Editorial Board:
Editor:
George H. Conklin,
 North Carolina
 Central University

Board:
Bob Davis,
 North Carolina
 Agricultural and
 Technical State
 University

Richard Dixon,
 UNC-Wilmington

Ken Land,
 Duke University

Miles Simpson,
 North Carolina
 Central University

Ron Wimberley,
 N.C. State University

Robert Wortham,
 North Carolina
 Central University

Editorial Assistants

John W.M. Russell,
 Technical
 Consultant

Austin W. Ashe,
 North Carolina
 Central University

® 

Volume 7, Number 2

Fall/Winter 2009
 
 

Racial Health Disparities in a Military County: A Research Report*

by

Akbar Aghajanian

and

Sharmila Udyavar

Fayetteville State University

Introduction

    Since 1972 CDC has sponsored the annual National Health Interview Survey (NHIS). The survey collects data from a large sample of US households, a sample of adults in each household, and a sample of children in each household. The survey is implemented by the US Bureau of Census and is analyzed by the National Center for Health Statistics.  NHIS data is the major source of health status statistics for the non-institutionalized population of the United States. The data provide strong excellent measures for health disparities at the national level.

    County level data on health status are not available as readily and consistently as compared to the national level. One reason for this is that the number of numerators for a large number of health status measures is small for small-population counties and this will result in unreliable estimates. However, large counties such as Cumberland County North Carolina with a population of more than 300, 0000, can benefit from having estimates of health status and health status differentials. The availability of such measures will help the County level government and local community based organization in better planning and utilization of their resources for improving the health and wellbeing of all groups and classes in the community. In 2006, with the establishment of the Survey Center funded by the National Center for Minority Health Disparities at Fayetteville State University, we started conducting a series of annual surveys at the county level. This paper reports on the results from the 2006 Cumberland County Survey.

    The data for this research was drawn from Cumberland County Health Survey conducted in fall 2006. The target population for the Cumberland County Health Survey (CCHS) was all population 18 years and older, residing in Cumberland County, North Carolina as of October 2006.  The respondents were contacted by telephone and after describing the survey purpose and receiving their consent, they were interviewed. The interview took between 11-13 minutes by trained interviewers. 

    The questionnaire used for this purpose was adopted from the National Health Interview Survey.   The sample was randomly selected from phone numbers of households in Cumberland County. The phone number selection procedure involved Comprehensive Sample Screening to ensure the telephone numbers represented residential locations and not cell phones or businesses. A total of 1567 were randomly selected and screened phone numbers were called. A total of 1058 eligible subjects were interviewed by trained interviewers. Among this sample there were 994 whites and African Americans adult men and women whose data are used in this study.

    Consistent with the national level data, the following variables were constructed: 

• Percent of the adult population that reported a health care provider has told them they have hypertension
• Percent of the adult population that reported a health care provider has told them they have coronary heart disease
• Percent of the adult population that reported a health care provider has told them they have diabetes
• Percent of the population that reported smoking
• Percent of the population who rate their heath as poor or fair
• Percent of the population who are overweight or obese as measured by BMI of more than 25 and 30 respectively
• Percent of the population who were seriously depressed as measured by Kessler’s Depression Index

• During the past 30 days, how often did you feel so sad that nothing could cheer you up?
• During the past 30 days, how often did you feel nervous? 
• During the past 30 days, how often did you feel restless or fidgety? 
• During the past 30 days, how often did you feel hopeless?
• During the past 30 days, how often did you feel that everything was an effort? 
• During the past 30 days, how often did you feel worthless? 

     Table 1 shows the distribution of the characteristics of the adult population 18 years and older from the national and county level surveys.

The sex and marital distribution of the two populations are consistent with Cumberland County having a higher percentage of married population and less percentage of single. The divorce and widowhood rates are similar. The main demographic difference is in the percentage of blacks in the two populations. In Cumberland County 43.1 percent of the adult population surveyed are black, consistent with almost 40 percent of the total Cumberland County population reported as African-Americans. The reported household incomes seem to be slightly better the national level using wide-range of classification. The observed age distribution is consistent with the national age distribution and shows a slightly younger age distribution for Cumberland County as expected in this military county.

    About 32 percent of the adult population reported hypertension as compared to the 30 percent at the national level (Table 2). 

The adult population in Cumberland County has a markedly higher level of coronary heart disease and almost two times the national rate diabetes. While the physiological indicators show a lower health status for the local adult population, their self-rated health report is slightly worse than the self-rate health report reported at the national level. About 18 percent of the adult population in Cumberland County report that their health is fair or poor as compared to 14 percent of the national sample. The overweight and obesity levels at the county and national level are consistent although we expected a higher rate for county population. The index of serious psychological distress was the same for the national and county sample.

    Table 3 shows the health status by race and gender. The first observation is that hypertension rate is higher for females than males and for black females than white females. 

On the other hand coronary heart disease is more prevalent among white males and females. Black females have the highest rate of diabetes and they also report the highest rate of poor and fair health. The high rates of low self rated health, and low health status based on clinical indicators for black women is consistent with their high rate of obesity. About 44 percent of African-American adult women are obese as compared to 31 percent of white females and 25 percent of white males.

    Kessler's index of serious psychological depression is very high for white females and higher than the national average. Similarly black women have a much higher rate of serious psychological distress. Overall women report a higher level of depression and white females express the highest level of distress. 

    Local government departments such as county health departments and community based organizations receive significant funding for intervention to improve the health of the population at the county level. Investing these funds based on specific target populations, based on social and demographic categories will be much more effective. Similarly evaluation of the impact of the intervention activities will benefit from county level data which allows measurement of change over time. Hence the collection of these data are very important. 

    The results from this project suggest that collection of local health data by socio-demographic characteristics utilizing telephone surveys is cost effective. It is possible to collect data similar to the national level data through local telephone surveys and such data are reliable and consistent. These data are very useful resource. For example, based on this data we know that black women are in the highest need of intervention for a combination of health complications which are inter-related; or smoking interventions are very important for white men. Similarly any mental health intervention should give priority to white women. With such data collected at least every three years, they provide the best resource for examining the effect of the intervention activities conducted during the previous three years allowing with enough time-lag the effect of intervention activities. Local government departments and community-based organization can include a small budget to support collection of data through collaboration with local colleges and universities such as Fayetteville State University. 
 

Kessler, R., Mroczek, D. 1992.  "An Update of the Development of Mental Health Screening Scales for the US National Health Interview Study [memo dated 12/22/92]."  Ann Arbort (MI): Survey Research Center of the Institute for Social Research. University of Michigan.

Kessler, R., Mroczek, D. 1994.  "Final Version of our Non-specific Psychological Distress Scale [memo dated 10/3/94]." Ann Arbor (MI): Survey Research Center of the Institute for Social Research. University of Michigan.

*Data collection and preparation for this paper was supported by grant P20 MD001089 from the National Institution of Health, NCMHD, and Department of Health and Human Services 
 

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©2009 by the North Carolina Sociological Association