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Mizel ML, Haas A, Adams JL, Martino SC, Haviland AM, Ghosh-Dastidar B, Dembosky JW, Williams M, Abel G, Maksut J, Gilder J, Elliott MN. County-level racial bias is associated with worse care for white and especially black older US adults: a cross-sectional observational study. BMJ Qual Saf 2024:bmjqs-2024-017430. [PMID: 39384249 DOI: 10.1136/bmjqs-2024-017430] [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: 04/11/2024] [Accepted: 09/12/2024] [Indexed: 10/11/2024]
Abstract
OBJECTIVE To assess the association of county-level bias about black and white people with patient experience, influenza immunisation, and quality of clinical care for black and white older US adults (age 65+ years). DESIGN Linear multivariable regression measured the cross-sectional association of county-level estimates of implicit and explicit bias about black and white people with patient experiences, influenza immunisation, and clinical quality-of-care for black and white older US adults. PARTICIPANTS We used data from 1.9 million white adults who completed implicit and explicit bias measures during 2003-2018, patient experience and influenza immunisation data from respondents to the 2009-2017 Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) Surveys, and clinical quality-of-care data from patients whose records were included in 2009-2017 Healthcare Effectiveness Data and Information Set (HEDIS) submissions (n=0.8-2.9 million per measure). MAIN OUTCOME MEASURES Three patient experience measures and patient-reported influenza immunisation from the MCAHPS Survey; five HEDIS measures. RESULTS In county-level models, higher pro-white implicit bias was associated with lower immunisation rates and worse scores for some patient experience measures for black and white adults as well as larger-magnitude black-white disparities. Higher pro-white implicit bias was associated with worse scores for some HEDIS measures for black and white adults but not with black-white disparities in clinical quality of care. Most significant associations were small in magnitude (effect sizes of 0.2-0.3 or less). CONCLUSIONS To the extent that county-level pro-white implicit bias is indicative of bias among healthcare providers, there may be a need for interventions designed to prevent such bias from adversely affecting the experiences and preventive care of black patients and the clinical quality of care for all patients.
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Affiliation(s)
| | - Ann Haas
- RAND Corporation, Pittsburgh, Pennsylvania, USA
| | - John L Adams
- Kaiser Permanente Research, Pasadena, California, USA
| | | | - Amelia M Haviland
- RAND Corporation, Pittsburgh, Pennsylvania, USA
- Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | | | | | | | - Gary Abel
- Medical School (Primary Care), University of Exeter, Exeter, UK
| | - Jessica Maksut
- Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA
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Ramos SZ, Rose B, Werner EF, Amutah-Onukagha N, Siegel M. Systemic racism and Non-Hispanic Black to Non-Hispanic White disparities in infant mortality at the county level. J Perinatol 2024:10.1038/s41372-024-02048-5. [PMID: 39014009 DOI: 10.1038/s41372-024-02048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/17/2024] [Accepted: 07/03/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE To use a novel measure of systemic racism to examine its relationship with Non-Hispanic Black (NHB) to Non-Hispanic White (NHW) racial disparities in infant mortality across U.S. counties. STUDY DESIGN In this cross-sectional study, a composite, multi-dimensional measure of systemic racism at the county level was developed using confirmatory factor analysis based on indicators across five dimensions of systemic racism. Using linear regression analysis, we examined the relationship between the systemic racism factor scores and the NHB to NHW racial disparities in county-level infant mortality rates. Additionally, we performed a multi-level analysis of infant mortality, with births nested within counties by running a random intercept model that controlled for factors at both the individual and county levels to take into account the clustered nature of the data. RESULTS There were 325 counties that met inclusion criteria for the county level analysis and 1181 counties for the individual level analysis. Each one standard deviation increase in the Systemic Racism Index was associated with an increase of 10.4% in the Non-Hispanic Black to Non-Hispanic White infant mortality rate ratio at the county level (aOR 1.104, 95% CI [1.061-1.148]). After controlling for individual level clinical factors and county level factors, each one standard deviation increase in the systemic racism index score was associated with a decrease of 3.5% in the NHW infant mortality rate (aOR 0.965, 95% CI [0.943-0.988]). CONCLUSION Systemic racism is significantly associated with differences between counties in the magnitude of their Non-Hispanic Black to Non-Hispanic White racial disparities in infant mortality rates.
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Affiliation(s)
- Sebastian Z Ramos
- Department of Obstetrics and Gynecology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Bliss Rose
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Erika F Werner
- Department of Obstetrics and Gynecology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ndidiamaka Amutah-Onukagha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
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Nayak SS, Fraser T, Aldrich DP, Panagopoulos C, Kim D. County-level political group density, partisan polarization, and individual-level mortality among adults in the United States: A lagged multilevel study. SSM Popul Health 2024; 26:101662. [PMID: 38813457 PMCID: PMC11134911 DOI: 10.1016/j.ssmph.2024.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 05/31/2024] Open
Abstract
Objective To investigate the associations between county-level political group density, partisan polarization, and individual-level mortality from all causes and from coronary heart disease (CHD) in the United States. Methods Using data from five survey waves (1998-2006) of the General Social Survey-National Death Index dataset and the County Presidential Election Return 2000 dataset, we fit weighted Cox proportional hazards models to estimate the associations between (1) political group density and (2) partisan polarization measured at the county level in 2000 (n = 313 counties) categorized into quartiles with individual-level mortality (n = 14,983 participants) from all causes and CHD, controlling for individual- and county-level factors. Maximum follow-up was from one year after the survey up until 2014. We conducted these analyses using two separate measures based on county-level vote share differences and party affiliation ideological extremes. Results In the overall sample, we found no evidence of associations between county-level political group density and individual-level mortality from all causes. There was evidence of a 13% higher risk of dying from heart disease in the highest quartile of county-level polarization (hazards ratio, HR = 1.13; 95% CI = 0.74-1.71). We observed heterogeneity of effects based on individual-level political affiliation. Among those identifying as Democrats, residing in counties with high (vs. low) levels of polarization appeared to be protective against mortality, with an associated 18% lower risk of dying from all causes (HR = 0.82, 95% CI = 0.71-0.94). This association was strongest in areas with the highest concentrations of Democrats. Conclusions Among all study participants, political group density and polarization at the county level in 2000 were not linked to individual-level mortality. At the same time, we found that Democratic party affiliation may be protective against the adverse effects of high polarization, particularly in counties with high concentrations of Democrats. Future research should further explore these associations to potentially identify new structural interventions to address political determinants of population health.
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Affiliation(s)
- Sameera S. Nayak
- Department of Sociology, Anthropology, and Public Health, College of Arts, Humanities, and Social Sciences, University of Maryland, Baltimore County, Baltimore, MD, USA
- Center for Health, Equity, & Aging, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Timothy Fraser
- Systems Engineering Program, Cornell University, Ithaca, NY, USA
| | - Daniel P. Aldrich
- College of Social Sciences and Humanities, Northeastern University, Boston, MA, USA
- School of Public Policy and Urban Affairs, Northeastern University, Boston, MA, USA
| | - Costas Panagopoulos
- College of Social Sciences and Humanities, Northeastern University, Boston, MA, USA
| | - Daniel Kim
- School of Public Policy and Urban Affairs, Northeastern University, Boston, MA, USA
- School of Community Health & Behavioral Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
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Vu H, Green TL, Swan LET. Born on the wrong side of the tracks: Exploring the causal effects of segregation on infant health. JOURNAL OF HEALTH ECONOMICS 2024; 95:102876. [PMID: 38763530 DOI: 10.1016/j.jhealeco.2024.102876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 01/24/2024] [Accepted: 03/15/2024] [Indexed: 05/21/2024]
Abstract
Prior research has found that a high level of residential racial segregation, or the degree to which racial/ethnic groups are isolated from one another, is associated with worsened infant health outcomes, particularly among non-Hispanic (NH) Black infant populations. However, because exposure to segregation is non-random, it is unclear whether and to what extent segregation is causally linked to infant health. To overcome this empirical limitation, we leverage exogenous variation in the placement of railroad tracks in the 19th century to predict contemporary segregation, an approach first introduced by Ananat (2011). In alignment with prior literature, we find that residential segregation has statistically significant associations with negative birth outcomes among Black infant populations in the area. Using OLS methods underestimates the negative impacts of segregation on infant health. We fail to detect comparable effects on health outcomes among NH White infant populations. Further, we identify several key mechanisms by which residential segregation could influence health outcomes among Black infant populations, including lower access to prenatal care during the first trimester, higher levels of anti-Black prejudice, greater transportation barriers, and increased food insecurity. Given that poor birth outcomes have adverse effects on adults' health and well-being, the findings suggest that in-utero exposure to residential segregation could have important implications for Black-White inequality over the life course.
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Affiliation(s)
- Hoa Vu
- School of Education and Social Policy, Northwestern University, United States of America.
| | - Tiffany L Green
- Department of Population Health Sciences, University of Wisconsin-Madison, United States of America.
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin-Madison, United States of America.
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Tung I, Keenan K, Hipwell AE. Adolescent Mothers' Psychological Wellbeing during Pregnancy and Infant Emotional Health. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:616-632. [PMID: 34605721 PMCID: PMC8977390 DOI: 10.1080/15374416.2021.1981339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Although many studies have identified risk factors for adolescent pregnancy, much less is known about factors that support pregnant adolescents' psychological wellbeing and offspring outcomes. This study drew on strength-based frameworks to investigate family and neighborhood factors linked to social connectedness that predict psychological wellbeing during adolescent pregnancy and offspring outcomes. METHOD Participants included 135 adolescent mothers (ages 14-21; 90% Black American) assessed annually since childhood as part of a longitudinal study. During preadolescence (ages 11-13), data on contextual stressors and neighborhood support were gathered from participants' caregivers; participants also rated their perceived trust/attachment with caregivers before and during pregnancy. To assess changes in psychological wellbeing, adolescents reported positive and depressed mood before and during pregnancy. A path analysis model tested the prospective associations between family and neighborhood factors, psychological wellbeing during pregnancy, and offspring outcomes (birth outcomes; observed infant positive/negative emotions at age 3-months). RESULTS Positive mood decreased from pre-pregnancy to pregnancy, whereas depressed mood remained stable. Adjusting for pre-pregnancy mood, perceived caregiver trust/attachment during pregnancy was associated with prenatal positive mood. Prenatal positive mood, in turn, reduced risk of preterm birth and indirectly predicted positive infant emotions via birth outcomes. Neighborhood support in preadolescence predicted lower prenatal depressed mood, but depressed mood did not predict infant outcomes beyond positive mood. Contextual life stress was not associated with prenatal mood after adjusting for family and neighborhood support. CONCLUSIONS Findings highlight changes in positive-valence emotions during adolescent pregnancy that may have unique associations with birth outcomes and offspring emotions.
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Affiliation(s)
- Irene Tung
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
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Harter ZJ, Marsh JD. Medical Student Perception of Strabismus in Race Implicit Association Test. J Pediatr Ophthalmol Strabismus 2023; 60:372-376. [PMID: 36441125 DOI: 10.3928/01913913-20221010-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether the appearance of strabismus is noted in a race implicit association test by medical students. METHODS Medical students participated in a survey evaluating for the appearance of strabismus in photographs from a commonly used race implicit association test. Analysis was performed to determine whether strabismus was perceived equally between both groups tested. RESULTS Photographs of six individuals of African descent were perceived as having strabismus more frequently (62%) than photographs of individuals of European descent (31%; odds ratio: 3.85; 95% CI: 3.34 to 4.44; P < .0001). Participants who identified as Black or African American similarly perceived strabismus more frequently in individuals of African descent (58%) than those of European descent (24%; odds ratio: 4.36; 95% CI: 2.13 to 8.96; P < .0001). CONCLUSIONS Photographs used in a common race implicit association test appear to differ not only in ethnicity but also in extraocular alignment. Because extraocular alignment is a known cause of negative prejudice, results of this particular implicit association test should be interpreted with caution. [J Pediatr Ophthalmol Strabismus. 2023;60(5):372-376.].
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Byrn MA, Buys EA, Mujahid M, Madsen K. Disparities in the provision of perinatal care based on patient race in the United States. Birth 2023; 50:627-635. [PMID: 36945902 DOI: 10.1111/birt.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND In the United States, there are significant health inequities in perinatal care. This study examined differences in perinatal care provided to women based on the birthing person's designated race, within a large and diverse cohort of women. METHODS This retrospective electronic medical record review identified patients receiving perinatal care within a large hospital system between January 2012 and September 2018 and examined associations between maternal designated race/ethnicity (Hispanic or non-Hispanic [NH] Black, Asian or White) and various provider treatment decisions. RESULTS The study sample (N = 7056) was comprised of 36% Hispanic, 34% NH White, 21% NH Black, and 4% NH Asian women, aged 29.7 ± 6.3 years; 53% of the sample had private insurance, and 45% had Medicaid. Few differences by race were seen in perinatal care based on guidelines or expert recommendations (nondiscretionary care). Discretionary care, however, varied by race: Compared with NH White women, NH Black women were less likely to receive a prenatal depression screen (OR 0.8 [95% CI: 0.7, 0.9]) and more likely to have a urine drug test when denying drug use (OR 1.6 [95% CI 1.3, 2.0]), whereas Hispanic (OR 0.6 [95% CI: 0.5, 0.8]) and NH Asian (0.4 [95% CI 0.2, 0.9]) women were less likely to have a urine drug test completed when denying drug use. DISCUSSION Perinatal care differs by maternal race/ethnicity, particularly when guidelines or expert recommendations are absent. Greater efforts need to be made to identify and mitigate providers' implicit and explicit biases; expanded professional guidelines may offer some protections against inequitable, discretionary care.
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Affiliation(s)
- Mary A Byrn
- Loyola University Chicago, Chicago, Illinois, USA
| | - Elizabeth A Buys
- Mountain Area Health Education Center, Asheville, North Carolina, USA
| | - Mahasin Mujahid
- University of California Berkeley, School of Public Health, Berkeley, California, USA
| | - Kristine Madsen
- University of California Berkeley, School of Public Health, Berkeley, California, USA
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MICHAELS ELIK, LAM‐HINE TRACY, NGUYEN THUT, GEE GILBERTC, ALLEN AMANIM. The Water Surrounding the Iceberg: Cultural Racism and Health Inequities. Milbank Q 2023; 101:768-814. [PMID: 37435779 PMCID: PMC10509530 DOI: 10.1111/1468-0009.12662] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/03/2023] [Accepted: 05/08/2023] [Indexed: 07/13/2023] Open
Abstract
Policy Points Cultural racism-or the widespread values that privilege and protect Whiteness and White social and economic power-permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities. Overt forms of racism, such as racial hate crimes, represent only the "tip of the iceberg," whereas structural and institutional racism represent its base. This paper advances cultural racism as the "water surrounding the iceberg," allowing it to float while obscuring its base. Considering the fundamental role of cultural racism is needed to advance health equity. CONTEXT Cultural racism is a pervasive social toxin that surrounds all other dimensions of racism to produce and maintain racial health inequities. Yet, cultural racism has received relatively little attention in the public health literature. The purpose of this paper is to 1) provide public health researchers and policymakers with a clearer understanding of what cultural racism is, 2) provide an understanding of how it operates in conjunction with the other dimensions of racism to produce health inequities, and 3) offer directions for future research and interventions on cultural racism. METHODS We conducted a nonsystematic, multidisciplinary review of theory and empirical evidence that conceptualizes, measures, and documents the consequences of cultural racism for social and health inequities. FINDINGS Cultural racism can be defined as a culture of White supremacy, which values, protects, and normalizes Whiteness and White social and economic power. This ideological system operates at the level of our shared social consciousness and is expressed in the language, symbols, and media representations of dominant society. Cultural racism surrounds and bolsters structural, institutional, personally mediated, and internalized racism, undermining health through material, cognitive/affective, biologic, and behavioral mechanisms across the life course. CONCLUSIONS More time, research, and funding is needed to advance measurement, elucidate mechanisms, and develop evidence-based policy interventions to reduce cultural racism and promote health equity.
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Affiliation(s)
- ELI K. MICHAELS
- Division of Epidemiology, School of Public HealthUniversity of California
| | - TRACY LAM‐HINE
- Division of Epidemiology & Population HealthStanford University School of Medicine
| | | | - GILBERT C. GEE
- Jonathan and Karin Fielding School of Public HealthUniversity of California
| | - AMANI M. ALLEN
- Division of Epidemiology, School of Public HealthUniversity of California
- Division of Community Health Sciences, School of Public HealthUniversity of California
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Green TL, Vu H, Swan LE, Luo D, Hickman E, Plaisime M, Hagiwara N. Implicit and explicit racial prejudice among medical professionals: updated estimates from a population-based study. THE LANCET REGIONAL HEALTH - AMERICAS 2023; 21:100489. [DOI: https:/doi.org/10.1016/j.lana.2023.100489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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Green TL, Vu H, Swan LE, Luo D, Hickman E, Plaisime M, Hagiwara N. Implicit and explicit racial prejudice among medical professionals: updated estimates from a population-based study. LANCET REGIONAL HEALTH. AMERICAS 2023; 21:100489. [PMID: 37179794 PMCID: PMC10172896 DOI: 10.1016/j.lana.2023.100489] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/02/2023] [Accepted: 03/23/2023] [Indexed: 05/15/2023]
Abstract
Background Prior research provides evidence of implicit and explicit anti-Black prejudice among US physicians. However, we know little about whether racialized prejudice varies among physicians and non-physician healthcare workers relative to the general population. Methods Using ordinary least squares models and data from Harvard's Project Implicit (2007-2019), we assessed the associations between self-reported occupational status (physician, non-physician healthcare worker) and implicit (N = 1,500,268) and explicit prejudice (N = 1,429,677) toward Black, Arab-Muslim, Asian, and Native American populations, net of demographic characteristics. We used STATA 17 for all statistical analyses. Findings Physicians and non-physician healthcare workers exhibited more implicit and explicit anti-Black and anti-Arab-Muslim prejudice than the general population. After controlling for demographics, these differences became non-significant for physicians but remained for non-physician healthcare workers (β = 0.027 and 0.030, p < 0.01). Demographic controls largely explained anti-Asian prejudice among both groups, and physicians and non-physician healthcare workers exhibited comparatively lower (β = -0.124, p < 0.01) and similar levels of anti-Native implicit prejudice, respectively. Finally, white non-physician healthcare workers exhibited the highest levels of anti-Black prejudice. Interpretation Demographic characteristics explained racialized prejudice among physicians, but not fully among non-physician healthcare workers. More research is needed to understand the causes and consequences of elevated levels of prejudice among non-physician healthcare workers. By acknowledging implicit and explicit prejudice as important reflections of systemic racism, this study highlights the need to understand the role of healthcare providers and systems in generating health disparities. Funding UW-Madison Centennial Scholars Program, Society of Family Planning Research Fund, UW Center for Demography and Ecology, the County Health Rankings and Roadmaps Program and the National Institutes of Health (NIH).
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Affiliation(s)
- Tiffany L. Green
- Department of Population Health Sciences, University of Wisconsin–Madison, Madison, WI, USA
| | - Hoa Vu
- Department of Population Health Sciences, University of Wisconsin–Madison, Madison, WI, USA
| | - Laura E.T. Swan
- Department of Population Health Sciences, University of Wisconsin–Madison, Madison, WI, USA
| | - Dian Luo
- Department of Population Health Sciences, University of Wisconsin–Madison, Madison, WI, USA
| | - Ellen Hickman
- Department of Population Health Sciences, University of Wisconsin–Madison, Madison, WI, USA
| | - Marie Plaisime
- FXB Center for Health & Human Rights, Harvard H.T. Chan School of Public Health, Boston, MA, USA
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Charlesworth TES, Navon M, Rabinovich Y, Lofaro N, Kurdi B. The project implicit international dataset: Measuring implicit and explicit social group attitudes and stereotypes across 34 countries (2009-2019). Behav Res Methods 2023; 55:1413-1440. [PMID: 35650381 PMCID: PMC9159648 DOI: 10.3758/s13428-022-01851-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 11/09/2022]
Abstract
For decades, researchers across the social sciences have sought to document and explain the worldwide variation in social group attitudes (evaluative representations, e.g., young-good/old-bad) and stereotypes (attribute representations, e.g., male-science/female-arts). Indeed, uncovering such country-level variation can provide key insights into questions ranging from how attitudes and stereotypes are clustered across places to why places vary in attitudes and stereotypes (including ecological and social correlates). Here, we introduce the Project Implicit:International (PI:International) dataset that has the potential to propel such research by offering the first cross-country dataset of both implicit (indirectly measured) and explicit (directly measured) attitudes and stereotypes across multiple topics and years. PI:International comprises 2.3 million tests for seven topics (race, sexual orientation, age, body weight, nationality, and skin-tone attitudes, as well as men/women-science/arts stereotypes) using both indirect (Implicit Association Test; IAT) and direct (self-report) measures collected continuously from 2009 to 2019 from 34 countries in each country's native language(s). We show that the IAT data from PI:International have adequate internal consistency (split-half reliability), convergent validity (implicit-explicit correlations), and known groups validity. Given such reliability and validity, we summarize basic descriptive statistics on the overall strength and variability of implicit and explicit attitudes and stereotypes around the world. The PI:International dataset, including both summary data and trial-level data from the IAT, is provided openly to facilitate wide access and novel discoveries on the global nature of implicit and explicit attitudes and stereotypes.
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Affiliation(s)
| | - Mayan Navon
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Yoav Rabinovich
- Department of Psychology, Harvard University, Cambridge, MA, 1-347-302-5900, USA
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Kellogg AJ, Hancock DW, Cho GY, Reid AE. Reprint of: Community-level age bias and older adult mortality. Soc Sci Med 2023; 320:115699. [PMID: 36739253 DOI: 10.1016/j.socscimed.2023.115699] [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: 03/14/2022] [Revised: 08/30/2022] [Accepted: 10/08/2022] [Indexed: 01/31/2023]
Abstract
RATIONALE As the older adult population increases, understanding the health effects of bias against older adults is increasingly important. Whether structural forms of age bias predict worse health has received limited attention. OBJECTIVE We hypothesized that communities with greater age bias would have higher mortality among residents aged 65 and older. We expected the association to be unique to age bias, rather than general bias (i.e., sexual minority and racial bias), and that the age bias-mortality association would be strongest in predominantly White and younger communities. METHODS Explicit and implicit attitudes toward older adults (N = 1,001,735), sexual minorities (N = 791,966), and Black Americans (N = 2,255,808) were drawn from Project Implicit. Post-stratification relative to U.S. Census demographics was executed to improve the representativeness of county-level explicit and implicit bias estimates. County older adult mortality, estimated cross-sectionally with and longitudinally relative to bias scores, served as outcomes. Models controlled for relevant county-level covariates (e.g., median age) and included all U.S. counties (N = 3142). RESULTS Contrary to hypotheses but consistent with prior work, explicit age bias was cross-sectionally and longitudinally associated with lower mortality, over and above covariates and generalized community bias. The explicit age bias-lower mortality association only emerged in younger counties but did not depend on county ethnic composition. Implicit age bias was unassociated with outcomes. Post-hoc analyses supported that ageist communities may be associated with better health across the lifespan. Explicit age bias predicted lower mortality in young and middle adulthood; better mental health in middle adulthood, but not exercise or self-rated health, mediated the explicit age bias-older adult mortality association. CONCLUSIONS Results highlight the uniqueness of older age relative to other stigmatized identities. Further examination of the association of community-level age bias with better health may improve longevity for all communities.
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Affiliation(s)
- Alexander J Kellogg
- University of Massachusetts, Amherst; Department of Psychological and Brain Sciences; 135 Hicks Way, Tobin Hall, Amherst, MA, 01003, USA
| | - David W Hancock
- University of Massachusetts, Amherst; Department of Psychological and Brain Sciences; 135 Hicks Way, Tobin Hall, Amherst, MA, 01003, USA
| | - Grace Y Cho
- University of Massachusetts, Amherst; Department of Psychological and Brain Sciences; 135 Hicks Way, Tobin Hall, Amherst, MA, 01003, USA
| | - Allecia E Reid
- University of Massachusetts, Amherst; Department of Psychological and Brain Sciences; 135 Hicks Way, Tobin Hall, Amherst, MA, 01003, USA.
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Sawyer JE, Gampa A. Social Movements as Parsimonious Explanations for Implicit and Explicit Attitude Change. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2023; 27:28-51. [PMID: 35652682 DOI: 10.1177/10888683221095697] [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: 01/27/2023]
Abstract
Recently, interest in aggregate and population-level implicit and explicit attitudes has opened inquiry into how attitudes relate to sociopolitical phenomenon. This creates an opportunity to examine social movements as dynamic forces with the potential to generate widespread, lasting attitude change. Although collective action remains underexplored as a means of reducing bias, we advance historical and theoretical justifications for doing so. We review recent studies of aggregate attitudes through the lens of social movement theory, proposing movements as a parsimonious explanation for observed patterns. We outline a model for conceptualizing causal pathways between social movements and implicit and explicit attitudes among participants, supporters, bystanders, and opponents. We identify six categories of mechanisms through which movements may transform attitudes: changing society; media representations; intergroup contact and affiliation; empathy, perspective-taking, and reduced intergroup anxiety; social recategorization; and social identification and self-efficacy processes. Generative questions, testable hypotheses, and promising methods for future work are discussed.
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Affiliation(s)
- Jeremy E Sawyer
- Kingsborough Community College, City University of New York, Brooklyn, USA
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Sasser G, Nafiu OO. Inaccuracies in Infant Race and Ethnicity Classifications: Implications for Vital Statistics Data. Pediatrics 2023; 151:190368. [PMID: 36575920 DOI: 10.1542/peds.2022-059540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Georgia Sasser
- College of Public Health, Ohio State University, Columbus, Ohio
| | - Olubukola O Nafiu
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
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15
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Snowden LR, Michaels E. Racial Bias Correlates with States Having Fewer Health Professional Shortage Areas and Fewer Federally Qualified Community Health Center Sites. J Racial Ethn Health Disparities 2023; 10:325-333. [PMID: 35006584 PMCID: PMC8744578 DOI: 10.1007/s40615-021-01223-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/09/2021] [Accepted: 12/21/2021] [Indexed: 02/03/2023]
Abstract
Federally Qualified Community Health Centers (FQHCs), serving Health Professional Shortage Areas (HPSAs), are fixtures of the healthcare safety net and are central to healthcare delivery for African Americans and other marginalized Americans. Anti-African American bias, tied to anti- "welfare" sentiment and to a belief in African Americans' supposed safety net dependency, can suppress states' willingness to identify HPSAs and to apply for and operate FQHCs. Drawing on data from n = 1,084,553 non-Hispanic White Project Implicit respondents from 2013-2018, we investigated associations between state-level implicit and explicit racial bias and availability of FQHCs and with HPSA designations. After controlling for states' sociopolitical conservatism, wealth, health status, and acceptance of the Affordable Care Act's Medicaid expansion, greater racial bias was correlated with fewer FQHC delivery sites and fewer HPSA designations. White's bias against African Americans is associated with fewer FQHC opportunities for care and fewer identifications of treatment need for African Americans and other low-income people lacking healthcare options, reflecting bias-influenced neglect.
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Affiliation(s)
- Lonnie R. Snowden
- grid.47840.3f0000 0001 2181 7878Health Policy and Management Division, School of Public Health, University of California, Berkeley, CA USA
| | - Eli Michaels
- grid.47840.3f0000 0001 2181 7878Epidemiology Division, School of Public Health, University of California, Berkeley, CA USA
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Kellogg AJ, Hancock DW, Cho GY, Reid AE. Community-level age bias and older adult mortality. Soc Sci Med 2023; 317:115449. [PMID: 36494219 PMCID: PMC11293901 DOI: 10.1016/j.socscimed.2022.115449] [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: 03/14/2022] [Revised: 08/30/2022] [Accepted: 10/08/2022] [Indexed: 11/22/2022]
Abstract
RATIONALE As the older adult population increases, understanding the health effects of bias against older adults is increasingly important. Whether structural forms of age bias predict worse health has received limited attention. OBJECTIVE We hypothesized that communities with greater age bias would have higher mortality among residents aged 65 and older. We expected the association to be unique to age bias, rather than general bias (i.e., sexual minority and racial bias), and that the age bias-mortality association would be strongest in predominantly White and younger communities. METHODS Explicit and implicit attitudes toward older adults (N = 1,001,735), sexual minorities (N = 791,966), and Black Americans (N = 2,255,808) were drawn from Project Implicit. Post-stratification relative to U.S. Census demographics was executed to improve the representativeness of county-level explicit and implicit bias estimates. County older adult mortality, estimated cross-sectionally with and longitudinally relative to bias scores, served as outcomes. Models controlled for relevant county-level covariates (e.g., median age) and included all U.S. counties (N = 3142). RESULTS Contrary to hypotheses but consistent with prior work, explicit age bias was cross-sectionally and longitudinally associated with lower mortality, over and above covariates and generalized community bias. The explicit age bias-lower mortality association only emerged in younger counties but did not depend on county ethnic composition. Implicit age bias was unassociated with outcomes. Post-hoc analyses supported that ageist communities may be associated with better health across the lifespan. Explicit age bias predicted lower mortality in young and middle adulthood; better mental health in middle adulthood, but not exercise or self-rated health, mediated the explicit age bias-older adult mortality association. CONCLUSIONS Results highlight the uniqueness of older age relative to other stigmatized identities. Further examination of the association of community-level age bias with better health may improve longevity for all communities.
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Affiliation(s)
- Alexander J Kellogg
- University of Massachusetts, Amherst; Department of Psychological and Brain Sciences; 135 Hicks Way, Tobin Hall, Amherst, MA, 01003, USA
| | - David W Hancock
- University of Massachusetts, Amherst; Department of Psychological and Brain Sciences; 135 Hicks Way, Tobin Hall, Amherst, MA, 01003, USA
| | - Grace Y Cho
- University of Massachusetts, Amherst; Department of Psychological and Brain Sciences; 135 Hicks Way, Tobin Hall, Amherst, MA, 01003, USA
| | - Allecia E Reid
- University of Massachusetts, Amherst; Department of Psychological and Brain Sciences; 135 Hicks Way, Tobin Hall, Amherst, MA, 01003, USA.
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Balascio P, Moore M, Gongalla M, Regan A, Ha S, Taylor BD, Hill AV. Measures of Racism and Discrimination in Preterm Birth Studies. Obstet Gynecol 2023; 141:69-83. [PMID: 36701611 PMCID: PMC9886318 DOI: 10.1097/aog.0000000000005023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Preterm birth (any birth at less than 37 weeks of gestation) disproportionally affects Black birthing people and is associated with adverse perinatal and fetal health outcomes. Racism increases the risk of preterm birth, but standardized measurement metrics are elusive. This narrative synthesis examines literature on measures of racial discrimination used in preterm birth research. DATA SOURCES Six databases (CINAHL, Cochrane, EMBASE, PubMed [MEDLINE], Scopus, Web of Science) and ClinicalTrials.gov were searched. Search terms were categorized into three groups (racism terms, measurement terms, preterm birth terms) to identify original research articles that explored associations between racism and preterm birth. English-language, original research articles with U.S. populations were included. METHODS OF STUDY SELECTION Studies were excluded if conducted in only White populations, if only paternal factors were included, or if only racial differences in preterm birth were described. Articles were independently reviewed by two blinded researchers for inclusion at every stage of screening and data extraction; a third reviewer resolved discrepancies. TABULATION, INTEGRATION, AND RESULTS Sixty studies were included in the final analysis. Articles primarily included measures examining interpersonal forms of racism (n=17) through the Experiences of Discrimination and Everyday Discrimination scales, neighborhood composition (n=22) with the Neighborhood Deprivation Index and the Index of Concentration at the Extremes, policy-level racism (n=12) through institutions such as residential racial segregation or policy inequities, or multiple forms (n=9). CONCLUSION Among studies, assessment methods and application of constructs varied. This heterogeneity poses significant challenges to understanding associations between racial discrimination and preterm birth and to describing potential etiologic pathways of preterm birth, which ultimately hinders development of effective intervention. Strategies to capture multilevel exposures to racism require the development and expansion of metrics that are culturally inclusive, empirically valid, and reliable among Black pregnant populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022327484.
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Affiliation(s)
- Phoebe Balascio
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, and the Department of Sociology, College of Liberal Arts, Temple University, Philadelphia, Pennsylvania; the Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas; and the School of Nursing and Health Professions, University of San Francisco, San Francisco, and the Department of Public Health, Health Science Research Institute, University of California, Merced, Merced, California
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18
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Seo-Mayer P, Ashoor I, Hayde N, Laster M, Sanderson K, Soranno D, Wigfall D, Brown D. Seeking justice, equity, diversity and inclusion in pediatric nephrology. Front Pediatr 2022; 10:1084848. [PMID: 36578658 PMCID: PMC9791125 DOI: 10.3389/fped.2022.1084848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
Inequity, racism, and health care disparities negatively impact the well-being of children with kidney disease. This review defines social determinants of health and describes how they impact pediatric nephrology care; outlines the specific impact of systemic biases and racism on chronic kidney disease care and transplant outcomes; characterizes and critiques the diversity of the current pediatric nephrology workforce; and aims to provide strategies to acknowledge and dismantle bias, address barriers to care, improve diversity in recruitment, and strengthen the pediatric nephrology community. By recognizing historical and current realities and limitations, we can move forward with strategies to address racism and bias in our field and clinical practices, thereby cultivating inclusive training and practice environments.
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Affiliation(s)
- Patricia Seo-Mayer
- Division of Pediatric Nephrology, Inova Children’s Hospital, University of Virginia School of Medicine-Inova Campus, Fairfax, VA, United States
| | - Isa Ashoor
- Division of Pediatric Nephrology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Nicole Hayde
- Division of Pediatric Nephrology, Children’s Hospital of Montefiore, Albert Einstein College of Medicine, New York, NY, United States
| | - Marciana Laster
- Division of Pediatric Nephrology, University of California Los Angeles Mattel Children’s Hospital, Los Angeles, CA, United States
| | - Keia Sanderson
- Division of Pediatric Nephrology, University of North Carolina, Chapel Hill, NC, United States
| | - Danielle Soranno
- Division of Pediatric Nephrology, Indiana University, Indianapolis, IN, United States
| | - Delbert Wigfall
- Division of Pediatric Nephrology, Duke University School of Medicine, Durham, NC, United States
| | - Denver Brown
- Division of Pediatric Nephrology, Children’s National Hospital, George Washington School of Medicine, Washington, DC, United States
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Abstract
Disparities in infant mortality by race and Hispanic origin groups continue to persist in the United States. Maternal and infant characteristics known to be associated with infant mortality vary by race and ethnicity. This report describes racial and ethnic disparities in infant mortality in the United States using the 2017-2018 cohort linked birth/infant death files from the National Vital Statistics System. Distributions of births and infant mortality rates are described by selected maternal and infant characteristics. Adjusted rates and rate ratios from logistic regression models, compared to unadjusted rates and ratios, show the extent to which race and Hispanic origin disparities would be attenuated if all groups had the same distributions of select maternal and infant factors. Results support the premise that the different distributions of several variables across racial/ethnic groups, most notably gestational age, account for a significant portion of the disparities in infant mortality between racial/ethnic groups.
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Affiliation(s)
- Anne K Driscoll
- Division of Vital Statistics, National Center for Health Statistics, USA.
| | - Danielle M Ely
- Division of Vital Statistics, National Center for Health Statistics, 3311 Toledo Rd, Rm 5442, Hyattsville, MD 20782, USA
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Côté-Gendreau M, Donnelly Moran K. Geographic heterogeneity in Black-white infant mortality disparities. Front Public Health 2022; 10:995585. [PMID: 36408030 PMCID: PMC9669983 DOI: 10.3389/fpubh.2022.995585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Despite recent decreases in Black infant mortality, racial disparities persist, motivating continued research into factors related to these inequalities. While the inverse association between education and infant mortality has been documented across races, less is known about its geographic heterogeneity. Using vital statistics from the National Center for Health Statistics, this study considers Black-white disparities in infant mortality for births occurring between 2011 and 2015 across regions and metropolitan status of maternal residence. With logistic regressions, we investigate heterogeneity in maternal educational gradients of infant mortality by geographic residence both within and between races. Beyond confirming the well-known relationship between education and infant mortality, our findings document a slight metropolitan advantage for infants born to white mothers as well as lower returns to education for infants born to Black mothers residing in nonmetropolitan counties. We observe a metropolitan advantage for infants born to Black mothers with at least a bachelor's degree, but a metropolitan disadvantage for infants born to Black mothers with less than a high school degree. The South is driving this divergence, pointing to particular mechanisms limiting returns to education for Southern Black mothers in nonmetropolitan areas. This paper's geographic perspective emphasizes that racial infant health disparities are not uniform across the country and cannot be fully understood through individual and household characteristics.
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Affiliation(s)
- Marielle Côté-Gendreau
- Office of Population Research, Princeton University, Princeton, NJ, United States,*Correspondence: Marielle Côté-Gendreau
| | - Katie Donnelly Moran
- Office of Population Research, Princeton University, Princeton, NJ, United States,Department of Sociology, Princeton University, Princeton, NJ, United States,Katie Donnelly Moran
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21
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A mixed methods study of perceptions of bias among neonatal intensive care unit staff. Pediatr Res 2022; 93:1672-1678. [PMID: 36038641 PMCID: PMC9971322 DOI: 10.1038/s41390-022-02217-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/07/2022] [Accepted: 07/12/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Inequity in neonatology may be potentiated within neonatal intensive care units (NICUs) by the effects of bias. Addressing bias can lead to improved, more equitable care. Understanding perceptions of bias can inform targeted interventions to reduce the impact of bias. We conducted a mixed methods study to characterize the perceptions of bias among NICU staff. METHODS Surveys were distributed to all staff (N = 245) in a single academic Level IV NICU. Respondents rated the impact of bias on their own and others' behaviors on 5-point Likert scales and answered one open-ended question. Kruskal-Wallis test (KWT) and Levene's test were used for quantitative analysis and thematic analysis was used for qualitative analysis. RESULTS We received 178 responses. More respondents agreed that bias had a greater impact on others' vs. their own behaviors (KWT p < 0.05). Respondents agreed that behaviors were influenced more by implicit than explicit biases (KWT p < 0.05). Qualitative analysis resulted in nine unique themes. CONCLUSIONS Staff perceive a high impact of bias across different domains with increased perceived impact of implicit vs. explicit bias. Staff perceive a greater impact of others' biases vs. their own. Mixed methods studies can help identify unique, unit-responsive approaches to reduce bias. IMPACT Healthcare staff have awareness of bias and its impact on their behaviors with patients, families, and staff. Healthcare staff believe that implicit bias impacts their behaviors more than explicit bias, and that they have less bias than others. Healthcare staff have ideas for strategies and approaches to mitigate the impact of bias. Mixed method studies are effective ways of understanding environment-specific perceptions of bias, and contextual assets and barriers when creating interventions to reduce bias and improve equity. Generating interventions to reduce the impact of bias in healthcare requires a context-specific understanding of perceptions of bias among staff.
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22
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Cyrus-Lai W, Tierney W, du Plessis C, Nguyen M, Schaerer M, Giulia Clemente E, Uhlmann EL. Avoiding Bias in the Search for Implicit Bias. PSYCHOLOGICAL INQUIRY 2022. [DOI: 10.1080/1047840x.2022.2106762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | | | | | - My Nguyen
- Lee Kong Chian School of Business, Singapore Management University, Singapore
| | - Michael Schaerer
- Lee Kong Chian School of Business, Singapore Management University, Singapore
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23
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24
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Beyond stereotypes: Prejudice as an important missing force explaining group disparities. Behav Brain Sci 2022; 45:e74. [PMID: 35550229 DOI: 10.1017/s0140525x21000832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We comment on Cesario's assertion that social psychological intergroup research focuses solely on stereotypes, neglecting actual differences between groups to explain group disparities. This reasoning, however, misses yet another explaining force: In addition to stereotypes, ample laboratory and field research documents relationships between group disparities, discrimination, and prejudice, which cannot be explained by people's accurate judgments of real-world group differences.
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25
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Cundiff JM, Bennett A, Carson AP, Judd SE, Howard VJ. Socioeconomic status and psychological stress: Examining intersection with race, sex and US geographic region in the REasons for Geographic and Racial Differences in Stroke study. Stress Health 2022; 38:340-349. [PMID: 34461676 DOI: 10.1002/smi.3095] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022]
Abstract
Socioeconomic status (SES) is a well-established determinant of health. Disparities in stress are thought to partially account for SES-health disparities. We tested whether multiple indicators of SES show similar associations with psychological stress and whether race, sex, and geographic region moderate associations. Participants (n = 26,451) are from a well-characterized national cohort of Black and White US adults aged 45 years or older. Psychological stress was measured using the 4-item perceived stress scale. Income was assessed as annual household income and education as highest level of education completed. Occupation was assessed during a structured interview and subsequently coded hierarchically. For all sex-race-region groups, the largest SES-stress associations were for income and the smallest were for occupation. Race moderated SES-stress associations, such that income and education were more closely associated with stress in Black adults than White adults. Additionally, education was more strongly associated with stress in individuals living in the stroke belt region. Black Americans with lower income and education reported greater psychological stress and may be at higher risk for disease through stress-related pathways. Thus, which SES indicator is examined and for whom may alter the magnitude of the association between SES and psychological stress.
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Affiliation(s)
| | - Aleena Bennett
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - April P Carson
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suzanne E Judd
- University of Alabama at Birmingham, Birmingham, Alabama, USA
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Pearlman J, Robinson DE. State Policies, Racial Disparities, and Income Support: A Way to Address Infant Outcomes and the Persistent Black-White Gap? JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2022; 47:225-258. [PMID: 34522974 DOI: 10.1215/03616878-9517205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
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.
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Ekstrom PD, Le Forestier JM, Lai CK. Racial Demographics Explain the Link Between Racial Disparities in Traffic Stops and County-Level Racial Attitudes. Psychol Sci 2022; 33:497-509. [PMID: 35319290 DOI: 10.1177/09567976211053573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Disparities in the treatment of Black and White Americans in police stops are pernicious and widespread. We examined racial disparities in police traffic stops by leveraging data on hundreds of U.S. counties from the Stanford Open Policing Project and corresponding county-level data on implicit and explicit racial attitudes from the Project Implicit research website. We found that Black-White traffic-stop disparities are associated with county-level implicit and explicit racial attitudes and that this association is attributable to racial demographics: Counties with a higher proportion of White residents had larger racial disparities in police traffic stops. We also examined racial disparities in several poststop outcomes (e.g., arrest rates) and found that they were not systematically related to racial attitudes, despite evidence of disparities. These findings indicate that racial disparities in counties' traffic stops are reliably linked to counties' racial attitudes and demographic compositions.
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Affiliation(s)
| | | | - Calvin K Lai
- Department of Psychological and Brain Sciences, Washington University in St. Louis
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28
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Stelter M, Essien I, Sander C, Degner J. Racial Bias in Police Traffic Stops: White Residents' County-Level Prejudice and Stereotypes Are Related to Disproportionate Stopping of Black Drivers. Psychol Sci 2022; 33:483-496. [PMID: 35319309 DOI: 10.1177/09567976211051272] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Racial disparities in policing are well documented, but the reasons for such disparities are often debated. In the current research, we weighed in on this debate using a regional-level bias framework: We investigated the link between racial disparities in police traffic stops and regional-level racial bias, employing data from more than 130 million police traffic stops in 1,413 U.S. counties and county-level measures of racial bias from more than 2 million online respondents. Compared with their population share in county demographics, Black drivers were stopped at disproportionate rates in the majority of counties. Crucially, disproportionate stopping of Black drivers was higher in counties with higher levels of racial prejudice by White residents (rs = .07-.36). Furthermore, county-level aggregates of White people's threat-related stereotypes were less consistent in predicting disproportionate stopping (rs = .00-.19). These observed relationships between regional-level bias and racial disparities in policing highlight the importance of the context in which police operate.
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Affiliation(s)
- Marleen Stelter
- Social Psychology Department, Universität Hamburg.,Institute of Psychology, FernUniversität in Hagen
| | - Iniobong Essien
- Institute of Psychology, FernUniversität in Hagen.,Department of Social and Organisational Psychology of Social Work, Leuphana Universität Lüneburg
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29
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Suresh S, Amegashie C, Patel E, Nieman KM, Rana S. Racial Disparities in Diagnosis, Management, and Outcomes in Preeclampsia. Curr Hypertens Rep 2022; 24:87-93. [PMID: 35254590 DOI: 10.1007/s11906-022-01172-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE OF THE REVIEW Racial disparities are prevalent in many aspects of obstetric care in the USA. Non-Hispanic black women have a higher prevalence of the diagnosis of hypertensive disorders of pregnancy in addition to associated morbidity and mortality. The purpose of this review is to review current data regarding racial disparities in the diagnosis and management of hypertensive disorders of pregnancy. RECENT FINDINGS Diagnosis of hypertensive disorders of pregnancy is more common among non-Hispanic black women even after adjustment for comorbidities. Furthermore, prevalence of severe morbidity among those with hypertensive disorders of pregnancy is increased in non-Hispanic black women, including cardiovascular events related. Proposed management solutions include quality improvement initiatives, telehealth, and strategies to reduce both structural racism and implicit bias. Racial disparities exist in both diagnosis and management of hypertensive disorders of pregnancy; further innovative work is needed to reduce these disparities.
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Affiliation(s)
- Sunitha Suresh
- Division of Maternal Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago Medicine, 5841 S. Maryland Ave, MC 2050, Chicago, IL, 60637, USA
| | | | - Easha Patel
- Division of Maternal Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago Medicine, 5841 S. Maryland Ave, MC 2050, Chicago, IL, 60637, USA
| | - Kristin M Nieman
- Division of Maternal Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago Medicine, 5841 S. Maryland Ave, MC 2050, Chicago, IL, 60637, USA
| | - Sarosh Rana
- Division of Maternal Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago Medicine, 5841 S. Maryland Ave, MC 2050, Chicago, IL, 60637, USA.
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Jimenez T, Arndt J, Helm PJ. Prejudicial reactions to the removal of Native American mascots. GROUP PROCESSES & INTERGROUP RELATIONS 2021. [DOI: 10.1177/13684302211040865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As Native American mascots are discontinued, research is needed to understand the impact on intergroup relations. Such discontinuations may be threatening to some and increase prejudice against Native Americans. In Study 1 ( N = 389), exposure to information about a Native American mascot removal increased punitive judgments against a Native American in a hypothetical legal scenario, particularly among those high in racial colorblindness and those residing in the implicated geographical location. Study 2 ( N = 358,644) conceptually replicated and extended these findings, using population-level implicit bias data to perform a natural quasi-experiment. Prejudice against Native Americans increased in the year following the removal of two Native American mascots: “Chief Illiniwek” and “Chief Wahoo.” However, in the case of Chief Illiniwek, the effect diminished after 6 years. Together, the studies contribute to understanding the psychological impact of Native American mascots, offering a first look at how their removal influence intergroup relations.
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Affiliation(s)
- Tyler Jimenez
- University of Washington, USA
- University of Missouri, USA
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31
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Regional Implicit Bias Does Not Account for Racial Disparity in Total Joint Arthroplasty Utilization. J Arthroplasty 2021; 36:3845-3849. [PMID: 34479764 DOI: 10.1016/j.arth.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/23/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Racial disparities surrounding the utilization of total hip and total knee arthroplasty (THA, TKA) are well documented. The Implicit Association Test (IAT) is a validated tool used to measure implicit and explicit bias. The purpose of this study is to evaluate if variations in IAT scores by geographical region in the United States (US) correspond with regional variations in THA and TKA utilization by blacks compared to whites. METHODS Data from the US Census and National Inpatient Sample from 2012 to 2014 were used to calculate THA and TKA utilization rates among Medicare-aged blacks and whites. Data were aggregated by US Census Bureau Division. Regional implicit bias was assessed by calculating a weighted average of IAT scores for each division. RESULTS Across all geographic regions and years, the surveyed population demonstrated an implicit bias favoring whites over blacks. The population adjusted ratio of white-to-black utilization of THA and TKA by geographic division varied between 0.86-1.85 and 0.87-2.01, respectively. The difference in utilization between geographic divisions reached statistical significance (P < .001). No correlation was found between the IAT scores and race-specific utilization ratios among geographic divisions. CONCLUSION Implicit bias as measured by regional IAT did not reflect THA and TKA utilization disparities. The racial disparity in utilization of THA and TKA significantly varied between divisions. The observed disparity was greater in divisions with a relatively higher proportion of blacks. To the authors' knowledge, this is the first study to evaluate the impact of implicit bias on utilization of THA and TKA.
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Bell SB, Farr R, Ofosu E, Hehman E, DeWall CN. Implicit bias predicts less willingness and less frequent adoption of Black children more than explicit bias. The Journal of Social Psychology 2021; 163:554-565. [PMID: 34749593 DOI: 10.1080/00224545.2021.1975619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In the United States, prospective adoptive parents often express preferences related to race. In two studies, we examined whether implicit racial bias against Black people may contribute to disparities in much less willingness to adopt Black children. The first study (N = 510) assessed individuals' implicit racial bias and their willingness to adopt a Black child. The second study (N = 2,001,652) used U.S. state-level implicit racial bias to predict adoption rates of Black foster children in each U.S. state. Greater implicit racial bias predicted less willingness to adopt Black children and less frequent adoptions of Black foster children. Implicit bias contributed to these disparities above and beyond explicit bias, with implicit bias having a 43% larger effect size than explicit bias on willingness to adopt a Black child. These are the first findings to demonstrate the role implicit bias plays in explaining large disparities between Americans' willingness to adopt Black and White children.
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Affiliation(s)
- Sarah Beth Bell
- The University of Oklahoma Health Sciences Center, Oklahoma, USA
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Payne BK, Vuletich H, Lundberg KB. Critique of the Bias-of-Crowds Model Simply Restates the Model: Reply to Connor and Evers (2020). PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 17:606-610. [PMID: 34524932 PMCID: PMC8902022 DOI: 10.1177/1745691621997394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- B Keith Payne
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Heidi Vuletich
- Department of Psychological and Brain Sciences, Indiana University Bloomington
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Abstract
Interest in unintended discrimination that can result from implicit attitudes and stereotypes (implicit biases) has stimulated many research investigations. Much of this research has used the Implicit Association Test (IAT) to measure association strengths that are presumed to underlie implicit biases. It had been more than a decade since the last published treatment of recommended best practices for research using IAT measures. After an initial draft by the first author, and continuing through three subsequent drafts, the 22 authors and 14 commenters contributed extensively to refining the selection and description of recommendation-worthy research practices. Individual judgments of agreement or disagreement were provided by 29 of the 36 authors and commenters. Of the 21 recommended practices for conducting research with IAT measures presented in this article, all but two were endorsed by 90% or more of those who felt knowledgeable enough to express agreement or disagreement; only 4% of the totality of judgments expressed disagreement. For two practices that were retained despite more than two judgments of disagreement (four for one, five for the other), the bases for those disagreements are described in presenting the recommendations. The article additionally provides recommendations for how to report procedures of IAT measures in empirical articles.
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Mark NDE. Whither weathering? The variable significance of age in Black-White low birth weight disparities. SSM Popul Health 2021; 15:100806. [PMID: 34169136 PMCID: PMC8207231 DOI: 10.1016/j.ssmph.2021.100806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
This paper uses birth certificate data to provide novel estimates of the age-specific risk of a low birth weight birth (LBW, an infant born weighting <2500 g) for U.S.-born non-Hispanic Black and White mothers, and finds that patterns vary markedly over space and time. Notably, risk of an LBW birth for Black mothers increased much more steeply with age in 1991-94 than in 2014-17. This decline in LBW risks among older Black mothers led to a decline in the Black-White LBW gap of more than half a percentage point. Both patterns and changes were regional; while age gradients on the Black-White LBW gap were lowest in the South in 1991-94, by 2014-17 they had increased in the South and declined in the rest of the country. These descriptive data allow a new examination of hypotheses regarding the causes of age-specific racial LBW gaps. Research has found that racial disparities in a number of health outcomes, including LBW, increase with age, leading some to speculate that this increase is due to the cumulative effects of exposure to disadvantage. The large degree of variability in Black-White LBW disparities suggests that age-specific causes may also play a role. A series of counterfactual trend analyses explore the roles of two specific mechanisms, smoking and hypertension, and compares these to a more fundamental indicator of socioeconomic status: education.
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Affiliation(s)
- Nicholas D E Mark
- Department of Sociology, New York University, Puck Building 4th Floor, 295 Lafayette Street, New York, NY, 10012-9605, USA
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Payne BK, Hannay JW. Implicit bias reflects systemic racism. Trends Cogn Sci 2021; 25:927-936. [PMID: 34426051 DOI: 10.1016/j.tics.2021.08.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
Implicit bias refers to automatically evoked mental associations about social groups. The idea has been influential across the social sciences as a way to explain persistent racial disparities amid changing self-report attitudes. Most research has treated implicit bias as an individual attitude. However, evidence suggests that it is neither a stable individual difference nor a strong correlate of individual behavior. Moreover, the individual-focused approach can lead researchers to neglect systemic racism as a cause of persistent disparities. We argue that implicit bias can be considered a cognitive reflection of systemic racism in the environment. In this view, implicit bias is an ongoing set of associations based on inequalities and stereotypes in the environment. As such, implicit bias changes when contexts change.
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Affiliation(s)
- B Keith Payne
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. @unc.edu
| | - Jason W Hannay
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Rae JR, Skinner-Dorkenoo AL, Reiman AK, Schmid K, Hewstone M. Mixed Evidence for Interactive Effects of Outgroup Proportions and Intergroup Contact on Racial Bias in the United States. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2021. [DOI: 10.1177/19485506211027756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dominant majority-group members living in areas with larger proportions of outgroup members tend to express more ingroup bias. However, prior research has rarely considered this in tandem with the bias-reducing effects of intergroup contact or tested whether outgroup proportions have similar effects for oppressed minority-group members. In two preregistered studies, we tested whether contact moderates the association between outgroup proportions and ingroup bias among White and Black Americans (total N > 75,000). As hypothesized, more Black residents in an area predicted greater explicit (but not implicit) ingroup bias among White respondents who reported low (but not high) contact with Black people. By contrast, more White residents in an area predicted lower explicit (but not implicit) ingroup bias among Black respondents regardless of intergroup contact with White people. We qualify previous findings by demonstrating that the association between outgroup proportions and ingroup bias depends on one’s group membership and level of intergroup contact.
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Affiliation(s)
| | | | | | - Katharina Schmid
- Universitat Ramon Llull, Esade Business School, Barcelona, Spain
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Cunningham GB, Nite C. Demographics, politics, and health factors predict mask wearing during the COVID-19 pandemic: a cross-sectional study. BMC Public Health 2021; 21:1403. [PMID: 34266409 PMCID: PMC8282266 DOI: 10.1186/s12889-021-11424-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/21/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Wearing a protective face covering can reduce the spread of COVID-19, but Americans' compliance with wearing a mask is uneven. The purpose of this study is to examine the association between health determinants (Health Behaviors, Clinical Care, Social and Economic Conditions, and the Physical Environment) and mask wearing at the county level. METHODS Data were collected from publicly available sources, including the County Health Rankings and the New York Times. The dependent variable was the percent of county residents who reported frequently or always wearing a mask when in public. County demographics and voting patterns served as controls. Two-levels random effects regression models were used to examine the study hypotheses. RESULTS Results indicate that, after considering the effects of the controls, Health Behaviors were positively associated with mask wearing, the Physical Environment held a negative association, and Clinical Care and Social and Behavioral Factors were unrelated. CONCLUSIONS Results indicate that patterns of healthy behaviors can help predict compliance with public health mandates that can help reduce the spread of COVID-19. From an instutitional theory perspective, the data suggest counties develop collective values and norms around health. Thus, public health officials can seek to alter governance structures and normative behaviors to improve healthy behaviors.
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Splan ED, Magerman AB, Forbes CE. Associations of regional racial attitudes with chronic illness in the United States. Soc Sci Med 2021; 281:114077. [PMID: 34126292 DOI: 10.1016/j.socscimed.2021.114077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/24/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
RATIONALE A growing body of literature has identified a robust relationship between the experience of racial discrimination and negative self-reported physical and mental health outcomes. OBJECTIVE The current study seeks to identify which factors -at the community level- predict racial disparities in actual disease manifestation. This study focuses on the extent to which regional demographics and racial attitudes, both implicit and explicit, are associated with prevalence rates of several diseases for Black and White patients in the United States. METHODS Implicit and explicit racial attitudes obtained from Project Implicit (Xu et al., 2017) were aggregated at the county level to predict variation in the prevalence rates of several chronic illnesses among Medicare recipients. RESULTS When controlling for economic indicators, Black and White patients who live in areas with high implicit and explicit racial bias tend to exhibit a higher incidence of chronic health problems, including cancer, stroke, asthma, diabetes, and heart failure. These relationships tended to be stronger for Black patients. Additionally, patients in racially diverse and racially segregated regions also tended to exhibit a higher incidence of chronic health problems. CONCLUSION Findings from the study highlight the reliable relationship between both racial biases and regional demographics and the incidence rates of several chronic diseases, particularly in Black patients.
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Rethinking Bias to Achieve Maternal Health Equity: Changing Organizations, Not Just Individuals. Obstet Gynecol 2021; 137:935-940. [PMID: 33831936 PMCID: PMC8055190 DOI: 10.1097/aog.0000000000004363] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/18/2021] [Indexed: 12/11/2022]
Abstract
To reduce and eliminate Black–White maternal health disparities, we must enact solutions that address systemic biases. In this article, we address the limitations of existing implicit bias interventions as a strategy for achieving maternal health equity. We then focus on how institutionally sanctioned racial stereotyping harms Black maternal health and marginalizes a key group in the fight for health equity—Black physicians. Finally, we provide strategies to address racial bias in perinatal health care and structural barriers impeding Black physicians' success.
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Johnson BT, Sisti A, Bernstein M, Chen K, Hennessy EA, Acabchuk RL, Matos M. Community-level factors and incidence of gun violence in the United States, 2014-2017. Soc Sci Med 2021; 280:113969. [PMID: 34111630 DOI: 10.1016/j.socscimed.2021.113969] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVE In the United States, gun violence claims thousands of lives each year and is a pressing public health issue. To gain a better understanding of this phenomenon, this study spatially analyzed county- and state-level predictors of yearly gun violence rates and gun-related casualty rates. METHODS This study modeled hypothesized predictors of gun violence incidence and casualties across four years. Data sources included the Gun Violence Archive (gun violence data in the United States for 2014-2017), the U.S. Census Bureau (socioeconomic, demographic, geologic features), ICPSR (crime reports), the U.S. Geologic Survey (elevation data), and U.S. gun laws and ownership. Random forest analyses identified relevant additional interaction terms to include. RESULTS The extent to which counties are urban was the most robust predictor of both gun violence incident and casualty rates. Similarly, places characterized by greater income disparity were also more likely to experience higher gun violence rates, especially when high income was paired with high poverty. CONCLUSIONS Community- and state-level features are markedly associated with gun violence. Gun violence is higher in counties with both high median incomes and higher levels of poverty; poverty did not seem related to gun violence rates in counties with relatively low median incomes. Some of these findings may well be due to racial segregation and concentrated disadvantage, due to institutional racism, police-community relations, and related factors.
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Korinek K, Ahmmad Z. The Racial Configuration of Parent Couples and Premature Birth: an Analysis of the Utah Population Database. J Racial Ethn Health Disparities 2021; 9:655-669. [PMID: 33754295 DOI: 10.1007/s40615-021-00997-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/21/2021] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
In this paper, we analyze detailed maternal and paternal race information in a 25-year time series of birth record data to consider racial inequities in premature births experienced by women of color and women within interracial parent couples. We analyze birth outcomes within Utah, a historically racially homogeneous state experiencing growing racial diversity and interracial marriage over the past two decades. Our analyses consider disparities in preterm birth according to maternal race and the interracial status of couples for all birth certificate records within the Utah Population Database from 1989 to 2015 (N = 1,148,818). Our results, consistent with a dyadic perspective on minority stress, indicate that maternal race and interracial parent-couple status are each significantly associated with heightened risk of premature birth. The odds of preterm birth are significantly greater among all four racialized groups in the analyses (African Americans, Asians, Native Americans, and Native Hawaiian or Pacific Islanders) as compared to White women. Furthermore, we find that mothers in mixed-race parent couples with either a white or a black father experience a greater risk of preterm birth than mothers parenting with a father of the same race. Our results suggest that in order to capture the complete perspective on racial-ethnic disparities in adverse birth outcomes, outcomes pivotal for subsequent health outcomes over the life course, it is critical to address racism's toxic effects across multiple levels of lived experience-from the individual level, to the parent dyad, to the local community and beyond.
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Affiliation(s)
- Kim Korinek
- University of Utah, Salt Lake City, UT, 84112, USA.
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Patterns of Implicit and Explicit Stereotypes III: Long-Term Change in Gender Stereotypes. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2021. [DOI: 10.1177/1948550620988425] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gender stereotypes are widely shared “collective representations” that link gender groups (e.g., male/female) with roles or attributes (e.g., career/family, science/arts). Such collective stereotypes, especially implicit stereotypes, are assumed to be so deeply embedded in society that they are resistant to change. Yet over the past several decades, shifts in real-world gender roles suggest the possibility that gender stereotypes may also have changed alongside such shifts. The current project tests the patterns of recent gender stereotype change using a decade (2007–2018) of continuously collected data from 1.4 million implicit and explicit tests of gender stereotypes (male-science/female-arts, male-career/female-family). Time series analyses revealed that, over just 10 years, both implicit and explicit male-science/female-arts and male-career/female-family stereotypes have shifted toward neutrality, weakening by 13%–19%. Furthermore, these trends were observed across nearly all demographic groups and in all geographic regions of the United States and several other countries, indicating worldwide shifts in collective implicit and explicit gender stereotypes.
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Girvan EJ, McIntosh K, Santiago-Rosario MR. Associations Between Community-Level Racial Biases, Office Discipline Referrals, and Out-of-School Suspensions. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2020.1838232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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45
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Lai CK, Wilson ME. Measuring implicit intergroup biases. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2021. [DOI: 10.1111/spc3.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Calvin K. Lai
- Department of Psychological & Brain Sciences Washington University in St. Louis St. Louis Missouri USA
| | - Megan E. Wilson
- Department of Psychological & Brain Sciences Washington University in St. Louis St. Louis Missouri USA
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Marini M, Banaji MR. An implicit gender sex-science association in the general population and STEM faculty. The Journal of General Psychology 2020; 149:299-326. [PMID: 33283665 DOI: 10.1080/00221309.2020.1853502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We investigated implicit associations between social categories female or male and the attributes sex or science. In six experiments, Implicit Association Tests (IATs) showed female + sex/male + science associations. The bias was observed (a) in both men and women; (b) in participants who reported sexual attraction to both females and males (greater for the former); (c) in members of the general population as well as among STEM faculty from the highest ranked U.S. STEM universities; (d) even when both gender categories were clearly presented as scientists, via photos and words, (e) using both the standard IAT and a single category variation; and (f) hardly at all on explicit measures in contrast to implicit measures. By introducing the attribute of sexuality, these studies bring to light a robust if unintended mental association of women as sexual beings. The automaticity and surprising generality of the effect suggests that this association may be an unintentional yet potent barrier to women's lower representation and success in STEM.
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Steine IM, LeWinn KZ, Lisha N, Tylavsky F, Smith R, Bowman M, Sathyanarayana S, Karr CJ, Smith AK, Kobor M, Bush NR. Maternal exposure to childhood traumatic events, but not multi-domain psychosocial stressors, predict placental corticotrophin releasing hormone across pregnancy. Soc Sci Med 2020; 266:113461. [PMID: 33126094 PMCID: PMC9380779 DOI: 10.1016/j.socscimed.2020.113461] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/19/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022]
Abstract
Maternal psychosocial stress increases the risk of adverse birth and postnatal outcomes for the mother and child, but the role of maternal exposure to childhood traumatic events (CTE) and multi-domain psychosocial stressors for the level and rise of placental Corticotrophin-Releasing Hormone (pCRH) across pregnancy has been understudied. In a sociodemographically and racially diverse sample of 1303 women (64% Black, 36% White/others) with low-medical risk pregnancies at enrollment from Shelby County, Tennessee, USA, blood samples were drawn twice, corresponding roughly to second and third trimester, and extracted prior to conducting radioimmune assays for pCRH. Mothers reported CTE (physical abuse, sexual abuse, or family violence, in childhood), adulthood traumatic events, and interpersonal violence during pregnancy. Neighborhood crime/deprivation was derived using geospatially-linked objective databases. General linear and mixed models tested associations between stress exposure variables and pCRH levels and rate of rise, adjusting for obstetric/clinical/health related factors. Maternal CTE did not predict pCRH levels at time 1, but positively predicted levels at time 2, and the rate of rise in pCRH across pregnancy. Race did not moderate this association. No additional maternal stress exposures across adulthood or during pregnancy predicted pCRH outcomes. Findings indicate that childhood violence or abuse exposure can become biologically embedded in a manner predicting later prenatal physiology relevant for maternal and offspring health, and that such embedding may be specific to childhood, but not adulthood, stress. Findings also highlight the placental-fetal unit as a mechanistic pathway through which intergenerational transmission of the adverse effects of childhood adversities may occur.
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Affiliation(s)
- Iris M Steine
- Visiting Scholar, UC Berkeley, Department of Psychology, 2121 Berkeley Way, Berkeley, CA, 94704, USA; Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015 Bergen, Norway.
| | - Kaja Z LeWinn
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, USA
| | - Nadra Lisha
- Department of General Internal Medicine, University of California San Francisco, USA
| | - Frances Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Roger Smith
- Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Maria Bowman
- Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Sheela Sathyanarayana
- University of Washington Department of Pediatrics, Seattle, USA; Seattle Children's Research Institute, Seattle, USA; University of Washington Department of Environmental and Occupational Health Sciences, Seattle, USA
| | - Catherine J Karr
- University of Washington Department of Environmental and Occupational Health Sciences, Seattle, USA; University of Washington Departments of Pediatrics, Seattle, USA
| | - Alicia K Smith
- Department of Gynecology and Obstetrics, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA
| | - Michael Kobor
- Department of Medical Genetics, University of British Columbia, Canada
| | - Nicole R Bush
- Departments of Psychiatry and Pediatrics, University of California San Francisco, USA
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Rauscher E, Rangel DE. Rising inequality of infant health in the U.S. SSM Popul Health 2020; 12:100698. [PMID: 33299927 PMCID: PMC7702186 DOI: 10.1016/j.ssmph.2020.100698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 11/12/2022] Open
Abstract
Has infant health inequality narrowed or grown in recent decades? Inequality may have narrowed due to expanded medical insurance coverage and greater knowledge about fetal health. However, greater income inequality may have reduced health for births to the most economically disadvantaged mothers, leading to growing infant health inequality. We use administrative birth certificate data for over 22 million births to examine trends in inequality of infant health from 1989 to 2018 in the U.S. This period allows us to consider how contextual factors – such as passage of the Affordable Care Act, changing demographics, the Great Recession, or delayed impacts of rising income inequality – may have altered infant health inequality. We assess gaps in infant health by maternal race, marital status, and education. Following previous research, we also examine gaps between the most economically advantaged mothers – married, white mothers with a college degree – and the most economically disadvantaged mothers – single, Black mothers without a high school degree. Results reveal that inequality of infant health has increased since 2010.
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Affiliation(s)
- Emily Rauscher
- Department of Sociology, Brown University, Box 1916, Providence, RI, 02912, USA
| | - David E Rangel
- Department of Education, Brown University, Box 1938, Providence, RI, 02912, USA
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Thomas MD, Michaels EK, Darling-Hammond S, Nguyen TT, Glymour MM, Vittinghoff E. Whites' County-Level Racial Bias, COVID-19 Rates, and Racial Inequities in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8695. [PMID: 33238526 PMCID: PMC7700363 DOI: 10.3390/ijerph17228695] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023]
Abstract
Mounting evidence reveals considerable racial inequities in coronavirus disease 2019 (COVID-19) outcomes in the United States (US). Area-level racial bias has been associated with multiple adverse health outcomes, but its association with COVID-19 is yet unexplored. Combining county-level data from Project Implicit on implicit and explicit anti-Black bias among non-Hispanic Whites, Johns Hopkins Coronavirus Resource Center, and The New York Times, we used adjusted linear regressions to estimate overall COVID-19 incidence and mortality rates through 01 July 2020, Black and White incidence rates through 28 May 2020, and Black-White incidence rate gaps on average area-level implicit and explicit racial bias. Across 2994 counties, the average COVID-19 mortality rate (standard deviation) was 1.7/10,000 people (3.3) and average cumulative COVID-19 incidence rate was 52.1/10,000 (77.2). Higher racial bias was associated with higher overall mortality rates (per 1 standard deviation higher implicit bias b = 0.65/10,000 (95% confidence interval: 0.39, 0.91); explicit bias b = 0.49/10,000 (0.27, 0.70)) and higher overall incidence (implicit bias b = 8.42/10,000 (4.64, 12.20); explicit bias b = 8.83/10,000 (5.32, 12.35)). In 957 counties with race-specific data, higher racial bias predicted higher White and Black incidence rates, and larger Black-White incidence rate gaps. Anti-Black bias among Whites predicts worse COVID-19 outcomes and greater inequities. Area-level interventions may ameliorate health inequities.
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Affiliation(s)
- Marilyn D. Thomas
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, 550 16th St 2nd floor, San Francisco, CA 94158, USA; (M.M.G.); (E.V.)
- Department of Psychiatry, School of Medicine, University of California, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Eli K. Michaels
- Division of Epidemiology, School of Public Health, University of California, 2121 Berkeley Way, Room 5302, Berkeley, CA 94720, USA;
| | - Sean Darling-Hammond
- Goldman School of Public Policy, University of California, 2607 Hearst Ave, Berkeley, CA 94720, USA;
| | - Thu T. Nguyen
- Department of Family and Community Medicine, School of Medicine, University of California, 995 Potrero Ave, San Francisco, CA 94110, USA;
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, 550 16th St 2nd floor, San Francisco, CA 94158, USA; (M.M.G.); (E.V.)
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, 550 16th St 2nd floor, San Francisco, CA 94158, USA; (M.M.G.); (E.V.)
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Cunningham GB, Wigfall LT. Race, explicit racial attitudes, implicit racial attitudes, and COVID-19 cases and deaths: An analysis of counties in the United States. PLoS One 2020; 15:e0242044. [PMID: 33206679 PMCID: PMC7673554 DOI: 10.1371/journal.pone.0242044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/26/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES To examine the potential moderating effects of explicit racial attitudes and implicit racial attitudes on the relationship between percent of Black county residents and COVID-19 cases and deaths. METHODS We collected data from a variety of publicly available sources for 817 counties in the US. (26% of all counties). Cumulative COVID-19 deaths and cases from January 22 to August 31, 2020 were the dependent variables; explicit racial attitudes and implicit racial attitudes served as the moderators; subjective poor or fair health, food insecurity, percent uninsured, percent unemployed, median family income, percent women, percent of Asian county resident, percent of Hispanic county residents, and percent of people 65 or older were controls. RESULTS The percent of Black county residents was positively associated with COVID-19 cases and deaths at the county level. The relationship between percent of Black residents and COVID-19 cases was moderated by explicit racial attitudes and implicit racial attitudes. CONCLUSIONS Implicit racial attitudes can take on a shared property at the community level and effectively explain racial disparities. COVID-19 cases are highest when both the percent of Black county residents and implicit racial attitudes are high.
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Affiliation(s)
- George B. Cunningham
- Department of Health and Kinesiology, Center for Sport Management Research and Education, Texas A&M University, College Station, TX, United States of America
| | - Lisa T. Wigfall
- Department of Health and Kinesiology, Transdisciplinary Center for Health Equity Research, Texas A&M University, College Station, TX, United States of America
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