed at tertiary prevention strategies or further down-staging of disease at diagnosis. Cancer 2011. © 2011 American Cancer Society.

The Soldier Health Promotion to Examine and Reduce Health Disparities (SHPERHD) Project was designed to be a partnership between the Institute for Partnerships to Eliminate Health Disparities at the University of South Carolina and the Fort Jackson United States Army Base located in Columbia, South Carolina. SHPERHD Project researchers are studying problems related to obesity and weight management, musculoskeletal injuries and infection, and mental health issues during recruitment, basic training, and post-deployment. In order to successfully develop targeted interventions to prevent and lower the incidence of injury, promote healthy nutrition, and decrease mental health issues, at the same time also reducing disparity gaps, the SHPERHD Project comprises a professional, technical, and administrative staff with specific competence in the operation of a Coordinating Center to handle the wide variety of areas related to military studies. This article discusses the procedures and processes that were implemented in the development of the SHPERHD Project Coordinating Center.

Human immunodeficiency virus (HIV) is a disease that has captured the attention of the media in various ways and to varying degrees. One of the ongoing debates and areas of research in HIV that provide many opportunities for discovery is the disproportionate number of African Americans infected with HIV compared to the amount of attention they receive in the media. This manuscript addresses the question that has preoccupied the minds of many people: Why have African Americans infected with HIV received so little media attention? Analysis of this question suggests that there are many reasons for this lack of media attention. One reason in particular is the media tends to be much less attentive to diseases, such as HIV, that disproportionately burden blacks relative to whites. We also find that the media is reluctant to write about HIV in African Americans because it portrays them negatively. The media suggests that people are bombarded with negative news about African Americans and writing about t...

Environmental inequality is the suggestion that the working class, the poor, persons of color, and ultimately the economically disadvantaged are subjected to living conditions that may prove to be hazardous both personally, professionally, and also to the infrastructure of the urban communities that these people inhabit. These injustices affect not only housing but education, quality healthcare access, and access to employment. This article investigates the distinct relationship of environmental inequalities imposed in urban communities that are promoted by a prominent institution: the government. It has been suggested that the government is primarily controlled by individuals who are incapable of identifying with individuals who are residents of these urban communities susceptible to the threat of environmental inequality. This introduces multiple questions: Are political leaders less concerned with such individuals and is this why the needed attention in these communities is positioned at the b...

Research has demonstrated that vulnerable populations including disadvantaged populations of color live in areas that may place them at higher risk of exposure to social and environmental hazards. Due to climate change, these populations may experience worse health outcomes and environmental health disparities. The purpose of this project was to explore the use of Geographic Information Systems (GIS) to assess areas that may be vulnerable to climate change across the United States. We employed ArcGIS 9.3 to create vulnerability scores for areas across the country that may be that may be impacted by climate change at the county level in the United States using different social, environmental, and health indicators. We included data on race/ethnicity and socioeconomic status from the US Census. Data on pollution sources and pollution levels were obtained from the United States Environmental Protection Agency. Health data were obtained from the Behavioral Risk Factor Surveillance System (BRFSS), the...

Community-based participatory research (CBPR) is a method to improve environmental quality in communities primarily inhabited by minorities or low-income families. The Buffalo Lupus Project was a CBPR partnership formed to explore the relationship between a local waste site and high rates of lupus. The “Behind the Fence” Community Environmental Forum Theater project was able to successfully funnel the results of scientific research and ongoing activities to the community by utilizing a Forum Theater approach, image-making techniques, an interactive workshop, and energetic public performance. Filming of project activities will expand the reach of that original performance and provide other communities with a potential model for similar efforts.

Exposure to environmental hazards is hypothesized to play an important role in the development of autoimmune diseases such as lupus. The Buffalo Lupus Project examined the relationship between a high incidence of disease and exposure to a toxic waste site in a poor, urban minority neighborhood in Buffalo, New York, U.S.A. The purpose of this study is to explore patients' experiences and concerns with their living environment and their perceptions of environmental effects on their health and disease status in an urban African American community with a high burden of lupus and other autoimmune diseases. To this end, we conducted two focus groups with a total of 13 community participants diagnosed with lupus. Participants were recruited through mail invitations and a semi-structured interview guide was used to gather information. Data analysis followed a theory-driven immersion-crystallization approach. Findings shed light on the following issues: 1) Environmental impact on illness; 2) Exposure to environmental hazards; 3) Community awareness about lupus; 4) Environmental determinants of lupus; and 5) Strategies for environmental action. The participants' experiences highlighted areas for improvement in environmental conditions as well as strategies for raising awareness of lupus and other autoimmune diseases in at-risk urban minority communities.

Community-based participatory research (CBPR) is a mechanism to improve environmental quality in communities primarily inhabited by minorities or low income families. A collaborative partnership be...

Minority communities across the United States have limited numbers of stores that offer a variety of fruits and vegetables, creating major barriers to good eating habits and nutritional practices among minority groups such as African Americans. Factors like environmental availability of healthy food options have not been fully investigated as possible sources of current cross-population differences in disease. The present study examined whether a predominantly African American neighborhood had disproportionately less availability of fruits and vegetables than a predominantly non-Hispanic White neighborhood. Availability was judged on the bases of the types of stores available in each community and the specific types of fruits and vegetables made available in each store. The availability of fruits and vegetables in the food stores of each community was assessed by physically canvassing neighborhood food stores and taking a census of available fruit and vegetable items based on a list of fruits and...

Lupus patients should avoid stress because physical or emotional stress can affect overall physical health. It has been suggested that social support has a positive influence on health status, but there is a lack of information in the literature on the association between the two among lupus patients. The current study investigated the association between social support and self-reported stress and coping status among African American women with lupus using data collected from two linked cross-sectional surveys. No social support differences in groups of high and low stress/coping were revealed; a duplicate study with a larger sample size is required.