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  • Breastfeeding Disparities in African American Women

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    By Regina Smith James, M.D.

    Director, Clinical and Health Services Research
    National Institute on Minority Health and Health Disparities


    Some say the best things in life are free…but are they really? Well, when it comes to providing our babies with the best nutrition ever, breastfeeding is not only economical, but it has positive health effects for both baby and mom. Did you know that breast milk is uniquely suited to your baby’s nutritional needs, with immunologic and anti-inflammatory properties? Yes, it’s true! And the American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months, with gradual introduction of solid foods after 6 months while continuing to breastfeed up to 1 year.

    What are some of the health benefits of breastfeeding? Breast milk not only offers a nutritionally balanced meal, but some studies suggest that breastfeeding may even reduce the risk for certain allergic diseases, asthma, and obesity in your baby, as well as type 2 diabetes in moms. Also, breastfeeding creates a close bond between mother and child. And from a financial standpoint, breastfeeding is economical. The United States Breastfeeding Committee noted that families who followed optimal breastfeeding practices could save approximately $1,500 that would have gone toward infant formula in the first year alone. Imagine what you could do with those extra dollars!

    Despite the many benefits of breastfeeding, African American mothers have the lowest rate of breastfeeding initiation and duration. The Centers for Disease Control and Prevention (CDC) noted that from 2011 to 2015, the percentage of women who initiated breastfeeding was 64.3 percent for African Americans, 81.5 percent for Whites, and 81.9 percent for Hispanics. And while 79.2 percent of infants began breastfeeding, only 20 percent breastfed exclusively for 6 months, and 27.8 percent met the recommended breastfeeding duration of 12 months. The Surgeon General’s Call to Action to Support Breastfeeding noted that even while researchers control for family’s income or education level, breastfeeding rates for African American infants are lower than for White infants at birth, 6 months, and 12 months.

    Why do these racial disparities persist? Here is what some research is showing us: (1) African American women tend to return to work earlier after childbirth and are more likely to work in environments that do not support breastfeeding; (2) healthcare settings that provide supplemental feeding to healthy full-term breastfed babies during the postpartum stay decrease the likelihood of exclusive breastfeeding; (3) healthcare settings that separate mothers from babies during their hospital stay; (4) lack of knowledge about the benefits of breastfeeding and the risks of not breastfeeding; (5) perceived inconvenience—a breastfeeding mother may have to give up too many habits of her lifestyle; (6) the mistaken belief that “big is healthy,” leading moms to introduce formula early; (7) the cultural belief that the use of cereal in a bottle will prolong the infant’s sleep; and (8) embarrassment—fearful of being stigmatized when they breastfeed in public.

    How can we begin to address these challenges? The National Institutes of Health are taking action by supporting high-quality research on breastfeeding. For example, Community Partnership for Breastfeeding Promotion and Support; Novel Intervention to Increase Lactation Practices by African American Women; and Breastfeeding Support and Weight Management for Black Women: A Dual Intervention are just a few projects currently being conducted. In addition to research efforts, there are a number of resources available for new mothers to support breastfeeding. Here are a few to get you started:

    As noted earlier, breastfeeding may reduce the risk for certain diseases, like obesity and type 2 diabetes; both are major causes of morbidity and mortality in adults in the United States, particularly for African Americans. Could it be that early life experiences, like breastfeeding, somehow have a protective effect against such diseases later in life? If we approach this question with a “life course perspective,” we might think about intervening as early as preconception or pregnancy to address these disparities before they develop. According to the U.S. Preventive Services Task Force (USPSTF), we should actually initiate our efforts early by providing interventions during pregnancy and after birth to support breastfeeding.

    August is National Breastfeeding Month, so let’s galvanize our efforts and raise more awareness about the importance of breastfeeding and the positive health effects it can have for both baby and mom.

    Related Posts
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    References
    1. Anstey, E., Chen, J., Elam-Evans, L. and Perrine, C. (2017). Racial and Geographic Differences in Breastfeeding — United States, 2011–2015. Morbidity and Mortality Weekly Report, 66(27), 723–727.

    2. Bibbins-Domingo, K., Grossman, D. C., Curry, S. J., Davidson, K. W., Epling, J. W., García, F. A., . . . Pignone, M. P. (2016). Primary Care Interventions to Support Breastfeeding: US Preventive Services Task Force Recommendation Statement. JAMA, 316(16), 1688–1693.

    3. Johnson, A., Kirk, R., Rosenblum, K. L., Muzik, M. (2015). Enhancing Breastfeeding Rates Among African American Women: A Systematic Review of Current Psychosocial Interventions. Breastfeeding Medicine, 10(1), 45–62.

    4. American Academy of Pediatrics. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827–41.

    5. U.S. Department of Health and Human Services. (2011). The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General. Available at http://www.surgeongeneral.gov/library/calls/breastfeeding/index.html.

    6. CDC. Racial and Socioeconomic Disparities in Breastfeeding — United States, 2004. (2006). Morbidity and Mortality Weekly Report, 55(12), 335–339.

    7. Centers for Disease Control and Prevention. (2002). National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2000. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

  • Minorities and Mental Health: Moving Beyond Stigma

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    By Courtney Ferrell Aklin, Ph.D.
    Former Chief of Staff, National Institute on Minority Health and Health Disparities

    By Marcia M. Gómez, M.D.
    Health Science Policy Analyst, National Institute on Minority Health and Health Disparities


    Dr. Courtney Ferrell Aklin

    Demographic trends in the United States have continued to change rapidly. Projections indicate that within the next 30 years, the majority of the United States will be non-White.1Among the racial and ethnic groups that will make up the majority, there is significant heterogeneity, making healthcare delivery even more challenging.

    Mental illness is one of the most prevalent health problems in the United States and one of the most taxing on the healthcare system. In addition, mental illness carries the highest disease burden among all diseases, with devastating effects on daily functioning; personal, social, and occupational impairment; and premature death if left untreated.2 One in 10 children and one in five adults are affected by mental illness.3

    Mental illness does not discriminate. It occurs in all racial, ethnic, and socioeconomic groups and is the leading cause of disability in the United States. However, two thirds of individuals with a diagnosable mental health disorder do not seek treatment.4 Most ethnic minorities have similar prevalence rates of mental health issues to those of Whites, but they have less access to mental health services, are less likely to seek and receive needed care, and, when they do receive it, are more likely to get poorer-quality care. This combination of disparities leads to racial and ethnic minorities having a higher proportion of unmet mental healthcare needs compared with majority populations.5

    In 1999, health disparities in mental health were highlighted in the Surgeon General’s report on mental health. Dr. David Satcher, former U.S. Surgeon General, called on all Americans to educate themselves and challenge the stigma, attitudes, fear, and misunderstanding that remain barriers to truly addressing mental illness.6 In 2008, in an effort to sustain dialogue on mental health in minority populations, the U.S. House of Representatives established July as National Minority Mental Health Awareness Month.

    Brother, You’re on My Mind, created as a partnership between Omega Psi Phi Fraternity, Inc., and the National Institute on Minority Health and Health Disparities (NIMHD), is an example of an initiative designed to increase awareness about mental health among African American men. The focus of the initiative is on starting a conversation to dispel the myths associated with mental health problems and assert the importance of seeking treatment. Expectations that men be “tough,” coupled with poor access to mental health services, leave men of color who struggle with mental illness especially susceptible to substance abuse, homelessness, incarceration, and homicide.7

    Particularly for populations of color, existing stigmas and the lack of discussion on mental health are major barriers to individuals seeking proper treatment. It is important to remember that mental health is fundamental to overall health and well-being at every stage of life.8 NIMHD is committed to envisioning an America in which all populations have an equal opportunity to live long, healthy, and productive lives. Therefore, we must continue to encourage discussion, awareness, and research about mental health.

    More research is needed to examine:

    • The best approaches to mental healthcare.
    • The best ways to increase communication between patients and mental healthcare providers.
    • The increased risk of mental illness among people who are poor, homeless, or incarcerated or who have substance abuse issues and how to address them.
    • Cultural aspects relating to mental health and how to integrate resources within communities.

    Resources:

    Mentalhealth.gov

    National Institute of Mental Health (NIMH)

    Substance Abuse and Mental Health Services Administration (SAMHSA)

    National Alliance on Mental Illness

    References:

    1. Colby, S. L., & Ortman, J. M. (2015). Projections of the Size and Composition of the U.S. Population: 2014 to 2060. Washington, D.C.: U.S. Census Bureau.

    2. Reeves, W. C., Strine, T. W., Pratt, L. A., Thompson, W., Ahluwalia, I., Dhingra, S. S., . . . Safran, M. A. (2011). Mental illness surveillance among adults in the United States. Morbidity and Mortality Weekly Report, 60(03), 1–32.

    3. U.S. Department of Health and Human Services. (n.d.). Any Disorder Among Children; and U.S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

    4. Mental Health America. (2017). The State of Mental Health in America. Alexandria, VA: Mental Health America.

    5. U.S. Department of Health and Human Services. (2001). Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; and Wahowiak, L. (2015). Addressing stigma, disparities in minority mental health: Access to care among barriers. The Nation’s Health, 45(1), 1–20.

    6. U.S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

    7. National Institute on Minority Health and Health Disparities. (2017). Brother, You’re on My Mind.

    8. U.S. Department of Health and Human Services. (2001). Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

  • Contradicting the Myth of the Model Minority Through a Population Health Equity Approach

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    Diabetes management class participants perform group exercises


    By Chau Trinh-Shevrin, DrPH
    Principal Investigator, NYU Center for the Study of Asian American Health
    Associate Professor, Departments of Population Health and Medicine
    Vice Chair for Research, Department of Population Health
    Director, Section for Health Equity
    NYU School of Medicine

    Asian Americans do not need an apple a day to keep the doctor away. Research suggests that doctors are less likely to follow evidence-based guidelines and meet standards of care with their Asian American patients compared with other racial groups in preventing and managing chronic conditions.1,2Asian Americans, however, face just as many health challenges, including an increasing rate of diabetes and certain cancers.

    This neglect seems to be linked to the “model minority” stereotype of Asian Americans, promoted in American culture and media, which portrays them as uniformly hardworking, affluent, and healthy. Yet, Asian Americans are not all alike: There are substantial differences in language, migration, and social experiences across Asian subgroups whose ancestral heritages hail from East, South, and Southeast Asia, and health concerns and risks vary across and within these communities.3

    The model minority myth systemically influences how health care is provided to Asian Americans. In fact, the evidence suggests the following:

    • Aggregated data mask important differences—such as diet and health risks—that may affect health outcomes among more than 30 Asian ethnic subgroups.
    • Diabetes rates are strikingly high for South Asians and Filipinos.4
    • Suicide is one of the leading causes of death among Korean American males,5 suggesting difficulties in accessing and seeking mental health services.

    For these reasons, the Center for the Study of Asian American Health at NYU School of Medicine’s Department of Population Health was established in 2003 and is the only National Institute on Minority Health and Health Disparities Center of Excellence devoted to Asian American health in the United States. Our center seeks to counter the model minority stereotype by employing a population health framework to advance the health of Asian Americans in New York City and nationally.6–8 We have focused on three key development areas:

    • Data Disaggregation: We have led data collection and analyses efforts to support the disaggregation of data on Asian Americans into subgroup to better understand the nature and prevalence of certain health conditions.9
    • Community and Clinical Linkages: Our studies prioritize patient-centered care that aims to bridge communities with poor access to care to doctors and clinics. The DREAM (Diabetes Research, Education, and Action for Minorities) Project, a culturally tailored intervention for Bangladeshi Americans with uncontrolled type 2 diabetes, has demonstrated efficacy in reducing HbA1c and increasing physical activity.10 Community health workers (CHW) lead sessions on diabetes management in Bengali and work with community members to overcome a range of barriers, such as how to use the subway to get to doctor’s appointments and how to ask the right questions. One study participant said, “I only knew [previously] that if I was feeling bad, I should go to the doctor. Now, I have my own doctor—myself.”
    • Multi-level Strategies: We are developing multi-level strategies that integrate health information technology as well as policy, systems, and environmental changes to address major disparities that Asian Americans experience. One focus area of our work is on developing culturally adapted interventions with CHWs and electronic health records in safety net clinical settings to improve adherence to preventive treatments against stomach cancer in high-risk Asian American communities.

    Korean American community screening event at a church in Queens.

    As we celebrate Asian American and Pacific Islander Heritage Month, health care systems increasingly face the challenges of ensuring culturally and linguistically relevant care. We hope more resources will be dedicated to the health of Asian Americans—the fastest growing minority population in the United States11—and meaningful evidence-based strategies will inform policy and practice. As patients and medical professionals, we must mindfully approach Asian Americans as we would any other population—with the intention of addressing complex health challenges and risks experienced by all Americans.

    References

    1. Tung, E.L., Baig, A.A., Huang, E.S., Laiteerapong, N., & Chua, K.P. (2017). Racial and ethnic disparities in diabetes screening between Asian Americans and other adults: BRFSS 2012–2014. Journal of General Internal Medicine 32(4), 423–429. doi: 10.1007/s11606-016-3913-x

    2. Islam, N.S., Kwon, S.C., Wyatt, L.C., Ruddock, C., Horowitz, C.R., Devia, C., & Trinh-Shevrin, C. (2015). Disparities in diabetes management in Asian Americans in New York City compared with other racial/ethnic minority groups. American Journal of Public Health, 105(Suppl. 3), S443–S446. doi: 10.2105/AJPH.2014.302523

    3. Yi, S.S., Kwon, S.C., Sacks, R., & Trinh-Shevrin, C. (2016). Commentary: Persistence and health-related consequences of the model minority stereotype for Asian Americans. Ethnicity and Disease, 26(1), 133–138. doi: 10.18865/ed.26.1.133

    4. King, G.L., McNeely, M.J., Thorpe, L.E., Mau, M.L., Ko, J., Liu, L.L., . . . Chow, E.A. (2012). Understanding and addressing unique needs of diabetes in Asian Americans, native Hawaiians, and Pacific Islanders. Diabetes Care, 35(5), 1181–1188. doi: 10.2337/dc12-0210

    5. Hastings, K.G., Jose, P.O., Kapphahn, K.I., Frank, A.T., Goldstein, B.A., Thompson, C.A., . . . Palaniappan, L.P. (2015). Leading causes of death among Asian American subgroups (2003–2011). PLoS One, 10(4), e0124341. doi: 10.1371/journal.pone.0124341

    6. Trinh-Shevrin, C., Sacks, R., Ahn, J., & Yi, S.S. (2017). Opportunities and challenges in precision medicine: Improving cancer prevention and treatment for Asian Americans. Journal of Racial and Ethnic Health Disparities. Advance online publication. doi:10.1007/s40615-016-0334-9

    7. Trinh-Shevrin, C., Islam, N.S., Nadkarni, S., Park, R., & Kwon, S.C. (2015). Defining an integrative approach for health promotion and disease prevention: A population health equity framework. Journal of Health Care for the Poor and Underserved, 26(Suppl. 2), 146–163. doi: 10.1353/hpu.2015.0067

    8. Trinh-Shevrin, C., Kwon, S.C., Park, R., Nadkarni, S.K., & Islam, N.S. (2015). Moving the dial to advance population health equity in New York City Asian American populations. American Journal of Public Health, 105(Suppl. 3), e16–e25. doi: 10.2105/AJPH.2015.302626

    9. Islam, N.S., Khan, S., Kwon, S., Jang, D., Ro, M., & Trinh-Shevrin, C. (2010). Methodological issues in the collection, analysis, and reporting of granular data in Asian American populations: Historical challenges and potential solutions. Journal of Health Care for the Poor and Underserved, 21(4), 1354–1381. doi: 10.1353/hpu.2010.0939

    10. Islam, N.S., Wyatt, L.C., Patel, S.D., Shapiro, E., Tandon, S.D., Mukherji, B.R., . . . Trinh-Shevrin, C. (2013). Evaluation of a community health worker pilot intervention to improve diabetes management in Bangladeshi immigrants with type 2 diabetes in New York City. Diabetes Educator, 39(4), 478–493. doi: 10.1177/0145721713491438

    11. Colby, S.L., & Ortman, J.M. (2014). Projections of the size and composition of the U.S. population: 2014 to 2060. Washington, DC: U.S. Census Bureau.