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Vidal AC, Sosnowski DW, Marchesoni J, Grenier C, Thorp J, Murphy SK, Johnson SB, Schlief W, Hoyo C. Maternal adverse childhood experiences (ACEs) and offspring imprinted gene DMR methylation at birth. Epigenetics 2024; 19:2293412. [PMID: 38100614 PMCID: PMC10730185 DOI: 10.1080/15592294.2023.2293412] [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: 05/24/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
Adverse childhood experiences (ACEs) contribute to numerous negative health outcomes across the life course and across generations. Here, we extend prior work by examining the association of maternal ACEs, and their interaction with financial stress and discrimination, with methylation status within eight differentially methylated regions (DMRs) in imprinted domains in newborns. ACEs, financial stress during pregnancy, and experience of discrimination were self-reported among 232 pregnant women. DNA methylation was assessed at PEG10/SGCE, NNAT, IGF2, H19, PLAGL1, PEG3, MEG3-IG, and DLK1/MEG3 regulatory sequences using pyrosequencing. Using multivariable linear regression models, we found evidence to suggest that financial stress was associated with hypermethylation of MEG3-IG in non-Hispanic White newborns; discrimination was associated with hypermethylation of IGF2 and NNAT in Hispanic newborns, and with hypomethylation of PEG3 in non-Hispanic Black newborns. We also found evidence that maternal ACEs interacted with discrimination to predict offspring PLAGL1 altered DMR methylation, in addition to interactions between maternal ACEs score and discrimination predicting H19 and SGCE/PEG10 altered methylation in non-Hispanic White newborns. However, these interactions were not statistically significant after multiple testing corrections. Findings from this study suggest that maternal ACEs, discrimination, and financial stress are associated with newborn aberrant methylation in imprinted gene regions.
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Affiliation(s)
- Adriana C. Vidal
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - David W. Sosnowski
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joddy Marchesoni
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Carole Grenier
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - John Thorp
- Department of Obstetrics and Gynecology, Maternal and Child Health, UNC Gillings School of Public Health, UNC, Chapel Hill, NC, USA
| | - Susan K. Murphy
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Sara B. Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William Schlief
- Johns Hopkins All Children’s Pediatric Biorepository, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
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Jones BW, Quick-Graham L, Martin SL. Perinatal Homicide in the United States: A Systematic Literature Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:2452-2467. [PMID: 38160243 DOI: 10.1177/15248380231217044] [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: 01/03/2024]
Abstract
This review focused on literature from the United States evaluating homicide during the perinatal period. It was completed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies met the criteria for inclusion, including: describing prevalence and risk factors related to homicide deaths of pregnant or postpartum birthing individuals; being conducted in the United States; and being published in English 2007 or later. This review found that homicide is an important contributor to maternal mortality and is a leading cause of death during pregnancy and the postpartum period, especially if an individual is Black and under the age of 30. Future efforts must be made to standardize data collection efforts and resolve nuanced terminology that results in interpretation challenges. The United States should examine maternal deaths through the entirety of the perinatal period and fully invest in violence prevention efforts.
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Affiliation(s)
- Brooke W Jones
- Department of Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, USA
| | | | - Sandra L Martin
- Department of Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, USA
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Buthelezi S, Gerber B. Cultural Competence in Ophthalmic Dispensing Education: A Qualitative Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:585-594. [PMID: 38915926 PMCID: PMC11195680 DOI: 10.2147/amep.s438707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/13/2023] [Indexed: 06/26/2024]
Abstract
Purpose Understanding and acknowledging cultural diversity in healthcare is essential in providing culturally competent care. Higher education institutions are critical to providing students with the necessary knowledge, attitudes, and skills to respond to cultural diversity in various contexts. Cultural competence teaching in ophthalmic dispensing education has emerged as an essential concept that needs to be included in the curriculum. This study explored ophthalmic dispensing lecturers' understandings, experiences, and attitudes in teaching cultural competence. Methods This study used a qualitative approach within an interpretivist paradigm by conducting semi-structured interviews with lecturers (n = 7) in the ophthalmic dispensing program. Braun and Clarke's framework for thematic analysis was utilized. The research was conducted at an ophthalmic dispensing department at a South African university. Results The analysis of the semi-structured interviews indicated three main themes of importance regarding factors influencing cultural competence education in the ophthalmic dispensing curriculum: the interplay between experiences and understandings of cultural competence, cross-cultural exposure and teaching practices, and inclusion of cultural competence into the curriculum. The participants recognized that cultural competence was not explicitly included in the curriculum. Including culture in education was rather unsystematic and, in most cases, unplanned. Conclusion Further training of lecturers on cultural competence skills and evidence-based teaching and assessment strategies are required to assist in developing curricula that include cultural competence.
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Affiliation(s)
- Sanele Buthelezi
- Department of Optometry, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
- Department of Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Berna Gerber
- Division of Speech-Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Cape Town, South Africa
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McCarthy D. Gendered anti-blackness, maternal health & chattel slavery: OB/Gyn knowledge as a determinant of death of black women. Soc Sci Med 2024; 353:117038. [PMID: 38936105 DOI: 10.1016/j.socscimed.2024.117038] [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: 11/14/2023] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/29/2024]
Abstract
This archival investigation of the Southern Medical and Surgical Journal (SMSJ) focuses on the construction of the American Ob/Gyn profession's medical knowledge system alongside chattel slavery, between 1834 and 1860. I find that language, methods of clinical management of bodies and decision-making processes illustrate the pathways that obstetrical knowledge served as a determinant of death for Black women under chattel slavery. These are byproducts of the condition of possibility, my theoretical framework. The condition, or use of gendered anti-Black logic/practice, specifically the social death and biological indispensability of Black women in the context of chattel slavery, shapes the subjective nature of medical knowledge into a determinant of maternal death for Black women. Using the condition of possibility as a theoretical framework, I will lay the groundwork to reframe the Ob/Gyn knowledge system as a current and ever-present threat to Black women and girls' health. This study's sociological contribution lies in examining medical knowledge construction as a series of social interactions, informed by gendered and racial ideologies, that determine health outcomes for Black women.
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Silva JBB, Howe CJ, Jackson JW, Riester MR, Bardenheier BH, Xu L, Puckrein G, van Aalst R, Loiacono MM, Zullo AR. Geographic Variation in Racial Disparities in Receipt of High-Dose Influenza Vaccine Among US Older Adults. J Racial Ethn Health Disparities 2024; 11:1520-1529. [PMID: 37184814 PMCID: PMC10184628 DOI: 10.1007/s40615-023-01628-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Racial disparities in receipt of high-dose influenza vaccine (HDV) have been documented nationally, but whether small-area geographic variation in such disparities exists remains unknown. We assessed the distribution of disparities in HDV receipt between Black and White traditional Medicare beneficiaries vaccinated against influenza within states and hospital referral regions (HRRs). METHODS We conducted a nationally representative retrospective cohort study of 11,768,724 community-dwelling traditional Medicare beneficiaries vaccinated against influenza during the 2015-2016 influenza season (94.3% White and 5.7% Black). Our comparison was marginalized versus privileged racial group measured as Black versus White race. Vaccination and type of vaccine were obtained from Medicare Carrier and Outpatient files. Differences in the proportions of individuals who received HDV between Black and White beneficiaries within states and HRRs were used to measure age- and sex-standardized disparities in HDV receipt. We restricted to states and HRRs with ≥ 100 beneficiaries per age-sex strata per racial group. RESULTS We detected a national disparity in HDV receipt of 12.8 percentage points (pps). At the state level, the median standardized HDV receipt disparity was 10.7 pps (minimum, maximum: 2.9, 25.6; n = 30 states). The median standardized HDV receipt disparity among HRRs was 11.6 pps (minimum, maximum: 0.4, 24.7; n = 54 HRRs). CONCLUSION Black beneficiaries were less likely to receive HDV compared to White beneficiaries in almost every state and HRR in our analysis. The magnitudes of disparities varied substantially across states and HRRs. Local interventions and policies are needed to target geographic areas with the largest disparities to address these inequities.
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Affiliation(s)
- Joe B B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA.
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Epidemiologic Research, Brown University School of Public Health, Providence, RI, USA
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Westat LLC, Rockville, MD, USA
| | - Liou Xu
- National Minority Quality Forum, Washington, DC, USA
| | - Gary Puckrein
- National Minority Quality Forum, Washington, DC, USA
| | - Robertus van Aalst
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Department of Modelling, Epidemiology, and Data Science, Sanofi, Lyon, France
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
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Silva JBB, Howe CJ, Jackson JW, Bardenheier BH, Riester MR, van Aalst R, Loiacono MM, Zullo AR. Geospatial Distribution of Racial Disparities in Influenza Vaccination in Nursing Homes. J Am Med Dir Assoc 2024; 25:104804. [PMID: 37739348 PMCID: PMC10950839 DOI: 10.1016/j.jamda.2023.08.018] [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: 03/31/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES This study aimed to assess the distribution of racial disparities in influenza vaccination between White and Black short-stay and long-stay nursing home residents among states and hospital referral regions (HRRs). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS We included short-stay and long-stay older adults residing in US nursing homes during influenza seasons between 2011 and 2018. Included residents were aged ≥65 years and enrolled in Traditional Medicare. Analyses were conducted using resident-seasons, whereby residents could contribute to one or more influenza seasons if they resided in a nursing home across multiple seasons. METHODS Our comparison of interest was marginalized vs privileged racial group membership measured as Black vs White race. We obtained influenza vaccination documentation from resident Minimum Data Set assessments from October 1 through June 30 of a particular influenza season. Nonparametric g-formula was used to estimate age- and sex-standardized disparities in vaccination, measured as the percentage point (pp) difference in the proportions of individuals vaccinated between Black and White nursing home residents within states and HRRs. RESULTS The study included 7,807,187 short-stay resident-seasons (89.7% White and 10.3% Black) in 14,889 nursing homes and 7,308,111 long-stay resident-seasons (86.7% White and 13.3% Black) in 14,885 nursing homes. Among states, the median age- and sex-standardized disparity between Black and White residents was 10.1 percentage points (pps) among short-stay residents and 5.3 pps among long-stay residents across seasons. Among HRRs, the median disparity was 8.6 pps among short-stay residents and 5.0 pps among long-stay residents across seasons. CONCLUSIONS AND IMPLICATIONS Our analysis revealed that the magnitudes of vaccination disparities varied substantially across states and HRRs, from no disparity in vaccination to disparities in excess of 25 pps. Local interventions and policies should be targeted to high-disparity geographic areas to increase vaccine uptake and promote health equity.
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Affiliation(s)
- Joe B B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center for Epidemiologic Research, Brown University School of Public Health, Providence, RI, USA
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public health, Baltimore, MD, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Robertus van Aalst
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Modelling, Epidemiology, and Data Science, Sanofi, Lyon, France; Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
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Haas S, Mullin G, Williams A, Reynolds A, Tuerxuntuoheti A, Reyes PGM, Mende-Siedlecki P. Racial bias in pediatric pain perception. THE JOURNAL OF PAIN 2024:104583. [PMID: 38823604 DOI: 10.1016/j.jpain.2024.104583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 05/21/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024]
Abstract
Racial disparities in pediatric pain care are prevalent across a variety of healthcare settings, and likely contribute to broader disparities in health, morbidity, and mortality. The present research expands on prior work demonstrating potential perceptual contributions to pain care disparities in adults and tests whether racial bias in pain perception extends to child targets. We examined the perception and hypothetical treatment of pain in Black and White boys (Experiment 1), Black and White boys and girls (Experiment 2), Black and White boys and adult men (Experiment 3), and Black, White, Asian, and Latinx boys (Experiment 4). Across this work, pain was less readily perceived on Black (versus White) boys' faces-though this bias was not observed within girls. Moreover, this perceptual bias was comparable in magnitude to the same bias measured with adult targets and consistently predicted bias in hypothetical treatment. Notably, bias was not limited to Black targets-pain on Hispanic/Latinx boys' faces was also relatively underperceived. Taken together, these results offer strong evidence for racial bias in pediatric pain perception. PERSPECTIVE: This article demonstrates perceptual contributions to racial bias in pediatric pain recognition. Participants consistently saw pain less readily on Black boys' faces, compared to White boys, and this perceptual bias consistently predicted race-based gaps in treatment. This work reveals a novel factor that may support pediatric pain care disparities.
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Takemoto E, Bolton A, Goetz CT. Inequities in naloxone administration among fatal overdose decedents by race and ethnicity in Pennsylvania, 2019-21. Addiction 2024. [PMID: 38808397 DOI: 10.1111/add.16478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/18/2024] [Indexed: 05/30/2024]
Abstract
AIMS The aim of this study was to characterize the circumstances of drug overdose deaths and determine whether naloxone administration differed by overdose decedent race and ethnicity. DESIGN AND SETTING Analysis of data on unintentional and undetermined intent drug overdose deaths in Pennsylvania (2019-21) was collected from death certificates and the State Unintentional Drug Overdose Reporting System. Multivariable logistic regression models were adjusted for overdose death circumstances and the odds of naloxone administration were estimated by race/ethnicity and year. CASES The analytical sample included 3386 fatal overdose decedents in 2019, 3864 in 2020 and 3816 in 2021. MEASUREMENTS Evidence of naloxone administration (yes/no) was defined using scene evidence and toxicology reports from coroner and medical examiner records, while race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White) was based on the death certificate. FINDINGS In the analytic sample, overdose death rates were the highest among Black people and increased over time (rate per 10 000 population, 2019: 4.3; 2020: 6.1; 2021: 6.5); rates were lowest among White people and remained constant over time (rate per 10 000 population, 2019: 2.6; 2020: 2.7; 2021: 2.6). Throughout all years, Black decedents had approximately 40-50% lower odds of naloxone administration compared with White decedents as referent [2019: odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.5-0.9; 2020: OR = 0.5, 95% CI = 0.4-0.7; 2021: OR = 0.6, 95% CI = 0.5-0.8], while Hispanic decedents had similar odds of naloxone administration to that of White decedents. CONCLUSION After controlling for overdose circumstances in drug overdose deaths in Pennsylvania, USA, from 2019 to 2021, Black people had lower odds of naloxone administration compared with White people, while there were no differences between Hispanic and White people.
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Affiliation(s)
- Erin Takemoto
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
- Bureau of Epidemiology, Pennsylvania Department of Health, Harrisburg, PA, USA
| | - Ashley Bolton
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
| | - Carrie Thomas Goetz
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
- Bureau of Epidemiology, Pennsylvania Department of Health, Harrisburg, PA, USA
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Burnett-Bowie SAM, Wright NC, Yu EW, Langsetmo L, Yearwood GMH, Crandall CJ, Leslie WD, Cauley JA. The American Society for Bone and Mineral Research Task Force on clinical algorithms for fracture risk report. J Bone Miner Res 2024; 39:517-530. [PMID: 38590141 DOI: 10.1093/jbmr/zjae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/23/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024]
Abstract
Using race and ethnicity in clinical algorithms potentially contributes to health inequities. The American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee convened the ASBMR Task Force on Clinical Algorithms for Fracture Risk to determine the impact of race and ethnicity adjustment in the US Fracture Risk Assessment Tool (US-FRAX). The Task Force engaged the University of Minnesota Evidence-based Practice Core to conduct a systematic review investigating the performance of US-FRAX for predicting incident fractures over 10 years in Asian, Black, Hispanic, and White individuals. Six studies from the Women's Health Initiative (WHI) and Study of Osteoporotic Fractures (SOF) were eligible; cohorts only included women and were predominantly White (WHI > 80% and SOF > 99%), data were not consistently stratified by race and ethnicity, and when stratified there were far fewer fractures in Black and Hispanic women vs White women rendering area under the curve (AUC) estimates less stable. In the younger WHI cohort (n = 64 739), US-FRAX without bone mineral density (BMD) had limited discrimination for major osteoporotic fracture (MOF) (AUC 0.53 (Black), 0.57 (Hispanic), and 0.57 (White)); somewhat better discrimination for hip fracture in White women only (AUC 0.54 (Black), 0.53 (Hispanic), and 0.66 (White)). In a subset of the older WHI cohort (n = 23 918), US-FRAX without BMD overestimated MOF. The Task Force concluded that there is little justification for estimating fracture risk while incorporating race and ethnicity adjustments and recommends that fracture prediction models not include race or ethnicity adjustment but instead be population-based and reflective of US demographics, and inclusive of key clinical, behavioral, and social determinants (where applicable). Research cohorts should be representative vis-à-vis race, ethnicity, gender, and age. There should be standardized collection of race and ethnicity; collection of social determinants of health to investigate impact on fracture risk; and measurement of fracture rates and BMD in cohorts inclusive of those historically underrepresented in osteoporosis research.
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Affiliation(s)
- Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Nicole C Wright
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Elaine W Yu
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Lisa Langsetmo
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care Center, Minneapolis, MN 55417, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States
| | - Gabby M H Yearwood
- Department of Anthropology and Center for Civil Rights and Racial Justice, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Carolyn J Crandall
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, United States
| | - William D Leslie
- Departments of Internal Medicine and Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg R3E 0T6, Canada
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States
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Lujan HL, DiCarlo SE. Misunderstanding of race as biology has deep negative biological and social consequences. Exp Physiol 2024. [PMID: 38698766 DOI: 10.1113/ep091491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
- Heidi L Lujan
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Stephen E DiCarlo
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
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Burton DC, Kelly A, Cardo D, Daskalakis D, Huang DT, Penman-Aguilar A, Raghunathan PL, Zhu BP, Bunnell R. Principles of Health Equity Science for Public Health Action. Public Health Rep 2024; 139:277-283. [PMID: 38044623 PMCID: PMC11037219 DOI: 10.1177/00333549231213162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Deron C. Burton
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- US Public Health Service, Washington, DC, USA
| | - Angele Kelly
- Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Denise Cardo
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Demetre Daskalakis
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David T. Huang
- US Public Health Service, Washington, DC, USA
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ana Penman-Aguilar
- Office of Health Equity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Bao-Ping Zhu
- Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca Bunnell
- Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Herrera A, Hall M, Alex Ahearn M, Ahuja A, Bradford KK, Campbell RA, Chatterjee A, Coletti HY, Crowder VL, Dancel R, Diaz M, Fuchs J, Guidici J, Lewis E, Stephens JR, Sutton AG, Sweeney A, Ward KM, Weinberg S, Zwemer EK, Harrison WN. Differences in testing for drugs of abuse amongst racial and ethnic groups at children's hospitals. J Hosp Med 2024; 19:368-376. [PMID: 38383949 DOI: 10.1002/jhm.13305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/13/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Racial and ethnic differences in drug testing have been described among adults and newborns. Less is known regarding testing patterns among children and adolescents. We sought to describe the association between race and ethnicity and drug testing at US children's hospitals. We hypothesized that non-Hispanic White children undergo drug testing less often than children from other groups. METHODS We conducted a retrospective cohort study of emergency department (ED)-only encounters and hospitalizations for children diagnosed with a condition for which drug testing may be indicated (abuse or neglect, burns, malnutrition, head injury, vomiting, altered mental status or syncope, psychiatric, self-harm, and seizure) at 41 children's hospitals participating in the Pediatric Health Information System during 2018 and 2021. We compared drug testing rates among (non-Hispanic) Asian, (non-Hispanic) Black, Hispanic, and (non-Hispanic) White children overall, by condition and patient cohort (ED-only vs. hospitalized) and across hospitals. RESULTS Among 920,755 encounters, 13.6% underwent drug testing. Black children were tested at significantly higher rates overall (adjusted odds ratio [aOR]: 1.18; 1.05-1.33) than White children. Black-White testing differences were observed in the hospitalized cohort (aOR: 1.42; 1.18-1.69) but not among ED-only encounters (aOR: 1.07; 0.92-1.26). Asian, Hispanic, and White children underwent testing at similar rates. Testing varied by diagnosis and across hospitals. CONCLUSIONS Hospitalized Black children were more likely than White children to undergo drug testing at US children's hospitals, though this varied by diagnosis and hospital. Our results support efforts to better understand and address healthcare disparities, including the contributions of implicit bias and structural racism.
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Affiliation(s)
- Adriana Herrera
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matt Hall
- Department of Analytics, Children's Hospital Association, Lenexa, Kansas, USA
| | - Marshall Alex Ahearn
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Arshiya Ahuja
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathleen K Bradford
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert A Campbell
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashmita Chatterjee
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hannah Y Coletti
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Virginia L Crowder
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ria Dancel
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melissa Diaz
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer Fuchs
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica Guidici
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emilee Lewis
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John R Stephens
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashley G Sutton
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alison Sweeney
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kelley M Ward
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steven Weinberg
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eric K Zwemer
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wade N Harrison
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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13
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Griffith DM, Efird CR, Baskin ML, Webb Hooper M, Davis RE, Resnicow K. Cultural Sensitivity and Cultural Tailoring: Lessons Learned and Refinements After Two Decades of Incorporating Culture in Health Communication Research. Annu Rev Public Health 2024; 45:195-212. [PMID: 37931182 DOI: 10.1146/annurev-publhealth-060722-031158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
In this article, we examine progress and challenges in designing, implementing, and evaluating culturally sensitive behavioral interventions by tailoring health communication to groups or individuals. After defining common tailoring constructs (i.e., culture, race, and ethnicity), cultural sensitivity, and cultural tailoring, we examine when it is useful to culturally tailor and address cultural sensitivity in health communication by group tailoring or individual tailoring and when tailoring health communication may not be necessary or appropriate for achieving behavior change. After reviewing selected approaches to cultural tailoring, we critique the quality of research in this domain with a focus on the internal validity of empirical findings. Then we explore the ways in which cultural sensitivity, group targeting, and individual tailoring have incorporated culture in health promotion and health communication. We conclude by articulating yet unanswered questions and suggesting future directions to move the field forward.
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Affiliation(s)
- Derek M Griffith
- Center for Men's Health Equity, Racial Justice Institute, Georgetown University, Washington, DC, USA;
- Racial Justice Institute, Georgetown University, Washington, DC, USA
- Department of Health Management and Policy, School of Health, Georgetown University, Washington, DC, USA
| | - Caroline R Efird
- Racial Justice Institute, Georgetown University, Washington, DC, USA
| | - Monica L Baskin
- Division of Hematology/Oncology, School of Medicine; and Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Monica Webb Hooper
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Rachel E Davis
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Ken Resnicow
- Department of Health Behavior and Health Education, School of Public Health; and Community Outreach and Health Disparities Research, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
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14
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Mahabamunuge J, Seifer DB. Moving toward Narrowing the United States Gap in Assisted Reproductive Technology (ART) Racial and Ethnic Disparities in the Next Decade. J Clin Med 2024; 13:2224. [PMID: 38673497 PMCID: PMC11050514 DOI: 10.3390/jcm13082224] [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: 02/21/2024] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The Disparities in Assisted Reproductive Technology (DART) hypothesis, initially described in 2013 and further modified in 2022, is a conceptual framework to examine the scope and depth of underlying contributing factors to the differences in access and treatment outcomes for racial and ethnic minorities undergoing ART in the United States. In 2009, the World Health Organization defined infertility as a disease of the reproductive system, thus recognizing it as a medical problem warranting treatment. Now, infertility care is largely recognized as a human right. However, disparities in Reproductive Endocrinology and Infertility (REI) care in the US persist today. While several studies and review articles have suggested possible solutions to racial and ethnic disparities in access and outcomes in ART, few have accounted for and addressed the multiple complex factors contributing to these disparities on a systemic level. This review aims to acknowledge and address the myriad of contributing factors through the DART hypothesis which converge in racial/ethnic disparities in ART and considers possible solutions to effect large scale societal change by narrowing these gaps within the next decade.
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Affiliation(s)
- Jasmin Mahabamunuge
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA;
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Barber LE, McCullough LE, Johnson DA. Eyes Wide Open: Sleep as a Potential Contributor to Racial and Ethnic Disparities in Cancer. Cancer Epidemiol Biomarkers Prev 2024; 33:471-479. [PMID: 38270540 PMCID: PMC10990828 DOI: 10.1158/1055-9965.epi-23-1117] [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: 09/13/2023] [Revised: 11/05/2023] [Accepted: 01/22/2024] [Indexed: 01/26/2024] Open
Abstract
U.S. racial and ethnic minoritized groups face disproportionate cancer burdens compared to White Americans. Investigating modifiable factors, such as sleep, that are socially patterned and inequitably distributed by race and ethnicity may advance understanding of cancer disparities and provide intervention opportunities. Emerging data suggest poor sleep health is associated with cancer. Yet, its contribution to racial and ethnic cancer disparities is understudied. In this narrative review, we explored the sleep-cancer relation through a disparities lens. We (i) summarized literature reporting on associations between sleep and cancer among racial and ethnic minority populations; (ii) examined potential sleep-cancer mechanisms; and (iii) discussed future directions. We identified five studies reporting on sleep-cancer associations among minoritized groups. Poor sleep health was associated with aggressive breast cancer among Black women, increased breast cancer risk among Asian women, and increased risk of breast and total cancer among Hispanic/Latinx Americans. Sleep and cancer disparities have similar socioeconomic and behavioral determinants, suggesting racial and ethnic minoritized groups may be vulnerable to poor sleep health and its adverse health impacts. Evidence indicates that the sleep-cancer disparities relation is an emerging, but important area of research that warrants further investigation, as sleep may be an avenue for reducing cancer disparities.
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Affiliation(s)
- Lauren E. Barber
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Lauren E. McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Dayna A. Johnson
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
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16
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Lang O, Yaya-Stupp D, Traynis I, Cole-Lewis H, Bennett CR, Lyles CR, Lau C, Irani M, Semturs C, Webster DR, Corrado GS, Hassidim A, Matias Y, Liu Y, Hammel N, Babenko B. Using generative AI to investigate medical imagery models and datasets. EBioMedicine 2024; 102:105075. [PMID: 38565004 PMCID: PMC10993140 DOI: 10.1016/j.ebiom.2024.105075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND AI models have shown promise in performing many medical imaging tasks. However, our ability to explain what signals these models have learned is severely lacking. Explanations are needed in order to increase the trust of doctors in AI-based models, especially in domains where AI prediction capabilities surpass those of humans. Moreover, such explanations could enable novel scientific discovery by uncovering signals in the data that aren't yet known to experts. METHODS In this paper, we present a workflow for generating hypotheses to understand which visual signals in images are correlated with a classification model's predictions for a given task. This approach leverages an automatic visual explanation algorithm followed by interdisciplinary expert review. We propose the following 4 steps: (i) Train a classifier to perform a given task to assess whether the imagery indeed contains signals relevant to the task; (ii) Train a StyleGAN-based image generator with an architecture that enables guidance by the classifier ("StylEx"); (iii) Automatically detect, extract, and visualize the top visual attributes that the classifier is sensitive towards. For visualization, we independently modify each of these attributes to generate counterfactual visualizations for a set of images (i.e., what the image would look like with the attribute increased or decreased); (iv) Formulate hypotheses for the underlying mechanisms, to stimulate future research. Specifically, present the discovered attributes and corresponding counterfactual visualizations to an interdisciplinary panel of experts so that hypotheses can account for social and structural determinants of health (e.g., whether the attributes correspond to known patho-physiological or socio-cultural phenomena, or could be novel discoveries). FINDINGS To demonstrate the broad applicability of our approach, we present results on eight prediction tasks across three medical imaging modalities-retinal fundus photographs, external eye photographs, and chest radiographs. We showcase examples where many of the automatically-learned attributes clearly capture clinically known features (e.g., types of cataract, enlarged heart), and demonstrate automatically-learned confounders that arise from factors beyond physiological mechanisms (e.g., chest X-ray underexposure is correlated with the classifier predicting abnormality, and eye makeup is correlated with the classifier predicting low hemoglobin levels). We further show that our method reveals a number of physiologically plausible, previously-unknown attributes based on the literature (e.g., differences in the fundus associated with self-reported sex, which were previously unknown). INTERPRETATION Our approach enables hypotheses generation via attribute visualizations and has the potential to enable researchers to better understand, improve their assessment, and extract new knowledge from AI-based models, as well as debug and design better datasets. Though not designed to infer causality, importantly, we highlight that attributes generated by our framework can capture phenomena beyond physiology or pathophysiology, reflecting the real world nature of healthcare delivery and socio-cultural factors, and hence interdisciplinary perspectives are critical in these investigations. Finally, we will release code to help researchers train their own StylEx models and analyze their predictive tasks of interest, and use the methodology presented in this paper for responsible interpretation of the revealed attributes. FUNDING Google.
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Affiliation(s)
| | | | - Ilana Traynis
- Work Done at Google Via Advanced Clinical, Deerfield, IL, USA
| | | | | | - Courtney R Lyles
- Google, Mountain View, CA, USA; University of California San Francisco, Department of Medicine, San Francisco, CA, USA
| | | | | | | | | | | | | | | | - Yun Liu
- Google, Mountain View, CA, USA
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17
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Flores MW, Mullin B, Sharp A, Kumar A, Moyer M, Cook BL. Examining Racial/Ethnic Disparities in Tobacco Dependence Treatment Among Medicaid Beneficiaries Using Fifty State Medicaid Claims, 2009-2014. J Racial Ethn Health Disparities 2024; 11:755-763. [PMID: 37326794 DOI: 10.1007/s40615-023-01558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/17/2023]
Abstract
In the USA, low-income racial/ethnic minority groups experience higher smoking rates and greater smoking-related disease burden than their White counterparts. Despite the adverse effects, racial/ethnic minorities are less likely to access tobacco dependence treatment (TDT). Medicaid is one of the largest payers of TDT in the USA and covers predominantly low-income populations. The extent of TDT use among beneficiaries from distinct racial/ethnic groups is unknown. The objective is to estimate racial/ethnic differences in TDT use among Medicaid fee-for-service beneficiaries. Using a retrospective study design and 50 state (including the District of Columbia) Medicaid claims (2009-2014), we employed multivariable logistic regression models and predictive margin methods to estimate TDT use rates among adults (18-64) enrolled (≥ 11 months) in Medicaid fee-for-service programs (January 2009-December 2014) by race/ethnicity. The population included White (n = 6,536,004), Black (n = 3,352,983), Latinx (n = 2,264,647), Asian (n = 451,448), and Native American/Alaskan Native (n = 206,472) beneficiaries. Dichotomous outcomes reflected service use in the past year. Any TDT use was operationalized as any smoking cessation medication fill, any smoking cessation counseling visit, or any smoking cessation outpatient visit. In secondary analyses, we disaggregated TDT use into three separate outcomes. Results suggested that Black (10.6%; 95% CI = 9.9-11.4%), Latinx (9.5%; 95% CI = 8.9-10.2%), Asian (3.7%; 95% CI = 3.4-4.1%), and Native American/Alaskan Native (13.7%; 95% CI = 12.7-14.7%) beneficiaries had lower TDT use rates compared to White beneficiaries (20.6%). Similar racial/ethnic treatment disparities were identified across all outcomes. By identifying significant racial/ethnic disparities in TDT use between 2009 and 2014, this study provides a benchmark against which to measure recent interventions in state Medicaid programs improving equity in smoking cessation interventions.
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Affiliation(s)
- Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Brian Mullin
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
| | - Amanda Sharp
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Center for Mindfulness & Compassion, Cambridge Health Alliance, Cambridge, MA, USA
| | - Anika Kumar
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Heller School of Social Policy, Brandies University, Waltham, MA, USA
| | - Margo Moyer
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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18
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Mũrage A, Morgan R, Samji H, Smith J. Gendered and racial experiences of moral distress: A scoping review. J Adv Nurs 2024; 80:1283-1298. [PMID: 37849045 DOI: 10.1111/jan.15901] [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: 03/13/2023] [Revised: 08/23/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
AIM To inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such research. DESIGN Scoping review. METHODS The PRISMA (Preferred Reporting Items for Systematic and Meta-Analysis) Extension for Scoping Reviews was adopted. DATA SOURCES Systematic literature search was conducted through PubMed, CINAHL and Web of Science databases. Boolean operators were used to identify moral distress literature which included gender and/or race data and published between 2012 and 2022. RESULTS After screening and full-text review, 73 articles reporting on original moral distress research were included. Analysis was conducted on how gender and race were incorporated in research and interpretation of moral distress experiences among healthcare professionals. IMPACT This study found that while there is an upward trend in including gender and race-disaggregated data in moral distress research, over half of such research did not conduct in-depth analysis of such data. Others only highlighted differential experiences such as moral distress levels of women vis-à-vis men. Only about 20% of publications interrogated how experiences of moral distress differed and/or explored factors behind their findings. CONCLUSION There is a need to not only collect disaggregated data in moral distress research but also engage this data through gender and race-based analysis. Particularly, we highlight the need for intersectional analysis, which can elucidate how social identities and categories (such as gender and race) and structural inequalities (such as those sustained by sexism and racism) interact to influence moral experiences. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Moral distress as experienced by healthcare professionals is increasingly recognized as an important area of research with significant policy implications in the healthcare sector. This study offers insights for nuanced and targeted policy approaches. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Alice Mũrage
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Pacific Institute on Pathogens, Pandemics, and Society, Burnaby, British Columbia, Canada
| | - Rosemary Morgan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasina Samji
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Julia Smith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Pacific Institute on Pathogens, Pandemics, and Society, Burnaby, British Columbia, Canada
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19
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Franklin JB, Leewiwatanakul B, Taylor AD, Baller EB, Zwiebel SJ. Consultation-Liaison Case Conference: Overcoming Bias in the Differential Diagnosis of Psychosis. J Acad Consult Liaison Psychiatry 2024; 65:195-203. [PMID: 37717789 PMCID: PMC10947773 DOI: 10.1016/j.jaclp.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/28/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
We present the case of a 34-year-old Black patient with no significant psychiatric history who presented with catatonia and psychotic symptoms following a recent severe acute respiratory syndrome coronavirus-2 infection, whose diagnosis of coronavirus disease 2019 encephalitis was delayed by premature attribution of his symptoms to a primary psychiatric etiology. Top experts in the consultation-liaison field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching topics include the diagnosis and management of coronavirus disease 2019 encephalitis, cognitive bias, and racial bias. Specifically, this case illustrates the role of the consultation-liaison psychiatrist in identifying medical conditions that may overlap with psychiatric presentations and in advocating for marginalized patients.
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Affiliation(s)
- Joshua B Franklin
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Bruce Leewiwatanakul
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Adrienne D Taylor
- Division of Medical Psychiatry, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - Erica B Baller
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Samantha J Zwiebel
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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20
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Bell K, White S, Diaz A, Bahria P, Sima F, Al-Delaimy WK, dosReis S, Hassan O, Drabarek D, Nisha M, Baptiste-Roberts K, Gwiazdon K, Raynes-Greenow C, Taylor Wilson R, Gaudino JA, da Silveira Moreira R, Jennings B, Gulliver P. Can evidence drive health equity in the COVID-19 pandemic and beyond? J Public Health Policy 2024; 45:137-151. [PMID: 38216689 PMCID: PMC10920204 DOI: 10.1057/s41271-023-00452-3] [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] [Accepted: 11/10/2023] [Indexed: 01/14/2024]
Abstract
Using scoping review methods, we systematically searched multiple online databases for publications in the first year of the pandemic that proposed pragmatic population or health system-level solutions to health inequities. We found 77 publications with proposed solutions to pandemic-related health inequities. Most were commentaries, letters, or editorials from the USA, offering untested solutions, and no robust evidence on effectiveness. Some of the proposed solutions could unintentionally exacerbate health inequities. We call on health policymakers to co-create, co-design, and co-produce equity-focussed, evidence-based interventions with communities, focussing on those most at risk to protect the population as a whole. Epidemiologists collaborating with people from other relevant disciplines may provide methodological expertise for these processes. As epidemiologists, we must interrogate our own methods to avoid propagating any unscientific biases we may hold. Epidemiology must be used to address, and never exacerbate, health inequities-in the pandemic and beyond.
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Affiliation(s)
- Katy Bell
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia.
- International Network for Epidemiology in Policy, Sydney, NSW, Australia.
| | - Sam White
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Abbey Diaz
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- First Nations Cancer and Wellbeing Research Team, School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Priya Bahria
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- European Medicines Agency, Amsterdam, The Netherlands
| | - Fiona Sima
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Institute for Health Research, University of Bedfordshire, Luton, England, UK
| | - Wael K Al-Delaimy
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Susan dosReis
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- University of Maryland School of Pharmacy, Pharmaceutical Health Services Research, Baltimore, MD, USA
| | - Omar Hassan
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Dorothy Drabarek
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Monjura Nisha
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Kesha Baptiste-Roberts
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
| | - Katy Gwiazdon
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Center for Environmental Ethics and Law, Vienna, VA, USA
| | - Camille Raynes-Greenow
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Robin Taylor Wilson
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Department of Epidemiology & Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA
| | - James A Gaudino
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- School of Public Health, Oregon Health & Sciences University and Portland State University, Portland, OR, USA
| | - Rafael da Silveira Moreira
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Area of Social Medicine, Faculty of Medicine, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Bruce Jennings
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN, USA
| | - Pauline Gulliver
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Section of Social and Community Health, University of Auckland, Auckland, New Zealand
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Syed A, Jacob MS. Languaging psychopathology: neurobiology and metaphor. Front Psychiatry 2024; 15:1320771. [PMID: 38374980 PMCID: PMC10875027 DOI: 10.3389/fpsyt.2024.1320771] [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: 10/22/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Explanatory models of the mind inform our working assumptions about mental illness with direct implications for clinical practice. Neurobiological models assert that the mind can be understood in terms of genetics, chemistry, and neuronal circuits. Growing evidence suggests that clinical deployment of neurobiological models of illness may have unintended adverse effects on patient attitudes, public perception, provider empathy, and the effectiveness of psychiatric treatment. New approaches are needed to find a better language for describing (let alone explaining) the experience of mental illness. To address this gap, we draw upon interdisciplinary sources and semiotic theory to characterize the role of metaphor in the conceptualization and communication of psychopathology. We examine the metaphors recruited by contemporary neurobiological models and metaphor's role in facilitating descriptive clarity or evocative creativity, depending on intention and context. These multiple roles reveal the implications of metaphorical reasoning in clinical practice, including cognitive flexibility, personalized communication, and uncertainty tolerance. With this analysis, we propose a clinical approach that embraces the meta-process of ongoing novel metaphor generation and co-elaboration, or languaging metaphors of psychopathology. Our goal is to bring attention to the value of employing ever-evolving, shapeable metaphorical depictions of psychiatric illness: metaphors that enable a capacity for change in individuals and society, reduce stigma, and nurture recovery.
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Affiliation(s)
- Adnan Syed
- Mental Health Service, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Michael S. Jacob
- Mental Health Service, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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22
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King DE, Lalwani PD, Mercado GP, Dolan EL, Frierson JM, Meyer JN, Murphy SK. The use of race terms in epigenetics research: considerations moving forward. Front Genet 2024; 15:1348855. [PMID: 38356697 PMCID: PMC10864599 DOI: 10.3389/fgene.2024.1348855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
The field of environmental epigenetics is uniquely suited to investigate biologic mechanisms that have the potential to link stressors to health disparities. However, it is common practice in basic epigenetic research to treat race as a covariable in large data analyses in a way that can perpetuate harmful biases without providing any biologic insight. In this article, we i) propose that epigenetic researchers open a dialogue about how and why race is employed in study designs and think critically about how this might perpetuate harmful biases; ii) call for interdisciplinary conversation and collaboration between epigeneticists and social scientists to promote the collection of more detailed social metrics, particularly institutional and structural metrics such as levels of discrimination that could improve our understanding of individual health outcomes; iii) encourage the development of standards and practices that promote full transparency about data collection methods, particularly with regard to race; and iv) encourage the field of epigenetics to continue to investigate how social structures contribute to biological health disparities, with a particular focus on the influence that structural racism may have in driving these health disparities.
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Affiliation(s)
- Dillon E. King
- Nicholas School of the Environment, Duke University, Durham, NC, United States
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, United States
| | - Pooja D. Lalwani
- Nicholas School of the Environment, Duke University, Durham, NC, United States
| | - Gilberto Padilla Mercado
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, United States
| | - Emma L. Dolan
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, United States
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, United States
| | - Johnna M. Frierson
- IDEALS Office, Duke University School of Medicine, Durham, NC, United States
| | - Joel N. Meyer
- Nicholas School of the Environment, Duke University, Durham, NC, United States
| | - Susan K. Murphy
- Nicholas School of the Environment, Duke University, Durham, NC, United States
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, United States
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Campo Redondo M, Andrade G. Nightmare experiences and perceived ethnic discrimination amongst female university students in the United Arab Emirates: a cross-sectional study. J Sleep Res 2024:e14148. [PMID: 38233953 DOI: 10.1111/jsr.14148] [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: 11/11/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
Perceived ethnic discrimination is known to be associated with anxiety and depression, and in turn, anxiety and depression are known to be associated with nightmare frequency and distress. This elicits a question: is perceived ethnic discrimination associated with nightmare frequency and distress? In this study, 179 female university students from the United Arab Emirates were assessed to answer that question. Results showed that while anxiety and depression were related to nightmare experiences, perceived ethnic discrimination was a stronger predictor of nightmare experiences. We posit two explanations for this finding: one based on psychoanalytical insights, and the other based on the Disposition-Stress model with neurobiological correlates. No significant differences were found across ethnicity when it comes to nightmare experiences or perceived ethnic discrimination. This is an encouraging sign of optimal societal integration in the United Arab Emirates.
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24
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Braveman P, Heck K, Dominguez TP, Marchi K, Burke W, Holm N. African immigrants' favorable preterm birth rates challenge genetic etiology of the Black-White disparity in preterm birth. Front Public Health 2024; 11:1321331. [PMID: 38239790 PMCID: PMC10794556 DOI: 10.3389/fpubh.2023.1321331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/07/2023] [Indexed: 01/22/2024] Open
Abstract
Background We examined over a million California birth records for 2010 through 2021 to investigate whether disparities in preterm birth (PTB) by nativity and race support the widely held but hitherto unsubstantiated belief that genetic differences explain the persistent Black-White disparity in PTB. Methods We examined PTB rates and risk ratios among African-, Caribbean-, and U.S.-born Black women compared to U.S.-born White women. Multivariate analyses adjusted for maternal age, education, number of live births, delivery payer, trimester of prenatal care initiation, pre-pregnancy BMI, smoking, and prevalence of poverty in a woman's residence census tract; and for paternal education. Results In adjusted analyses, African-born Black women's PTB rates were no different from those of U.S.-born White women. Discussion The results add to prior evidence making a genetic etiology for the racial disparity in PTB unlikely. If genetic differences tied to "race" explained the Black-White disparity in PTB among U.S.-born women, the African immigrants in this study would have had higher rates of PTB, not the lower rates observed. Multiple explanations for the observed patterns and their implications are discussed. Failure to distinguish causes of PTB from causes of the racial disparity in PTB have likely contributed to erroneous attribution of the racial disparity to genetic differences. Based on the literature, unmeasured experiences of racism, including racism-related stress and adverse environmental exposures, are plausible explanations for the PTB disparity between Black and White U.S.-born women. The favorable birth outcomes of African-born Black immigrants may reflect less exposure to racism during sensitive life periods, e.g., childhood, when they were in African countries, where Black people are in the racial majority.
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Affiliation(s)
- Paula Braveman
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine Heck
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Tyan Parker Dominguez
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Kristen Marchi
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, DC, United States
| | - Nicole Holm
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
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Lo RF, Sasaki JY. Lay Misperceptions of Culture as "Biological" and Suggestions for Reducing Them. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2024; 19:295-311. [PMID: 37493140 PMCID: PMC10790513 DOI: 10.1177/17456916231181139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Culture is typically studied as socialized and learned. Yet lay intuitions may hold that culture is associated with biology via perceptions of race, presenting a problem for those who study culture: There may be a mismatch between how psychologists study culture and how their research is interpreted by lay audiences. This article is a call to researchers to recognize this mismatch as a problem and to critically evaluate the way we study culture. We first describe evidence that laypeople tend to associate culture with notions of folk biology. Next, we propose three suggestions for researchers: explicitly address whether biological processes are, or are not, relevant for studying culture in their work; consider using multiple methods because different methods for studying culture may come with assumptions about culture as more tied to socialization or biology; and represent all people as cultural by studying multiple forms of culture and by contextualizing all psychological research. Last, we provide an example for how researchers can implement these suggestions to encourage more accurate interpretations of findings.
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Affiliation(s)
| | - Joni Y. Sasaki
- Department of Psychology, University of Hawai‘i at Ma-noa
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26
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Nyman K, Okolie F, Davis NL, Hager E, El-Metwally D. Implicit Racial Bias in Evaluation of Neonatal Opioid Withdrawal Syndrome. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01887-w. [PMID: 38110799 DOI: 10.1007/s40615-023-01887-w] [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: 08/22/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE To assess implicit bias by administrating the Modified Finnegan Score (MFS) for quantifying neonatal opioid withdrawal and to evaluate risk of decreased opioid treatment of Black versus White infants. STUDY DESIGN Study participants were nurses recruited from a large tertiary care center who received three clinical vignettes portraying withdrawing infants and were randomized to receive an accompanying photo of either a Black or White infant. MFS results were compared for identical vignettes based on race of infant photo. RESULTS Out of 275 nurses, 70 completed the survey. In vignette 2, nurses aged ≤35 years scored Black infants lower than White infants (MFS=8.3 ± 2 vs. 9.5 ± 1.2, p=0.012). Nurses with <5 years of experience and ≤10 years of experience also scored Black infants lower for the same vignette (8.2 ± 2.3 vs. 9.6 ± 1.2, p=0.032 and 8.3 ± 2 vs. 9.5 ± 1.2, p=0.0083). CONCLUSION Implicit bias may contribute to the difference in opioid treatment.
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Affiliation(s)
- Katherine Nyman
- University of California San Diego School of Medicine, San Diego, CA, USA
- Division of Neonatology, Rady Children's Hospital, San Diego, CA, USA
| | - Francesca Okolie
- University of Maryland Medical Center, Baltimore, MD, USA
- Department of Pediatrics, University of Maryland School of Medicine, 110 South Paca Street, 8th Floor, Baltimore, MD, S-512, USA
| | - Natalie L Davis
- University of Maryland Medical Center, Baltimore, MD, USA
- Department of Pediatrics, University of Maryland School of Medicine, 110 South Paca Street, 8th Floor, Baltimore, MD, S-512, USA
| | - Erin Hager
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dina El-Metwally
- University of Maryland Medical Center, Baltimore, MD, USA.
- Department of Pediatrics, University of Maryland School of Medicine, 110 South Paca Street, 8th Floor, Baltimore, MD, S-512, USA.
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27
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Bennett SJ, Hunt RP, Breathett K, Eaton CB, Garcia L, Jiménez M, Johns TS, Mouton CP, Nassir R, Nuño T, Urrutia RP, Wactawski-Wende J, Cené CW. Racial and Ethnic Differences in Self-Reported COVID-19 Exposure Risks, Concerns, and Behaviors Among Diverse Participants in the Women's Health Initiative Study. J Gerontol A Biol Sci Med Sci 2023; 78:2294-2303. [PMID: 37267463 PMCID: PMC10692417 DOI: 10.1093/gerona/glad133] [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: 07/25/2022] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in coronavirus disease 2019 (COVID-19) risk are well-documented; however, few studies in older adults have examined multiple factors related to COVID-19 exposure, concerns, and behaviors or conducted race- and ethnicity-stratified analyses. The Women's Health Initiative (WHI) provides a unique opportunity to address those gaps. METHODS We conducted a secondary analysis of WHI data from a supplemental survey of 48 492 older adults (mean age 84 years). In multivariable-adjusted modified Poisson regression analyses, we examined predisposing factors and COVID-19 exposure risk, concerns, and behaviors. We hypothesized that women from minoritized racial or ethnic groups, compared to non-Hispanic White women, would be more likely to report: exposure to COVID-19, a family or friend dying from COVID-19, difficulty getting routine medical care or deciding to forego care to avoid COVID-19 exposure, and having concerns about the COVID-19 pandemic. RESULTS Asian women and non-Hispanic Black/African American women had a higher risk of being somewhat/very concerned about risk of getting COVID-19 compared to non-Hispanic White women and each was significantly more likely than non-Hispanic White women to report forgoing medical care to avoid COVID-19 exposure. However, Asian women were 35% less likely than non-Hispanic White women to report difficulty getting routine medical care since March 2020 (adjusted relative risk 0.65; 95% confidence interval 0.57, 0.75). CONCLUSIONS We documented COVID-related racial and ethnic disparities in COVID-19 exposure risk, concerns, and care-related behaviors that disfavored minoritized racial and ethnic groups, particularly non-Hispanic Black/African American women.
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Affiliation(s)
- Serenity J Bennett
- College of Arts & Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca P Hunt
- Fred Hutchinson Cancer Center, Public Health Sciences, Seattle, Washington, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Institute of Cardiology, Indiana University, Indianapolis, Indiana, USA
| | - Charles B Eaton
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA
| | - Lorena Garcia
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Monik Jiménez
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tanya S Johns
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Charles P Mouton
- Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Rami Nassir
- Department of Pathology, University of California, Davis, Davis, California, USA
| | - Tomas Nuño
- Department of Epidemiology & Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Rachel P Urrutia
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jean Wactawski-Wende
- School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Crystal W Cené
- Department of Medicine, University of California San Diego, La Jolla, California, USA
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Mohottige D, Davenport CA, Bhavsar N, Schappe T, Lyn MJ, Maxson P, Johnson F, Planey AM, McElroy LM, Wang V, Cabacungan AN, Ephraim P, Lantos P, Peskoe S, Lunyera J, Bentley-Edwards K, Diamantidis CJ, Reich B, Boulware LE. Residential Structural Racism and Prevalence of Chronic Health Conditions. JAMA Netw Open 2023; 6:e2348914. [PMID: 38127347 PMCID: PMC10739116 DOI: 10.1001/jamanetworkopen.2023.48914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023] Open
Abstract
Importance Studies elucidating determinants of residential neighborhood-level health inequities are needed. Objective To quantify associations of structural racism indicators with neighborhood prevalence of chronic kidney disease (CKD), diabetes, and hypertension. Design, Setting, and Participants This cross-sectional study used public data (2012-2018) and deidentified electronic health records (2017-2018) to describe the burden of structural racism and the prevalence of CKD, diabetes, and hypertension in 150 residential neighborhoods in Durham County, North Carolina, from US census block groups and quantified their associations using bayesian models accounting for spatial correlations and residents' age. Data were analyzed from January 2021 to May 2023. Exposures Global (neighborhood percentage of White residents, economic-racial segregation, and area deprivation) and discrete (neighborhood child care centers, bus stops, tree cover, reported violent crime, impervious areas, evictions, election participation, income, poverty, education, unemployment, health insurance coverage, and police shootings) indicators of structural racism. Main Outcomes and Measures Outcomes of interest were neighborhood prevalence of CKD, diabetes, and hypertension. Results A total of 150 neighborhoods with a median (IQR) of 1708 (1109-2489) residents; median (IQR) of 2% (0%-6%) Asian residents, 30% (16%-56%) Black residents, 10% (4%-20%) Hispanic or Latino residents, 0% (0%-1%) Indigenous residents, and 44% (18%-70%) White residents; and median (IQR) residential income of $54 531 ($37 729.25-$78 895.25) were included in analyses. In models evaluating global indicators, greater burden of structural racism was associated with greater prevalence of CKD, diabetes, and hypertension (eg, per 1-SD decrease in neighborhood White population percentage: CKD prevalence ratio [PR], 1.27; 95% highest density interval [HDI], 1.18-1.35; diabetes PR, 1.43; 95% HDI, 1.37-1.52; hypertension PR, 1.19; 95% HDI, 1.14-1.25). Similarly in models evaluating discrete indicators, greater burden of structural racism was associated with greater neighborhood prevalence of CKD, diabetes, and hypertension (eg, per 1-SD increase in reported violent crime: CKD PR, 1.15; 95% HDI, 1.07-1.23; diabetes PR, 1.20; 95% HDI, 1.13-1.28; hypertension PR, 1.08; 95% HDI, 1.02-1.14). Conclusions and Relevance This cross-sectional study found several global and discrete structural racism indicators associated with increased prevalence of health conditions in residential neighborhoods. Although inferences from this cross-sectional and ecological study warrant caution, they may help guide the development of future community health interventions.
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Affiliation(s)
- Dinushika Mohottige
- Institute for Health Equity Research, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Nrupen Bhavsar
- Center for Community and Population Health Improvement, Duke Clinical and Translational Science Institute, Duke University, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Tyler Schappe
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Michelle J. Lyn
- Center for Community and Population Health Improvement, Duke Clinical and Translational Science Institute, Duke University, Durham, North Carolina
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
| | - Pamela Maxson
- Center for Community and Population Health Improvement, Duke Clinical and Translational Science Institute, Duke University, Durham, North Carolina
| | - Fred Johnson
- Center for Community and Population Health Improvement, Duke Clinical and Translational Science Institute, Duke University, Durham, North Carolina
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
| | - Arrianna M. Planey
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, North Carolina
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
| | - Lisa M. McElroy
- Division of Abdominal Transplant Surgery, Department of Surgery, Duke University, Durham, North Carolina
- Department of Population Health, Duke University, Durham, North Carolina
| | - Virginia Wang
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
- Department of Population Health, Duke University, Durham, North Carolina
| | - Ashley N. Cabacungan
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Patti Ephraim
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
| | - Paul Lantos
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Pediatrics, Duke University, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Sarah Peskoe
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Joseph Lunyera
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Keisha Bentley-Edwards
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
- Samuel DuBois Cook Center on Social Equity, Duke University, Durham, North Carolina
| | - Clarissa J. Diamantidis
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
- Division of Nephrology, Department of Medicine, Duke University, Durham, North Carolina
| | - Brian Reich
- Department of Statistics, North Carolina State University, Raleigh
| | - L. Ebony Boulware
- Wake Forest University School of Medicine, Winston Salem, North Carolina
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Summey R, Benoit M, Williams-Brown MY. Survival differences by race and surgical approach in early-stage operable cervical Cancer. Gynecol Oncol 2023; 179:63-69. [PMID: 37926048 DOI: 10.1016/j.ygyno.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To evaluate if the higher rate of open radical hysterectomy in Black patients, prior to the widespread return to open surgical techniques, mitigated survival disparities and to identify other actionable factors to target for systemic change. METHODS This is a retrospective cohort study including patients from the National Cancer Database with cervical cancer who underwent radical hysterectomy from 2010 to 2018. Patient demographics, clinical characteristics and survival were compared by race and surgical route. Kaplan-Meier plots were constructed. Cox proportional hazards modeling was used to adjust for covariates. RESULTS 7201 patients were eligible for inclusion, 687 (9.5%) Black and 4870 (68%) White. We found that 51% of Black patients and 39% of White patients underwent open surgery. Black patients were 10% less likely to receive Guideline Concordant Care (GCC). Those with publicly-funded insurance had a 40% higher hazard of death compared to private insurance (CI 1.19-1.73 p < 0.001). Black patients who had open surgery had similar 5-year survival compared to White patients who had MIS surgery (0.90 vs 0.91, NS). After adjusting for potential confounders including age, insurance, nodal status, and lymphovascular space invasion, Black patients who had surgery had a 40% higher hazard for death (HR 1.40 95% CI 1.10-1.79, p = 0.007) compared to White patients. CONCLUSIONS A lower 5 and 10-year survival was seen in Black patients, regardless of surgical approach. Adjustment for significant covariates did not resolve this disparity, confirming that these factors do not fully account racial disparities.
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Affiliation(s)
- Rebekah Summey
- Department of Obstetrics and Gynecology at the Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | | | - M Yvette Williams-Brown
- Department of Obstetrics and Gynecology at the Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; Department of Women's Health at the University of Texas at Austin Dell Medical School, 1301 W 38(th) St., Suite 705, Austin, TX 78705, USA.
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30
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Long B, Laux S, Lemon B, Guarente A, Davis M, Casadevall A, Fang F, Shi M, Resnik DB. Factors related to the severity of research misconduct administrative actions: An analysis of office of research integrity case summaries from 1993 to 2023. Account Res 2023:1-22. [PMID: 38010310 PMCID: PMC11128533 DOI: 10.1080/08989621.2023.2287046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
We extracted, coded, and analyzed data from 343 Office of Research Integrity (ORI) case summaries published in the Federal Register and other venues from May 1993 to July 2023 to test hypotheses concerning the relationship between the severity of ORI administrative actions and various demographic and institutional factors. We found that factors indicative of the severity of the respondent's misconduct or a pattern of misbehavior were associated with the severity of ORI administrative actions. Being required by ORI to retract or correct publications and aggravating factors, such as interfering with an investigation, were both positively associated with receiving a funding debarment and with receiving an administrative action longer than three years. Admitting one's guilt and being found to have committed plagiarism (only) were negatively associated with receiving a funding debarment but were neither positively nor negatively associated with receiving an administrative action longer than three years. Other factors, such as the respondent's race/ethnicity, gender, academic position, administrative position, or their institution's NIH funding level or extramural vs. intramural or foreign vs. US status, were neither positively nor negatively associated with the severity of administrative actions. Overall, our findings suggest that ORI has acted fairly when imposing administrative actions on respondents and has followed DHHS guidelines.
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Affiliation(s)
- Brandon Long
- Philosophy, Bowling Green State University, Bowling Green, KY, USA
| | - Savannah Laux
- Philosophy, Mount Saint Mary College, Newburgh, NY, USA
| | | | | | | | - Arturo Casadevall
- Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - Ferric Fang
- Microbiology, University of Washington, Seattle, WA, USA
| | - Min Shi
- Biostatistics, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - David B. Resnik
- Bioethics, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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Pinkney JA, Davis JB, Collins JE, Shebl FM, Jamison MP, Acosta Julbe JI, Bogart LM, Ojikutu BO, Chen AF, Nelson SB. Racial Disparities in Periprosthetic Joint Infections after Primary Total Joint Arthroplasty: A Retrospective Study. Antibiotics (Basel) 2023; 12:1629. [PMID: 37998831 PMCID: PMC10668943 DOI: 10.3390/antibiotics12111629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/05/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
In the United States, racial disparities have been observed in complications following total joint arthroplasty (TJA), including readmissions and mortality. It is unclear whether such disparities also exist for periprosthetic joint infection (PJI). The clinical data registry of a large New England hospital system was used to identify patients who underwent TJA between January 2018 and December 2021. The comorbidities were evaluated using the Elixhauser Comorbidity Index (ECI). We used Poisson regression to assess the relationship between PJI and race by estimating cumulative incidence ratios (cIRs) and 95% confidence intervals (CIs). We adjusted for age and sex and examined whether ECI was a mediator using structural equation modeling. The final analytic dataset included 10,018 TJAs in 9681 individuals [mean age (SD) 69 (10)]. The majority (96.5%) of the TJAs were performed in non-Hispanic (NH) White individuals. The incidence of PJI was higher among NH Black individuals (3.1%) compared with NH White individuals (1.6%) [adjusted cIR = 2.12, 95%CI = 1.16-3.89; p = 0.015]. Comorbidities significantly mediated the association between race and PJI, accounting for 26% of the total effect of race on PJI incidence. Interventions that increase access to high-quality treatments for comorbidities before and after TJA may reduce racial disparities in PJI.
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Affiliation(s)
- Jodian A. Pinkney
- Massachusetts General Hospital, Boston, MA 02114, USA; (F.M.S.)
- Harvard Medical School, Boston, MA 02115, USA; (J.E.C.)
| | - Joshua B. Davis
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.B.D.); (M.P.J.); (J.I.A.J.)
| | - Jamie E. Collins
- Harvard Medical School, Boston, MA 02115, USA; (J.E.C.)
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.B.D.); (M.P.J.); (J.I.A.J.)
| | - Fatma M. Shebl
- Massachusetts General Hospital, Boston, MA 02114, USA; (F.M.S.)
| | - Matthew P. Jamison
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.B.D.); (M.P.J.); (J.I.A.J.)
| | - Jose I. Acosta Julbe
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.B.D.); (M.P.J.); (J.I.A.J.)
| | - Laura M. Bogart
- RAND Corporation, Santa Monica, CA 90401, USA
- Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Bisola O. Ojikutu
- Massachusetts General Hospital, Boston, MA 02114, USA; (F.M.S.)
- Harvard Medical School, Boston, MA 02115, USA; (J.E.C.)
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.B.D.); (M.P.J.); (J.I.A.J.)
- Boston Public Health Commission, Boston, MA 02118, USA
| | - Antonia F. Chen
- Harvard Medical School, Boston, MA 02115, USA; (J.E.C.)
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.B.D.); (M.P.J.); (J.I.A.J.)
| | - Sandra B. Nelson
- Massachusetts General Hospital, Boston, MA 02114, USA; (F.M.S.)
- Harvard Medical School, Boston, MA 02115, USA; (J.E.C.)
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Jayasekera J, El Kefi S, Fernandez JR, Wojcik KM, Woo JMP, Ezeani A, Ish JL, Bhattacharya M, Ogunsina K, Chang CJ, Cohen CM, Ponce S, Kamil D, Zhang J, Le R, Ramanathan AL, Butera G, Chapman C, Grant SJ, Lewis-Thames MW, Dash C, Bethea TN, Forde AT. Opportunities, challenges, and future directions for simulation modeling the effects of structural racism on cancer mortality in the United States: a scoping review. J Natl Cancer Inst Monogr 2023; 2023:231-245. [PMID: 37947336 PMCID: PMC10637025 DOI: 10.1093/jncimonographs/lgad020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/23/2023] [Accepted: 07/03/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Structural racism could contribute to racial and ethnic disparities in cancer mortality via its broad effects on housing, economic opportunities, and health care. However, there has been limited focus on incorporating structural racism into simulation models designed to identify practice and policy strategies to support health equity. We reviewed studies evaluating structural racism and cancer mortality disparities to highlight opportunities, challenges, and future directions to capture this broad concept in simulation modeling research. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Articles published between 2018 and 2023 were searched including terms related to race, ethnicity, cancer-specific and all-cause mortality, and structural racism. We included studies evaluating the effects of structural racism on racial and ethnic disparities in cancer mortality in the United States. RESULTS A total of 8345 articles were identified, and 183 articles were included. Studies used different measures, data sources, and methods. For example, in 20 studies, racial residential segregation, one component of structural racism, was measured by indices of dissimilarity, concentration at the extremes, redlining, or isolation. Data sources included cancer registries, claims, or institutional data linked to area-level metrics from the US census or historical mortgage data. Segregation was associated with worse survival. Nine studies were location specific, and the segregation measures were developed for Black, Hispanic, and White residents. CONCLUSIONS A range of measures and data sources are available to capture the effects of structural racism. We provide a set of recommendations for best practices for modelers to consider when incorporating the effects of structural racism into simulation models.
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Affiliation(s)
- Jinani Jayasekera
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Safa El Kefi
- NYU Langone Health, New York University, New York, NY, USA
| | - Jessica R Fernandez
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlyn M Wojcik
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer M P Woo
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Adaora Ezeani
- Health Behaviors Research Branch of the Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jennifer L Ish
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Manami Bhattacharya
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, and the Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kemi Ogunsina
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Che-Jung Chang
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Camryn M Cohen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Stephanie Ponce
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Dalya Kamil
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Julia Zhang
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
- Sophomore at Williams College, Williamstown, MA, USA
| | - Randy Le
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Amrita L Ramanathan
- Diabetes, Endocrinology, & Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA
| | - Christina Chapman
- Department of Radiation Oncology, Baylor College of Medicine, and the Center for Innovations in Quality, Effectiveness, and Safety in the Department of Medicine, Baylor College of Medicine and the Houston Veterans Affairs, Houston, TX, USA
| | - Shakira J Grant
- Department of Medicine, Division of Hematology, University of North Carolina, Chapel Hill, NC, USA
| | - Marquita W Lewis-Thames
- Department of Medical Social Science, Center for Community Health at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chiranjeev Dash
- Office of Minority Health and Health Disparities Research at the Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research at the Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Allana T Forde
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Spencer JC, Burger EA, Campos NG, Regan MC, Sy S, Kim JJ. Adapting a model of cervical carcinogenesis to self-identified Black women to evaluate racial disparities in the United States. J Natl Cancer Inst Monogr 2023; 2023:188-195. [PMID: 37947333 PMCID: PMC10637021 DOI: 10.1093/jncimonographs/lgad015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/31/2023] [Accepted: 06/11/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Self-identified Black women in the United States have higher cervical cancer incidence and mortality than the general population, but these differences have not been clearly attributed across described cancer care inequities. METHODS A previously established microsimulation model of cervical cancer was adapted to reflect demographic, screening, and survival data for Black US women and compared with a model reflecting data for all US women. Each model input with stratified data (all-cause mortality, hysterectomy rates, screening frequency, screening modality, follow-up, and cancer survival) was sequentially replaced with Black-race specific data to arrive at a fully specified model reflecting Black women. At each step, we estimated the relative contribution of inputs to observed disparities. RESULTS Estimated (hysterectomy-adjusted) cervical cancer incidence was 8.6 per 100 000 in the all-race model vs 10.8 per 100 000 in the Black-race model (relative risk [RR] = 1.24, range = 1.23-1.27). Estimated all-race cervical cancer mortality was 2.9 per 100 000 vs 5.5 per 100 000 in the Black-race model (RR = 1.92, range = 1.85-2.00). We found the largest contributors of incidence disparities were follow-up from positive screening results (47.3% of the total disparity) and screening frequency (32.7%). For mortality disparities, the largest contributor was cancer survival differences (70.1%) followed by screening follow-up (12.7%). CONCLUSION To reduce disparities in cervical cancer incidence and mortality, it is important to understand and address differences in care access and quality across the continuum of care. Focusing on the practices and policies that drive differences in treatment and follow-up from cervical abnormalities may have the highest impact.
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Affiliation(s)
- Jennifer C Spencer
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Emily A Burger
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Nicole G Campos
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mary Caroline Regan
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stephen Sy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Flores MW, Sharp A, Carson NJ, Cook BL. Estimates of Major Depressive Disorder and Treatment Among Adolescents by Race and Ethnicity. JAMA Pediatr 2023; 177:1215-1223. [PMID: 37812424 PMCID: PMC10562990 DOI: 10.1001/jamapediatrics.2023.3996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/08/2023] [Indexed: 10/10/2023]
Abstract
Importance The COVID-19 pandemic has contributed to poorer mental health and a greater need for treatment. Nationally representative estimates of major depressive disorder (MDD) and mental health treatment among US adolescents during the pandemic are needed. Objective To estimate MDD prevalence among adolescents, evaluate mental health treatment use among adolescents with MDD, and assess differences by race and ethnicity. Design, Setting, and Participants This cross-sectional analysis of the nationally representative 2021 National Survey on Drug Use and Health included noninstitutionalized US adolescents between the ages of 12 and 17 years (n = 10 743). Analytic weights were applied to all rates and model estimates to be nationally representative and account for sample design and survey nonresponse. Data were collected from January 14 to December 20, 2021, and analyzed from February 11 to April 3, 2023. Exposures Self-reported race and ethnicity. Main Outcomes and Measures Dichotomous outcomes of MDD as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), MDD-specific mental health treatment, any type of mental health treatment, telehealth visits, and delays in mental health treatment. Results The sample included 10 743 adolescents (51.1% male). Self-reported race and ethnicity included 5.1% Asian, 14.1% Black, 23.3% Latinx, 51.2% White, and 6.3% more than 1 race. Ages were evenly distributed: 34.0% aged 12 to 13 years; 33.3% aged 14 to 15 years; and 32.7% aged 16 to 17 years. Adolescents of more than 1 race or ethnicity had the highest MDD rate (26.5%). Compared with White adolescents, the lowest rates of any MDD treatment overall were found among Latinx adolescents (29.2% [95% CI, 22.2%-36.2%]) and those of more than 1 race or ethnicity (21.1% [95% CI, 11.6%-30.7%]). Similar results were found for treatment by any clinician (Latinx, 25.6% [95% CI, 18.8%-32.4%]; >1 race or ethnicity, 19.1% [95% CI, 9.7%-28.6%]), treatment by a mental health specialist (Latinx, 22.9% [95% CI, 16.9%-28.9%]; >1 race or ethnicity, 16.7% [95% CI, 7.1%-26.3%]), treatment by a nonspecialist clinician (Latinx, 7.3% [95% CI, 3.3%-11.3%]; >1 race or ethnicity, 4.8% [95% CI, 1.9%-7.7%]), and use of any psychotropic medication prescription (Latinx, 11.6% [95% CI, 7.3%-15.9%]; >1 race or ethnicity, 8.3% [95% CI, 2.8%-13.7]). Compared with White adolescents, Black adolescents had lower rates of MDD treatment by any clinician (31.7% [95% CI, 23.7%-39.8%]) and by nonspecialist clinicians (8.4% [95% CI, 3.8%-13.2%]) and experienced lower prescription rates for any psychotropic medication (12.6 [95% CI, 4.6%-20.6%]). Asian (16.0% [95% CI, 5.0%-27.2%]) and Latinx (17.8% [95% CI, 12.6%-23.0%]) adolescents had lower rates of virtual mental health treatment compared with White adolescents. Black (19.1% [95% CI, 14.1%-24.2%]) and Latinx (17.9% [95% CI, 15.0%-21.1%]) adolescents had lower rates of appointments transition to telehealth, while Black adolescents (14.1% [95% CI, 10.7%-17.4%]) experienced delays getting their prescriptions. Conclusions and Relevance During the first full calendar year of the pandemic, approximately 1 in 5 adolescents had MDD, and less than half of adolescents who needed treatment had any mental health treatment. Adolescents in racial and ethnic minority groups, particularly Latinx, experienced the lowest treatment rates. Federal policy should target adolescents as a whole, and minority populations in particular, to ensure equitable treatment access. Efforts should consider the social, racial, ethnic, and cultural determinants of health.
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Affiliation(s)
- Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Amanda Sharp
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Nicholas J. Carson
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Benjamin L. Cook
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Allidina S, Cunningham WA. Motivated Categories: Social Structures Shape the Construction of Social Categories Through Attentional Mechanisms. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2023; 27:393-413. [PMID: 37212415 PMCID: PMC10559649 DOI: 10.1177/10888683231172255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PUBLIC ABSTRACT Social categories like race and gender often give rise to stereotypes and prejudice, and a great deal of research has focused on how motivations influence these biased beliefs. Here, we focus on potential biases in how these categories are even formed in the first place, suggesting that motivations can influence the very categories people use to group others. We propose that motivations to share schemas with other people and to gain resources shape people's attention to dimensions like race, gender, and age in different contexts. Specifically, people will pay attention to dimensions to the degree that the conclusions produced from using those dimensions align with their motivations. Overall, we suggest that simply examining the downstream effects of social categorization like stereotyping and prejudice is not enough, and that research should look earlier in the process at how and when we form the categories on which those stereotypes are based.
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Woo JM, Simmonds F, Dennos A, Son MBF, Lewandowski LB, Rubinstein TB. Health Equity Implications of Missing Data Among Youths With Childhood-Onset Systemic Lupus Erythematosus: A Proof-of-Concept Study in the Childhood Arthritis and Rheumatology Research Alliance Registry. Arthritis Care Res (Hoboken) 2023; 75:2285-2294. [PMID: 37093036 PMCID: PMC10593908 DOI: 10.1002/acr.25136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/15/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Health disparities in childhood-onset systemic lupus erythematosus (SLE) disproportionately impact marginalized populations. Socioeconomically patterned missing data can magnify existing health inequities by supporting inferences that may misrepresent populations of interest. Our objective was to assess missing data and subsequent health equity implications among participants with childhood-onset SLE enrolled in a large pediatric rheumatology registry. METHODS We evaluated co-missingness of 12 variables representing demographics, socioeconomic position, and clinical factors (e.g., disease-related indices) using Childhood Arthritis and Rheumatology Research Alliance Registry childhood-onset SLE enrollment data (2015-2022; n = 766). We performed logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) for missing disease-related indices at enrollment (Systemic Lupus Erythematosus Disease Activity Index 2000 [SLEDAI-2K] and/or Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]) associated with data missingness. We used linear regression to assess the association between socioeconomic factors and SLEDAI-2K at enrollment using 3 analytic methods for missing data: complete case analysis, multiple imputation, and nonprobabilistic bias analyses, with missing values imputed to represent extreme low or high disadvantage. RESULTS On average, participants were missing 6.2% of data, with over 50% of participants missing at least 1 variable. Missing data correlated most closely with variables within data categories (i.e., demographic). Government-assisted health insurance was associated with missing SLEDAI-2K and/or SDI scores compared to private health insurance (OR 2.04 [95% CI 1.22, 3.41]). The different analytic approaches resulted in varying analytic sample sizes and fundamentally conflicting estimated associations. CONCLUSION Our results support intentional evaluation of missing data to inform effect estimate interpretation and critical assessment of causal statements that might otherwise misrepresent health inequities.
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Affiliation(s)
- Jennifer M.P. Woo
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, NC, USA
| | - Faith Simmonds
- Lupus Genomics and Global Health Disparities Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH, DHHS, Bethesda, MD, USA
| | - Anne Dennos
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Mary Beth F. Son
- Division of Immunology, Boston Children’s Hospital, Boston MA, USA
| | - Laura B. Lewandowski
- Lupus Genomics and Global Health Disparities Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH, DHHS, Bethesda, MD, USA
| | - Tamar B. Rubinstein
- Division of Pediatric Rheumatology, Children’s Hospital at Montefiore, Bronx, NY, USA
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
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Faber SC, Metzger IW, La Torre J, Fisher C, Williams MT. The illusion of inclusion: contextual behavioral science and the Black community. Front Psychol 2023; 14:1217833. [PMID: 38022926 PMCID: PMC10643524 DOI: 10.3389/fpsyg.2023.1217833] [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: 05/05/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
Anti-racism approaches require an honest examination of cause, impact, and committed action to change, despite discomfort and without experiential avoidance. While contextual behavioral science (CBS) and third wave cognitive-behavioral modalities demonstrate efficacy among samples composed of primarily White individuals, data regarding their efficacy with people of color, and Black Americans in particular, is lacking. It is important to consider the possible effects of racial stress and trauma on Black clients, and to tailor approaches and techniques grounded in CBS accordingly. We describe how CBS has not done enough to address the needs of Black American communities, using Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP) as examples. We also provide examples at the level of research representation, organizational practices, and personal experiences to illuminate covert racist policy tools that maintain inequities. Towards eradicating existing racism in the field, we conclude with suggestions for researchers and leadership in professional psychological organizations.
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Affiliation(s)
- Sonya C. Faber
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Isha W. Metzger
- Department of Psychology, Georgia State University, Atlanta, GA, United States
| | - Joseph La Torre
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Carsten Fisher
- Behavioral Wellness Clinic, LLC, Tolland, CT, United States
| | - Monnica T. Williams
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Behavioral Wellness Clinic, LLC, Tolland, CT, United States
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
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Martinez JE. Facecraft: Race Reification in Psychological Research With Faces. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023:17456916231194953. [PMID: 37819250 DOI: 10.1177/17456916231194953] [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: 10/13/2023]
Abstract
Faces are socially important surfaces of the body on which various meanings are attached. The widespread physiognomic belief that faces inherently contain socially predictive value is why they make a generative stimulus for perception research. However, critical problems arise in studies that simultaneously investigate faces and race. Researchers studying race and racism inadvertently engage in various research practices that transform faces with specific phenotypes into straightforward representatives of their presumed race category, thereby taking race and its phenotypic associations for granted. I argue that research practices that map race categories onto faces using bioessentialist ideas of racial phenotypes constitute a form of racecraft ideology, the dubious reasoning of which presupposes the reality of race and mystifies the causal relation between race and racism. In considering how to study racism without reifying race in face studies, this article places these practices in context, describes how they reproduce racecraft ideology and impair theoretical inferences, and then suggests counterpractices for minimizing this problem.
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Affiliation(s)
- Joel E Martinez
- Data Science Initiative, Harvard University
- Department of Psychology, Harvard University
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Subramaniam B, Bartlett M. Re-imagining Reproduction: The Queer Possibilities of Plants. Integr Comp Biol 2023; 63:946-959. [PMID: 37024265 PMCID: PMC10563651 DOI: 10.1093/icb/icad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 04/08/2023] Open
Abstract
How did plant sexuality come to so hauntingly resemble human sexual formations? How did plant biology come to theorize plant sexuality with binary formulations of male/female, sex/gender, sperm/egg, active males and passive females-all of which resemble western categories of sex, gender, and sexuality? Tracing the extant language of sex and sexuality in plant reproductive biology, we examine the histories of science to explore how plant reproductive biology emerged historically from formations of colonial racial and sexual politics and how evolutionary biology was premised on the imaginations of racialized heterosexual romance. Drawing on key examples, the paper aims to (un)read plant sexuality and sexual anatomy and bodies to imagine new possibilities for plant sex, sexualities, and their relationalities. In short, plant sex and sexuality are not two different objects of inquiry but are intimately related-it is their inter-relation that is the focus of this essay. One of the key impulses from the humanities that we bring to this essay is a careful consideration of how terms and terminologies are related to each other historically and culturally. In anthropomorphizing plants, if plant sexuality were modeled on human sexual formations, might a re-imagination of plant sexuality open new vistas for the biological sciences? While our definitions of plant sexuality will always be informed by contemporary society and culture, interrogating the histories of our theories and terminologies can help us reimagine a biology that allows for new and more accurate understandings of plants, plant biology, and the evolution of reproduction.
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Affiliation(s)
- Banu Subramaniam
- Department of Women, Gender, Sexuality Studies, UMass Amherst, 130 Hicks Way, Amherst, MA 01003, USA
| | - Madelaine Bartlett
- Department of Biology, UMass Amherst, 611 N Pleasant St, Amherst, MA 01003, USA
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Holt JM, Talsma A, Johnson TS, Ehlinger T. Artificial neural network approaches to identify maternal and infant risk and asset factors using Peridata.Net: a WI-MIOS study. JAMIA Open 2023; 6:ooad080. [PMID: 37719084 PMCID: PMC10500218 DOI: 10.1093/jamiaopen/ooad080] [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: 02/25/2023] [Revised: 06/22/2023] [Accepted: 08/28/2023] [Indexed: 09/19/2023] Open
Abstract
Objective To analyze PeriData.Net, a clinical registry with linked maternal-infant hospital data of Milwaukee County residents, to demonstrate a predictive analytic approach to perinatal infant risk assessment. Materials and Methods Using unsupervised learning, we identified infant birth clusters with similar multivariate health indicator patterns, measured using perinatal variables from 2008 to 2019 from n = 43 969 clinical registry records in Milwaukee County, WI, followed by supervised learning risk-propagation modeling to identify key maternal factors. To understand the relationship between socioeconomic status (SES) and birth outcome cluster assignment, we recoded zip codes in Peridata.Net according to SES level. Results Three self-organizing map clusters describe infant birth outcome patterns that are similar in the multivariate space. Birth outcome clusters showed higher hazard birth outcome patterns in cluster 3 than clusters 1 and 2. Cluster 3 was associated with lower Apgar scores at 1 and 5 min after birth, shorter infant length, and premature birth. Prediction profiles of birth clusters indicate the most sensitivity to pregnancy weight loss and prenatal visits. Majority of infants assigned to cluster 3 were in the 2 lowest SES levels. Discussion Using an extensive perinatal clinical registry, we found that the strongest predictive performance, when considering cluster membership using supervised learning, was achieved by incorporating social and behavioral risk factors. There were inequalities in infant birth outcomes based on SES. Conclusion Identifying infant risk hazard profiles can contribute to knowledge discovery and guide future research directions. Additionally, presenting the results to community members can build consensus for community-identified health and risk indicator prioritization for intervention development.
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Affiliation(s)
- Jeana M Holt
- School of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, United States
| | - AkkeNeel Talsma
- School of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, United States
| | - Teresa S Johnson
- School of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, United States
| | - Timothy Ehlinger
- School of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, United States
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Igbinosa II, Leonard SA, Noelette F, Davies-Balch S, Carmichael SL, Main E, Lyell DJ. Racial and Ethnic Disparities in Anemia and Severe Maternal Morbidity. Obstet Gynecol 2023; 142:845-854. [PMID: 37678935 PMCID: PMC10510811 DOI: 10.1097/aog.0000000000005325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To evaluate antepartum anemia prevalence by race and ethnicity, to assess whether such differences contribute to severe maternal morbidity (SMM), and to estimate the contribution of antepartum anemia to SMM and nontransfusion SMM by race and ethnicity. METHODS We conducted a population-based cohort study using linked vital record and birth hospitalization data for singleton births at or after 20 weeks of gestation in California from 2011 through 2020. Pregnant patients with hereditary anemias, out-of-hospital births, unlinked records, and missing variables of interest were excluded. Antepartum anemia prevalence and trends were estimated by race and ethnicity. Centers for Disease Control and Prevention criteria were used for SMM and nontransfusion SMM indicators. Multivariable logistic regression modeling was used to estimate risk ratios (RRs) for SMM and nontransfusion SMM by race and ethnicity after sequential adjustment for social determinants, parity, obstetric comorbidities, delivery, and antepartum anemia. Population attributable risk percentages were calculated to assess the contribution of antepartum anemia to SMM and nontransfusion SMM by race and ethnicity. RESULTS In total, 3,863,594 births in California were included. In 2020, Black pregnant patients had the highest incidence of antepartum anemia (21.5%), followed by Pacific Islander (18.2%), American Indian-Alaska Native (14.1%), multiracial (14.0%), Hispanic (12.6%), Asian (10.6%), and White pregnant patients (9.6%). From 2011 to 2020, the prevalence of anemia increased more than100% among Black patients, and there was a persistent gap in prevalence among Black compared with White patients. Compared with White patients, the adjusted risk for SMM was high among most racial and ethnic groups; adjustment for anemia after sequential modeling for known confounders decreased SMM risk most for Black pregnant patients (approximated RR 1.47, 95% CI 1.42-1.53 to approximated RR 1.27, 95% CI 1.22-1.37). Compared with White patients, the full adjusted nontransfusion SMM risk remained high for most groups except Hispanic and multiracial patients. Within each racial and ethnic group, the population attributable risk percentage for antepartum anemia and SMM was highest for multiracial patients (21.4%, 95% CI 17.5-25.0%), followed by Black (20.9%, 95% CI 18.1-23.4%) and Hispanic (20.9%, 95% CI 19.9-22.1%) patients. The nontransfusion SMM population attributable risk percentages for Asian, Black, and White pregnant patients were less than 8%. CONCLUSION Antepartum anemia, most prevalent among Black pregnant patients, contributed to disparities in SMM by race and ethnicity. Nearly one in five to six SMM cases among Black, Hispanic, American Indian-Alaska Native, Pacific Islander, and multiracial pregnant patients is attributable in part to antepartum anemia.
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Affiliation(s)
- Irogue I Igbinosa
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, and the Department of Pediatrics, School of Medicine, Stanford University, Stanford, and the BLACK Wellness & Prosperity Center, Fresno, California
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Jarvis GE, Andermann L, Ayonrinde OA, Beder M, Cénat JM, Ben-Cheikh I, Fung K, Gajaria A, Gómez-Carrillo A, Guzder J, Hanafi S, Kassam A, Kronick R, Lashley M, Lewis-Fernández R, McMahon A, Measham T, Nadeau L, Rousseau C, Sadek J, Schouler-Ocak M, Wieman C, Kirmayer LJ. Taking Action on Racism and Structural Violence in Psychiatric Training and Clinical Practice. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:780-808. [PMID: 37198904 PMCID: PMC10517653 DOI: 10.1177/07067437231166985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- G Eric Jarvis
- Division of Social and Transcultural Psychiatry, McGill University, Montréal, QC, Canada; Cultural Consultation Service and Culture and Psychosis Working Group, Jewish General Hospital, Montréal, QC, Canada
| | - Lisa Andermann
- Equity and Inclusion Council; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Oyedeji A Ayonrinde
- Department of Psychiatry, Queen's University, Kingston, ON, Canada; Community Psychiatry, Providence Care, Kingston, ON, Canada
| | - Michaela Beder
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON, Canada
| | - Imen Ben-Cheikh
- Department of Psychiatry, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Kenneth Fung
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Asian Initiative in Mental Health, University Health Network, Toronto, ON, Canada; Society for the Study of Psychiatry and Culture, Beverly Hills, CA, USA
| | - Amy Gajaria
- Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ana Gómez-Carrillo
- Montréal Children's Hospital (MCH), McGill University Health Centre (MUHC), Montréal, QC, Canada; Inuulitsivik Health Centre, Puvirnituq, QC, Canada; Ungava Tulattavik Health Centre, Kuujjuaq, QC, Canada
| | | | - Sarah Hanafi
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Azaad Kassam
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Ottawa Newcomer Health Centre, Ottawa, ON, Canada; Wholistic Health and Wellness, Mohawk Council of Akwesasne, Akwesasne, QC, Canada
| | - Rachel Kronick
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montréal, QC, Canada; Lady Davis Institute and Sherpa Research Institute, Montréal, QC, Canada
| | - Myrna Lashley
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Research Ethics Board, CIUSSS du Centre-Ouest-de-l'île-de-Montréal, Sir B. Mortimer Jewish General Hospital, Montréal, QC, Canada; Lady Davis Institute for Medical Research, Sir B. Mortimer Jewish General Hospital, Montréal, QC, Canada
| | - Roberto Lewis-Fernández
- Columbia University, New York, NY, USA; New York State Center of Excellence for Cultural Competence and Research Area Leader, Anxiety, Mood, Eating and Related Disorders, New York State Psychiatric Institute, New York, NY, USA
| | | | - Toby Measham
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Divisions of Child Psychiatry and Social and Transcultural Psychiatry, McGill University, Montréal, QC, Canada
| | - Lucie Nadeau
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Montréal University Health Centre, Montréal, QC, Canada; Inuulitsivik Health Centre, Puvirnituq, QC, Canada
| | - Cécile Rousseau
- Division of Social and Cultural Psychiatry, McGill University, Montréal, QC, Canada
| | - Joseph Sadek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Meryam Schouler-Ocak
- Social Psychiatry, Charité - Universitätsmedizin, Berlin, Germany; Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Cornelia Wieman
- Indigenous Physicians Association of Canada (IPAC), Vancouver, BC, Canada; First Nations Health Authority (FNHA), Vancouver, BC, Canada
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, Montréal, QC, Canada; Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada
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Francis J, West K. Physical Activity Message Framing and Ethnicity Before and During COVID-19. HEALTH COMMUNICATION 2023; 38:2419-2429. [PMID: 35593173 DOI: 10.1080/10410236.2022.2074344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
People of Black ethnicities are well known to be disproportionately burdened by coronavirus and have poorer health outcomes. Public health messages encouraged physical activity during the pandemic as it is evidenced to positively affect the immune system, however people of Black ethnicities are often reported as failing to achieve the recommended daily amount. Health message framing during COVID-19 specifically in relation to ethnicity and physical activity motivation has yet to be investigated. Two studies examined message frame effect on physical activity motivation prior to and at the onset of the pandemic and how this differed by ethnicity. Gain framed messages were found to positively affect physical activity motivation pre-COVID-19 and during the pandemic fear framed messages were found to positively affect physical activity motivation. Neither of these effects differed by ethnicity. Implications for future physical activity health message framing are discussed.
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Affiliation(s)
| | - Keon West
- Department of Psychology, Goldsmiths, University of London
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DeZure C. Race-Based Medicine Is Racist. Pediatr Ann 2023; 52:e365-e367. [PMID: 37820704 DOI: 10.3928/19382359-20230829-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Race is a social construct and cannot be used as a biological proxy, inherently making race-based medicine racist. Given the history of slavery in the United States, there are deep-rooted racist laws and policies that have impacted the health of families and children of color for centuries. The American Academy of Pediatrics (AAP) has come to acknowledge its racist past and promised a more equitable future for children and its organization. White physicians from the days of slavery created false myths regarding biological differences between races to strengthen their argument for keeping the institution of slavery - some of which are still in use today. It is vital to the health of future generations of this country that there be a shift to practicing race-conscious medicine and addressing the social determinants of health that are responsible for inequitable care. Pediatricians can play a significant role in ensuring health care equity for children now and in the future. [Pediatr Ann. 2023;52(10):e365-e367.].
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Holt EW, Murarka SM, Zhao Z, Baker MV, Omosigho UR, Adam RA. Investigating disparities in compliance of nursing pain reassessment for obstetrics and gynecology patients. Am J Obstet Gynecol 2023; 229:314.e1-314.e11. [PMID: 37330130 PMCID: PMC10268944 DOI: 10.1016/j.ajog.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/13/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Racial and socioeconomic disparities, exacerbated during the COVID-19 pandemic and surrounding socio-political polarization, affect access to, delivery of, and patient perception of healthcare. Perioperatively, the bedside nurse carries the greatest responsibility of direct care, which includes pain reassessment, a metric tracked for compliance. OBJECTIVE This study aimed to critically assess disparities in obstetrics and gynecology perioperative care and how these have changed since March 2020 using nursing pain reassessment compliance within a quality improvement framework. STUDY DESIGN A retrospective cohort of 76,984 pain reassessment encounters from 10,774 obstetrics and gynecology patients at a large, academic hospital from September 2017 to March 2021 was obtained from Tableau: Quality, Safety and Risk Prevention platform. Noncompliance proportions were analyzed by patient race across service lines; a sensitivity analysis was performed excluding patients who were of neither Black nor White race. Secondary outcomes included analysis by patient ethnicity, body mass index, age, language, procedure, and insurance. Additional analyses were performed by temporally stratifying patients into pre- and post-March 2020 cohorts to investigate potential pandemic and sociopolitical effects on healthcare disparities. Continuous variables were assessed with Wilcoxon rank test, categorical variables were assessed with chi-squared test, and multivariable logistic regression analyses were performed (P<.05). RESULTS Noncompliance proportions of pain reassessment did not differ significantly between Black and White patients as an aggregate of all obstetrics and gynecology patients (8.1% vs 8.2%), but greater differences were found within the divisions of Benign Subspecialty Gynecologic Surgery (Minimally Invasive Gynecologic Surgery + Urogynecology) (14.9% vs 10.70%; P=.03) and Maternal Fetal Medicine (9.5% vs 8.3%; P=.04). Black patients admitted to Gynecologic Oncology experienced lower noncompliance proportions than White patients (5.6% vs 10.4%; P<.01). These differences persisted after adjustment for body mass index, age, insurance, timeline, procedure type, and number of nurses attending to each patient with multivariable analyses. Noncompliance proportions were higher for patients with body mass index ≥35 kg/m2 within Benign Subspecialty Gynecology (17.9% vs 10.4%; P<.01). Non-Hispanic/Latino patients (P=.03), those ≥65 years (P<.01), those with Medicare (P<.01), and those who underwent hysterectomy (P<.01) also experienced greater noncompliance proportions. Aggregate noncompliance proportions differed slightly pre- and post-March 2020; this trend was seen across all service lines except Midwifery and was significant for Benign Subspecialty Gynecology after multivariable analysis (odds ratio, 1.41; 95% confidence interval, 1.02-1.93; P=.04). Though increases in noncompliance proportions were seen for non-White patients after March 2020, this was not statistically significant. CONCLUSION Significant race, ethnicity, age, procedure, and body mass index-based disparities were identified in the delivery of perioperative bedside care, especially for those admitted to Benign Subspecialty Gynecologic Services. Conversely, Black patients admitted to Gynecologic Oncology experienced lower levels of nursing noncompliance. This may be in part be related to the actions of a Gynecologic Oncology nurse practioner at our institution who helps coordinate care for the division's postoperative patients. Noncompliance proportions increased after March 2020 within Benign Subspecialty Gynecologic Services. Although this study was not designed to establish causation, possible contributing factors include implicit or explicit biases regarding pain experience across race, body mass index, age, or surgical indication, discrepancies in pain management across hospital units, and downstream effects of healthcare worker burnout, understaffing, increased use of travelers, or sociopolitical polarization since March 2020. This study demonstrates the need for ongoing investigation of healthcare disparities at all interfaces of patient care and provides a way forward for tangible improvement of patient-directed outcomes by utilizing an actionable metric within a quality improvement framework.
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Affiliation(s)
- Edwin W Holt
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
| | - Shivani M Murarka
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Zhiguo Zhao
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Mary V Baker
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Ukpebo R Omosigho
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Rony A Adam
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN
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Loeb S, Ravenell JE, Gomez SL, Borno HT, Siu K, Sanchez Nolasco T, Byrne N, Wilson G, Griffith DM, Crocker R, Sherman R, Washington SL, Langford AT. The Effect of Racial Concordance on Patient Trust in Online Videos About Prostate Cancer: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2324395. [PMID: 37466938 DOI: 10.1001/jamanetworkopen.2023.24395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Importance Black men have a higher risk of prostate cancer compared with White men, but Black adults are underrepresented in online content about prostate cancer. Across racial groups, the internet is a popular source of health information; Black adults are more likely to trust online health information, yet have more medical mistrust than White adults. Objective To evaluate the association between racial representation in online content about prostate cancer and trust in the content and identify factors that influence trust. Design, Setting, and Participants A randomized clinical trial was conducted from August 18, 2021, to January 7, 2022, consisting of a 1-time online survey. Participants included US men and women aged 40 years and older. Data were analyzed from January 2022 to June 2023. Interventions Participants were randomized to watch the same video script about either prostate cancer screening or clinical trials presented by 1 of 4 speakers: a Black physician, a Black patient, a White physician, or a White patient, followed by a questionnaire. Main Outcomes and Measures The primary outcome was a published scale for trust in the information. χ2 tests and multivariable logistic regression were used to compare trust according to the video's speaker and topic. Results Among 2904 participants, 1801 (62%) were men, and the median (IQR) age was 59 (47-69) years. Among 1703 Black adults, a greater proportion had high trust in videos with Black speakers vs White speakers (72.7% vs 64.3%; adjusted odds ratio [aOR], 1.62; 95% CI, 1.28-2.05; P < .001); less trust with patient vs physician presenter (64.6% vs 72.5%; aOR, 0.63; 95% CI, 0.49-0.80; P < .001) and about clinical trials vs screening (66.3% vs 70.7%; aOR, 0.78; 95% CI, 0.62-0.99; P = .04). Among White adults, a lower proportion had high trust in videos featuring a patient vs physician (72.0% vs 78.6%; aOR, 0.71; 95% CI, 0.54-0.95; P = .02) and clinical trials vs screening (71.4% vs 79.1%; aOR, 0.57; 95% CI, 0.42-0.76; P < .001), but no difference for Black vs White presenters (76.8% vs 73.7%; aOR, 1.11; 95% CI, 0.83-1.48; P = .49). Conclusions and Relevance In this randomized clinical trial, prostate cancer information was considered more trustworthy when delivered by a physician, but racial concordance was significantly associated with trust only among Black adults. These results highlight the importance of physician participation and increasing racial diversity in public dissemination of health information and an ongoing need for public education about clinical trials. Trial Registration ClinicalTrials.gov Identifier: NCT05886751.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University Langone Health, New York
- Department of Population Health, New York University Langone Health, New York
- Department of Surgery/Urology, Manhattan Veterans Affairs, New York, New York
| | - Joseph E Ravenell
- Department of Population Health, New York University Langone Health, New York
| | - Scarlett Lin Gomez
- Department of Urology and Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | - Hala T Borno
- Department of Urology and Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
- Trial Library, Inc., San Francisco, California
| | - Katherine Siu
- Department of Urology, New York University Langone Health, New York
- Department of Population Health, New York University Langone Health, New York
| | - Tatiana Sanchez Nolasco
- Department of Urology, New York University Langone Health, New York
- Department of Population Health, New York University Langone Health, New York
| | - Nataliya Byrne
- Department of Urology, New York University Langone Health, New York
- Department of Population Health, New York University Langone Health, New York
| | | | | | - Rob Crocker
- Stakeholder Advisory Board, New York, New York
| | | | - Samuel L Washington
- Department of Urology and Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | - Aisha T Langford
- Department of Population Health, New York University Langone Health, New York
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Schmidt IM, Shohet M, Serrano M, Yadati P, Menn-Josephy H, Ilori T, Eneanya ND, Cleveland Manchanda EC, Waikar SS. Patients' Perspectives on Race and the Use of Race-Based Algorithms in Clinical Decision-Making: a Qualitative Study. J Gen Intern Med 2023; 38:2045-2051. [PMID: 36811702 PMCID: PMC9945816 DOI: 10.1007/s11606-023-08035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/30/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Clinical algorithms that incorporate race as a modifying factor to guide clinical decision-making have recently been criticized for propagating racial bias in medicine. Equations used to calculate lung or kidney function are examples of clinical algorithms that have different diagnostic parameters depending on an individual's race. While these clinical measures have multiple implications for clinical care, patients' awareness of and their perspectives on the application of such algorithms are unknown. OBJECTIVE To examine patients' perspectives on race and the use of race-based algorithms in clinical decision-making. DESIGN Qualitative study using semi-structured interviews. PARTICIPANTS Twenty-three adult patients recruited at a safety-net hospital in Boston, MA. APPROACH Interviews were analyzed using thematic content analysis and modified grounded theory. KEY RESULTS Among the 23 study participants, 11 were women and 15 self-identified as Black or African American. Three categories of themes emerged: The first theme described definitions and the individual meanings participants ascribed to the term race. The second theme described perspectives on the role and consideration of race in clinical decision-making. Most study participants were unaware that race has been used as a modifying factor in clinical equations and rejected the incorporation of race in these equations. The third theme related to exposure to and experience of racism in healthcare settings. Experiences described by non-White participants ranged from microaggressions to overt acts of racism, including perceived racist encounters with healthcare providers. In addition, patients alluded to a deep mistrust in the healthcare system as a major barrier to equitable care. CONCLUSIONS Our findings suggest that most patients are unaware of how race has been used to make risk assessments and guide clinical care. Further research on patients' perspectives is needed to inform the development of anti-racist policies and regulatory agendas as we move forward to combat systemic racism in medicine.
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Affiliation(s)
- Insa M Schmidt
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA.
| | - Merav Shohet
- Department of Anthropology, Boston University College of Arts and Sciences, Boston, MA, USA
| | - Mariana Serrano
- UMass Memorial Health's Office for Diversity, Equity, Inclusion and Belonging, Boston, MA, USA
| | - Pranav Yadati
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA
| | - Hanni Menn-Josephy
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA
| | - Titilayo Ilori
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA
| | - Nwamaka D Eneanya
- Division of Renal-Electrolyte and Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Global Medical Office Fresenius Medical Care, Waltham, MA, USA
| | - Emily C Cleveland Manchanda
- Department of Emergency Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Sushrut S Waikar
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA
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Buxton MA, Fleischer NL, Ro A, O’Neill MS. Structural racism, air pollution and the association with adverse birth outcomes in the United States: the value of examining intergenerational associations. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1190407. [PMID: 38455927 PMCID: PMC10910959 DOI: 10.3389/fepid.2023.1190407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/26/2023] [Indexed: 03/09/2024]
Abstract
Structurally racist policies and practices of the past are likely to be a driving factor in current day differences in exposure to air pollution and may contribute to observed racial and ethnic disparities in adverse birth outcomes in the United States (U.S.). Non-Hispanic Black women in the U.S. experience poorer health outcomes during pregnancy and throughout the life course compared to non-Hispanic White women. This disparity holds even among non-Hispanic Black women with higher socioeconomic status. Reasons for this finding remain unclear, but long-term environmental exposure, either historical exposure or both historical and ongoing exposure, may contribute. Structural racism likely contributes to differences in social and environmental exposures by race in the U.S. context, and these differences can affect health and wellbeing across multiple generations. In this paper, we briefly review current knowledge and recommendations on the study of race and structural racism in environmental epidemiology, specifically focused on air pollution. We describe a conceptual framework and opportunities to use existing historical data from multiple sources to evaluate multi-generational influences of air pollution and structurally racist policies on birth and other relevant health outcomes. Increased analysis of this kind of data is critical for our understanding of structural racism's impact on multiple factors, including environmental exposures and adverse health outcomes, and identifying how past policies can have enduring legacies in shaping health and well-being in the present day. The intended purpose of this manuscript is to provide an overview of the widespread reach of structural racism, its potential association with health disparities and a comprehensive approach in environmental health research that may be required to study and address these problems in the U.S. The collaborative and methodological approaches we highlight have the potential to identify modifiable factors that can lead to effective interventions for health equity.
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Affiliation(s)
- Miatta A. Buxton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Nancy L. Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Annie Ro
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, CA, United States
| | - Marie S. O’Neill
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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Cook NE, Gaudet CE, Kissinger-Knox A, Liu BC, Hunter AA, Norman MA, Saadi A, Iverson GL. Race, ethnicity, and clinical outcome following sport-related concussion: a systematic review. Front Neurol 2023; 14:1110539. [PMID: 37388549 PMCID: PMC10306165 DOI: 10.3389/fneur.2023.1110539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/10/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction This systematic review examined whether race or ethnicity are associated with clinical outcomes (e.g., time to return to school/sports, symptom duration, vestibular deficits, and neurocognitive functioning) following sport-related concussion among child, adolescent, or college-aged student athletes. Additionally, this review assessed whether the existing literature on this topic incorporated or included broader coverage of social determinants of health. Methods The online databases PubMed, MEDLINE®, PsycINFO®, CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus, and Web of Science were searched. Results A total of 5,118 abstracts were screened and 12 studies met inclusion criteria, including 2,887 youth and young adults. Among the included articles, only 3 studies (25%) examined whether race and ethnicity were associated with outcomes following concussion as a primary objective. None of the studies assessed the association between social determinants of health and outcomes following concussion as a primary objective, although 5 studies (41.7%) addressed a social determinant of health or closely related topic as a secondary objective. Discussion Overall, the literature to date is extremely limited and insufficient for drawing conclusions about whether race or ethnicity are categorically associated with outcomes from sport-related concussion, or more specifically, whether there are socioeconomic, structural, or cultural differences or disparities that might be associated with clinical outcome. Systematic review registration identifier: PROSPERO, CRD42016041479, CRD42019128300.
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Affiliation(s)
- Nathan E. Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Charles E. Gaudet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Brian C. Liu
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Amy A. Hunter
- Department of Public Health Sciences and Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, United States
- Injury Prevention Center, Connecticut Children's Medical Center and Hartford Hospital, Hartford, CT, United States
| | - Marc A. Norman
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Altaf Saadi
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, United States
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James AK, Matthiesen MI, Jasrasaria R, Jowell AR, Kelly MS, Vyas DA, Zeidman JA, Burnett-Bowie SAM. An Anti-Racism and Equity Initiative Improves Residency Educational Conferences. J Grad Med Educ 2023; 15:322-327. [PMID: 37363675 PMCID: PMC10286935 DOI: 10.4300/jgme-d-22-00443.1] [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] [Received: 06/05/2022] [Revised: 01/07/2023] [Accepted: 03/07/2023] [Indexed: 06/28/2023] Open
Abstract
Background Graduate medical education curricula may reinforce systemic inequities and bias, thus contributing to health disparities. Curricular interventions and evaluation measures are needed to increase trainee awareness of bias and known inequities in health care. Objective This study sought to improve the content of core noontime internal medicine residency educational conferences by implementing the Department of Medicine Anti-Racism and Equity (DARE) educational initiative. Methods DARE best practices were developed from available anti-racism and equity educational materials. Volunteer trainees and faculty in the department of medicine of a large urban academic medical center were recruited and underwent an hourlong training to utilize DARE best practices to coach faculty on improving the anti-racist and equity content of educational conferences. DARE coaches then met with faculty to review the planned 2021-2022 academic year (AY) lectures and facilitate alignment with DARE best practices. A rubric was created from DARE practices and utilized to compare pre-intervention (AY21) and post-intervention (AY22) conferences. Results Using the DARE best practices while coaching increased the anti-racism and equity content from AY21 to AY22 (total rubric score mean [SD] 0.16 [1.19] to 1.38 [1.39]; P=.001; possible scores -4 to +5), with 75% (21 of 28) of AY22 conferences showing improvement. This included increased diversity of photographs, discussion of the racial or ethnic makeup of research study participants, appropriate use of race in case vignettes, and discussion of the impact of racism or bias on health disparities. Conclusions Training coaches to implement DARE best practices improved the anti-racism and equity content of existing noontime internal medicine residency educational conferences.
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Affiliation(s)
- Aisha K. James
- Aisha K. James, MD, MEd, is a Primary Care Physician, Director for Racial Justice in Medicine, Department of Medicine, and Associate Director, Diversity, Equity, and Inclusion Committee, Department of Pediatrics, Massachusetts General Hospital (MGH) and Massachusetts General Hospital for Children (MGfC), and Instructor in Medicine, Harvard Medical School (HMS)
| | - Madeleine I. Matthiesen
- Madeleine I. Matthiesen, MD, is a Hospitalist and Associate Program Director, Internal Medicine and Pediatrics Residency Program, MGH and MGfC, and Instructor in Medicine, HMS
| | - Rashmi Jasrasaria
- Rashmi Jasrasaria, MD, is a Primary Care Physician and Associate Director, Center for Immigrant Health, MGH, and Instructor in Medicine, HMS
| | | | | | - Darshali A. Vyas
- Darshali A. Vyas, MD, is a PGY-4 Pulmonary and Critical Care Fellow, MGH
| | - Jessica A. Zeidman
- Jessica A. Zeidman, MD, is a Primary Care Physician and Primary Care Program Director, Department of Medicine, MGH, and Instructor in Medicine, HMS
| | - Sherri-Ann M. Burnett-Bowie
- Sherri-Ann M. Burnett-Bowie, MD, MPH, is an Endocrinologist, Associate Director, Massachusetts General Center for Diversity and Inclusion, and Chair, Diversity and Inclusion Board, Department of Medicine, MGH, and Assistant Professor, HMS
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