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Posted: 4/27/2009

Ready to Fly: Evaluating Health Disparities in the U.S. Air Force
Access to affordable health care accounts for some of the racial and ethnic health disparities among the general U.S. population. But does access to free health care by military women and men eliminate disparities? When it comes to the Air Force, the news is mixed, according to the doctoral dissertation of Johns Hopkins University School of Nursing student Jennifer Hatzfeld, PhD(c), RN, an active-duty officer in the Air Force Nurse Corps.  Hatzfeld, whose doctoral studies have been funded by the Air Force, explored the relationship between deployment readiness among airmen and women and known racial and ethnic disparities in chronic illness. She hypothesized that active duty personnel would manifest health disparities similar to those in the general population, with the greatest adverse effects among those of lower rank. The findings, in part, did not match the hypotheses. In contrast to the general public, when members of the Air Force are diagnosed with a chronic illness diabetes, asthma, hypertension, high cholesterol treatment outcomes are the same without regard to ethnicity, race, gender, or rank. Equal access to health care appears to counteract the effect of health disparities. However, Hatzfeld also found that more active-duty African-American airmen than their white or Hispanic counterparts develop one or more of these conditions, as do more senior enlisted members than other personnel of the same age. These findings have significant implications for medical readiness, deployability, and career advancement. "We know these chronic health problems developed after people entered the Air Force; we know everyone has the same access to preventive care," notes Hatzfeld. "We need to figure out what causes these differences and do what we can to intervene early, through prevention, whenever possible. That's where I hope to focus my future work as a member of the Air Force Nurse Corps."

Partnering with Parents for Emotionally Healthy Children
Young children take in and process nearly everything they see, feel, and hear, whether quiet or loud, inconsistent or consistent, loving or hurtful. JHUSON Professor Deborah Gross, DNSc, RN, FAAN, notes that "When very young children grow up exposed to high levels of stress, it can change the way their brains develop. Intervening early in children's lives, through their parents, is probably the most powerful and cost-effective way to prevent mental health problems in children." The Chicago Parent Program (CPP), a 12-session, nurse-delivered, parenting skills development program, was created for that purpose by Gross and colleagues in partnership with low-income, Chicago-area, African-American and Latino parents. A first-of-its-kind program, the CPP was tested in a controlled study of almost 300 families at seven day care centers. In Efficacy of the Chicago Parent Program with Low-Income African American and Latino Parents of Young Children, (Preventive Science, March 2009), Gross and colleagues report that by adopting positive, consistent, stress-busting, culturally relevant parenting skills provided in the CPP, African-American and Latino families lower the chance their young children will develop behavior problems. In fact, the cumulative effect of better parenting resulted in even longer-term improvements in child behavior than anticipated, up to a full year later. Gross notes that nurses are ideally poised to deliver parenting programs, observing, "Parents trust nurses for guidance and support because we work with parents every day in the community, clinics, schools, and hospitals. Programs like the CPP help us offer effective guidance in ways that build on parents strengths and values and result in better behavioral health for their children."

Violence Against Women: Community-Based Prevention and Connections to HIV/AIDS
Intimate partner violence (IPV) -- once called domestic violence -- occurs worldwide and affects women and men of all ages, races, and ethnicities. JHUSON nurse Associate Professor Nancy Glass, PhD, MPH, RN, and colleagues are studying the best approaches to overcoming cultural barriers that can stand between women victims of IPV and the help and protection they need. Reporting in "Partnering with Community-based Organizations to Reduce Intimate Partner Violence" (Hispanic Journal of Behavioral Sciences, March 2009), Glass describes the development of a successful, culturally appropriate, IPV intervention specifically designed for Latinas. Developing and nurturing relationships with Latina-serving community-based organizations opened the door for Glass and her colleagues to reach and serve Latina IPV victims. Glass notes, "Partnerships are at the heart of community-based participatory research. Our research and the IPV support services we left behind were made possible and sustainable only because community organizations were active, engaged partners."

Predicting the Future: Health History Tool IDs Familial Colon Cancer Risk
Colorectal cancer, the number two cancer killer in the U.S., is responsible for over 52,000 deaths annually. Most people have no family history of colon cancer and can lower their risk through diet, exercise, smoking cessation, and reduced alcohol use and regular screenings after age 50. However, around 20% have a hereditary risk.  According to JHUSON Assistant Professor Sharon Dudley-Brown, PhD, RN, CRNP, "We know that if a parent had hereditary colorectal cancer, their offspring are at risk. But because we don't have the proper tools to screen for people at high risk, many are not identified early enough to prevent them from developing colorectal cancer." In "Hereditary Colorectal Cancer in the Gastroenterology Clinic: How Common Are At-risk Patients and How Do We Find Them?" (Gastroenterology Nursing, January-February 2009), Dudley-Brown and a colleague describe two assessment tools for hereditary colorectal cancer risk tested among 1,150 patients at six gastroenterology clinics. Both tools successfully identified at-risk patients and both improve on current practice which places little if any emphasis on family history despite the study's finding that one in four patients in the study population was at risk for hereditary colorectal cancer.

Health Care Debates: Pain in Coma Exams; Preventing Heart Attack
JHUSON faculty play a significant role in exploring health policy and clinical care issues.  Associate Professors Cynda H. Rushton, PhD, RN, FAAN, and Cheryl R. Dennison, PhD, RN,ANP, FAHA, are two such faculty. In "Justified Use of Painful Stimuli in the Coma Examination: A Neurologic and Ethical Rationale" (Neurocritical Care, March 2009), Rushton, an expert in medical ethics, proposes an assessment tool to identify appropriate boundaries for conducting coma examinations that involve infliction of pain. She observes since nurses routinely assess patients levels of consciousness, we are ideally positioned to model and demonstrate respectful, compassionate coma assessments for all members of the treatment team. In the Journal of Cardiovascular Nursing (January-February 2009), "Should We Screen for Risk Factors or Disease? A Current Debate in the Prevention of Cardiovascular Events," Dennison explores recent suggestions that screening otherwise healthy individuals to identify early heart disease is a more effective approach than screening for and managing risk factors such as smoking, inactivity, diabetes, high cholesterol and blood pressure, and obesity.  She notes, "The availability and use of methods to identify early heart disease is increasing. Regardless of whether we screen for risk factors or disease, nurses are critical in counseling individuals about their level of risk and the appropriate lifestyle changes necessary to decrease risk."