Оглавление
Группа авторов. The Science of Health Disparities Research
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
The Science of Health Disparities Research
List of Contributors
Foreword
Acknowledgements
1 Definitions, Principles, and Concepts for Minority Health and Health Disparities Research
1.1 Introduction
1.2 NIMHD Mission
1.3 Definitions and Concepts of Minority Health and Health Disparities. 1.3.1 Racial/Ethnic Minority Populations
1.3.2 Minority Health and Minority Health Research
1.3.3 Health Disparities and Health Disparities Research
1.3.4 Is It Minority Health or Health Disparities?
1.3.5 Standardized Measures of Minority Health‐ and Health Disparities‐Related Constructs
1.4 The NIMHD Research Framework: Health Determinants in Action
1.5 Inclusion of Diverse Participants in Clinical Research
1.6 Conclusions
1.7 Key Points
Disclaimer
References
Notes
2 Getting Under the SkinPathways and Processes that Link Social and Biological Determinants of Disease
2.1 Introduction
2.2 Allostasis and Allostatic Load
2.3 The HPA Axis
2.3.1 How We Feed: The Role of the Hypothalamus in Pathways Controlling Feeding and Nutrition
2.3.2 How We Sleep: Light–Day Cycle, Circadian Clock, and Hypothalamic Linkages to Metabolic Control and Sleep
2.3.3 How We Feel: Stress and the Role of HPA Axis in Memory and Mood
2.4 Anticipatory Biology and Behavior: The Embedding of Exposures Across the Life Course
2.4.1 Studies of Stress and Allostatic Load Across the Life Course
2.5 Sleep
2.5.1 Sleep Health Disparities and Allostatic Load
2.5.2 Sleep Health Disparities and Genetics
2.5.3 Methodologies in Sleep Research
2.6 How We Feed: Nutrition and Nutrition‐related Health Disparities
2.7 How We Feel: Mood and Depression
2.8 Summary
2.9 Key Points
Disclaimer
References
Note
3 Racial/Ethnic, Socioeconomic, and Other Social Determinants
3.1 Introduction
3.2 Introduction to the Topic, Including Key Definitions
3.3 Used and Recommended Measures and Research Methods. 3.3.1 Conceptual Model
3.3.2 US Census Definitions
3.3.3 Race Versus Ethnicity
3.4 How and Why this Topic is Important to Minority Health and Health Disparities Research. 3.4.1 The Epidemiological Profile of Racial/Ethnic Minorities. 3.4.1.1 Mortality/Morbidity
3.4.1.2 Life Expectancy
3.4.1.3 Socioeconomic Status
3.4.2 Other Social Determinants. 3.4.2.1 Acculturation
3.4.2.2 Social and Physical Environments
3.5 Selected Examples of the State of the Science in the Field to Illustrate Best Practices. 3.5.1 Exploring Health Disparities in Integrated Communities Study
3.5.2 Hispanic Community Health Study/Study of Latinos
3.5.3 Pittsburgh Hill/Homewood Research on Neighborhoods and Health Study
3.6 Challenges and Future Opportunities. 3.6.1 Biological Links to Social Determinants
3.7 Summary
3.8 Key Points
Disclaimer
References
4 Behavioral Determinants in Population Health and Health Disparities Research
4.1 Introduction
4.2 Importance of Behavioral Determinants to Minority Health and Health Disparities Research
4.3 Relevant Metrics and Research Methods. 4.3.1 Relevant Metrics
4.3.2 Research Methods
4.4 State of the Science: Promising Practices
4.4.1 Salud America!
4.4.2 Health Technology—New Vital Signs
4.4.3 Health Technology—Smartphone Use
4.4.4 Underresearched Constituencies
4.4.5 Advancing the Cycle of Better Care, Better Health, Lower Costs
4.5 Challenges and Future Opportunities
4.6 Summary
4.7 Key Points
Disclaimer
References
5 Sociocultural Environments and Health Disparities ResearchFrameworks, Methods, and Promising Directions
5.1 Introduction
5.2 Selected Overarching Sociocultural Environment Factors. 5.2.1 Culture
5.2.2 Acculturation
5.2.3 Racism
5.2.4 Interconnection of Race/Ethnicity and Socioeconomic Status
5.3 Social Capital and Health Disparities
5.3.1 Definitions and Operationalization
5.3.2 Relationship to Health Disparities
5.3.3 Social Capital Interventions
5.3.4 Future Directions for Social Capital Research
5.4 Implicit Bias of Healthcare Providers
5.4.1 Relationship Between Implicit Bias and Behavior
5.4.2 Promising Interventions that Reduce Biased Behavior
5.5 Sociocultural Factors that Influence the Quality of Healthcare Provider‐Patient Interactions and Communication
5.5.1 Communication Characteristics
5.5.2 Cultural Factors
5.5.3 Factors Related to Individual Values and Beliefs
5.5.4 Conclusion
5.6 Synthesis. 5.6.1 Culture
5.6.2 Adaptations to New Cultural Contexts
5.6.3 Social Capital
5.6.4 Implicit Bias
5.6.5 Patient‐Provider Communication
5.7 Key Points
Disclaimer
References
6 Physical Environment, and Minority Health and Health Disparities Research
6.1 Introduction
6.2 Methodologies and Measures. 6.2.1 Exposure Assessment
6.2.1.1 Geographic Information Systems
6.2.1.2 Community‐level Sampling
6.2.1.3 Personal Sampling
6.2.2 Biomarkers of Exposure
6.2.3 Qualitative Research
6.3 Importance of Physical Environment Determinants to Health Disparities Research
6.3.1 Housing
6.3.2 Food and Green Space Access
6.3.3 Neighborhood Walkability
6.3.4 Air Pollution
6.3.5 Toxic Metals Exposure
6.4 Case Study. 6.4.1 Urban Built Environment: Park Equity in Los Angeles
6.5 Challenges and Opportunities. 6.5.1 Challenges
6.5.2 Opportunities
6.6 Key Points
Disclaimer
References
7 Genome‐wide Genetic Approaches to Metabolic and Inflammatory Health Disparities
7.1 Introduction
7.2 Landscape of Genetic Variation
7.3 Pathogenic Potential of Low‐frequency and Rare Variants
7.4 Admixture in the Americas
7.5 Identifying Disease Genes Associated with Health Disparities: Methods and Approaches
7.5.1 Genome‐wide Association Studies
7.5.2 Mapping by Admixture Linkage Disequilibrium
7.6 Joint Admixture Mapping and Genome‐wide Association Studies for Gene Discovery in Admixed Populations
7.7 Whole‐Genome and Whole‐Exome Sequencing Approaches to Health Disparities
7.8 Summary
7.9 Key Points
Definitions
Disclaimer
References
8 Biologic Factors and Molecular Determinants in Inflammatory and Metabolic Diseases
8.1 Introduction and Approaches
8.2 Asthma
8.3 Metabolic Syndrome, Obesity, and Diabetes
8.4 Lupus and Other Rheumatologic Diseases
8.5 Kidney Disease
8.6 Key Points
Disclaimer
References
9 Insights into the Genomic Landscape of African Ancestry PopulationsImplications for Health and Disease Disparities
9.1 Introduction: Viewing the Complex Architecture of African Genomes from a Global Perspective
9.2 Adaptive Forces that Shaped the Human Genome in Health and Disease among African Ancestry Populations. 9.2.1 Protection Against Malaria
9.2.2 Protection Against African Sleeping Sickness (Trypanosomiasis)
9.2.3 Protection Against Lassa Fever
9.2.4 Ecological Adaptations to Tropical Climate (Hypertension and Skin Pigmentation) 9.2.4.1 Hypertension
9.2.4.2 Dark Skin
9.2.4.3 Evidence of Adaptation with Implications for Metabolic Processes
9.2.4.4 Neglected Tropical Disease
9.3 Pharmacogenomics
9.4 Considerations for Future Studies
9.5 Conclusions
9.6 Key Points
Disclaimer
References
10 Applying Self‐report Measures in Minority Health and Health Disparities Research
10.1 Introduction
10.2 Measurement Issues When Using Self‐report Measures in Diverse Populations
10.2.1 Conceptual Adequacy and Equivalence
10.2.2 Psychometric Adequacy and Equivalence
10.3 Methods for Evaluating Conceptual and Psychometric Properties of Self‐report Measures. 10.3.1 Methods for Assessing Conceptual Adequacy and Equivalence
10.3.2 Methods for Assessing Psychometric Adequacy and Equivalence
10.4 Locating and Selecting Self‐report Measures for Use in Diverse Populations. 10.4.1 Resources for Locating Measures
10.4.2 Template for Reviewing Self‐report Measures for Appropriateness in Your Study
10.5 Adapting Measures for Diverse Populations
10.5.1 Examining the Breadth and Meaning of Constructs
10.5.2 Language Translation of Measures
10.6 Future Directions
10.6.1 Interactions of Socioeconomic Status and Race/Ethnicity Across the Life Course
10.6.2 Measuring Culture and Acculturation Processes
10.7 Conclusions
10.8 Key Points
Disclaimer
References
11 Conducting Community‐based Participatory Research with Minority Communities to Reduce Health Disparities
11.1 Introduction
11.1.1 Learning Objectives
11.2 Conducting Community‐based Participatory Research with Minority Communities to Reduce Health Disparities
11.3 Evidence of CBPR Effectiveness and Advancement in CBPR Evaluation
11.4 Case Studies
11.4.1 Connecting to Testing and Prevention
11.4.2 Healthy Living: The Chinese Lay Health Workers Project
11.4.3 Nuestro Futuro Saludable [Our Healthy Future]
11.4.4 Participatory Health Impact Assessment to Inform Tribal Policy
11.4.5 Pacific Islander “Let's Move”
11.5 Anticipating Challenges and Opportunities in CBPR
11.6 Research Support for CBPR
11.7 Conclusions
11.8 Key Points
Disclaimer
References
12 Racial/Ethnic Health and Healthcare Disparities MeasurementThe Application of the Principles and Methods of Causal Inference
12.1 Introduction
12.2 Aligning Definitions of Disparity with Appropriate Statistical Methods
12.2.1 Definitions of Racial/Ethnic Healthcare Disparity
12.3 A Method of Measuring Healthcare Disparities Incorporating a “Counterfactual” Scenario
12.4 Extending the Use of “Partial Differencing” to Identifying Targets for Health and Healthcare Disparities Reduction Using Decomposition Methods
12.5 Adapting Causal Models to Identify Interventions to Reduce Racial/Ethnic Health Disparities. 12.5.1 Mediators of the Relationship Between Race/Ethnicity and Health Outcomes
12.6 Investigating the Meaning of the Race/Ethnicity Coefficient in Regression Models
12.6.1 Can One Identify the Causal Effect of Race?
12.7 Statistical Methods Used to Evaluate Causal Effects in Intervention Studies. 12.7.1 Experimental Methods: Randomized Controlled Trials and Field Experiments
12.7.2 Quasi‐Experimental Methods: Propensity Scores
12.7.3 Quasi‐Experimental Methods: Instrumental Variables
12.7.4 Quasi‐Experimental Methods: Difference‐in‐Differences
12.8 Conclusion and Limitations
12.9 Key Points
Disclaimer
References
13 Small Area Estimation and Bayesian Disease Mapping for Minority Health and Health Disparities
13.1 Introduction
13.2 Basic Statistical Models for Small Area Estimation
13.2.1 Area‐level Models
13.2.2 Unit‐level Models
13.2.3 Auxiliary Data and Model Selection for Small Area Estimation
13.2.4 Applications of Small Area Estimation in Public Health
13.3 Small Area Estimation: A Brief Practical Guide
13.4 Small Area Estimation for Quantifying Health and Health Disparities of Small Populations
13.5 Bayesian Disease Mapping
13.5.1 Basic Statistical Models for Bayesian disease mapping
13.5.2 Bayesian Hierarchical Spatial Model Specification and Fitting
13.5.3 Applications of Bayesian Hierarchical Spatial Models for Health Disparities Research
13.6 Conclusions
13.7 Key Points
Disclaimer
Acknowledgments
References
Further Reading
Notes
14 Applications of Big Data Science and Analytic Techniques for Health Disparities Research
14.1 Introduction
14.2 Characteristics of Big Data
14.3 Importance of Big Data for Minority Health and Health Disparities Research
14.4 Goals of Big Data Analytics and Opportunities for Health Disparities Research
14.5 Research Methods in Big Data. 14.5.1 Types of Big Data Research Methods and Approaches
14.5.2 Commonly Used Big Data Science Analytics and Models
14.5.2.1 Descriptive Analytics
14.5.2.2 Predictive Analytics
14.5.2.3 Prescriptive Analytics
14.5.2.4 Similarity Analytics
14.5.3 Applied Big Data Analytics and Artificial Intelligence
14.6 Selected Examples Illustrating Best Practices. 14.6.1 Example 1. Electronic Health Record and Its Applications in the Reduction of Health Outcome Disparities
14.6.2 Example 2. National and Global Surveillance for Health Inequities
14.6.3 Example 3. Using the Internet and Social Media to Understand and Address Health Disparities
14.6.4 Example 4: Chronic Disease Management
14.7 Challenges and Opportunities on Big Data Approaches in Health Disparities Research. 14.7.1 Training in Big Data Approaches
14.7.2 Big Data Access
14.7.3 Representation of the Under‐served in Big Data Sets
14.7.4 Emerging Opportunities
14.8 Summary and Conclusion
14.9 Key Points
Disclaimer
References
Notes
15 Complex Systems Science
15.1 Introduction
15.2 Unique Properties of Minority Health and Health Disparities Research
15.3 Data and Methodological Challenges in Health Disparities Research
15.4 Strong Alignment Between Hypothesized Causes of Minority and Health Disparities and Complex Systems Science Approaches
15.5 Types of Questions that Complex Adaptive Systems Models Can Help Answer
15.6 Elements of a Successful Complex Adaptive Systems Model
15.6.1 Engagement with Theory
Example 15.1 Model‐Building Example: Tobacco Town
15.6.2 Selection of a Modeling Approach
15.6.2.1 The Perspective from Which the Research Question Is Analyzing the System: Top‐down, Bottom‐up, or Process‐oriented
15.6.2.2 The Importance of Heterogeneity Among System Entities
15.6.2.3 The Importance of Active Agency
15.6.2.4 The Importance of Geographic and Social Space
15.6.2.5 The Handling of Time
Example 15.2 Model‐Building Example: Tobacco Town
15.6.3 Use of Available Data
Example 15.3 Model‐Building Example: Tobacco Town
15.7 Systems Science as Iterative Research
15.8 Limitations and Challenges
15.9 Key Points
Disclaimer
References
16 Improving Equity in Healthcare through Multilevel Interventions
16.1 What Are Multilevel Interventions?
16.2 Challenges of Multilevel Interventions
16.2.1 Addressing Health Disparities Through Multilevel Interventions
16.2.2 Measures in Multilevel Interventions
16.2.3 Methodology and Evaluation of Multilevel Interventions
16.3 Multilevel Interventions: 2012–2017
16.4 Future Directions
16.5 Case Study to Illustrate Multilevel Interventions
16.5.1 Case Study: Heart‐Healthy Lenoir High Blood Pressure Study
16.6 Key Points
Disclaimer
References
17 Using Implementation Science to Move from Knowledge of Disparities to Achievement of Equity
17.1 Introduction. 17.1.1 Overview of Implementation Science. 17.1.1.1 Definitions
17.1.1.2 Principles
17.1.1.3 Approaches and Methods
17.1.2 Why Health Disparities Research Needs Implementation Science
17.2 Selected Implementation Frameworks Applied to Health Disparities Research
17.2.1 Community‐based Participatory Research
17.2.2 The RE‐AIM Framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance)
17.2.3 Practical, Robust Implementation and Sustainability Model (PRISM)
17.2.4 Consolidated Framework for Implementation (CFIR)
17.2.5 Public Health Critical Race Praxis (PHCR)
17.3 Best Practices in Health Disparities Implementation Science: Selected Examples
17.3.1 Asking Relevant Questions
17.3.2 Testing Multilevel Interventions
17.3.3 Leveraging Technology, Existing Data Sources, and Natural Experiments
17.3.4 Study Designs and Methods
17.3.5 Measures of Implementation Success
17.3.6 Innovative Approaches to Data Analysis
17.3.7 Dissemination of Findings
17.4 Challenges and Opportunities for Implementation Science in Health Disparities Research. 17.4.1 Stakeholder Engagement
17.4.1.1 Improving Researcher and Interventionist Communication Skills and Cultural and Structural Competence
17.4.1.2 Partnering with and Aligning Priorities and Incentives of Diverse Stakeholders
17.4.1.3 Building Trustworthiness
17.4.1.4 Framing and Education about Disparities to Engage Diverse Audiences
17.4.1.5 Case Study: The Johns Hopkins Center for Health Equity Community Advisory Board
17.4.2 Contextual Considerations. 17.4.2.1 Overcoming Limited Infrastructure and Resources
17.4.2.2 Targeting and Tailoring Intervention Approaches to Context and Persons
17.4.2.3 Addressing Social Determinants of Health
17.4.2.4 Increasing Reach
17.4.3 Intervention Design and Delivery. 17.4.3.1 Involving Implementers
17.4.3.2 Training, Technical Support, and Capacity‐building
17.4.3.3 Evaluations, Adjustments, and Reiterations
17.4.3.4 Measurement and Monitoring of Uptake and Fidelity
17.4.4 Planning for Sustainability
17.4.4.1 Sustaining Program Benefits for Target Patient Populations
17.4.4.2 Sustaining Collaborative Partnerships with Key Stakeholders
17.4.4.3 Case Study: Project ReD CHiP
17.5 Summary and Implications for Future Research, Practice, Policy, and Social Change
17.6 Key Points
Disclaimer
References
Notes
18 Healthcare and Public Policy: Challenges and Opportunities for Research
18.1 Summary
18.2 Background/Context
18.3 Key Constructs
18.4 Selected Examples of Healthcare Policy Research
18.4.1 Immigration Reform
18.4.2 The Veterans Affairs Home‐Based Primary Care Model
18.4.3 Oregon Health Insurance Experiment
18.5 Non‐Healthcare Policy Research
18.5.1 Nutrition Program for Women, Infants, and Children
18.5.2 Flint Water Crisis
18.5.3 Minimum Wage Policies
18.5.4 Residential Segregation
18.6 Key Challenges
18.7 Future Directions and Opportunities
18.8 Key Points
Disclaimer
References
Note
19 Addressing Disparities in Access to High‐quality Care
19.1 Racial Disparities as a Quality Problem
19.2 Defining Quality and Access
19.3 Examples of Racial Disparities as a Quality Problem. 19.3.1 Cardiovascular Care and Implantable Defibrillators
19.3.2 End‐Stage Renal Disease
19.4 Addressing Disparities in Access to Quality Care
19.5 Steps to Addressing Healthcare Disparities. 19.5.1 Identify and Prioritize Reducing Healthcare Disparities. 19.5.1.1 Relevant and Reliable Data are Needed
19.5.1.1.1 Measuring Race and Ethnicity
19.5.1.1.2 Other Measurement Challenges
19.5.1.2 To Improve Patient Outcomes, Basic Quality Improvement Structures and Processes Must be in Place
19.5.1.3 Disparities Must be Recognized as a Quality Problem
19.6 Implement Evidence‐based Strategies to Eliminate Disparities. 19.6.1 After Prioritizing Health Equity and Identifying Existing Health Disparities, the Next Challenge is to Develop an Intervention
19.6.2 Determine the Root Cause(s) of the Disparity
19.6.3 Consider the Levels of Influence of Patients, Providers, the Microsystem (Immediate Care Team), Organizations, Communities, and Policy
19.6.4 Build on Prior Work and Modify for Specific Context
19.6.5 Implement, Evaluate, and Adjust the Intervention
19.7 Invest in Health Equity Performance Measures. 19.7.1 One Must Define What Is Meant by Equity in Quality
19.7.2 Measure Capacity for Health Equity
19.8 Incentivize the Reduction of Health Disparities. 19.8.1 Design Quality Improvement and Payment Interventions to Achieve Equity
19.8.2 Consider the Impact of Social Risk Factors on Public Reporting and Pay‐For‐Performance
19.8.3 Develop a Business Case to Enable Organizations to Implement and Sustain Health Equity Interventions
19.9 Advice for a Healthcare Disparities Researcher. 19.9.1 Pick an Important Research Question
19.9.2 Review the Relevant Literature
19.9.3 Choose, Adapt, or Develop a Conceptual Model to Guide Your Research
19.9.4 Select the Appropriate Quantitative and/or Qualitative Approach for Your Study Question
19.9.5 Use the Appropriate Analytical Methods
19.9.5.1 Qualitative Research as Part of Root Cause Analysis to Identify Drivers of Disparities and Design Solutions
19.9.5.2 Multilevel Modeling Exploring Individual and Place Effects
19.9.5.3 Mixed‐Method Research that Covers Clinical Outcomes, the Process of Organizational Change, and Economic Outcomes
19.10 Conclusion
19.11 Key Points
Disclaimer
References
Note
20 Health Communication as a Mediator of Health and Healthcare Disparities
20.1 Introduction: Scope and Conceptual Framework. 20.1.1 Prevalence of the Problem
20.1.2 Narrative, Elicitation, Explanatory, and Relationship Aspects
20.1.3 Communication Domains Affecting Health and Healthcare Outcomes
20.1.3.1 Respect
20.1.3.2 Trust
20.1.3.3 Participation in Decision Making
20.1.4 An Operational and Contextual Framework for Organizing Communication in the Clinical Encounter
20.2 Risk Factors for Health Communication Disparities and Impact on Communication and Health Outcomes. 20.2.1 Limited Health Literacy
20.2.2 Limited English Proficiency and Patient‐Provider Language Discordance
20.2.3 Discordance in Race/Ethnicity
20.2.4 Implicit Bias
20.3 An Example of Systems‐based Approaches: Creating Health‐Literate Healthcare Systems. 20.3.1 Defining Health‐Literate Organizations
20.3.2 Clinician‐Patient Level Interventions
20.3.3 System‐Patient‐Level Interventions
20.3.3.1 Employing Appropriate Health Education Materials
20.3.3.2 Leveraging Accessible Health Information Technology
20.3.3.3 Standardizing Medication Drug Labels and Drug Information
20.3.3.4 Employing Disease Management Programs
20.3.3.5 Creating an Empowering Environment
20.3.3.6 Clinician Communication Training
20.3.4 Community‐level Interventions
20.4 Interventions to Mitigate Other Communication Risk Factors
20.4.1 Cultural Competence of Healthcare Providers and Organizations
20.4.2 Diversity of Health Professional Workforce
20.4.3 Building the Healthcare Team: Professional Medical Interpreters and Lay Health Educators and Patient Navigators
20.5 Future Directions for Communications Research: Measurement and Implementation. 20.5.1 Health Literacy
20.5.1.1 Measurement
20.5.1.2 Verbal, Auditory, and Other Cognitive Skills
20.5.1.3 Study Designs
20.5.1.4 Mobile Health Technology
20.5.1.5 Health Communication Messengers and Vehicles
20.5.2 Sociodemographic Concordance
20.5.3 Implicit Bias
20.5.4 Direct Observation of Health Communication Behaviors
20.5.5 Patient Experience and Patient‐Reported Outcomes Measurement
20.6 Key Points
Disclaimer
References
Note
21 Comparative Effectiveness Research in Health Disparity Populations
21.1 Introduction
21.2 Background
21.3 CER Study Designs
21.4 CER Measures
21.5 Approaches to CER
21.6 Applications of CER in Health Disparity Populations
21.6.1 Examples of CER Questions in Minority Health
21.7 Social Determinants of Health
21.8 Groups with Particular Needs for CER
21.8.1 African Americans
21.8.2 Hispanics/Latinos
21.8.3 Sexual and Gender Minorities
21.8.4 American Indians and Alaska Natives
21.8.5 Underserved Rural Populations
21.8.6 Considerations for the CER Needs of Health Disparity Populations
21.9 Major Public Health/Policy Interventions as a Result of CER
21.10 Multisectoral Impact of CER on Disparities
21.11 Future Directions of CER
21.12 Key Points
Disclaimer
References
Note
22 The Role of Electronic Health Records and Health Information Technology in Addressing Health Disparities
22.1 Introduction
22.2 Healthcare Data and Electronic Records
22.3 Overview of Health Information Technologies
22.3.1 Personal Health Record
22.3.2 Consumer Health IT Applications
22.3.3 Clinical Decisions Support Systems
22.3.4 Electronic Disease Registries
22.3.5 Telehealth, Telemedicine, and Mobile Health
22.3.6 Health Information Technologies Data
22.4 Application of Digital Health and Health Information Technologies to Addressing Disparities
22.4.1 Population‐level Health Outcomes
22.4.1.1 Access and Healthcare Delivery
22.4.1.2 Enhanced Surveillance and Monitoring Activities
22.4.1.3 Adherence to Protocols and Quality Care Metrics
22.4.2 Consumer or Individual‐level Health Outcomes
22.4.2.1 Prevention
22.4.2.2 Treatment
22.4.2.3 Management
22.5 Conclusions: Challenges and Opportunities in Health Information Technologies Implementation
22.6 Key Points
Acknowledgments
Disclaimer
References
Note
23 Precision Medicine and Health Disparities
Abstract
23.1 The Promise of Precision Medicine. 23.1.1 Precision Medicine Defined
23.1.2 Natural History of Precision Medicine
23.1.3 Precision Medicine and Health Disparities
23.1.4 Pharmacogenomics‐Biologic Predictors of Disparities in Treatment Response
23.1.5 Existing Gaps in Precision Medicine
23.2 Methods in Precision Medicine and Applications in Health Disparities. 23.2.1 Methods of Characterizing Individuals. 23.2.1.1 Genetics Approaches: Genome‐wide Association Study and Phenome‐wide Association Study
23.2.1.2 Proteomics and Metabolomics
23.2.1.3 Person‐specific Modeling
23.2.1.4 Data Integration
23.2.2 Methods of Predicting Disease Risk
23.3 Future Directions and Research Needs
23.3.1 Engaging Minority Communities
23.3.2 Engaging Health Providers
23.3.3 Challenges Unique to Precision Medicine
23.4 Genomic Health Literacy
23.4.1 Cross‐training in Precision Medicine and Health Disparities
23.4.2 Integration of Cultural, Social, and Environmental Data
23.5 Success in Precision Medicine
23.6 Conclusion
23.7 Key Points
Acknowledgments
Disclaimer
References
Notes
24 Recruitment, Inclusion, and Diversity in Clinical Trials
24.1 Background/Context
24.2 Understanding Barriers to Inclusion in Clinical Research
24.2.1 Patient‐level Barriers
24.2.2 Investigator‐level Barriers
24.2.3 Structural and Institutional Barriers
24.3 Best Practices for Optimizing Inclusion in Clinical Research
24.3.1 Site Selection
24.3.2 Screening
24.3.3 Community Engagement
24.3.4 Communication Strategies
24.3.5 Retention
24.4 Future Directions and Research Needs. 24.4.1 Federal Policies
24.4.2 Interactive Online Toolkits
24.5 Conclusion
24.6 Key Points
Disclaimer
References
Note
25 Sexual and Gender Minority Health DisparitiesConcepts, Methods, and Future Directions
25.1 Introduction to the Topic, Including Key Definitions
25.2 How and Why This Topic is Important to Minority Health and Health Disparities Research
25.3 Most Relevant Measures and Research Methods Used and Recommended
25.3.1 Individual/Interpersonal Measures
25.3.2 Structural Measures
25.4 Selected Examples of the State of the Science to Illustrate Best Practices
25.4.1 Cross‐sectional Designs
25.4.2 Daily Diary Studies
25.4.3 Quasi‐experiments
25.4.4 Field Experiments
25.4.5 Interventions
25.5 Challenges and Future Opportunities
25.5.1 Methodological Challenges Related to Sampling SGM Populations
25.5.2 Ethical Challenges and Considerations
25.5.3 Directions for Future Research
25.5.4 Methodological and Measurement Innovations
25.5.5 Intersectional Perspectives
25.5.6 Interventions to Reduce Stigma and Its Negative Consequences
25.5.7 Research on Other Determinants of SGM Health Disparities
25.6 Summary
25.7 Key Points
Disclaimer
References
Notes
26 Workforce Diversity and Capacity Building to Address Health Disparities
26.1 Background
26.2 Introduction
26.3 Diversity in the US Scientific and Health Workforce
26.4 Diversity and Health Disparities: What Are the Links?
26.5 Methodological Approaches to Understanding Workforce Diversity and Health Disparities
26.5.1 Expand Scholarship of the Science of Diversity as Related to Health Outcomes
26.5.2 Promote Rigorous Data Collection and Evaluation
26.5.3 Expand Study of Sociocultural Factors as Related to Health Outcomes
26.5.4 Can Scientific Workforce Diversity Partnerships with the Private Sector and Community Organizations Reduce Health Disparities?
26.6 Closing Thoughts
26.7 Key Points
Acknowledgments
Disclaimer
References
Notes
Index
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