The Health Effect

Woodson, Lisa Fryar

Problem

African-Americans have a significantly greater prevalence of a range of health conditions across their lifespan when compared to other racial or ethnic groups which are often due to negative social determinants of health. These health conditions include but are not limited to infant mortality, teen pregnancy, asthma, hypertension, tobacco usage, obesity, high cholesterol, lack of physical activity, seasonal influenza, HIV/AIDS, and tuberculosis (TB). Mortality rates are also greater in African-Americans under 65 years of age when compared to other racial and ethnic populations. These disparities are mainly attributed to reduced access and quality of healthcare, poor nutrition, inadequate housing, lower education, and under employment. Other additional factors include the effects of social and economic inequalities, prejudice, and systematic bias on the overall health of this population.

Purpose

The Health Effect project was implemented to determine the needs of a predominantly African-American inner-city community popularly known for its high crime rates, high prevalence of chronic mental and medical conditions, limited access to quality healthcare, and a high poverty rate. The project assessed unmet healthcare needs in order to develop a new service strategy plan to address identified health needs.

Methods

Study Design: Data were collected using a mixed methods (qualitative and quantitative) approach. Questionnaires garnered demographic information (age, gender, race/ethnicity, income, and education), and perceptions of personal family and community health status and issues, and about health insurance needs and barriers to access to care and quality of healthcare services in the community. Focus groups and individual interviews were conducted using open-ended interview schedules which allowed participants to express their opinions. Focus group interviews were conducted with youth and adults. Quantitative data were analyzed by basic descriptive statistics. Qualitative data were analyzed and coded based on thematic analysis. Research methods were approved by a university institutional review board.

Sample: One-hundred twenty-nine participants completed survey questionnaires and 62 of those respondents participated in six focus groups. The participants were youth and adults living in an economically-challenged African-American community. The youth were students of a community high-school and the adults were faculty from the high school, community members, and parents of some of the high school teens.

Results

Among adult respondents, 54% were unemployed, and nearly 50% of the teenagers and adult participants reported chronic related physical and mental health illnesses such as asthma, anxiety, depression, diabetes and hypertension. All participants reported a lack of adequate access to quality primary care. Although 86% of participants reported their healthcare needs are being met, 70% of males over the age of 40 had not received a prostate examination within the last year and 38% of females over the age of 35 had not received a mammogram within the last year.

Findings for Youth (Teenage Respondents)

Among the youth, 17% reported they have no regular health care provider to meet health needs, and 21% of youth indicated their health was “poor” or “fair.” Of those youth who sought health care, 33% had asthma, 23% had dental problems, 13% migraines and headaches. Youth most frequently felt they needed health information regarding diet and nutrition (44%), exercise (33%), weight control (27%), visual problems (19%), and high blood pressure (17%).

Qualitative data indicated that teens worry most about the following:

(1) Teen sex, its consequences and sex education issues;

(2) Life style issues that affect their health such as inadequate sleep, poor nutrition and obesity;

(3) Mental health issues including stress, depression, anxiety, panic attacks, anger issues, poor self-esteem, PTSD, bi-polar disorder, schizophrenia, use of illegal drugs and misuse of prescription drugs.

(4) Teen relationship problems such as abusive sexual relationships and sexual abused by their parent’s sexual partner;

(5) Acquiring a long-term chronic disease or terminal disease, such as breast cancer; and

(6) Parental and family health issues, such as parental and grandparent physical health issues, and having to care for sick or aging parents or grandparents.

Youth reported need for extensive family and community health education.

Findings for Adult Respondents

Among adult respondents, 23% reported they have no health insurance and 23% have no regular health care provider while 42% have been treated for high blood pressure, 25% for high cholesterol, 21% for diabetes, and 10% for mental health problems. Five percent of adult respondents reported they needed more information about “thoughts of self-harm,” 10% reported they had been treated for depression, and 6% reported treatment for anxiety. Adults were most concerned about the following:

(1) Youth sex and its consequences such as unprotected sex and little knowledge about contraceptives, pregnancy prevention and STDs.

(2) Mental and emotional health of youth such as youth’s “out of control anger and bullying,” poor self-esteems, homosexuality and bi-sexuality in middle school children. Children have PTSD from all the killings in the community.

(3) Youth lifestyle issues and health consequences, such as childhood obesity, drug abuse, gun violence, lack of finances to buy nutritional foods, lack of quality foods in neighborhood stores, and gun violence.

(4) Sexual, physical and emotional abuse of children: Parents corroborated youth’s reports that neighborhood children are sexually abused by the mother’s boyfriends who often pay the bills.

Parental and family health education issues:

Neighborhood parents have limited parenting skills.
Several parents felt they were too young to know how to properly raise children.
Parents felt their knowledge about sex was “outdated.
Emotional support through family, friends and the church are needed.

Conclusions

Youth and adults in this inner city community perceive inadequate access to healthcare and multiple needs for primary care focused on mental/emotional and physical health disorders. There was also much need for health education of youth, parents and community members in a variety of areas.