1
|
Brown KK, Thomas SP, Brothers RM, Liao Y. "Lord Knows What's Being Done with My Blood!": Black Women's Perceptions of Biospecimen Donation for Clinical Research in the United States. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02015-y. [PMID: 38714639 DOI: 10.1007/s40615-024-02015-y] [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: 11/05/2023] [Revised: 04/06/2024] [Accepted: 04/28/2024] [Indexed: 05/10/2024]
Abstract
PURPOSE Black women are underrepresented in clinical research and clinical trials. Knowledge gaps lead to biased clinical practice and care. There is a small but growing body of literature on Black women's perceptions about participation when biospecimen donation is sought by researchers. This is the first known study to investigate willingness to participate in clinical research involving biospecimen donation among Black women of reproductive age in the United States. METHODS This cross-sectional study recruited 496 Black women (ages 18-49) from a research crowdsourcing platform. Participants completed a 46-item online survey which asked about their willingness to provide blood samples for clinical health research and reasons for their willingness or for any unwillingness. Descriptive statistics and thematic analysis method were used to analyze the data. RESULTS Less than half (44%) of participants reported willingness to provide blood samples for clinical research. The most common concerns of those expressing unwillingness to provide samples were "fear of blood sample being misused" and "distrust with the health researchers handling the samples." We identified six qualitative themes from the analysis of participants' open-ended responses. The most important factors include a desire for integrity and transparency in research, institutional racism contributing to mistrust, and adequate compensation and clearly defined benefits to participation. CONCLUSIONS The recruitment and engagement of Black women in clinical biospecimen research should involve transparent, trustworthy, and anti-racist practices and informed respect for Black women's autonomy. There is a need to address Black women's concerns about exploitative profits and mistrust of academic and medical institutions.
Collapse
Affiliation(s)
- Kyrah K Brown
- Department of Kinesiology, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 76019, USA.
| | | | - R Mathew Brothers
- Department of Kinesiology, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 76019, USA
| | - Yue Liao
- Department of Kinesiology, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 76019, USA
| |
Collapse
|
2
|
Thomas SP, Fletcher FE, Willard R, Ranson TM, Bonham VL. Patient Perceptions on the Advancement of Noninvasive Prenatal Testing for Sickle Cell Disease among Black Women in the United States. AJOB Empir Bioeth 2024; 15:154-163. [PMID: 38349128 DOI: 10.1080/23294515.2024.2302996] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
BACKGROUND Noninvasive prenatal testing (NIPT) designed to screen for fetal genetic conditions, is increasingly being implemented as a part of routine prenatal care screening in the United States (US). However, these advances in reproductive genetic technology necessitate empirical research on the ethical and social implications of NIPT among populations underrepresented in genetic research, particularly Black women with sickle cell disease (SCD). METHODS Forty (N = 40) semi-structured interviews were conducted virtually with Black women in the US (19 participants with SCD; 21 participants without SCD) from June 2021 to January 2022. We employed a qualitative approach to examine the study participants' perceptions of the potential advancement of NIPT for screening SCD in the fetus. Data were analyzed using NVivo 12 qualitative software. RESULTS The themes revealed the complexities involving the intersectional lived experiences of SCD, prenatal care, lack of synergy among health providers, and NIPT decision-making. The results further revealed that even when Black women have shared commonalities in their lived experiences while navigating SCD and motherhood, their perceptions of NIPT screening technologies are divergent. CONCLUSION Expanding the ethical discourse on the social implications of NIPT is critical to fully elucidate how Black women perceive NIPT's utility, particularly as NIPT advances to screen for SCD in the fetus. Neglecting to include Black women with genetic conditions in empirical studies on NIPT may contribute to ongoing health inequities and limit and constrain reproductive choices among Black women with and without SCD.
Collapse
Affiliation(s)
- Shameka P Thomas
- School of Public Health, Harvard University, Boston, Massachusetts, USA
- National Institutes of Health-National Genome Research Institute, Bethesda, Maryland, USA
| | - Faith E Fletcher
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Rachele Willard
- National Institutes of Health-National Genome Research Institute, Bethesda, Maryland, USA
| | - Tiara Monet Ranson
- National Institutes of Health-National Genome Research Institute, Bethesda, Maryland, USA
- School of Public Health, University of Washington, Washington, Seattle, USA
| | - Vence L Bonham
- National Institutes of Health-National Genome Research Institute, Bethesda, Maryland, USA
| |
Collapse
|
3
|
Fleming E, Taylor GW, Neighbors HW. Systemic racism and racial inequities in periodontal health: The long journey from upstream determinants to downstream treatment. Periodontol 2000 2024. [PMID: 38501675 DOI: 10.1111/prd.12559] [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: 10/28/2023] [Accepted: 01/11/2024] [Indexed: 03/20/2024]
Abstract
Racial disparities in the prevalence of periodontal disease are consistent and persistent. The epidemiology of periodontal disease demonstrates racial inequities: non-Hispanic Black (14.7%), Mexican American (13.4%), and other Hispanic adults (7.8%) experience a higher prevalence of severe periodontal disease than non-Hispanic White adults (5.9%). Epidemiologic and clinical research on periodontal health suffers from the same problem that has plagued the health equity movement, an over emphasis on describing racial inequities coupled with few interventions that reduce racial health inequity. Over the decades that racial inequities in periodontal disease have been observed, many have argued that systemic racism is the fundamental driver of racial health inequity. This paper interrogates the roles of systemic racism, dental education, clinical treatment, and patient behavior in periodontal disease. We describe how, together, these mechanisms contribute to racial disparities in periodontal outcomes. However, it is insufficient for oral health equity scientists to only describe and discuss the negative effects of systemic racism. The imperative is to create antiracist strategies designed to eliminate systemic racism. Health equity scientists must also specify how dental systems operate in a racist manner and create effective clinical strategies designed to reduce racial disparities in periodontal disease.
Collapse
Affiliation(s)
- Eleanor Fleming
- Department of Dental Public Health, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - George W Taylor
- Department of Preventive and Restorative Dental Sciences, Division of Oral Epidemiology and Dental Public Health, University of California San Francisco School of Dentistry, San Francisco, California, USA
| | - Harold Woody Neighbors
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
4
|
Fletcher FE. Ethical, Legal, and Social Implications of Genomics Research: Implications for Building a More Racially Diverse Bioethics Workforce. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:106-108. [PMID: 37339311 PMCID: PMC10392768 DOI: 10.1080/15265161.2023.2207519] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Affiliation(s)
- Faith E Fletcher
- Baylor College of Medicine Center for Medical Ethics and Health Policy
| |
Collapse
|
5
|
Lebow-Skelley E, Scott Tomlinson M, Charles S, Fuller C, Ames B, Pearson MA. A Collaborative Approach to Address Racism in a Community-Academic Partnership. Prev Chronic Dis 2023; 20:E47. [PMID: 37290007 DOI: 10.5888/pcd20.220365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
The HERCULES Exposome Research Center at Emory University uses an exposome approach to study the environment's effect on health and community well-being. HERCULES is guided by a Stakeholder Advisory Board (SAB) that includes representatives of neighborhoods, nonprofit organizations, government agencies, and academic institutions in the Atlanta metropolitan region. This region (and the SAB) has a large proportion of Black residents, many of whom live in areas experiencing environmental injustices. Historic and current racial injustices in Atlanta and public health research made it imperative to initiate dialogue and implement actions to address racism and power dynamics that may impact research and partnerships between affected communities and our institution.After initial discussion, the HERCULES Community Engagement Core and SAB members formed a workgroup to develop an internal anti-racism process. The workgroup drafted an Anti-Racism Commitment, hosted a Racism and Equity Dialogue Series, and initiated a strategic planning process to implement the resulting recommendations, which fell into the following categories: anti-racist guidance/policies and recommendations for research, community engagement, and the department. Center leadership and the SAB were engaged throughout the iterative process.This deliberate and ongoing process allows HERCULES to identify and begin implementing action items that go beyond a written proclamation to address racialized power imbalances and systemic inequities. HERCULES is committed to working collaboratively to earn community trust while addressing systemic issues, recognizing that these are essential to forming research partnerships that address health inequities.
Collapse
Affiliation(s)
- Erin Lebow-Skelley
- Emory University, Rollins School of Public Health, Gangarosa Department of Environmental Health, HERCULES Exposome Research Center, Atlanta, Georgia
- Emory University, 1518 Clifton Road NE, Atlanta, GA 30322
| | - Martha Scott Tomlinson
- Emory University, Rollins School of Public Health, Gangarosa Department of Environmental Health, HERCULES Exposome Research Center, Atlanta, Georgia
| | - Simone Charles
- University of Michigan, School of Public Health, Environmental Sciences, Ann Arbor, Michigan
- HERCULES Exposome Research Center, Stakeholder Advisory Board, Atlanta, Georgia
| | - Christina Fuller
- HERCULES Exposome Research Center, Stakeholder Advisory Board, Atlanta, Georgia
- University of Georgia, College of Engineering, School of Environmental, Civil, Agricultural and Mechanical (ECAM) Engineering, Athens, Georgia
| | - Bren Ames
- HERCULES Exposome Research Center, Stakeholder Advisory Board, Atlanta, Georgia
- Aye Open Outcomes, National Human Ecology Action League (HEAL), Atlanta, Georgia
| | - Melanie A Pearson
- Emory University, Rollins School of Public Health, Gangarosa Department of Environmental Health, HERCULES Exposome Research Center, Atlanta, Georgia
| |
Collapse
|
6
|
Martschenko DO, Wand H, Young JL, Wojcik GL. Including multiracial individuals is crucial for race, ethnicity and ancestry frameworks in genetics and genomics. Nat Genet 2023; 55:895-900. [PMID: 37202500 DOI: 10.1038/s41588-023-01394-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Daphne O Martschenko
- Center for Biomedical Ethics, Department of Pediatrics, Stanford Medicine, Stanford, CA, USA
| | - Hannah Wand
- Department of Cardiology, Stanford Medicine, Stanford, CA, USA
| | - Jennifer L Young
- Center for Biomedical Ethics, Department of Pediatrics, Stanford Medicine, Stanford, CA, USA
- Center for Genetic Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Genevieve L Wojcik
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
7
|
Martschenko DO, Young JL. Precision Medicine Needs to Think Outside the Box. Front Genet 2022; 13:795992. [PMID: 35559033 PMCID: PMC9086532 DOI: 10.3389/fgene.2022.795992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Precision medicine offers a precious opportunity to change clinical practice and disrupt medicine’s reliance on crude racial, ethnic, or ancestral categories by focusing on an individual’s unique genetic, environmental, and lifestyle characteristics. However, precision medicine and the genomic studies that are its cornerstone have thus far failed to account for human diversity. This failure is made clearer when looking at individuals who encapsulate a mosaic of different genetic ancestries and do not fit neatly into existing population labels. This piece argues that precision medicine continues to rely on the same forms of crude categorization it seeks to unsettle. Until the scientific community creates inclusive solutions for individuals who fall outside or between our existing population labels, precision medicine will continue to fall short in its aims.
Collapse
Affiliation(s)
- Daphne O Martschenko
- Center for Biomedical Ethics, School of Medicine, Stanford University, Stanford, CA, United States
| | - Jennifer L Young
- Center for Biomedical Ethics, School of Medicine, Stanford University, Stanford, CA, United States.,Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| |
Collapse
|
8
|
Fletcher FE, Ray KS, Brown VA, Smith PT. Addressing Anti-Black Racism in Bioethics: Responding to the Call. Hastings Cent Rep 2022; 52 Suppl 1:S3-S11. [PMID: 35470874 PMCID: PMC10118282 DOI: 10.1002/hast.1360] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As a field concerned with ethical issues in health and health care, particularly how structures, policies, and practices unfairly advantage some and disadvantage others, bioethics has a moral obligation to address the long-standing challenges that racism has posed to the overall health and well-being of Black, Indigenous, and Latinx people and other people of color. Arguably, the premature death and disease disproportionately affecting Black Americans and the well-documented association of such death and illness with racism are issues that have not gained due attention in bioethics. This multiauthored report highlights the intergenerational work of mostly Black scholars and aims to create an agenda for bioethics that addresses anti-Black racism and the ways in which this form of racism threatens the actualization of justice in health and health care, not only for Black people and other minoritized groups but also for all people. This special report contains five major sections representing different approaches to scholarship, including theoretical, empirical, and narrative forms. The first section features two target articles focused on anti-Black racism and health care settings, with each article accompanied by two commentaries. The second section includes four essays thematically centered around anti-Black racism and health equity research and practice. Section three features four essays that explore anti-Black racism and bioethics. The next section consists of four essays framing a braver, bolder, and broader bioethics. We conclude with a powerful tribute to the late Marian Gray Secundy, a bioethics luminary, friend, colleague, role model, and mentor, and a tie that binds together many bioethics scholars who prioritize social justice in their scholarship and praxis.
Collapse
|
9
|
Fletcher F, Thomas SP, Lapite FC, Ray K. Bioethics Must Exemplify a Clear Path toward Justice: A Call to Action. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:14-16. [PMID: 34962203 PMCID: PMC9302876 DOI: 10.1080/15265161.2021.2001113] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
| | | | | | - Keisha Ray
- UTHealth Houston, McGovern Center for Humanities and
Ethics
| |
Collapse
|
10
|
The Road to Greater Diversity in the Genomics Workforce. Am J Med Genet A 2021; 185:3527-3528. [PMID: 34784114 DOI: 10.1002/ajmg.a.61712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|