Disparities in health status among racial and ethnic groups in Massachusetts

156 Pages·1992·6.5 MB·English

by  Christian, Christopher

Among
Disparities in Health Status
Racial and Ethnic Groups in Massachusetts
Massachusetts Department of Public Health

Among
Disparities in Health Status Racial
and Ethnic Groups in Massachusetts
Christopher Christian,
Health and Addictions Research, Inc.
David H. Mulligan,
Commissioner of Public Health
Massachusetts Department of Public Health
Dennis McCarty,
Director, Bureau of Substance Abuse Services,
Massachusetts Department of Public Health
April, 1992
Digitized by the Internet Archive
2014
in
https://archive.org/details/disparitiesinheaOOchri
ACKNOWLEDGEMENTS
A CKNOWLEDGEMENTS
This report, Disparities in Health Status Among Racial and Ethnic Groups In
Massachusetts, is the result of collaboration among a project steering committee, a
project advisory group, staff from the Massachusetts Department of Public Health
(MDPH), staff from Health and Addictions Research, Inc., and members of
community groups.
Project Steering Committee MDPH ProjectAdvisory Group
Marlene Anderka, M.P.H., Pirector, Office of Maria Contreras, Regional Manager, Bureau of
Statistics and Evaluation, Bureau of Parent, Child Substance Abuse Services
and Adolescent Health, MDPH
Sandra Crespo, Program Specialist, Healthy Start
Bruce Cohen, Ph.D., Director, Research and Program
Epidemiology, Bureau of Health Statistics,
Research and Evaluation, MDPH E. Theresa Daniel, M.Ed., Specialist, Early
Childhood Programs, Bureau of Parent, Child and
Van Dunn, M.D., M.P.H., Deputy Commissioner, Adolescent Health
Environmental and Biological Sciences, MCPH
Ralph Edwards, Regional Manager, Bureau of
Daniel J. Friedman, Ph.D., Assistant Substance Abuse Services
Commissioner, Bureau of Health Statistics,
Research and Evaluation, MDPH Rafael Guillen, Coordinator, HIV Education
Milly Krakow, Ph.D., Executive Director, Health Muriel Hodges, Manager, High Risk Infant
and Addictions Research, Inc. Identification System, Bureau of Parent, Child and
Adolescent Health
Ruth Lederman, M.P.H., Director, Chronic Disease
Surveillance Unit, Bureau of Health Statistics, Milagros Padilla, P.A., M.P.A., Family Health &
Research and Evaluation, MDPH Work Coordinator, Division of Women's Health
Dennis McCarty, Ph.D., Director, Bureau of Florence C. Petersen, M.S., Assistant Director,
Substance Abuse Services, MDPH Programs and Nutrition, WIC
Doralba Munoz, Director, Office of Regional Nicole Prudent, M.D., M.P.H., Assistant Professor
Operations, Bureau of Parent, Child and of Medicine in Public Health, Boston University
Adolescent Health, MDPH
Linda Shepherd, M.Ed., Acting Boston Regional
Carol Williams, Ph.D., Director of Research, Health Manager, Bureau of Parent, Child and Adolescent
and Addictions Research, Inc. Health
Donalda Silva, Southeast Regional Coordinator,
Healthy Start
Sue Tenorio, Ed.D., Consultant, HIV
Prevention and Service Development, AIDS Office
Davy Um Heder, Cambodian Women's Health
Project, Division of Women's Health, MDPH
Bich-Ngoc Mary Vu, Coordinator, Refugee House
Program
Barbara Wethers, Northeast Regional Coordinator,
Division of Chronic Disease Prevention
ACKNOWLEDGEMENTS
Massachusetts Department ofPublic Health Staff
Robert Bishop, Director of Diabetes Control Joel Reisman, Systems Analyst, Chronic Disease
Program, Division of Chronic Disease Prevention Surveillance Program, Division of Research and
Epidemiology
Gregory Connelly, D.M.D., Ph.D., Director, Office
for Non-Smoking and Health Cindy Rodgers, Director, SCIPP, Bureau of Parent,
Child and Adolescent Health
Robert Danley, Ph.D., Senior Social Science
Analyst, Division of Health Statistics and Research Pearl K. Russo, Senior Medical Writer/Editor
Al DeMaria, M.D., Assistant Commissioner, Maxine Schuster, Assistant Director, Research and
Division of Communicable Disease Control Evaluation, SCIPP, Bureau of Parent, Child and
Adolescent Health
G. Warren Erskine, Senior Analyst, Management
Information Systems, Bureau of Substance Abuse Candace Waldron, Director, Women's Health Unit
Services
Arthur Stolow, Management Analyst, Management
Saul Franklin, Project Manager, Office of Statistics Information Systems, Bureau of Substance Abuse
and Evaluation, Bureau of Parent, Child and Services
Adolescent Health
Charlene Zion, Public Information Coordinator,
Joan Gancarski, Research A' alyst, Bureau of Bureau of Health Statistics, Research and
Health Statistics, Research < id Evaluation Evaluation
Susan Gershman, Ph.D., Director, Massachusetts
Cancer Registry, Bureau of Health Statistics, Health andAddictions Research, Inc.
Research and Evaluation
Michael Hofmann, M.S., Research Associate,
Dorcas Grigg-Saito, M.S.P H., Director, Division of Health and Addictions Research, Inc.
Refugee and Immigrant Health
Kathy J. Kalkbrenner, Research Assistant, Health
Lily Hsu, Director, Division of Chronic Disease and Addictions Research, Inc.
Prevention Program
Julie M. Nardone, M.A., Research Associate,
Rosemarie Kappes, M.P.H., Epidemiologist, State Health and Addictions Research, Inc.
Laboratory
Lisa Steriti, M.A., Research Associate, Health and
Lauren Koumjian, Consultant, Chronic Disease Addictions Research, Inc.
Surveillance Program
Jim Laprade, HIV Counseling and Testing Community Groups
Coordinator, Bureau of Substance Abuse Services
The Latino Health Council
Annie MacMillan, Data Coordinator, Massachusetts
Cancer Registry, Bureau of Health Statistics, The Refugee Health Council
Research and Evaluation
John Moye, M.D., Medical Director, Sexually
Transmitted Disease Program, State Laboratory
Ron O'Connor, Southeast Regional Coordinator,
Division of Chronic Disease Prevention
Stephanie Oddleifson, M.P.H., Epidemiologist,
AIDS Surveillance Program, State Laboratory
TABLE OF CONTENTS
TABLE OF CONTENTS
EXECUTIVE SUMMARY
1
INTRODUCTION 7
DEMOGRAPHIC PROFILE 9
SUBSTANCE ABUSE
CHAPTER 1 11
HEALTH OUTCOMES 12
Substance abuse-related deaths 12
Substance abuse-related deaths by condition 13
Substance abuse-related illnesses 14
Cancer 14
Adult AIDS 15
Pediatric AIDS 16
RISK FACTORS 18
Initiation of drug use 18
Attitudes toward alcohol and drug use 19
Alcohol and other drug use 19
SERVICE UTILIZATION 21
Trends in substance abuse treatment service utilization 21
Clients in substance abuse treatment 22
Differences in alcohol abuse patterns 23
Differences in preferences for other drugs by racial/ethnic
group 23
Pregnant women in substance abuse treatment 24
DISCUSSION AND RECOMMENDATIONS 25
Data collection and research 25
Prevention and community involvement 26
SUBSTANCE ABUSE SERVICES RESOURCE LIST 28
TABLE OF CONTENTS
HIV INFECTION AND AIDS
CHAPTER 2 31
HEALTH OUTCOMES 32
AIDS deaths 32
AIDS cases by race/ethnicity and gender 33
HIV infection 34
RISK FACTORS 35
Transmission categories 35
Injection drug use-related AIDS 36
Use of contaminated drug paraphernalia 36
Injection drug use and pediatric AIDS 37
Infrequent condom use 38
SERVICE UTILIZATION 39
Hospitalization of people with AIDS 39
Injection drug users in substance abuse treatment 40
DISCUSSION AND RECOMMENDATIONS 41
Education 41
Prevention 42
Research 43
Community involvement 44
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH INITIATIVES 45
. .
Educational materials 45
Community-based organizations 45
AIDS RESOURCE LIST 46
ii
TABLE OF CONTENTS
SEXUALLY TRANSMITTED DISEASES
CHAPTER 3 .... 49
,
HEALTH OUTCOMES 50
Syphilis 50
Gonorrhea 51
Chlamydia 52
Pelvic inflammatory disease 53
RISK FACTORS 54
Condom use 54
Alcohol and other drug use 55
Number of sexual partners 55
SERVICE UTILIZATION 56
Use of STD testing and counseling facilities 56
DISCUSSION AND RECOMMENDATIONS 57
Education 57
Prevention 57
Research 59
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH INITIATIVES 60
. .
Sexually Transmitted Disease Division 60
STD PROGRAM RESOURCE LIST 61
MA TERNAL AND INFANT HEALTH
CHAPTER 4 63
HEALTH OUTCOMES 64
Infant mortality 64
Low birthweight births 65
RISK FACTORS 66
Adequacy of prenatal care 66
Adequacy of prenatal care among Asian, black, and Hispanic
subgroups 67
Births to teenagers 68
Tobacco use during pregnancy 68
TABLE OF CONTENTS
SERVICE UTILIZATION 70
Site of prenatal care 70
Payment source 70
Payment source among Hispanic subgroups 71
Payment source among black subgroups 71
DISCUSSION AND RECOMMENDATIONS 73
Education 73
Prevention 73
Research 74
Community efforts 75
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH INITIATIVES 77
. .
Healthy Start 77
Perinatal Community Initiatives Program 77
Women, Infants and Children Supplemental Food Program, Inc. 77
Prenatal and Pediatric Primary Care Programs 77
Adolescent Health Care Programs 77
Family Planning Programs 78
Early Intervention Programs 78
Community-based Support Programs for High Risk Infants and
Their Families 78
Failure to Thrive Programs 78
The Bureau of Substance Abuse Services 78
Massachusetts Infant Mortality Strategy 78
MATERNAL AND INFANT HEALTH RESOURCE LIST 80
SELECTED CHRONIC DISEASES
(AMONG MEN AND WOMEN AGES 45-64)
CHAPTER 5 83
HEALTH OUTCOMES 84
Chronic disease deaths 84
Heart disease 86
Cancer deaths in Massachusetts 87
Deaths by seven major cancer sites 88
Lung 88
Colo-rectal 89
Breast 90
Pancreas 90
Stomach 91
iv