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Study 1Health behaviors, access to healthcare, and health outcomes: Comparison of African‐American participants with SCI and TBI with general population data from the BRFSS

Researchers will interview 500 African-Americans from population-based surveillance systems with SCI or TBI and compare their health behaviors, access to services, and the prevalence of chronic diseases with African-Americans in the general population (based on CDC surveillance). Researchers will then identify the extent to which disparities observed in the general population are magnified after injury.


  1. Identify whether risk behaviors are more common among African‐Americans with neurologic injuries than among the general population (high risk behaviors often lead to such injuries).
  2. Identify the extent to which African‐Americans with neurologic injuries have equal access to care compared to African‐Americans in the general population (disparities for African‐Americans exist in the general population compared with Caucasians).
  3. Identify the extent to which African‐Americans with neurologic injuries are at risk for chronic diseases that are not directly related to the neurologic injury itself, or at least have not traditionally been linked to the neurologic injury (such as hypertension, cardiovascular disease, diabetes), in comparison to African‐Americans in the general population (African‐Americans in the general population are at greater risk for these chronic diseases than Caucasians).

Study 2 :  Race/ethnicity and risk of adverse health outcomes after spinal cord injury: A multisite collaborative study

This study is a collaboration of four entities:

  • Medical University of South Carolina, Charleston, SC – The primary medical school in the state of South Carolina
  • South Carolina State University, Orangeburg, SC - A historically black university
  • Craig Hospital, Denver, CO - Specialty rehabilitation and research hospital for patients with spinal cord injury and traumatic brain injury
  • Rancho, Los Angeles, CA - One of the oldest and most renowned rehabilitation centers in the United States

The purpose of this study is to identify risk and protective factors for secondary health conditions among SCI participants from 4 racial‐ethnic groups including: (a) African‐American, (b) Hispanic, (c) American Indian, and (d) Caucasian from three sites across the United States. Identification of risk and protective factors is essential to the development of effective interventions to prevent and treat secondary conditions. This study will determine the extent to which patterns of risk and protective factors associated with secondary conditions are consistent across racial‐ethnic groups.  Study 2 will involve interviews with 836 participants with SCI, 575 of whom come from underserved populations (African-Americans, Hispanics, and American Indians) in order to identify psychological, environmental, and behavioral predictors of secondary health conditions. Meditational models will be tested to identify the risk and protective factors most strongly associated with disparities in health outcomes (e.g., pain, depression, pressure ulcers) and the extent to which disparities disappear when accounting for these factors. Researchers will also determine whether the predictive model is invariant across race-ethnicity (i.e., whether the significant predictors are the same across different racial-ethnic groups) and, if not, which predictors are most important for each. Capacity building efforts will include workshops, mentorship of undergraduate and graduate students, and technical assistance.


  1. Identify the specific risk and protective factors that are predictive of the health outcomes in the four racial‐ethnic cohorts.
  2. Test mediational models to determine if differences in health outcomes between the 4 racial‐ethnic cohorts (if there are any) are mediated by the significant risk and protective factors such that the relationship disappears after accounting for these factors.
  3. Determine whether there are interactions between significant risk and protective factors with outcomes as a function of race‐ethnicity, such that a different set of predictors are observed between two or more racial‐ethnic groups for a particular outcome.
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