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An Overview of Disparities and Improving the Collection of Race, Ethnicity, and Language Data: the MDPH Approach NAPHSIS ANNUAL MEETING, 2007. Bruce B. Cohen and Brunilda Torres Massachusetts Department of Public Health June 2007. Overview: Improving Data Collection. Historical Context

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An Overview of Disparities and Improving the Collection of Race, Ethnicity, and Language Data: the MDPH ApproachNAPHSIS ANNUAL MEETING, 2007

Bruce B. Cohen and Brunilda Torres

Massachusetts Department of Public Health

June 2007


Overview improving data collection
Overview: Improving Data Collection Race, Ethnicity, and Language Data: the MDPH Approach

  • Historical Context

  • History of MDPH efforts

  • Need for more detailed data

  • Defining principles

  • Proposed questions


Historical context

Historical Context Race, Ethnicity, and Language Data: the MDPH Approach


Omb standards
OMB Standards Race, Ethnicity, and Language Data: the MDPH Approach

Office of Management and Budget Directive 15 issued in 1977 set standards

  • revised in 1997

  • sets minimum standards for the collection of race and ethnicity data for all federal data sets

  • all current surveys should have complied with the 1997 revision by January 1, 2003


Omb 1997 revision
OMB 1997 revision Race, Ethnicity, and Language Data: the MDPH Approach

  • Major changes

    • when self identification is used,

      • a method for reporting more than one race should be adopted

        • this method should NOT be a “multiracial” category, but rather a multiple response to a single question

      • a two question format should be used, with the Hispanic origin question preceding the race question


Omb 1997 revision1
OMB 1997 revision Race, Ethnicity, and Language Data: the MDPH Approach

Major changes (continued)

  • when self identification is NOT used (ie. observer, proxy or record based)

    • a method for reporting more than one race should be adopted

      • this method should NOT be a “multiracial” category, but rather a multiple response to a single question

    • a two question format should be used, with the Hispanic origin question preceding the race question

    • a one question format may be used, with “Hispanic” as a race category


Omb revised race categories

1997 Race, Ethnicity, and Language Data: the MDPH Approach

white

black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or Other Pacific Islander

NOTE: Only the US Census Bureau for the purpose of the Census 2000 and NCHS for the revised standard certificates of birth and death have been granted variances to include an “other” category

1977

white

black

American Indian

Asian or Pacific Islander

OMB Revised Race Categories


Census 2000 ethnicity question adopted by nchs in revised certificate
Census 2000: Ethnicity Question Race, Ethnicity, and Language Data: the MDPH Approach(ADOPTED by NCHS in Revised Certificate)

  • Is person 1 Spanish/Hispanic/Latino? Mark x in the “No” box if not Spanish/Hispanic/Latino.

    • No, not Spanish/Hispanic/Latino

    • Yes, Mexican, Mexican Am., Chicano

    • Yes, Puerto Rican

    • Yes, Cuban

    • Yes, other Spanish/Hispanic Latino- print group.


Census 2000 race question adopted by nchs
Census 2000: Race question Race, Ethnicity, and Language Data: the MDPH ApproachAdopted by NCHS

What is Person 1’s race? Mark x in one or more races

White

Black, African American or Negro

American Indian or Alaskan Native- print name of enrolled or principal tribe

Asian IndianNative Hawaiian

ChineseGuamanian or Chamorro

FilipinoSamoan

Japanese Other Pacific Islander- print race

Korean Some other race- print race

Vietnamese

Other Asian- print race


Omb 15 in historical context

OMB in Historical Context Race, Ethnicity, and Language Data: the MDPH Approach

OMB 15 in historical context

Lessons for states in implementing OMB 15

  • race categories changed regularly over time

  • race categories determined by social and cultural context

  • race categories will continue to be determined by and reflect social and cultural context

  • ethnicity and national origin categories

    • more stable over time

    • change to reflect changing demographics, not social and cultural context

    • highly salient to state and local public health practice


Impact of omb and federal and state public health practice
Impact of OMB and Federal and State Public Health Practice Race, Ethnicity, and Language Data: the MDPH Approach

Purpose of data collection

  • state and federal similar: ongoing monitoring to identify priorities, program evaluation, and high need areas

  • state and federal differ:

    • state needs for service targeting to high risk individuals

    • state needs for service targeting to high risk communities


History of massachusetts efforts

History of Massachusetts Efforts Race, Ethnicity, and Language Data: the MDPH Approach


Dph efforts to date
DPH efforts to date Race, Ethnicity, and Language Data: the MDPH Approach

1980-90’s: Special reports on disparities, e.g.: Black Men Endangered, Disparities Commission testimony, ongoing surveillance reports, detailed ethnicity perinatal reports

2000: Efforts to identify R/E/L methods in MDPH databases

2001: Collection of race/ethnicity and language required in hospital acute care settings as result of Interpreters’ Services Regulations

2002: Internal meetings to develop MDPH standards

2003: MDPH data standards committee review

2005: Collaboration with Boston Public Health Commission for consistent standards

2006: Joined with Division of Health Care Finance and Policy to promulgate case-mix data regulations implement 1/2007 for hospital discharge and emergency department data

2007: February, MDPH issues new standards


Why do we need more detailed information
Why do we need more detailed information? Race, Ethnicity, and Language Data: the MDPH Approach


Mother s race births 2004
Mother’s Race – Births 2004 Race, Ethnicity, and Language Data: the MDPH Approach


Mother s ancestry births 2004
Mother’s Ancestry – Births 2004 Race, Ethnicity, and Language Data: the MDPH Approach


Breastfeeding among mothers by race massachusetts 2000 2004
Breastfeeding among Mothers by Race Massachusetts: 2000-2004 Race, Ethnicity, and Language Data: the MDPH Approach

Source: Massachusetts Births 2002-20044

*Non-Hispanic


Breastfeeding among Mothers by Ethnicity, MA:2000-2004 Race, Ethnicity, and Language Data: the MDPH Approach

Blacks

Hispanics

Asians

Source: MDPH, Center for Health Information, Statistics, Research & Evaluation, Research & Epidemiology Program


Cesarean section deliveries among mothers by race ma 2000 2004
Cesarean Section Deliveries among Mothers by Race, MA:2000-2004

Source: Massachusetts Births 2002-20044

*Non-Hispanic


Mother’s Ethnicity and Cesarean Rates MA:2000-2004All Deliveries* MA 2004

* A delivery of multiples is counted once

Source: Massachusetts Births 2004


Defining principles
Defining Principles MA:2000-2004


Mdph proposal
MDPH Proposal MA:2000-2004

  • Collect Hispanic ancestry and race categories consistent with Federal OMB standards

  • Expand collection to include detailed ethnicity data

  • Collect language data consistent with LEP (Limited English Proficiency) guidance issued by DHSS in 2002


Principles for data collection
Principles for Data Collection MA:2000-2004

  • Encourage client self-report

  • Allow for the selection of multiple categories

  • Collect information on detailed ethnicity groups as well as broad race categories

  • Incorporate language preference as basic sociodemographic characteristic

  • Maintain consistency with Federal OMB standards


Basic concepts
Basic concepts MA:2000-2004

Race: group or groups that an individual identifies with because they share similar physical characteristics or social and geographic origins.

Ethnicity: a person’s background, heritage, culture, ancestry, country of birth


Added value

OF RACE MA:2000-2004

monitors discrimination,

yields more stable rates

Follows OMB standard

more routinely collected

OF ETHNICITY

better understood

less context dependent

more useful for program targeting and development

improved sensitivity to linguistic needs

added insight into acculturation

Added Value


Concerns

WITH RACE MA:2000-2004

changing over time

not clearly understood conceptually

context dependent

heterogeneity within groups

used as proxy

WITH ETHNICITY

lack of denominators for population based rates

small numbers for analysis

requires more complex data collection

more variable by geography

Concerns


Collecting both

Advantages MA:2000-2004

client centered care

target interventions

monitor demographic change

health status monitoring

Disadvantages

expanded IT efforts

moves beyond Federal minimum standards

lack of denominator data for calculating rates

increases data collector and respondent burden

Collecting Both


Proposed questions
Proposed Questions MA:2000-2004


Proposed new questions
Proposed New Questions MA:2000-2004

  • 5-Question Format

  • Define a Minimum set of categories

  • Allow for expansion to meet local needs

  • Allows for free text

  • Maintain consistency with Federal standards


Question 1
Question 1 MA:2000-2004

1. Are you Hispanic/Latino/Spanish?

❑ Yes

❑ No


Question 2
Question 2 MA:2000-2004


Question 3 race
Question 3, Race MA:2000-2004

  • What is your race? (You can specify one or more)

    ❑ American Indian/Alaska Native (specify tribal nation___________________)

    ❑ Asian

    ❑ Black

    ❑ Native Hawaiian or other Pacific Islander (specify)

    ❑ White

    ❑ Other (specify ___________________)

    ❑ Unknown/not specified


Questions 4 and 5 language preference
Questions 4 and 5: Language Preference MA:2000-2004

4. In what language do you prefer to discuss health-related concerns?

❑ Albanian ❑ Portuguese

❑ Arabic ❑ Russian

❑ Cape Verdean Creole ❑ Somali

❑ Chinese (specify) ❑ Spanish

❑ English❑ Vietnamese

❑ Haitian Creole ❑ Other (specify)

❑ Khmer

5. In what language do you prefer to read health-related materials?_____________


Implementation
Implementation MA:2000-2004


Keys to successful implementation
Keys to successful implementation MA:2000-2004

  • Making the data collector comfortable

  • Making the respondent comfortable

  • Helping the respondent understand the importance of the information


Field testing and training
Field Testing and Training MA:2000-2004

  • ~ 9000 patients

  • ~1,200 WIC participants

  • Four statewide “Train the Trainer” training sessions for 200 hospital personnel


Current status
Current Status MA:2000-2004

  • DHCFP -- Implementation 1/2007

  • BPHC --Implementation 7/2007

  • MDPH – Implementation ongoing

  • Support via BPHC, DHCFP, MHA – Ongoing http://www.mhalink.org/


Lessons learned
Lessons learned MA:2000-2004

  • Overall, data collectors and program participants feel very favorably about this process.

  • Training of data collectors is crucial:

    • Purpose and importance of data

    • Strategies for using new data

    • Strategies for answering common questions;

  • Need to reach out to our community partners

  • Need to bring IT into this process


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