Health Care Providers

Throughout the history of the United States, African Americans have a long, at times tragic, and at times triumph. Many families have been in the United States since colonial times and others are modern immigrants from places around the world. The 2017 total population of African Americans made up 13.4% of the total U.S. population. English is the primary language and 15.65% of the subpopulation has obtained at least a Bachelor’s degree. 30.83% of African Americans are living in poverty. (Centers for Disease, 2014)

Leading causes of death among African Americans include Heart Disease, Cancer, Strokes, Diabetes, Unintentional Injuries, kidney diseases, Chronic Obstructive Pulmonary Disease, homicide, septicemia, and Alzheimer’s disease (Centers for Disease, 2014).

Many African Americans get glaucoma at earlier ages and glaucoma appears to be more aggressive: thus, blindness due to glaucoma is 6x-8x more prevalent in African Americans. Tobacco-related diseases claim more black Americans’ lives each year for death than car crashes, AIDS, murders, and drug and alcohol abuse combined: African Americans smoke less than other ethnic groups but have higher rates of lung cancer (NAATPN, 2009)

African Americans and Health Status in McDowell County, WV

This paper topic focuses specifically on McDowell County, West Virginia.

Until the early 1980s, McDowell had been one of the largest coal-producing areas in our country. The coal mining industry created a population dependency on the coal companies for housing, social life, food, clothing, churches, stores, etc. When the coal industry began shutting down the deep mines in the early 1980s and replacing miners with equipment in the remaining mines, McDowell County suffered the loss of more than 80% of its population to other states (dropping from over 100,000 to under 19,000 people).

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McDowell County has a large African American population at more than double the state average at 6.9%, in comparison to the state’s 3% African American population average.

McDowell County is among the poorest coIn unties among the poorest states in the nation. More than half of McDowell County households have incomes below $25,000 compared to one-quarter of households nationally. The median household income in McDowell County is under $22,500 – less than half the nearly $52,000 median household income at the national level

(WV DHHR, 2014). One in three families in McDowell are living in poverty, including more than 40 percent of those with children under 18 and more than 60 percent of those with children under five (U.S. Census American Community Survey). Residents of McDowell County have limited Internet and phone access and face serious transportation challenges for meeting even the most basic needs.

Adults in McDowell County have the worst health status in the entire state: 29% have no health insurance, 38% have no leisure time or physical activity, 44.8% are obese, 20.50% are diabetic, 19.5% have some form of cardiovascular disease, 45.2% have hypertension, 50.3% have high cholesterol, 49.6% have arthritis, 14% have asthma, and 42.7% are classified as disabled (WV DHHR, 2016). In McDowell County, West Virginia, the life expectancy for men is just 64 years – an 18-year difference. Men in McDowell County have the same life expectancy as men in Namibia.

The rate of women who smoke during pregnancy in McDowell County is 43%, and the county ranks fifth in West Virginia for adult male smokeless tobacco use (11.9%). Dual tobacco use is an emerging trend among West Virginian tobacco users. The current adult smoking rate is 33.1%. Thus, McDowell County ranks #1 in WV for lung cancer, bronchus cancer, trachea cancer, and chronic obstructive pulmonary disease and #3 in WV for cardiovascular disease.

Tobacco Use is the largest determinant of the health of African Americans in WV and McDowell County, WV

Healthcare to address Tobacco Use in McDowell County, WV

McDowell County does have a state-owned and operated acute care small rural hospital, 1 federally qualified healthcare center, 1 federal rural health clinic, 3 part-time dentists (2 private practice and 1 at the FQHC), 1mobile dental unit (comes from 2.5 hours away) and 4 independent family practice clinics.

According to Health Resources & Services Administration, McDowell County is a Medically Underserved Areas/Population (MUA ID#07780) area or population designated by HRSA as having too few primary care providers, high infant mortality, high poverty, or a high elderly population. McDowell County is also a Health Professional Shortage Area (HPSAs) designated by HRSA (ID# 1545286351) as having shortages of primary care, dental care, or mental health providers. The dental health HSPA designation shows only 0.50 FTE.

Problem Analysis

Tobacco and the African American Community have been linked for centuries from slave crop cultivation to now being a large target community for tobacco companies. While African Americans smoke less than whites, they suffer disproportionally from marketing strategies and death and disease. West Virginia has 65,000 African Americans and the current smoking rate is 27.8%. West Virginia has the highest adult smoking rate and adult male smokeless tobacco use rate in the nation.

Approximately 75% of African-American smokers prefer menthol cigarettes, compared to 25% of white smokers. Some studies suggest that the Menthol favor may allow African American smokers to inhale the carcinogens deeper into the lungs: thus, African American men smoke fewer cigarettes but have a higher rate of lung cancer. Popular brands include Newport, Kool, and Salem (Centers for Disease, 1998). Interestingly, the U.S. Food and Drug Administration has proposed a plan to ban menthol cigarettes and flavored cigars in the United States.

Of current African-American adult smokers, over seventy percent indicated that they have a desire to quit smoking entirely. African American smokers are more likely to have a recent cessation attempt but white smokers are more successful at their quit attempts (Centers for Disease, 1998).

Key research conducted by Steven Fu suggests that African American smokers are as likely to quit smoking at a level similar to whites when using nicotine replacement theory in their cessation attempt (Fu et all, 2008).

In the study The Importance of Location for Tobacco Cessation: Rural-Urban Disparities in Quit Success in Underserved West Virginia Counties conducted by Mary Northridge and reported by the National Rural Health Association, it was recommended that cessation programs for the African American Church increase sustainability (Northridge et all, 2010)

When looking at this issue through the lenses of the Public Health Model: tobacco prevention strategies that focus on the tobacco (the agent) are aimed at reducing both the supply and the demand (microeconomics) for tobacco products by addressing policy and social issues such as availability and access of the product, advertising and promotion of the project, pricing and taxation of the product by the government, content labeling by the FDA, and health and safety warning labeling (US DHHS, 2012) – thus attacking this system by both policy and process.

Healthcare Solution Strategies

When patients in emergency departments are educated on the dangers of tobacco use and are referred to a treatment source, they are more likely to initiate contact with a treatment provider (Boudreaux, Abar, Haskins, Bauman, & Grissom, 2015). Patients prefer a wide variety of tobacco cessation interventions that focus on individualized feedback and autonomy: nicotine replacement therapy options, referral to state quitlines and community cessation workshops, and inpatient cessation counseling (Choo et al., 2012).

The United States Public Health Service updated its clinical practice guidelines in 2008 to include the use of brief tobacco interventions and, specifically, the 5-As, a tobacco intervention model designed to encourage people to quit. Increasing the use of the Brief Tobacco Intervention (2-As: Ask, Advice and 1-R: Referral to Quit Line) for smokeless tobacco users in the emergency department. Evidence-based practice is the “integration of best research evidence with clinical experience and client values” (Sackett et al., 2000, p. 1).

Brief tobacco interventions result in increased quit attempts in low-income tobacco users, especially after they link their smoking to the cause of a pediatric emergency department visit: thus, linking the illness of a child to the adult tobacco use(Mahabee-Gittens, Khoury, Ho, Stone, & Gordon, 2015). Emergency department tobacco cessation interventions result in low three-month cessation rates (Palin, 2015).