Nazleen Hatim Bharmal

All Publications

• Family caregivers: an essential link in achieving health information equity. The Lancet. Global health Alam, S., Bharmal, N., Elliott, E. 2024; 12 (12): e1934

  View details for DOI 10.1016/S2214-109X(24)00466-2

  View details for PubMedID 39577967

• Racial and ethnic differences in uncontrolled diabetes mellitus among adults taking antidiabetic medication. Primary care diabetes Berg, K. A., Bharmal, N., Tereshchenko, L. G., Le, P., Payne, J. Y., Misra-Hebert, A. D., Rothberg, M. B. 2024; 18 (3): 368-373

  Abstract

  To examine whether racial and ethnic disparities in uncontrolled type 2 diabetes mellitus (T2DM) persist among those taking medication and after accounting for other demographic, socioeconomic, and health indicators.Adults aged ≥20 years with T2DM using prescription diabetes medication were among participants assessed in a retrospective cohort study of the National Health and Nutrition Examination Survey 2007-2018. We estimated weighted sequential multivariable logistic regression models to predict odds of uncontrolled T2DM (HbA1c ≥ 8%) from racial and ethnic identity, adjusting for demographic, socioeconomic, and health indicators.Of 3649 individuals with T2DM who reported taking medication, 27.4% had uncontrolled T2DM (mean HgA1c 9.6%). Those with uncontrolled diabetes had a mean BMI of 33.8, age of 57.3, and most were non-Hispanic white (54%), followed by 17% non-Hispanic Black, and 20% Hispanic identity. In multivariable analyses, odds of uncontrolled T2DM among those with Black or Hispanic identities lessened, but persisted, after accounting for other indicators (Black OR 1.38, 97.5% CI: 1.04, 1.83; Hispanic OR 1.79, 97.5% CI 1.25, 2.57).Racial and ethnic disparities in T2DM control persisted among individuals taking medication. Future research might focus on developmental and epigenetic pathways of disparate T2DM control across racially and ethnically minoritized populations.

  View details for DOI 10.1016/j.pcd.2024.02.004

  View details for PubMedID 38423828

• Healthcare and Social Needs Assessment and Response Quality Among Black Men. Journal of community health Bharmal, N., Sack, E., Guo, N., Alejandro-Rodriguez, M., Holmes, J. C., Modlin, C., Pfoh, E. R. 2024; 49 (2): 187-192

  Abstract

  To understand Black men's healthcare and social needs and determine if the resources that healthcare systems offer meet expectations. We surveyed men who had previously participated in at least one Minority Men's Health Fair in Cleveland, Ohio. In this descriptive study, we spoke with men up to three times (i.e., phases) between May and October 2020 by email and/or telephone. Phase 1 was a needs assessment survey. Phase 2 involved outreach to those who identified a need to provide a resource. Phase 3 determined whether the resource met individuals' needs. We described the demographic characteristics of the survey respondents, the percentage of men reporting a need and wanting a resource, and whether the resource resolved their need. Of the 768 men contacted, 275 completed the survey (36% response rate). The majority of respondents were 50-69 years old, identified as Black, and had at least a bachelor's degree. Eighty-five percent reported a need, of which wellness, financial, and healthcare access were among the top-reported needs. Among the men identifying a need, 35% were interested in a resource. Resources that were provided for employment, behavioral health, oral health, vision, or wellness needs were deemed insufficient. A few individuals reported that resources for food/personal hygiene, financial support, health care access, annual health screening, and medication met their needs. Among men with healthcare and social needs, only a fraction were interested in a resource, and fewer reported that the resource met their needs. These results warrant a greater understanding of what constitutes a resolution of healthcare and social needs from patients' perspectives.

  View details for DOI 10.1007/s10900-023-01272-y

  View details for PubMedID 37634220

  View details for PubMedCentralID 10652909

• Health-Related Social Needs: Which Patients Respond to Screening and Who Receives Resources? Journal of general internal medicine Bharmal, N., Rennick, A., Shideler, A., Blazel, M., Jones, R., Wilson, C., Pfoh, E. R. 2023; 38 (12): 2695-2702

  Abstract

  Health systems are screening patients for health-related social needs (HRSN) but the optimal approach is unknown.To describe the variation in responding to an HRSN questionnaire delivered via patient portal, and whether referral to and resources provided by social workers differed by response status.Retrospective observational study.Primary care patients with a visit between June 2020 and January 2022.HRSN questionnaire MAIN MEASURES: We identified each patient's index visit (e.g., date of their first questionnaire response for responders or their first visit within the study period for non-responders). Through the EHR, we identified patients' demographic characteristics. We linked the area deprivation index (ADI) to each patient and grouped patients into quintiles. We used multilevel logistic regressions to identify characteristics associated with responding to the questionnaire and, for responders, reporting a need. We also determined if responder status was associated with receiving a social worker referral or receiving a resource. We included patient demographics and ADI quintile as fixed variables and practice site as a random variable.Our study included 386,997 patients, of which 51% completed at least one HRSN questionnaire question. Patients with Medicaid insurance (AOR: 0.62, 95%CI: 0.61, 0.64) and those who lived in higher ADI neighborhoods had lower adjusted odds of responding (AOR: 0.76, 95% CI: 0.75, 0.78 comparing quintile 5 to quintile 1). Of responders, having Medicaid insurance (versus private) increased the adjusted odds of reporting each of the HRSN needs by two- to eightfold (p < 0.01). Patients who completed a questionnaire (versus non-responders) had similar adjusted odds of receiving a referral (AOR: 0.91, 95% CI: 0.80, 1.02) and receiving a resource from a SW (AOR: AOR: 1.18, 95%CI: 0.79, 1.77).HRSN questionnaire responses may not accurately represent the needs of patients, especially when delivered solely via patient portal.

  View details for DOI 10.1007/s11606-023-08135-1

  View details for PubMedID 36932266

  View details for PubMedCentralID PMC10506999

• Primary care referral patterns for patients with asthma: analysis of real-world data. The Journal of asthma : official journal of the Association for the Care of Asthma Ortega, H., Bharmal, N., Khatri, S. 2023; 60 (3): 609-615

  Abstract

  To identify features related to management of patients prior to referral from primary care physicians (PCPs) to pulmonologists and allergists.This is an analysis of patient claims data from Symphony Health (2013-2018). To characterize referrals, a longitudinal cohort included 12 months with no asthma claims prior to the index date, followed by 36 months of observation. We also assessed a cross-sectional cohort for 12 months at the end of the observational period to characterize disease control and treatment patterns. Referral was defined as the first appearance of a claim from an allergist or pulmonologist for a patient's initial visit for asthma. Descriptive statistics were used to analyze the data.The majority of patients with asthma were managed by PCPs (60%), followed by pulmonologists (16%) and allergists (8%). Forty-three percent had uncontrolled asthma. Only 8% were referred to specialists within the first 24 months after initial diagnosis, of which 76% were seen by pulmonologists and 24% by allergists. Referrals resulted in treatment change in 55%-68% of the cases. Patients who received a referral were more likely to be on oral corticosteroids (OCS) and/or have more hospitalizations/ED visits.About one-third of the patients managed by PCPs received intermittent and/or chronic OCS prior to referral, which may be an indication of uncontrolled disease. The referral patterns in this analysis illustrate underutilization of specialists in the consultation and management of patients with uncontrolled asthma.

  View details for DOI 10.1080/02770903.2022.2082308

  View details for PubMedID 35620831

• Social Determinants and Health Equity in Functional Medicine. Physical medicine and rehabilitation clinics of North America Bharmal, N. 2022; 33 (3): 665-678

  Abstract

  The functional medicine matrix provides us with an opportunity to understand how social determinants of health (SDOH) and health related social needs may be root causes and contributors to current health and illness among patients. The matrix also allows us to map and recognize the intersectionality of SDOH on exposures and behaviors that influence antecedents, triggers, mediators, lifestyle factors, and clinical imbalances. Incorporating SDOH into clinical evaluations helps uncover and address the complex factors that lead to health disparities in order to provide more optimal patient-centered care.

  View details for DOI 10.1016/j.pmr.2022.04.007

  View details for PubMedID 35989057

• A nutrition and lifestyle-focused shared medical appointment in a resource-challenged community setting: a mixed-methods study. BMC public health Bharmal, N., Beidelschies, M., Alejandro-Rodriguez, M., Alejandro, K., Guo, N., Jones, T., Bradley, E. 2022; 22 (1): 447

  Abstract

  In order to address disparities in preventable chronic diseases, we adapted a nutrition and lifestyle-focused shared medical appointment (SMA) program to be delivered in an underserved community setting. The objective was to evaluate a community-based nutrition and lifestyle-focused SMA as it relates to acceptability and health and behavior-related outcomes.A mixed-methods study was performed to evaluate pre-post changes in wellness indices, biometrics, self-efficacy, and trust in medical researchers as part of a community-based SMA. To understand program acceptability including barriers and facilitators for implementation and scalability, we conducted two participant focus groups and five stakeholder interviews and used content analysis to determine major themes.Fifteen participants attended 10 weekly sessions. The majority were older adult, African American women. There were pre-post improvements in mean [SD] systolic (-10.5 [7.7] mmHg, p = 0.0001) and diastolic (-4.7 [6.7] mmHg, p = 0.17) blood pressures and weight (-5.7 [6.3] pounds, p = 0.003) at 3 months though these were not significant at 6 months. More individuals reported improvements in health status, daily fruit and vegetable intake, and sleep than at baseline. There were no significant pre-post changes in other wellness indices, self-efficacy, trust in medical researchers, hemoglobin A1c, insulin, or LDL cholesterol. Participants discussed positive health changes as a result of the SMA program, program preferences, and facilitators and barriers to continuing program recommendations in focus groups. SMA implementation was facilitated by clinical staff who adjusted content to a low health literacy group and partnership with a trusted community partner. Sustainability barriers include heavy personnel time and in-kind resources to deliver the program.Nutrition and lifestyle-focused SMAs in a resource-challenged community setting may be an acceptable intervention for underserved patients.

  View details for DOI 10.1186/s12889-022-12833-6

  View details for PubMedID 35255887

  View details for PubMedCentralID PMC8900391

• Addressing COVID-19 health disparities through a regional community health response. Cleveland Clinic journal of medicine Bharmal, N., Bailey, J., Johnson, V., Alejandro-Rodriguez, M., Holmes, J. C., Li-Ng, M., Modlin, C., Kim, A. 2021

  Abstract

  To combat racial/ethnic and socioeconomic health disparities associated with COVID-19 in our surrounding communities, the Cleveland Clinic Community Health & Partnership team developed a comprehensive program focused on connecting and communicating with local officials, faith-based organizations, and individual community members. Since March of 2020, our team has donated resources (e.g., personal protective equipment) to local organizations, referred thousands of community members to community or clinical resources, and partnered with federally-qualified health centers to support community COVID-19 testing. Future work will include the use of these networks to deploy the COVID-19 vaccine.

  View details for DOI 10.3949/ccjm.88a.ccc072

  View details for PubMedID 33579780

• The Association of Religious Affiliation with Overweight/Obesity Among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study JOURNAL OF RELIGION & HEALTH Bharmal, N. H., McCarthy, W. J., Gadgil, M. D., Kandula, N. R., Kanaya, A. M. 2018; 57 (1): 33-46

  Abstract

  Religiosity has been associated with greater body weight. Less is known about South Asian religions and associations with weight. Cross-sectional analysis of the MASALA study (n = 906). We examined associations between religious affiliation and overweight/obesity after controlling for age, sex, years lived in the USA, marital status, education, insurance status, health status, and smoking. We determined whether traditional cultural beliefs, physical activity, and dietary pattern mediated this association. The mean BMI was 26 kg/m2. Religious affiliation was associated with overweight/obesity for Hindus (OR 2.12; 95 % CI: 1.16, 3.89), Sikhs (OR 4.23; 95 % CI: 1.72, 10.38), and Muslims (OR 2.79; 95 % CI: 1.14, 6.80) compared with no religious affiliation. Traditional cultural beliefs (7 %), dietary pattern (1 %), and physical activity (1 %) mediated 9 % of the relationship. Interventions designed to promote healthy lifestyle changes to reduce the burden of overweight/obesity among South Asians need to be culturally and religiously tailored.

  View details for DOI 10.1007/s10943-016-0290-z

  View details for Web of Science ID 000419917100004

  View details for PubMedID 27460674

  View details for PubMedCentralID PMC5269531

• A Community Engagement Symposium to Prevent and Improve Stroke Outcomes in Diverse Communities PROGRESS IN COMMUNITY HEALTH PARTNERSHIPS-RESEARCH EDUCATION AND ACTION Bharmal, N., Lucas-Wright, A., Vassar, S. D., Jones, F., Jones, L., Wells, R., Cienega, J., Brown, A. F. 2016; 10 (1): 149-158

  Abstract

  Racial/ethnic minorities have a higher burden of stroke, but lower awareness and understanding of stroke and its risk factors. Our community-academic collaborative hosted a symposium in South Los Angeles to increase awareness about stroke, provide information on the Los Angeles Stroke Intervention and Research Program (SPIRP), and facilitate bidirectional communication between researchers and community stakeholders.We discuss our partnered approach to increase stroke awareness, elicit community perspectives and perceptions about stroke prevention and research participation, and increase community involvement in research using a community engagement symposium (CES).We used a community-partnered participatory research (CPPR) conference framework to guide symposium planning, implementation and analysis. The morning session included clinical lectures, a panel of researchers describing LA SPIRP, and a panel presentation by stroke caregivers and survivors. In afternoon breakout sessions, attendees identified 1) community-based strategies to prevent stroke and 2) methods to increase recruitment of diverse populations in stroke research studies. Attendees were surveyed about stroke knowledge before and after the morning session. Data from breakout sessions were analyzed using content analysis and pile sorting to identify themes.We found that the CES based on CPPR principles was effective method to increase short-term stroke awareness and stimulate discussion about stroke research among community members and community stakeholders who serve racial/ethnic minorities.

  View details for DOI 10.1353/cpr.2016.0010

  View details for Web of Science ID 000372682200019

  View details for PubMedID 27018364

  View details for PubMedCentralID PMC4943874

• Older Ethnic Minority Women's Perceptions of Stroke Prevention and Walking WOMENS HEALTH ISSUES Kwon, I., Bharmal, N., Choi, S., Araiza, D., Moore, M. R., Trejo, L., Sarkisian, C. A. 2016; 26 (1): 80-86

  Abstract

  To inform the development of a tailored behavioral stroke risk reduction intervention for ethnic minority seniors, we sought to explore gender differences in perceptions of stroke prevention and physical activity (walking).In collaboration with community-based organizations, we conducted 12 mixed-gender focus groups of African American, Latino, Chinese, and Korean seniors aged 60 years and older with a history of hypertension (89 women and 42 men). Transcripts were coded and recurring topics compared by gender.Women expressed beliefs that differed from men in 4 topic areas: 1) stroke-related interest, 2) barriers to walking, 3) facilitators to walking, and 4) health behavior change attitudes. Compared with men, women were more interested in their role in response to a stroke and post-stroke care. Women described walking as an acceptable form of exercise, but cited neighborhood safety and pain as walking barriers. Fear of nursing home placement and weight loss were identified as walking facilitators. Women were more prone than men to express active/control attitudes toward health behavior change.Older ethnic minority women, a high-risk population for stroke, may be more receptive to behavioral interventions that address the gender-specific themes identified by this study.

  View details for DOI 10.1016/j.whi.2015.08.003

  View details for Web of Science ID 000368262500017

  View details for PubMedID 26411494

  View details for PubMedCentralID PMC4690776

• Innovative Approach to Patient-Centered Care Coordination in Primary Care Practices AMERICAN JOURNAL OF MANAGED CARE Clarke, R., Bharmal, N., Di Capua, P., Tseng, C., Mangione, C. M., Mittman, B., Skootsky, S. A. 2015; 21 (9): 623-630

  Abstract

  Although care coordination is an essential component of the patient-centered medical home structure, current case manager models have limited usefulness to population health because they typically serve a small group of patients defined based on disease or utilization. Our objective was to support our health system's population health by implementing and evaluating a program that embedded nonlicensed coordinators within our primary care practices to support physicians in executing care plans and communicating with patients.Matched case-control differences-in-differences.Comprehensive care coordinators (CCC) were introduced into 14 of the system's 28 practice sites in 2 waves. After a structured training program, CCCs identified, engaged, and intervened among patients within the practice in conjunction with practice primary care providers. We counted and broadly coded CCC activities that were documented in the intervention database. We examined the impact of CCC intervention on emergency department (ED) utilization at the practice level using a negative binomial multivariate regression model controlling for age, gender, and medical complexity.CCCs touched 10,500 unique patients over a 1-year period. CCC interventions included execution of care (38%), coordination of transitions (32%), self-management support/link to community resources (15%), monitor and follow-up (10%), and patient assessment (1%). The CCC intervention group had a 20% greater reduction in its prepost ED visit rate compared with the control group (P < .0001).Our CCC intervention demonstrated a significant reduction in ED visits by focusing on the centrality of the primary care provider and practice. Our model may serve as a cost-effective and scalable alternative for care coordination in primary care.

  View details for Web of Science ID 000362947500007

  View details for PubMedID 26618365

• Study protocol of "Worth the Walk": a randomized controlled trial of a stroke risk reduction walking intervention among racial/ethnic minority older adults with hypertension in community senior centers BMC NEUROLOGY Kwon, I., Choi, S., Mittman, B., Bharmal, N., Liu, H., Vickrey, B., Song, S., Araiza, D., McCreath, H., Seeman, T., Oh, S., Trejo, L., Sarkisian, C. 2015; 15: 91

  Abstract

  Stroke disproportionately kills and disables ethnic minority seniors. Up to 30 % of ischemic strokes in the U.S. can be attributed to physical inactivity, yet most Americans, especially older racial/ethnic minorities, fail to participate in regular physical activity. We are conducting a randomized controlled trial (RCT) to test a culturally-tailored community-based walking intervention designed to reduce stroke risk by increasing physical activity among African American, Latino, Chinese, and Korean seniors with hypertension. We hypothesize that the intervention will yield meaningful changes in seniors' walking levels and stroke risk with feasibility to sustain and scale up across the aging services network.In this randomized single-blind wait-list control study, high-risk ethnic minority seniors are enrolled at senior centers, complete baseline data collection, and are randomly assigned to receive the intervention "Worth the Walk" immediately (N = 120, intervention group) or in 90 days upon completion of follow-up data collection (N = 120, control group). Trained case managers employed by the senior centers implement hour-long intervention sessions twice weekly for four consecutive weeks to the intervention group. Research staff blinded to participants' group assignment collect outcome data from both intervention and wait-list control participants 1 and 3-months after baseline data collection. Primary outcome measures are mean steps/day over 7 days, stroke knowledge, and self-efficacy for reducing stroke risk. Secondary and exploratory outcome measures include selected biological markers of health, healthcare seeking, and health-related quality of life. Outcomes will be compared between the two groups using standard analytic methods for randomized trials. We will conduct a formal process evaluation to assess barriers and facilitators to successful integration of Worth the Walk into the aging services network and to calculate estimated costs to sustain and scale up the intervention. Data collection is scheduled to be completed in December 2016.If this RCT demonstrates superior improvements in physical activity and stroke knowledge in the intervention group compared to the control group and is found to be sustainable and scalable, Worth the Walk could serve as a primary stroke prevention model for racial/ethnic communities across the nation.ClinicalTrials.gov NCT02181062 ; registered on June 30, 2014.

  View details for DOI 10.1186/s12883-015-0346-9

  View details for Web of Science ID 000356038400001

  View details for PubMedID 26072359

  View details for PubMedCentralID PMC4465734

• The Association of Duration of Residence in the United States with Cardiovascular Disease Risk Factors Among South Asian Immigrants JOURNAL OF IMMIGRANT AND MINORITY HEALTH Bharmal, N., Kaplan, R. M., Shapiro, M. F., Mangione, C. M., Kagawa-Singer, M., Wong, M. D., McCarthy, W. J. 2015; 17 (3): 781-790

  Abstract

  South Asians are disproportionately impacted by cardiovascular disease (CVD). Our objective was to examine the association between duration of residence in the US and CVD risk factors among South Asian adult immigrants. Multivariate logistic regression analyses using pooled data from the 2005, 2007, 2009 California Health Interview Surveys. Duration of residence in the US < 15 years was significantly associated with overweight/obese BMI (OR 0.59; 95% CI 0.35, 0.98 for 5 to < 10 years), daily consumption of 5+ servings of fruits/vegetables (OR 0.37; 95% CI 0.15, 0.94 for 10 to < 15 years), and sedentary lifestyle (OR 2.11; 95% CI 1.17, 3.81 for 10 to < 15 years) compared with duration of residence ≥ 15 years after adjusting for illness burden, healthcare access, and socio-demographic characteristics. Duration of residence was not significantly associated with other CVD risk factors. Duration of residence is an important correlate of overweight/obesity and other risk factors among South Asian immigrants.

  View details for DOI 10.1007/s10903-013-9973-7

  View details for Web of Science ID 000355254500020

  View details for PubMedID 24380928

• Validity of Temporal Measures as Proxies for Measuring Acculturation in Asian Indian Survey Respondents JOURNAL OF IMMIGRANT AND MINORITY HEALTH Bharmal, N., Hays, R. D., McCarthy, W. J. 2014; 16 (5): 889-897

  Abstract

  There are few validated acculturation measures for Asian Indians in the U.S. We used the 2004 California Asian Indian Tobacco Survey to examine the relationship between temporal measures and eleven self-reported measures of acculturation. These items were combined to form an acculturation scale. We performed psychometric analysis of scale properties. Greater duration of residence in the U.S., greater percentage of lifetime in the U.S., and younger age at immigration were associated with more acculturated responses to the items for Asian Indians. Item-scale correlations for the 11-item acculturation scale ranged from 0.28-0.55 and internal consistency reliability was 0.73. Some support was found for a two-factor solution; one factor corresponding to cultural activities (α = 0.70) and the other to social behaviors (α = 0.59). Temporal measures only partially capture the full dimensions of acculturation. Our scale captured several domains and possibly two dimensions of acculturation.

  View details for DOI 10.1007/s10903-013-9837-1

  View details for Web of Science ID 000341687400014

  View details for PubMedID 23649666

  View details for PubMedCentralID PMC3905052

• DEVELOPMENT AND APPLICATION OF A CLASSIFICATION SCHEME FOR CARE COORDINATION ACTIVITIES IN AN ACADEMIC PRIMARY CARE SYSTEM Bharmal, N., Clarke, R., Di Capua, P., Gupta, I., Doyle, B., Ali, A., Malim, A., Mittman, B. S. SPRINGER. 2014: S67

  View details for Web of Science ID 000340996200165

• A COMMUNITY PARTNERED APPROACH TO ENGAGE DIVERSE COMMUNITIES IN STROKE DISPARITIES RESEARCH Bharmal, N., Wright, A. L., Vassar, S. D., Jones, F. U., Jones, L., Wells, R., Cienega, J., Brown, A. SPRINGER. 2014: S6-S7

  View details for Web of Science ID 000340996200016

• The association of religiosity with overweight/obese body mass index among Asian Indian immigrants in California PREVENTIVE MEDICINE Bharmal, N., Kaplan, R. M., Shapiro, M. F., Kagawa-Singer, M., Wong, M. D., Mangione, C. M., Divan, H., McCarthy, W. J. 2013; 57 (4): 315-321

  Abstract

  The aim of this study was to examine the association between religiosity and overweight or obese body mass index among a multi-religious group of Asian Indian immigrants residing in California.We examined cross-sectional survey data obtained from in-language telephone interviews with 3228 mostly immigrant Asian Indians in the 2004 California Asian Indian Tobacco Survey using multivariate logistic regression.High self-identified religiosity was significantly associated with higher BMI after adjusting for socio-demographic and acculturation measures. Highly religious Asian Indians had 1.53 greater odds (95% CI: 1.18, 2.00) of being overweight or obese than low religiosity immigrants, though this varied by religious affiliation. Religiosity was associated with greater odds of being overweight/obese for Hindus (OR 1.54; 95% CI: 1.08, 2.22) and Sikhs (OR 1.88; 95% CI: 1.07, 3.30), but not for Muslims (OR 0.69; 95% CI: 0.28, 1.70).Religiosity in Hindus and Sikhs, but not immigrant Muslims, appears to be independently associated with greater body mass index among Asian Indians. If this finding is confirmed, future research should identify potentially mutable mechanisms by which religion-specific religiosity affects overweight/obesity risk.

  View details for DOI 10.1016/j.ypmed.2013.06.003

  View details for Web of Science ID 000324789100009

  View details for PubMedID 23769898

• Preventive Health Services Delivery to South Asians in the United States JOURNAL OF IMMIGRANT AND MINORITY HEALTH Bharmal, N., Chaudhry, S. 2012; 14 (5): 797-802

  Abstract

  There is limited information on the health status of South Asians. Our objective was to examine the delivery of clinical preventive services to South Asian adults. We used data from a 2001 mail survey to a nationwide sample of South Asians. We quantified the percentage of eligible adults who received screenings for colorectal cancer, cervical cancer, breast cancer, high blood pressure, lipid disorders, and vaccinations against influenza, pneumococcus, and tetanus. We also calculated the number of individuals who were up-to-date with all their recommended preventive healthcare. One-fourth of South Asians were up-to-date with their recommended preventive services, while more than half were not up-to-date with their services. Having a regular source of care was significantly associated with being up-to-date on recommended schedules. Despite their high level of education, the majority of South Asians in the US are not receiving the appropriate amount of preventive health services.

  View details for DOI 10.1007/s10903-012-9610-x

  View details for Web of Science ID 000308656200009

  View details for PubMedID 22466312

• Through Our Eyes: Exploring African-American Men's Perspective on Factors Affecting Transition to Manhood JOURNAL OF GENERAL INTERNAL MEDICINE Bharmal, N., Kennedy, D., Jones, L., Lee-Johnson, C., Morris, D., Caldwell, B., Brown, A., Houston, T., Meeks, C., Vargas, R., Franco, I., Razzak, A., Brown, A. F. 2012; 27 (2): 153-159

  Abstract

  Premature mortality and disparities in morbidity observed in African-American men may be associated with factors in their social, economic, and built environments that may be especially influential during the transition to adulthood.To have young, African-American men from Los Angeles County identify and prioritize factors associated with their transition to manhood using photovoice methodology and pile-sorting exercises.Qualitative study using community-based participatory research (CBPR) and photovoiceTwelve African-American men, ages 16-26 years, from Los Angeles County, California.We used CBPR principles to form a community advisory board (CAB) whose members defined goals for the partnered project, developed the protocols, and participated in data collection and analysis. Participants were given digital cameras to take 50-300 photographs over three months. Pile-sorting techniques were used to facilitate participants' identification and discussion of the themes in their photos and selected photos of the group. Pile-sorts of group photographs were analyzed using multidimensional scaling and hierarchical cluster analysis to systematically compare participants' themes and identify patterns of associations between sorted photographs. Sub-themes and related quotes were also elicited from the pile-sorting transcripts. The CAB and several study participants met periodically to develop dissemination strategies and design interventions informed by study findings.Four dominant themes emerged during analysis: 1) Struggles face during the transition to manhood, 2) Sources of social support, 3) Role of sports, and 4) Views on Los Angeles lifestyle. The project led to the formation of a young men's group and community events featuring participants.CBPR and photovoice are effective methods to engage young, African-American men to identify and discuss factors affecting their transition to manhood, contextualize research findings, and participate in intervention development.

  View details for DOI 10.1007/s11606-011-1836-0

  View details for Web of Science ID 000300064900008

  View details for PubMedID 21910088

  View details for PubMedCentralID PMC3270242

• State-Level Variations in Racial Disparities in Life Expectancy HEALTH SERVICES RESEARCH Bharmal, N., Tseng, C., Kaplan, R., Wong, M. D. 2012; 47 (1): 544-555

  Abstract

  To explore state patterns in the racial life expectancy gap.The 1997-2004 Multiple Cause of Death PUF, 2000 U.S. Census.We calculated life expectancy at birth for black and white men and women.Data were obtained by the NCHS and U.S. Census Bureau.States with small racial differences are due to higher-than-expected life expectancy for blacks or lower-than-expected for whites. States with large disparity are explained by higher-than-average life expectancy among whites or lower-than-average life expectancy among blacks.Heterogeneous state patterns in racial disparity in life expectancy exist. Eliminating disparity in states with large black populations would make the greatest impact nationally.

  View details for DOI 10.1111/j.1475-6773.2011.01345.x

  View details for Web of Science ID 000299041600014

  View details for PubMedID 22092060

  View details for PubMedCentralID PMC3393007