Daniel L Howard

Texas A&M University | TAMU · Department of Psychological and Brain Sciences

This study examines differences in breast cancer survival between African-American and white women to determine whether there is a racial difference in survival after accounting for established influences on outcome, such as stage of cancer, health status, health behavior, utilization patterns, access to care, quality of care, and the doctor-patien...

This study examines whether the racial mix of clients is related to treatment organization outcome rates after controlling for the social environment in which the organization operates. A nationally representative sample of 326 nonmethadone outpatient substance misuser treatment organizations was surveyed in 1990. Unit analysis is the treatment org...

In this study, we examined racial separation in long-term care. We used a survey of a stratified sample of 181 residential care/assisted living (RC/AL) facilities and 39 nursing homes in 4 states. Most African Americans resided in nursing homes and smaller RC/AL facilities and tended to be concentrated in a few predominantly African American facili...

This study measures the level of cultural competency with respect to African American clients that exists among a national sample of outpatient substance abuse treatment (OSAT) units and determines the relationship of cultural competency to various characteristics of these units and their clients. The study utilizes cross-sectional data from the 19...

To examine the relationship that international medical school graduates (IMGs) in comparison with United States medical school graduates (USMGs) have on health care-seeking behavior and satisfaction with medical care among African-American and white elderly. Secondary data analysis of the 1986-1998 Piedmont Health Survey of the Elderly, Established...

Prostate cancer is a significant impediment that can reduce physical functional status. Mobility is fundamental for quality of life and church attendance to be associated with improved physical functioning. Few studies have examined how religious participation have implications for mobility limitation among men in general and among prostate cancer...

Prostate cancer is a significant impediment in men’s lives as this condition often exacerbates stress and reduces quality of life. Faith can be a resource through which men cope with health crises; however, few studies examine how religion or spirituality can have implications for racial disparities in health outcomes among men. The purpose of this...

The objective of this paper was to determine whether there were any race differences in mobility limitation among PCa survivors, and understand the impact of socioeconomic status (SES) on this relationship. Data consisted of 661 PCa survivors (296 Black and 365 White) from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes (DAD) Stud...

Background: /Purpose: Little is known about primary care physicians' (PCPs) beliefs about prostate cancer screening efficacy, evidence uncertainty, and their actual screening behaviors. We examined factors associated with PCP beliefs about screening efficacy and uncertainty and whether beliefs were associated with prostate specific-antigen (PSA) t...

p> Objectives: The objectives of our study were to determine the prevalence of major depressive symptoms and identify factors that are associated with major depressive symptoms among Black men with prostate cancer (PCa). Design: This study consisted of 415 Black men aged 40-81 years that entered the North Carolina Central Cancer Registry during t...

Background: Medical mistrust is thought to affect health care-based decisions and has been linked to poor health outcomes. The effects of medical mistrust among men with prostate cancer are unknown. Thus, the goal of the current study is to examine the association between medical mistrust and quality of life (QOL) among black and white men with pr...

Background: Disparities among patients with prostate cancer exist across the continuum of care. The interval of time that lapses between first diagnosis and treatment is another disparity that may exist but has not been fully explored. Methods: Our study looked at the data of 749 men (353 black and 396 white) who were 40 to 81 years of age when...

The objective of this study is to examine factors among a group of African American and White men in North Carolina and their assessment of prostate cancer treatment choice or belief that treatment chosen was best. A sample of men (N = 877) with a history of prostate cancer diagnosis was recruited from the North Carolina Cancer Registry during 2007...

We assessed associations between pastor and congregant characteristics and congregant attitudes about research participation among African American churches. Respondents shared their attitudes regarding how willing, ready, and confident they were about research participation. The outcome measure, the index of research preparedness, summed responses...

Background: Although churches are an important partner for improving health within the African American community, it is not known how congregants are best reached by health promotion activities and thus how best to target members in recruitment. This study examined how characteristics of churches and congregants' beliefs and interests in faith-ba...

African Americans face the most severe burden of HIV among other racial and ethnic groups in the United States. One group warranting attention in North Carolina has been African American male college students. Between 2000 and 2003, 11% of new HIV infections among men ages 18-30 were enrolled in college at the time of their diagnosis, with 87% of t...

African Americans face the most severe burden of HIV among other racial and ethnic groups in the United States. One group warranting attention in North Carolina has been African American male college students. Between 2000 and 2003, 11% of new HIV infections among men ages 18-30 were enrolled in college at the time of their diagnosis, with 87% of t...

Background: This article describes the process our community-academic partnership used to lay the groundwork for successful implementation of an adolescent-focused, evidence-based HIV/AIDS prevention curriculum in two Black churches. Objectives: We highlight the challenges encountered and lessons learned in building a relationship with two churc...

Complementary and alternative medicine (CAM) has been commonly used among Americans; however, less is known about its use among men with a history of prostate cancer. This study used the 2002 National Health Interview Survey (NHIS) to explore the amount and type of CAM use among 218 Black and White men with a history of prostate cancer. Over 90% of...

Data management is essential for health services research. Data sources such as inpatient records, insurance claims, and large national surveys form the basis for majority of research studies addressing questions related to health care access, delivery and outcomes. The purpose of these secondary data sources is generally not specific to the my...

Background: Despite the indication that the majority of service needs for African-Americans are unmet, there has been a strong and consistent response from the African-American church to serve as the surrogate for the medical sector. Historically, African-American churches have been a strong source of support for the spiritual, mental, and physical...

Background: Disturbing trends regarding the sex, age, and race of gunshot victims have been reported in previous national studies; however, gunshot trends have not been well documented in individual cities in the southeastern United States. Objectives: 1) Analyze trends in gunshot wounds, particularly the association between gunshot wounds and r...

Research objectives Since the late 1980s, research examining this particular abuse has become more complex as both nationally and globally crack use/abuse has often been framed as an African American. problem in part resulting from the high volume of African Americans seeking treatment for illnesses resultant from their crack-cocaine use and an inc...

We assessed church readiness to engage in health disparities research using a newly developed instrument, examined the correlates of readiness, and described strategies that churches used to promote health. We pilot tested the instrument with churches in a church-academic partnership (n = 12). We determined level of readiness to engage in research...

Though research has examined race as an important factor in defining the scope of glaucoma in the United States, further exploration into other specific factors may help inform the design of preventive services to decrease rates of blindness due to glaucoma among minority groups. This study examined glaucoma diagnosis among a sample of elderly pati...

Objective This study examined prostate-specific antigen (PSA) test use among men and identified sociodemographic and health-related characteristics associated with its use over time. Methods The National Health Interview Survey collected information on PSA test use among 16,058 men ≥40 years of age in 2000 and 2005. We examined two outcomes: (7) h...

This study examined prostate-specific antigen (PSA) test use among men and identified sociodemographic and health-related characteristics associated with its use over time. The National Health Interview Survey collected information on PSA test use among 16,058 men > or = 40 years of age in 2000 and 2005. We examined two outcomes: (1) having had a r...

To determine the impact of ethnicity on "near miss"/severe obstetric morbidity in a multi-ethnic, tertiary care population. We carried out a cross-sectional analysis using birth data for 12,774 women with Medicaid who gave birth between January 1994 and January 2005 at Duke University. Univariate and multivariate analyses were carried out to compar...

Issues Researchers have found that behaviors associated with managing and controlling CVD, such as seeking treatment, controlling diet, and exercising, may be significantly influenced not only by a man's awareness and knowledge, but also by his racial/ethnic identity, gender role socialization, and culture, among other influences. This study examin...

Background: The 2001 Surgeon General's landmark findings identified an unarguably significant racial disparity in publicly provided behavioral health care that results in overrepresentation, underdiagnosis, inappropriate treatment, and inaccessibility of services for minorities. Many policy initiatives focusing on behavioral health have examined th...

Androgen deprivation therapy (ADT) is widely used to manage the symptoms of advanced prostate cancer and has been shown to slow the progression of the disease. Previous research investigating racial differences in the use of ADT has reported inconsistent findings. The purpose of this study was to assess use trends for ADT overall and by type (orchi...

There is emerging evidence that weight change during older adulthood is associated with decreased physical function; however, less is known about the association between weight change during middle to older adulthood and physical function. This study assessed the association of weight change between middle and older adulthood and functional limitat...

Shaw University, the oldest historically black college or university in the southern USA, recently partnered with the University of North Carolina at Chapel Hill, a major research institution in North Carolina, to further develop Shaw's research infrastructure. One aim of the partnership involved establishing a human research ethics committee and a...

This study examined PSA screening interval of black and white men aged 65 or older and its association with prostate cancer stage at diagnosis. SEER-Medicare data were examined for 18,067 black and white men diagnosed with prostate cancer between 1994 and 2002. Logistic regression was used to assess the association between race, PSA screening inter...

Although national methadone treatment trends have improved substantially from 1988 to 2001, current research has found that African Americans still receive lower dosages of methadone treatment than their white and Hispanic counterparts, which has significant public health concerns. We sought to empirically examine whether the degree of cultural com...

This study examined the impact of physical and sexual trauma on a sample of 239 homeless men. Study participants completed a self-administered survey that collected data on demographics, exposure to psychological trauma, physical health and mental health problems, and substance use or misuse. Binomial logistic regression analyses were used to exami...

This article describes the development of the Center for Survey Research at Shaw University, a Historically Black College and University (HBCU), and its efforts to build a data collection infrastructure that addresses issues germane to health disparities research in the African American population. Academic institutions that are similar to Shaw in...

Introduction. Though some research has begun to examine specific factors related to race that should be targeted in the design of interventions to improve medication adherence, there remains an underreporting of factors that contribute to the use of hypertensive medications by race. Methods. This study examined medication use reported by a sample...

Introduction. Though research has examined race as an important factor in defining the scope of glaucoma in the United States, further exploration into other specific factors may help inform the design of preventive services to decrease rates of blindness due to glaucoma among minority groups. There remains an underreporting of individual and servi...

To determine whether there is a difference in the incidence of pressure ulcers (PU) between African American (AA) and White nursing home (NH) residents in the Southeastern United States. Data from the Centers for Medicare and Medicaid Services Minimum Data Set were examined for 113,869 residents who were free of PU at NH admission during 1999-2002....

African-American men experience greater incidence and mortality from prostate cancer compared to White men as well as men from other groups. Few studies have examined prostate-specific antigen (PSA) test and digital rectal examination (DRE) use in African-American men. This study examined use of the PSA test and DRE among African-American men over...

To determine whether racial differences exist between consistency of medical care and blood pressure (BP) control over time among elderly, hypertensive African Americans and whites. Participants included 1402 African Americans and 1058 whites from the Piedmont Health Survey of the Elderly who were hypertensive (systolic BP > or =140 mm Hg, diastoli...

Studies have examined prostate-specific antigen (PSA) test and digital rectal examination (DRE) use among men; however, few have examined use of these procedures together over time. This study examined use of the PSA test and DRE among men over time and identified correlates associated with test use for the PSA test only, the DRE only, and both pro...

Though some research has begun to examine specific factors related to race that should be targeted in the design of interventions to improve medication adherence, there remains an underreporting of factors that contribute to the use of hypertensive medications by race. This study examined medication use reported by a sample of elderly, controlled a...

This study is a continuation of an earlier study that examined hospitalization rates for ambulatory care sensitive (ACS) conditions, as a proxy for quality of care, and found evidence of a racial disparity among African American and White Medicare beneficiaries. The current study sought to determine whether neighborhood socioeconomic status (SES) e...

This study investigates associations between hospital and surgeon volume, and racial differences in recurrence after surgery for prostate cancer. Data from the 1991 to 2002 Surveillance, Epidemiology, and End-Results-Medicare database were examined for 962 black and 7387 white men who received surgery for prostate cancer within 6 months of diagnosi...

At least 10.8 million living Americans have been diagnosed with cancer, and about 1.5 million new cancer cases are expected to be diagnosed in 2008. The purpose of this study was to examine prayer for health and self-reported health among a sample of men and women with a personal history of cancer. We used data from the 2002 National Health Intervi...

Background: Black churches have traditionally played a significant role in the African American community. Increasingly, African American churches are recognized as an important setting for health interventions and research by researchers and health professionals. We describe the process of developing and implementing a Congregational Health Assess...

Objective. To explore racial differences in self-rated health (SRH) and its relationship to activities of daily living (ADLs) and mobility limitations among stroke survivors. Method. Data from 580 Black and White participants of the North Carolina Established Populations for Epidemiologic Studies of the Elderly (EPESE) were used to assess relations...

There are limited population-based studies of benign prostate hyperplasia (BPH) and lower urinary tract symptoms (LUTS) in men, and most studies examined to date have been restricted to predominately white populations. This study examines treatment and all-cause mortality among a cohort of African-American and white men aged > or =65 with BPH/LUTS...

This article describes the Carolina-Shaw Partnership for the Elimination of Health Disparities efforts to engage a diverse group of Black churches in a sustainable network. We sought to develop a diverse network of 25 churches to work with the Carolina-Shaw Partnership to develop sustainable health disparities research, education, and intervention...

Prostate cancer is the second leading cancer killer in men. Men in general and African American men in particular face crucial decisions regarding prostate cancer screening and perhaps treatment for this disease. Major health organizations agree that men should discuss prostate cancer screening with their physicians or other health care professiona...

The Shaw-UNC Undergraduate Program in Prostate Cancer Research and Training (SUUPPRT) is a collaborative project between the University of North Carolina at Chapel Hill (UNC-CH), and Shaw University, the oldest Historically Black College/University in the South. SUUPPRT provides research and academic training to prepare young men and women of color...

Self rated health (SRH), an important measure in epidemiological studies, is also proven a strong predictor of survival and future health outcomes. As a chronic disease construct, it reportedly consists of three factors: disease, disability and functional (ADL) limitations. Stroke accounts for the largest impact on SRH among chronic conditions. How...

The purpose of this study was to examine racial disparities and the "Hispanic paradox" in pregnancy outcomes at a tertiary-care medical center. A cross-sectional study of pregnancy events was performed with information from the Duke University birth database. The latter includes data on birth outcomes, cost, and health services factors. The final s...

The reasons for African-American men to seek care for lower urinary care symptoms has not been determined due to sparse population-based data. Our study examines the solicitation and receipt of medical care for urinary symptoms among racially oversampled elderly urban and rural cohort of African Americans and whites. Longitudinal analyses were cond...

Relatively little is known about differences in the prevalence of urinary incontinence (UI) by race and region in the United States. To use the 1999-2002 Centers for Medicare and Medicaid Services (CMS) Minimum Data Set (MDS), Atlanta Region, to investigate the prevalence of UI among African American and Caucasian residents of nursing homes (NH) in...

This study examines race variations in quality of care through the proxy of ambulatory care sensitive (ACS) conditions. Hospital admission rates for eight ACS conditions were examined for African American and white Medicare beneficiaries in North Carolina. Temporal variations for ACS were also examined. Enrollment and inpatient claims files from th...

To assess the effects of physician-patient racial concordance and continuity of care on hypertension outcomes, we described patterns of care for hypertension; we used cross-tabulations and repeated measures (generalized estimating equations) analyses with panel survey data from elderly persons interviewed and examined in 1987 and 1990. Continuity o...

Health disparities are an enormous challenge to American society. Addressing these disparities is a priority for U.S. society and especially for institutions of higher learning, with their threefold mission of education, service, and research. Collaboration across multiple intellectual disciplines will be critical as universities address health dis...

This study examines whether organizational treatment goals varied among outpatient substance abuse treatment (OSAT) units identified as providing a level of culturally competent care for African Americans. Cross-sectional data from the 1995 National Drug Abuse Treatment System Survey (NDATSS) was used. Of the nationally representative, stratified s...

The authors examined how racial matching between older patients and physicians relates to effectiveness of care, use of services, and satisfaction with care. In this cross-sectional, community-based cohort study, 2,867 elderly African American and White North Carolina residents with regular physicians were interviewed and screened for hypertension...

Access is a multidimensional concept representing the ease with which health services are initiated and sustained. In this study, conceptual domains of access--affordability, acceptability, accommodation, availability, service diversity, and competitive stance--are hypothesized to predict the time clients wait to receive services. A large, recently...

Do outpatient substance misuse treatment organizations have different outcomes for court-mandated and voluntary clients depending on the mix of those clients? Do client characteristics, organizational factors, and treatment practices predict organizational treatment outcome rates? A nationally representative sample of 330 nonmethadone outpatient su...

Research on Latinos receiving substance abuse care lacks detail in terms of client characteristics, treatment services, and the effectiveness of treatment. This study uses data from a large, recent, nationally representative sample of outpatient substance abuse treatment units to examine differences in client characteristics, treatment services, an...