<p class="Default">Addressing minority health and health disparities has been a missing piece of the puzzle in Big Data science. This article focuses on three priority opportunities that Big Data science may offer to the reduction of health and health care disparities. One opportunity is to incorporate standardized information on demographic and social determinants in electronic health records in order to target ways to improve quality of care for the most disadvantaged popula­tions over time. A second opportunity is to enhance public health surveillance by linking geographical variables and social determinants of health for geographically defined populations to clinical data and health outcomes. Third and most impor­tantly, Big Data science may lead to a better understanding of the etiology of health disparities and understanding of minority health in order to guide intervention devel­opment. However, the promise of Big Data needs to be considered in light of significant challenges that threaten to widen health dis­parities. Care must be taken to incorporate diverse populations to realize the potential benefits. Specific recommendations include investing in data collection on small sample populations, building a diverse workforce pipeline for data science, actively seeking to reduce digital divides, developing novel ways to assure digital data privacy for small populations, and promoting widespread data sharing to benefit under-resourced minority-serving institutions and minority researchers. With deliberate efforts, Big Data presents a dramatic opportunity for re­ducing health disparities but without active engagement, it risks further widening them.</p><p class="Default"><em>Ethn.Dis;</em>2017;27(2):95-106; doi:10.18865/ed.27.2.95.</p>

Background Black-white disparities in mortality persist after adjustment for socioeconomic status and health behaviors. We examined whether allostatic load, the physiological profile influenced by repeated or chronic life stressors, is associated with black-white mortality disparities independent of traditional sociobehavioral risk factors. Methods We studied 4515 blacks and whites aged 35 to 64 years from the third National Health and Nutrition Examination Survey (1988–1994), using the linked mortality file, to ascertain participant deaths through 2006. We estimated unadjusted sex-specific black-white disparities in cardiovascular/diabetes-related mortality and noninjury mortality. We constructed baseline allostatic load scores based on 10 biomarkers and examined attenuation of mortality disparities in 4 sets of sex-stratified multivariate models, sequentially adding risk factors: (1) age/clinical conditions, (2) socioeconomic status (SES) variables, (3) health behaviors, and (4) allostatic load. Results Blacks had higher allostatic load scores than whites; for men, 2.5 vs 2.1, p < .01; and women, 2.6 vs 1.9, p < .01. For cardiovascular/diabetes-related mortality among women, the magnitude of the disparity after adjustment for other risk factors (hazard ratio [HR], 1.63; 95% confidence interval [CI], 0.96–2.75) decreased after adjustment for allostatic load (HR, 1.15; 95% CI, 0.70–1.88). For noninjury mortality among women, the magnitude of the disparity after adjustment for other risk factors (HR, 1.43; 95% CI, 1.00–2.04) also decreased after adjustment for allostatic load (HR, 1.26; 95% CI, 0.90–1.78). For men, disparities were attenuated but persisted after adjustment for allostatic load. Conclusions Allostatic load burden partially explains higher mortality among blacks, independent of SES and health behaviors. These findings underscore the importance of chronic physiologic stressors as a negative influence on the health and lifespan of blacks in the United States.

Objective-To evaluate a faith-based intervention ("Sisters in Motion") intended to increase walking among older, sedentary African American women.Design-RCT, using within-church randomization. Setting-Three Los Angeles churches.Participants-Sixty-two African American women >60 years who reported being active <30 minutes 3×/week and walked <35,000 steps/week as measured by a baseline pedometer reading. Intervention-Intervention participants received a multi-component curriculum includingScripture readings, prayer, goal-setting, a community resource guide, and walking competitions. Both intervention and control participants participated in physical activity sessions.Measurements-The primary outcome was change in weekly steps walked as measured by pedometer. Secondary outcomes included change in systolic blood pressure (SBP). Outcomes were assessed at baseline and 6 months post intervention.Results-Eighty-five percent of participants attended at least 6 of 8 sessions. Intervention participants averaged 12,727 steps per week at baseline, compared to 13,089 steps among controls. Mean baseline SBP was 156 mmHg for intervention participants and 147 mmHg among controls (p=0.10). At 6 months, intervention participants had increased their weekly steps by 9,883 on average, compared to an increase of 2,426 for controls (p=0.016); SBP decreased on average by 12.5 mmHg among intervention participants and only 1.5 mmHg among controls (p=0.007). Conclusions-TheSisters in Motion intervention led to an increase in walking and a decrease in SBP at 6 months. This is the first RCT of a faith-based physical activity program to increase physical activity among older African American women, and represents an attractive approach to stimulate lifestyle change within this population. Integrating behavioral strategies such as building self-efficacy for exercise within a faith-based structure holds promise for decreasing sedentary lifestyles among older African American women. 2,8,9 Spirituality and religion are powerful cultural influences for many African Americans, and over 95% of African American older adults report praying nearly every day. 10 Spirituality and faith are often used as resources to help overcome personal crises and barriers, and together with approaches such as personal goal setting may help to overcome obstacles to behavior change.We developed a faith-based, physical activity intervention ("Sisters in Motion") for African American women 60 years of age and over, and tested it in a pilot randomized controlled trial within 3 churches located in South Los Angeles. We hypothesized that the multi-component Sisters in Motion curriculum would increase physical activity levels among intervention participants compared to control participants, measured at 6 months of follow-up. In addition, we hypothesized that this increase in physical activity would in turn lead to improvement in multiple secondary outcomes, including blood pressure reduction, weight loss, and a decrease in chronic pain. Methods Study Design and Partici...

IMPORTANCE Chronic kidney disease (CKD) is serious and common, yet recognition and public health responses are limited. OBJECTIVE To describe clinical features of, prevalence of, major risk factors for, and care for CKD among patients treated in 2 large US health care systems. DESIGN, SETTING, AND PARTICIPANTS This cohort study collected data from the Center for Kidney Disease Research, Education, and Hope (CURE-CKD) registry, an electronic health recordbased registry jointly curated and sponsored by Providence St Joseph Health and the University of California, Los Angeles. Patients were adults and children with CKD (excluding end-stage kidney disease) and adults at risk of CKD (ie, with diabetes, hypertension, or prediabetes) identified by laboratory values, vital signs, prescriptions, and administrative codes. Data were collected from

ABSTRACT. Objective:The purpose of this study was to examine the effectiveness of a patient-provider educational intervention in reducing at-risk drinking among older adults. Method: This was a cluster-randomized controlled trial of 31 primary care providers and their patients ages 60 years and older at a community-based practice with seven clinics. Recruitment occurred from July 2005 to August 2007. Eligibility was determined by telephone and a baseline mailed survey. A total of 1,186 at-risk drinkers were identifi ed by the Comorbidity Alcohol Risk Evaluation Tool. Follow-up patient surveys were administered at 3, 6, and 12 months after baseline. Study physicians and their patients were randomly assigned to usual care (n = 640 patients) versus the Project SHARE (Senior Health and Alcohol Risk Education) intervention (n = 546 patients), which included personalized reports, educational materials, drinking diaries, physician advice during offi ce visits, and telephone counseling delivered by a health educator. Main outcomes were alcohol consumption, at-risk drinking (overall and by type), alcohol discussions with physicians, health care utilization, and screening and intervention costs. Results: At 12 months, the intervention was signifi cantly associated with an increase in alcohol-related discussions with physicians (23% vs. 13%; p .01) and reductions in at-risk drinking (56% vs. 67%; p .01), alcohol consumption (-2.19 drinks per week; p .01), physician visits (-1.14 visits; p = .03), emergency department visits (16% vs. 25%; p .01), and nonprofessional caregiving visits (12% vs. 17%; p .01). Average variable costs per patient were $31 for screening and $79 for intervention. Conclusions:The intervention reduced alcohol consumption and at-risk drinking among older adults. Effects were sustained over a year and may have been associated with lower health care utilization, offsetting screening and intervention costs. (J. Stud. Alcohol Drugs, 75, 447-457, 2014)

Background Prediabetes affects 1 in 3 Americans. Both intensive lifestyle intervention and metformin can prevent or delay progression to diabetes. Over the past decade, lifestyle interventions have been translated across various settings, but little is known about the translation of evidence surrounding metformin use. Objective To examine metformin prescription for diabetes prevention and patient characteristics that may affect metformin prescription. Design Retrospective cohort analysis over a 3-year period. Setting Employer groups that purchased health plans from the nation’s largest private insurer. Participants A national sample of 17 352 working-age adults with prediabetes insured for 3 continuous years between 2010 and 2012. Measurements Percentage of health plan enrollees with prediabetes who were prescribed metformin. Results Only 3.7% of patients with prediabetes were prescribed metformin over the 3-year study window. After adjustment for age, income, and education, the predicted probability of metformin prescription was almost 2 times higher among women and obese patients and more than 1.5 times higher among patients with 2 or more comorbid conditions. Limitation Missing data on lifestyle interventions, possible mis-classification of prediabetes and metformin use, and inability to define eligible patients exactly as defined in the American Diabetes Association guidelines. Conclusion Evidence shows that metformin is rarely prescribed for diabetes prevention in working-age adults. Future studies are needed to understand potential barriers to wider adoption of this safe, tolerable, evidence-based, and cost-effective prediabetes therapy. Primary Funding Source Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases.

We examined potential correlates of sex without HIV disclosure within a sample of 875 participants from the HIV Cost and Services Utilization Study. Interviews with each participant assessed sexual activities with up to six recent partners, and this study included both respondent and partnership characteristics. Compared with marriage and/or primary same-sex relationsips, occasional partnerships and one-time encounters were associated with sex with disclosure, and shorter relationships were more likely to involve sex without disclosure. Knowledge of partner scrostatus was also associated with sex without disclosure. Women were less likely to have sex without disclosure than men having sex with men. We found an association between the perceived duty to disclosure to all partners and sex without disclosure, while we found no association in multivariate analyses between outcome expectancies and sex without disclosure.

Lack of insurance is associated with lower rates of BP control among treated hypertensives, whereas the odds of elevated BP are similar among untreated hypertensives with different insurance status. Variation in BP control between the uninsured and privately insured with hypertension is likely related to differences in appropriate treatment intensification or adherence, rather than differences in rates of treatment initiation.