Linda McClellan | Meharry Medical College (original) (raw)
Papers by Linda McClellan
Ethnicity & disease, 2004
In order to gain a better understanding of diabetes-related health disparities, Nashville REACH 2... more In order to gain a better understanding of diabetes-related health disparities, Nashville REACH 2010 conducted a community baseline survey on health status. A total of 3204 randomly selected African-American (AA) and Caucasian (C) residents of North Nashville, and a comparison sample of residents living in Nashville/Davidson County were interviewed using a computer-assisted telephone interviewing system. Diabetes prevalence was determined, and similarities/differences relative to access to health care, co-morbid conditions, diabetes care, and lifestyle behaviors, were examined. Age-adjusted prevalence of diabetes was 1.7 times higher among AAs. Increasing age (P<.0001) and being AA (P<.01) were predictive of diabetes status in a regression model. African Americans were more likely to be uninsured (P<.01), while Cs had to travel farther to get medical care (P<.0002). Compared to Caucasians, African Americans were 1.6 times more likely to have co-morbid hypertension (P<...
Journal of Ambulatory Care Management, 2007
Disparities in health status persist for many sociodemographic groups in the United States. An un... more Disparities in health status persist for many sociodemographic groups in the United States. An understanding of barriers to healthcare access and utilization can assist community-based initiatives in developing strategies to improve the health of minority and low-income populations. Using self-reported information from 3014 community residents, a factor analysis was conducted that defined barriers to healthcare by 4 dimensions: (1) time and competing priorities, (2) convenience and availability, (3) healthcare utilization, and (4) healthcare affordability. Differential effects of demographics were observed on all factors. Racial disparities were found where African Americans experienced more problems based on the convenience and availability of services (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .02) than did whites, after controlling for income, education, age, and marital status. In addition, gender differences showed that women experienced greater difficulty with time and competing priorities than men (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001); however, women experienced fewer problems related to utilization (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Of the covariates, income was significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01) on 3 of the 4 indicators. This study points to the need to develop interventions that address the unique challenges faced by different population groups to ensure timely healthcare. In addition, the reduction of economic disparities should be considered as an important strategy to improve public health.
Racial and Ethnic Approaches to Community Health (REACH 2010) is a federally sponsored initiative... more Racial and Ethnic Approaches to Community Health (REACH 2010) is a federally sponsored initiative with the goal of reducing and eliminating disparities in health by 2010. The approach is community-driven, wherein community coalitions design, implement, and evaluate the strategies to eliminate health disparities. This article describes the history, development, and activities of Nashville, Tenn, REACH 2010&amp;amp;amp;amp;amp;amp;amp;#39;s initiative that targets the reduction of cardiovascular disease and diabetes in African Americans. The team-based strategies, generated with considerable community input, focused on effecting changes in access to healthcare, health and wellness, screening, and tobacco use with the goal of making sustainable behavioral and environmental changes. Evaluation includes a Web-based system for collecting process data and random telephone surveys to monitor the program&amp;amp;amp;amp;amp;amp;amp;#39;s impact on health disparities.
Journal of Health Care for The Poor and Underserved, 2006
An important national health care effort is elimination of racial and ethnic disparities in six s... more An important national health care effort is elimination of racial and ethnic disparities in six specific conditions: infant mortality, cancer screening and management, cardiovascular disease, diabetes, human immunodeficiency virus infection, and child and adult immunizations. To address this concern, several health entities in Nashville, Tennessee responded to a grant initiative from the Centers for Disease Control and Prevention to develop a Racial and Ethnic Approaches to Community Health (REACH) demonstration project. The resulting award is the Nashville REACH 2010 Project, charged to develop sustainable methods to reduce and, in time, eliminate racial and ethnic disparities in cardiovascular disease and diabetes in the North Nashville community, where mortality rates of these diseases are substantially higher than in other parts of the county. As one of its many interests, the project included potential health care providers to receive and disseminate messages about disease prevention and health education. The present paper describes the community-campus partnership between the Nashville REACH 2010 project and the post-baccalaureate program of Meharry Medical College, a partnership that enfolded Meharry&amp;amp;amp;#39;s pre-professional health care students into the community-based participatory service research project to increase the awareness and sensitivity of future minority health care providers to issues in minority and poor, underserved populations and to increase potential providers&amp;amp;amp;#39; familiarity with the processes involved in community-based participatory research.
Journal of Health Care for The Poor and Underserved, 2006
An important national health care effort is elimination of racial and ethnic disparities in six s... more An important national health care effort is elimination of racial and ethnic disparities in six specific conditions: infant mortality, cancer screening and management, cardiovascular disease, diabetes, human immunodeficiency virus infection, and child and adult immunizations. To address this concern, several health entities in Nashville, Tennessee responded to a grant initiative from the Centers for Disease Control and Prevention to develop a Racial and Ethnic Approaches to Community Health (REACH) demonstration project. The resulting award is the Nashville REACH 2010 Project, charged to develop sustainable methods to reduce and, in time, eliminate racial and ethnic disparities in cardiovascular disease and diabetes in the North Nashville community, where mortality rates of these diseases are substantially higher than in other parts of the county. As one of its many interests, the project included potential health care providers to receive and disseminate messages about disease prevention and health education. The present paper describes the community-campus partnership between the Nashville REACH 2010 project and the post-baccalaureate program of Meharry Medical College, a partnership that enfolded Meharry&amp;amp;amp;#39;s pre-professional health care students into the community-based participatory service research project to increase the awareness and sensitivity of future minority health care providers to issues in minority and poor, underserved populations and to increase potential providers&amp;amp;amp;#39; familiarity with the processes involved in community-based participatory research.
Incidence of type II diabetes is increasing in the United States and is most prevalent among low-... more Incidence of type II diabetes is increasing in the United States and is most prevalent among low-income African Americans. Community health initiatives supported by partnerships of community leaders and health professionals can contribute to the elimination of inequalities in health status. The focus of Racial and Ethnic Approaches to Community Health (REACH) 2010, an initiative sponsored by the Centers for Disease Control and Prevention, is to facilitate the initiation of community-wide changes as well as increase individual empowerment to reduce disparities in diabetes, cardiovascular disease, and cancer. A pilot program developed by REACH health educators and community health partners to improve disease self-management among low-income African American diabetic patients was implemented at a community health center in Nashville, Tenn. The program&amp;amp;amp;amp;amp;amp;amp;#39;s major components included health education, individual counseling, screenings, and outreach. The program shows promise of improving patient care and outcomes.
This study examined the relation between sense of community (SOC), sociodemographic characteristi... more This study examined the relation between sense of community (SOC), sociodemographic characteristics, and health status to inform community-based interventions designed to prevent and reduce chronic disease in African Americans. A telephone survey was conducted with 1463 randomly selected residents in Nashville, Tenn. Respondents were majority female (69%), African American (59%), and single (59%), with a mean age of 55 (+/-17.61 years). African Americans have lower overall SOC scores, or lower scores on the domains related to perceived influence over community and sharing of common community values compared to Whites. High rates of chronic disease and low SES, combined with a low SOC, can hinder efforts to reduce and eliminate disparities. The goal of community-based participatory initiatives is to create programs that are sustainable by the target community after the funding is gone. Thus, to maximize the success, uptake, and sustainability of disease-specific interventions, it is imperative to incorporate assessment of SOC, identify factors that depress SOC, and engage in community collaboration to develop a plan to improve SOC.
To gain an understanding of health-related practices and perceptions, Nashville REACH 2010 conduc... more To gain an understanding of health-related practices and perceptions, Nashville REACH 2010 conducted focus studies among 5 community groups. Attitudes about health, personal risk behaviors, quality of health care, and models of personal behavior change were assessed. All focus-group sessions were transcribed and analyzed using a consensus panel methodology.
Community-based screening is 1 of 4 strategies selected by the Nashville REACH 2010 project for r... more Community-based screening is 1 of 4 strategies selected by the Nashville REACH 2010 project for reducing disparities in heart disease and diabetes among African Americans in North Nashville, Tenn. We evaluated our screening efforts by asking 4 questions: (1) Are the screening participants representative of the target population? (2) How often were screening participants with possible undiagnosed hypertension, high cholesterol, and diabetes identified? (3) How often were screening participants with an elevated risk for developing hypertension, high cholesterol, and diabetes identified? and (4) How often did we identify screening participants with known hypertension, high cholesterol, and diabetes whose disease management was suboptimal? Results from 1757 persons screened were compared to telephone surveys from 16,199 Nashville residents. Those screened were younger and healthier than the target population. Rates of potentially undiagnosed cases among African Americans were 0.8% for diabetes, 17.4% for hypertension, and 32.7% for high cholesterol. High-risk individuals were identified 13.1% of the time for diabetes, 45.3% of the time for hypertension, and 21.3% of the time for total cholesterol. Rates of poorly controlled known disease were 23.5% for diabetes, 39.0% for hypertension, and 58.2% for total cholesterol. Although we reached a younger and healthier group than the community population, community-based screenings identified many people with potential health risks. We present a model of how to organize and implement successful community-based screening.
Depression and psychological distress often go unrecognized and untreated in primary care setting... more Depression and psychological distress often go unrecognized and untreated in primary care settings. The association between depression, socioeconomic status, and chronic disease underscore the importance of incorporating mental health education and screening into community-based health initiatives. This is particularly critical for African Americans who bear a disproportionate burden of poverty and chronic disease. This descriptive study assessed associations between symptoms of depression, socioeconomic status, healthcare utilization, physical and mental health functioning, and reactions to race among a sample of low-income African Americans. Consistent with the findings of previous research, respondents with symptoms of depression reported lower levels of physical and mental health functioning, and perceived that they had been treated worse by others at work, and had worse healthcare experiences than those of other races. Community-based programs for reducing disparities in physical illness may need to address the burden of undiagnosed and untreated depression in order to become optimally effective.
Purpose: To describe and map the spatial clustering of obesity, diabetes, and hypertension in Nas... more Purpose: To describe and map the spatial clustering of obesity, diabetes, and hypertension in Nashville, Tennessee. • Method: Data from two random community phone surveys was geocoded and combined into a single dataset. Data was aggregated by census tract, and those tracts with 10 or more interviews (129 of 144, 7,606 cases) were included. • Results: Obesity, hypertension, and diabetes prevalence in the 129 census tracts showed clear geographic clustering when mapped using GIS software. Linear regression analysis shows that spatial distribution of risk factors clusters with diabetes, hypertension, and obesity prevalence. Geographic clusters were similar for the health access, health behaviors, neighborhood safety, demographics, socioeconomic status, and neighborhood contextual measures obtained from census data. • Conclusion: Analysis of geographic clustering can be used to identify high-risk neighborhoods and may be useful in planning and targeting public health interventions.
Ethnicity & disease, 2004
In order to gain a better understanding of diabetes-related health disparities, Nashville REACH 2... more In order to gain a better understanding of diabetes-related health disparities, Nashville REACH 2010 conducted a community baseline survey on health status. A total of 3204 randomly selected African-American (AA) and Caucasian (C) residents of North Nashville, and a comparison sample of residents living in Nashville/Davidson County were interviewed using a computer-assisted telephone interviewing system. Diabetes prevalence was determined, and similarities/differences relative to access to health care, co-morbid conditions, diabetes care, and lifestyle behaviors, were examined. Age-adjusted prevalence of diabetes was 1.7 times higher among AAs. Increasing age (P<.0001) and being AA (P<.01) were predictive of diabetes status in a regression model. African Americans were more likely to be uninsured (P<.01), while Cs had to travel farther to get medical care (P<.0002). Compared to Caucasians, African Americans were 1.6 times more likely to have co-morbid hypertension (P<...
Journal of Ambulatory Care Management, 2007
Disparities in health status persist for many sociodemographic groups in the United States. An un... more Disparities in health status persist for many sociodemographic groups in the United States. An understanding of barriers to healthcare access and utilization can assist community-based initiatives in developing strategies to improve the health of minority and low-income populations. Using self-reported information from 3014 community residents, a factor analysis was conducted that defined barriers to healthcare by 4 dimensions: (1) time and competing priorities, (2) convenience and availability, (3) healthcare utilization, and (4) healthcare affordability. Differential effects of demographics were observed on all factors. Racial disparities were found where African Americans experienced more problems based on the convenience and availability of services (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .02) than did whites, after controlling for income, education, age, and marital status. In addition, gender differences showed that women experienced greater difficulty with time and competing priorities than men (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001); however, women experienced fewer problems related to utilization (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Of the covariates, income was significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01) on 3 of the 4 indicators. This study points to the need to develop interventions that address the unique challenges faced by different population groups to ensure timely healthcare. In addition, the reduction of economic disparities should be considered as an important strategy to improve public health.
Racial and Ethnic Approaches to Community Health (REACH 2010) is a federally sponsored initiative... more Racial and Ethnic Approaches to Community Health (REACH 2010) is a federally sponsored initiative with the goal of reducing and eliminating disparities in health by 2010. The approach is community-driven, wherein community coalitions design, implement, and evaluate the strategies to eliminate health disparities. This article describes the history, development, and activities of Nashville, Tenn, REACH 2010&amp;amp;amp;amp;amp;amp;amp;#39;s initiative that targets the reduction of cardiovascular disease and diabetes in African Americans. The team-based strategies, generated with considerable community input, focused on effecting changes in access to healthcare, health and wellness, screening, and tobacco use with the goal of making sustainable behavioral and environmental changes. Evaluation includes a Web-based system for collecting process data and random telephone surveys to monitor the program&amp;amp;amp;amp;amp;amp;amp;#39;s impact on health disparities.
Journal of Health Care for The Poor and Underserved, 2006
An important national health care effort is elimination of racial and ethnic disparities in six s... more An important national health care effort is elimination of racial and ethnic disparities in six specific conditions: infant mortality, cancer screening and management, cardiovascular disease, diabetes, human immunodeficiency virus infection, and child and adult immunizations. To address this concern, several health entities in Nashville, Tennessee responded to a grant initiative from the Centers for Disease Control and Prevention to develop a Racial and Ethnic Approaches to Community Health (REACH) demonstration project. The resulting award is the Nashville REACH 2010 Project, charged to develop sustainable methods to reduce and, in time, eliminate racial and ethnic disparities in cardiovascular disease and diabetes in the North Nashville community, where mortality rates of these diseases are substantially higher than in other parts of the county. As one of its many interests, the project included potential health care providers to receive and disseminate messages about disease prevention and health education. The present paper describes the community-campus partnership between the Nashville REACH 2010 project and the post-baccalaureate program of Meharry Medical College, a partnership that enfolded Meharry&amp;amp;amp;#39;s pre-professional health care students into the community-based participatory service research project to increase the awareness and sensitivity of future minority health care providers to issues in minority and poor, underserved populations and to increase potential providers&amp;amp;amp;#39; familiarity with the processes involved in community-based participatory research.
Journal of Health Care for The Poor and Underserved, 2006
An important national health care effort is elimination of racial and ethnic disparities in six s... more An important national health care effort is elimination of racial and ethnic disparities in six specific conditions: infant mortality, cancer screening and management, cardiovascular disease, diabetes, human immunodeficiency virus infection, and child and adult immunizations. To address this concern, several health entities in Nashville, Tennessee responded to a grant initiative from the Centers for Disease Control and Prevention to develop a Racial and Ethnic Approaches to Community Health (REACH) demonstration project. The resulting award is the Nashville REACH 2010 Project, charged to develop sustainable methods to reduce and, in time, eliminate racial and ethnic disparities in cardiovascular disease and diabetes in the North Nashville community, where mortality rates of these diseases are substantially higher than in other parts of the county. As one of its many interests, the project included potential health care providers to receive and disseminate messages about disease prevention and health education. The present paper describes the community-campus partnership between the Nashville REACH 2010 project and the post-baccalaureate program of Meharry Medical College, a partnership that enfolded Meharry&amp;amp;amp;#39;s pre-professional health care students into the community-based participatory service research project to increase the awareness and sensitivity of future minority health care providers to issues in minority and poor, underserved populations and to increase potential providers&amp;amp;amp;#39; familiarity with the processes involved in community-based participatory research.
Incidence of type II diabetes is increasing in the United States and is most prevalent among low-... more Incidence of type II diabetes is increasing in the United States and is most prevalent among low-income African Americans. Community health initiatives supported by partnerships of community leaders and health professionals can contribute to the elimination of inequalities in health status. The focus of Racial and Ethnic Approaches to Community Health (REACH) 2010, an initiative sponsored by the Centers for Disease Control and Prevention, is to facilitate the initiation of community-wide changes as well as increase individual empowerment to reduce disparities in diabetes, cardiovascular disease, and cancer. A pilot program developed by REACH health educators and community health partners to improve disease self-management among low-income African American diabetic patients was implemented at a community health center in Nashville, Tenn. The program&amp;amp;amp;amp;amp;amp;amp;#39;s major components included health education, individual counseling, screenings, and outreach. The program shows promise of improving patient care and outcomes.
This study examined the relation between sense of community (SOC), sociodemographic characteristi... more This study examined the relation between sense of community (SOC), sociodemographic characteristics, and health status to inform community-based interventions designed to prevent and reduce chronic disease in African Americans. A telephone survey was conducted with 1463 randomly selected residents in Nashville, Tenn. Respondents were majority female (69%), African American (59%), and single (59%), with a mean age of 55 (+/-17.61 years). African Americans have lower overall SOC scores, or lower scores on the domains related to perceived influence over community and sharing of common community values compared to Whites. High rates of chronic disease and low SES, combined with a low SOC, can hinder efforts to reduce and eliminate disparities. The goal of community-based participatory initiatives is to create programs that are sustainable by the target community after the funding is gone. Thus, to maximize the success, uptake, and sustainability of disease-specific interventions, it is imperative to incorporate assessment of SOC, identify factors that depress SOC, and engage in community collaboration to develop a plan to improve SOC.
To gain an understanding of health-related practices and perceptions, Nashville REACH 2010 conduc... more To gain an understanding of health-related practices and perceptions, Nashville REACH 2010 conducted focus studies among 5 community groups. Attitudes about health, personal risk behaviors, quality of health care, and models of personal behavior change were assessed. All focus-group sessions were transcribed and analyzed using a consensus panel methodology.
Community-based screening is 1 of 4 strategies selected by the Nashville REACH 2010 project for r... more Community-based screening is 1 of 4 strategies selected by the Nashville REACH 2010 project for reducing disparities in heart disease and diabetes among African Americans in North Nashville, Tenn. We evaluated our screening efforts by asking 4 questions: (1) Are the screening participants representative of the target population? (2) How often were screening participants with possible undiagnosed hypertension, high cholesterol, and diabetes identified? (3) How often were screening participants with an elevated risk for developing hypertension, high cholesterol, and diabetes identified? and (4) How often did we identify screening participants with known hypertension, high cholesterol, and diabetes whose disease management was suboptimal? Results from 1757 persons screened were compared to telephone surveys from 16,199 Nashville residents. Those screened were younger and healthier than the target population. Rates of potentially undiagnosed cases among African Americans were 0.8% for diabetes, 17.4% for hypertension, and 32.7% for high cholesterol. High-risk individuals were identified 13.1% of the time for diabetes, 45.3% of the time for hypertension, and 21.3% of the time for total cholesterol. Rates of poorly controlled known disease were 23.5% for diabetes, 39.0% for hypertension, and 58.2% for total cholesterol. Although we reached a younger and healthier group than the community population, community-based screenings identified many people with potential health risks. We present a model of how to organize and implement successful community-based screening.
Depression and psychological distress often go unrecognized and untreated in primary care setting... more Depression and psychological distress often go unrecognized and untreated in primary care settings. The association between depression, socioeconomic status, and chronic disease underscore the importance of incorporating mental health education and screening into community-based health initiatives. This is particularly critical for African Americans who bear a disproportionate burden of poverty and chronic disease. This descriptive study assessed associations between symptoms of depression, socioeconomic status, healthcare utilization, physical and mental health functioning, and reactions to race among a sample of low-income African Americans. Consistent with the findings of previous research, respondents with symptoms of depression reported lower levels of physical and mental health functioning, and perceived that they had been treated worse by others at work, and had worse healthcare experiences than those of other races. Community-based programs for reducing disparities in physical illness may need to address the burden of undiagnosed and untreated depression in order to become optimally effective.
Purpose: To describe and map the spatial clustering of obesity, diabetes, and hypertension in Nas... more Purpose: To describe and map the spatial clustering of obesity, diabetes, and hypertension in Nashville, Tennessee. • Method: Data from two random community phone surveys was geocoded and combined into a single dataset. Data was aggregated by census tract, and those tracts with 10 or more interviews (129 of 144, 7,606 cases) were included. • Results: Obesity, hypertension, and diabetes prevalence in the 129 census tracts showed clear geographic clustering when mapped using GIS software. Linear regression analysis shows that spatial distribution of risk factors clusters with diabetes, hypertension, and obesity prevalence. Geographic clusters were similar for the health access, health behaviors, neighborhood safety, demographics, socioeconomic status, and neighborhood contextual measures obtained from census data. • Conclusion: Analysis of geographic clustering can be used to identify high-risk neighborhoods and may be useful in planning and targeting public health interventions.