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Estupiñán Fdez de Mesa M, Marcu A, Ream E, Whitaker KL. Relationship between intersectionality and cancer inequalities: a scoping review protocol. BMJ Open 2023; 13:e066637. [PMID: 36707112 PMCID: PMC9884887 DOI: 10.1136/bmjopen-2022-066637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Persistent inequalities in cancer care and cancer outcomes exist within and between countries. However, the evidence pertaining to the root causes driving cancer inequalities is mixed. This may be explained by the inadequate attention paid to experiences of patients with cancer living at the intersection of multiple social categories (eg, social class, ethnicity). This is supported by the intersectionality framework. This framework offers an alternative lens through which to analyse and understand how these interlocking systems of oppression uniquely shape the experiences of patients with cancer and drive inequalities. In this protocol, we outline a scoping review that will systematically map what is known about the relationship between intersectionality and inequalities in care experience and cancer outcomes of patients with cancer; and to determine how the intersectionality framework has been applied in studies across the cancer care pathway and across countries. METHODS AND ANALYSIS This study will be guided by Arksey and O'Malley's, and Levac et al's frameworks for scoping reviews. We will identify and map the evidence on cancer inequalities and intersectionality from 1989 to present date. Electronic databases (EMBASE, PsychINFO, CINAHL, Medline, Web of Science, ProQuest) and a systematic search strategy using a combination of keywords and Boolean operators AND/OR will be used to identify relevant studies. Screening of eligible papers and data extraction will be conducted by two independent reviewers, and disagreements resolved by discussion with the research team. We will use an iterative process to data charting using a piloted form. Findings will be collated into a narrative report. ETHICS AND DISSEMINATION Ethical approval is not required since data used are from publicly available secondary sources. Findings will be disseminated through peer-reviewed journals, conferences and stakeholder meetings. Further, findings will inform the next phases of a multistage research project aimed at understanding inequalities among patients with breast cancer.
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Affiliation(s)
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, UK
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Hasemann Lara JE. Health Sector Reform in Honduras: Privatization as Institutional Bad Faith. Med Anthropol 2023; 42:62-75. [PMID: 36174649 DOI: 10.1080/01459740.2022.2125388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
I address the privatization of public health care services in Honduras by focusing on one family's experiences using both private and public health services. I juxtapose their increasing use of private health care services, over public services, against sustained and consistent episodes of health sector reform culminating in protests against decrees that sought to further restructure the Ministry of Health during early 2019. By complementing the concept of "privatization by attrition" with "institutional bad faith," I argue that the increased use of private health care may be understood as privatization by coercion.
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Santos LAD, Unsain RF, Brasil SA, Silva LAVD, Duarte FM, Couto MT. PrEP perception and experiences of adolescent and young gay and bisexual men: an intersectional analysis. CAD SAUDE PUBLICA 2023; 39Suppl 1:e00134421. [PMID: 36995863 DOI: 10.1590/0102-311xen134421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/11/2021] [Indexed: 03/29/2023] Open
Abstract
Studies indicate gaps in knowledge about the barriers to access and adhere to HIV pre-exposure prophylaxis (PrEP) in adolescents. In this article, we explore the perceptions and experiences of young gay, bisexual, and other men who have sex with men (YGBMSM) of the search, use and adherence to PrEP, considering their positions according to social markers of difference such as race/skin color, gender, sexuality, and social status. Intersectionality provides theoretical and methodological tools to interpret how the interlinking of these social markers of difference constitutes barriers and facilitators in the PrEP care continuum. The analyzed material is part of the PrEP1519 study and is comprised of 35 semi-structured interviews with YGBMSM from two Brazilian capitals (Salvador and São Paulo). The analyses suggest connections between social markers of difference, sexual cultures, and the social meanings of PrEP. Subjective, relational and symbolic aspects permeate the awareness of PrEP in the range of prevention tools. Willingness to use and adhere to PrEP is part of a learning process, production of meaning, and negotiation in the face of getting HIV and other sexually transmittable infections and the possibilities of pleasure. Thus, accessing and using PrEP makes several adolescents more informed about their vulnerabilities, leading to more informed decision-making. Interlinking the PrEP continuum of care among YGBMSM with the intersections of the social markers of difference may provide a conceptual framework to problematize the conditions and effects of implementing this prevention strategy, which could bring advantages to HIV prevention programs.
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Dove ES, Reed-Berendt R, Pareek M. "Data makes the story come to life:" understanding the ethical and legal implications of Big Data research involving ethnic minority healthcare workers in the United Kingdom-a qualitative study. BMC Med Ethics 2022; 23:136. [PMID: 36527096 PMCID: PMC9756740 DOI: 10.1186/s12910-022-00875-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of UK-REACH ("The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers") is to understand if, how, and why healthcare workers (HCWs) in the United Kingdom (UK) from ethnic minority groups are at increased risk of poor outcomes from COVID-19. In this article, we present findings from the ethical and legal stream of the study, which undertook qualitative research seeking to understand and address legal, ethical, and social acceptability issues around data protection, privacy, and information governance associated with the linkage of HCWs' registration data and healthcare data. We interviewed 22 key opinion leaders in healthcare and health research from across the UK in two-to-one semi-structured interviews. Transcripts were coded using qualitative thematic analysis. Participants told us that a significant aspect of Big Data research in public health is varying drivers of mistrust-of the research itself, research staff and funders, and broader concerns of mistrust within participant communities, particularly in the context of COVID-19 and those situated in more marginalised community settings. However, despite the challenges, participants also identified ways in which legally compliant and ethically informed approaches to research can be crafted to mitigate or overcome mistrust and establish greater confidence in Big Data public health research. Overall, our research indicates that a "Big Data Ethics by Design" approach to research in this area can help assure (1) that meaningful community and participant engagement is taking place and that extant challenges are addressed, and (2) that any new challenges or hitherto unknown unknowns can be rapidly and properly considered to ensure potential (but material) harms are identified and minimised where necessary. Our findings indicate such an approach, in turn, will help drive better scientific breakthroughs that translate into medical innovations and effective public health interventions, which benefit the publics studied, including those who are often marginalised in research.
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Affiliation(s)
- Edward S. Dove
- grid.4305.20000 0004 1936 7988Edinburgh Law School, University of Edinburgh, Old College, South Bridge, Edinburgh, EH8 9YL UK
| | - Ruby Reed-Berendt
- grid.4305.20000 0004 1936 7988Edinburgh Law School, University of Edinburgh, Old College, South Bridge, Edinburgh, EH8 9YL UK
| | - Manish Pareek
- grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, Leicester, UK ,grid.269014.80000 0001 0435 9078Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Boyd RC, Castro FG, Finigan-Carr N, Okamoto SK, Barlow A, Kim BKE, Lambert S, Lloyd J, Zhang X, Barksdale CL, Crowley DM, Maldonado-Molina M, Obasi EM, Kenney A. Strategic Directions in Preventive Intervention Research to Advance Health Equity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:577-596. [PMID: 36469162 PMCID: PMC9734404 DOI: 10.1007/s11121-022-01462-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/09/2022]
Abstract
As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.
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Affiliation(s)
- Rhonda C Boyd
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Allison Barlow
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
| | | | | | - Jacqueline Lloyd
- Office of Disease Prevention, National Institutes of Health, Rockville, MD, USA
| | - Xinzhi Zhang
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Crystal L Barksdale
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Anne Kenney
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
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Luff D, Buscher SW, Ward VL, Ballal SA, Holden P, Pierre R, Won P, Yu EJ, Toomey SL. Understanding Racial, Ethnic, and Socioeconomic Differences in the Ambulatory Care Experience. Pediatrics 2022; 150:189912. [PMID: 36336649 DOI: 10.1542/peds.2021-056001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Racial and ethnic and socioeconomic differences in patient experience are prevalent and can negatively impact health outcomes. Our objective was to examine differences in family experience of care in the pediatric ambulatory setting. METHODS We conducted interviews with parents of patients from different demographic groups who had received care at 1 of 3 clinics at a quaternary children's hospital. Multidisciplinary team conducted inductive and deductive thematic analysis of transcribed interviews. Sentiments and recurring themes were compared within and between racial and ethnic groups, insurance status, and language. RESULTS Eighty parents were interviewed. Three primary themes were identified: (1) mitigation of system issues: parents' mixed experiences with staff or clinicians mitigating system issues impacted their overall perceptions of care; (2) pivotal role of personal interactions: clinicians' interactions positively influenced family-clinician relationships and offset negative experiences; (3) effective explanations: clinicians' clear and thorough explanations were crucial in enhancing parent confidence in care. As an overarching theme, discrimination and disrespect by staff undermined trust in care, affecting all aspects of experience. With the exception of explanations, a higher proportion of publicly-insured parents reported negative experiences across all themes compared to those with private insurance. Asian parents with public insurance had the highest proportion of interviews that were mainly negative in sentiment. CONCLUSIONS Our findings offer nuanced insights into differences in the experience of ambulatory care. Insurance status emerged as an important marker of differential perceptions of care. Our study points to areas for improvement and highlights family-clinician interactions as vital to overall positive experience.
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Affiliation(s)
- Donna Luff
- Simulator Program (SIMPeds).,Harvard Medical School, Boston, Massachusetts
| | | | - Valerie L Ward
- Office of Health Equity and Inclusion, Department of Radiology.,Harvard Medical School, Boston, Massachusetts
| | - Sonia A Ballal
- Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Sara L Toomey
- Division of General Pediatrics.,Harvard Medical School, Boston, Massachusetts
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Chen JC, Pawlik T, Kelly EP, Obeng-Gyasi S. Intersectionality in patients with cancer: who should care and why? Future Oncol 2022; 18:4137-4140. [PMID: 36802840 PMCID: PMC10072129 DOI: 10.2217/fon-2022-0992] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/21/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
- JC Chen
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH 43210, USA
| | - Timothy Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH 43210, USA
| | - Elizabeth Palmer Kelly
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH 43210, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH 43210, USA
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Jaiswal J, Mumba MN. The Role of Nursing in Loosening the Pervasive Grip of Intersectional Stigma. J Psychosoc Nurs Ment Health Serv 2022; 60:9-15. [DOI: 10.3928/02793695-20221109-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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The Relationship Between Intersectional Drug Use and HIV Stigma and HIV Care Engagement Among Women Living with HIV in Ukraine. AIDS Behav 2022; 27:1914-1925. [PMID: 36441406 PMCID: PMC9703403 DOI: 10.1007/s10461-022-03925-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
This study used an intersectional approach to explore the association between enacted and internalized drug use and HIV stigma on HIV care outcomes among HIV-positive women who inject drugs in Ukraine. Surveys were conducted in Kyiv in 2019-2020. Among the 306 respondents, 55% were engaged in HIV care. More than half (52%) of participants not engaged in care reported internalized stigma related to both drug use and HIV status (i.e., intersectional stigma), compared to only 35% of those who were engaged in HIV care. Among those engaged in care, 36% reported intersectional enacted stigma compared to 44% of those not engaged in care; however, this difference was not statistically significant in the univariable analysis (p = 0.06). In the univariable analysis, participants who reported intersectional internalized stigma had 62% lower odds of being engaged in HIV care (OR 0.38, 95% CI 0.22, 0.65, p < 0.001). In the adjusted model, reported intersectional internalized stigma (aOR 0.52, 95% CI 0.30, 0.92, p = 0.026), reported intersectional enacted stigma (aOR 0.47, 95% CI 0.23, 0.95, p = 0.036), and knowing their HIV status for more than 5-years (aOR 2.29, 95% CI 1.35, 3.87, p = 0.002) were significant predictors of HIV care engagement. These findings indicate that interventions to improve HIV care engagement must address women's experiences of both HIV and drug use stigma and the different mechanisms through which stigma operates.
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Bindley K, Lewis J, Travaglia J, DiGiacomo M. Bureaucracy and burden: An Intersectionality-Based Policy Analysis of social welfare policy with consequences for carers of people with life-limiting illness. Palliat Med 2022; 37:543-557. [PMID: 36114642 DOI: 10.1177/02692163221122289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND For informal carers of people with life-limiting illness, social welfare policy related to income support and housing has been associated with varied psychosocial issues, yet remains relatively under-explored. An intersectional approach offers potential to illuminate diverse experiences and implications. AIM To explore the way in which caring in the context of life-limiting illness is framed within welfare policy, to articulate inequities encountered by carers, and to identify policy and practice recommendations. DESIGN The Intersectionality-Based Policy Analysis (IBPA) Framework was used to situate findings of a broader qualitative study. SETTING/PARTICIPANTS Data were collected via semi-structured interviews with participants who were bereaved carers (n = 12), welfare workers (n = 14) and palliative care workers (n = 7), between November 2018 and April 2020, in an Australian region associated with socioeconomic disadvantage. Five elements of IBPA were applied to the products of analysis of this data. RESULTS Use of the IBPA Framework revealed that representations of carers and causes of their welfare needs in policy were underpinned by several assumptions; including that caring and grieving periods are temporary or brief, and that carers have adequate capacity to navigate complex systems. Policy and processes had differentiated consequences for carers, with those occupying certain social locations prone to accumulating disadvantage. CONCLUSIONS This intersectional analysis establishes critical exploration of the framing and consequences of welfare policy for carers of people with life-limiting illness, presented in a novel conceptual model. Implications relate to intersectoral development of structural competency, responsiveness to structurally vulnerable carers in clinical practice, and needed policy changes.
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Affiliation(s)
- Kristin Bindley
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Supportive and Palliative Care, Western Sydney Local Health District, Mount Druitt, NSW, Australia
| | - Joanne Lewis
- School of Nursing and Health, Avondale University, Wahroonga, NSW, Australia.,School of Nursing and Midwifery, University of Technology Sydney, Ultimo, NSW, Australia
| | - Joanne Travaglia
- Health Services Management, School of Public Health, The University of Technology Sydney, Ultimo, NSW, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Uhlin K, Persson E, Stålnacke BM, Löfgren M. Healthcare professionals' experiences and perspectives of team-based interdisciplinary pain rehabilitation with immigrants requiring an interpreter. A qualitative study. Disabil Rehabil 2022:1-12. [PMID: 35996890 DOI: 10.1080/09638288.2022.2111608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE There is a lack of knowledge about interprofessional rehabilitation for culturally diverse patients with chronic pain. This study explores experiences of healthcare professionals developing and working with rehabilitation with patients in need of an interpreter and their experience of working with interpreters. METHODS Twelve healthcare professionals at two Swedish specialist rehabilitation centres were interviewed. Grounded theory principles were used for the data collection and analysis. RESULTS The main category "Demanding and Meaningful Work" represents three concurrently interacting categories: "Frustration" includes the informants' doubts regarding the benefits of the rehabilitation, lack of care for patients and cultural dissonance between professionals and patients. "Challenges" describes problems in the rehabilitation work due to the need for interpreted mediated communication, the complexity in health status and social aspects among the patients. "Solutions" represents practical working methods and personal approaches developed by the informants for managing frustrations and challenges. CONCLUSIONS The informants' frustration and challenges when working with a new group of patients, vulnerable and different in their preconceptions, led to new solutions in working methods and approaches. When starting a pain rehabilitation programme for culturally diverse patients, it is important to consider the rehabilitation team's need for additional time and support.IMPLICATIONS FOR REHABILITATIONHealthcare professionals who encounter immigrants with chronic pain need resources to develop their own skills in order to handle complex ethical questions as the patients represent a vulnerable patient group with many low status identitiesIn order to adapt rehabilitation programmes to patient groups with different languages and pre-understandings of chronic pain, there is a need for a team with specific qualities, i.e., close cooperation, an innovative atmosphere, time and also support from expertsFor appropriate language interpretation it is important to have a professional interpreter and a healthcare professional who are aware of and adopt the rules, possibilities and restrictions of interpretationThe rehabilitation of patients in need of language interpretation needs more time and organisation compared to the rehabilitation of patients who speak the national language.
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Affiliation(s)
- Karin Uhlin
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Elisabeth Persson
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Britt-Marie Stålnacke
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Monika Löfgren
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
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Veldhuis CB, Juster RP, Corbeil T, Wall M, Poteat T, Hughes TL. Testing whether the combination of victimization and minority stressors exacerbate PTSD risks in a diverse community sample of sexual minority women. PSYCHOLOGY & SEXUALITY 2022; 14:252-278. [PMID: 38549608 PMCID: PMC10978045 DOI: 10.1080/19419899.2022.2106147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
Informed by minority stress and intersectionality frameworks, we examined: 1) associations of sexual identity and race/ethnicity with probable diagnosis of post-traumatic stress disorder (PTSD-PD) among sexual minority women (SMW; e.g., lesbian, bisexual); and 2) potential additive and interactive associations of minority stressors (discrimination, stigma consciousness, and internalized homonegativity) and potentially traumatic childhood and adulthood events (PTEs) with PTSD-PD. Data come from a large and diverse community sample of SMW (N = 662; age range: 18-82; M = 40.0, SD = 14.0). The sample included 35.8% Black, 23.4% Latinx, and 37.2% White participants. Logistic regressions tested associations of sexual identity and race/ethnicity, minority stressors, and PTEs with PTSD-PD. More than one-third of SMW (37.2%) had PTSD-PD with significantly higher prevalence among bisexual, particularly White bisexual women, than lesbian women. Discrimination, stigma consciousness, and internalized homonegativity were each associated with higher odds of PTSD-PD, but only internalized homonegativity was additively associated with PTSD-PD in mutually adjusted models above and beyond effects of PTEs. No evidence for interactive effects between PTEs and minority stressors was found. In a diverse community sample of sexual minority women, PTSD is strongly associated with potentially traumatic childhood events and with minority stressors above and beyond the associations with other potentially traumatic events and stressors in adulthood. Our findings suggest a strong need for therapists to address the effects of stigma and homophobia in treatment for PTSD, as these minority stressors likely maintain and exacerbate the effects of past traumas.
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Affiliation(s)
| | | | - Thomas Corbeil
- Mental Health Data Science, New York State Psychiatric Institute
| | - Melanie Wall
- Mental Health Data Science, New York State Psychiatric Institute
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill
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Singh H, Sangrar R, Wijekoon S, Nekolaichuk E, Kokorelias KM, Nelson MLA, Mirzazada S, Nguyen T, Assaf H, Colquhoun H. Applying 'cultural humility' to occupational therapy practice: a scoping review protocol. BMJ Open 2022; 12:e063655. [PMID: 35906054 PMCID: PMC9345050 DOI: 10.1136/bmjopen-2022-063655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Cultural humility is becoming increasingly important in healthcare delivery. Recognition of power imbalances between clients and healthcare providers is critical to enhancing cross-cultural interactions in healthcare delivery. While cultural humility has been broadly examined in healthcare, knowledge gaps exist regarding its application in occupational therapy (OT) practice. This scoping review protocol aims to: (1) describe the extent and nature of the published health literature on cultural humility, including concepts, descriptions and definitions and practice recommendations, (2) map the findings from objective one to OT practice using the Canadian Practice Process Framework (CPPF), and (3) conduct a consultation exercise to confirm the CPPF mapping and generate recommendations for the practice of cultural humility in OT. METHODS AND ANALYSIS We will search Ovid Medline, Ovid Embase, Ovid PsycINFO, Ebsco CINAHL Plus, ProQuest ASSIA, ProQuest Sociological Abstracts, ProQuest ERIC, WHO Global Index Medicus, and Web of Science databases. Published health-related literature on cultural humility will be included. There will be no restrictions on population or article type. Following deduplication on Endnote, the search results will undergo title, abstract, and full-text review by two reviewers working independently on Covidence. Extracted data will include descriptors of the article, context, population, and cultural humility. After descriptive extraction, data describing cultural humility-related content will be descriptively and interpretively analysed using an inductive thematic synthesis approach. The data will also be mapped to OT practice through deductive coding using the CPPF. Occupational therapists and clients will be consulted to further critique, interpret and validate the mapping and generate practice recommendations. ETHICS AND DISSEMINATION Ethics approval was not required for this scoping review protocol. We will disseminate the findings, which can enhance understanding of cultural humility in OT, facilitate cross-cultural encounters between occupational therapists and clients and improve care outcomes through publications and presentations.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ruheena Sangrar
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sachindri Wijekoon
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Erica Nekolaichuk
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kristina Marie Kokorelias
- Department of Medicine, Geriatrics Program, Sinai Health and University Health Network, Toronto, Ontario, Canada
| | - Michelle L A Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sofia Mirzazada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Tram Nguyen
- March of Dimes Canada, Toronto, Ontario, Canada
| | - Holly Assaf
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Fagrell Trygg N, Gustafsson PE, Hurtig AK, Månsdotter A. Reducing or reproducing inequalities in health? An intersectional policy analysis of how health inequalities are represented in a Swedish bill on alcohol, drugs, tobacco and gambling. BMC Public Health 2022; 22:1302. [PMID: 35794588 PMCID: PMC9260990 DOI: 10.1186/s12889-022-13538-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to post-structural policy analyses, policies and interventions aiming at reducing social inequalities have been found to be part in producing and reifying such inequalities themselves. Given the central role of health inequalities on the public health policy agenda globally it seems important to examine the way policy on health inequalities may potentially counteract the goal of health equity. The aim of this intersectional policy analysis, was to critically analyze the representation of health inequalities in a government bill proposing a national strategy on alcohol, drugs, tobacco and gambling, to examine its performative power, and to outline alternative representations. METHOD A post-structural approach to policy analysis was combined with an intersectional framework. The material was analyzed through an interrogating process guided by the six questions of the "What's the problem represented to be?" (WPR) approach. Thus, the underlying assumptions of the problem representation, its potential implications and historical background were explored. In a final step of the analysis we examined our own problem representations. RESULTS The recommendations found in the gender and equity perspective of the bill represented the problem of health inequalities as a lack of knowledge, with an emphasis on quantitative knowledge about differences in health between population groups. Three underlying assumptions supporting this representation were found: quantification and objectivity, inequalities as unidimensional, and categorization and labelling. The analysis showed how the bill, by opting into these partly overlapping assumptions, is part of enacting a discourse on health inequalities that directs attention to specific subjects (e.g., vulnerable) with special needs (e.g., health care), in certain places (e.g., disadvantaged neighborhoods). It also showed how underlying processes of marginalization are largely neglected in the bill due to its focus on describing differences rather than solutions. Finally, we showed how different intersectional approaches could be used to complement and challenge this, potentially counteractive, problem representation. CONCLUSIONS The problem representation of health inequalities and its underlying assumptions may have counteractive effects on health equity, and even though some of its strengths are raised, it seems to be profoundly entangled with a system resisting the kind of change that the bill itself advocates for. If carefully used, intersectionality has the potential to support a more comprehensive and inclusive equality-promoting public health policy and practice.
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Affiliation(s)
- Nadja Fagrell Trygg
- Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Per E. Gustafsson
- Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Anna Månsdotter
- Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
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Kia H, Rutherford L, Jackson R, Grigorovich A, Ricote CL, Scheim AI, Bauer GR. Impacts of COVID-19 on trans and non-binary people in Canada: a qualitative analysis of responses to a national survey. BMC Public Health 2022; 22:1284. [PMID: 35780082 PMCID: PMC9250198 DOI: 10.1186/s12889-022-13684-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 06/15/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Emerging international evidence indicates the COVID-19 pandemic has exacerbated socioeconomic and health challenges faced by transgender (trans) and non-binary populations globally. This qualitative study is among the first to characterize impacts of the pandemic on these groups in Canada. METHODS Drawing on data from the Trans PULSE Canada survey (N = 820), we used thematic analysis to examine the free-form responses of 697 participants to one open-ended question on impacts of the pandemic. We first organized responses into descriptive themes, and then used this preliminary analytical process to construct more refined, higher order themes that provided a rich account of the pandemic's impacts. RESULTS Our results are organized into five themes that highlight the pandemic's impacts on trans and non-binary populations in Canada. These include: (1) reduced access to both gender-affirming and other healthcare, (2) heightened financial, employment, and housing precarity, (3) strained social networks in an era of physical distancing and virtual communication, (4) an intensification of safety concerns, and (5) changes in experiences of gender affirmation. CONCLUSION Our findings highlight the pandemic's systemic impacts on the lives of trans and non-binary people in domains such as healthcare, employment, and housing, and on the social networks of these groups, many of which reflect an exacerbation of pre-existing inequities. Based on our analysis, we recommend that public health researchers, policymakers, and practitioners attend to the structural impacts of the pandemic on these groups as primary sites of inquiry and intervention.
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Affiliation(s)
- Hannah Kia
- School of Social Work, The University of British Columbia, 2080 West Mall, Vancouver, BC, V6T 1Z2, Canada.
| | - Leo Rutherford
- School of Public Health and Social Policy, University of Victoria, Room B202, Human and Social Development Building, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Randy Jackson
- School of Social Work, McMaster University, Room 319, Kenneth Taylor Hall, 1280 Main Street West, Hamilton, ON, L8S 4M4, Canada
- Department of Health, Aging and Society, McMaster University, Room 226, Kenneth Taylor Hall, 1280 Main Street West, Hamilton, ON, L8S 4M4, Canada
| | - Alisa Grigorovich
- Recreation and Leisure Studies, Brock University, 1812 Sir Isaac Brock Way, St Catharines, ON, L2S 3A1, Canada
| | - Carol Lopez Ricote
- Department of Epidemiology and Biostatistics, Western University, 3rd Floor, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Ayden I Scheim
- Department of Epidemiology and Biostatistics, Western University, 3rd Floor, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, London, ON, N6G 2M1, Canada
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Greta R Bauer
- Department of Epidemiology and Biostatistics, Western University, 3rd Floor, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, London, ON, N6G 2M1, Canada
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Addison HA, Richmond TS, Lewis LM, Jacoby S. Mental health outcomes in formerly incarcerated Black men: A systematic mixed studies review. J Adv Nurs 2022; 78:1851-1869. [PMID: 35362166 DOI: 10.1111/jan.15235] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/22/2022] [Accepted: 03/16/2022] [Indexed: 11/27/2022]
Abstract
AIMS The aim of this review was to evaluate the current state of scientific knowledge describing the mental health of Black men who have experienced incarceration. DESIGN This systematic mixed studies review employed a sequential explanatory design integrating quantitative and qualitative published research. DATA SOURCES PubMed, CINAHL, PsycINFO, Social Work and Criminal Justice databases were searched using search terms addressing core constructs of mental health, Black men, incarceration and re-entry, January 2010 through October 2021. REVIEW METHODS Articles identified through a search protocol were screened for inclusion as: peer-reviewed original research, published in English and relevant to the mental health of formerly incarcerated Black men in the United States. RESULTS Twenty-three articles met inclusion criteria. Quantitative findings demonstrated significant associations between incarceration history and poor mental health, including higher levels of psychological distress, increased severity of depressive and PTSD symptoms, and delayed mental health treatment. Discrimination, negative police encounters, solitary confinement and difficulty finding employment were associated with the relationship between incarceration and mental health outcomes. Four themes were identified from the qualitative synthesis: (1) Social Determinants of Mental Health (2) Pushing Through Emotional Despair (3) Challenges to Healthcare Engagement and (4) Gender, Race and Intersections between Social Identities. IMPACT The United States has the highest rate of incarceration in the world and disproportionately incarcerates Black men. This review contextualizes the relationship between incarceration history and mental health in the lived experiences and perspectives of formerly incarcerated Black men. Findings indicate the need for interventions to support mental health needs and prevent downstream health consequences in this population. CONCLUSION Mental health concerns are pervasive in formerly incarcerated Black men; to address key gaps in current scientific understandings future research should focus on how Black men navigate help-seeking experiences and use mental health services in the context of an incarceration history.
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Affiliation(s)
- Helena A Addison
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Therese S Richmond
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Lisa M Lewis
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Sara Jacoby
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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Chan V, Estrella MJ, Beaulieu-Dearman Z, Babineau J, Colantonio A. Protocol for a scoping review on rehabilitation among individuals with traumatic brain injury who intersect with the criminal justice system. PLoS One 2022; 17:e0269696. [PMID: 35771837 PMCID: PMC9246198 DOI: 10.1371/journal.pone.0269696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/25/2022] [Indexed: 11/20/2022] Open
Abstract
Traumatic brain injury (TBI), a leading cause of both death and disability worldwide, is highly prevalent among individuals who intersect with the criminal justice system. TBI is associated with increased behavioural, psychological, or negative outcomes, such as higher rates of mental health problems, aggression, and violent offending that may lead to negative interactions with the criminal justice system, reincarceration, and recidivism. Although rehabilitation is often recommended and holds promise in addressing TBI-related impairments, there is currently a paucity of reviews on rehabilitation for individuals with TBI who intersect with the criminal justice system (CJS). Concurrently, to the best of our knowledge, there is currently no review that considers rehabilitation among individuals with TBI who intersect with all parts of the CJS (i.e., policing, courts, corrections, and parole). This protocol is for a scoping review to address the above gaps, specifically, to identify the types of rehabilitation interventions and/or programs available to, or used by, individuals with TBI who intersect with all parts of the CJS. Primary research articles that meet pre-defined inclusion criteria will be identified from electronic databases (MEDLINE® ALL, Embase and Embase Classic, Cochrane CENTRAL Register of Clinical Trials, CINAHL, APA PsycINFO, Applied Social Sciences Index and Abstracts, Criminal Justice Abstracts, Nursing and Allied Health, and Dissertation and These Global), reference lists of included articles, and scoping or systematic reviews. Grey literature will also be searched to identify non-peer-reviewed reports. Retrieved articles will be screened by two reviewers and any disagreements will be resolved by a third reviewer. Data will be summarized quantitatively and analyzed using content analytic techniques. Intersecting identities will be charted and considered in the analysis. Stakeholders will be engaged to obtain feedback on preliminary results and the implications of findings. The scoping review will summarize the current state of rehabilitation available to, or used by, individuals with TBI who intersect with all parts of the CJS to (a) inform opportunities to integrate rehabilitation in the criminal justice system for diverse individuals and (b) identify opportunities for future research.
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Affiliation(s)
- Vincy Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Maria Jennifer Estrella
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Jessica Babineau
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
- The Institute for Education Research, University Health Network, Toronto, Ontario, Canada
| | - Angela Colantonio
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Niemann J, Schenk L, Stadler G, Richter M. What happens when you stop using the combined contraceptive pill? A qualitative study protocol on consequences and supply needs for women who discontinued the combined contraceptive pill in Germany. BMJ Open 2022; 12:e057089. [PMID: 35760546 PMCID: PMC9237896 DOI: 10.1136/bmjopen-2021-057089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION For more than 60 years, contraceptive pills have been prescribed to mostly healthy biological women. An emerging body of research concerning the possible physiological and psychological side effects of hormonal contraception has been published over the past two decades. Consequently, discontinuing combined oral contraceptives (COCs) as a conscious decision for reasons other than desired pregnancy has become increasingly common for menstruating individuals. The question remains as to what physical and psychological consequences can be observed after discontinuing COCs. In addition, the consequent healthcare needs and situations of affected individuals in Germany have not been explored. This study aims to gain greater insight into the relationship between discontinuation of COCs and (1) possible health consequences, and (2) to explore the supply situation for affected women within the German healthcare system. METHODS AND ANALYSIS Qualitative episodic interviews with women who discontinue COC therapy will explore possible health consequences, and their current healthcare needs and situations in Germany. The interviews will be transcribed verbatim, coded, and in-depth thematic interpretation will be conducted. Subsequently, expert interviews with health professionals who work with women who discontinue COCs will also be conducted. The expert interviews will be analysed according to the documentary method. Overarching themes will represent the perspectives of women and health professionals on the discontinuation of COCs. ETHICS AND DISSEMINATION Ethical approval for this study has been granted by the Ethics Review Committee of Martin Luther University, Halle-Wittenberg (Germany), reference number 2021-34. The findings will be disseminated via peer-reviewed publications, posting via social media and presentations at conferences. This study is registered on the OSF platform under the following number: https://doi.org/10.17605/OSF.IO/JYWXM.
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Affiliation(s)
- Jana Niemann
- Institute of Medical Sociology, Martin Luther University Halle Wittenberg, Halle, Sachsen-Anhalt, Germany
- Institute of Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gertraud Stadler
- Institute for Gender Research in Medicine (GiM), Charité Universitätsmedizin Berlin, Berlin, Germany
- University of Aberdeen, Aberdeen, UK
| | - Matthias Richter
- Institute of Medical Sociology, Martin Luther University Halle Wittenberg, Halle, Sachsen-Anhalt, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munchen, Bayern, Germany
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Kelleher S, Murphy M. Asexual identity development and internalisation: a thematic analysis. SEXUAL AND RELATIONSHIP THERAPY 2022. [DOI: 10.1080/14681994.2022.2091127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sinéad Kelleher
- School of Applied Psychology, University College Cork, Ireland
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Ireland
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Belzer LT, Wright SM, Goodwin EJ, Singh MN, Carter BS. Psychosocial Considerations for the Child with Rare Disease: A Review with Recommendations and Calls to Action. CHILDREN (BASEL, SWITZERLAND) 2022; 9:933. [PMID: 35883917 PMCID: PMC9325007 DOI: 10.3390/children9070933] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023]
Abstract
Rare diseases (RD) affect children, adolescents, and their families infrequently, but with a significant impact. The diagnostic odyssey undertaken as part of having a child with RD is immense and carries with it practical, emotional, relational, and contextual issues that are not well understood. Children with RD often have chronic and complex medical conditions requiring a complicated milieu of care by numerous clinical caregivers. They may feel isolated and may feel stigmas in settings of education, employment, and the workplace, or a lack a social support or understanding. Some parents report facing similar loneliness amidst a veritable medicalization of their homes and family lives. We searched the literature on psychosocial considerations for children with rare diseases in PubMed and Google Scholar in English until 15 April 2022, excluding publications unavailable in full text. The results examine RD and their psychosocial ramifications for children, families, and the healthcare system. The domains of the home, school, community, and medical care are addressed, as are the implications of RD management as children transition to adulthood. Matters of relevant healthcare, public policies, and more sophisticated translational research that addresses the intersectionality of identities among RD are proposed. Recommendations for interventions and supportive care in the aforementioned domains are provided while emphasizing calls to action for families, clinicians, investigators, and advocacy agents as we work toward establishing evidence-based care for children with RD.
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Affiliation(s)
- Leslee T. Belzer
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Division of General Academic Pediatrics, The Beacon Program, Children’s Mercy Kansas City, Kansas City, MO 64111, USA
| | - S. Margaret Wright
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Division of General Academic Pediatrics, The Beacon Program, Children’s Mercy Kansas City, Kansas City, MO 64111, USA
- School of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | - Emily J. Goodwin
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Division of General Academic Pediatrics, The Beacon Program, Children’s Mercy Kansas City, Kansas City, MO 64111, USA
- School of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | - Mehar N. Singh
- Department of Psychology, Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045, USA;
| | - Brian S. Carter
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Department of Medical Humanities & Bioethics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
- Bioethics Center, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
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Exploring the lived experience of diabetes through an intersectional lens: A qualitative study of adults with type 1 and type 2 diabetes. Can J Diabetes 2022; 46:620-627. [DOI: 10.1016/j.jcjd.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/23/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022]
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72
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Champine RB, McCullough WR, El Reda DK. Critical Race Theory for Public Health Students to Recognize and Eliminate Structural Racism. Am J Public Health 2022; 112:850-852. [PMID: 35446604 PMCID: PMC9137028 DOI: 10.2105/ajph.2022.306846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Robey B Champine
- Robey B. Champine is with the Division of Public Health and the Department of Family Medicine in the College of Human Medicine at Michigan State University, Flint. Wayne R. McCullough is with the Division of Public Health and the Department of Family Medicine in the College of Human Medicine at Michigan State University, Flint. Darline K. El Reda is with the Division of Public Health in the College of Human Medicine at Michigan State University, Flint
| | - Wayne R McCullough
- Robey B. Champine is with the Division of Public Health and the Department of Family Medicine in the College of Human Medicine at Michigan State University, Flint. Wayne R. McCullough is with the Division of Public Health and the Department of Family Medicine in the College of Human Medicine at Michigan State University, Flint. Darline K. El Reda is with the Division of Public Health in the College of Human Medicine at Michigan State University, Flint
| | - Darline K El Reda
- Robey B. Champine is with the Division of Public Health and the Department of Family Medicine in the College of Human Medicine at Michigan State University, Flint. Wayne R. McCullough is with the Division of Public Health and the Department of Family Medicine in the College of Human Medicine at Michigan State University, Flint. Darline K. El Reda is with the Division of Public Health in the College of Human Medicine at Michigan State University, Flint
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73
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Stenzel AE, Bustamante G, Sarkin CA, Harripersaud K, Jewett P, Teoh D, Vogel RI. The intersection of sexual orientation with race and ethnicity in cervical cancer screening. Cancer 2022; 128:2753-2759. [PMID: 35570647 DOI: 10.1002/cncr.34213] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cervical cancer screening is recommended for those with a cervix who are 21 to 65 years old, with specific timelines being dependent on individual risk. This study compared rates of ever undergoing Papanicolaou (Pap) testing at the intersection of self-reported sexual minority (SM) status and race/ethnicity. METHODS Data from the National Health Interview Survey (2015 and 2018) were used to examine cervical cancer screening disparities. Natal females without a history of hysterectomy who were 21 to 65 years old and had reported their sexual orientation and Pap testing history were included. Demographic and health characteristics were summarized with descriptive statistics. To adjust for differences in confounding variables between groups, propensity score-based inverse probability of treatment weighting (IPTW) was performed. IPTW-adjusted multivariable logistic regression models estimated odds of ever undergoing a Pap test by sexual orientation alone and with race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic). RESULTS SM persons (n = 877) had significantly reduced odds of ever undergoing Pap testing (odds ratio, 0.54; 95% confidence interval, 0.42-0.70) in comparison with heterosexual persons (n = 17,760). When the intersection of sexual orientation and race/ethnicity was considered, non-Hispanic White SM participants and Hispanic SM participants had reduced odds of ever undergoing Pap testing in comparison with non-Hispanic White heterosexual participants. No significant differences were observed between non-Hispanic White heterosexual participants and participants of non-Hispanic Black SM or Hispanic heterosexual identities. CONCLUSIONS SM participants were significantly less likely to have ever undergone a Pap test in comparison with heterosexual participants, with Hispanic SM participants having the lowest uptake. Future studies should further examine the roles of systemic discrimination and other key drivers of these disparities.
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Affiliation(s)
- Ashley E Stenzel
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota.,Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Gabriela Bustamante
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.,School of Public Health, Universidad San Francisco de Quito, Quito, Ecuador
| | - Courtney A Sarkin
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.,Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Katherine Harripersaud
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Patricia Jewett
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota.,Division of Hematology and Oncology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Deanna Teoh
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota
| | - Rachel I Vogel
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota
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Bambra C. Placing intersectional inequalities in health. Health Place 2022; 75:102761. [PMID: 35397319 DOI: 10.1016/j.healthplace.2022.102761] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 12/29/2022]
Abstract
Research into geographical inequalities in health has focused almost exclusively on examining the effects of area-level deprivation and has been largely framed through a compositional-contextual lens, their inter-relationship and the influence of vertical macro-economic and political/policy drivers. However, in the broader health inequalities field, intersectionality has recently emerged as a critical theoretical and methodical approach which examines the concurrent and interacting influences on health of multiple axes of inequality (such as socio-economic status, gender, race/ethnicity and sexuality or gender-identity). Simultaneously, social geography has been explicitly using intersectionality to analyse how mutually constitutive forms of social oppression interact and interrelate with place. This paper exploits the analytical space opened up by this 'intersectional turn' by outlining the benefits for research into geographical inequalities in health that can be achieved by taking a more explicit approach to intersectional inequalities. It argues that: (1) geographical research into health inequalities should more explicitly and widely apply an intersectional lens; and relatedly that, in turn, (2) place needs to be considered as an aspect of intersectionality and integrated into the wider intersectional inequalities in health literature. The paper summarises the evolution of theories of place and health inequalities and outlines intersectional theory and the work to date that has been undertaken to integrate this perspective into our understanding of health inequalities. Drawing on the social geography literature into place and intersectionality, the paper explores how this perspective is being used to enhance our understanding of place effects more generally - and how place itself can be considered as an element of intersectional inequalities. Drawing these different bodies of work together, the paper concludes by considering the implications for theories of geographical inequalities in health.
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Affiliation(s)
- Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
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Williams D, Bartelt E, Thomas B, Guerra-Reyes L, Carspecken L, Rosenstock Gonzalez YR, Klimek S, Dodge B. Beyond the Boundaries: Exploring the Identity-Related Experiences of Biracial/Multiracial and Bisexual Adults. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2241-2259. [PMID: 35622076 PMCID: PMC9137263 DOI: 10.1007/s10508-021-02236-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 06/15/2023]
Abstract
Most prior bisexual research takes a monolithic approach to racial identity, and existing racial/ethnic minority research often overlooks bisexuality. Consequently, previous studies have rarely examined the experiences and unique health needs of biracial/multiracial and bisexual individuals. This exploratory qualitative study investigated the identity-related experiences of biracial/multiracial and bisexual adults within the context of health and well-being. Data were collected through 90-min semi-structured telephone interviews. Participants were recruited through online social network sites and included 24 adults between ages 18 and 59 years. We aimed to explore how identity-related experiences shape biracial/multiracial and bisexual individuals' identity development processes; how biracial/multiracial and bisexual individuals negotiate their identities; how the blending of multiple identities may contribute to perceptions of inclusion, exclusion, and social connectedness; and how biracial/multiracial and bisexual individuals may attribute positive and negative experiences to their identities. Interview transcripts were analyzed using an inductive thematic approach. Analysis highlighted four major themes: passing and invisible identities, not measuring up and erasing complexity, cultural binegativity/queerphobia and intersectional oppressions, and navigating beyond boundaries. Our findings imply promoting affirmative visibility and developing intentional support networks may help biracial/multiracial and bisexual individuals cultivate resiliency and navigate sources of identity stress. We encourage future research to explore mental health and chronic stress among this community.
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Affiliation(s)
- Deana Williams
- Center for Sexual Health Promotion, School of Public Health, Indiana University-Bloomington, 1025 E 7th St., Bloomington, IN, 47405, USA.
| | - Elizabeth Bartelt
- School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY, USA
| | - Breanna Thomas
- Center for Sexual Health Promotion, School of Public Health, Indiana University-Bloomington, 1025 E 7th St., Bloomington, IN, 47405, USA
| | - Lucia Guerra-Reyes
- Center for Sexual Health Promotion, School of Public Health, Indiana University-Bloomington, 1025 E 7th St., Bloomington, IN, 47405, USA
| | - Lucinda Carspecken
- School of Education, Indiana University-Bloomington, Bloomington, IN, USA
| | - Yael R Rosenstock Gonzalez
- Center for Sexual Health Promotion, School of Public Health, Indiana University-Bloomington, 1025 E 7th St., Bloomington, IN, 47405, USA
| | - Sally Klimek
- Center for Sexual Health Promotion, School of Public Health, Indiana University-Bloomington, 1025 E 7th St., Bloomington, IN, 47405, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health, Indiana University-Bloomington, 1025 E 7th St., Bloomington, IN, 47405, USA
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Mencher SR, Weinzimer SA, Nally LM, Van Name M, Nunez-Smith M, Sadler LS. Technology Utilization in Black Adolescents with Type 1 Diabetes: Exploring the Decision-Making Process. Diabetes Technol Ther 2022; 24:249-257. [PMID: 35085444 PMCID: PMC11074720 DOI: 10.1089/dia.2021.0413] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Significant disparities in diabetes device (DD) use exist for Black adolescents with type 1 diabetes (T1D), meriting further exploration. We sought to describe how Black adolescents with T1D and their parents make decisions about using DDs and understand personal, familial, and cultural beliefs that may influence use. Materials and Methods: Nineteen Black adolescents with T1D and 17 parents participated in individual qualitative semistructured interviews. Adolescents were purposively sampled for a range of socioeconomic and clinical demographics. Interview data were recorded, transcribed, and coded for thematic analysis, analyzed separately for parents and adolescents, and then compared across groups. Data collection continued until thematic saturation was achieved. Results: Adolescents and parents reported similar themes related to the (1) intersectionality of multiple identities: T1D experience of Black adolescents; (2) decision to use DDs: complexities of T1D management and easing the burden; and (3) reasons for differential uptake of DDs in Black adolescents. Adolescents reported lacking peers with T1D "who look like me," leading to stigmatization, exacerbated by device visibility and alarms. Cultural and familial traditions as well as individual factors were described as both facilitators and barriers in DD use. Lack of familiarity with T1D, limited exposure to DDs, and mistrust of the medical community, both historically and currently, were brought up as reasons for inequities in DD use. Conclusions: Understanding the decision-making process surrounding DDs in one sample of Black adolescents and their parents is critical to guide further research to improve equity in DD use and glycemic outcomes.
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Affiliation(s)
- Shana R. Mencher
- Department of Pediatrics, Division of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stuart A. Weinzimer
- Department of Pediatrics, Division of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
- School of Nursing, Yale University, Orange, Connecticut, USA
| | - Laura M. Nally
- Department of Pediatrics, Division of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michelle Van Name
- Department of Pediatrics, Division of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lois S. Sadler
- School of Nursing, Yale University, Orange, Connecticut, USA
- Yale Child Study Center, New Haven, Connecticut, USA
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Vacca R. Intersectional elaboration: Using a multiracial feminist co-design technique with Latina teens for emotional health. FEMINIST THEORY 2022. [DOI: 10.1177/14647001221082297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Underlying the growing epidemic of mental distress and suicidal ideation amongst certain marginalised groups (e.g. Latina teens) are complex intersections of ecologies and interrelated structures of inequality such as class, culture, race and gender. Through the use of a multiracial feminist framework, the proposed intersectional elaboration technique examines how technology might be designed in ways that explicitly consider intersecting structures of inequality and eco-developmental contexts. The core of this technique involves co-constructing narratives using prompts that directly address specific layers of one's ecology and the interactions across ecological layers – purposely addressing intersecting systems of inequality acting along these ecologies. This article describes the application of the intersectional elaboration technique in co-design research with adolescent Latinas, in a highly urbanised context, towards designing emotional health technology. Findings suggest that intersectional elaborations can serve as a useful generative co-design technique to inform designs that address complex arrangements of intra-ecological conflicts and cultural legitimacy.
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Bond KT, Gunn A, Williams P, Leonard NR. Using an Intersectional Framework to Understand the Challenges of Adopting Pre-exposure Prophylaxis (PrEP) Among Young Adult Black Women. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:180-193. [PMID: 35401855 PMCID: PMC8992539 DOI: 10.1007/s13178-021-00533-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 06/14/2023]
Abstract
Introduction There is limited functional knowledge and utilization of pre-exposure prophylaxis (PrEP) among young adult Black cisgender women (YBW). Methods We conducted four focus groups with YBW using an intersectional framework to explore multiple levels of factors that impede YBW awareness, interest, and utilization of PrEP in conjunction with their sexual and reproductive healthcare needs. Results Influences at the cultural-environmental level included a lack of information and resources to access to PrEP and medical mistrust in the healthcare system. At the social normative level, influences included attitudes towards the long-term effects on sexual and reproductive health and self-efficacy to follow the PrEP regimen. At the proximal intrapersonal level, influences included anticipated HIV stigma from family and peers along with the fear of rejection from their main partners. Conclusions Translation of these results indicated that interventions to increase PrEP utilization and adherence among YBW will require multi-level strategies to address barriers to integrating HIV prevention into sexual and reproductive healthcare.
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Affiliation(s)
- Keosha T. Bond
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, New York, United States
| | - Alana Gunn
- Department of Criminology, Law, and Justice, University of Illinois At Chicago, Chicago, Illinois, United States
| | - Porche Williams
- CUNY Lehman College, Bronx, New York, New York, United States
| | - Noelle R. Leonard
- Silver School of Social Work, New York University, New York, New York, United States
- Center for Drug Use and HIV Research, NYU School of Global Public Health, New York, New York, United States
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79
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Spencer S, Samateh T, Wabnitz K, Mayhew S, Allen H, Bonell A. The Challenges of Working in the Heat Whilst Pregnant: Insights From Gambian Women Farmers in the Face of Climate Change. Front Public Health 2022; 10:785254. [PMID: 35237548 PMCID: PMC8883819 DOI: 10.3389/fpubh.2022.785254] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/17/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The expected increase in heat in The Gambia is one of the most significant health threats caused by climate change. However, little is known about the gendered dynamics of exposure and response to heat stress, including women's perceived health risks, their adaptation strategies to heat, and their perceptions of climate change. This research project aims to answer the question of whether and how pregnant farmers in The Gambia perceive and act upon occupational heat stress and its health impacts on both themselves and their unborn children, against the backdrop of current and expected climatic changes. METHOD In-depth semi-structured interviews were conducted with 12 women who practice subsistence farming and were either pregnant or had delivered within the past month in West Kiang, The Gambia. Participants were selected using purposive sampling. Translated interview transcripts were coded and qualitative thematic content analysis with an intersectional lens was used to arrive at the results. RESULTS All women who participated in the study experience significant heat stress while working outdoors during pregnancy, with symptoms often including headache, dizziness, nausea, and chills. The most common adaptive techniques included resting in the shade while working, completing their work in multiple shorter time increments, taking medicine to reduce symptoms like headache, using water to cool down, and reducing the amount of area they cultivate. Layered identities, experiences, and household power structures related to age, migration, marital situation, socioeconomic status, and supportive social relationships shaped the extent to which women were able to prevent and reduce the effects of heat exposure during their work whilst pregnant. Women who participated in this study demonstrated high awareness of climate change and offered important insights into potential values, priorities, and mechanisms to enable effective adaptation. CONCLUSION Our findings reveal many intersecting social and economic factors that shape the space within which women can make decisions and take adaptive action to reduce the impact of heat during their pregnancy. To improve the health of pregnant working women exposed to heat, these intersectionalities must be considered when supporting women to adapt their working practices and cope with heat stress.
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Affiliation(s)
- Shantelle Spencer
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Tida Samateh
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Katharina Wabnitz
- Chair for Public Health and Health Services Research, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Susannah Mayhew
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, University of London, London, United Kingdom
| | - Haddijatou Allen
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Ana Bonell
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
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80
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Cohen SA, Nash CC, Byrne EN, Mitchell LE, Greaney ML. Black/White Disparities in Obesity Widen with Increasing Rurality: Evidence from a National Survey. Health Equity 2022; 6:178-188. [PMID: 35402770 PMCID: PMC8985531 DOI: 10.1089/heq.2021.0149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Steven A. Cohen
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Caitlin C. Nash
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Erin N. Byrne
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Lauren E. Mitchell
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
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81
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Quinn KG. The relationship between syndemics and intersectionality: A response to the commentary by Sangaramoorthy and Benton. Soc Sci Med 2022; 295:113784. [PMID: 33678479 PMCID: PMC8410884 DOI: 10.1016/j.socscimed.2021.113784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
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82
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Allana S, Ski CF, Thompson DR, Clark AM. Bringing Intersectionality to Cardiovascular Health Research in Canada. CJC Open 2022; 3:S4-S8. [PMID: 34993427 PMCID: PMC8712551 DOI: 10.1016/j.cjco.2021.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/28/2021] [Indexed: 01/10/2023] Open
Affiliation(s)
- Saleema Allana
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
| | - Chantal F Ski
- Integrated Care Academy, University of Suffolk, Ipswich, United Kingdom
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
| | - Alexander M Clark
- Faculty of Health Disciplines, Athabasca University. Edmonton, Alberta, Canada
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83
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Agénor M, Murchison GR, Najarro J, Grimshaw A, Cottrill AA, Janiak E, Gordon AR, Charlton BM. Mapping the scientific literature on reproductive health among transgender and gender diverse people: a scoping review. Sex Reprod Health Matters 2021; 29:1886395. [PMID: 33625311 PMCID: PMC8011687 DOI: 10.1080/26410397.2021.1886395] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We conducted a scoping review to map the extent, range and nature of the scientific research literature on the reproductive health (RH) of transgender and gender diverse assigned female at birth and assigned male at birth persons. A research librarian conducted literature searches in Ovid MEDLINE®, Ovid Embase, the Cochrane Library, PubMed, Google Scholar, Gender Studies Database, Gender Watch, and Web of Science Core Collection. The results were limited to peer-reviewed journal articles published between 2000 and 2018 involving human participants, written in English, pertaining to RH, and including disaggregated data for transgender and gender diverse people. A total of 2197 unique citations with abstracts were identified and entered into Covidence. Two independent screeners performed a title and abstract review and selected 75 records for full-text review. The two screeners independently extracted data from 37 eligible articles, which were reviewed, collated, summarised, and analysed using a numerical summary and thematic analysis approach. The existing scientific research literature was limited in terms of RH topics, geographic locations, study designs, sampling and analytical strategies, and populations studied. Research is needed that: focuses on the full range of RH issues; includes transgender and gender diverse people from the Global South and understudied and multiply marginalised subpopulations; is guided by intersectionality; and uses intervention, implementation science, and community-based participatory research approaches. Further, programmes, practices, and policies that address the multilevel barriers to RH among transgender and gender diverse people addressed in the existing scientific literature are warranted.
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Affiliation(s)
- Madina Agénor
- Gerald R. Gill Assistant Professor, Department of Community Health, Tufts University, Medford, MA, USA; Adjunct Faculty, Department of Obstetrics and Gynecology, Tufts University School of Medicine, and The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Gabriel R. Murchison
- PhD Student, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jesse Najarro
- Undergraduate Student, Department of Community Health, Tufts University, Medford, MA, USA
| | - Alyssa Grimshaw
- Clinical Research and Education Librarian, Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Alischer A. Cottrill
- Research Coordinator, Planned Parenthood League of Massachusetts, Boston, MA, USA
| | - Elizabeth Janiak
- Director of Social Science Research, Planned Parenthood League of Massachusetts, Boston, MA, USA; Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA, USA and Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA; Instructor, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Allegra R. Gordon
- Assistant Professor, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA; Instructor, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Brittany M. Charlton
- Assistant Professor, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA, Department of Pediatrics, Harvard Medical School, Boston, MA, USA and Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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84
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Clark KA, Björkenstam C, Kosidou K, Björkenstam E. Psychological Distress, Suicidal Ideation, and Suicide Attempt Among Lesbian, Gay, and Bisexual Immigrants: Population-Based Findings from the Stockholm Public Health Cohort. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3563-3574. [PMID: 34725752 PMCID: PMC9308978 DOI: 10.1007/s10508-021-01997-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 06/13/2023]
Abstract
In a large, population-based sample in Sweden, we sought to examine mental health disparities between lesbian, gay and bisexual (LGB) and heterosexual individuals with different immigration statuses. We conducted a population-based study including 1799 LGB and 69,324 heterosexual individuals, recruited in 2010 and 2014 as part of the Stockholm Public Health Cohort. Data were obtained from self-administered surveys that were linked to nationwide registers. We examined associations between mental health outcomes (i.e., psychological distress, suicidal ideation, and suicide attempt) and sexual orientation (LGB versus heterosexual), immigration status (immigrant versus Nordic-born), and their interaction. Sex-stratified weighted multivariable logistic regression analyses were used to calculate adjusted odds ratios with 95% confidence intervals. LGB individuals demonstrated substantially elevated odds of all mental health outcomes compared to heterosexuals; immigrants reported moderately elevated odds of psychological distress and suicide attempt, but not suicidal ideation, compared to Nordic-born individuals. Interaction terms between sexual orientation and immigration status were significant at p < 0.05 for psychological distress for both sexes and for suicidal ideation and attempt among women. Unexpectedly, models probing interactions generally demonstrated that Nordic-born LGB individuals demonstrated greater risk of psychological distress, suicidal ideation, and suicide attempt than did immigrant LGB individuals, especially among women. Supplemental analyses showed that Nordic-born bisexual women demonstrated the highest risk of all studied outcomes. Being LGB in Sweden is generally a stronger risk factor for poor mental health among Nordic-born than immigrant populations. These findings call for future intersectionality-focused research to delineate the unique cultural, social, and psychological factors associated with mental health and resilience among LGB immigrants.
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Affiliation(s)
- Kirsty A Clark
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, 37235, USA.
| | | | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Emma Björkenstam
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, CA, USA
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85
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Opara I, Brown TL. Teaching Note-#BlackGirlsMatter and the Social Work Curriculum: Integrating Intersectionality Within Social Work Education. JOURNAL OF SOCIAL WORK EDUCATION 2021; 59:263-269. [PMID: 36874948 PMCID: PMC9983732 DOI: 10.1080/10437797.2021.1985026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 06/18/2023]
Abstract
Black girls in the United States face a double or triple jeopardy that places them at risk compared to White girls and other ethnic minority girls. Furthermore, their voices and experiences are often ignored and not discussed fully within the social work classrooms. Since the social work profession is founded on social justice and equity, we urge educators to center the experiences of Black girls within their curriculum by recognizing their experiences within the context of power, privilege and oppression. This teaching note presents intersectionality as a framework for teaching social work students about working effectively with Black girls by focusing on their unique social location. Specifically, we provide strategies that engage social work students through case studies using qualitative research, student reflections, educational videos, and guest speakers. By using an intersectionality lens, social work curriculums can provide an important foundation for students to understand the nuanced ways that Black girls develop and experience the world.
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Affiliation(s)
- Ijeoma Opara
- Department of Social and Behavioral Sciences, Yale School of Public Health
| | - Tiffany L Brown
- Department of Family and Consumer Sciences, California State Long Beach
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86
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Willie TC, Monger M, Nunn A, Kershaw T, Stockman JK, Mayer KH, Chan PA, Adimora AA, Mena LA, Knight D, Philllips KA, Baral SD. "PrEP's just to secure you like insurance": a qualitative study on HIV pre-exposure prophylaxis (PrEP) adherence and retention among black cisgender women in Mississippi. BMC Infect Dis 2021; 21:1102. [PMID: 34702165 PMCID: PMC8549215 DOI: 10.1186/s12879-021-06786-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/12/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) has the potential to reduce transmission of HIV among Black cisgender women in the Southern United States (U.S.); however, national data suggests that PrEP initiation is lowest in the South and among Black women compared to other U.S. regions and white women. This study applied intersectionality and PrEP multilevel resilience frameworks to assess how socio-structural and clinical contexts shaped PrEP persistence among Black cisgender women in Mississippi. METHODS Semi-structured interviews were conducted with eight Black cisgender women in Jackson, Mississippi. This sample was purposively recruited to include PrEP-initiated Black cisgender women. RESULTS Six themes identified that shaped PrEP care among Black cisgender women: (1) internal assets, (2) sole responsibility to HIV prevention, (3) added protection in HIV serodifferent relationships, (4) financial issues, (5) trust and distrust in the medical system, and (6) side effects. Black cisgender women reported that PrEP persistence increased control over their sexual health, reduced anxiety about HIV, and promoted self-care. Black cisgender women also indicated that medication assistance programs increased PrEP affordability resulting in continued persistence. CONCLUSIONS In addition to preventing HIV, PrEP may yield secondary positive impacts on the health and relationships of Black cisgender women. However, very few Black cisgender women in the South are using PrEP given intersectional barriers and thus necessitates adaptive strategies to support PrEP initiation and persistence. Efforts aimed at increasing the coverage of PrEP among Black cisgender women should consider implementation strategies responsive to lived realities of Black women.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Mauda Monger
- MLM Center for Health Education and Equity Consulting Services, Jackson, MS, USA
| | - Amy Nunn
- Department of Psychiatry, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Medicine, The Miriam Hospital, Providence, RI, USA
- School of Public Health, Brown University, Providence, RI, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Kenneth H Mayer
- Harvard Medical School and Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Philip A Chan
- Department of Psychiatry, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Medicine, The Miriam Hospital, Providence, RI, USA
| | - Adaora A Adimora
- Department of Medicine, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Leandro A Mena
- Department of Medicine, University of Mississippi Medical Center, Jackson, USA
| | - Deja Knight
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karlye A Philllips
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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Leuenberger A, Cambaco O, Zabré HR, Lyatuu I, Utzinger J, Munguambe K, Merten S, Winkler MS. "It Is Like We Are Living in a Different World": Health Inequity in Communities Surrounding Industrial Mining Sites in Burkina Faso, Mozambique, and Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111015. [PMID: 34769535 PMCID: PMC8582703 DOI: 10.3390/ijerph182111015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/29/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022]
Abstract
Background: Health equity features prominently in the 2030 Agenda for Sustainable Development, yet there are wide disparities in health between and within countries. In settings of natural resource extraction (e.g., industrial mines), the health of surrounding communities is affected through myriad changes in the physical, social, and economic environment. How changes triggered by such projects translate into health inequities is poorly understood. Methods: This qualitative study explores potential layers of inequities by systematically coding perceived inequities of affected communities. Drawing on the framework method, we thematically analyzed data from 83 focus group discussions, which enrolled 791 participants from 10 study sites in Burkina Faso, Mozambique, and Tanzania. Results: Participants perceived inequities related to their individual characteristics, intermediate factors acting on the community level, and structural conditions. Due to environmental pollution and land loss, participants were concerned about unsecured livelihoods. Positive impacts, such as job opportunities at the mine, remained scarce for local communities and were claimed not to be equally distributed among community members. Conclusion: Extractive industries bear considerable risks to widen existing health gaps. In order to create equal opportunities among affected populations, the wider determinants of health must be considered more explicitly in the licensing process of resource extraction projects.
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Affiliation(s)
- Andrea Leuenberger
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
- Correspondence:
| | - Olga Cambaco
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
- Manhiça Health Research Centre, Maputo C.P. 1929, Mozambique;
| | - Hyacinthe R. Zabré
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
- Research Institute of Health Sciences, Ouagadougou B.P. 7192, Burkina Faso
| | - Isaac Lyatuu
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
- Ifakara Health Institute, P.O. Box, Dar es Salaam 78 373, Tanzania
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Khátia Munguambe
- Manhiça Health Research Centre, Maputo C.P. 1929, Mozambique;
- Faculty of Medicine, Eduardo Mondlane University, Maputo C.P. 257, Mozambique
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Mirko S. Winkler
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (O.C.); (H.R.Z.); (I.L.); (J.U.); (S.M.); (M.S.W.)
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
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88
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Reitzel M, Letts L, Di Rezze B, Phoenix M. Critically Examining the Person–Environment Relationship and Implications of Intersectionality for Participation in Children's Rehabilitation Services. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:709977. [PMID: 36188778 PMCID: PMC9397911 DOI: 10.3389/fresc.2021.709977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/16/2021] [Indexed: 01/03/2023]
Abstract
Participation of children in rehabilitation services is associated with positive functional and developmental outcomes for children with disabilities. Participation in therapy is at risk when the personal and environmental contexts of a child create barriers to accessing services. The International Classification of Functioning, Disability and Health (ICF) provides a framework for conceptualizing the personal and environmental factors linked to a child. However, it does not facilitate critical examination of the person–environment relationship and its impact on participation in children's rehabilitation. This perspective study proposes the use of intersectionality theory as a critical framework in complement with the ICF to examine the impact of systemic inequities on the participation in therapy for children with disabilities. Clinicians are called to be critical allies working alongside children and families to advocate for inclusive participation in children's rehabilitation by identifying and transforming systemic inequities in service delivery.
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Affiliation(s)
- Meaghan Reitzel
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- *Correspondence: Meaghan Reitzel
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Briano Di Rezze
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Michelle Phoenix
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- Bloorview Research Institute, Toronto, ON, Canada
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89
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Abstract
Diversions occur when research disregards the inequality-generating actions of advantaged groups and instead focuses attention on the actions and behaviors of disadvantaged groups. We incorporate important insights from COVID-19 to illustrate historical and contemporary examples of diversions. This paper highlights US immigrant health inequities—a burgeoning subfield within the broader health inequalities canon—to explore: (1) if and how diversions appear in immigrant health studies; (2) how often white supremacy and intersectionality are explicitly named in grants, publicly available datasets, and published research. The data derive from: NIH R01 grants (17), publicly available datasets that focus on immigrant health (7), and research published in three health journals (14). Using a qualitative content analysis approach, we analyzed these data as evidence concerning the knowledge production cycle, and investigate whether: (a) the role of advantaged groups in generating inequalities is explicitly mentioned; (b) disadvantaged groups are asked about discriminatory actions perpetuated by advantaged groups; (c) health inequalities are placed on the conditions of disadvantaged groups; (d) if white supremacy and intersectionality are explicitly mentioned in grants, publicly available datasets, and research articles. The findings demonstrate the prevalence of diversions in immigrant health research, given an overemphasis on health behaviors and cultural explanations towards explaining immigrant health inequities. There was no mention of white supremacy across the knowledge production cycle. Intersectionality was mentioned once in a research article. We argue that understanding white supremacy’s role in the knowledge production cycle illuminates how diversions occur and prevail. We provide suggestions on moving away from diversionary research, toward adopting an intersectional approach of the study of immigrant health inequities.
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90
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Craig SL, Eaton AD, Kirkland A, Egag E, Pascoe R, King K, Krishnan S. Towards an integrative self: a digital photo elicitation study of resilience among key marginalized populations of sexual and gender minority youth. Int J Qual Stud Health Well-being 2021; 16:1961572. [PMID: 34375157 PMCID: PMC8366624 DOI: 10.1080/17482631.2021.1961572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: Sexual and gender minority youth (SGMY) experience unique challenges related to identity and disclosure, and cope in vibrant ways. Qualitative research has not yet fulsomely explored the risk, resilience, and identity intersections that impact vulnerable SGMY wellbeing. Methods: This digital photo-elicitation study (QueerView) recruited thirty SGMY (aged 14–29) from priority populations that had one or more of the following experiences: trans and gender diverse, homelessness, child welfare, and immigration. From submission of fifteen photos representing resilience and a semi-structured interview via web conferencing, constructivist grounded theory was utilized for multimodal analysis of photos, interview video, and interview transcript. Triangulation, an audit trail, and member checking were employed to support trustworthiness. Results: A visual model emerged showing how participants work towards an integrative self, with themes of reflecting and knowing, discrimination and intersectional challenges, connecting, performing, curating, coping, (re)defining and (re)creating, growing and being. Sub-themes of the impact of family dynamic and values, mental health and trauma, and the cathartic benefit from advocacy and leadership offered insight. Participant images were captured in a digital gallery. Conclusions: QueerView animates the complex lives of multiply marginalized SGMY and their intersectional strengths and challenges while demonstrating the utility of a digital multimodal approach.
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Affiliation(s)
- Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Andrew D Eaton
- Faculty of Social Work, University of Regina - Saskatoon Campus, Regina, Canada
| | - Alexa Kirkland
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Egag Egag
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Rachael Pascoe
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Kourteney King
- Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Sreedevi Krishnan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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91
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Merz S, Jaehn P, Mena E, Pöge K, Strasser S, Saß AC, Rommel A, Bolte G, Holmberg C. Intersectionality and eco-social theory: a review of potentials for public health knowledge and social justice. CRITICAL PUBLIC HEALTH 2021. [DOI: 10.1080/09581596.2021.1951668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sibille Merz
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
| | - Philipp Jaehn
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Potsdam and Cottbus, Germany
| | - Emily Mena
- , Department of Social Epidemiology, University of Bremen, Institute of Public Health and Nursing Research, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Kathleen Pöge
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit 24 - Health Reporting, Berlin, Germany
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Unit 34 - HIV/AIDS, STI and Blood-borne Infections, Berlin, Germany
| | - Sarah Strasser
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit 24 - Health Reporting, Berlin, Germany
| | - Anke-Christine Saß
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit 24 - Health Reporting, Berlin, Germany
| | - Alexander Rommel
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit 24 - Health Reporting, Berlin, Germany
| | - Gabriele Bolte
- , Department of Social Epidemiology, University of Bremen, Institute of Public Health and Nursing Research, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Potsdam and Cottbus, Germany
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Dai H, Younis A, Kong JD, Bragazzi NL, Wu J. Trends and Regional Variation in Prevalence of Cardiovascular Risk Factors and Association With Socioeconomic Status in Canada, 2005-2016. JAMA Netw Open 2021; 4:e2121443. [PMID: 34410395 PMCID: PMC8377569 DOI: 10.1001/jamanetworkopen.2021.21443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Cardiovascular disease remains the second leading cause of death in Canada. Monitoring and tracking the trends and disparities in major cardiovascular risk factors could provide benchmarks for future cardiovascular health strategies. OBJECTIVE To investigate the temporal trends, regional variations, and socioeconomic disparities in major cardiovascular risk factors in Canada from 2005 to 2016. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional survey study included adults aged 20 years and older from 6 Canadian Community Health Survey cycles between 2005 and 2016. Cardiovascular risk factors included hypertension, diabetes, obesity, and current smoking. Socioeconomic status was measured using equivalized household income. Data analysis was performed from September 2019 to April 2020. EXPOSURES A total of 112 health regions and socioeconomic status. MAIN OUTCOMES AND MEASURES Age- and sex-adjusted prevalence of hypertension, diabetes, obesity, and current smoking by year; health regions; and socioeconomic status. Absolute numbers were rounded to base 100 for confidentiality purposes, and percentages were based on weighted numbers. Slope index of inequality (SII) and relative index of inequality (RII) were calculated to assess absolute and relative socioeconomic inequalities, respectively. RESULTS A total of 670 000 respondents (329 000 [49.1%] men; 341 000 [50.9%] women) aged 20 years and older from 6 survey cycles were enrolled for this study. The largest age group was those aged 40 to 59 years (eg, 2005 cycle: 40.2% [95% CI, 39.9%-40.6%]). In the 2015/2016 cycle, the overall age- and sex-adjusted prevalence rates of hypertension, diabetes, obesity, and current smoking were 20.7% (95% CI, 20.4%-21.1%), 7.2% (95% CI, 7.0%-7.5%), 20.1% (95% CI, 19.7%-20.6%), and 17.8% (95% CI, 17.4%-18.2%), respectively. From 2005 to 2016, there was a significant increase in the prevalence of hypertension, diabetes, and obesity (eg, prevalence of diabetes in both sexes, 2005: 5.8% [95% CI, 5.6%-6.0%]; 2015/2016: 7.2% [95% CI, 7.0%-7.5%]; P < .001) but a significant decrease in the prevalence of current smoking (both sexes, 2005: 22.1% [95% CI, 21.7%-22.5%]; 2015/2016: 17.8% [95% CI, 17.4%-18.2%]; P < .001). The prevalence of all the risk factors varied widely across health regions (eg, obesity, Vancouver Health Service Delivery Area: 6.7% [95% CI, 4.5%-9.0%]; Miramichi Area: 36.8% [95% CI, 27.3%-46.3%]). In addition to obesity among men, all risk factors tended to be more common among those with lower income (eg, prevalence of hypertension in both sexes, 2015/2016, lowest income group: 23.2% [95% CI, 22.4%-24.0%]; highest income group: 18.4% [95% CI, 17.7%-19.1%]). The SII and RII indicated consistent absolute and relative socioeconomic inequalities in hypertension, diabetes, and current smoking over time (eg, RII for hypertension in both sexes, 2005: 1.25; 95% CI, 1.18-1.33; 2015/2016: 1.34; 95% CI, 1.26-1.43). However, the phenomenon of absolute and relative socioeconomic inequalities in obesity was only observed among women (eg, RII for 2015/2016 for obesity in women; 1.74 (95% CI, 1.56-1.93); men: 1.09; 95% CI, 0.99-1.21). CONCLUSIONS AND RELEVANCE During the study period, the prevalence of hypertension, diabetes, and obesity significantly increased, while the prevalence of current smoking significantly decreased. Geographic and socioeconomic gaps should be considered and addressed in future interventions and policies targeted at reducing these cardiovascular risk factors in Canada.
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Affiliation(s)
- Haijiang Dai
- Laboratory for Industrial and Applied Mathematics, Centre for Disease Modelling, York University, Toronto, Ontario, Canada
| | - Arwa Younis
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Jude Dzevela Kong
- Laboratory for Industrial and Applied Mathematics, Centre for Disease Modelling, York University, Toronto, Ontario, Canada
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Centre for Disease Modelling, York University, Toronto, Ontario, Canada
| | - Jianhong Wu
- Laboratory for Industrial and Applied Mathematics, Centre for Disease Modelling, York University, Toronto, Ontario, Canada
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Ramos SR, Lardier DT, Opara I, Turpin RE, Boyd DT, Gutierrez JI, Williams CN, Nelson LE, Kershaw T. Intersectional Effects of Sexual Orientation Concealment, Internalized Homophobia, and Gender Expression on Sexual Identity and HIV Risk Among Sexual Minority Men of Color: A Path Analysis. J Assoc Nurses AIDS Care 2021; 32:495-511. [PMID: 34101701 PMCID: PMC8221709 DOI: 10.1097/jnc.0000000000000274] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In the United States, 13 million people identify as sexual and gender minorities. The purposes of this article were to (a) examine the associations among sexual orientation concealment and internalized homophobia with HIV knowledge, health literacy, and transactional sex through sexual identity; and (b) assess whether gender expression moderates those relationships in sexual minority men of color. A multigroup mediation path model examined the association between sexual orientation concealment and internalized homophobia on HIV knowledge, health literacy, and transactional sex through sexual identity by gender expression. Results suggest that, among those with a masculine gender expression, as sexual concealment increased, health literacy decreased. The association between sexual orientation concealment and transactional sex varied by participant's gender expression as did the association between internalized homophobia and HIV knowledge. Multiple intersecting identities, when faced with anticipated discrimination and homophobia, can negatively affect health outcomes and increase HIV risk in sexual minority men of color.
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Affiliation(s)
- S. Raquel Ramos
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - David T. Lardier
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Ijeoma Opara
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Rodman E. Turpin
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Donte T. Boyd
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - José I. Gutierrez
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Chase Nicole Williams
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - LaRon E. Nelson
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Trace Kershaw
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
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Holman D, Salway S, Bell A, Beach B, Adebajo A, Ali N, Butt J. Can intersectionality help with understanding and tackling health inequalities? Perspectives of professional stakeholders. Health Res Policy Syst 2021; 19:97. [PMID: 34172066 PMCID: PMC8227357 DOI: 10.1186/s12961-021-00742-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/30/2021] [Indexed: 12/12/2022] Open
Abstract
Background The concept of “intersectionality” is increasingly employed within public health arenas, particularly in North America, and is often heralded as offering great potential to advance health inequalities research and action. Given persistently poor progress towards tackling health inequalities, and recent calls to reframe this agenda in the United Kingdom and Europe, the possible contribution of intersectionality deserves attention. Yet, no existing research has examined professional stakeholder understandings and perspectives on applying intersectionality to this field. Methods In this paper we seek to address that gap, drawing upon a consultation survey and face-to-face workshop (n = 23) undertaken in the United Kingdom. The survey included both researchers (n = 53) and policy and practice professionals (n = 20) with varied roles and levels of engagement in research and evaluation. Topics included familiarity with the term and concept “intersectionality”, relevance to health inequalities work, and issues shaping its uptake. Respondents were also asked to comment on two specific policy suggestions: intersectionally targeting and tailoring interventions, and evaluating the intersectional effects of policies. The workshop aims were to share examples of applying intersectionality within health inequalities research and practice; understand the views of research and practice colleagues on potential contributions and challenges; and identify potential ways to promote intersectional approaches. Results Findings indicated a generally positive response to the concept and a cautiously optimistic assessment that intersectional approaches could be valuable. However, opinions were mixed and various challenges were raised, especially around whether intersectionality research is necessarily critical and transformative and, accordingly, how it should be operationalized methodologically. Nonetheless, there was general agreement that intersectionality is concerned with diverse inequalities and the systems of power that shape them. Conclusions We position intersectionality within the wider context of health inequalities policy and practice, suggesting potential ways forward for the approach in the context of the United Kingdom. The views of policy and practice professionals suggest that intersectionality has far to travel to help counter individualistic narratives and to encourage an approach that is sensitive to subgroup inequalities and the processes that generate them. Examples of promising practice, albeit mostly in North America, suggest that it is possible for intersectionality to gain traction. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-021-00742-w.
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Affiliation(s)
- Daniel Holman
- Department of Sociological Studies, University of Sheffield, Elmfield building, Northumberland Road, Sheffield, S10 2TU, United Kingdom.
| | - Sarah Salway
- Department of Sociological Studies, University of Sheffield, Elmfield building, Northumberland Road, Sheffield, S10 2TU, United Kingdom
| | - Andrew Bell
- Sheffield Methods Institute, Interdisciplinary Centre of the Social Sciences, University of Sheffield, 219 Portobello, Sheffield, S1 4DP, United Kingdom
| | - Brian Beach
- International Longevity Centre-UK. Vintage House, 36-37 Albert Embankment, Vauxhall, London, SE1 7TL, United Kingdom
| | - Adewale Adebajo
- Centre for Assistive Technology and Connected Healthcare, University of Sheffield, 217 Portobello, Sheffield, S1 4DP, United Kingdom
| | - Nuzhat Ali
- Public Health England. Seaton House, City Link, Nottingham, NG2 4LA, United Kingdom
| | - Jabeer Butt
- Race Equality Foundation, 27 Greenwood Pl, Kentish Town, London, NW5 1LB, United Kingdom
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95
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Mattison C, Bourret K, Hebert E, Leshabari S, Kabeya A, Achiga P, Robinson J, Darling E. Health systems factors impacting the integration of midwifery: an evidence-informed framework on strengthening midwifery associations. BMJ Glob Health 2021; 6:bmjgh-2020-004850. [PMID: 34083246 PMCID: PMC8174493 DOI: 10.1136/bmjgh-2020-004850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/08/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Midwifery associations are organisations that represent midwives and the profession of midwifery. They support midwives to reduce maternal and newborn mortality and morbidity by promoting the overall integration of midwifery in health systems. Our objective was to generate a framework for evidence-informed midwifery association strengthening. Methods A critical interpretive synthesis complemented by key informant interviews, focus groups, observations, and document review was used to inform the development of concepts and theory. Three electronic bibliographical databases (CINAHL, EMBASE and MEDLINE) were searched through to 2 September 2020. A coding structure was created to guide the synthesis across the five sources of evidence. Results A total of 1634 records were retrieved through electronic searches and 57 documents were included in the critical interpretive synthesis. Thirty-one (31) key informant interviews and five focus groups were completed including observations (255 pages) and audio recordings. Twenty-four (24) programme documents were reviewed. The resulting theoretical framework outlines the key factors by context, describes the system drivers that impact the sustainability of midwifery associations and identifies the key-enabling elements involved in designing programmes that strengthen midwifery associations. Conclusion Midwifery associations act as the web that holds the profession together and are key to the integration of the profession in health systems, supporting enabling environments and improving gender inequities. Our findings highlight that in order to strengthen midwifery (education, regulation and services), we have to lead with association strengthening. Building strong associations is the foundation necessary to create formal quality midwifery education systems and to support midwifery regulation and accreditation mechanisms.
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Affiliation(s)
- Cristina Mattison
- Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Kirsty Bourret
- Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Emmanuelle Hebert
- University of Quebec at Trois-Rivières, Trois-Rivieres, Quebec, Canada.,Congolese Society of Midwifery Practice, Kinshasa, Democratic Republic of Congo
| | - Sebalda Leshabari
- Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ambrocckha Kabeya
- Congolese Society of Midwifery Practice, Kinshasa, Democratic Republic of Congo
| | - Patrick Achiga
- Vice-secretary, South Sudan Nurses and Midwives Association, Juba, South Sudan
| | - Jamie Robinson
- Global Programs Manager, Canadian Association of Midwives, Montreal, Quebec, Canada
| | - Elizabeth Darling
- Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
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96
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Jayes M, Moulam L, Meredith S, Whittle H, Lynch Y, Goldbart J, Judge S, Webb E, Meads D, Hemsley B, Murray J. Making Public Involvement in Research More Inclusive of People With Complex Speech and Motor Disorders: The I-ASC Project. QUALITATIVE HEALTH RESEARCH 2021; 31:1260-1274. [PMID: 33645331 PMCID: PMC8182336 DOI: 10.1177/1049732321994791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
In this study, we aimed to identify processes that enabled the involvement of a person with complex speech and motor disorders and the parent of a young person with these disorders as co-researchers in a U.K. research project. Semi-structured individual and focus group interviews explored participants' experiences and perceptions of public involvement (PI). Sixteen participants were recruited, with representation from (a) the interdisciplinary project team; (b) academics engaged in discrete project activities; (c) individuals providing organizational and operational project support; and (d) the project's two advisory groups. Data were analyzed using Framework Analysis. Five themes were generated: (a) the challenge of defining the co-researcher role; (b) power relations in PI; (c) resources used to enable PI; (d) perceived benefits of PI; and (e) facilitators of successful PI. Our findings provide new evidence about how inclusive research teams can support people with complex speech and motor disorders to contribute meaningfully to co-produced research.
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Affiliation(s)
- Mark Jayes
- Manchester Metropolitan
University, Manchester, United Kingdom
| | - Liz Moulam
- Manchester Metropolitan
University, Manchester, United Kingdom
| | - Stuart Meredith
- Manchester Metropolitan
University, Manchester, United Kingdom
| | - Helen Whittle
- Manchester Metropolitan
University, Manchester, United Kingdom
| | - Yvonne Lynch
- Manchester Metropolitan
University, Manchester, United Kingdom
| | - Juliet Goldbart
- Manchester Metropolitan
University, Manchester, United Kingdom
| | - Simon Judge
- Barnsley Hospital NHS Foundation
Trust, Barnsley, United Kingdom
| | | | | | - Bronwyn Hemsley
- University of Technology Sydney,
Sydney, New South Wales, Australia
| | - Janice Murray
- Manchester Metropolitan
University, Manchester, United Kingdom
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97
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Logan RG, Daley EM, Vamos CA, Louis-Jacques A, Marhefka SL. "When Is Health Care Actually Going to Be Care?" The Lived Experience of Family Planning Care Among Young Black Women. QUALITATIVE HEALTH RESEARCH 2021; 31:1169-1182. [PMID: 33622078 PMCID: PMC8114454 DOI: 10.1177/1049732321993094] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
While family planning care (FPC) visits may serve as opportunities to address gaps in knowledge and access to limited resources, young Black women may also face structural barriers (i.e., racism, discrimination, bias) to engaging in care due to the intersections of racial identity, age, and socioeconomic status. Findings from interviews with 22 Black women, ages 18 to 29 years, about the lived experience of FPC highlighted dynamic patient-provider encounters. Women's narratives uncovered the following essences: silence around sex impedes engagement in care, patient-provider racial concordance as protection from harm, providers as a source of discouragement and misinformation, frustration as a normative experience, decision making excludes discussion and deliberation, medical mistrust is pervasive and a part of Black consciousness, and meaningful and empathic patient-provider encounters are elusive. Health systems should prioritize developing and enhancing young Black women's relationship with FPC providers to help mitigate persistent inequities that perpetuate disadvantage among this population.
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Understanding the Intersection of Race/Ethnicity, Socioeconomic Status, and Geographic Location: A Scoping Review of U.S. Consumer Food Purchasing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207677. [PMID: 33096828 PMCID: PMC7593902 DOI: 10.3390/ijerph17207677] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 01/11/2023]
Abstract
Disparities in diet quality persist in the U.S. Examining consumer food purchasing can provide unique insight into the nutritional inequities documented by race/ethnicity, socioeconomic status (SES), and geographic location (i.e., urban vs. rural). There remains limited understanding of how these three factors intersect to influence consumer food purchasing. This study aimed to summarize peer-reviewed scientific studies that provided an intersectional perspective on U.S. consumer food purchasing. Thirty-four studies were examined that presented objectively measured data on purchasing outcomes of interest (e.g., fruits, vegetables, salty snacks, sugar-sweetened beverages, Healthy Eating Index, etc.). All studies were of acceptable or high quality. Only six studies (17.6%) assessed consumer food purchases at the intersection of race/ethnicity, SES, or geographic location. Other studies evaluated racial/ethnic or SES differences in food purchasing or described the food and/or beverage purchases of a targeted population (example: low-income non-Hispanic Black households). No study assessed geographic differences in food or beverage purchases or examined purchases at the intersection of all three factors. Overall, this scoping review highlights the scarcity of literature on the role of intersectionality in consumer food and beverage purchasing and provides recommendations for future studies to grow this important area of research.
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99
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Holman D, Walker A. Understanding unequal ageing: towards a synthesis of intersectionality and life course analyses. Eur J Ageing 2020; 18:239-255. [PMID: 33082738 PMCID: PMC7561228 DOI: 10.1007/s10433-020-00582-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/24/2022] Open
Abstract
Intersectionality has received an increasing amount of attention in health inequalities research in recent years. It suggests that treating social characteristics separately—mainly age, gender, ethnicity, and socio-economic position—does not match the reality that people simultaneously embody multiple characteristics and are therefore potentially subject to multiple forms of discrimination. Yet the intersectionality literature has paid very little attention to the nature of ageing or the life course, and gerontology has rarely incorporated insights from intersectionality. In this paper, we aim to illustrate how intersectionality might be synthesised with a life course perspective to deliver novel insights into unequal ageing, especially with respect to health. First we provide an overview of how intersectionality can be used in research on inequality, focusing on intersectional subgroups, discrimination, categorisation, and individual heterogeneity. We cover two key approaches—the use of interaction terms in conventional models and multilevel models which are particularly focussed on granular subgroup differences. In advancing a conceptual dialogue with the life course perspective, we discuss the concepts of roles, life stages, transitions, age/cohort, cumulative disadvantage/advantage, and trajectories. We conclude that the synergies between intersectionality and the life course hold exciting opportunities to bring new insights to unequal ageing and its attendant health inequalities.
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Affiliation(s)
- Daniel Holman
- Department of Sociological Studies, The University of Sheffield, Elmfield, Northumberland Road, Sheffield, S10 2TU UK
| | - Alan Walker
- Department of Sociological Studies, The University of Sheffield, Elmfield, Northumberland Road, Sheffield, S10 2TU UK
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