CDC News Conference Transcript

African American Health Disparities: A Closer Look at Diabetes, Influenza and Domestic Violence

Press Kit

October 24, 2003

MS. HUNTER: Welcome to today's news briefing on African American health disparities, a closer look at diabetes, influenza and domestic violence.

My name is Karen Hunter with CDC's Division of Media Relations and I'm going to be your moderator this afternoon.

Addressing health disparities in the United States is a cornerstone of disease prevention. Many individuals from minority communities suffer a greater burden of death and disease from cardiovascular disease, various types of cancer, and other illnesses.

Today's briefing will feature three speakers and we're going to hear from each one individually for about three minutes and then we'll open it up to questions for that specific topic instead of holding all the questions until the end like we typically do.

The first speaker will be Dr. Jane Kelly, director of CDC's National Diabetes Education Program, and she's going to be talking about type 2 diabetes.

As many of you probably know, November is National Diabetes Awareness Month and African Americans do have a higher prevalence of type 2 diabetes.

Then, after we hear from Dr. Kelly, well open it up to questions about diabetes.

Dr. Kelly will be followed by Dr. Walt Orenstein, director of CDC's National Immunization Program, who's going to talk about flu shots, who should get them and why they're so important, and we're getting ready to start flu season in a couple of weeks.

And finally we're going to hear from Dr. Ileana Arias who's the branch chief of CDC's Division of Violence Prevention.

For those of you who aren't familiar with the briefings that we do here at CDC, a transcript from this briefing will be available on our Web site on the “In The News” site later on this afternoon.

There's also a companion press kit on the news site with information about all three topics that are being discussed today as well as ideas for localizing the story.

As always, reporters needing additional information after this briefing can contact our media relations office at [404] 639-3286, and I'll give that number again at least once, probably more than that, at the conclusion of this briefing.

And now we're going to begin with our first speaker, Dr. Jane Kelly, to talk about diabetes.

Dr. Kelly.

DR. KELLY: Thanks, Karen. I'm very grateful for this opportunity to talk to you all about type 2 diabetes – the type of diabetes that we usually associate with older adults – and with increasing obesity and sedentary lifestyle, but which we are seeing in younger and younger age groups, especially in some of our ethnic populations such as African Americans.

I know you have a press kit that has a lot of the statistics about the increase in prevalence, the increase in rate of type 2 diabetes among African Americans. What's going on in that population is going on in the United States in general, in fact in the world.

But there are higher rates of complications, the devastating complications of diabetes among African Americans, complications such as heart disease, kidney disease, and blindness, resulting in complications such as amputation and yet I'm here to talk to you not just about all these worrisome complications, these terrible consequences, but what we can do about it.

And I'd like to take a step back in time for a minute and just share with you a personal anecdote.

I started out my career as a primary care provider, a physician in rural South Carolina, 15 to 20 years ago, with a mostly African-American population, and at that time a lot of what I saw was diabetes, high blood pressure, heart disease, a lot of complications.

But when I think back to those days, I realize that we didn't have the technology we have today. We didn't have the science. We didn't know what worked and what didn't for preventing complications. And now we do. We have a lot more medications, we have a lot more evidence about how to prevent complications and, in fact, prevent diabetes from starting in the first place, primary prevention of diabetes.

So in terms of why we are gathered here today, it's not just to talk about why diabetes is important. You have all the terrible statistics in front of you. But also what are we doing about it? How can we gather around this issue? How can we communicate to the public what actions can be taken?

CDC has a Division of Diabetes Translation. What that means is trying to translate the science that comes out of CDC as well as other institutions about diabetes; but also communicate it to the public; also support community interventions, supporting interventions, for example in African American communities; to understand better what changes we can make about health systems delivery, so that people get the proper care they need and understand about diabetes prevention.

Now I work specifically with the National Diabetes Education Program and the NDEP has a whole host of materials about educational brochures, for example, for people with diabetes or people at risk, as well as educational materials for health care providers, materials for supporting intervention, too much for me to focus on in a short period of time.

But I also wanted to direct you to our Web site. For those of you who are joining us by audio only, all the materials that I'm going to mention are available on our Web site.

NDEP is a joint initiative of CDC and the National Institutes of Health and our materials are posted on the NIH server. That's www.nih. Excuse me, www.ndep.nih.gov. I've also brought a few materials that we have available to look through during the Q&A period, or afterwards.

One most important thing that I want to focus on today, out of all of our materials, is primary prevention, and I brought with me a prop, something called the Game Plan Tool Kit, and some material that we've developed about primary prevention, to help health care providers and help people at risk for diabetes know what steps they can do to prevent it, because this is an important arena.

We now have new science to tell us how to identify people at highest risk for diabetes and what steps they can take about it.

For example I have as part of this tool kit a fat and activity tracker, so that people can track what they eat, not just the number of fat grams and calories, but what they eat compared to what they do, because it's an equation of calories in and calories out, to help them guide their behavior changes around prevention of type 2 diabetes.

I feel like there's so much that we could talk about and I know we've got limited time today.

I'm going to let the material stand for itself and maybe we can talk more about it during Q&A. But I think that this is really an exciting time in diabetes because we not only are facing a terrible epidemic, we have the tools to deal with it if we can get the word out about them, get people gathered around, empowered about using them.

MS. HUNTER: Thanks, Dr. Kelly.

I think we'll go ahead and open it up for questions.

Do we have any questions from the room?

QUESTION: For people who might not be Internet- savvy, how else are you going to get the message out? In other words, churches – a lot of African Americans are very active in their church communities. Is that going to be part of the plan? What kind of grassroots efforts to get this word out to people?

DR. KELLY: Absolutely. Thank you very much.

One of the features of NDEP is that we have an extensive partnership network; that it's not just CDC and NIH. We also partner with over 200 organizations, some of which are the ones you would expect, like American Diabetes Association, but others, such as the National Urban League, are organizations that have outreach to the population we want to focus on--in this case African Americans. They'll help us get the word out.

But we are also partnering with state-based institutions, trying to get the word out through those partners.

And in answer to your question about, yes, it's posted on the website, but how else can people get it?

Single copies are free, and they're available at our 1-800 number. That number is different from the CDC's 1-800 number, and it is 1-800-438-5383.

We're also promoting this via various media. For example, we talked about this on BET, as well as promoting primary prevention in a number of publications targeting African Americans, as well as other ethnic groups and the general audience.

QUESTION: And, again, if you're talking to African-American viewers, not to me as a member of the media, but what might a person watching Channel 2 tonight in the next six months see different in their community that would get this message to them? Church? Barbershop? What might they be seeing?

DR. KELLY: Some of it through health care providers, which I realize is not community oriented, but it's still an important source of this sort of information, but we are trying to work with the American Diabetes Association, with their Diabetes Sundays, which are events in predominantly African-American churches, as well as through beauty and barbershops to try and, because they're an outlet for information exchange, and many have been willing to participate with our efforts to get the word out.

MS. HUNTER: Now, let's take a question from the phone, please.

OPERATOR: Thank you, ma'am.

Nikki Burns from Mississippi Link Newspaper, your line is now open.

QUESTION: Yes, I have a question. Can you pinpoint ways the National Diabetes Education Program is working to slow down the prevalence of diabetes in children.

DR. KELLY: Thank you. In fact, just this morning I was meeting with the Division of Adolescent and School Health here at CDC. The concern is the increase in type 2 diabetes, the type of diabetes we normally associate with adult onset. There has been an increase in type 2 diabetes in children, at least by what statistics we have available, and we still need to gather better national data on that.

As part of that effort, we've been talking to multiple organizations involved in children's health--the American Academy of Pediatrics, National Association of School Nurses, many more, more than I can name right now--to gather them around that question.

For example, NDEP does have a Children and Adolescents Work Group, and recently we published a school guide. It's a guide to help the child at school succeed, the child with diabetes succeed. It's a guide for school personnel. A lot of those issues revolve around insulin and type 1 diabetes, but they also are apropos to type 2 diabetes. So, number one, trying to involve the school environment, because diabetes control isn't just a doctor's office issue; it's a community issue, it's a school issue.

It doesn't stop when the child goes to school. But also we're now beginning focus on nutrition, nutrition education, physical activity, in both the school environment, such as with physical education, but also the community environment and the family. Our African-American Work Group is developing a modular curriculum. You try and get family involvement around physical activity and healthy lifestyle behaviors.

MS. HUNTER: Do we have any more diabetes questions from the room?

QUESTION: I have a quick question. We know that the diabetes rates are higher for African Americans than for whites, but we also know it's increasing I think for both groups. Is it increasing faster for blacks than whites?

DR. KELLY: It is increasing for all groups throughout the United States, and in fact it's increasing worldwide. I'm not certain that I have those precise statistics at hand, but I'm sure we can get that for you later.

MS. HUNTER: And do we have any more callers on the phone that would like to ask a diabetes question right now?

[No response.]

MS. HUNTER: I'll take that as a no.

I just wanted to let everybody know we should have some time at the end of this briefing, so if a question occurs to you between now and then, we should be able to open it up for questions for all of our speakers at the end.

But right now we're going to move to our next speaker who is Dr. Walt Orenstein, and he is going to talk about the importance of flu shots.

Dr. Orenstein?

DR. ORENSTEIN: Thank you very much. Influenza can be a very serious disease. The average influenza epidemic in the United States is associated with 36,000 people who die and 114,000 who are hospitalized. A great majority of the deaths, 90 percent, are persons 65 years of age or older. And as I said earlier, it's highly contagious. Protecting yourself can also protect your loved ones.

Who should get influenza vaccine? We recommend it for people 50 years of age or older. We also recommend it for those under age 50 with certain underlying chronic conditions, such as asthma, lung disease, heart disease, diabetes, and a variety of other conditions.

When is the best time to get influenza vaccine? Right now. Influenza disease season normally peaks sometime between December and May, usually in January, February or March. It's good to get protected now before influenza hits the community. However, in most years, you can still get the shot even into December.

Getting your flu shot not only protects yourself, it protects your children, it protects your grandchildren, and that's an important message which needs to get out because that's one of the best ways we protect some of our highest-risk individuals.

The flu shot is safe. Let me dispel one major myth. You cannot, from the flu shot, get the flu. The flu shot is composed of killed virus, not only killed, but it's purified or disruptive. It's not even whole. It can give you a sore arm, but it cannot give you the flu.

Despite the effectiveness of influenza vaccine and the health burden, there are major racial and ethnic disparities. In 2002, the coverage rate among whites 65 years of age and older was 69 percent. In contrast, the coverage rate for African Americans was 49 percent--this, despite the fact that Medicare fully covers influenza vaccination.

To put it in another perspective, if you look at persons who had at least 10 doctor visits in the preceding 12 months, the coverage among whites was 74 percent. The coverage among African Americans was only 53 percent. So it's not purely an access issue. It involves concerns and misconceptions. What are those misconceptions?

First, that flu vaccine can give you the flu. And as I said earlier, the flu vaccine, the flu shot cannot give you influenza.

Second, concerns that the shot doesn't work. The shot is very effective against influenza. There are many other causes of respiratory illness. The shot will not protect against them, but it will protect against influenza in most people.

Third, many people feel, well, I'm not sick enough. There are other people who are sicker, more frail. I'm fine. I exercise. I can control my health. Anybody can be stricken down by influenza. Not only again are you protecting yourself, but you're also protecting your loved ones, and you're protecting your grandchildren.

Another concern is distrust, distrust with government, distrust with other programs, and I think it's important to get across the message that there's no reason to tolerate this kind of health burden which is so preventable.

What are we doing to address it? First, on the childhood side, and we do encourage and will be recommending vaccination for all children 6 to 23 months, we have purchase programs that allow for free vaccines for our poorest children.

Second is, on the adult side, we have Medicare coverage that covers both the vaccine and its administration, and this year Medicare almost doubled its reimbursement for administration to encourage physicians to use this vaccine more widely.

Third, we have developed health and information campaigns based on our qualitative research, our focus groups, trying to target people and trying to give messages, such as protect your grandchildren, protect yourself, get a flu shot.

And, finally, we are working on a special demonstration project, which we call READI, which is Racial and Ethnic Adult Disparities in Immunization initiative, which works with five areas: Rochester, New York; Milwaukee, Wisconsin; Chicago, Illinois; San Antonio, Texas; and 19 counties in Mississippi, to try and get a better understanding of what works to try and reduce and eliminate these gaps.

The READI initiative was launched in 2002 and is going to be a 3-year initiative. We are now in our first real intervention year. We have one more intervention year to go, and our hope is to learn enough that we can go for a national program after that.

Thank you.

MS. HUNTER: Thank you, Dr. Orenstein.

Now, we're going to open it up for questions about flu and flu shots, and I think we'll start with a question from the phone.

OPERATOR: Thank you. Nikki Burns from Mississippi Link Newspaper, your line is now open.

QUESTION: Thank you. I'm Adam Lynch. I'm with Nikki Burns at the Mississippi Link.

My question is, with so many countless varieties of influenza floating around out there, how can the shot be effective?

DR. ORENSTEIN: Well, first of all, there are three components in the influenza vaccine to take care of the three major forms of influenza. One needs to remember that when influenza hits, influenza itself can count for about, in adults, a quarter to a third of the respiratory illnesses.

A vaccine, in most years, will protect against influenza, and that's because the vaccine changes every year. That's why you have to get it annually because the flu strains change. But we watched the flu strains, and about nine out of 10 years the vaccine strains matched the subsequent season strains and the vac strains, and the vaccine is highly effective.

MS. HUNTER: Now, we'll take a question from the room. Are there any questions for Dr. Orenstein?

DR. KELLY: I just want to go on record I got my flu shot last week.

[Laughter.]

MS. HUNTER: Excellent.

Okay. We'll move on to our next speaker. And our final speaker this afternoon is Dr. Illeana Arias, who is going to talk about domestic violence.

Dr. Arias?

DR. ARIAS: Thank you.

Domestic violence is a significant problem in our country in all of our communities. Approximately, 5.3 million victimizations are committed against women every year, and that includes physical and sexual assaults. Not surprisingly, [audio break] million injuries result from that, and again, not surprisingly, the costs are fairly astronomical. We've recently estimated that the medical care costs only, that is limited to medical care costs of intimate partner violence against women, is in excess of $4 billion a year.

As unfortunate as the numbers are, generally, for the population of women in our country and why we're here today, women in African-American communities are significantly more negatively impacted than white women and women from other racial and ethnic groups.

African-American women are more likely to be assaulted by an intimate partner, either physically or sexually, and unfortunately are also more likely to be murdered or killed by an intimate partner than white women are or women from other racial and ethnic groups.

Not surprisingly, we at CDC take this seriously, as a serious threat to the public health of women in this country, in that not only are injuries directly resulting from violence against women prevalent, and not only are the costs associated with treating those injuries significant, chronic illnesses are significantly more likely to be found among women who are victims of intimate partner violence than women who are not. Therefore, health generally is significantly negatively affected by domestic violence.

We, at CDC, attempt to address the problem by continuing to provide services and support those who provide services for women who are victimized as a way of coping with the situations that they're in or responding to those situations by leaving as they so choose.

Unfortunately, what we need to do, and what we have committed ourselves to doing at CDC, is attempting primary prevention of domestic violence more so than traditionally has been done. And in doing that, what we've had to do, and what the field recognizes has to be done, is focus on individuals who commit domestic violence--that means primarily men--and focus as early on in the process as possible. So not only focus prevention programs and interventions on men, but also on young boys and young men; the idea being that not only do we want to be able to provide services for women who are victimized, we want to make sure that we don't have women in the future who need those services.

So, to the extent that we can engage and reach men who either are engaging in domestic violence or have the potential for engaging in assault of their intimate partners, then we will need a commitment.

In addition to focusing on men as the targets of prevention and intervention, we also are in the process of trying to encourage and emphasize the need for men to be involved in prevention efforts; that is, men who deliver messages about healthy relationships, who deliver messages about what are appropriate ways of resolving conflict within a relationship has significant more credibility and a greater impact, especially on young men and boys, than women do.

Traditionally, women have been involved in the prevention of violence prevention. The involvement of men in that effort is invaluable. And one of the things that we are very committed to is increasing that involvement of men.

We hope that by, again, focusing on those individuals who are at high risk for engaging in physical assault of intimate partners, who are predisposed to do it, but haven't done so yet, that we will be not only effective in reducing domestic violence that's committed against women and the negative impact, both health and psychological impact of that.

But we're also hoping to be able to improve the lives of children in that a significant number of children are involved in domestic violence situations, either as direct witnesses or simply being exposed, and that they are aware of the violence because of the consequences that are available to them after an incident.

We know that, unfortunately, children who, even if they have not been abused themselves, who are exposed to domestic violence, are at significant risk for a number of health consequences, both in the short run and in the long run. And unfortunately, we also know that they are at significantly higher risk for being assaulted themselves in adulthood.

So that without addressing the children in violent homes, we are shortchanging the impact that we could have in breaking that cycle of violence that, unfortunately, has been so common and reliable over time.

So that again by reaching individuals as early on as possible, in their childhood, before their ideas about relationships have been formulated or have been crystallized, we're hoping that they will be prevented from the negative consequences themselves, in childhood, and we reduce the problem in the long run as well.

MS. HUNTER: Thank you, Dr. Arias.

Do we have any questions from the room for Dr. Arias?

QUESTION: Cynthia Post, the Atlanta Daily World. As far as the flip side of the problem, any research in women battering men? Are there any programs to help that on that situation?

DR. ARIAS: Yes there is. Most of the programs have focused and continue to focus on male perpetrators because the data suggests that, number one, it is significantly more common for the individual who is doing the assaulting to be the male partner in the relationship, and in addition to that, the consequences of male violence are significantly more pronounced than the consequence of female violence, not just in terms of the physical consequences but the psychological consequences as well.

In addition to that, there's some research suggesting that the motivation for engaging in violence or the things that lead to engaging in violence are slightly different for men and women.

Women have a greater probability of being violent in response to violence, in self-defense, and their backgrounds are slightly different.

They usually have more of a background of being victimized themselves, than men do, and so the approaches have to be very different.

Again, as I said, most of the approaches do focus on men who perpetrate violence against women; however, there are a few approaches that focus on women who have domestic violence as a problem themselves.

MS. HUNTER: Can we have a question from the phone, please.

MODERATOR: Thank you. The question comes from Stan Washington of Atlanta Voice.

QUESTION: Can you hear me?

MS. HUNTER: Yes.

QUESTION: Okay.

In your data that you have, is it broken down economically, in terms of looking at where that is happening, the violence against women?

DR. ARIAS: Yeah, that's an excellent point, for two reasons.

One, it is the case that although violence is found in every economic strata that we can measure, it is significantly more likely to be found in families that are in lower socioeconomic circles.

In addition to that, the sort of racial disparity can in part be accounted for differences in socioeconomic standings of those families, but not all, so that it is the case that some of the disparities can be explained away by differences in family income, occupational attainment, education, et cetera.

However, even when we control for those variables, there appears to be again a greater risk for domestic violence among African-American families than in white families.

MS. HUNTER: Thank you and I think we'll take a question--David, did you have a question?

QUESTION: David Wahlberg, Atlanta Journal-Constitution.

It looks like most of the data about African Americans having more domestic violence comes from Justice Department statistics and I've heard some black people wonder if those statistics might count more of what's really going on in that community than, say, the white community.

Might that be possible?

DR. ARIAS: There's a possibility that the disparities that are uncovered by sort of more criminal justice surveys or police data is a little more pronounced; however, even phone surveys that do not rely on police data or the sort of police signaling as a criminal behavior do suggest that there is a disparity there, so that again, very similar to the socioeconomic factors, it accounts for some of the difference but not for all of it.

We're still in a situation where we have to identify not only what accounts for the difference, but, more importantly, what are the changes that have to be made or what are the programs that have to be tailored and supported that are going to address the specific needs of African American community.

MS. HUNTER: And let's take a question from the phone for Dr. Arias, please.

MODERATOR: Thank you. The next question is from Mississippi Link newspaper. Your line is now open.

QUESTION: Yes. I was wondering: Are you targeting intimate partner violence on the collegiate level or younger, perhaps?

DR. ARIAS: Yes. The work that we have been involved in does cut across the life span and we address children as young as we are capable of doing. So that some of the programs that we fund--and I should say the majority of the programs that are currently in place, and that we fund ourselves, and support, are focused on adult women.

However, there's a significant number of work and projects that we support that focus on college students and high school students, and now are even starting to focus on middle school-aged kids as well.

MS. HUNTER: Any other questions from the room specifically on domestic violence?

I think we have a few minutes to open it up for questions for any of our three speakers.

Is there anyone on the phone that has a question about diabetes, flu shots, or domestic violence?

MODERATOR: We do have a question from Peter Gorner [ph] from Chicago Tribune. Your line is open.

QUESTION: About diabetes, doctors, when 47 million people have no access to health insurance, how can you reasonably expect them to get the type of screening and constant medication and monitoring to have any chance against diabetes?

DR. KELLY: I think your question is an excellent one and we're certainly very concerned with access-to-care issues. That is a part of health disparities. But you also raise a secondary point. If we have difficulties with access to care to manage diabetes, all the more reason to try and emphasize primary prevention, preventing it before it begins, and that's not necessarily a high tech or a medication-driven issue. It's not even necessarily a health care issue in terms of access to health care providers.

Primary prevention, preventing diabetes, is something that can be done through behavior, lifestyle interventions. I mean it basically does indeed boil down to eat less, exercise more.

That’s easy for me to say. I know it's hard to do those things in everyday life and I know a lot of lower socioeconomic folks are challenged in their environments with access to proper food, access to safe physical activity. But I think the call, the need for primary prevention is very strong for just the reasons that you outlined.

MS. HUNTER: Do we have any questions from the room for any of our three speakers?

We'll take another question from the phone, please.

MODERATOR: Thank you. Dan Washington from Atlanta Voice, your line is now open.

QUESTION: Yes; thank you. I wanted to go back to the domestic violence data.

Is there any trend that shows, that you may have, that shows that the rates are increasing amongst middle class families, upper class families, say, within like a 10 year period?

DR. ARIAS: That's an excellent question. The trends that are available do not usually look at specific groups mostly because the numbers don't allow us to make any firm conclusions about that.

There is evidence that domestic violence has been decreasing over time, and the latest data that point in those trends were for the year 2000, and so there have been significant decreases over the last 10 or 20 years in the incidence of domestic violence, again, across groups, both socioeconomic groups and across racial or ethnic groups.

But whether or not the trend seems to be different as a function of socioeconomic group, it's not clear.

MS. HUNTER: And we'll take one more question from the phone, please.

MODERATOR: Thank you. The next [inaudible] your line is open.

QUESTION: How you doing? Adam Lynch again. I have two questions, actually, if I can convey them both.

MS. HUNTER: Sure.

QUESTION: All right. The first one deals with flu shots. There have been concerns in the past about inoculations concerning mercury poisonings. Are there any kind of permanent heavy compounds in a flu shot that could potentially remain with the system?

And my second question is: Why is the CDC taking up intimate partner violence as a CDC item?

DR. ORENSTEIN: Let me answer the flu shot question. There is, in most of the flu vaccine shots, is a preservative, Thimerosal, about 25 micrograms, which is a very, very small amount.

If you look at that in an adult, it's a very, very tiny amount of mercury. It's a different form of mercury than the one associated with most toxicity. It's ethyl mercury versus methyl mercury, and we have reviewed this multiple times with our senior advisory groups, and all of them feel the benefits of the influenza vaccine far, far exceed the risks for those to whom it's recommended.

MS. HUNTER: Dr. Arias, you can answer the intimate partner violence question.

DR. ARIAS: Sure. Intimate partner violence, like other forms of violence, has a direct impact, negative impact on both the morbidity and mortality of U.S. citizens, which is what CDC is primarily charged with addressing and protecting.

In addition to the fact that it does have a detrimental impact on morbidity and mortality, both again in the short run and the long run, it is the case that it is preventable, and to the extent that it is preventable, and it has a negative impact on individuals' health, the CDC then is committed to do anything that it can in order to prevent it and therefore improve the public health of individuals who are affected or may be affected by it.

MS. HUNTER: I think that's going to conclude the briefing.

Just a reminder, anybody needing additional information can call our press office at [404] 639-3286.

The Web address, CDC's main Web address is www.cdc.gov. If you click on In The News over there on the left-hand column, that will take you into our news room.

As I mentioned, the transcript from this briefing will be up there later on this afternoon.

We also have a Web-based press kit with fact sheets and contact information for all three of our speakers, and also local story ideas for those who are interested.

That's going to conclude today's briefing and we want to thank everybody for joining us today.

Listen to the telebriefing

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