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Sullivan PS, Castel A, Fenton K, Rodriguez-Diaz C, Reisner S, Dean HD. From equality to equity: Increasing the use and reporting of equity-based approaches in epidemiology. Ann Epidemiol 2024; 98:32-35. [PMID: 39146758 DOI: 10.1016/j.annepidem.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 08/17/2024]
Affiliation(s)
- Patrick S Sullivan
- Emory University Rollins School of Public Health, Atlanta, GA, United States.
| | - Amanda Castel
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Kevin Fenton
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | | | - Sari Reisner
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Hazel D Dean
- Emory University Rollins School of Public Health, Atlanta, GA, United States
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Johnson EI, Planalp EM, Williams DT, Poehlmann J. Parental incarceration and health risks in a population-based study of U.S. early adolescents: Results among racialized groups. SSM Popul Health 2024; 27:101702. [PMID: 39184526 PMCID: PMC11342108 DOI: 10.1016/j.ssmph.2024.101702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/25/2024] [Accepted: 07/25/2024] [Indexed: 08/27/2024] Open
Abstract
Parental incarceration is an adverse childhood experience that inequitably burdens families of color and affects millions of U.S. children and adolescents. Although racialized disparities in exposure to parental incarceration are often acknowledged, researchers have yet to examine whether manifestations of racism may affect the link between parental incarceration and youth outcomes. This study provides a first look at how parental incarceration relates to health vulnerabilities in the Adolescent Brain Cognitive Development (ABCD) study, an ongoing, population-based study of U.S. children born between 2006 and 2008. We start by describing exposure to parental incarceration and then examine how parental incarceration, state-level racial prejudice, and discrimination relate to health risks among 9191 White (66%), Black (19%), or Hispanic (15%) youth. Consistent with what we know about pervasive racialized disparities in the U.S. criminal legal system, we find that 19.3% of Black children in our sample have experienced parental incarceration, followed by 7.8% of Hispanic children, and 4.8% of White children. Results of multilevel mixed models further indicate that parental incarceration was associated with increased health risks among White children whereas family economic hardship and discrimination experiences were more robustly associated with health vulnerabilities among Black and Hispanic children. Additional analyses explored whether parental incarceration was associated with other outcomes among Black and Hispanic children, revealing increased risk for behavior problems contingent upon parental incarceration and discrimination for Black children and Hispanic boys. Among Hispanic girls, parental incarceration was associated with increased risk of behavior problems in states with higher levels of racism. Results suggest that parental incarceration contributes to risk among early adolescents across racialized groups, but that the specific toll it takes depends on outcomes assessed and the context in which it occurs.
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Atere-Roberts J, Delamater PL, Robinson WR, Aiello AE, Hargrove TW, Martin CL. Indicators of inequity: Exploring the complexities of operationalizing area-level structural racism. SSM Popul Health 2024; 27:101701. [PMID: 39211734 PMCID: PMC11357850 DOI: 10.1016/j.ssmph.2024.101701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/12/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024] Open
Abstract
•Examines two types of area-level indicators commonly used in structural racism and health research.•Uses choropleth maps to assess the spatial patterning of the area-level indicators.•Offers methodological considerations for using area-level indicators.•Highlights the prospects and limits of using area-level indicators as proxies of structural racism.
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Affiliation(s)
- Joëlle Atere-Roberts
- Department of Epidemiology, University of North Carolina Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina Chapel Hill, NC, USA
| | - Paul L. Delamater
- Carolina Population Center, University of North Carolina Chapel Hill, NC, USA
- Department of Geography, University of North Carolina Chapel Hill, NC, USA
| | - Whitney R. Robinson
- Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Allison E. Aiello
- Department of Epidemiology, Robert N Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, NY, USA
| | - Taylor W. Hargrove
- Carolina Population Center, University of North Carolina Chapel Hill, NC, USA
- Department of Sociology, University of North Carolina Chapel Hill, NC, USA
| | - Chantel L. Martin
- Department of Epidemiology, University of North Carolina Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina Chapel Hill, NC, USA
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Gangopadhyaya A, Dubay L, Johnston E, Pancini V. How structural racism, neighborhood deprivation, and maternal characteristics contribute to inequities in birth outcomes. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae092. [PMID: 39099704 PMCID: PMC11296672 DOI: 10.1093/haschl/qxae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/08/2024] [Accepted: 07/20/2024] [Indexed: 08/06/2024]
Abstract
Decades of disparities in health between infants born to Black and White mothers have persisted in recent years, despite policy initiatives to improve maternal and reproductive health for Black mothers. Although scholars have increasingly recognized the critical role that structural racism plays in driving health outcomes for Black people, measurement of this relationship remains challenging. This study examines trends in preterm birth and low birth weight between 2007 and 2018 separately for births to Black and White mothers. Using a multivariate regression model, we evaluated potential factors, including an index of racialized disadvantage as well as community- and individual-level factors that serve as proxy measures for structural racism, that may contribute to White-Black differences in infant health. Finally, we assessed whether unequal effects of these factors may explain differences in birth outcomes. We found that differences in the effects of these factors appear to explain about half of the underlying disparity in infant health.
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Affiliation(s)
- Anuj Gangopadhyaya
- Department of Economics, Quinlan School of Business, Loyola University, Chicago, IL 60611United States
| | - Lisa Dubay
- The Urban Institute, Health Policy Center, Washington, DC 20034, United States
| | - Emily Johnston
- The Urban Institute, Health Policy Center, Washington, DC 20034, United States
| | - Vincent Pancini
- The Urban Institute, Health Policy Center, Washington, DC 20034, United States
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Rabia RA, Alfayumi-Zeadna S, Hendel T, Kagan I. Barriers to Adopting Healthy Lifestyle and Health Promotion among Ethnic Minority Bedouin Women in Southern Israel: A Qualitative Study. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02022-z. [PMID: 38809466 DOI: 10.1007/s40615-024-02022-z] [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: 11/30/2023] [Revised: 04/16/2024] [Accepted: 05/08/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND A healthy lifestyle is a crucial step in disease prevention and management, as well as a significant predictor of health promotion. Yet, despite an increase in chronic morbidity among Bedouin women in southern Israel, little research has been conducted on their health behaviors. Therefore, the aim of this study is to examine barriers to adopting a healthy lifestyle and health promotion among ethnic minority Bedouin women in southern Israel. METHODS This qualitative study was based on data collected through focus groups during June and July 2021. Participants included 44 Bedouin women aged 18-55. Focus groups were recorded and transcribed. Transcriptions were thematically analyzed and coded using the ecological model. RESULTS We found multiple barriers at various levels that prevent Bedouin women from adopting a healthy lifestyle and health promotion. At the individual level, such factors included the impact of financial limitations on healthful nutrition, as well as a lack of awareness or knowledge regarding healthy lifestyle and health promotion. At the organizational level, barriers include a lack of clinics, accessibility, and availability of health services and cultural incompatibility of the health services. At the community level, impediments to a healthy lifestyle include inaccessibility to sports facilities and suppression of physical activity. At the public policy level, participants, especially those living in unrecognized villages, described difficult living conditions related to environmental and social neglect as affecting their health status and ability to maintain a healthy lifestyle. CONCLUSION Study findings emphasize the need for policymaking and a systemic approach to address health disparities and ensure equal health promotion for the Bedouin population.
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Affiliation(s)
- Rasmiya Abu Rabia
- Nursing Department, School of Health Sciences, Ashkelon Academic College, 78211, Ashkelon, Israel
- Clalit Health Services, Southern Region, 84417, Be'er-Sheva, Israel
| | - Samira Alfayumi-Zeadna
- Nursing Department, School of Health Sciences, Ashkelon Academic College, 78211, Ashkelon, Israel.
| | - Tova Hendel
- Nursing Department, School of Health Sciences, Ashkelon Academic College, 78211, Ashkelon, Israel
| | - Ilya Kagan
- Nursing Department, School of Health Sciences, Ashkelon Academic College, 78211, Ashkelon, Israel
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Straton E, Bryant BL, Kang L, Wang C, Barber J, Perkins A, Gallant L, Marks B, Agarwal S, Majidi S, Monaghan M, Streisand R. ROUTE-T1D: A behavioral intervention to promote optimal continuous glucose monitor use among racially minoritized youth with type 1 diabetes: Design and development. Contemp Clin Trials 2024; 140:107493. [PMID: 38460913 PMCID: PMC11065587 DOI: 10.1016/j.cct.2024.107493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/13/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Type 1 diabetes management is often challenging during adolescence, and many youth with type 1 diabetes struggle with sustained and optimal continuous glucose monitor (CGM) use. Due to racial oppression and racially discriminatory policies leading to inequitable access to quality healthcare and life necessities, racially minoritized youth are significantly less likely to use CGM. METHODS ROUTE-T1D: Research on Optimizing the Use of Technology with Education is a pilot behavioral intervention designed to promote optimal CGM use among racially minoritized youth with type 1 diabetes. Intervention strategies include problem solving CGM challenges and promoting positive caregiver-youth communication related to CGM data. RESULTS This randomized waitlist intervention provides participants with access to three telemedicine sessions with a Certified Diabetes Care and Education Specialist. Caregiver participants are also connected with a peer-parent coach. CONCLUSION Hypothesized findings and anticipated challenges are discussed. Future directions regarding sustaining and optimizing the use of diabetes technology among racially minoritized pediatric populations are reviewed.
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Affiliation(s)
- Emma Straton
- Children's National Hospital, Washington DC, United States of America
| | - Breana L Bryant
- Children's National Hospital, Washington DC, United States of America
| | - Leyi Kang
- Children's National Hospital, Washington DC, United States of America
| | - Christine Wang
- Children's National Hospital, Washington DC, United States of America
| | - John Barber
- Children's National Hospital, Washington DC, United States of America
| | - Amanda Perkins
- Children's National Hospital, Washington DC, United States of America
| | - Letitia Gallant
- Children's National Hospital, Washington DC, United States of America
| | - Brynn Marks
- Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Shivani Agarwal
- Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Shideh Majidi
- Children's National Hospital, Washington DC, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America
| | - Maureen Monaghan
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Randi Streisand
- Children's National Hospital, Washington DC, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America.
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Tyrell FA, Wang YS, Eboigbe LI, Skeeter BD. A multisystem model for understanding stress and adaptation in ethnically and racially diverse youth. Dev Psychopathol 2024:1-13. [PMID: 38506061 DOI: 10.1017/s0954579424000592] [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: 03/21/2024]
Abstract
Contemporary biological and contextually based theoretical frameworks have conceptualized how stress exposure may influence adaptation in youth. However, nearly all of this scholarship neglects the role of specific contextual features and/or biological processes that are involved in ethnic-racial minority youth's responses and adaptation to sociocultural stressors. Drawing on the theoretical principles of the developmental psychopathology framework and contemporary models of stress and adaptation, this article proposes a new multisystem model that explains how multiple levels and systems within and outside of individual youth influence their sociocultural adaptation. We provide empirical evidence to support components of this multisystem model. We propose that research based on our new theoretical framework will capture the sociocultural experiences of ethnic-racial minority youth by centering processes that are relevant to their lived experiences, coping, and adjustment. In doing so, this model will inform psychosocial interventions focused on promoting healthy adaptation among ethnic and racial diverse youth. Finally, we offer recommendations to guide future research on stress and adaptation among ethnic and racial diverse youth, in particular, and developmental psychopathology more broadly.
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Affiliation(s)
- Fanita A Tyrell
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Yuqi S Wang
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Loretta I Eboigbe
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Bailey D Skeeter
- Department of Psychology, University of Maryland, College Park, MD, USA
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Hayba N, Cheek C, Austin E, Testa L, Richardson L, Safi M, Ransolin N, Carrigan A, Harrison R, Francis-Auton E, Clay-Williams R. Strategies to Improve Care in the Emergency Department for Culturally and Linguistically Diverse Adults: a Systematic Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01876-z. [PMID: 38117444 DOI: 10.1007/s40615-023-01876-z] [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: 07/13/2023] [Revised: 11/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The emergency department (ED) is an important gateway into the health system for people from culturally and linguistically diverse (CALD) backgrounds; their experience in the ED is likely to impact the way they access care in the future. Our review aimed to describe interventions used to improve ED health care delivery for adults from a CALD background. METHODS An electronic search of four databases was conducted to identify empirical studies that reported interventions with a primary focus of improving ED care for CALD adults (aged ≥ 18 years), with measures relating to ED system performance, patient outcomes, patient experience, or staff experience. Studies published from inception to November 2022 were included. We excluded non-empirical studies, studies where an intervention was not provided in ED, papers where the full text was unavailable, or papers published in a language other than English. The intervention strategies were categorised thematically, and measures were tabulated. RESULTS Following the screening of 3654 abstracts, 89 articles underwent full text review; 16 articles met the inclusion criteria. Four clear strategies for targeting action tailored to the CALD population of interest were identified: improving self-management of health issues, improving communication between patients and providers, adhering to good clinical practice, and building health workforce capacity. CONCLUSIONS The four strategies identified provide a useful framework for targeted action tailored to the population and outcome of interest. These detailed examples show how intervention design must consider intersecting socio-economic barriers, so as not to perpetuate existing disparity. REGISTRATION PROSPERO registration number: CRD42022379584.
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Affiliation(s)
- Nematullah Hayba
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia.
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Internal Medicine Research Unit, Department of Regional Health Research, University Hospital of Southern Denmark, Aabenraa, University of Southern Denmark, Odense, Denmark
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Robyn Clay-Williams
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
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Pattillo M, Stieglitz S, Angoumis K, Gottlieb N. Racism against racialized migrants in healthcare in Europe: a scoping review. Int J Equity Health 2023; 22:201. [PMID: 37770879 PMCID: PMC10540333 DOI: 10.1186/s12939-023-02014-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Racism is frequently mentioned as a social determinant of migrants' health and a barrier to health services. However, in the European context, racism and its impact on racialized migrants' access to healthcare is remarkably under-researched. This scoping review makes a first step toward filling this void by mapping the existing literature on racial and ethnic discrimination against racialized migrants in healthcare in Europe, identifying evidence gaps, and offering recommendations for future research on this topic. METHODS Following PRISMA guidelines, four databases were searched for empirical studies published in English between 1992 and 2022. Studies were included if they report findings on manifestations, experiences and/or impacts of racial or ethnic discrimination against racialized migrants in a healthcare setting in a European country. They were summarized by study characteristics (geographical scope, study design, research question and measures) and research findings were synthesized. RESULTS Out of 2365 initial hits, 1724 records were included in the title/abstract-screening, 87 records in the full text-screening, and 38 records in the data extraction. For many country and healthcare contexts, evidence on racism in healthcare is lacking. Most studies apply an explorative qualitative research design; comparability and generalizability of research results are low. Our analysis furthermore shows a near-exclusive research focus on racism on the interpersonal level as compared to institutional and structural levels. Our synthesis of study results identifies three interrelated ways in which racism manifests in and impacts migrants' healthcare: 1) general anti-migration bias, 2) health- and healthcare-related prejudice, and 3) differential medical treatment. CONCLUSIONS Our review underscores how racism reinforces inequities in healthcare access and quality for racialized migrants. It also highlights the need for more research on racism in Europe across a greater scope of country contexts, healthcare settings and migrant/racialized categories in order to understand specific forms of racism and capture race as a context-contingent social construct. It is critical that future research includes the consideration of individual-level racism as embedded in racism on institutional and structural levels. Methods and insights from other disciplines may help to critically examine concepts in light of underlying historical, sociopolitical and socioeconomic processes and structures, and to improve methods for researching racialization and racism in healthcare.
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Affiliation(s)
- Mia Pattillo
- Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10021, USA
| | - Sigsten Stieglitz
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany
| | - Konstantinos Angoumis
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany
| | - Nora Gottlieb
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany.
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Rosa WE, Brown CE, Curtis JR. Race-conscious serious illness communication: An interpersonal tool to dismantle racism in practice and research. Palliat Support Care 2023; 21:492-497. [PMID: 37016914 PMCID: PMC10262215 DOI: 10.1017/s147895152300038x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND Racism significantly contributes to inequitable care quality and outcomes for people of color with serious illness, their families, and their communities. Clinicians use serious illness communication (SIC) to foster trust, elicit patients' needs and values, and deliver goal-concordant services. Current SIC tools do not actively guide users to incorporate patients' experiences with racism into care. OBJECTIVES 1) To explicitly address racism during SIC in the context of the patient's lived experience and 2) to provide race-conscious SIC recommendations for clinicians and researchers. METHODS Applying the conceptual elements of Public Health Critical Race Praxis to SIC practice and research through reflection on inclusive SIC approaches and a composite case. RESULTS Patients' historical and ongoing narratives of racism must be intentionally welcomed in physically and psychologically safe environments by leveraging empathic communication opportunities, forging antiracist palliative care practices, removing interpersonal barriers to promote transparent patient-clinician relationships, and strengthening organizational commitments to strategically dismantle racism. Race-conscious SIC communication strategies, skills, and examples of talking points are provided. DISCUSSION Race-conscious SIC practices may assist to acknowledge racial dynamics within the patient-clinician encounter. Furthermore, race-conscious SIC may help to mitigate implicit and explicit bias in clinical practices and the exclusionary research cultures that guide them.
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Affiliation(s)
- William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Crystal E. Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Cambia Palliative Care Center of Excellence, UW Medicine, Seattle WA
| | - J. Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Cambia Palliative Care Center of Excellence, UW Medicine, Seattle WA
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11
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Castro-Dominguez Y, Smolderen KG, Mena-Hurtado C. The problem of disparities in vascular health. Vasc Med 2023; 28:179-181. [PMID: 37293740 DOI: 10.1177/1358863x231178044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Yulanka Castro-Dominguez
- Harrington Heart & Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Kim G Smolderen
- Department of Medicine, Division of Cardiology, Vascular Medicine Outcomes Program (VAMOS), Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Carlos Mena-Hurtado
- Department of Medicine, Division of Cardiology, Vascular Medicine Outcomes Program (VAMOS), Yale School of Medicine, New Haven, CT, USA
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Hearn MF, Biggs DL, Brown PS, Krastev MA, Szwarc MJ, Riggs APE. Finding our own ways of working together: reflections on implementing and facilitating a multidisciplinary and equity-oriented model of Group Pregnancy Care for women of refugee background. Midwifery 2023; 123:103709. [PMID: 37209583 DOI: 10.1016/j.midw.2023.103709] [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: 12/13/2022] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE This paper explores professional staff experiences of implementing and facilitating a multidisciplinary equity-oriented model of Group Pregnancy Care for women of refugee background. This model was the first of its kind in Australia and one of the first worldwide. DESIGN AND SETTING This exploratory descriptive qualitative study reports the process evaluation findings from the formative evaluation of Group Pregnancy Care for women of refugee background. Data were collected in Melbourne, Australia between January and March 2021 via semi-structured interviews, and analysed using reflexive thematic analysis. PARTICIPANTS Purposive sampling was used to recruit twenty-three professional staff involved in the implementation, facilitation, or oversight of Group Pregnancy Care. FINDINGS This paper reports five themes: knowledge sharing, bicultural family mentors - the critical link, finding our own ways of working together, power dynamics at the intersection of community and clinical knowledge, and system capacity for change. KEY CONCLUSIONS The bicultural family mentor role contributes to the cultural safety of the group, and increases the confidence and competence of professional staff through cultural bridging. Multidisciplinary cross-sector teams that collaborate well can provide cohesive care. It is possible for hospital and community-based services to establish cross-sector equity-oriented partnerships. However, there are challenges sustaining partnerships in the absence of explicit funding to support collaboration, and in context of organisational and professional inflexibility. IMPLICATIONS FOR PRACTICE Investing in change is necessary to achieve health equity. Creating explicit funding pathways for the bicultural family mentor workforce, multidisciplinary collaboration, and cross-sector partnerships would strengthen service capacity to provide equity-oriented care. Working towards health equity also requires a commitment to continuing professional development for professional staff and organisations to increase knowledge and capacity.
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Affiliation(s)
- Ms Fran Hearn
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Dr Laura Biggs
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Professor Stephanie Brown
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia; University of Melbourne, Department of General Practice, Swanston St, Parkville, VIC, 3052, Australia; University of Melbourne, Department of Paediatrics, Swanston St, Parkville, VIC, 3052, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, 5001, Australia
| | - Ms Ann Krastev
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Mr Josef Szwarc
- The Victorian Foundation for Survivors of Torture Inc., Brunswick, VIC, 3056, Australia
| | - Associate Professor Elisha Riggs
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia; University of Melbourne, Department of General Practice, Swanston St, Parkville, VIC, 3052, Australia
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13
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Neblett EW, Neal AJ. Measuring institutional and structural racism in research on adolescence and developmental science. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2022; 32:1280-1284. [PMID: 36519420 PMCID: PMC10108306 DOI: 10.1111/jora.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/17/2023]
Abstract
Dismantling racism and oppression in adolescence requires sound measurement and rigorous methods. In this commentary, we discuss the measurement of institutional and structural racism and approaches to operationalizing structures and systems in adolescent research. Drawing on a recent framework for the conceptualization, measurement, and analysis of institutional racism and health (Needham et al., Journal of Racial and Ethnic Health Disparities, in press), we highlight several considerations for measuring institutional and structural racism. These include definitional issues, the tension between individual- and area-level measures, questions of timing, and matters of design and analysis. We conclude with suggestions to address gaps in existing literature and call for transdisciplinary training, collaboration, and partnership to promote the healthy development of Black and Indigenous People of Color (BIPOC) adolescents and young people.
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Affiliation(s)
- Enrique W. Neblett
- Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Aaron J. Neal
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
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