Objectives
We explored whether the introduction of 3 lifesaving innovations introduced between 1989 and 1996 increased, decreased, or had no effect on disparities in Black-White mortality in the United States through 2006.
Methods
Centers for Disease Control and Prevention data were used to assess disease-, age-, gender-, and race-specific changes in mortality after the introduction of highly active anti-retroviral therapy (HAART) for treatment of HIV, surfactants for neonatal respiratory distress syndrome, and Medicare reimbursement of mammography screening for breast cancer.
Results
Disparities in Black-White mortality from HIV significantly increased after the introduction of HAART, surfactant therapy, and reimbursement for screening mammography. Between 1989 and 2006, these circumstances may have accounted for an estimated 22441 potentially avoidable deaths among Blacks.
Conclusions
These descriptive data contribute to the formulation of the hypothesis that federal laws promote increased disparities in Black-White mortality by inadvertently favoring Whites with respect to access to lifesaving innovations. Failure of legislation to address known social factors is a plausible explanation, at least in part, for the observed findings. Further research is necessary to test this hypothesis, including analytic epidemiological studies designed a priori to do so.
Teenage drivers, especially males, have higher rates of motor vehicle crashes and engage in riskier driving behavior than adults. Motor vehicle deaths disproportionately impact youth from poor and minority communities and in many communities there are higher rates of risky behaviors among minority youth. In this paper, the authors review the data on teens, risky driving behaviors, and morbidity and mortality. They identify areas in which known disparities exist, and examine strategies for changing teen driving behavior, identifying what has worked for improving the use of seat belts and for reducing other risky behaviors. A multifaceted, multilevel model based on ecological theory is proposed for understanding how teens make choices about driving behaviors, and to understand the array of factors that can influence these choices. The model is used to create recommendations for comprehensive intervention strategies that can be used in minority communities to reduce disparities in risk behaviors, injury, disability, and death.
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