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Highlights from AHCPR's October Research Activities

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Media Advisory: November 6, 1998

The Agency for Health Care Policy and Research (AHCPR) works to improve the quality of health care, reduce costs, and broaden access to essential services. Here are some of the findings described in the most recent issue of AHCPR's Research Activities.

Community Violence Exacts a High Emotional Toll on Urban Black Children and Adolescents

Urban black children who witness or are victims of violence exhibit some symptoms of post-traumatic stress disorder, the same condition that sometimes affects men and women returning from war, according to a study supported by AHCPR. Researchers led by Bonita F. Stanton, M.D., of the University of Maryland Center for Minority Health Research, analyzed responses of 349 low-income black children in Baltimore to the Checklist of Children's Distress Symptoms to correlate distress symptoms with type and frequency of violence exposure. These children typically suffer from intrusive fearful thoughts or feelings; are easily distracted by thoughts, sights, or smells that remind them of something bad that happened; and feel that they do not belong anywhere. These emotional distress symptoms increase according to the number of violent acts the child has been victimized by or witnessed.

["Distress symptoms among urban African American children and adolescents: A psychometric evaluation of the Checklist of Children's Distress Symptoms," by Xiamoming Li, Ph.D., Donna Howard, Dr.PH, Dr. Stanton, and others, in the June 1998 Archives of Pediatric and Adolescent Medicine 152, pp. 569-577.]

Socioeconomic Barriers Limit Participation in Diabetes Education Programs

Mexican-American patients are just as likely to attend diabetes education programs as non-Hispanic patients, despite the socioeconomic barriers that often confront them, according to Jacqueline A. Pugh, M.D., of the University of Texas Health Science Center and the AHCPR-funded Mexican-American Medical Effectiveness Research Center. Dr. Pugh and her colleagues randomly assigned 596 patients with type-2 diabetes to a group where participants were given a choice of programs or a group where they had no choice. Nearly 85 percent of study participants were Hispanic. Those in the choice group could select either a standard introductory diabetes education program or a program with an enhanced nutritional component that taught them how to modify the fat and cholesterol content in traditional Hispanic foods. Of the 305 participants in the choice group, 78 percent selected the nutritional program. However, patients given a choice did not complete more classes than those not given a program choice (2.94 vs. 2.79 out of 5 classes). Despite the culturally sensitive approach of this program, the overall no-show rate was 30 percent. The most common reasons for not coming to class were socioeconomic: illness, inability to leave work, family obligations or emergencies, and transportation problems.

["Patient choice in diabetes education," by Polly Hitchcock Noel, Ph.D., Anne C. Larme, Ph.D., Julie Meyer, M.S.N., Dr, Pugh, and others, June 1998 Diabetes Care 21(6), pp. 896-901.]

Chronic Hypertension Substantially Increases the Number of Preterm Births Among Pregnant Black Women

Preterm birth, which is associated with 75 percent of newborn deaths not caused by congenital anomalies, is much more common among black than white women. Black women with pregnancy-induced hypertension are almost twice as likely, and those with chronic hypertension further aggravated by pregnancy, are more than four times more likely to have a preterm birth (37 weeks of gestation or earlier) as black women with normal blood pressure, concludes an AHCPR-supported study. Given the 2.5 times greater prevalence of chronic hypertension among black pregnant women compared with pregnant women of other races, the impact of hypertension on preterm births among black women is more serious than previously recognized, comments Robert M. Mayberry, Ph.D., of the Morehouse School of Medicine. The researchers based their findings on an analysis of the records of black women with preterm births from the National Hospital Discharge Survey between 1988 and 1993.

["Maternal hypertension and spontaneous preterm births among black women," by Aziz R. Samadi, M.D., M.P.H., and Dr. Mayberry, in the June 1998 Obstetrics & Gynecology 91(6), pp. 899-904.]

A Growing Number of Americans Have No Usual Source of Care, Perhaps Reflecting Declining Access to Care

Individuals with a usual source of care, either a physician's office or outpatient clinic, typically have better access to care and are more likely to receive needed medical services ranging from immunizations to cancer screening. However, 4 percent fewer individuals in 1992 had a regular source of care compared with 1987, and this source was more likely to be a hospital outpatient department than a physician's office, according to a study by Carolyn M. Clancy, M.D., director of AHCPR's Center for Outcomes and Effectiveness Research, and her colleagues from the American Association of Medical Colleges and the University of Maryland. They analyzed data from the 1987 and 1992 National Health Interview Surveys and found that between 1987 and 1992 the estimated number of Americans who did not have a usual source of care rose from 30 to 39 million (17 to 21 percent). Every population group experienced an increase in the lack of a usual source of care. However, Hispanics, individuals with less education or lower income, those in worse health and residents of the South and/or rural areas experienced particularly large increases.

["Changes in usual sources of medical care between 1987 and 1992," by Ernest Moy, M.D., M.P.H., Barbara A. Bartman, M.D., M.P.H., Dr. Clancy, and Llewellyn J. Cornelius, Ph.D., in the Journal of Health Care for the Poor and Underserved 9(2), pp. 126-138, 1998]

Other articles in Research Activities include findings on:

  • Improved care for hip fracture patients.
  • Trends in treatment for benign prostatic hyperplasia.
  • Early treatment of suspected tuberculosis.
  • Impact of insurance type on seeking emergency care.
  • Research agenda for clinical preventive services.
  • Delivery of primary care to older Americans.
  • Racial differences in care received for asthma.
  • Improving satisfaction with prenatal care.
  • Evaluating the appropriateness of medical procedures.
  • Impact of chronic headache pain on employment.
  • Quality improvement in primary care practice.

For additional information, contact AHCPR Press Office: Salina Prasad, (301) 427-1864 (

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