Miles to go before we sleep: racial inequities in health

Screening for adverse childhood experiences in pediatrics: A randomized trial of aggregate-level versus item-level response screening formats

BACKGROUND

While there is growing support for screening for Adverse Childhood Experiences (ACEs), rigorous evidence on the efficacy and preference of screening methods is needed.

OBJECTIVE

To examine caregiver: (1) rates of disclosure of their child's exposure to ACEs using item-level response (each item can be endorsed) versus aggregate-level response (only total score reported) screening format, (2) associations between family demographic factors and disclosure by screening format, and (3) emotional reaction and experience of screening formats in a diverse, low-income pediatric population.

METHODS

Caregiver participants (n = 367) were randomized to complete the Pediatric ACEs and Related Life Events Screener (PEARLS) tool, in an aggregate-level response vs item-level response format from 2016-2019. Select caregivers (n = 182) participated in debriefing interviews. T-test and chi-square analyses in 2019 compared PEARLS disclosure rates and reactions between the screening modalities. Regression models explored interactions with child characteristics. Thematic analysis of interview notes captured caregiver screening experience.

RESULTS

PEARLS disclosure rates were significantly higher in the aggregate-level response compared to the item-level response screening arm (p <0.05). This difference was accentuated for children identified as black and/or male (p <0.05). Caregiver reactions to PEARLS screening were rarely negative in either screening format. Qualitative data demonstrated strong caregiver preference for the item-level response format; additional themes include provider relationship, fear with disclosure, and screening outcome expectations.

CONCLUSION

While caregivers reported a preference for the item-level response format, the aggregate-level response screening format elicited higher disclosures rates particularly for children who are black or ma.

TRIAL REGISTRATION

Clinical trial registry: NCT04182906.

The Association Between John Henryism and Depression and Suicidal Ideation Among African-American and Caribbean Black Adolescents in the United States

PURPOSE

The aim of this study is to investigate the relationship between John Henryism (JH), a psychological construct indexing repeated high effort coping, and depression and SI among Black adolescents, and to explore whether these relationships vary by sex.

METHODS

Data came from the National Survey of American Life-Adolescent Supplement, a cross-sectional, multistage probability sample of African-American and Caribbean Black adolescents aged 13-17 (N = 1,170). JH was measured using a 12-item scale (alpha = 0.71) and dichotomized at the median. Lifetime history of major depression (MD) and SI were assessed using the Composite International Diagnostic Inventory and self-report, respectively. Logistic regression was used to assess the relationship between JH and likelihood of MD and SI, adjusting for demographic and psychosocial characteristics and accounting for the complex survey design. Moderation by sex was assessed using interaction terms.

RESULTS

Lifetime prevalence of MD was 6.3% (N = 87) and lifetime history of SI was 7.6% (N = 91). In unadjusted models, high JH was inversely associated with MD (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.34-0.90) and SI (OR: 0.45, 95% CI: 0.23-0.91). In adjusted models, the relationship between JH and MD was attenuated (OR: 0.68, 95% CI = 0.39-1.18, p = .16) and remained marginally significant for SI (OR: 0.55, 95% CI: 0.28-1.06, p = .07). These relationships were similar by sex.

DISCUSSION

Consistent with prior work in adults, JH was inversely associated with MD and SI among Black adolescents. Findings illustrate the importance of considering culturally salient protective factors for mental health among Black adolescents.

Racism and health care: Experiences of Latinx immigrant women in NYC during COVID-19

The COVID-19 pandemic has disproportionately affected minoritized racial groups, especially Latinx immigrants, evidenced by the high rates of COVID-19 infections, hospitalizations, and deaths among this population. With increasing xenophobia and anti-immigrant sentiment in parallel to the pandemic, it is critical to understand the perspectives of Latinx populations. This study explores Latinx immigrant women's perceptions of racism and xenophobia in their health care experiences in New York City (NYC) during the COVID-19 pandemic and, further, seeks to understand the role of perceived discrimination in health care settings and on health care access. Data were analyzed using a constant comparative method of analysis from twenty-one in-depth interviews conducted with foreign-born women in the five boroughs of New York City from diverse countries across Latin America. Four central themes emerged including: structural inequalities, discriminatory health care experiences, victimization in public institutions, and overcoming discrimination in health care settings. Latinx immigrant women described the ways in which perceptions and experiences of discrimination shaped their capacity to address health-related needs during the COVID-19 pandemic. This study provides evidence to a growing body of literature suggesting that structural racism and xenophobia and perceptions of anti-immigrant discrimination, including resulting structural inequalities, may have a negative effect on individuals' ability to access and engage the health care system, resulting in avoidance of health care services - a critical need during a global pandemic. Scholars, policymakers, and practitioners alike should be mindful of how racism and xenophobia shape Latinx immigrant communities' engagement with the health care system.

Examining Racial Disparities in Historical Change of Mental and Physical Health Across Midlife and Old Age in the United States

OBJECTIVES

To examine whether racial disparities are narrowing or widening with historical time among U.S. middle-aged and older adults, and test the extent to which educational attainment moderates racial disparities over historical time.

METHODS

Multilevel models were applied to longitudinal data on middle-aged (ages 40-65) and older adults (ages 66 and older) from the Health and Retirement Study. Historical change was indexed as cohort or birth year. The outcomes of focus were depressive symptoms, episodic memory, health conditions, functional limitations, and self-rated health.

RESULTS

Results revealed a differential pattern of racial disparities in historical change between midlife and old age. Across midlife and old age, on average, Blacks and Hispanics reported poorer levels of mental and physical health, compared with Whites. In midlife, racial disparities narrowed with historical time; later-born cohorts of Hispanics but not Whites reported fewer depressive symptoms than their earlier-born peers. Likewise, historical improvements in health were stronger among Hispanics and Blacks than Whites. Conversely, in old age, later-born cohorts across race consistently showed historical improvements in each of the outcomes examined. Regarding educational attainment, we observed little consistent evidence that health-promoting effects of educational attainment differ across race and cohort. Examining questions about heterogeneity, results revealed that in midlife and old age there was greater heterogeneity between race across each of the outcomes.

DISCUSSION

Our discussion elaborates on reasons behind the documented racial differences in historical changes among U.S. middle-aged and older adults, and how the protective role of education is changing over time.

Social Work and the Next Frontier of Racial Justice: Using COVID-19 as a Vehicle for Healing

The COVID-19 pandemic has put the United States and the world into a state of uncertainty. Before the onset of the coronavirus, awareness of health disparities across cities in the United States was questionable at best. As the world continues to grapple with the fallout of the pandemic and the response to it, several states and developed and developing countries created and implemented response efforts that were used as a guide, which social workers are most qualified to address but have not been a focus on a national nor international stage. This commentary focuses on two American states - Texas and Ohio as well as other global countries, and their responses that gained worldwide attention related to healthcare accessibility, service provision, and the role social workers should play moving forward and beyond the pandemic.

Inflammation and depression symptoms are most strongly associated for Black adults

Although race/ethnicity is associated with substantial differences in risk for depression and other diseases of aging in the United States, the processes underlying these health disparities remain poorly understood. We addressed this issue by examining how levels of a robust marker of inflammatory activity, C-reactive protein (CRP), and depression symptoms varied across racial/ethnic groups. Additionally, we tested whether the inflammation-depression association differed across groups. Data were drawn from the Chicago Community Adult Health Survey, an epidemiological survey examining biopsychosocial factors affecting health and well-being. Participants were 3105 Chicago community adults, of which 610 provided blood samples and were included in analyses. C-reactive protein was assayed from blood samples, and depression symptoms were assessed using the 11-item Center for Epidemiologic Studies-Depression scale. Race/ethnicity was self-reported and consisted of Black, Hispanic, White, and other racial/ethnic groups. Results revealed that these racial/ethnic groups differed in terms of both their CRP and depression levels. Specifically, Black Americans exhibited higher levels of CRP as compared to White and other race/ethnicity Americans. Moreover, Black Americans exhibited more depression symptoms than Hispanic Americans. Finally, we found that inflammatory levels were strongly related to depression symptoms but only for Black Americans, with CRP alone accounting for 8% of the variance in depression symptoms in this subgroup. These data thus point to a biological process that may help to explain disparities in mental health outcomes across race/ethnicity in the United States. At the same time, additional research is needed to understand the social and structural factors driving these effects.

Shades of health: Skin color, ethnicity, and mental health among Black Americans

Skin color is an important predictor of health outcomes among Black Americans. Black Americans with darker complexions experience worse physical and psychological functioning than those with lighter complexions. However, most research on the health effects of colorism focuses solely on African Americans, omitting the experiences of other Black subpopulations. Using data from the National Survey of American Life (NSAL), we investigate the relationship between skin color and mental health among African Americans (N = 3393) and Caribbean Blacks (N = 1378). Findings from multivariate logistic regressions reveal that Black Americans with the lightest complexions-regardless of ethnicity-report worse psychological functioning. However, the shape of the association between skin tone and mental health varies significantly based on ethnicity and the specific psychiatric outcome under study. For Caribbean Blacks, the association between skin color and any mental disorders and mood disorders is linear, while the relationship for anxiety disorders is curvilinear. For African Americans, the relationship between skin color and mental health shows an elevated risk among only those with the lightest skin tones. These results illustrate the heterogeneity within the Black community and highlight the importance of recognizing ethnicity in health disparities research.

Health systems and health equity: Advancing the agenda

Despite a compelling body of evidence and decades of policy recommendations, deep inequities in health persist with historically marginalized groups. Operationalizing strategies to achieve equity in health and health care continues to remain elusive to health systems. We propose several focus areas; attention to semantics and concepts, building knowledge of health inequities, redesigning care and transforming cultures, to advance health equity work by health system nurse leaders and clinical nurses. Health equity frameworks, traditionally applied in population and public health, are also discussed to tackle health equity issues and formulate, implement and evaluate solutions to inequities. Examples illustrate ongoing work in our health system in targeted areas and challenges in advancing health equity work. Future efforts by health system nurse leaders should concentrate on technology for point of care health screening and data acquisition, data-driven decisions, and organizational performance measures to narrow health equity gaps.

Burden of Allergic Disease in Racial and Ethnic Structurally Oppressed Communities Within Canada and the United States: A Scoping Review

BACKGROUND

The social determinants of health have been extensively studied as potential mediating variables in the development and/or progression of many chronic illnesses, including allergic diseases, and may contribute to social inequities as barriers in accessing health care.

OBJECTIVE

We aimed to perform a scoping literature review to describe the burden of disease and access to health care for treatment of allergic disease within literature specific to structurally oppressed racial and ethnic populations.

METHODS

We performed a scoping review, guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines for Scoping Reviews, of 3 scientific databases and 5 relevant gray literature sites. Search strategy including keywords describing race and ethnicity were selected based on the acceptable nomenclature in Canada and the United States. We imposed no restrictions on date or country of publication, study design, or age of participants.

RESULTS

Our literature search yielded 1,198 potentially relevant articles following deduplication. After title and abstract, and subsequently full-text screening, a total of 12 (1.08% of all articles) were included. These 12 included studies pointed toward a higher burden of allergic and atopic disease, including increased presentations to emergency departments, hospitalizations, mortality, younger age of diagnosis, and/or greater severity of disease, among Black or African American individuals, than the general population. Allergies beyond the top 9 food allergens, eosinophilic esophagitis, and asthma appeared to be more prevalent and more severe in this population than in the general population. There appears to be an increased burden of allergic and atopic disease among the Indigenous Peoples of Canada, whereas this was not noted for Latinx or Hispanic populations, in part due to a paucity of studies involving these populations. Owing to a lack of published literature, no conclusions could be drawn regarding allergy and atopy in Native American populations.

CONCLUSIONS

Structurally oppressed racial and ethnic communities may face an increased burden of allergic and atopic disease-but that this may be magnified by issues regarding oppression, access, and social environment that warrant further investigation.

Ethnic heterogeneity in body composition patterning and CVD risk factors: a multi-ethnic study of Asian Indian Tribes

BACKGROUND

Indian subcontinent exhibits considerable degree of ethnic heterogeneity in cardiovascular disease (CVD) risks. Given the importance of ethnicity, the present multi-ethnic study was conducted to find out the differences in body composition patterning and its influence on CVD risk variables.

OBJECTIVE

Owing to considerable ethnic heterogeneity among Asian Indians the study was performed to determine the association of variability between body composition and CVD risk factors at the micro-level among different tribes by sex, province, and generation.

METHODS

Nine tribes from three different states (provinces) were considered. Anthropometric measurements, body composition, adiposity, blood pressure, and fasting blood glucose was measured using standard technique. Body composition was measured using BIA method by means of body fat monitor. Mean differences of the body composition measures were analysed by ANOVA. Stepwise multiple regressions were done with CVD risk variables as dependent and body composition profiles as independent variables to find out the significant predictors. Those were then loaded for principal component factor analyses (PCFA).

RESULTS

Tribal subjects of both sexes and from both younger and older generations in Gujarat had significantly higher percentage body fat, subcutaneous fat-whole body, and subcutaneous fat-trunk as compared to tribal subjects of Odisha, and West Bengal, as well as significantly lower skeletal mass-whole body and skeletal mass-trunk. PCFA showed two components: (i) percentage body fat with muscle mass; and (ii) visceral fat with resting metabolism. These two components cumulatively explained 80-90% of the total variance associated with CVD risk variables, across the nine tribes.

CONCLUSION

Tribal subjects of Gujarat had higher CVD risks with significantly higher fat mass and lower muscle mass followed by the tribal subjects of Odisha, and West Bengal respectively. The younger generation are equally at risk as their older counterparts. The CVD risks are developing at a much faster rate resulting in a serious public health threat, even in traditional societies. Body composition measures could be considered as a better non-invasive technique for early intervention and proper risk management among the Asian Indians in general and tribal populations in particular.

Admission Code Status and End-of-life Care for Hospitalized Patients With COVID-19

CONTEXT

The COVID-19 pandemic has highlighted variability in intensity of care. We aimed to characterize intensity of care among hospitalized patients with COVID-19.

OBJECTIVES

Examine the prevalence and predictors of admission code status, palliative care consultation, comfort-measures-only orders, and cardiopulmonary resuscitation (CPR) among patients hospitalized with COVID-19.

METHODS

This cross-sectional study examined data from an international registry of hospitalized patients with COVID-19. A proportional odds model evaluated predictors of more aggressive code status (i.e., Full Code) vs. less (i.e., Do Not Resuscitate, DNR). Among decedents, logistic regression was used to identify predictors of palliative care consultation, comfort measures only, and CPR at time of death.

RESULTS

We included 29,923 patients across 179 sites. Among those with admission code status documented, Full Code was selected by 90% (n = 15,273). Adjusting for site, Full Code was more likely for patients who were of Black or Asian race (ORs 1.82, 95% CIs 1.5-2.19; 1.78, 1.15-3.09 respectively, relative to White race), Hispanic ethnicity (OR 1.89, CI 1.35-2.32), and male sex (OR 1.16, CI 1.0-1.33). Of the 4951 decedents, 29% received palliative care consultation, 59% transitioned to comfort measures only, and 29% received CPR, with non-White racial and ethnic groups less likely to receive comfort measures only and more likely to receive CPR.

CONCLUSION

In this international cohort of patients with COVID-19, Full Code was the initial code status in the majority, and more likely among patients who were Black or Asian race, Hispanic ethnicity or male. These results provide direction for future studies to improve these disparities in care.

Disparities in years of potential life lost among racial and ethnic groups in Washington state

Background

The disproportionate mortality burden racial and ethnic groups endure compared to their non-Hispanic white (NHW) counterparts is a widely known public health issue in the United States.

Methods

We examined disparities in premature mortality through a measure of years of potential life lost (YPLL) among racial and ethnic groups after accounting for individual and place-based risk factors. Data were nearly 400,000 geocoded death records from Washington state mortality records from 2011 to 2018. Decedent records included information on marital status and educational attainment at time of death. We linked these records to census tract indicators of rurality and area deprivation based on residential longitude and latitude coordinates at time of death. We conducted censored Poisson regression to test adjusted associations between racial and ethnic identity and YPLL.

Results

Relative to non-Hispanic whites, non-Hispanic blacks, American Indian and Alaska Natives, Asian or other Pacific Islanders, multiracial, and Hispanic decedents had significantly higher rates of YPLL. Controlling for sociodemographic factors reduced but did not eliminate the disparities in YPLL between non-Hispanic whites and other racial and ethnic groups. Controlling for place-based risk factors did not further attenuate differences.

Conclusions

Racial and ethnic minorities suffer disproportionately from premature mortality. Researchers and policy makers must recognize the disproportionate risks to premature mortality and work together to alleviate them through the delivery of better and more accessible targeted services.

Effect of Race and Nativity on Functional Outcomes Following Traumatic Brain Injury Among Asian, Hispanic, and Non-Hispanic White Survivors in the United States: A NIDILRR TBI Model Systems Study

OBJECTIVE

To compare the racial/ethnic differences in traumatic brain injury (TBI) recovery among Asians, Hispanics, and Whites, and explore the effect of nativity in the recovery process.

SETTING

Six Traumatic Brain Injury Model Systems (TBIMS) centers.

PARTICIPANTS

In total, 7953 patients who had at least 1 severe TBI between 2000 and 2016 were admitted to one of the TBIMS centers.

DESIGN

Secondary data analysis.

MAIN MEASURES

Functional Independent Measure (FIM instrument) ratings.

RESULTS

Asians had the lowest injury severity at admission, but they failed to make the improvements made by the Hispanics and the Whites between the rehabilitation discharge and the 1-year follow-up. The magnitude of improvement made by the foreign-born Asians was less than that made by their native-born counterparts. Both Asian and the Hispanic groups had lower functional outcomes at the 1-year follow-up, and the differences in functional outcomes between the Asian and Hispanic groups were not statistically significant. The above racial/ethnic disparities in functional outcomes were not fully explained by differences in sociodemographic status, injury characteristics, and immigration-related factors. The effect of nativity was mediated by covariates.

CONCLUSIONS

This study reveals racial/ethnic disparities post-TBI functional recovery. Despite lower injury severity and apparent financial resource advantages, Asians did not experience better functional outcomes. Although the effect of nativity was not established in this study, contextual factors related to ethnicity and immigration experiences should be further investigated.

Discrimination, social support, and health-related quality of life among individuals with criminal records

Several studies have found an association between social identity-based discrimination and reduced physical health. Research also indicates that social support may sometimes protectively moderate this relationship. This study addresses the lack of sufficient research regarding these connections among individuals facing criminal record discrimination. The authors analyzed the responses of 168 people with felony records who completed a nationwide, online survey. While controlling for several other potentially impactful variables, the authors used regression analyses to explore the relationship between criminal record discrimination and reported healthy days per month and whether social support protectively moderated this relationship. There was a significant negative association between criminal record discrimination and healthy days among those with notably low social support. Meanwhile, moderate levels of social support appeared to protectively extinguish this relationship. This study suggests that social support may influence whether criminal record discrimination negatively impacts health.

Trends in lifespan variation across the spectrum of rural and urban places in the United States, 1990–2017

Mortality disparities between urban and rural areas in the United States widened in recent decades as mortality improvements in rural areas slowed. Although the existence of a rural mortality penalty is well-documented, previous research in this area has focused almost exclusively on differences in average levels of mortality between rural and urban areas rather than differences in levels of lifespan variation within rural and urban areas. This oversight is important because monitoring trends in lifespan variation provides unique insights into levels of inequality in the age-at-death distribution within a population. Does the rural mortality penalty in life expectancy extend to lifespan variation? We used U.S. Multiple Cause of Death data files to measure life disparity at birth (e0†) from 1990 to 2017. We found that the rural mortality penalty extends to lifespan variation as large metropolitan areas had greater improvements in life disparity than nonmetropolitan areas. Beginning around 2011, all areas began to show increased life disparity with the largest increases occurring in nonmetropolitan areas. Age decomposition results showed that the nonmetropolitan increases were due to rising working-age mortality. Greater variability in the age-at-death distribution represents an additional dimension of inequality for Americans living in rural places.

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Improvements in metropolitan mortality beginning in the early 1990s resulted in a growing rural mortality penalty

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Recent increases in working-age mortality have contributed to the rural mortality penalty.

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Life expectancy improvements in metropolitan areas are associated with a decrease in lifespan variation.

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Greater lifespan inequality represents an additional dimension of inequality for rural Americans.

Beyond Black vs White: racial/ethnic disparities in chronic pain including Hispanic, Asian, Native American, and multiracial US adults

ABSTRACT

Previous literature on race/ethnicity and pain has rarely included all major US racial groups or examined the sensitivity of findings to different pain operationalizations. Using data from the 2010 to 2018 National Health Interview Surveys on adults 18 years or older (N = 273,972), we calculated the weighted prevalence of 6 definitions of pain to provide a detailed description of chronic pain in White, Black, Hispanic, Asian, Native American, and multiracial groups. We also estimated modified Poisson models to obtain relative disparities, net of demographic and socioeconomic (SES) factors including educational attainment, family income, and home ownership; finally, we calculated average predicted probabilities to show prevalence disparities in absolute terms. We found that Asian Americans showed the lowest pain prevalence across all pain definitions and model specifications. By contrast, Native American and multiracial adults had the highest pain prevalence. This excess pain was due to the lower SES among Native Americans but remained significant and unexplained among multiracial adults. The pain prevalence in White, Black, and Hispanic adults fell in between the 2 extremes. In this trio, Hispanics showed the lowest prevalence, an advantage not attributable to immigrant status or SES. Although most previous research focuses on Black-White comparisons, these 2 groups differ relatively little. Blacks report lower prevalence of less severe pain definitions than Whites but slightly higher prevalence of severe pain. Net of SES, however, Blacks experienced significantly lower pain across all definitions. Overall, racial disparities are larger than previously recognized once all major racial groups are included, and these disparities are largely consistent across different operationalizations of pain.

Neighborhood disadvantage is associated with biological aging: Intervention-induced enhancement of couple functioning confers resilience

The accelerated pace of biological aging predicts mortality and morbidity later in life. The current study examines whether a change in supportive couple functioning buffers accelerated aging associated with stressful community environments among Black Americans who live in rural, Southern, disadvantaged neighborhoods. We examined 348 Black American middle-aged adults assigned randomly to receive the Protecting Strong African American Families (ProSAAF) intervention or a control condition. The program was designed to enhance supportive couple functioning among Black Americans. We used DunedinPoAm to quantify the methylation pace of aging and employed the Area Deprivation Index at the census block group level to measure neighborhood disadvantage. Neighborhood disadvantage was associated with the accelerated pace of aging. Further, participation in ProSAAF enhanced supportive couple functioning, and improvement in couple functioning protected participants from the harmful effects of neighborhood disadvantage on the accelerated pace of aging. These findings supported mediated moderation and suggested that family-based prevention programs that enhance couple support may decrease the erosive effects of neighborhood disadvantage and improve prospects for healthy aging among rural, Southern, Black Americans living in difficult circumstances. This may provide a supplemental strategy for decreasing health disparities due to neighborhood disadvantage by enhancing family systems.

Inclusion and reporting of sex, gender, and race/ethnicity in randomized controlled trials of nonpharmacological treatments for alcohol use disorder: A meta-epidemiologic review

Alcohol use disorders (AUDs) are among the most prevalent behavioral and mental health diagnoses. Individuals with an AUD are at increased risk for numerous consequences across their social, health, and psychological functioning. Research suggests that differences may exist in the prevalence and consequences of AUD and in the efficacy of AUD treatment across demographic characteristics (i.e., sex/gender and race/ethnicity). This meta-epidemiologic review examined the inclusion of diverse groups (sex/gender and race/ethnicity) in published randomized controlled trials of nonpharmacological treatments for AUD since 1994, following passage of the National Institutes of Health Revitalization Act of 1993. We systematically searched databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement criteria. The initial search strategy yielded 7931 articles. After excluding ineligible articles, 155 were included in the present review for synthesis. Of the articles included in this review, only 57 (36.8%) fully reported on both their sample's sex/gender and racial/ethnic breakdown. Of the total sample, seven articles specifically examined one racial/ethnic group and 32 specifically examined one sex/gender group. Six articles (3.9%) reported no information regarding the racial/ethnic breakdown of their sample and five articles (3.2%) reported no information regarding the sex/gender breakdown of their participants. Only two articles (1.3%) reported on subgroup analyses that examined differences in treatment outcomes by both sex/gender and race/ethnicity, despite guidelines set forth by NIH. Only 46 articles (29.7%) described the failure to include diverse sex/gender or racial/ethnic groups or concerns about the generalizability of study findings given their sample's sex/gender or racial/ethnic composition as methodological limitations. These results indicate that substantial efforts must be put forth by the scientific community to ensure the inclusion, analysis, and reporting of data focused on women/females and members of minoritized racial/ethnic groups.

Racial and ethnic differences in the prevalence of work organization and occupational psychosocial exposures

BACKGROUNDS

This study sought to assess if there were differences in exposure to job insecurity, shift work, work-life imbalance, workplace harassment, and nonstandard work arrangements according to race and ethnicity in the United States.

METHODS

Using data from the nationally representative National Health Interview Survey conducted in 2015, we calculated the prevalence of job insecurity, shift work, work-life imbalance, workplace harassment, and nonstandard work arrangements according to race and ethnicity. Using this data, we then modeled the prevalence of these exposures while adjusting for covariates including occupation.

RESULTS

Compared to non-Hispanic White workers, Hispanic (prevalence ratio [PR] = 1.47, 95% confidence interval [CI] = 1.30, 1.66) and non-Hispanic Asian (PR = 1.57, 95% CI = 1.28, 1.92) workers reported more job insecurity. Non-Hispanic Black workers were more likely to report working in shifts (PR = 1.34, 95% CI = 1.22, 1.46) and Hispanic workers reported being employed in alternative work arrangements (PR = 1.40, 95% CI = 1.23, 1.58) more often than non-Hispanic White workers. Non-Hispanic White workers were slightly more likely to report work-life imbalance and workplace harassment than other races/ethnicities. Occupational segregation accounted for some of the racial/ethnic differences in shift work and alternative work arrangements.

CONCLUSIONS

These findings are consistent with some previous research on differences in the prevalence of these work organization and psychosocial exposures by race/ethnicity, especially with respect to shift work and alternative work arrangements. However, other studies have found contradictory findings, especially with respect to workplace harassment. There is a need for future research that tackles the association between these exposures and racial/ethnic health disparities.

Association of subjective social status with epigenetic aging among Black and White women

OBJECTIVE

Subjective social status (SSS), an individual's assessment of their own social status in relation to others, is associated with health and mortality independently of objective SES; however, no studies have tested whether SSS influences epigenetic aging. The current study examines if SSS is associated with epigenetic age acceleration in both Black and White women, independently of objective SES measured during both childhood and adulthood.

METHOD

For 9- and 10-year-old Black and White girls, parental education and annual household income was obtained. At ages 39-42, 361 participants (175 Black, 186 White) reported their current education, household income, and SSS, and provided saliva to assess age acceleration using the GrimAge epigenetic clock. Linear regression estimated the association of SSS with epigenetic age acceleration, controlling for objective SES (current education, current income, parents' education, income during childhood), smoking, and counts of cell types.

RESULTS

When all objective SES variables were included in the model, SSS remained significantly associated with epigenetic age acceleration, b = - 0.31, p = .003, ß = - 0.15. Black women had significantly greater age acceleration than White women, (t(359) = 5.20, p > .001, d = 0.55) but race did not moderate the association between SSS and epigenetic age acceleration.

CONCLUSIONS

Women who rated themselves lower in SSS had greater epigenetic age acceleration, regardless of income and education. There was no difference by race for this association.

Socioeconomic status and immune aging in older US adults in the health and retirement study

Socioeconomic and demographic factors including educational attainment, race and ethnicity, and childhood socioeconomic status (SES) are powerful predictors of inequalities in aging, morbidity, and mortality. Immune aging, including accumulation of late-differentiated, senescent-like lymphocytes and lower levels of naïve lymphocytes, may play a role in the development of the age-related health inequalities. This study used nationally representative data from more than 9,000 US adults from the Health and Retirement Study to investigate associations between educational attainment, race and ethnicity, and childhood SES and lymphocyte percentages. Respondents with lower educational attainment, Hispanic adults, and those who had a parent with less than a high school education had lymphocyte percentages consistent with more immune aging compared to those with greater educational attainment, non-Hispanic White adults, and respondents who had parents with a high school education, respectively. Associations between education, Hispanic ethnicity, and parents' education and late differentiated senescent-like T lymphocytes (TemRA) and B cells were largely driven by cytomegalovirus (CMV), suggesting it is a factor in observed SES inequalities in immunosenescence. Naïve T lymphocytes may be particularly affected by socioeconomic position and may therefore be of particular interest to research interested in inequalities in health and aging.

Structural Racism and Quantitative Causal Inference: A Life Course Mediation Framework for Decomposing Racial Health Disparities

Quantitative studies of racial health disparities often use static measures of self-reported race and conventional regression estimators, which critics argue is inconsistent with social-constructivist theories of race, racialization, and racism. We demonstrate an alternative counterfactual approach to explain how multiple racialized systems dynamically shape health over time, examining racial inequities in cardiometabolic risk in the National Longitudinal Study of Adolescent to Adult Health. This framework accounts for the dynamics of time-varying confounding and mediation that is required in operationalizing a "race" variable as part of a social process (racism) rather than a separable, individual characteristic. We decompose the observed disparity into three types of effects: a controlled direct effect ("unobserved racism"), proportions attributable to interaction ("racial discrimination"), and pure indirect effects ("emergent discrimination"). We discuss the limitations of counterfactual approaches while highlighting how they can be combined with critical theories to quantify how interlocking systems produce racial health inequities.

An experimental study of the effects of messaging strategies on vaccine acceptance and hesitancy among Black Americans

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Acknowledging past medical harm led to more positive COVID-19 vaccine attitudes.

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Presenting general information about the vaccine did not improve vaccine attitudes.

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Tailored messaging strategies showed no backfire effects in other racial groups.

Black Americans have been disproportionately affected by COVID-19 but have comparatively low vaccination rates, creating a need for vaccine messaging strategies that are tailored to this population. We conducted an experimental study to examine the effects of three messaging strategies on Black Americans’ reported willingness to receive the vaccine and vaccine hesitancy. We also recruited White and Hispanic Americans to assess any potential backfire effects of the tailored strategies for non-Black participants. A total of 739 participants completed the study. Results from 4x2 ANCOVAs indicate that, among Black participants, messaging that acknowledged past unethical treatment of Black Americans in medical research and emphasized current safeguards to prevent medical mistreatment was associated with significantly less vaccine hesitancy than the control condition. The same effects were not observed for messaging strategies that provided general safety information about the vaccine or that emphasized the role of the vaccine in reducing racial inequities. There were no significant differences across conditions for participants of other races. Results demonstrate that public health messages tailored to address specific vaccine concerns may aid future vaccination campaigns.

Relationship intervention indirectly buffers financial strain's effect on biological aging among Black adults

Black adults in the rural South experience elevated financial strain and other contextual stressors, increasing their risk for poor health. Supportive relationships, particularly positive romantic relationships, have been shown to offset these risks. The present study aims to provide experimental evidence of the buffering effect of supportive relationships by testing whether participation in a relationship enhancement program (ProSAAF) that improves couple functioning (Barton, Beach, Wells, et al., 2018) subsequently buffers the effect of cumulative financial strain on biological aging (weathering). Postintervention financial strain was assessed four times. Deoxyribonucleic acid (DNA) was extracted from peripheral whole blood collected 6 years after baseline (n = 348 individuals), and patterns of methylation were used to index accelerated pace of aging. Couple functioning was treated as a latent construct comprising four self-report indicators: effective communication, relationship confidence, relationship satisfaction, and perceived partner support. Results indicated that cumulative financial strain was associated with accelerated pace of aging with a medium to large effect size. This effect was moderated by change in couple functioning such that individuals with greater improvement in couple functioning showed less epigenetic aging in response to cumulative financial strain. Additionally, there was a significant indirect buffering effect of ProSAAF on the association between cumulative financial strain and accelerated pace of aging. This is the first study to demonstrate that a couple-focused preventive intervention can reduce the impact of financial strain on rate of aging by enhancing couple functioning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Patients undergoing colorectal surgery at a Veterans Affairs Hospital do not experience racial disparity in length of stay either before or after implementing an enhanced recovery pathway

Background

Enhanced Recovery Pathways (ERP) have been shown to reduce racial disparities following surgery. The objective of this study is to determine whether ERP implementation mitigates racial disparities at a Veterans Affairs Hospital.

Methods

A retrospective cohort study was conducted using data obtained from the Veterans Affairs Surgical Quality Improvement Program. All patients undergoing elective colorectal surgery following ERP implementation were included. Current procedural terminology (CPT) codes were used to identify patients who underwent similar procedures prior to ERP implementation.

Results

Our study included 417 patients (314 pre-ERP vs. 103 ERP), 97.1% of which were male, with an average age of 62.32 (interquartile range (IQR): 25–90). ERP patients overall had a significantly shorter post-operative length of stay (pLOS) vs. pre-ERP patients (median 4 days (IQR: 3–6.5) vs. 6 days (IQR: 4–9) days (p < 0.001)). Within the pre-ERP group, median pLOS for both races was 6 days (IQR: 4–6; p < 0.976) and both groups experienced a decrease in median pLOS (4 vs. 6 days; p < 0.009 and p < 0.001) following ERP implementation.

Conclusions

Racial disparities did not exist in patients undergoing elective surgery at a single VA Medical Center. Implementation of an ERP significantly reduced pLOS for black and white patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12893-022-01647-3.

Everyday discrimination in later life: A social network approach

What factors shape everyday discrimination among older adults? Existing perspectives focus on individual identities and social group membership (e.g., race/ethnicity, age) as key determinants of perceived discrimination. This paper examines the idea that individuals' broader social contexts - including their personal social networks - also shape perceived discrimination, and in ways that may differ across racial groups. Using data from Round 3 of the National Social Life, Health, and Aging Project (N = 3312), I consider how properties of personal networks are associated with how frequently older adults report everyday discrimination. Results indicate that more kin-centric personal networks protect against more frequent everyday discrimination, but that this protective effect may be stronger among White older adults. I propose why more kin-centric networks may play a different role in the perceived discrimination of White and Black older adults, and close by suggesting that social network composition may be a source of heterogeneity in the link between everyday discrimination and inequality in later life outcomes such as health.

Endocrine-Disrupting Chemicals and Breast Cancer: Disparities in Exposure and Importance of Research Inclusivity

Endocrine-disrupting chemicals (EDCs) are known contributors to breast cancer development. Exposures to EDCs commonly occur through food packaging, cookware, fabrics, and personal care products, as well as external environmental sources. Increasing evidence highlights disparities in EDC exposure across racial/ethnic groups, yet breast cancer research continues to lack the inclusion necessary to positively impact treatment response and overall survival in socially disadvantaged populations. Additionally, the inequity in environmental exposures has yet to be remedied. Exposure to EDCs due to structural racism poses an unequivocal risk to marginalized communities. In this review, we summarize recent epidemiological and molecular studies on 2 lesser-studied EDCs, the per- and polyfluoroalkyl substances (PFAS) and the parabens, the health disparities that exist in EDC exposure between populations, and their association with breast carcinogenesis. We discuss the importance of understanding the relationship between EDC exposure and breast cancer development, particularly to promote efforts to mitigate exposures and improve breast cancer disparities in socially disadvantaged populations.

Childhood adversity predicts black young adults' DNA methylation-based accelerated aging: A dual pathway model

We expand upon prior work (Gibbons et al., ) relating childhood stressor effects, particularly harsh childhood environments, to risky behavior and ultimately physical health by adding longer-term outcomes - deoxyribonucleic acid (DNA) methylation-based measures of accelerated aging (DNA_m-aging). Further, following work on the effects of early exposure to danger (McLaughlin et al., ), we also identify an additional pathway from harsh childhood environments to DNA_m-aging that we label the danger/FKBP5 pathway, which includes early exposure to dangerous community conditions that are thought to impact glucocorticoid regulation and pro-inflammatory mechanisms. Because different DNA_m-aging indices provide different windows on accelerated aging, we contrast effects on early indices of DNA_m-aging based on chronological age with later indices that focused on predicting biological outcomes. We utilize data from Family and Community Health Study participants (N = 449) from age 10 to 29. We find that harshness influences parenting, which, in turn, influences accelerated DNA_m-aging through the risky cognitions and substance use (i.e., behavioral) pathway outlined by Gibbons et al. (). Harshness is also associated with increased exposure to threat/danger, which, in turn, leads to accelerated DNA_m-aging through effects on FKBP5 activity and enhanced pro-inflammatory tendencies (i.e., the danger/FKBP5 pathway).

Racial Inequities in Birth Weight by Maternal Age Among College-Educated Mothers: The Role of Early Disadvantage

INTRODUCTION

Non-Hispanic Black infants experience disproportionately high risks of low birth weight compared with non-Hispanic White infants, particularly among mothers with high educational attainment and greater socioeconomic advantage. This study investigates how maternal early-life disadvantage contributes to ongoing racial birth weight inequities among U.S. college‒educated mothers, specifically declining birth weights with age among non-Hispanic Black mothers.

METHODS

Study analyses used cohort data from the National Longitudinal Study of Adolescent to Adult Health. Racial inequities in birth weight by maternal age and early-life disadvantage were assessed using completed reproductive histories among college-educated mothers at ages 33-44 years collected in 2016‒2018 and regression-based marginal standardization techniques. Early-life disadvantage was measured using a study-based composite measure of early-life concentrated poverty and social disadvantage in homes, neighborhoods, and schools, collected in previous waves. Primary analyses were completed in 2020‒2021.

RESULTS

Among non-Hispanic Black mothers who experienced high early-life disadvantage, a 1-year increase in maternal age at delivery was associated with lower birth weight by 26.07 g (95% CI= -48.74, -3.40). Similar declines were not found among non-Hispanic Black mothers with low early-life disadvantage. Non-Hispanic White mothers experienced increased birth weight with maternal age, 6.85 g (95% CI= -1.12, 14.82) per year, which did not significantly vary by early-life disadvantage.

CONCLUSIONS

Early-life disadvantage modifies whether and how college-educated mothers experience birth weight decline with older age. The effects of early-life contexts and embedded racial inequities on maternal health inequities and differential weathering warrant further public health attention.

Impact of Federal, State, and Local Housing Policies on Disparities in Cardiovascular Disease in Black/African American Men and Women: From Policy to Pathways to Biology

Racist and discriminatory federal, state, and local housing policies significantly contribute to disparities in cardiovascular disease incidence and mortality for individuals that self-identify as Black or African American. Here we highlight three key housing policies - "redlining," zoning, and the construction of highways - which have wrought a powerful, sustained, and destructive impact on cardiovascular health in Black/African American communities. Redlining and highway construction policies have restricted access to quality health care, increased exposure to carcinogens such as PM2.5, and increased exposure to extreme heat. At the root of these policy decisions are longstanding, toxic societal factors including racism, segregation, and discrimination, which also serve to perpetuate racial inequities in cardiovascular health. Here, we review these societal and structural factors and then link them with biological processes such as telomere shortening, allostatic load, oxidative stress, and tissue inflammation. Lastly, we focus on the impact of inflammation on the immune system and the molecular mechanisms by which the inflamed immune microenvironment promotes the formation of atherosclerotic plaques. We propose that racial residential segregation and discrimination increases tissue inflammation and cytokine production, resulting in dysregulated immune signaling, which promotes plaque formation and cardiovascular disease. This framework has the power to link structural racism not only to cardiovascular disease, but also to cancer.

Assessing the Validity of Self-rated Health Across Ethnic Groups: Implications for Health Disparities Research

OBJECTIVES

This study examines the association between morbidity (i.e., chronic health conditions) and self-rated health (SRH) with the aim of testing the within-group and across-group validity of SRH across nine ethnic groups: non-Latinx White, Mexican, Puerto Rican, Cuban, African American, Afro-Caribbean, Chinese, Filipino, and Vietnamese Americans. In addition, we assess whether acculturation (i.e., nativity, years of US residency, language of interview) and health-related factors (e.g., mental disorder) account for ethnic distinctions in SRH.

DESIGN

Data are from the National Survey of American Life (NSAL) and the National Latino and Asian American Study (NLAAS) (N = 8338). Weighted proportions and means for SRH and chronic conditions are reported. Ordered logistic regression analysis is used to determine ethnic group patterns in SRH.

RESULTS

Despite evidence of within-group validity of SRH for each ethnic group, our results seriously challenge the across-group validity of SRH. For example, Chinese and Vietnamese respondents report lower SRH despite having fewer chronic conditions relative to non-Latinx Whites. Moreover, Mexican Americans report fewer chronic health problems but lower SRH compared to non-Latinx Whites. Acculturation factors (e.g., language of interview) partially explain the Mexican-White difference in SRH. Among Chinese Americans, completing an interview in English is associated with higher SRH relative to those who completed an interview in Chinese.

CONCLUSION

These findings have implications for health disparities research that uses SRH as the dependent measure. Studies that compare the health profiles of diverse ethnic groups should use the SRH measure with caution, as SRH does not align with ethnic patterns of morbidity.

State Policies, Racial Disparities, and Income Support: A Way to Address Infant Outcomes and the Persistent Black-White Gap?

Low birth weight and preterm births vary by state, and Black mothers typically face twice the risk that their white counterparts do. This gap reflects an accumulation of psychosocial and material exposures that include interpersonal racism, differential experience with area-level deprivation such as residential segregation, and other harmful exposures that the authors refer to as "institutional" or "structural" racism. The authors use logistic regression models and a dataset that includes all births from 1994 to 2017 as well as five state policies from this period-Aid to Families with Dependent Children/Temporary Aid for Needy Families, housing assistance, Medicaid, minimum wage, and the earned income tax credit (EITC)-to examine whether these state social policies, designed to provide a financial safety net, are associated with risk reduction of low birth weight and preterm birth to Black and white mothers, and whether variations in state generosity attenuate the racial inequalities in birth outcomes. The authors also examine whether the relationship between state policies and racial inequalities in birth outcomes is moderated by the education level of the mother. We find that the EITC reduces the risk of low birth weight and preterm birth for Black mothers. The impact is much less consistent for white mothers. For both Black and white mothers, the benefits to birth outcomes are larger for mothers with less education.

Where are race-based oral health inequities bound? Protocol for a systematic review on interventions to tackle racial injustice in dental outcomes

BACKGROUND

Only three literature reviews have assessed the impact of interventions on the reduction of racial inequities in general health to date; none has drawn from attempts at promoting racial oral health equity. This protocol aims to increase transparency and reduce the potential for bias of an ongoing systematic review conceived to answer the following questions: Are there any interventions to mitigate racial oral health inequities or improve the oral health of racially marginalized groups? If so, how successful have they been at promoting racial oral health equity? How do conclusions of previous reviews change by taking the findings of oral health interventions into account?

METHODS

Reviewed studies must deploy interventions to reduce racial gaps or promote the oral health of groups oppressed along ancestral and/or cultural lines. We will analyze randomized clinical trials, natural experiments, pre-post studies, and observational investigations that emulate controlled experiments by assessing interactions between race and potentially health-enhancing interventions. Either clinically assessed or self-reported oral health outcomes will be considered by searching for original studies in MEDLINE, LILACS, PsycInfo, SciELO, Web of Science, Scopus, and Embase from their earliest records to March 2022. Upon examining abstracts of conference proceedings, trial registries, reports of related stakeholder organizations, as well as contacting researchers for unpublished data, we will identify studies in the grey literature. If possible, we will carry out a meta-analysis with subgroup and sensitivity analysis, including formal meta-regression, to address potential heterogeneity and inconsistency among selected studies.

DISCUSSION

Conducting a systematic review of interventions to mitigate racial oral health inequities is crucial for determining which initiatives work best and under which conditions they succeed. Such knowledge will help consolidate an evidence base that may be used to inform policy and practice against persistent and pervasive racial inequities in general and oral health.

SYSTEMATIC REVIEW REGISTRATION

This protocol has been registered at the International Prospective Register of Systematic Reviews, under the identification number CRD42021261450 .

Mapping mental health inequalities: The intersecting effects of gender, race, class, and ethnicity on ADHD diagnosis

While the effects of social stratification by gender, race, class, and ethnicity on health inequalities are well-documented, our understanding of the intersecting consequences of these social dimensions on diagnosis remains limited. This is particularly the case in studies of mental health, where "paradoxical" patterns of stratification have been identified. Using a Bayesian multi-level random-effects Poisson model and a nationally representative random sample of 138,009 households from the National Survey of Children's Health, this study updates and extends the literature on mental health inequalities through an intersectional investigation of one of the most commonly diagnosed psychiatric conditions of childhood/adolescence: attention-deficit hyperactivity disorder (ADHD). Findings indicate that gender, race, class, and ethnicity combine in mutually constitutive ways to explain between-group variation in ADHD diagnosis. Observed effects underscore the importance and feasibility of an intersectional, multi-level modelling approach and data mapping technique to advance our understanding of social subgroups more/less likely to be diagnosed with mental health conditions.

Sick And Tired Of Being Excluded: Structural Racism In Disenfranchisement As A Threat To Population Health Equity

Theoretical research suggests that racialized felony disenfranchisement-a form of structural racism-is likely to undermine the health of Black people, yet empirical studies on the topic are scant. We used administrative data on disproportionate felony disenfranchisement of Black residents across US states, linked to geocoded individual-level health data from the 2016 Health and Retirement Study, to estimate race-specific regression models describing the relationship between racialized disenfranchisement and health among middle-aged and older adults, adjusting for other individual- and state-level factors. Results show that living in states with higher levels of racialized disenfranchisement is associated with more depressive symptoms, more functional limitations, more difficulty performing instrumental activities of daily living, and more difficulty performing activities of daily living among Black people. However, there are no statistically significant relationships between racialized disenfranchisement and health among White people. These findings suggest that policies aiming to mitigate disproportionate Black felony disenfranchisement not only are essential for political inclusion but also may be valuable tools for improving population health equity.

Racial-ethnic Disparities in Pain Intensity and Interference Among Middle-aged and Older U.S. Adults

BACKGROUND

This study aims to better understand differing pain experiences across U.S. racial/ethnic subgroups by estimating racial-ethnic disparities in both pain intensity and domain-specific pain-related interference. To address this issue, we use a nationally representative sample of non-Hispanic White, non-Hispanic Black, and Hispanic adults ages 50+ who report recently experiencing pain.

METHODS

Using data from the 2010 wave of the Health and Retirement Study (HRS; N = 684), we conducted a series of multivariate analyses to assess possible racial/ethnic disparities in pain intensity and 7 domains of pain interference, controlling for relevant sociodemographic variables and other health problems.

RESULTS

Black and Hispanic participants reported higher pain intensity than White participants after controlling for socioeconomic status (SES) and other health conditions. Both Black and Hispanic individuals reported more domain-specific pain interference in bivariate analyses. In multivariate analyses, Black (vs White) participants reported significantly higher levels of pain interference with family-home responsibilities, occupation, sexual behavior, and daily self-care. We did not find significant Hispanic-White differences in the 7 pain interference domains, nor did we find Black-White differences in 3 domains (recreation, social activities, and essential activities).

CONCLUSIONS

Our findings highlight the need for using multidimensional measures of pain when assessing for possible pain disparities with respect to race/ethnicity. Future studies on pain interventions should consider contextualizing the pain experience across different racial subgroups to help pain patients with diverse needs, with the ultimate goal of reducing racial/ethnic disparities in pain.

An Antiracism Approach to Conducting, Reporting, and Evaluating Pediatric Critical Care Research

Reporting race and ethnicity without consideration for the complexity of these variables is unfortunately common in research. This practice exacerbates the systemic racism present in healthcare and research, of which pediatric critical care is not immune. Scientifically, this approach lacks rigor, as people are grouped into socially derived categories that are often not scientifically justified, and the field is denied the opportunity to examine closely the true associations between race/ethnicity and clinical outcomes. In this Special Article for Pediatric Critical Care Medicine, we introduce an antiracism approach to conducting, reporting, and evaluating pediatric critical care research. We propose four recommendations: 1) race and ethnicity are social constructs that should be evaluated as such, with researchers considering the context and relevance of related social determinants of health; 2) race and ethnicity data should be collected with sufficient detail to allow detection of meaningful results and minimize the risk of overgeneralizing findings; 3) as health equity research evolves, the pediatric critical care research field must adapt and proactively strive for inclusivity; and 4) the research community, including investigators, authors, research ethics committees, funding organizations, professional organizations, and journal editorial boards, are all accountable for rigorously conducting and reporting race/ethnicity in research. Taking an antiracism approach to research requires the field to ask the difficult question of why racial/ethnic differences exist to eliminate healthcare disparities and optimize healthcare outcomes for all children.

The Intersecting Consequences of Race-Gender Health Disparities on Workforce Engagement for Older Workers: An Examination of Physical and Mental Health

The dramatic growth of older adults' labor participation over the past 25 years, including women and people of color, is reshaping the American labor force. The current study contributes new knowledge concerning why individuals over age 50 years may be working longer despite negative impacts of deteriorating physical and mental health associated with aging. Inquiries regarding who continues to work and why can be answered, in part, by addressing how workforce engagement and health are shaped by notable social inequities along the dimensions of age, race, and gender. Guided by cumulative advantage/disadvantage and intersectionality frameworks, we examine whether having multiple chronic conditions (MCC)-two or more physical conditions-and depression affect workforce participation. Using multinomial logistic regression models, we analyze the 2014-2016 waves of the Health and Retirement Study (N = 4250). Findings reveal that having multiple chronic illnesses increase the likelihood of labor force exit, especially among workers who also have depression. We also discover intersectional nuances which illuminate complex race-gender dynamics related to health and work processes in later life. We conclude with recommendations for workplace policy that promote the retention of older workers with chronic illness and depression and aim to decrease disparities in older workers' work engagement.

Dismantling "Race" in Health Research

In this era of confronting racism in public space, it is critical to keep addressing the covert systemic racism in the healthcare system. We want to bring attention to the continued unscientific practice of race-based medicine and the absurdity of treating race as a biological indicator in the 21st century. We believe race is a social construct that does not qualify as a scientific biological indicator for predicting health outcomes. In this paper, we first present arguments for inappropriate use of race in health research and then discuss alternative explanations for health disparity findings that use race as a predictor. Our main concern centers on two specific aspects of the concept of "race": (1) its fundamental lack of scientific basis as a predictor for health outcomes, (2) the misguided narrative that the term creates, placing the onus of racial discrimination on the victim, instead of highlighting the act of discrimination and the role researchers play in actively reinforcing racism when using "race" as a variable. We conclude by proposing that "race" be replaced by the variable "racism" in health.

The Relationship between Systemic Racism, Residential Segregation, and Racial/Ethnic Disparities in COVID-19 Deaths in the United States

Introduction

Although Black Americans are not substantially more likely to be diagnosed with COVID-19, hospitalization rates and death rates are considerably higher than for White Americans. The aim of this study was to assess the relationship between systemic racism generally, and residential segregation in particular, and racial/ethnic disparities in deaths due to COVID-19.

Methods

To assess racial disparities in COVID-19 and systemic racism in US states, we calculated descriptive statistics and bivariate Pearson correlations. Using data on deaths through December 2020, we developed a weighted logistic mixed model to assess whether state-level systemic racism generally and residential segregation, in particular, predicted the probability of COVID-19 deaths among Americans, considering key sociodemographic factors.

Results

Residential segregation is a stronger predictor of COVID-19 deaths among Black Americans, as compared to systemic racism more generally. Looking at the interaction between residential segregation and COVID-19 death rates by race, residential segregation is associated with negative outcomes for Black and White Americans, but disproportionately impacts Black state residents (P<.001), who have 2.14 times higher odds of dying from COVID-19 when residential segregation is increased.

Conclusion

To understand and address disparities in infectious disease, researchers and public health practitioners should acknowledge how different forms of systemic racism shape health outcomes in the United States. More attention should be given to the mechanisms by which infectious disease pandemics exacerbate health disparities in areas of high residential segregation and should inform more targeted health policies. Such policy changes stand to make all American communities more resilient in the face of new and emerging infectious diseases.

Nonverbal Synchrony: An Indicator of Clinical Communication Quality in Racially-Concordant and Racially-Discordant Oncology Interactions

Objectives

The aim of this cross-sectional study was to apply a novel software to measure and compare levels of nonverbal synchrony, as a potential indicator of communication quality, in video recordings of racially-concordant and racially-discordant oncology interactions. Predictions include that the levels of nonverbal synchrony will be greater during racially-concordant interactions than racially-discordant interactions, and that levels of nonverbal synchrony will be associated with traditional measures of communication quality in both racially-concordant and racially-discordant interactions.

Design

This is a secondary observational analysis of video-recorded oncology treatment discussions collected from 2 previous studies.

Setting

Two National Cancer Institute-designated Comprehensive Cancer Centers and another large urban cancer center.

Participants

Participants from Study 1 include 161 White patients with cancer and 11 White medical oncologists. Participants from Study 2 include 66 Black/African-American patients with cancer and 17 non-Black medical oncologists. In both studies inclusion criteria for patients was a recent cancer diagnosis; in Study 2 inclusion criteria was identifying as Black/African American.

Main outcome measures

Nonverbal synchrony and communication quality.

Results

Greater levels of nonverbal synchrony were observed in racially-discordant interactions than in racially-concordant interactions. Levels of nonverbal synchrony were associated with indicators of communication quality, and these associations were more consistently found in racially-discordant interactions.

Conclusion

This study advances clinical communication and disparities research by successfully applying a novel approach capturing the unconscious nature of communication, and revealing differences in communication in racially-discordant and racially-concordant oncology interactions. This study highlights the need for further exploration of nonverbal aspects relevant to patient-physician interactions.

Racial and ethnic disparities in cancer caregiver burden and potential sociocultural mediators

PURPOSE

Black and Hispanic cancer patients experience many worse care quality and health outcomes than non-Hispanic White patients, yet less is known about disparities in caregiving responsibilities and burden among cancer caregivers.

METHODS

We analyzed cross-sectional data from Cancer Care Outcomes Research and Surveillance consortium, a large multi-regional, population-based study of colorectal and lung cancer patients and their caregivers. Bivariate and multivariable regression models assessed differences by racial and ethnic groups in caregiving responsibilities and social/emotional, financial, and health burdens. Structural equation models estimated whether sociocultural resources (social support, caregiving preparedness, caregiver-patient communication) mediated racial and ethnic differences in caregiver burden.

RESULTS

Compared with non-Hispanic White caregivers (N = 1,169), Black (N = 220) and Hispanic (N = 84) caregivers spent more time caregiving (18 vs. 26 vs. 26 h/week; P < 0.001), completed more tasks (6.8 vs. 7.6 vs. 8.7; P < 0.05), and reported greater financial burden (P = 0.02). Yet, compared to non-Hispanic Whites, Hispanic caregivers reported similar social/emotional and health burdens, while Black caregivers reported lower levels (P < 0.01). In adjusted models, disparities in financial burden disappeared, and Hispanic caregivers had less health burden than non-Hispanic White caregivers (P = 0.01). Social support and/or caregiving preparedness partially mediated the Black-White gap for all three types of burdens.

CONCLUSIONS

Black and Hispanic cancer caregivers perform more caregiving and report greater financial burden than non-Hispanic White caregivers, but experience lower or equivalent social/emotional and health burdens. Racial differences in caregivers' social support and caregiving preparedness levels partially explain Black-White burden differences. Research and policy should address Black and Hispanic caregivers' increased financial burden.

U.S. State Policy Contexts and Physical Health among Midlife Adults

This study examines how state policy contexts may have contributed to unfavorable adult health in recent decades. It merges individual-level data from the 1993-2016 Behavioral Risk Factor Surveillance System (n=2,166,835) with 15 state-level policy domains measured annually on a conservative to liberal continuum. We examined associations between policy domains and health among adults ages 45-64 years and assess how much of the associations is accounted by adults' socioeconomic, behavioral/lifestyle, and family factors. A more liberal version of the civil rights domain was associated with better health. It was disproportionately important for less-educated adults and women, and its association with adult health was partly accounted by educational attainment, employment, and income. Environment, gun safety, and marijuana policy domains were, to a lesser degree, predictors of health in some model specifications. In sum, health improvements require a greater focus on macro-level factors that shape the conditions in which people live.

Neighborhood structural disadvantage and biological aging in a sample of Black middle age and young adults

OBJECTIVES

Research on the social determinants of health has suggested that neighborhood disadvantage may undermine healthy aging and is particularly relevant for understanding health disparities. Recently, this work has examined deoxyribonucleic acid methylation (DNAm)-based measures of biological aging to understand the risk factors for morbidity and mortality. However, it is unknown whether neighborhood disadvantage is related to different indices of DNAm-based aging among Black Americans and whether such neighborhood effects vary as a function of age or gender.

METHODS

Our analyses of a Black American sample included 448 young adults and 493 middle-aged adults. We measured neighborhood disadvantage using the Area Deprivation Index at the census block group level. DNAm-based accelerated aging indices were measured using established procedures. Regressions with clustered standard errors were used for the analysis.

RESULTS

Neighborhood disadvantage was independently associated with acceleration in PhenoAge, GrimAge, and DunedinPoAm, among young and middle-aged adults. Further, there was no evidence that gender conditioned the effects of neighborhood disadvantage on the aging indices.

CONCLUSIONS

Regardless of age groups or gender, accelerated biological aging among Black Americans is partly rooted in differences in neighborhood disadvantage. From a policy standpoint, our findings suggest that programs that decrease neighborhood disadvantage are likely to increase healthy aging, especially among Black Americans.

Monetary Sanctions as Chronic and Acute Health Stressors: The Emotional Strain of People Who Owe Court Fines and Fees

In this article, we explore the experiences of people who carry monetary sanction (or penal) debt across eight U.S. states. Using 519 interviews with people sentenced to fines and fees, we analyze the mental and emotional aspects of their experiences. Situating our analysis within research on the social determinants of health and the stress universe, we suggest that monetary sanctions create an overwhelmingly palpable sense of fear, frustration, anxiety, and despair. We theorize the ways in which monetary sanctions function as both acute and chronic health stressors for people who are unable to pay off their debts, highlight the mechanisms linking penal debt with mental and emotional burdens, and generalize our findings using national data from the U.S. Federal Reserve. We find that the system of monetary sanctions generates a great deal of stress and strain that becomes an internalized punishment affecting many realms of people's lives.

Unstable Childhood, Adult Adversity, and Smoking Accelerate Biological Aging Among Middle-Age African Americans: Similar Findings for GrimAge and PoAm

Objectives: The recent biological clocks GrimAge and PoAm are robust predictors of morbidity and mortality. Little research, however, has investigated the factors that influence their ticking speed. No study has used multivariate analyses to examine whether childhood adversity, adult hardship, lifestyle practices, or some combination of these factors best explains acceleration of these indices. Methods: Using a sample of 506 middle-age African Americans, the present study investigated the extent to which childhood instability, adult adversity, and lifestyle predict accelerated GrimAge and PoAm. Results: The two clocks were highly correlated and the pattern of findings was very similar for the two measures. Childhood instability, adult financial hardship, and smoking were significant predictors of both clocks. Discussion: The findings support a life course perspective where both the long arm of childhood as well as later life conditions influence speed of aging. Similar results across the two clocks enhance confidence in the findings.

Skin Tone and Perceived Discrimination: Health and Aging Beyond the Binary in NSHAP 2015

OBJECTIVES

This paper introduces new measures of skin tone (self-reported) and perceived discrimination that are included in the third round of the National Social Life, Health, and Aging Project (NSHAP). We explain the rationale for these new measures, emphasizing, in particular, how they help researchers to conceptualize and measure the significance of race/ethnicity for health and aging beyond binary ethnoracial categories.

METHOD

We describe new measures of skin tone and perceived discrimination for use in NSHAP 2015. We provide descriptive statistics on the distribution of skin tone (self-reported) by race/ethnicity. As a proof of concept, we use logistic and ordinary least squares regression analyses to examine the relationship between skin tone, perceived discrimination, and perceived stress among ethnoracial minorities.

RESULTS

We find that there is significant variation in skin tone among non-White respondents in NSHAP 2015 (e.g., non-Hispanic Black and Latinx). We also find that skin tone (self-reported) is a significant predictor of the frequency of perceived discrimination and perceived stress among African American, but not Latinx respondents in NSHAP.

DISCUSSION

The inclusion of new skin tone and discrimination measures in NSHAP 2015 provides a unique and novel opportunity for researchers to more deeply understand how race/ethnicity is connected to health and aging among ethnoracial minorities. Furthermore, it will enable analyses of how stress and perceived discrimination also affect patterns of health and aging among Whites against the backdrop of steadily increasing socioeconomic inequalities and shifting ethnoracial demographics in the United States.