The Science of Health Disparities Research

Cover
Title Page
Copyright Page
Contents
List of Contributors
Foreword
Acknowledgements
Chapter 1 Definitions, Principles, and Concepts for Minority Health and Health Disparities Research
	1.1 Introduction
	1.2 NIMHD Mission
	1.3 Definitions and Concepts of Minority Health and Health Disparities
		1.3.1 Racial/Ethnic Minority Populations
		1.3.2 Minority Health and Minority Health Research
		1.3.3 Health Disparities and Health Disparities Research
		1.3.4 Is It Minority Health or Health Disparities?
		1.3.5 Standardized Measures of Minority Health- and Health Disparities-Related Constructs
	1.4 The NIMHD Research Framework: Health Determinants in Action
	1.5 Inclusion of Diverse Participants in Clinical Research
	1.6 Conclusions
	1.7 Key Points
	Disclaimer
	References
Chapter 2 Getting Under the Skin: Pathways and Processes that Link Social and Biological Determinants of Disease
	2.1 Introduction
	2.2 Allostasis and Allostatic Load
	2.3 The HPA Axis
		2.3.1 How We Feed: The Role of the Hypothalamus in Pathways Controlling Feeding and Nutrition
		2.3.2 How We Sleep: Light–Day Cycle, Circadian Clock, and Hypothalamic Linkages to Metabolic Control and Sleep
		2.3.3 How We Feel: Stress and the Role of HPA Axis in Memory and Mood
	2.4 Anticipatory Biology and Behavior: The Embedding of Exposures Across the Life Course
		2.4.1 Studies of Stress and Allostatic Load Across the Life Course
	2.5 Sleep
		2.5.1 Sleep Health Disparities and Allostatic Load
		2.5.2 Sleep Health Disparities and Genetics
		2.5.3 Methodologies in Sleep Research
	2.6 How We Feed: Nutrition and Nutrition-related Health Disparities
	2.7 How We Feel: Mood and Depression
	2.8 Summary
	2.9 Key Points
	Disclaimer
	References
Chapter 3 Racial/Ethnic, Socioeconomic, and Other Social Determinants
	3.1 Introduction
	3.2 Introduction to the Topic, Including Key Definitions
	3.3 Used and Recommended Measures and Research Methods
		3.3.1 Conceptual Model
		3.3.2 US Census Definitions
		3.3.3 Race Versus Ethnicity
	3.4 How and Why this Topic is Important to Minority Health and Health Disparities Research
		3.4.1 The Epidemiological Profile of Racial/Ethnic Minorities
		3.4.2 Other Social Determinants
	3.5 Selected Examples of the State of the Science in the Field to Illustrate Best Practices
		3.5.1 Exploring Health Disparities in Integrated Communities Study
		3.5.2 Hispanic Community Health Study/Study of Latinos
		3.5.3 Pittsburgh Hill/Homewood Research on Neighborhoods and Health Study
	3.6 Challenges and Future Opportunities
		3.6.1 Biological Links to Social Determinants
	3.7 Summary
	3.8 Key Points
	Disclaimer
	References
Chapter 4 Behavioral Determinants in Population Health and Health Disparities Research
	4.1 Introduction
	4.2 Importance of Behavioral Determinants to Minority Health and Health Disparities Research
	4.3 Relevant Metrics and Research Methods
		4.3.1 Relevant Metrics
		4.3.2 Research Methods
	4.4 State of the Science: Promising Practices
		4.4.1 Salud America!
		4.4.2 Health Technology—New Vital Signs
		4.4.3 Health Technology—Smartphone Use
		4.4.4 Underresearched Constituencies
		4.4.5 Advancing the Cycle of Better Care, Better Health, Lower Costs
	4.5 Challenges and Future Opportunities
	4.6 Summary
	4.7 Key Points
	Disclaimer
	References
Chapter 5 Sociocultural Environments and Health Disparities Research: Frameworks, Methods, and Promising Directions
	5.1 Introduction
	5.2 Selected Overarching Sociocultural Environment Factors
		5.2.1 Culture
		5.2.2 Acculturation
		5.2.3 Racism
		5.2.4 Interconnection of Race/Ethnicity and Socioeconomic Status
	5.3 Social Capital and Health Disparities
		5.3.1 Definitions and Operationalization
		5.3.2 Relationship to Health Disparities
		5.3.3 Social Capital Interventions
		5.3.4 Future Directions for Social Capital Research
	5.4 Implicit Bias of Healthcare Providers
		5.4.1 Relationship Between Implicit Bias and Behavior
		5.4.2 Promising Interventions that Reduce Biased Behavior
	5.5 Sociocultural Factors that Influence the Quality of Healthcare Provider-Patient Interactions and Communication
		5.5.1 Communication Characteristics
		5.5.2 Cultural Factors
		5.5.3 Factors Related to Individual Values and Beliefs
		5.5.4 Conclusion
	5.6 Synthesis
		5.6.1 Culture
		5.6.2 Adaptations to New Cultural Contexts
		5.6.3 Social Capital
		5.6.4 Implicit Bias
		5.6.5 Patient-Provider Communication
	5.7 Key Points
	Disclaimer
	References
Chapter 6 Physical Environment, and Minority Health and Health Disparities Research
	6.1 Introduction
	6.2 Methodologies and Measures
		6.2.1 Exposure Assessment
		6.2.2 Biomarkers of Exposure
		6.2.3 Qualitative Research
	6.3 Importance of Physical Environment Determinants to Health Disparities Research
		6.3.1 Housing
		6.3.2 Food and Green Space Access
		6.3.3 Neighborhood Walkability
		6.3.4 Air Pollution
		6.3.5 Toxic Metals Exposure
	6.4 Case Study
		6.4.1 Urban Built Environment: Park Equity in Los Angeles
	6.5 Challenges and Opportunities
		6.5.1 Challenges
		6.5.2 Opportunities
	6.6 Key Points
	Disclaimer
	References
Chapter 7 Genome-wide Genetic Approaches to Metabolic and Inflammatory Health Disparities
	7.1 Introduction
	7.2 Landscape of Genetic Variation
	7.3 Pathogenic Potential of Low-frequency and Rare Variants
	7.4 Admixture in the Americas
	7.5 Identifying Disease Genes Associated with Health Disparities: Methods and Approaches
		7.5.1 Genome-wide Association Studies
		7.5.2 Mapping by Admixture Linkage Disequilibrium
	7.6 Joint Admixture Mapping and Genome-wide Association Studies for Gene Discovery in Admixed Populations
	7.7 Whole-Genome and Whole-Exome Sequencing Approaches to Health Disparities
	7.8 Summary
	7.9 Key Points
	Definitions
	References
Chapter 8 Biologic Factors and Molecular Determinants in Inflammatory and Metabolic Diseases
	8.1 Introduction and Approaches
	8.2 Asthma
	8.3 Metabolic Syndrome, Obesity, and Diabetes
	8.4 Lupus and Other Rheumatologic Diseases
	8.5 Kidney Disease
	8.6 Key Points
	Disclaimer
	References
Chapter 9 Insights into the Genomic Landscape of African Ancestry Populations: Implications for Health and Disease Disparities
	9.1 Introduction: Viewing the Complex Architecture of African Genomes from a Global Perspective
	9.2 Adaptive Forces that Shaped the Human Genome in Health and Disease among African Ancestry Populations
		9.2.1 Protection Against Malaria
		9.2.2 Protection Against African Sleeping Sickness (Trypanosomiasis)
		9.2.3 Protection Against Lassa Fever
		9.2.4 Ecological Adaptations to Tropical Climate (Hypertension and Skin Pigmentation)
	9.3 Pharmacogenomics
	9.4 Considerations for Future Studies
	9.5 Conclusions
	9.6 Key Points
	Disclaimer
	References
Chapter 10 Applying Self-report Measures in Minority Health and Health Disparities Research
	10.1 Introduction
	10.2 Measurement Issues When Using Self-report Measures in Diverse Populations
		10.2.1 Conceptual Adequacy and Equivalence
		10.2.2 Psychometric Adequacy and Equivalence
	10.3 Methods for Evaluating Conceptual and Psychometric Properties of Self-report Measures
		10.3.1 Methods for Assessing Conceptual Adequacy and Equivalence
		10.3.2 Methods for Assessing Psychometric Adequacy and Equivalence
	10.4 Locating and Selecting Self-report Measures for Use in Diverse Populations
		10.4.1 Resources for Locating Measures
		10.4.2 Template for Reviewing Self-report Measures for Appropriateness in Your Study
	10.5 Adapting Measures for Diverse Populations
		10.5.1 Examining the Breadth and Meaning of Constructs
		10.5.2 Language Translation of Measures
	10.6 Future Directions
		10.6.1 Interactions of Socioeconomic Status and Race/Ethnicity Across the Life Course
		10.6.2 Measuring Culture and Acculturation Processes
	10.7 Conclusions
	10.8 Key Points
	Disclaimer
	References
Chapter 11 Conducting Community-based Participatory Research with Minority Communities to Reduce Health Disparities
	11.1 Introduction
		11.1.1 Learning Objectives
	11.2 Conducting Community-based Participatory Research with Minority Communities to Reduce Health Disparities
	11.3 Evidence of CBPR Effectiveness and Advancement in CBPR Evaluation
	11.4 Case Studies
		11.4.1 Connecting to Testing and Prevention
		11.4.2 Healthy Living: The Chinese Lay Health Workers Project
		11.4.3 Nuestro Futuro Saludable [Our Healthy Future]
		11.4.4 Participatory Health Impact Assessment to Inform Tribal Policy
		11.4.5 Pacific Islander “Let’s Move”
	11.5 Anticipating Challenges and Opportunities in CBPR
	11.6 Research Support for CBPR
	11.7 Conclusions
	11.8 Key Points
	Disclaimer
	References
Chapter 12 Racial/Ethnic Health and Healthcare Disparities Measurement: The Application of the Principles and Methods of Causal Inference
	12.1 Introduction
	12.2 Aligning Definitions of Disparity with Appropriate Statistical Methods
		12.2.1 Definitions of Racial/Ethnic Healthcare Disparity
	12.3 A Method of Measuring Healthcare Disparities Incorporating a “Counterfactual” Scenario
	12.4 Extending the Use of “Partial Differencing” to Identifying Targets for Health and Healthcare Disparities Reduction Using Decomposition Methods
	12.5 Adapting Causal Models to Identify Interventions to Reduce Racial/Ethnic Health Disparities
		12.5.1 Mediators of the Relationship Between Race/Ethnicity and Health Outcomes
	12.6 Investigating the Meaning of the Race/Ethnicity Coefficient in Regression Models
		12.6.1 Can One Identify the Causal Effect of Race?
	12.7 Statistical Methods Used to Evaluate Causal Effects in Intervention Studies
		12.7.1 Experimental Methods: Randomized Controlled Trials and Field Experiments
		12.7.2 Quasi-Experimental Methods: Propensity Scores
		12.7.3 Quasi-Experimental Methods: Instrumental Variables
		12.7.4 Quasi-Experimental Methods: Difference-in-Differences
	12.8 Conclusion and Limitations
	12.9 Key Points
	Disclaimer
	References
Chapter 13 Small Area Estimation and Bayesian Disease Mapping for Minority Health and Health Disparities
	13.1 Introduction
	13.2 Basic Statistical Models for Small Area Estimation
		13.2.1 Area-level Models
		13.2.2 Unit-level Models
		13.2.3 Auxiliary Data and Model Selection for Small Area Estimation
		13.2.4 Applications of Small Area Estimation in Public Health
	13.3 Small Area Estimation: A Brief Practical Guide
	13.4 Small Area Estimation for Quantifying Health and Health Disparities of Small Populations
	13.5 Bayesian Disease Mapping
		13.5.1 Basic Statistical Models for Bayesian disease mapping
		13.5.2 Bayesian Hierarchical Spatial Model Specification and Fitting
		13.5.3 Applications of Bayesian Hierarchical Spatial Models for Health Disparities Research
	13.6 Conclusions
	13.7 Key Points
	Disclaimer
	Acknowledgments
	References
Chapter 14 Applications of Big Data Science and Analytic Techniques for Health Disparities Research
	14.1 Introduction
	14.2 Characteristics of Big Data
	14.3 Importance of Big Data for Minority Health and Health Disparities Research
	14.4 Goals of Big Data Analytics and Opportunities for Health Disparities Research
	14.5 Research Methods in Big Data
		14.5.1 Types of Big Data Research Methods and Approaches
		14.5.2 Commonly Used Big Data Science Analytics and Models
		14.5.3 Applied Big Data Analytics and Artificial Intelligence
	14.6 Selected Examples Illustrating Best Practices
		14.6.1 Example 1. Electronic Health Record and Its Applications in the Reduction of Health Outcome Disparities
		14.6.2 Example 2. National and Global Surveillance for Health Inequities
		14.6.3 Example 3. Using the Internet and Social Media to Understand and Address Health Disparities
		14.6.4 Example 4: Chronic Disease Management
	14.7 Challenges and Opportunities on Big Data Approaches in Health Disparities Research
		14.7.1 Training in Big Data Approaches
		14.7.2 Big Data Access
		14.7.3 Representation of the Under-served in Big Data Sets
		14.7.4 Emerging Opportunities
	14.8 Summary and Conclusion
	14.9 Key Points
	Disclaimer
	References
Chapter 15 Complex Systems Science
	15.1 Introduction
	15.2 Unique Properties of Minority Health and Health Disparities Research
	15.3 Data and Methodological Challenges in Health Disparities Research
	15.4 Strong Alignment Between Hypothesized Causes of Minority and Health Disparities and Complex Systems Science Approaches
	15.5 Types of Questions that Complex Adaptive Systems Models Can Help Answer
	15.6 Elements of a Successful Complex Adaptive Systems Model
		15.6.1 Engagement with Theory
		15.6.2 Selection of a Modeling Approach
		15.6.3 Use of Available Data
	15.7 Systems Science as Iterative Research
	15.8 Limitations and Challenges
	15.9 Key Points
	Disclaimer
	References
Chapter 16 Improving Equity in Healthcare through Multilevel Interventions
	16.1 What Are Multilevel Interventions?
	16.2 Challenges of Multilevel Interventions
		16.2.1 Addressing Health Disparities Through Multilevel Interventions
		16.2.2 Measures in Multilevel Interventions
		16.2.3 Methodology and Evaluation of Multilevel Interventions
	16.3 Multilevel Interventions: 2012–2017
	16.4 Future Directions
	16.5 Case Study to Illustrate Multilevel Interventions
		16.5.1 Case Study: Heart-Healthy Lenoir High Blood Pressure Study
	16.6 Key Points
	Disclaimer
	References
Chapter 17 Using Implementation Science to Move from Knowledge of Disparities to Achievement of Equity
	17.1 Introduction
		17.1.1 Overview of Implementation Science
		17.1.2 Why Health Disparities Research Needs Implementation Science
	17.2 Selected Implementation Frameworks Applied to Health Disparities Research
		17.2.1 Community-based Participatory Research
		17.2.2 The RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance)
		17.2.3 Practical, Robust Implementation and Sustainability Model (PRISM)
		17.2.4 Consolidated Framework for Implementation (CFIR)
		17.2.5 Public Health Critical Race Praxis (PHCR)
	17.3 Best Practices in Health Disparities Implementation Science: Selected Examples
		17.3.1 Asking Relevant Questions
		17.3.2 Testing Multilevel Interventions
		17.3.3 Leveraging Technology, Existing Data Sources, and Natural Experiments
		17.3.4 Study Designs and Methods
		17.3.5 Measures of Implementation Success
		17.3.6 Innovative Approaches to Data Analysis
		17.3.7 Dissemination of Findings
	17.4 Challenges and Opportunities for Implementation Science in Health Disparities Research
		17.4.1 Stakeholder Engagement
		17.4.2 Contextual Considerations
		17.4.3 Intervention Design and Delivery
		17.4.4 Planning for Sustainability
	17.5 Summary and Implications for Future Research, Practice, Policy, and Social Change
	17.6 Key Points
	Disclaimer
	References
Chapter 18 Healthcare and Public Policy: Challenges and Opportunities for Research
	18.1 Summary
	18.2 Background/Context
	18.3 Key Constructs
	18.4 Selected Examples of Healthcare Policy Research
		18.4.1 Immigration Reform
		18.4.2 The Veterans Affairs Home-Based Primary Care Model
		18.4.3 Oregon Health Insurance Experiment
	18.5 Non-Healthcare Policy Research
		18.5.1 Nutrition Program for Women, Infants, and Children
		18.5.2 Flint Water Crisis
		18.5.3 Minimum Wage Policies
		18.5.4 Residential Segregation
	18.6 Key Challenges
	18.7 Future Directions and Opportunities
	18.8 Key Points
	Disclaimer
	References
Chapter 19 Addressing Disparities in Access to High-quality Care
	19.1 Racial Disparities as a Quality Problem
	19.2 Defining Quality and Access
	19.3 Examples of Racial Disparities as a Quality Problem
		19.3.1 Cardiovascular Care and Implantable Defibrillators
		19.3.2 End-Stage Renal Disease
	19.4 Addressing Disparities in Access to Quality Care
	19.5 Steps to Addressing Healthcare Disparities
		19.5.1 Identify and Prioritize Reducing Healthcare Disparities
	19.6 Implement Evidence-based Strategies to Eliminate Disparities
		19.6.1 After Prioritizing Health Equity and Identifying Existing Health Disparities, the Next Challenge is to Develop an Intervention
		19.6.2 Determine the Root Cause(s) of the Disparity
		19.6.3 Consider the Levels of Influence of Patients, Providers, the Microsystem (Immediate Care Team), Organizations, Communities, and Policy
		19.6.4 Build on Prior Work and Modify for Specific Context
		19.6.5 Implement, Evaluate, and Adjust the Intervention
	19.7 Invest in Health Equity Performance Measures
		19.7.1 One Must Define What Is Meant by Equity in Quality
		19.7.2 Measure Capacity for Health Equity
	19.8 Incentivize the Reduction of Health Disparities
		19.8.1 Design Quality Improvement and Payment Interventions to Achieve Equity
		19.8.2 Consider the Impact of Social Risk Factors on Public Reporting and Pay-For-Performance
		19.8.3 Develop a Business Case to Enable Organizations to Implement and Sustain Health Equity Interventions
	19.9 Advice for a Healthcare Disparities Researcher
		19.9.1 Pick an Important Research Question
		19.9.2 Review the Relevant Literature
		19.9.3 Choose, Adapt, or Develop a Conceptual Model to Guide Your Research
		19.9.4 Select the Appropriate Quantitative and/or Qualitative Approach for Your Study Question
		19.9.5 Use the Appropriate Analytical Methods
	19.10 Conclusion
	19.11 Key Points
	Disclaimer
	References
Chapter 20 Health Communication as a Mediator of Health and Healthcare Disparities
	20.1 Introduction: Scope and Conceptual Framework
		20.1.1 Prevalence of the Problem
		20.1.2 Narrative, Elicitation, Explanatory, and Relationship Aspects
		20.1.3 Communication Domains Affecting Health and Healthcare Outcomes
		20.1.4 An Operational and Contextual Framework for Organizing Communication in the Clinical Encounter
	20.2 Risk Factors for Health Communication Disparities and Impact on Communication and Health Outcomes
		20.2.1 Limited Health Literacy
		20.2.2 Limited English Proficiency and Patient-Provider Language Discordance
		20.2.3 Discordance in Race/Ethnicity
		20.2.4 Implicit Bias
	20.3 An Example of Systems-based Approaches: Creating Health-Literate Healthcare Systems
		20.3.1 Defining Health-Literate Organizations
		20.3.2 Clinician-Patient Level Interventions
		20.3.3 System-Patient-Level Interventions
		20.3.4 Community-level Interventions
	20.4 Interventions to Mitigate Other Communication Risk Factors
		20.4.1 Cultural Competence of Healthcare Providers and Organizations
		20.4.2 Diversity of Health Professional Workforce
		20.4.3 Building the Healthcare Team: Professional Medical Interpreters and Lay Health Educators and Patient Navigators
	20.5 Future Directions for Communications Research: Measurement and Implementation
		20.5.1 Health Literacy
		20.5.2 Sociodemographic Concordance
		20.5.3 Implicit Bias
		20.5.4 Direct Observation of Health Communication Behaviors
		20.5.5 Patient Experience and Patient-Reported Outcomes Measurement
	20.6 Key Points
	Disclaimer
	References
Chapter 21 Comparative Effectiveness Research in Health Disparity Populations
	21.1 Introduction
	21.2 Background
	21.3 CER Study Designs
	21.4 CER Measures
	21.5 Approaches to CER
	21.6 Applications of CER in Health Disparity Populations
		21.6.1 Examples of CER Questions in Minority Health
	21.7 Social Determinants of Health
	21.8 Groups with Particular Needs for CER
		21.8.1 African Americans
		21.8.2 Hispanics/Latinos
		21.8.3 Sexual and Gender Minorities
		21.8.4 American Indians and Alaska Natives
		21.8.5 Underserved Rural Populations
		21.8.6 Considerations for the CER Needs of Health Disparity Populations
	21.9 Major Public Health/Policy Interventions as a Result of CER
	21.10 Multisectoral Impact of CER on Disparities
	21.11 Future Directions of CER
	21.12 Key Points
	Disclaimer
	References
Chapter 22 The Role of Electronic Health Records and Health Information Technology in Addressing Health Disparities
	22.1 Introduction
	22.2 Healthcare Data and Electronic Records
	22.3 Overview of Health Information Technologies
		22.3.1 Personal Health Record
		22.3.2 Consumer Health IT Applications
		22.3.3 Clinical Decisions Support Systems
		22.3.4 Electronic Disease Registries
		22.3.5 Telehealth, Telemedicine, and Mobile Health
		22.3.6 Health Information Technologies Data
	22.4 Application of Digital Health and Health Information Technologies to Addressing Disparities
		22.4.1 Population-level Health Outcomes
		22.4.2 Consumer or Individual-level Health Outcomes
	22.5 Conclusions: Challenges and Opportunities in Health Information Technologies Implementation
	22.6 Key Points
	Acknowledgments
	Disclaimer
	References
Chapter 23 Precision Medicine and Health Disparities
	23.1 The Promise of Precision Medicine
		23.1.1 Precision Medicine Defined
		23.1.2 Natural History of Precision Medicine
		23.1.3 Precision Medicine and Health Disparities
		23.1.4 Pharmacogenomics-Biologic Predictors of Disparities in Treatment Response
		23.1.5 Existing Gaps in Precision Medicine
	23.2 Methods in Precision Medicine and Applications in Health Disparities
		23.2.1 Methods of Characterizing Individuals
		23.2.2 Methods of Predicting Disease Risk
	23.3 Future Directions and Research Needs
		23.3.1 Engaging Minority Communities
		23.3.2 Engaging Health Providers
		23.3.3 Challenges Unique to Precision Medicine
	23.4 Genomic Health Literacy
		23.4.1 Cross-training in Precision Medicine and Health Disparities
		23.4.2 Integration of Cultural, Social, and Environmental Data
	23.5 Success in Precision Medicine
	23.6 Conclusion
	23.7 Key Points
	Acknowledgments
	Disclaimer
	References
Chapter 24 Recruitment, Inclusion, and Diversity in Clinical Trials
	24.1 Background/Context
	24.2 Understanding Barriers to Inclusion in Clinical Research
		24.2.1 Patient-level Barriers
		24.2.2 Investigator-level Barriers
		24.2.3 Structural and Institutional Barriers
	24.3 Best Practices for Optimizing Inclusion in Clinical Research
		24.3.1 Site Selection
		24.3.2 Screening
		24.3.3 Community Engagement
		24.3.4 Communication Strategies
		24.3.5 Retention
	24.4 Future Directions and Research Needs
		24.4.1 Federal Policies
		24.4.2 Interactive Online Toolkits
	24.5 Conclusion
	24.6 Key Points
	Disclaimer
	References
Chapter 25 Sexual and Gender Minority Health Disparities: Concepts, Methods, and Future Directions
	25.1 Introduction to the Topic, Including Key Definitions
	25.2 How and Why This Topic is Important to Minority Health and Health Disparities Research
	25.3 Most Relevant Measures and Research Methods Used and Recommended
		25.3.1 Individual/Interpersonal Measures
		25.3.2 Structural Measures
	25.4 Selected Examples of the State of the Science to Illustrate Best Practices
		25.4.1 Cross-sectional Designs
		25.4.2 Daily Diary Studies
		25.4.3 Quasi-experiments
		25.4.4 Field Experiments
		25.4.5 Interventions
	25.5 Challenges and Future Opportunities
		25.5.1 Methodological Challenges Related to Sampling SGM Populations
		25.5.2 Ethical Challenges and Considerations
		25.5.3 Directions for Future Research
		25.5.4 Methodological and Measurement Innovations
		25.5.5 Intersectional Perspectives
		25.5.6 Interventions to Reduce Stigma and Its Negative Consequences
		25.5.7 Research on Other Determinants of SGM Health Disparities
	25.6 Summary
	25.7 Key Points
	Disclaimer
	References
Chapter 26 Workforce Diversity and Capacity Building to Address Health Disparities
	26.1 Background
	26.2 Introduction
	26.3 Diversity in the US Scientific and Health Workforce
	26.4 Diversity and Health Disparities: What Are the Links?
	26.5 Methodological Approaches to Understanding Workforce Diversity and Health Disparities
		26.5.1 Expand Scholarship of the Science of Diversity as Related to Health Outcomes
		26.5.2 Promote Rigorous Data Collection and Evaluation
		26.5.3 Expand Study of Sociocultural Factors as Related to Health Outcomes
		26.5.4 Can Scientific Workforce Diversity Partnerships with the Private Sector and Community Organizations Reduce Health Disparities?
	26.6 Closing Thoughts
	26.7 Key Points
	Acknowledgments
	Disclaimer
	References
Index
EULA