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Rattan J, Bartlett TR, Blanchard C, Tipre M, Amiri A, Baskin ML, Sinkey R, Turan JM. The Relationship Between Provider and Patient Racial Concordance and Receipt of Postpartum Care. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02164-0. [PMID: 39269565 DOI: 10.1007/s40615-024-02164-0] [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: 02/22/2024] [Revised: 08/23/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024]
Abstract
Access to postpartum care (PPC) varies in the US and little data exists about whether patient factors may influence receipt of care. Our study aimed to assess the effect of provider-patient racial concordance on Black patients' receipt of PPC. We conducted a cross-sectional study analyzing over 24,000 electronic health records of childbirth hospitalizations at a large academic medical center in Alabama from January 2014 to March 2020. The primary outcome variable was whether a Black patient with a childbirth hospitalization had any type of PPC visit within 12 weeks after childbirth. We used a generalized estimating equation (GEE) logistic regression model to assess the relationship between provider-patient racial concordance and receipt of PPC. Black patients with Black main providers of prenatal or childbirth care had significantly higher adjusted odds of receiving PPC (adj. OR 2.26, 95% CI 1.65-3.09, p < .001) compared to Black patients with non-Black providers. White patients who had White providers did not have statistically significantly different odds of receiving PPC compared to those with non-White providers after adjustment (adj. OR 0.88, 95% CI 0.68-1.14). Although these results should be interpreted with caution given the low number of Black providers in this sample, our findings suggest that in one hospital system in Alabama, Black birthing people with a racially concordant main prenatal and delivery care provider may have an increased likelihood of getting critical PPC follow-up.
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Affiliation(s)
- Jesse Rattan
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - T Robin Bartlett
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Christina Blanchard
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meghan Tipre
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Azita Amiri
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- College of Nursing, University of Alabama in Huntsville, Huntsville, AL, USA
| | - Monica L Baskin
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rachel Sinkey
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M Turan
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Goodwyn WL, Caiola C, Roberson D. An Integrative Review of the Literature Examining Sexual Relationship Power, Depressive Symptoms, Silencing the Self, and HIV Vulnerability for Women in the United States. J Assoc Nurses AIDS Care 2024:00001782-990000000-00122. [PMID: 39241218 DOI: 10.1097/jnc.0000000000000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2024]
Abstract
ABSTRACT The purpose of our integrative review was to synthesize the literature examining relationships between depressive symptoms, silencing the self (STS), sexual relationship power (SRP), and HIV vulnerability among women in the United States. Literature searches were conducted through CINAHL, MEDLINE, PsycINFO, SCOPUS, Sociological Abstracts, and SocINDEX. Integrative review methodology of Whittemore and Knafl guided the review process, and 37 articles met inclusion criteria. The Theory of Gender and Power, modified by Wingood and DiClemente, was the guiding framework to organize and synthesize findings. Primary findings suggest that depressive symptoms, STS, and SRP in relationships may individually influence women's vulnerability for acquiring HIV, yet research lags behind. Evidence documenting relationships between these factors is insufficient to draw generalizable conclusions. Findings suggest that the current literature on this topic does not reflect those women most highly affected by HIV and those who identify as African American or Black in the Southeast region of the United States.
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Affiliation(s)
- Wanda L Goodwyn
- Wanda Goodwyn, PhD, MSN, RN, (2024 Graduate), East Carolina College of Nursing, Greenville, North Carolina, USA. Courtney Caiola, PhD, MPH, RN, CNE, is an Associate Professor, East Carolina College of Nursing, Affiliated Faculty, Center for Health Disparities, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA. Donna Roberson, PhD, FNP-BC, is Professor and Executive Director for Program Evaluation, East Carolina University, Greenville, North Carolina, USA
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Leve LD, Kanamori M, Humphreys KL, Jaffee SR, Nusslock R, Oro V, Hyde LW. The Promise and Challenges of Integrating Biological and Prevention Sciences: A Community-Engaged Model for the Next Generation of Translational Research. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024:10.1007/s11121-024-01720-8. [PMID: 39225944 DOI: 10.1007/s11121-024-01720-8] [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] [Accepted: 08/11/2024] [Indexed: 09/04/2024]
Abstract
Beginning with the successful sequencing of the human genome two decades ago, the possibility of developing personalized health interventions based on one's biology has captured the imagination of researchers, medical providers, and individuals seeking health care services. However, the application of a personalized medicine approach to emotional and behavioral health has lagged behind the development of personalized approaches for physical health conditions. There is potential value in developing improved methods for integrating biological science with prevention science to identify risk and protective mechanisms that have biological underpinnings, and then applying that knowledge to inform prevention and intervention services for emotional and behavioral health. This report represents the work of a task force appointed by the Board of the Society for Prevention Research to explore challenges and recommendations for the integration of biological and prevention sciences. We present the state of the science and barriers to progress in integrating the two approaches, followed by recommended strategies that would promote the responsible integration of biological and prevention sciences. Recommendations are grounded in Community-Based Participatory Research approaches, with the goal of centering equity in future research aimed at integrating the two disciplines to ultimately improve the well-being of those who have disproportionately experienced or are at risk for experiencing emotional and behavioral problems.
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Affiliation(s)
- Leslie D Leve
- Prevention Science Institute, University of Oregon, Eugene, USA.
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA.
- Cambridge Public Health, University of Cambridge, Cambridge, UK.
| | - Mariano Kanamori
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Kathryn L Humphreys
- Department of Psychology and Human Development, Vanderbilt University, Nashville, USA
| | - Sara R Jaffee
- Department of Psychology, University of Pennsylvania, Philadelphia, USA
| | - Robin Nusslock
- Department of Psychology & Institute for Policy Research, Northwestern University, Evanston, USA
| | - Veronica Oro
- Prevention Science Institute, University of Oregon, Eugene, USA
| | - Luke W Hyde
- Department of Psychology & Survey Research Center at the Institute for Social Research, University of Michigan, Ann Arbor, USA
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Gray A, Fisher CB. An examination of the independent and intersectional effects of racial and heterosexist medical mistrust on timing of sexual/reproductive health care visits among Black sexual minority women in the USA. CULTURE, HEALTH & SEXUALITY 2024; 26:1167-1184. [PMID: 38240328 DOI: 10.1080/13691058.2024.2304150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/05/2024] [Indexed: 09/04/2024]
Abstract
Experiences of racism and heterosexism in medical settings are social and systemic barriers to 'on-time' receipt of sexual and reproductive health services among women with both racial and sexual minority identities. Medical mistrust based on experiences related to these dual identities is associated with avoidance and delays in care. However, investigators are just beginning to apply an intersectional lens to quantitatively understanding such barriers. The purpose of this study was to examine the independent and interaction effects of racial and heterosexist medical mistrust on timing of sexual/reproductive health care among Black sexual minority women who have sex with women and men. A total of 320 women participated in an online study of factors affecting sexual health in this population. Ordinal logistic regression was used to assess the independent and interaction effects of racial and heterosexist medical mistrust on self-reported time since last sexual/reproductive health visit. Results indicated an interaction between the two types of medical mistrust. Research on Black women who have sex with women and men's experiences of racism and heterosexism in the US healthcare system can lead to the development of the comprehensive training programmes needed to alleviate medical mistrust among women with racial and sexual minority identities.
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Affiliation(s)
- Aaliyah Gray
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Celia B Fisher
- Department of Psychology, Fordham University, Bronx, NY, USA
- Center for Ethics Education, Fordham University, Bronx, NY, USA
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ACOG Committee Statement No. 10: Racial and Ethnic Inequities in Obstetrics and Gynecology. Obstet Gynecol 2024; 144:e62-e74. [PMID: 39146552 DOI: 10.1097/aog.0000000000005678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Indexed: 08/17/2024]
Abstract
Disparate health outcomes and unequal access to care have long plagued many communities in the United States. Individual demographic characteristics, such as geography, income, education, and race, have been identified as critical factors when seeking to address inequitable health outcomes. To provide the best care possible, obstetrician-gynecologists should be keenly aware of the existence of and contributors to health inequities and be engaged in the work needed to eliminate racial and ethnic health inequities. Obstetrician-gynecologists should improve their understanding of the etiologies of health inequities by participating in lifelong learning to understand the roles clinician bias and personally mediated, systemic, and structural racism play in creating and perpetuating adverse health outcomes and health care experiences.
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Miller ML, Dupree J, Monette MA, Lau EK, Peipert A. Health Equity and Perinatal Mental Health. Curr Psychiatry Rep 2024; 26:460-469. [PMID: 39008146 DOI: 10.1007/s11920-024-01521-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE OF REVIEW Pregnancy and the postpartum period are vulnerable times to experience psychiatric symptoms. Our goal was to describe existing inequities in perinatal mental health, especially across populations, geography, and in the role of childbirth. RECENT FINDINGS People of color are at an increased risk for perinatal mental health difficulties and more likely to experience neglect, poor communication, and racial discrimination. LGBTQ + individuals encounter unique challenges, implicating the role of heteronormativity, cisnormativity, and gender dysphoria through pregnancy-related processes. Rural-dwelling women are significantly less likely to seek care, be screened for, or receive treatment for perinatal mental health conditions. Trauma-informed, comprehensive mental health support must be provided to all patients during pregnancy, childbirth, and the postpartum period, especially for racially and ethnically minoritized individuals that have often been omitted from care. Future research needs to prioritize inclusion of perinatal populations not well represented in the literature, including rural-dwelling individuals.
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Affiliation(s)
- Michelle L Miller
- Indiana University School of Medicine, Goodman Hall / IU Health Neuroscience Center, Suite 2800 355 W. 16 St. Indianapolis, IN, 46202, Indiana, United States.
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Adler A, Antonia Biggs M, Kaller S, Schroeder R, Prata N, Scott K, Ralph L. The association of experiences of medical mistrust and mistreatment and ever considering self-managing an abortion. Contraception 2024:110697. [PMID: 39214268 DOI: 10.1016/j.contraception.2024.110697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 08/16/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To assess the prevalence of ever considering self-managing an abortion (SMA) and its associations with experiences of medical mistrust and mistreatment in a nationally representative sample. STUDY DESIGN In 2021-22, we conducted a national, cross-sectional, online probability-based survey of US people assigned female at birth ages 15-49. Among those who had ever been pregnant, we ran weighted multivariable logistic regressions to examine whether having had difficulty trusting medical providers and/or experiencing medical mistreatment was associated with SMA consideration. RESULTS Of 4260 participants who had ever been pregnant, 5.2% (95% CI, 4.3%-6.3%) ever considered SMA. Additionally, 38.8% (95% CI, 36.8%-40.9%) reported prior moderate medical mistrust; 17.0% (15.4%-18.6%) experienced neglect of symptoms only, and 22.2% (20.6%-24.0%) experienced ridicule or humiliation in a previous healthcare encounter. In multivariable analyses, those who reported prior high medical mistrust had increased odds of considering SMA (aOR=5.2, [95% CI, 2.9-9.2]), compared to those who had no prior medical mistrust. Those who had experienced ridicule or humiliation by healthcare providers had increased odds of considering SMA (aOR=3.8, [95% CI, 2.3-6.1]), compared to those without such experiences. Participants who believed others perceived them as Black or Arab/Middle Eastern, were poor in their youth, or identified as Lesbian, Gay, Bisexual, Transgender, Queer, and other had higher proportions of considering SMA (p-values<0.01). CONCLUSIONS Experiences of medical mistrust and mistreatment are common and are associated with increased likelihood of considering SMA. Those who identified with a structurally minoritized group were more likely to consider SMA, and those whose "street race" was Arab/Middle Eastern had the highest likelihood. IMPLICATIONS If restrictions on abortion continue to increase, individuals may further consider SMA. Our findings suggest a need to create healthcare environments that foster trust and respect, as well as to ensure people have access to safe options for SMA.
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Affiliation(s)
- Aliza Adler
- Innovating Education in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States.
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Rosalyn Schroeder
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Ndola Prata
- Bixby Center for Population Health and Sustainability, School of Public Health, University of California, Berkeley, CA, United States
| | - Karen Scott
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States; Birthing Cultural Rigor, LLC, Nashville, TN, United States
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
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Clowse MEB, Li J, Snyderman A, Schmajuk G. Alignment of contraception use with the ACR reproductive health guidelines in women with systemic lupus erythematosus within the RISE registry. Lupus Sci Med 2024; 11:e001192. [PMID: 39181689 PMCID: PMC11344492 DOI: 10.1136/lupus-2024-001192] [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: 02/27/2024] [Accepted: 06/27/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES Contraception is crucial for safely timing pregnancies in patients with SLE. This study investigated predictors of contraception documentation in patients with SLE, and the alignment of contraception practices with the 2020 American College of Rheumatology (ACR) guidelines, within the Rheumatology Informatics System for Effectiveness (RISE) registry. MATERIALS AND METHODS Female patients (aged 18-44 years) with SLE were identified via International Classification of Diseases (ICD)-9/ICD-10 coding within the RISE registry, which includes data from rheumatology clinics across the USA. Eligible patients were required to have ≥1 clinical visit in 2019 (prepandemic) or between 1 April 2020 and 30 March 2021 (mid-pandemic). Adjusted multilevel logistic modelling assessed patient, provider and practice characteristics for associations with contraception documentation. Contraception patterns were identified and compared with the 2020 ACR guidelines. RESULTS Contraception documentation rates were similar in the prepandemic and mid-pandemic groups (8.1% and 8.5%, respectively). Higher documentation rates were found in women who were younger, White, and had more visits, as well as those seen within a health system, by a female provider, and within specific regions and electronic health record (EHR) systems. Prescription of a teratogenic medication did not influence contraception documentation or type. Oestrogen-containing contraceptives were prescribed less often to women at high risk for thrombosis (26.2% with thrombotic risk vs 60.6% without, p<0.0001) and history of lupus nephritis (LN) (53.8% with history of LN vs 63.2% without, p=0.024). CONCLUSIONS Practices participating in the RISE registry do not currently record contraception in the large majority of women with SLE, although increased documentation in some EHRs suggests that system changes may improve rates of documentation. Women at higher risk for thrombosis were less likely to receive oestrogen, suggesting that warnings against oestrogen use has impacted contraception prescription, although the limited documentation and limited contraception among women taking teratogenic medications suggest a high unmet need.
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Affiliation(s)
- Megan E B Clowse
- Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jing Li
- Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Amanda Snyderman
- Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gabriela Schmajuk
- Medicine, University of California San Francisco, San Francisco, California, USA
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Gibbs L, Shoai B, Becks A, Yan F, Mitchell-Leef D. Infertility care in an underserved population: A retrospective chart review of a resident-run clinic at an urban, public hospital. J Natl Med Assoc 2024; 116:403-409. [PMID: 39097432 DOI: 10.1016/j.jnma.2024.07.006] [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: 05/09/2023] [Revised: 03/05/2024] [Accepted: 07/02/2024] [Indexed: 08/05/2024]
Abstract
Despite major advances in infertility services, barriers to care as well as disparities in outcomes remain a significant problem. The cost of treatment, lack of or inadequate coverage, and location of infertility clinics are obvious contributors, however, advanced pathology, coexistent medical conditions, and lack of preconception care also contribute to delay in fertility particularly in underserved communities. Previous studies have discussed the role of trainee-run clinics in lower socioeconomic populations in providing low-cost infertility evaluation and management. This study uses a retrospective chart review to compare the etiology and duration of infertility in our patients to the general infertility patient population, to describe the coexistent medical pathologies within our population at initial presentation to infertility care, and to discuss how our clinic is addressing the gap in infertility care. PRECIS: Resident-run clinics offer a unique role in increasing access to care through preconception care and low-cost fertility treatment.
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Affiliation(s)
- Lauren Gibbs
- Department of Obstetrics & Gynecology, Morehouse School of Medicine, Atlanta, GA, USA.
| | - Banafsheh Shoai
- Department of Obstetrics & Gynecology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Alahni Becks
- Department of Obstetrics & Gynecology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Fengxia Yan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Dorothy Mitchell-Leef
- Department of Obstetrics & Gynecology, Morehouse School of Medicine, Atlanta, GA, USA
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Mollard E, Elya A, Gaines C, Salahshurian E, Riordan E, Moore T, Maloney S, Balas MC, Shah N, Owens DC. Reclaiming narratives of empowerment around Black maternal health: a strengths-based, community-informed focus group study. ETHNICITY & HEALTH 2024; 29:703-719. [PMID: 38805258 PMCID: PMC11272425 DOI: 10.1080/13557858.2024.2359384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES Research on Black maternal populations often focuses on deficits that can reinforce biases against Black individuals and communities. The research landscape must shift towards a strengths-based approach focused on the protective assets of Black individuals and communities to counteract bias. This study engaged the local Black community using a strengths-based approach to discuss the assets of Black maternal populations and to inform the design of a future clinical trial focused on reducing Black maternal health disparities. DESIGN Guided by the Theory of Maternal Adaptive Capacity, we conducted three purposive focus group sessions with Black adult community members. The focus groups were semi-structured to cover specific topics, including the strengths of the local community, strengths specific to pregnant community members, how the strengths of community members can support pregnant individuals, and how the strengths of pregnant community members can facilitate a healthy pregnancy. The focus group interviews were transcribed verbatim and analyzed using thematic content analysis. RESULTS Three focus group sessions were conducted with sixteen female individuals identifying as Black or African American. Central themes include (1) the power of pregnancy and motherhood in Black women, (2) challenging negative perceptions and media representation of Black mothers, (3) recognizing history and reclaiming cultural traditions surrounding birth, and (4) community as the foundation of Black motherhood. CONCLUSION Black community members identified powerful themes on Black maternal health through a strengths-based lens. These focus groups fostered relationships with the Black community, elucidated possible solutions to improve Black women's health and wellness, and offered direction on our research design and intervention.
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Affiliation(s)
- Elizabeth Mollard
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anabelle Elya
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Cydney Gaines
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Erin Salahshurian
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Elizabeth Riordan
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tiffany Moore
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shannon Maloney
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michele C. Balas
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Neel Shah
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
- Maven Clinic, New York, NY,USA
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Bastiany A, Towns C, Kimmaliardjuk DM, Kalenga CZ, Burgess SN. Engaging women in decision-making about their heart health: a literature review with patients' perspective. Can J Physiol Pharmacol 2024; 102:431-441. [PMID: 38815591 DOI: 10.1139/cjpp-2023-0471] [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: 06/01/2024]
Abstract
Cardiovascular disease (CVD) remains the leading cause of death globally. Although the burden of CVD risk factors tends to be lower in women, they remain at higher risk of developing complications when affected by these risk factors. There is still a lack of awareness surrounding CVD in women, both from a patient's and a clinician's perspective, especially among visible minorities. However, women who are informed about their heart health and who engage in decision-making with their healthcare providers are more likely to modify their lifestyle, and improve their CVD risk. A patient-centered care approach benefits patients' physical and mental health, and is now considered gold-standard for efficient patient care. Engaging women in their heart health will contribute in closing the gap of healthcare disparities between men and women, arising from sociocultural, socioeconomic, and political factors. This comprehensive review of the literature discusses the importance of engaging women in decision-making surrounding their heart health and offers tools for an effective and culturally sensitive patient-provider relationship.
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Affiliation(s)
- Alexandra Bastiany
- Thunder Bay Regional Health Sciences Centre, Department of Cardiology, Northern Ontario School of Medicine University (NOSMU), Thunder Bay, ON, Canada
| | - Cindy Towns
- Wellington Hospital, Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | | | - Cindy Z Kalenga
- Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Sonya N Burgess
- Nepean Hospital, Department of Cardiology, University of Sydney, Sydney, NSW, Australia
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Dorsey Holliman B, Dieujuste N, Yost E, Allison MA. A Qualitative Inquiry into Nurse-Family Partnership Black Client Perspectives. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024:10.1007/s11121-024-01709-3. [PMID: 39044009 DOI: 10.1007/s11121-024-01709-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Abstract
Nurse-Family Partnership (NFP) is a home visiting program designed to improve pregnancy outcomes, child health and development, and life course outcomes for families facing socioeconomic inequalities through support and education provided by nurses to first-time mothers during pregnancy and up to 2 years postpartum. Studies show that home visiting programs like NFP have positive outcomes, but attrition remains a concern which may impact the desired health equity goals. Black mothers are more likely to withdraw from the NFP program, and research is lacking regarding their experiences in home visiting programs despite facing maternal health inequities rooted in racism. The present study aimed to understand factors that influenced program continuation and provide insights for program improvement. Semi-structured qualitative interviews were conducted with 21 Black NFP clients from multiple sites. Key findings include the importance of the nurse-client relationship, access to reliable health information, and racial concordance in the nurse-client pairing. Clients valued supportive, nonjudgmental nurses who provided dependable support and education. Racially concordant partnerships were perceived as more comfortable and understanding, fostering trust and open communication. Clients also suggested that invasion of privacy during home visits and a lack of connection with their nurse could contribute to program discontinuation. Efforts to increase program retention of Black clients should focus on fostering a strong nurse-client alliance. Recommendations include increasing racial diversity in the nurse workforce, implementing a nurse-client matching system, and allowing clients to request a new nurse if needed.
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Affiliation(s)
- Brooke Dorsey Holliman
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Mailstop F443 | 1890 North Revere Court, Suite P12-3200, Aurora, CO, 80045, USA.
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Nathalie Dieujuste
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Mailstop F443 | 1890 North Revere Court, Suite P12-3200, Aurora, CO, 80045, USA
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Elly Yost
- National Service Office for Nurse-Family Partnership and Child First, Denver, CO, USA
| | - Mandy A Allison
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Mailstop F443 | 1890 North Revere Court, Suite P12-3200, Aurora, CO, 80045, USA
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Rex J, Fifer N, Johnson-Webb KD, Menich M, Horn A, Salamone C, T Renzhofer Pappada H, Arsene C, Martin C, Cunningham M. "She's a Family Member": How Community Health Workers Impact Perinatal Mothers' Stress Through Social-Emotional Support and Connections to Programs and Resources. Health Equity 2024; 8:469-479. [PMID: 39011078 PMCID: PMC11249134 DOI: 10.1089/heq.2024.0038] [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] [Accepted: 05/05/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction This study examines whether being a client in the Northwest Ohio Pathways HUB program reduces stress and improves mental wellbeing for perinatal mothers. The HUB works to improve health by connecting mothers to community health workers (CHWs) who assess mothers' risk factors and connect them to evidence-based care pathways to reduce known risks associated with adverse birth outcomes. Methods A one-time survey of 119 mothers in the program and monthly semi-structured interviews with 41 mothers, totaling 220 interviews. Results Almost all mothers reported significantly reduced stress after joining the program. The majority also reported an improved sense of safety, security, and hope. Interviews show additional moderate reductions in stress over time while being a program client. Interviews also indicate that mothers' relationship with their CHW is key to these improvements: CHW provide social-emotional support, access to tangible goods, and help navigating social service bureaucracies. Discussion The results support the broader literature on the health benefits of community health workers and address identified gaps within the literature, which has infrequently studied CHWs in the perinatal context. Conclusion CHWs may be one way to address racial inequity in birth outcomes linked to infant mortality, given research on the links between inequitable exposure to stressors, the impacts of racism-induced stress, and preterm and low birth weight babies. Further, the findings indicate the need to better support CHWs, and the programs that utilize them, with increased funding, insurance reimbursement, and certification.
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Affiliation(s)
- Justin Rex
- Political Science, Bowling Green State University, Bowling Green, Ohio, USA
| | - Nichole Fifer
- Center for Regional Development, Bowling Green State University, Bowling Green, Ohio, USA
| | - Karen D Johnson-Webb
- School of Earth, Environment, & Society, Bowling Green State University, Bowling Green, Ohio, USA
| | - Maddi Menich
- Center for Regional Development, Bowling Green State University, Bowling Green, Ohio, USA
| | | | | | | | - Camelia Arsene
- ProMedica Health System, University of Toledo School of Population Health, Toledo, Ohio, USA
| | | | - Malcolm Cunningham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Mayor's Office of Neighborhood Safety and Engagement, City of Toledo, Office of the Mayor, Toledo, Ohio, USA
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14
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Agénor M, Noh M, Eiduson R, LeBlanc M, Line EC, Goldman RE, Potter J, Austin SB. Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States. BMC Womens Health 2024; 24:362. [PMID: 38907205 PMCID: PMC11191319 DOI: 10.1186/s12905-024-03151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/17/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND In the United States (U.S.), racially minoritized people have higher rates of cervical cancer morbidity and mortality compared to white individuals as a result of racialized structural, social, economic, and health care inequities. However, cervical cancer screening guidelines are based on studies of predominately white individuals and do not substantially discuss or address racialized cervical cancer inequities and their social determinants, including racism. METHODS We conducted in-depth interviews with health care providers (N = 30) and key informants with expertise in health equity (N = 18). We utilized semi-structured interview guides that addressed providers' views and experiences delivering cervical cancer screening to racially minoritized individuals and key informants' recommendations for advancing racial equity in the development and implementation of cervical cancer screening guidelines. Interviews were analyzed using a template style thematic analysis approach involving deductive and inductive coding, memo writing, and matrix analysis for theme development. RESULTS Most health care providers adopted a universal, one-size-fits-all approach to cervical cancer screening with the stated goal of ensuring racial equality. Despite frequently acknowledging the existence of racialized cervical cancer inequities, few providers recognized the role of social inequities in influencing them, and none discussed the impact of racism. In contrast, key informants overwhelmingly recommended that providers adopt an approach to cervical cancer screening and follow-up care that recognizes the role of racism in shaping racialized cervical cancer and related social inequities, is developed in partnership with racially minoritized communities, and involves person-centered, structurally-competent, and trauma-informed practices that address racially minoritized peoples' unique lived experiences in historical and social context. This racism-conscious approach is not to be confused with race-based medicine, which is an essentialist and racist approach to health care that treats race as a biological variable rather than as a social and political construct. CONCLUSIONS Developers and implementers of cervical cancer screening guidelines should explicitly recognize and address the impact of racism on cervical cancer screening, follow-up care, and outcomes, meaningfully incorporate racially minoritized communities' perspectives and experiences, and facilitate provider- and institutional-level practices that foster racial equity in cervical cancer.
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Affiliation(s)
- Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, MPH Box G-S121-4, Providence, RI, 02912, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Madeline Noh
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA
| | - Rose Eiduson
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Merrily LeBlanc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Sociology, Northeastern University, Boston, MA, USA
| | - Emmett C Line
- Teachers College, Columbia University, New York, NY, USA
| | - Roberta E Goldman
- Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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15
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Lapping-Carr L, Pappa ML. Evidence for the Impact of Stress and Trauma on Sexual Function in Women: Review and Clinical Recommendations. Obstet Gynecol Clin North Am 2024; 51:285-298. [PMID: 38777484 DOI: 10.1016/j.ogc.2024.02.003] [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: 05/25/2024]
Abstract
Stressors occur in a spectrum, ranging from daily hassles to life-threatening experiences, and can significantly impact sexual functioning. Thus, this review summarizes the intricate relationship between trauma spectrum experiences and women's sexual functioning. Biological mechanisms are described to elucidate the physiologic complexity that manifests because of trauma-related experiences. Additionally, both psychological and social implications are discussed. Treatment recommendations for practitioners working with women are discussed, underscoring the importance of adopting a trauma-informed care model.
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Affiliation(s)
- Leiszle Lapping-Carr
- Northwestern University, 676 North St Clair Street, Suite 1100, Chicago, IL 60611, USA.
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16
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Small L, Mellins C. Mental Health and Treatment Engagement among Low-Income Women of Color Living with HIV. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:393-404. [PMID: 38535437 DOI: 10.1080/19371918.2024.2323693] [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: 04/10/2024]
Abstract
Low-income women of color are disproportionately more likely to contract HIV, struggle with treatment adherence, and have compromised health as a result of HIV infections in comparison to White and more affluent women. The current study is a secondary analysis aimed at examining the association between stress, symptoms of depression, trauma exposure, healthcare engagement, and adherence self-efficacy, among low-income women of color with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Structural equation modeling is used to identify latent mental health symptoms that may influence one another, as well as outcomes involving treatment engagement. Participants contributing to this dataset (n = 134) were low income, women of color (primarily African American) living with HIV or AIDS, receiving care at a major medical center in the northeastern United States. Findings indicate significant indirect associations between perceived stress and the outcome of medical appointment attendance. Significant mediators of this indirect relationship include depressive symptoms, parenting stress, and adherence self-efficacy. Implications for health and behavioral health practice and policy interventions are drawn. Areas in need of future research are identified.
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Affiliation(s)
- Latoya Small
- UCLA Luskin School of Public Affairs, Department of Social Welfare, Los Angeles, California, USA
| | - Claude Mellins
- Medical Psychology (in Sociomedical Sciences and Psychiatry), Columbia University and New York State Psychiatric Institute, New York, USA
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17
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Darko NA, Wilson CL, Oliver V. "We are mothers, sisters, and lovers too": Examining young Black women's experiences navigating sex and sexual health. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 38736243 DOI: 10.1002/ajcp.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/20/2024] [Accepted: 04/09/2024] [Indexed: 05/14/2024]
Abstract
In Canada, there is a lack of research that addresses the sexual health and well-being of African, Caribbean, and Black young women. This paper aims to gather perspectives of young Black women to address the social contexts of how young Black women navigate issues related to sex and sexual health. Young Black women experience unique dynamics in navigating their sexualities and sexual healthcare. The nuanced experiences stem from social contexts with historical underpinnings, such as the perception of Black women's bodies, Black identity, gender roles, and sexual double standards. This Community-Based Participatory Research study (N = 24) utilized focus groups to examine young Black women's experiences navigating sexual health. Employing a thematic analysis, participants identified four themes representing their narratives of navigating sexual health. The themes included the perceptions and hypersexuality of Black women's bodies, navigating sexual double standards and gender roles as Black women, diverse Blackness, and migration experiences concerning sexual health and surveillance of Black women's bodies. This paper is intended to add to scholarly discourse and will include practical strategies for use by researchers and community practitioners in sexual health within the Black community.
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Affiliation(s)
- Natasha A Darko
- Department of Psychology, Faculty of Science, Wilfrid Laurier University, Waterloo, Canada
| | - Ciann L Wilson
- Department of Psychology, Faculty of Science, Wilfrid Laurier University, Waterloo, Canada
| | - Vanessa Oliver
- Faculty of Liberal Arts, Child and Youth Studies, Wilfrid Laurier University, Brantford, Canada
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18
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Hernandez-Green N, Haiman M, McDonald A, Rollins L, Franklin C, Farinu O, Clarke L, Huebshmann A, Fort M, Chandler R, Brocke P, McLaurin-Glass D, Harris E, Berry K, Suarez A, Williams T. A Development and Implementation of a Preconception Counseling Program for Black Women and Men in the Southeastern United States: A Pilot Protocol. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.22.24306171. [PMID: 38712274 PMCID: PMC11071590 DOI: 10.1101/2024.04.22.24306171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Introduction Racial/ethnic disparities in maternal mortality rates represent one of the most significant areas of disparities amongst all conventional population perinatal health measures in the U.S. The alarming trends and persistent disparities of outcomes by race/ethnicity and geographic location reinforce the need to focus on ensuring quality and safety of maternity care for all women. Despite complex multilevel factors impacting maternal mortality and morbidity, there are evidence-based interventions that, when facilitated consistently and properly, are known to improve the health of mothers before, during and after pregnancy. The objective of this project is to test implementation of pre-conception counseling with father involvement in community-based settings to improve cardiovascular health outcomes before and during pregnancy in southeastern United States. Methods and Analysis This study has two components: a comprehensive needs and assets assessment and a small-scale pilot study. We will conduct a community informed needs and assets assessment with our diverse stakeholders to identify opportunities and barriers to preconception counseling as well as develop a stakeholder-informed implementation plan. Next, we will use the implementation plan to pilot preconception counseling with father involvement in community-based settings. Finally, we will critically assess the context, identify potential barriers and facilitators, and iteratively adapt the way preconception counseling can be implemented in diverse settings. Results of this research will support future research focused on identifying barriers and opportunities for scalable and sustainable public health approaches to implementing evidence-based strategies that reduce maternal morbidity and mortality in the southeastern United States' vulnerable communities. Discussion Findings will demonstrate that preconception counseling can be implemented in community health settings in the southeastern United States. Furthermore, this study will build the capacity of community-based organizations in addressing the preconception health of their clients. We plan for this pilot to inform a larger scaled-up clinical trial across community health settings in multiple southeastern states.
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Affiliation(s)
- N. Hernandez-Green
- Morehouse School of Medicine, Center for Maternal Health Equity, Atlanta, GA, USA
| | - M. Haiman
- Morehouse School of Medicine, Center for Maternal Health Equity, Atlanta, GA, USA
- University of Texas at Austin, Steve Hicks School of Social Work, Austin, TX, USA
| | - A. McDonald
- Morehouse School of Medicine, Center for Maternal Health Equity, Atlanta, GA, USA
| | - L. Rollins
- Morehouse School of Medicine, Department of Community Health and Preventive Medicine, Atlanta, GA, USA
- National African American Child & Family Research Center, Atlanta, GA, USA
| | - C.G. Franklin
- Morehouse School of Medicine, Department of Obstetrics and Gynecology, Atlanta, GA, USA
| | - O.T.O Farinu
- Morehouse School of Medicine, Center for Maternal Health Equity, Atlanta, GA, USA
| | - L. Clarke
- Morehouse School of Medicine, Center for Maternal Health Equity, Atlanta, GA, USA
| | - A. Huebshmann
- University of Colorado Anschutz Medical Campus, School of Medicine, Department of Medicine, Division of General Internal Medicine Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, School of Medicine, Ludeman Family Center for Women’s Health Research, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, School of Medicine, Adult & Child Center for Outcomes Research & Delivery Science, Aurora, CO, USA
| | - M. Fort
- Colorado School of Public Health, Department of Health Systems, Management & Policy, Aurora, CO, USA
| | - R. Chandler
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - P. Brocke
- Morehouse School of Medicine, Atlanta, GA, USA
| | | | - E. Harris
- Morehouse School of Medicine, Center for Maternal Health Equity, Atlanta, GA, USA
| | - K. Berry
- Morehouse School of Medicine, Center for Maternal Health Equity, Atlanta, GA, USA
| | - A. Suarez
- Morehouse School of Medicine, Center for Maternal Health Equity, Atlanta, GA, USA
| | - T. Williams
- Morehouse School of Medicine, Center for Maternal Health Equity, Atlanta, GA, USA
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19
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Jarlenski M, Cole E, McClure C, Sanders S, Smalls M, Méndez DD. Implementation and early effects of medicaid policy interventions to promote racial equity in pregnancy and early childhood outcomes in Pennsylvania: protocol for a mixed methods study. BMC Health Serv Res 2024; 24:498. [PMID: 38649983 PMCID: PMC11036682 DOI: 10.1186/s12913-024-10982-5] [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: 12/12/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND There are large racial inequities in pregnancy and early childhood health within state Medicaid programs in the United States. To date, few Medicaid policy interventions have explicitly focused on improving health in Black populations. Pennsylvania Medicaid has adopted two policy interventions to incentivize racial health equity in managed care (equity payment program) and obstetric service delivery (equity focused obstetric bundle). Our research team will conduct a mixed-methods study to investigate the implementation and early effects of these two policy interventions on pregnancy and infant health equity. METHODS Qualitative interviews will be conducted with Medicaid managed care administrators and obstetric and pediatric providers, and focus groups will be conducted among Medicaid beneficiaries. Quantitative data on healthcare utilization, healthcare quality, and health outcomes among pregnant and parenting people will be extracted from administrative Medicaid healthcare data. Primary outcomes are stakeholder perspectives on policy intervention implementation (qualitative) and timely prenatal care, pregnancy and birth outcomes, and well-child visits (quantitative). Template analysis methods will be applied to qualitative data. Quantitative analyses will use an interrupted time series design to examine changes over time in outcomes among Black people, relative to people of other races, before and after adoption of the Pennsylvania Medicaid equity-focused policy interventions. DISCUSSION Findings from this study are expected to advance knowledge about how Medicaid programs can best implement policy interventions to promote racial equity in pregnancy and early childhood health.
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Affiliation(s)
- Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, A619, 15261, Pittsburgh, PA, USA.
| | - Evan Cole
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, A619, 15261, Pittsburgh, PA, USA
| | - Christine McClure
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, A619, 15261, Pittsburgh, PA, USA
| | - Sarah Sanders
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Marquita Smalls
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Dara D Méndez
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
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20
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Thorpe S, Vigil K, Iyiewuare P, Malone N, Peterson RL, Hargons CN. "Make Sure You Wash Your Monkey": Multigenerational Vaginal Hygiene Messages from Black Women. HEALTH COMMUNICATION 2024:1-13. [PMID: 38557391 DOI: 10.1080/10410236.2024.2335057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
In the United States, the messages Black women receive about vaginal hygiene are often rooted in misogynoir. As a result, Black women across multiple generations may engage in extensive vaginal hygiene practices that are harmful to their health as a means of decreasing the potential for dehumanization or confirming racist stereotypes. The purpose of the current qualitative study is to explore the messages four generations of Black women (n = 12) received about genital hygiene and grooming and the sociocultural factors that influence these messages. Reflexive thematic analysis was used to analyze the semi-structured interview data. The following themes were identified: (1) a culture of silence, (2) knowledge acquisition, (3) pressure to maintain Black cleanliness standards, and (4) gendered racist messaging. Subthemes emerged within the knowledge acquisition theme, including learning through word-of-mouth, observation, deduction, trial and error, and direct messaging. Overall, themes and subthemes were consistent across generations; however, some differences were discussed. Participants highlighted the importance of intergenerational conversations in promoting safe vaginal hygiene practices. Recommendations for sexuality educators and healthcare professionals are discussed.
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Affiliation(s)
- Shemeka Thorpe
- Department of Kinesiology & Health Promotion, University of Kentucky
| | - Kasey Vigil
- Department of Educational, School, and Counseling Psychology, University of Kentucky
| | | | - Natalie Malone
- Department of Educational, School, and Counseling Psychology, University of Kentucky
| | - Rayven L Peterson
- Department of Educational, School, and Counseling Psychology, University of Kentucky
| | - Candice N Hargons
- Department of Educational, School, and Counseling Psychology, University of Kentucky
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21
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McKetta S, Chakraborty P, Gimbrone C, Soled KRS, Hoatson T, Beccia AL, Reynolds CA, Huang AK, Charlton BM. Restrictive abortion legislation and adverse mental health during pregnancy and postpartum. Ann Epidemiol 2024; 92:47-54. [PMID: 38432536 PMCID: PMC10983835 DOI: 10.1016/j.annepidem.2024.02.009] [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: 08/07/2023] [Revised: 02/06/2024] [Accepted: 02/27/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To determine the impact of abortion legislation on mental health during pregnancy and postpartum and assess whether pregnancy intention mediates associations. METHODS We quantified associations between restrictive abortion laws and stress, depression symptoms during and after pregnancy, and depression diagnoses after pregnancy using longitudinal data from Nurses' Health Study 3 in 2010-2017 (4091 participants, 4988 pregnancies) using structural equation models with repeated measures, controlling for sociodemographics, prior depression, state economic and sociopolitical measures (unemployment rate, gender wage gap, Gini index, percentage of state legislatures who are women, Democratic governor). RESULTS Restrictive abortion legislation was associated with unintended pregnancies (β = 0.127, p = 0.02). These were, in turn, associated with increased risks of stress and depression symptoms during pregnancy (total indirect effects β = 0.035, p = 0.03; β = 0.029, p = 0.03, respectively, corresponding <1% increase in probability), but not after pregnancy. CONCLUSIONS Abortion restrictions are associated with higher proportions of unintended pregnancies, which are associated with increased risks of stress and depression during pregnancy.
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Affiliation(s)
- Sarah McKetta
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States.
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States
| | - Catherine Gimbrone
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Kodiak R S Soled
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States
| | - Tabor Hoatson
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States
| | - Ariel L Beccia
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States
| | - Colleen A Reynolds
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States
| | - Aimee K Huang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States; Department of Pediatrics, Harvard Medical School, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, United States
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22
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Coates EE, de Heer R, McLeod A, Porter SC, Hoffman SB. "Shouldn't Nobody Make a Woman do What they Don't Want to do with their Body": Black Women's Reactions to the Supreme Court's Overturn of Roe v. Wade. J Racial Ethn Health Disparities 2024; 11:968-979. [PMID: 36976512 DOI: 10.1007/s40615-023-01577-7] [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: 11/27/2022] [Revised: 11/27/2022] [Accepted: 03/19/2023] [Indexed: 03/29/2023]
Abstract
Black women, particularly those with low-income, are projected to be the most negatively impacted group following the Supreme Court's overturn of Roe v Wade. It is expected that the rate of increase in live births, as well as the rate of maternal mortality, will be steepest for Black women due to high rates of unmet needs for contraception, unintended pregnancies, poverty, barriers to legal abortion access, and systemic racism. Previous research has shown that the legalization of abortion in 1973 significantly improved educational and employment outcomes for Black women, in particular. The current study seeks to assess the perceptions of predominantly under-resourced Black women following the overturning of Roe v Wade. Eighteen Black women participated in one of five focus groups during the summer of 2022 and shared their reactions to the Supreme Court ruling. Using grounded theory, researchers generated the following themes: sexism via forced births, economic implications, and dangers of banned abortions. Based on participants' concerns resulting from the Roe v Wade overturn, policy implications are provided for improving the following systems: safety net, child welfare, and infant and perinatal mental health care.
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Affiliation(s)
- Erica E Coates
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA.
- MedStar Georgetown University Hospital, 2115 Wisconsin Ave NW, Washington, DC, 20007, USA.
| | - Rebecca de Heer
- Department of Psychology, Georgetown University, Washington, DC, USA
| | - Alison McLeod
- Department of Psychology, Georgetown University, Washington, DC, USA
| | - Shy C Porter
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA
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23
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Chrisphonte P, Bath E. Overturning Roe v Wade and Planned Parenthood v Casey: An Assault to Reproductive and Racial Justice and the Mental Health of Youth. J Am Acad Child Adolesc Psychiatry 2024; 63:393-395. [PMID: 37678665 DOI: 10.1016/j.jaac.2023.08.013] [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: 10/08/2022] [Revised: 07/08/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
On June 24, 2022, the Supreme Court of the United States overturned Roe v Wade and Planned Parenthood v Casey, ending a woman's constitutional right to access abortion. Child and adolescent psychiatrists should be gravely concerned about these decisions. Youth with mental health disorders are an at-risk population. Lack of access to reproductive care, including abortion, will adversely impact the physical and mental health of teens,2 exerting a disproportionate impact on Black and Brown youth, many of whom experience systemic racism and are in systems that leave them structurally vulnerable (ie, in foster care or legal system). These decisions will have a lasting, negative impact on medical, social, and economic outcomes of youth for generations to come. Thus, we make the case that access to reproductive care is a matter of reproductive and racial justice.
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Affiliation(s)
| | - Eraka Bath
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, California
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24
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Haro E, Butcher EA, Alves ML, El Khoury C, Vinson A, Harper DM. Barriers to Cervical Cancer Screening and Satisfaction with Self-Sampling among Black Women in Michigan: a Mixed Methods Study. MEDICAL RESEARCH ARCHIVES 2024; 12:10.18103/mra.v12i4.5209. [PMID: 38818307 PMCID: PMC11138408 DOI: 10.18103/mra.v12i4.5209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Background In recent years, cervical cancer screening among Black women in the United States has declined, followed by increased incidence and mortality. We aim to evaluate the individual, sociocultural, and structural barriers to cervical cancer screening in relationship to the exam technique barriers. Methods Participants received cervical cancer self-screening kits in the mail. They returned their samples and a quantitative survey developed from the Health Information National Trends Survey (HINTS) modules designed to address the known individual, sociocultural, and structural barriers to screening. We established the fourteen attributes of cervical cancer screening techniques from prior work. Participants then shared their experiences in a semi-structured qualitative interview informed by the Theoretical Domains Framework (TDF) to explore the answers to the survey questions. We coded themes from the interviews. Women were grouped as younger (30-45 years) and older (46-65 years). Results Of the 41 women completing the study, 21 were in the younger age group (mean 37.3, SD 4.7), and 20 were in the older age group (56.5 (5.5)). All participants self-identified as African American/Black and were due for cervical cancer screening. Women indicated that individual, sociocultural, and structural barriers influenced their cervical cancer screening, but the most significant barrier was the speculum-based technique itself. Three positive attributes and eight negative attributes significantly differed by screening technique, favoring the self-screening technique. Conclusions The self-screening technique for screening for cervical cancer is feasible and acceptable to this group of Black women.
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Affiliation(s)
- Elizabeth Haro
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Emma A. Butcher
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Martha L Alves
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | | | - Alexandra Vinson
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI
| | - Diane M Harper
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
- Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI
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Hernandez-Green N, Davis MV, Beshara MS, Hernandez-Spalding K, Francis S, Parker A, Farinu O, Chandler R. Examining the Perceptions of mHealth on Racial and Ethnic Disparities in Postpartum Health for Black Women: A Scoping Review. Health Promot Pract 2024:15248399241234636. [PMID: 38556711 DOI: 10.1177/15248399241234636] [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: 04/02/2024]
Abstract
Background. Several disparities exist for Black mothers during the postpartum period, including but not limited to increased maternal mortality and morbidity rates, decreased access to care, and limited access to resources. Given the racial discrepancies in attention to postpartum care, coupled with the critical importance of the postpartum period for preventing adverse maternal health outcomes, research is warranted to explore how mobile health (mHealth) applications may help to alleviate maternal health disparities by optimizing postpartum care and addressing barriers to care for postpartum Black women. Thus, this review examines the perceptions of mHealth applications and their utility in health outcomes among postpartum Black women. Methods. We undertook a comprehensive literature search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included peer-reviewed articles published between 2010 and 2022 that were written in English, utilized mHealth as a primary intervention, and focused on postpartum health and access to resources, primarily among Black women in the United States. Results. A total of eight articles were included in our synthesis, encompassing mobile phone-based interventions for Black women. Cultural tailoring was included in five studies. Interventions that incorporated tailored content and fostered interactions reported high rates of follow-up. Conclusions. Tailored mHealth interventions can effectively promote behavior change and improve health care outcomes for Black women. However, there is a critical need for more research to assess user engagement and retention and whether these improvements indicate long-term sustainability.
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Tiruneh YM, Anwoju O, Harrison AC, Garcia MT, Elbers SK. Examining Health-Seeking Behavior among Diverse Ethnic Subgroups within Black Populations in the United States and Canada: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:368. [PMID: 38541367 PMCID: PMC10970228 DOI: 10.3390/ijerph21030368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 07/13/2024]
Abstract
The Black populations, often treated as ethnically homogenous, face a constant challenge in accessing and utilizing healthcare services. This study examines the intra-group differences in health-seeking behavior among diverse ethnic subgroups within Black communities. A cross-sectional analysis included 239 adults ≥18 years of age who self-identified as Black in the United States and Canada. Multiple logistic regression assessed the relationship between health-seeking behaviors and ethnic origin, controlling for selected social and health-related factors. The mean age of the participants was 38.6 years, 31% were male, and 20% were unemployed. Sixty-one percent reported a very good or excellent health status, and 59.7% were not receiving treatment for chronic conditions. Advancing age (OR = 1.05, CI: 1.01-1.09), female gender (OR = 3.09, CI: 1.47-6.47), and unemployment (OR = 3.46, CI: 1.35-8.90) were associated with favorable health-seeking behaviors. Compared with the participants with graduate degrees, individuals with high school diplomas or less (OR = 3.80, CI: 1.07-13.4) and bachelor's degrees (OR = 3.57, CI: 1.3-9.23) were more inclined to have engaged in favorable health-seeking behavior compared to those with graduate degrees. Across the Black communities in our sample, irrespective of ethnic origins or country of birth, determinants of health-seeking behavior were age, gender, employment status, and educational attainment.
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Affiliation(s)
- Yordanos M. Tiruneh
- School of Medicine, University of Texas at Tyler, Tyler, TX 75708, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | | | - Ariel C. Harrison
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Martha T. Garcia
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Shauna K. Elbers
- School of Interdisciplinary Arts and Sciences, University of Washington Bothell, Bothell, WA 98011, USA;
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Vereen RJ, Wolf MF. Physician Workforce Diversity Is Still Necessary and Achievable if It Is Intentionally Prioritized. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01953-x. [PMID: 38466513 DOI: 10.1007/s40615-024-01953-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/13/2024]
Abstract
The 2023 Supreme Court Decision from Students for Fair Admissions v. Harvard and Students for Fair Admissions v. University of North Carolina threatens the current progress in achieving diversity within undergraduate and graduate medical education. This is necessary to achieve a diverse healthcare workforce, which is a key to healing historical healthcare trauma, eliminating health disparities, and providing equitable healthcare access for all communities. Although the Supreme Court decision seems obstructionist, viable opportunities exist to enhance recruitment further and solidify diversity efforts in undergraduate and graduate medical education to achieve these goals.
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Affiliation(s)
- Rasheda J Vereen
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Uniformed Services University, Carl R. Darnall Army Medical Center, Fort Cavazos, TX, USA.
| | - Mattie F Wolf
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory University School of Medicine & Children's Healthcare of Atlanta, Atlanta, GA, USA
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Waldron EM, Goodman GR, Rivas AM, Ott C, Blyler A, McDonald VW, Campbell M, Underwood E, Bonner A, Wise JM, Elopre L, Kudroff K, Krakower D, Sherr K, Kempf MC, Psaros C. Perceptions of and preferences for PrEP use among African American women and providers in the U.S. South: a qualitative study. Psychol Health 2024:1-20. [PMID: 38441003 PMCID: PMC11374930 DOI: 10.1080/08870446.2024.2322079] [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: 08/12/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE African American (AA) women in the U.S. South experience significant HIV incidence, and efforts to support antiretroviral pre-exposure prophylaxis (PrEP) uptake and maintenance among this group have been insufficient. This study aimed to explore perceptions, attitudes, and implementation preferences surrounding PrEP use for AA women in the U.S. South. METHODS AND MEASURES The study team conducted qualitative interviews with AA cisgender women clients (n = 21) and their providers (n = 20) in Federally Qualified Health Centers and HIV clinics in Alabama. The research team employed directed qualitative content analysis to analyze interview data. RESULTS Five themes emerged: a) inconsistent access to PrEP and PrEP knowledge, b) need for improving low PrEP awareness, c) managing hesitancy to prescribe or use PrEP, d) perceived HIV vulnerability and inherent stigma, and e) normalizing PrEP as part of routine sexual healthcare to increase uptake and maintenance. Interviews revealed an openness towards PrEP as an HIV prevention strategy for AA, cisgender women in Alabama. CONCLUSION Improving PrEP uptake and maintenance among AA women in the U.S. South must go beyond increasing awareness to improving PrEP access and trust through visibility of AA women's PrEP use and incorporating PrEP education and services into routine sexual healthcare.
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Affiliation(s)
- Elizabeth M Waldron
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Georgia R Goodman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- The Fenway Institute at Fenway Health, Boston, MA, USA
| | - Alexa M Rivas
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Corilyn Ott
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Abigail Blyler
- Positive Psychology Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria W McDonald
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marquetta Campbell
- Maude L. Whatley Health Center, Whatley Health Services, Inc, Tuscaloosa, AL, USA
| | - Eric Underwood
- Maude L. Whatley Health Center, Whatley Health Services, Inc, Tuscaloosa, AL, USA
| | - Aharisi Bonner
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jenni M Wise
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Latesha Elopre
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kachina Kudroff
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Douglas Krakower
- The Fenway Institute at Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Mirjam-Colette Kempf
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Thorpe S, Dogan-Dixon J, Malone N, Palomino KA. 'Just be strong and keep going': the influence of Superwoman Schema on Black women's perceived expectations of coping with sexual pain. CULTURE, HEALTH & SEXUALITY 2024; 26:346-361. [PMID: 37226881 PMCID: PMC11214806 DOI: 10.1080/13691058.2023.2210199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 05/01/2023] [Indexed: 05/26/2023]
Abstract
Superwoman Schema, a conceptual framework that reflects Black women's ability to overcome gendered racism and stress, affects the way Black women choose to cope with health-related issues. The purpose of this study was to investigate how Black women perceive they should cope with sexual pain using the Superwoman Schema as an analytic and interpretative guide. Data were derived from participants who completed an individual interview on sexual pain and pleasure. Deductive thematic analysis was conducted. Results indicated whereas some Black women endorsed all five components of Superwoman Schema as coping strategies for sexual pain, other Black women resisted SWS completely. Additionally, one participant was an outlier and did not endorse or resist SWS. Implications for generational sexual health interventions for Black women are discussed.
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Affiliation(s)
- Shemeka Thorpe
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | - Jardin Dogan-Dixon
- Department of Educational, School & Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Natalie Malone
- Department of Educational, School & Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Kaylee A. Palomino
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
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Noh M, Hughto JMW, Austin SB, Goldman RE, Potter J, Agénor M. Promoting equitable sexual health communication among patients with minoritized racial/ethnic, sexual orientation, and gender identities: Strategies, challenges, and opportunities. Soc Sci Med 2024; 344:116634. [PMID: 38394863 PMCID: PMC10947744 DOI: 10.1016/j.socscimed.2024.116634] [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: 07/06/2023] [Revised: 12/15/2023] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
People assigned female at birth (AFAB) with minoritized racial/ethnic, sexual orientation, and gender identities experience notable barriers to high-quality sexual healthcare. In confronting these barriers, patient-provider communication can be a crucial factor, influencing patients' experiences and access to relevant sexual health information and services by determining the quality of care. However, research that investigates this communication among AFAB patients with minoritized social positions is scarce, indicating a research gap regarding the perspectives and roles of healthcare providers in addressing such barriers to care for minoritized patients. Thus, we conducted a qualitative research study, using individual in-depth interviews, to explore the multi-level factors that influence providers' attitudes, knowledge, and skills regarding sexual health communication with AFAB patients with minoritized racial/ethnic, sexual orientation, and gender identities. Interpreting study findings within frameworks of person-centered care, intersectionality, and structural competency, we identified three cross-cutting themes. We found that providers frequently drew on their prior professional training, personal lived experiences, and population-level health disparities data when engaging in sexual health communication with minoritized AFAB patients. Participants reported minimal explicit training in anti-racist and lesbian, gay, bisexual, transgender, and queer (LGBTQ+)-competent care as a significant barrier to engaging in equitable sexual health communication with minoritized AFAB patients, which was exacerbated by many providers' lack of shared social positions and lived experiences with these patients. Providers also frequently applied population-level data to individual patients when formulating counseling and recommendations, which may undermine person-centered sexual health communication. Our findings suggest that critical anti-racist and LGBTQ+-competent provider training is urgently needed, and that health professional education and institutions must be transformed to better reflect and consider the experiences of patients with minoritized racial/ethnic, sexual orientation, and gender identities.
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Affiliation(s)
- Madeline Noh
- Department of Behavioral and Social Sciences, Brown University School of Public Health, USA; Center for Health Promotion and Health Equity, Brown University School of Public Health, USA.
| | - Jaclyn M W Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, USA; Center for Health Promotion and Health Equity, Brown University School of Public Health, USA; Department of Epidemiology, Brown University School of Public Health, USA; The Fenway Institute, Fenway Health, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA; Department of Pediatrics, Harvard Medical School, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, USA
| | - Roberta E Goldman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA; Warren Alpert Medical School, Brown University, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, USA; Department of Medicine, Harvard Medical School, USA; Division of General Medicine, Beth Israel Lahey Health, USA
| | - Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, USA; Center for Health Promotion and Health Equity, Brown University School of Public Health, USA; Department of Epidemiology, Brown University School of Public Health, USA; The Fenway Institute, Fenway Health, USA
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Lerma K, Arey W, Strelitz-Block E, Nathan S, White K. Abortion Clients' Perceptions of Alternative Medication Abortion Service Delivery Options in Mississippi. Womens Health Issues 2024; 34:156-163. [PMID: 38151449 DOI: 10.1016/j.whi.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES We assessed Mississippi abortion clients' perceptions of alternative medication abortion service delivery options that were restricted under state law but available elsewhere. METHODS We conducted in-depth interviews with medication abortion clients between November 2020 and March 2021 at Mississippi's only abortion facility. We described alternative service delivery models: telemedicine, medications by mail, and follow-up care in their community versus returning to the facility. We asked if participants would be interested in using any of these models, if available, and how use of each model would have changed their abortion experience. We used thematic analysis, organizing codes into common themes based on participants' preferences and concerns for each option. RESULTS Of the 25 participants interviewed, nearly all (n = 22) expressed interest in at least one option and reported that, had they been available, these would have alleviated cost, travel, and childcare barriers. Many believed these options would further ensure privacy, but a minority thought abortion was too sensitive for telemedicine or were concerned about mailing errors. Participants not interested in the alternative options also feared missing valued aspects of face-to-face care. Most did not return to the facility for follow-up (n = 19), citing financial and logistical barriers. Largely, participants were not interested in obtaining follow-up care in their community, citing concerns about provider judgment, stigma, and privacy. CONCLUSIONS Mississippi abortion clients were interested in models that would make abortion care more convenient while ensuring their privacy and allowing for meaningful client-provider interaction. These features of care should guide the development of strategies aimed at helping those in restricted settings, such as Mississippi, to overcome barriers to abortion care following the implementation of abortion bans in many states following the overturn of Roe v. Wade.
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Affiliation(s)
- Klaira Lerma
- Population Research Center, The University of Texas at Austin, Austin, Texas.
| | - Whitney Arey
- Population Research Center, The University of Texas at Austin, Austin, Texas; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eva Strelitz-Block
- Population Research Center, The University of Texas at Austin, Austin, Texas
| | - Sacheen Nathan
- Jackson Women's Health Organization, Jackson, Mississippi
| | - Kari White
- Population Research Center, The University of Texas at Austin, Austin, Texas; Department of Sociology, The University of Texas at Austin, Austin, Texas; Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas
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Suarez-Balcazar Y, Buckingham S, Rusch DB, Charvonia A, Young RI, Lewis RK, Ford-Paz RE, Mehta TG, Perez CM. Reproductive justice for Black, Indigenous, Women of Color: Uprooting race and colonialism. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 73:159-169. [PMID: 36912117 DOI: 10.1002/ajcp.12650] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 07/01/2022] [Accepted: 11/25/2022] [Indexed: 06/18/2023]
Abstract
Historically, atrocities against Black, Indigenous, and Women of Color's (BIWoC) reproductive rights have been committed and continue to take place in contemporary society. The atrocities against BIWoC have been fueled by White supremacy ideology of the "desirable race" and colonial views toward controlling poverty and population growth, particularly that of "undesirable" races and ethnicities. Grounded in Critical Race Theory, this paper aims to provide a critical analysis of historical and contemporary violations of BIWoC reproductive rights; discuss interventions based on empowerment and advocacy principles designed to promote women's reproductive justice; and discuss implications for future research, action, and policy from the lenses of Critical Race Theory and Community Psychology. This paper contributes to the special issue by critically analyzing historical and contemporary racism and colonialism against BIWoC, discussing implications for future research and practice, and making policy recommendations.
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Affiliation(s)
| | - Sara Buckingham
- Department of Psychology, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Dana B Rusch
- Department of Psychiatry, Institute for Juvenile Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Alissa Charvonia
- Department of Psychology, Howard University, Washington, District of Columbia, USA
| | | | - Rhonda K Lewis
- Department of Psychology, Wichita State University, Wichita, Kansas, USA
| | - Rebecca E Ford-Paz
- Pritzker Department of Psychiatry and Behavioral Health; Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tara G Mehta
- Department of Psychiatry, Institute for Juvenile Research, University of Illinois Chicago, Chicago, Illinois, USA
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Emerson A, Dogan M, Hawes E, Wilson K, Chana SM, Kelly PJ, Comfort M, Ramaswamy M. Cervical cancer screening barriers and facilitators from the perspectives of women with a history of criminal-legal system involvement and substance use. HEALTH & JUSTICE 2024; 12:9. [PMID: 38407688 PMCID: PMC10895855 DOI: 10.1186/s40352-024-00262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND The wide availability of routine screening with Papanicolaou (Pap) tests and vaccinations against human papillomavirus has resulted in a decline in rates of cervical cancer. As with other diseases, however, disparities in incidence and mortality persist. Cervical cancer, is found more often, at later stages, and has worse outcomes in people who live in rural areas, identify as Black or Hispanic, and in people who are incarcerated. Studies report 4-5 times higher rates of cervical cancer incidence in people detained in jails and prisons than in community-based samples. Studies to explain cervical cancer differences have been inconclusive, though there is broad consensus that issues of access play a role. In this study, we sought to learn more from people who have a history of criminal-legal system involvement and substance use about what barriers and facilitators they perceive in accessing cervical cancer preventive health and other support services in the community. RESULTS We conducted semi-structured interviews with open-ended questions by telephone with 20 self-identified women, ages 22-58, in Birmingham, Alabama. Interviews were audio recorded and transcribed and the transcripts analyzed using immersion-crystallization techniques. Our team identified two main themes, making connections: the importance of interpersonal communication, which stressed barriers and facilitators related to what makes for effective and humanistic interactions in cervical health prevention and other services, and getting it done: the logistics of access and availability, which highlighted elements of cost and payment; scheduling; transportation; and clinic policies. CONCLUSIONS People with a history of criminal-legal system involvement and substance abuse meet with a variety of enabling and impeding factors at personal and interpersonal as well as systemic levels in obtaining cervical health services. To better ensure that women in this high-risk group have equitable access to cervical cancer prevention and treatment-and thus better cancer outcomes-will require multilevel efforts that include an emphasis on improving the human connection in health care encounters and improving the nuts-and-bolts logistics related to accessing that care.
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Affiliation(s)
- Amanda Emerson
- KU School of Nursing, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66180, USA.
| | - Marissa Dogan
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Elizabeth Hawes
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Kiana Wilson
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Sofía Mildrum Chana
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Patricia J Kelly
- Jefferson College of Nursing, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA, 19107, USA
| | | | - Megha Ramaswamy
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66106, USA
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Rao TSS, Tripathi A, Manohar S, Tandon A. Promoting sexual well-being. Indian J Psychiatry 2024; 66:S262-S271. [PMID: 38445287 PMCID: PMC10911331 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_612_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/08/2023] [Accepted: 01/05/2024] [Indexed: 03/07/2024] Open
Affiliation(s)
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India E-mail:
| | - Shivanand Manohar
- Department of Psychiatry, JSS Medical College, Mysore, Karnataka, India
| | - Abhinav Tandon
- Department of Psychiatry, MLN Medical College, Prayagraj, Uttar Pradesh, India
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Stransky ML, Bremer-Kamens M, Bair-Merritt M, Howard C, Brooks C, Meill A, Morris A, Sheldrick RC. Conceptualizations of health, ability to act upon those definitions and desire for supports among families from historically marginalized communities. Child Care Health Dev 2024; 50:e13214. [PMID: 38062906 DOI: 10.1111/cch.13214] [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: 05/31/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/25/2024]
Abstract
Respect for parents' values and clinician-parent collaboration is less common among families from historically marginalized communities. We investigated how parents from marginalized communities operationalize health and their preferences for paediatric primary care. We recruited families who spoke English, Haitian Creole or Spanish with at least one child younger than 6 years old. Staff queried families' values and life experiences, perspectives on health and healthcare, social supports and resources. Fourteen interviews with the parents of 26 children were thematically analysed. Interviews revealed the following four themes: (1) parents' definitions of 'health' extend beyond physical health; (2) families' ability to actuate health definitions is complicated by poverty's impact on agency; (3) parents engage in ongoing problem recognition and identify solutions, but enacting solutions can be derailed by barriers and (4) parents want support from professionals and peers who acknowledged the hard work of parenting. Eliciting parents' multidimensional conceptualizations of health can support families' goal achievement and concern identification in the context of isolation, limited agency and few resources. Efforts to improve family centred care and reduce disparities in paediatric primary care must be responsive to the strengths, challenges, resources and priorities of marginalized families.
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Affiliation(s)
- Michelle L Stransky
- Center for the Urban Child and Healthy Family, Boston Medical Center, Boston, MA, USA
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Miriam Bremer-Kamens
- Center for the Urban Child and Healthy Family, Boston Medical Center, Boston, MA, USA
| | - Megan Bair-Merritt
- Center for the Urban Child and Healthy Family, Boston Medical Center, Boston, MA, USA
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | | | | | - Anita Morris
- Center for the Urban Child and Healthy Family, Boston Medical Center, Boston, MA, USA
| | - R Christopher Sheldrick
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
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36
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Kheyfets A, Dhaurali S, Feyock P, Khan F, Lockley A, Miller B, Cohen L, Anwar E, Amutah-Onukagha N. The impact of hostile abortion legislation on the United States maternal mortality crisis: a call for increased abortion education. Front Public Health 2023; 11:1291668. [PMID: 38115843 PMCID: PMC10728320 DOI: 10.3389/fpubh.2023.1291668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
The growing restrictive abortion policies nationwide and the Supreme Court decision on Dobbs v. Jackson Women's Health Organization place increasing barriers to abortion access in the United States. These restrictions disproportionately affect low-income people of color, immigrants, and non-English speakers, and have the potential to exacerbate already existing racial inequities in maternal and neonatal outcomes. The United States is facing a Black maternal health crisis where Black birthing people are more than twice as likely to experience maternal mortality and severe maternal morbidity compared to White birthing people. Restrictions creating geographic, transportation, and financial barriers to obtaining an abortion can result in increased rates of maternal death and adverse outcomes across all groups but especially among Black birthing people. Restrictive abortion laws in certain states will decrease already limited training opportunities in abortion care for medical professionals, despite the existing abortion provider shortage. There is an immediate need for federal legislation codifying broad abortion care access into law and expanding access to abortion training across medical education. This commentary explores the impact of restrictive abortion laws on the Black maternal health crisis through multiple pathways in a logic model. By identifying current barriers to abortion education in medical school and residency, we created a list of action items to expand abortion education and access.
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Affiliation(s)
- Anna Kheyfets
- Tufts University School of Medicine, Boston, MA, United States
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Shubhecchha Dhaurali
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Paige Feyock
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
- University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Farinaz Khan
- Collective Energy for Nurturing Training in Reproductive and Sexual Health (CENTRS Health), Albuquerque, NM, United States
| | - April Lockley
- Collective Energy for Nurturing Training in Reproductive and Sexual Health (CENTRS Health), Albuquerque, NM, United States
| | - Brenna Miller
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Lauren Cohen
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Eimaan Anwar
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Ndidiamaka Amutah-Onukagha
- Tufts University School of Medicine, Boston, MA, United States
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
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Hill AV, Balascio P, Moore M, Hossain F, Dwarkananth M, De Genna NM. Young black women's desired pregnancy and birthing support during coronavirus disease 2019 pandemic. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 4:100333. [PMID: 38106375 PMCID: PMC10722556 DOI: 10.1016/j.ssmqr.2023.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Objective To document pregnancy and birthing experiences of young, Black pregnant women in one geographic area to make recommendations for improving young Black women's pregnancy and birthing experiences. Methods Participants were recruited through The YoungMoms Study (R01 DA04640101A1) in Pittsburgh, Pennsylvania, and included Black or biracial participants ages 16-23 (n = 25). Individual interviews were conducted from March 2022-July 2022 to assess pre-, peri-, and post-natal healthcare system encounters; experiences of structural and obstetric racism and discrimination in healthcare settings while obtaining prenatal care; attitudes around healthcare systems and medical professionals; effects of COVID-19 pandemic on participants lives and the impact of enacted healthcare policies in their perinatal experience; substance use changes during pregnancy; and coping mechanisms for stress. NVivo 13 was used to code transcripts, then major themes and subthemes were identified using thematic content analysis and based on grounded theory. Results Twenty-five interviews were conducted, and four themes emerged from participant experiences of racial discrimination in healthcare settings; (1) awareness of historical racism that influences perinatal care; (2) clinical providers assume participant substance use and enact reproductive coercion; (3) clinical providers question validity of Black women's birthing complaint; and (4) Young Black pregnant women know and will express what they desire in their perinatal experience if asked. Conclusions Young Black pregnant women encounter structural racism and intersectional bias from healthcare providers. By centering the perspectives and experiences of this overlooked population, public health researchers and clinical providers can utilize anti-racist frameworks to create more equitable, just practices in reproductive healthcare.
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Affiliation(s)
- Ashley V. Hill
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Phoebe Balascio
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Mikaela Moore
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Fahmida Hossain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Megana Dwarkananth
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Natacha M. De Genna
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Chisolm DJ, Dugan JA, Figueroa JF, Lane‐Fall MB, Roby DH, Rodriguez HP, Ortega AN. Improving health equity through health care systems research. Health Serv Res 2023; 58 Suppl 3:289-299. [PMID: 38015859 PMCID: PMC10684038 DOI: 10.1111/1475-6773.14192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To describe health equity research priorities for health care delivery systems and delineate a research and action agenda that generates evidence-based solutions to persistent racial and ethnic inequities in health outcomes. DATA SOURCES AND STUDY SETTING This project was conducted as a component of the Agency for Healthcare Research and Quality's (AHRQ) stakeholder engaged process to develop an Equity Agenda and Action Plan to guide priority setting to advance health equity. Recommendations were developed and refined based on expert input, evidence review, and stakeholder engagement. Participating stakeholders included experts from academia, health care organizations, industry, and government. STUDY DESIGN Expert group consensus, informed by stakeholder engagement and targeted evidence review. DATA COLLECTION/EXTRACTION METHODS Priority themes were derived iteratively through (1) brainstorming and idea reduction, (2) targeted evidence review of candidate themes, (3) determination of preliminary themes; (4) input on preliminary themes from stakeholders attending AHRQ's 2022 Health Equity Summit; and (5) and refinement of themes based on that input. The final set of research and action recommendations was determined by authors' consensus. PRINCIPAL FINDINGS Health care delivery systems have contributed to racial and ethnic disparities in health care. High quality research is needed to inform health care delivery systems approaches to undo systemic barriers and inequities. We identified six priority themes for research; (1) institutional leadership, culture, and workforce; (2) data-driven, culturally tailored care; (3) health equity targeted performance incentives; (4) health equity-informed approaches to health system consolidation and access; (5) whole person care; (6) and whole community investment. We also suggest cross-cutting themes regarding research workforce and research timelines. CONCLUSIONS As the nation's primary health services research agency, AHRQ can advance equitable delivery of health care by funding research and disseminating evidence to help transform the organization and delivery of health care.
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Affiliation(s)
- Deena J. Chisolm
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Department of PediatricsThe Ohio State University College of MedicineColumbusOhioUSA
| | - Jerome A. Dugan
- Department of Health Systems and Population Health, School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Jose F. Figueroa
- Harvard T.H. Chan School of Public HealthBrigham and Women's HospitalCambridgeMassachusettsUSA
| | - Meghan B. Lane‐Fall
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine and Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dylan H. Roby
- Department of Health, Society, and Behavior, Program in Public HealthUniversity of California, IrvineIrvineCaliforniaUSA
| | - Hector P. Rodriguez
- Division of Health Policy and Management, School of Public HealthUniversity of California, BerkeleyBerkeleyCaliforniaUSA
| | - Alexander N. Ortega
- Department of Health Management and Policy, Dornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
- Present address:
Thompson School of Social Work & Public HealthUniversity of Hawaii at ManoaHonoluluHawaiiUSA
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Willie TC, Phillips K, Shah A, Monger MPHM, Nunn A, Kershaw T, Chan PA, Baral SD, Mayer KH, Adimora AA, Mena LA, Stockman JK. Perspectives on HIV pre-exposure prophylaxis (PrEP) implementation in Mississippi among Black women and clinical staff: Recommendations for clinical trauma-informed programs. Prev Med Rep 2023; 36:102490. [PMID: 38116259 PMCID: PMC10728323 DOI: 10.1016/j.pmedr.2023.102490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 10/03/2023] [Accepted: 10/31/2023] [Indexed: 12/21/2023] Open
Abstract
Intimate partner violence (IPV) can constraint Black women's ability to prioritize and access Human Immunodeficiency Virus (HIV) pre-exposure prophylaxis (PrEP) services. Recent research has called for the development of trauma-informed PrEP implementation programs to improve the delivery of PrEP to Black cisgender women; however, many PrEP-prescribing settings do not reflect this recommendation. The current study sought to identify key components to develop a trauma-informed PrEP implementation program for Black cisgender women and clinical staff. We conducted focus groups with PrEP-eligible Black cisgender women (February-June 2019), and semi-structured interviews with clinical staff offering HIV prevention and treatment services (October-November 2020) in community healthcare clinics in Mississippi. Seven themes were identified as needed to facilitate integration of trauma-informed approaches into existing PrEP programs, including defining intimate partner violence (IPV), appropriate IPV screening and response, HIV prevention in abusive relationships, staff training needs, and creating supportive clinic environments. PrEP-eligible Black women and clinical staff generally agreed on how to best operationalize IPV screening and response, the importance of trauma-informed staff training, and the need for Black women-specific informational campaigns. However, Black women highlighted the need for providers to discuss HIV prevention in controlling relationships, and to respond to IPV disclosure. HIV pre-exposure prophylaxis has yet to achieve the potential impact observed in trials. Ultimately, realizing the HIV prevention potential of PrEP in the US necessitates centering the perspectives of Black cisgender women and staff to better integrate trauma-informed approaches.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Karlye Phillips
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Aashna Shah
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - M P H Mauda Monger
- MLM Center for Health Education and Equity Consulting Services, 123-A Hwy 80 East #258 Clinton, MS 39056, USA
| | - Amy Nunn
- School of Public Health, Brown University, 121 S Main St, Providence, RI 02903, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
| | - Philip A Chan
- Department of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore MD, 21205, USA
| | - Kenneth H Mayer
- Harvard Medical School and Harvard T H Chan School of Public Health, Harvard University, 25 Shattuck St, Boston, MA 02115, USA
| | - Adaora A Adimora
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, 170 Rosenau Hall, CB#7400, 135 Dauer Drive, Chapel Hill, NC 27599-7400, USA
| | - Leandro A Mena
- Department of Medicine, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, 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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Adams OR, Holder-Dixon AR, Campbell JT, Bennett-Brown M, Moscovici Z, Gesselman AN. Medical Mistrust and Healthcare Seeking Among Women of Color with Chronic Vulvovaginal Pain. Int J Behav Med 2023:10.1007/s12529-023-10236-4. [PMID: 37923884 DOI: 10.1007/s12529-023-10236-4] [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] [Accepted: 10/17/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Chronic vulvovaginal pain (CVVP), an umbrella term encompassing several gynecological pain conditions (e.g., vulvodynia, vaginismus), has a prevalence rate of 7-8% in the USA and is characterized by considerable diagnostic delay in patient experience research. Furthermore, current research in this area focuses largely on the experiences of white women, while the experiences of women of color are underrepresented. METHOD In the present cross-sectional study (N = 488), we surveyed women of color (i.e., Asian, Black, and/or Hispanic/Latinx women) with CVVP about their perceptions and experiences with medical mistrust, healthcare seeking, and healthcare avoidance. RESULTS Using the suspicion subscale of the Group-Based Medical Mistrust Scale, we found significant racial and ethnic differences in medical suspicion scores, with non-Black Hispanic/Latinx women reporting the highest suspicion scores and non-Hispanic/Latinx Black women reporting the lowest scores. Racial differences disappeared, however, after examining medical mistrust and perceived discrimination as predictors for various healthcare outcomes related to the journey to diagnosis and healthcare avoidance behaviors. We found that while suspicion was a reliable predictor of increased diagnostic delay and healthcare avoidance in many contexts, the results for perceived discrimination were more varied, suggesting considerable nuance in the relationship between medical mistrust, perceived discrimination, and healthcare seeking outcomes. CONCLUSION These findings point to shared experiences of medical mistrust via suspicion that broadly characterize women of color's experiences in seeking CVVP-related care-future research is needed to examine nuances within racial and ethnic groups regarding their healthcare seeking experiences in the CVVP context.
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Affiliation(s)
- Olivia R Adams
- Department of Gender, Sexuality, and Women's Studies, University of Florida, Gainesville, USA.
- The Kinsey Institute, Indiana University Bloomington, Bloomington, USA.
| | - Amani R Holder-Dixon
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, USA
| | | | - Margaret Bennett-Brown
- The Kinsey Institute, Indiana University Bloomington, Bloomington, USA
- College of Media & Communication, Texas Tech University, Lubbock, USA
| | - Zoe Moscovici
- The Kinsey Institute, Indiana University Bloomington, Bloomington, USA
- Department of Gender Studies, Indiana University Bloomington, Bloomington, USA
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Zimmermann K, Haen LS, Desloge A, Handler A. The Role of a Local Health Department in Advancing Health Equity: Universal Postpartum Home Visiting in a Large Urban Setting. Health Equity 2023; 7:703-712. [PMID: 37908403 PMCID: PMC10615061 DOI: 10.1089/heq.2023.0104] [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] [Accepted: 09/05/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction Racial and ethnic inequities persist among birthing families in urban U.S. communities, despite public health efforts to improve outcomes. To address these inequities, in 2020, the Chicago Department of Public Health (CDPH) launched Family Connects Chicago (FCC), an evidence-based, universal, postpartum home visiting program. We examine CDPH's transition from "high risk" to universal home visiting to determine whether and how this change represent an explicit commitment to advancing maternal and child health equity. Methods We conducted a secondary analysis of key informant interview data (n=45 interviews) collected from stakeholders involved in FCC's early implementation. Our analysis involved identifying processes used by CDPH in their planning and early implementation of FCC and examining the alignment of these processes with approaches for promoting health equity proposed by Calancie et al. Results The processes used by CDPH to plan and implement the FCC pilot are reflected in two major themes: (1) CDPH emphasized improving outcomes for all birthing families, and (2) CDPH prioritized engaging multiple stakeholders throughout planning and implementation. Alignment of these themes and their subthemes with the approaches proposed by Calancie et al. demonstrated that CDPH's implementation of FCC represents a commitment to advancing health equity. Discussion In their planning and implementation of FCC, CDPH appears to have exhibited a concerted effort to address Chicago's persistent health inequities. Institutional commitment, continued stakeholder engagement, ongoing data sharing, and sustainable funding will be crucial to implementing and expanding FCC. Health Equity Implications The implementation of FCC, a new service delivery approach for maternal and infant health, marks a new beginning in tackling inequities for Chicago's birthing families.
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Affiliation(s)
- Kristine Zimmermann
- Department of Family and Community Medicine, University of Illinois College of Medicine Rockford, Rockford, Illinois, USA
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lisa S. Haen
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Allissa Desloge
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Arden Handler
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
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Hood RB, Miller WC, Shoben A, Harris RE, Norris AH. Maternal hepatitis C virus infection and three adverse maternal outcomes in the United States. PLoS One 2023; 18:e0291994. [PMID: 37851609 PMCID: PMC10584094 DOI: 10.1371/journal.pone.0291994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/09/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Hepatitis Virus C (HCV) infection rates have trended upwards among pregnant people in the USA since 2009. Existing evidence about HCV infections and maternal outcomes is limited; therefore, we used birth certificate data to investigate the association between HCV infection and maternal health outcomes. METHODS We used the 2017 US birth certificate dataset (a cross-section of 1.4 million birth records) to assess the association between prevalent HCV infection and gestational diabetes, gestational hypertension, and eclampsia. Potential confounding variables included prenatal care, age, education, smoking, presence of sexually transmitted infections (STIs), body mass index (BMI), and weight gain during pregnancy. We restricted our analysis to only women with a first singleton pregnancy. Odds ratios were estimated by logistic regression models and separate models were tested for white and Black women. RESULTS Only 0.31% of the women in our sample were infected with HCV (n = 4412). In an unadjusted model, we observed a modest significant protective association between HCV infection and gestational diabetes (Odds ratio [OR]: 0.83; 95% CI: 0.76-0.96); but this was attenuated with adjustment for confounding variables (Adjusted odds ratio [AOR]: 0.88; 95% CI: 0.76, 1.02). There was no association between HCV and gestational hypertension (AOR: 1.03; 95% CI: 0.91, 1.16) or eclampsia (AOR: 1.15; 95% CI: 0.69, 1.93). Results from the race stratified models were similar to the non-stratified summary models. CONCLUSION We observed no statistically significant associations between maternal HCV infection with maternal health outcomes. Although, our analysis did indicate that HCV may lower the risk of gestational diabetes, this may be attributable to confounding. Studies utilizing more accurately measured HCV infection including those collecting type and timing of testing, and timing of infection are warranted to ensure HCV does not adversely impact maternal and/or fetal health. Particularly in the absence of recommended therapy for HCV during pregnancy.
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Affiliation(s)
- Robert B. Hood
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - William C. Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Abigail Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Randall E. Harris
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Alison H. Norris
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America
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Kalita N, Corr PG, Ward MC, Xavier J, McDonald PL. Identifying facilitators and barriers to culturally responsive communication for racial, ethnic, sexual, and gender minoritized patients when screened for COVID-19 vaccinations: A scoping review protocol. PLoS One 2023; 18:e0290514. [PMID: 37796975 PMCID: PMC10553356 DOI: 10.1371/journal.pone.0290514] [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: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Racial, ethnic, sexual, and gender minoritized groups are considered historically excluded groups and have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. The influence of social determinants of health (SDOH), including access to screening and treatment, and other systemic and structural factors are largely responsible for these disparities. Primary care practitioner (PCP) competence in culturally responsive screening practices will be critical to reducing the impact of systemic and structural factors serving as barriers to screening and treatment. Correspondingly, improving the capacity of PCPs to communicate with patients in a culturally responsive manner may influence improved screening and treatment outcomes for minoritized groups related to COVID-19. This scoping literature review aims to determine the current breadth of literature on culturally responsive communication (CRC) in regard to COVID-19 vaccination screening for historically excluded, or minoritized groups. Results from this review will inform the development of a training series and social marketing campaign to improve PCPs capacity in CRC. This manuscript provides details on our study protocol. OBJECTIVES This scoping literature review aims to analyze existing literature on culturally responsive COVID-19 vaccinations between PCPs and patients in the U.S., specifically for racial, ethnic, sexual, and gender minoritized groups. Results of this scoping review will inform the development of a training series and social marketing campaign to improve capacity of PCPs in this area. Additionally, the review will inform recommendations for future research. MATERIALS AND METHODS This scoping review will be performed following the framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Relevant studies between the years 2019-2022 were identified using a rigorous search strategy across four databases: MEDLINE (via PubMed), Scopus, Cochrane (CENTRAL; via Wiley), and CINAHL (via EBSCO), using Boolean and Medical Subject Headings (MeSH) search terms. Studies will be uploaded to the data extraction tool, Covidence, to remove duplicates and perform a title/abstract screening, followed by a full-text screening. RESULTS The data extraction and analysis phases of the scoping review are in progress. Data will be analyzed for themes related to culturally responsive COVID-19 screening practices in clinical encounters with the identified study populations. Results will be reported by theme and align to PRISMA-ScR guidelines. DISCUSSION To our knowledge, this is the first study to use scoping methods to investigate the barriers and facilitators to CRC of COVID-19 vaccine screening for historically excluded communities in the U.S. The work and results from this research will be directly utilized for the development of nationally-accessible, continuing medical education materials to teach PCPs about CRC, as well as other materials to influence relevant policy changes within the healthcare landscape.
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Affiliation(s)
- Nikhil Kalita
- Department of Epidemiology, The George Washington University Milken School of Public Health, Washington, D.C., United States of America
| | - Patrick G. Corr
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Maranda C. Ward
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Julia Xavier
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Paige L. McDonald
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
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Gopalani SV, Dasari SR, Adam EE, Thompson TD, White MC, Saraiya M. Variation in hysterectomy prevalence and trends among U.S. States and Territories-Behavioral Risk Factor Surveillance System, 2012-2020. Cancer Causes Control 2023; 34:829-835. [PMID: 37329443 PMCID: PMC10643045 DOI: 10.1007/s10552-023-01735-6] [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: 03/08/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE We estimated up-to-date state- and territory-level hysterectomy prevalence and trends, which can help correct the population at risk denominator and calculate more accurate uterine and cervical cancer rates. METHODS We analyzed self-reported data for a population-based sample of 1,267,013 U.S. women aged ≥ 18 years who participated in the Behavioral Risk Factor Surveillance System surveys from 2012 to 2020. Estimates were age-standardized and stratified by sociodemographic characteristics and geography. Trends were assessed by testing for any differences in hysterectomy prevalence across years. RESULTS Hysterectomy prevalence was highest among women aged 70-79 years (46.7%) and ≥ 80 years (48.8%). Prevalence was also higher among women who were non-Hispanic (NH) Black (21.3%), NH American Indian and Alaska Native (21.1%), and from the South (21.1%). Hysterectomy prevalence declined by 1.9 percentage points from 18.9% in 2012 to 17.0% in 2020. CONCLUSIONS Approximately one in five U.S. women overall and half of U.S. women aged ≥ 70 years reported undergoing a hysterectomy. Our findings reveal large variations in hysterectomy prevalence within and between each of the four census regions and by race and other sociodemographic characteristics, underscoring the importance of adjusting epidemiologic measures of uterine and cervical cancers for hysterectomy status.
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Affiliation(s)
- Sameer V Gopalani
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, 37830, USA
| | | | - Emily E Adam
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, 37830, USA
| | - Trevor D Thompson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Mary C White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
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Richardson MB, Toluhi AA, Baskin ML, Budhwani H, Julian ZI, Knight CC, Sinkey R, Szychowski JM, Tita AT, Wingate MS, Turan JM. Community and Systems Contributors and Strategies to Reduce Racial Inequities in Maternal Health in the Deep South: Provider Perspectives. Health Equity 2023; 7:581-591. [PMID: 37736520 PMCID: PMC10510686 DOI: 10.1089/heq.2023.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 09/23/2023] Open
Abstract
Purpose Black pregnant individuals in Alabama are disproportionately affected by severe maternal morbidity and mortality (SMM). To understand why racial disparities in maternal health outcomes persist and identify potential strategies to reduce these inequities, we sought perspectives from obstetric health care providers, health administrators, and members of local organizations who provide pregnancy, delivery, and postpartum care services in Alabama. Methods We conducted qualitative in-depth interviews with stakeholders (n=20), purposively recruited from community-based organizations, clinical settings, government organizations, and academic institutions. Interview guides were based on Howell's conceptual model of pathways to racial disparities in maternal mortality. Data were coded using a modified framework theory approach and analyzed thematically. Results Racism, unjust laws and policies, and poverty/lack of infrastructure in communities emerged as major themes contributing to racial disparities in maternal health at the community and systems levels. Inadequate health insurance coverage was described as a strong driver of the disparities. Service providers suggested strategies for Alabama should be community focused, evidence based, and culturally sensitive. These should include Medicaid expansion, expanded parental leave, and removal of laws restricting choice. Community- and systems-level interventions should include community infrastructure improvements, choice in maternity services, and provision of digital communication options. Conclusions Providers shared perspectives on community and structural areas of intervention to reduce racial inequities in SMM. These results can inform discussions with health system and community partners about Alabama and other Deep South initiatives to improve maternal health outcomes in black communities.
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Affiliation(s)
- Molly B. Richardson
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Angelina A. Toluhi
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Monica L. Baskin
- Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
| | - Henna Budhwani
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University (FSU), Tallahassee, Florida, USA
| | - Zoë I. Julian
- Department of Obstetrics and Gynecology, WellStar Kennestone Regional Medical Center, Marietta, Georgia, USA
| | - Candace C. Knight
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- School of Nursing, UAB, Birmingham, Alabama, USA
| | - Rachel Sinkey
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, UAB, Birmingham, Alabama, USA
| | - Jeff M. Szychowski
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- Department of Biostatistics, UAB, Birmingham, Alabama, USA
| | - Alan T.N. Tita
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, UAB, Birmingham, Alabama, USA
| | - Martha S. Wingate
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
| | - Janet M. Turan
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
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47
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Girardi G, Longo M, Bremer AA. Social determinants of health in pregnant individuals from underrepresented, understudied, and underreported populations in the United States. Int J Equity Health 2023; 22:186. [PMID: 37674167 PMCID: PMC10483713 DOI: 10.1186/s12939-023-01963-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 07/13/2023] [Indexed: 09/08/2023] Open
Abstract
Women represent the cornerstone of a family's overall health. Therefore, supporting women's health, particularly in pregnancy, is important to promote public health. Emerging data highlight the contribution of social determinants of health (SDOH) on pregnancy outcomes in understudied, underrepresented, and underreported (U3) populations. Importantly, women are uniquely affected by and more vulnerable to adverse outcomes associated with SDOH. The maternal mortality rate has also increased significantly in the United States, especially among U3 individuals. Factors such as access to safe food, housing and environment, access to education and emergency/health services, and stressors such as interpersonal racism, poverty, unemployment, residential segregation, and domestic violence may make women from U3 populations more vulnerable to adverse reproductive health outcomes. Despite progress in promoting women's health, eliminating social and health disparities in pregnant individuals remains an elusive goal in U3 populations. Moreover, chronic exposure to excessive social/cultural stressors may have a physiologic cost leading to pregnancy complications such as miscarriages, preterm birth, and preeclampsia. Thus, the identification of SDOH-related factors that drive differences in pregnancy-related complications and deaths and the implementation of prevention strategies to address them could reduce disparities in pregnancy-related mortality in U3 populations.
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Affiliation(s)
- Guillermina Girardi
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
| | - Monica Longo
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Andrew A Bremer
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
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48
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Hoang TMH, Lee BA, Hsieh WJ, Lukacena KM, Tabb KM. Experiences of racial Trauma among perinatal women of color in seeking healthcare services. Gen Hosp Psychiatry 2023; 84:60-66. [PMID: 37393649 DOI: 10.1016/j.genhosppsych.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To describe the experiences of perinatal Black, Indigenous, and other People of Color (BIPOC) women in healthcare interactions. METHODS We conducted eight virtual focus groups with perinatal BIPOC women across the USA from November 2021 to March 2022. A semi-structured interview protocol was used, and focus groups were audio recorded and transcribed verbatim. Our team used reflexive thematic analysis to analyze the qualitative data and describe our findings. RESULTS Three latent themes emerged related to racial trauma in healthcare interactions: (1) observations and experiences of anti-Black bias, (2) experiences of dismissal of pain and withholding of care, particularly among Black and Latinx patients, and (3) common race-based traumatic experiences across all BIPOC women, including a consistent lack of bodily autonomy and deferral to White people for decision-making. Recommendations from participants included more transparent communication and greater empathic care for all patients, with calls to specifically address anti-Black bias in healthcare treatment. CONCLUSION The study's findings suggest that perinatal healthcare needs to reduce mental stress and exposure to racial trauma for perinatal BIPOC women. This study offers a discussion of implications for future training for healthcare providers and implications for addressing systemic racial disparities in perinatal mental health.
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Affiliation(s)
- Tuyet-Mai H Hoang
- School of Social Work at the University of Illinois Urbana-Champaign, USA.
| | - B Andi Lee
- Department of Psychology at the University of Illinois Urbana-Champaign, USA
| | - Wan-Jung Hsieh
- Department of Social Work at the National, Taiwan University, USA
| | - Kaylee Marie Lukacena
- Center for Social and Behavioral Science at the University of Illinois Urbana-Champaign, USA
| | - Karen M Tabb
- School of Social Work at the University of Illinois Urbana-Champaign, USA
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49
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Savabi M. Systemic Oppression, the Impact on Obstetric Care, and Interventions to Achieve Ideal Obstetric Outcomes. Obstet Gynecol Clin North Am 2023; 50:567-578. [PMID: 37500217 DOI: 10.1016/j.ogc.2023.03.008] [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: 07/29/2023]
Abstract
Systemic oppression contributes to adverse obstetric outcomes. It is possible to interrupt these adverse outcomes and achieve ideal patient outcomes by learning about our participation in oppression.
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Affiliation(s)
- Mariam Savabi
- General Obstetrician and Gynecologist, HealthCare Anti-oppression Institute (Founder), Tacoma, WA, USA.
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50
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Dahl AA, Yada FN, Butts SJ, Tolley A, Hirsch S, Lalgondar P, Wilson KS, Shade L. Contextualizing the experiences of Black pregnant women during the COVID-19 pandemic: 'It's been a lonely ride'. Reprod Health 2023; 20:124. [PMID: 37626357 PMCID: PMC10463995 DOI: 10.1186/s12978-023-01670-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
The emergence of the COVID-19 pandemic significantly changed the prenatal care experience, specifically regarding medical appointments and social opportunities. It is critical to capture this change through the narratives of pregnant people, particularly those of marginalized populations, whose voices may often be underrepresented in the literature. This mixed-methods paper summarizes the experiences of 40 pregnant Black/African American (AA) women during the COVID-19 pandemic. A cross-sectional, online survey was administered between 2020 and 2021 to assess prenatal health and the impacts of the COVID-19 pandemic on patients' pregnancy experience. Coping behaviors during the pandemic were self-reported using the COPE-IS. Univariate analyses were conducted. An additional analysis of participants (n = 4) was explored through a week-long qualitative exercise using a photo documentation procedure. Photo-Elicitation Interviews (PEI) were conducted to capture and center their pandemic pregnancy experiences. Sources of stress during the pandemic varied, with the most common being financial concerns (n = 19, 47.5%). Over half of the sample (n = 18, 54.5%) self-reported increases in their positive coping behaviors during the pandemic, such as communicating with friends and family, talking to healthcare providers, listening to music, and engaging in spiritual practices-such as prayer. The four PEI study participants reflected on the impacts of social distancing on their prenatal experience and mentioned hospital and provider-related weariness due to their race. The findings of this study suggest that during the COVID-19 pandemic, Black/AA pregnant women in Charlotte, NC used social support, mindfulness practices, self-advocacy, and health literacy to navigate challenges present during their prenatal health experience. This paper highlights the personal, social, and structural experiences of pregnant women during a public health crisis so that responsive and effective programs or policies can be planned in the future.
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Affiliation(s)
- Alicia A Dahl
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA.
| | - Farida N Yada
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Shanika Jerger Butts
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Annalise Tolley
- Department of Psychological Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Sophie Hirsch
- Department of Psychological Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Priyanka Lalgondar
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Kala S Wilson
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Lindsay Shade
- Department of Family Medicine, Atrium Health, 2001 Vail Avenue, Suite 400-B Mercy Medical Plaza, Charlotte, NC, 28207, USA
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