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Michaels TI, Simon-Pearson L, Kane JM, Cornblatt B. Racial Disparities Among Clinical High-Risk and First-Episode Psychosis Multisite Research Participants: A Systematic Review. Psychiatr Serv 2024; 75:451-460. [PMID: 38204372 DOI: 10.1176/appi.ps.20230120] [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] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The NIH has mandated equal representation of Black, Indigenous, and people of color (BIPOC) individuals in clinical research, but it is unclear whether such inclusion has been achieved in multisite research studies of individuals at clinical high risk for psychosis or with first-episode psychosis (FEP). An assessment of inclusion rates is important for understanding the social determinants of psychosis and psychosis risk that specifically affect BIPOC individuals. METHODS The authors conducted a systematic review of the literature published between 1993 and 2022 of multisite research studies of clinical high risk for psychosis and FEP in North America to determine ethnoracial inclusion rates. Using an online systematic review tool, the authors checked 2,278 studies for eligibility. Twelve studies met all inclusion criteria. Data were extracted, and demographic characteristics, socioeconomic status, study design, and recruitment strategies used by each study were analyzed. RESULTS Most (62%) of the participants in studies of clinical high risk for psychosis were White. Compared with national data, the demographic characteristics of individuals with clinical high risk were representative across most ethnoracial groups. Black participants (43%) made up the largest ethnoracial group in FEP studies and were overrepresented compared with their representation in the U.S. population. FEP studies were more likely to recruit participants from community mental health centers than were the studies of clinical high risk. CONCLUSIONS Although these results suggest high representation of BIPOC individuals in psychosis research, opportunities exist for an improved focus on ethnoracial representation. The authors offer recommendations for practices that may increase ethnoracial diversity in future psychosis study samples.
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Affiliation(s)
- Timothy I Michaels
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Laura Simon-Pearson
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - John M Kane
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Barbara Cornblatt
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
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2
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Lalani N, Hamash K, Wang Y. Palliative care needs and preferences of older adults with advanced or serious chronic illnesses and their families in rural communities of Indiana, USA. J Rural Health 2024; 40:368-375. [PMID: 37526585 DOI: 10.1111/jrh.12787] [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: 03/07/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE To explore the palliative care needs and preferences of older adults with advanced or serious chronic illnesses and their families. Also, to propose strategies to promote supportive palliative care in the rural communities of Indiana, USA. METHOD We conducted qualitative interviews to gather rural caregivers' experiences of palliative care. Recruitment was done in collaboration with community partners using social media, flyers, emails, invitations, and word-of-mouth. A purposive sample of family caregivers was obtained. All the interviews were conducted online. The average interview was 30-45 minutes. Data were analyzed using a thematic analysis approach. FINDINGS Our findings showed 6 major themes that indicated several palliative care needs and preferences of older patients and their families in rural communities that include: (1) difficulties in pain and symptom burden; (2) perceived discrimination and lack of trust; (3) longer distances to care facilities; (4) difficult conversations; (5) caregiving burden; and (6) use of telehealth in a rural palliative care context. CONCLUSION Rural family caregivers experience several social inequities and disparities causing a lack of access to and low utilization of palliative care. All these disparities cause several challenges for patients and their families trying to manage serious illnesses and die in place with peace and comfort. Inadequate access and lack of resources cause pain and distress for both patients and their families. Provider education and trainings, initiating early palliative care models, integrating behavioral health in palliative care, and using culturally congruent care delivery approaches in support of community partners can improve palliative care services in rural communities.
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Affiliation(s)
- Nasreen Lalani
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
- Center for Aging and Life Course Purdue University, West Lafayette, Indiana, USA
| | - Kawther Hamash
- WellStar School of Nursing, Kennesaw State University, Kennesaw, Georgia, USA
| | - Yitong Wang
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
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3
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Powers A, Lathan EC, McAfee E, Mekawi Y, Dixon HD, Lopez E, Ali S, Hinrichs R, Bradley B, Carter S, Kaslow NJ. Feasibility and acceptability of a virtual mindfulness intervention for Black adults with PTSD and depression: Randomized controlled trial. JOURNAL OF MOOD AND ANXIETY DISORDERS 2024; 5:100048. [PMID: 38606374 PMCID: PMC11008567 DOI: 10.1016/j.xjmad.2024.100048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Mindfulness-based cognitive therapy (MBCT) offers promise as a group-based intervention to alleviate posttraumatic stress disorder (PTSD) and depression symptoms in traumatized Black adults. Given the high level of barriers that exist for low-income Black adults, virtual delivery of MBCT may be helpful. This pilot randomized controlled trial assessed feasibility and acceptability of an adapted 8-week virtual MBCT group intervention for Black adults screening positive for PTSD and depression. Forty-six participants (89.3% women) recruited from an urban safety net hospital were randomized to MBCT or waitlist control (WLC). Overall feasibility was fair (70%); however, completion rates were higher for WLC than MBCT (90% vs. 54%). Group acceptability was high across quantitative and qualitative measures for study completers. Perceived barriers to psychological treatment were high (>9). While showing potential via improved coping skills and positive health changes, this intervention's success hinges on mitigating engagement barriers for future delivery; additional studies are warranted.
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Affiliation(s)
- Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Emma C. Lathan
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Elizabeth McAfee
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - H. Drew Dixon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Estefania Lopez
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Shifa Ali
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- VA Medical Center, Atlanta, GA, USA
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Nadine J. Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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4
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Budhwani H, Yiğit İ, Maragh-Bass AC, Rainer CB, Claude K, Muessig KE, Hightow-Weidman LB. Development and Validation of the Youth Pre-Exposure Prophylaxis (PrEP) Stigma Scale. AIDS Behav 2023; 27:929-938. [PMID: 36029425 PMCID: PMC9968821 DOI: 10.1007/s10461-022-03829-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 01/05/2023]
Abstract
To date, there are no established scales to assess PrEP stigma among youth. We validated the Youth PrEP Stigma Scale within the Adolescent Trials Network P3 study (2019-2021). Data from sexual and gender minority youth (16-24 years) who were prescribed PrEP across nine domestic sites were evaluated (N = 235). Descriptive statistics, exploratory factor analysis, and correlation coefficients are reported. Results yielded a three-factor solution (PrEP Disapproval by Others, Enacted PrEP Stigma, and PrEP User Stereotypes) with strong factor loadings and Cronbach's alphas ranging from 0.83 to 0.90, suggesting excellent internal consistency. Correlations between this Scale, anticipated HIV stigma, perceived HIV risk, and disclosure of sexual identity were significant, indicating potential for robust application. Given the persistence of HIV infections among youth, stigma as a barrier to prevention, and expansion of PrEP modalities, the Youth PrEP Stigma Scale could enhance intervention and mechanistic research among youth at elevated risk for HIV acquisition.
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Affiliation(s)
- Henna Budhwani
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, 32306, Tallahassee, FL, USA.
| | - İbrahim Yiğit
- Department of Psychology, Faculty of Arts and Sciences, TED University, Ankara, Turkey
| | - Allysha C Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Crissi B Rainer
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | - Kristina Claude
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | - Kathryn E Muessig
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | - Lisa B Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
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5
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Okoli CZ. Diversity as a Solution to Health Inequities and Disparities. J Am Psychiatr Nurses Assoc 2023; 29:171-173. [PMID: 36782082 DOI: 10.1177/10783903231153872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Chizimuzo Zim Okoli
- Chizimuzo (Zim) Okoli, PhD, MPH, MSN, PMHNP-BC, FAAN, American Psychiatric Nurses Association, Falls Church, VA, USA
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6
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Vidales CA, Vogel DL, Levant RF. The Self-Stigma of Seeking Help (SSOSH) Scale: Measurement Invariance Across Men from Different Backgrounds. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2023. [DOI: 10.1080/07481756.2022.2160356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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7
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Dopelt K, Davidovitch N, Davidov N, Plot I, Boas H, Barach P. "As if we are branded with the mark of Cain": stigma, guilt, and shame experienced by COVID-19 survivors in Israel - a qualitative study. CURRENT PSYCHOLOGY 2023:1-14. [PMID: 36684454 PMCID: PMC9838295 DOI: 10.1007/s12144-023-04241-9] [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: 01/06/2023] [Indexed: 01/13/2023]
Abstract
Stigma is associated with harmful health outcomes, and it fuels social and health inequalities. It can undermine social cohesion and encourage social exclusion of groups, which may contribute to secrecy about disease symptoms, avoidance of disease testing and vaccination, and further spread of a contagious illness. Stigmatization is a social process set to exclude those who are perceived to be a potential source of disease and may pose a threat to effective interpersonal and social relationships. In this qualitative study, we delved into the stigmatization experiences of twenty COVID-19 recovered patients during the COVID-19 first wave, using in-depth semi-structured interviews conducted during November 2020. Using thematic analysis, we found that the process of stigmatization was all-encompassing, from the stage of diagnosis throughout the duration of the disease and the recovery phases. On the basis of the data, we hypothesized that stigma is a significant public health concern, and effective and comprehensive interventions are needed to counteract the damaging and insidious effects during infectious disease pandemics such as COVID-19, and reduce infectious disease-related stigma. Interventions should address provision of emotional support frameworks for the victims of stigmatization and discrimination that accompany the COVID-19 pandemic and future pandemics. This study was conducted in the early days of the COVID-19 pandemic, when uncertainty about the disease was high and fear of contamination fueled high levels of stigmatization against those who became ill with Covid-19.
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Affiliation(s)
- Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Nadav Davidovitch
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Nikol Davidov
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Ira Plot
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Hagai Boas
- Department of Politics and Governance, Ben Gurion University of the Negev, Beer Sheva, Israel
- The Van Leer Jerusalem Institute, Jerusalem, Israel
| | - Paul Barach
- Thomas Jefferson University, Philadelphia, PA USA
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8
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Turan B, Budhwani H, Yigit I, Ofotokun I, Konkle-Parker DJ, Cohen MH, Wingood GM, Metsch LR, Adimora AA, Taylor TN, Wilson TE, Weiser SD, Kempf MC, Brown-Friday J, Gange S, Kassaye S, Pence BW, Turan JM. Resilience and Optimism as Moderators of the Negative Effects of Stigma on Women Living with HIV. AIDS Patient Care STDS 2022; 36:474-482. [PMID: 36484762 PMCID: PMC9805859 DOI: 10.1089/apc.2022.0185] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Resilience and optimism may not only have main effects on health outcomes, but may also moderate and buffer negative effects of stressors. We examined whether dispositional resilience and optimism moderate the associations between HIV-related stigma in health care settings and health-related outcomes (trust in HIV health care providers and depression symptoms) among women living with HIV (WLHIV). One thousand four hundred five WLHIV in nine US cities completed validated questionnaires for cross-sectional analyses. Higher self-reported experienced and anticipated stigma and lower resilience and optimism were associated with higher depression symptoms and with lower trust in HIV providers. Importantly, resilience moderated the effects of experienced stigma (but not of anticipated stigma): When resilience was high, the association of experienced stigma with higher depression symptoms and lower trust in HIV providers was weaker compared with when resilience was low. Further, significant moderation effects suggested that when optimism was high, experienced and anticipated stigma was both less strongly associated with depression symptoms and with lower trust in one's HIV care providers compared with when optimism was low. Thus, the effects of experienced stigma on depression symptoms and provider trust were moderated by both resilience and optimism, but the effects of anticipated stigma were moderated only by optimism. Our findings suggest that in addition to their main effects, resilience and optimism may function as buffers against the harmful effects of stigma in health care settings. Therefore, optimism and resilience may be valuable intervention targets to reduce depression symptoms or improve trust in providers among populations that experience or anticipate stigma, such as WLHIV.
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Affiliation(s)
- Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Henna Budhwani
- Health Care Organization & Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- College of Nursing, Florida State University, Tallahassee, Florida, USA
| | - Ibrahim Yigit
- Department of Psychology, TED University, Ankara, Turkey
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
| | - Deborah J. Konkle-Parker
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center (UMMC), Jackson, Mississippi, USA
| | | | - Gina M. Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Adaora A. Adimora
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tonya N. Taylor
- College of Medicine, Division of Infectious Disease, Downstate Health Sciences University, Brooklyn, New York, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, Downstate Health Sciences University, Brooklyn, New York, USA
| | - Sheri D. Weiser
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Janet Brown-Friday
- Albert Einstein College of Medicine-Montefiore Medical Center, New York, New York, USA
| | - Stephen Gange
- Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Seble Kassaye
- Department of Medicine/Infectious Diseases, Georgetown University, Washington, District of Columbia, USA
| | - Brian W. Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Janet M. Turan
- Health Care Organization & Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- School of Medicine, Department of Pubic Health, Koc University, Istanbul, Turkey
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9
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Yufika A, Pratama R, Anwar S, Winardi W, Librianty N, Prashanti NAP, Sari TNW, Utomo PS, Dwiamelia T, Natha PPC, Salwiyadi S, Asrizal FW, Ikram I, Wulandari I, Haryanto S, Fenobilire N, Wagner AL, Jamil KF, Mudatsir M, Harapan H. Stigma Associated with COVID-19 Among Health Care Workers in Indonesia. Disaster Med Public Health Prep 2022; 16:1942-1946. [PMID: 33762053 PMCID: PMC8207538 DOI: 10.1017/dmp.2021.93] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of this study was to assess the stigma associated with coronavirus disease - 2019 (COVID-19) among health care workers (HCWs) in Indonesia during the early phase of the pandemic. METHODS A cross-sectional study was conducted in 12 hospitals across the country in March, 2020. A logistic regression was employed to assess the association between stigma and explanatory variables. RESULTS In total, 288 HCWs were surveyed, of which 93.4% had never experienced any outbreaks. Approximately 21.9% of the respondents had stigma associated with COVID-19. HCWs who were doctors, had not participated in trainings related to COVID-19, worked in the capital of the province, worked at private hospitals, or worked at a hospital with COVID-19 triage protocols were likely to have no stigma associated with COVID-19. CONCLUSIONS The stigma associated with COVID-19 is relatively high among HCWs in the early phase of the COVID-19 pandemic in Indonesia. Adequate dissemination of knowledge and adequate protection are necessary to reduce stigma among HCWs.
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Affiliation(s)
- Amanda Yufika
- Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Rovy Pratama
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Wira Winardi
- Department of Pulmonology and Respiratory Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Nurfanida Librianty
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | | | | | - Prattama Santoso Utomo
- Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Putu Pangestu Cendra Natha
- Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia
- Department of Internal Medicine, Sanglah Hospital, Denpasar, Bali, Indonesia
| | - Salwiyadi Salwiyadi
- Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Department of Internal Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
| | | | - Ikram Ikram
- Dr H Yuliddin Away Hospital, Tapaktuan, Aceh, Indonesia
| | - Irma Wulandari
- M. Hatta Brain Hospital, Bukittinggi, West Sumatra, Indonesia
| | - Sotianingsih Haryanto
- Raden Mattaher Hospital, Jambi, Jambi, Indonesia
- Faculty of Medicine and Medical Sciences, Jambi University, Jambi, Jambi, Indonesia
| | | | - Abram L Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kurnia Fitri Jamil
- Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Department of Internal Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
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10
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Jansli SM, Hudson G, Negbenose E, Erturk S, Wykes T, Jilka S. Investigating mental health service user views of stigma on Twitter during COVID-19: a mixed-methods study. J Ment Health 2022; 31:576-584. [PMID: 35786178 PMCID: PMC9612929 DOI: 10.1080/09638237.2022.2091763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Mental health stigma on social media is well studied, but not from the perspective of mental health service users. Coronavirus disease-19 (COVID-19) increased mental health discussions and may have impacted stigma. Objectives: (1) to understand how service users perceive and define mental health stigma on social media; (2) how COVID-19 shaped mental health conversations and social media use. Methods: We collected 2,700 tweets related to seven mental health conditions: schizophrenia, depression, anxiety, autism, eating disorders, OCD, and addiction. Twenty-seven service users rated them as stigmatising or neutral, followed by focus group discussions. Focus group transcripts were thematically analysed. Results: Participants rated 1,101 tweets (40.8%) as stigmatising. Tweets related to schizophrenia were most frequently classed as stigmatising (411/534, 77%). Tweets related to depression or anxiety were least stigmatising (139/634, 21.9%). A stigmatising tweet depended on perceived intention and context but some words (e.g. “psycho”) felt stigmatising irrespective of context. Discussion: The anonymity of social media seemingly increased stigma, but COVID-19 lockdowns improved mental health literacy. This is the first study to qualitatively investigate service users' views of stigma towards various mental health conditions on Twitter and we show stigma is common, particularly towards schizophrenia. Service user involvement is vital when designing solutions to stigma.
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Affiliation(s)
- Sonja M Jansli
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Georgie Hudson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Esther Negbenose
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sinan Erturk
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sagar Jilka
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,Warwick Medical School, University of Warwick, Coventry, UK
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11
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Gullett LR, Alhasan DM, Gaston SA, Jackson WB, Kawachi I, Jackson CL. Neighborhood social cohesion and serious psychological distress among Asian, Black, Hispanic/Latinx, and White adults in the United States: a cross-sectional study. BMC Public Health 2022; 22:1191. [PMID: 35705933 PMCID: PMC9199195 DOI: 10.1186/s12889-022-13572-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Serious psychological distress (SPD) is common and more prevalent in women, older adults, and individuals with a low-income. Prior studies have highlighted the role of low neighborhood social cohesion (nSC) in potentially contributing to SPD; however, few have investigated this association in a large, nationally representative sample of the United States. Therefore, our objective was to investigate the overall and racial/ethnic-, sex/gender-, self-rated health status-, age-, and household income-specific relationships between nSC and SPD. METHODS We used data from survey years 2013 to 2018 of the National Health Interview Survey to investigate nSC and SPD among Asian, Non-Hispanic (NH)-Black, Hispanic/Latinx, and NH-White men as well as women in the United States (N = 168,573) and to determine modification by race/ethnicity, sex/gender, self-rated health status, age, and annual household income. nSC was measured by asking participants four questions related to the trustworthiness and dependability of their neighbors. nSC scores were trichotomized into low (< 12), medium (12-14), and high (15-16). SPD was measured using the Kessler 6 psychological distress scale with scores ≥ 13 indicating SPD. After adjusting for sociodemographic, health behavior, and clinical confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS Among 168,573 participants, most were Non-Hispanic (NH)-White (69%), and mean age was 47 ± 0.01 years. After adjustment, low vs. high nSC was associated with a 75% higher prevalence of SPD overall (PR = 1.75 [1.59-1.92]), 4 times the prevalence of SPD among Asian men (PR = 4.06 [1.57-10.50]), 2 times the prevalence of SPD among participants in at least good health (PR = 2.02 [95% CI: 1.74-2.35]), 92% higher prevalence of SPD among participants ≥ 50 years old (PR = 1.92 [1.70-2.18]), and approximately 3 times the prevalence of SPD among Hispanic/Latinx participants with household incomes ≥ $75,000 (PR = 2.97 [1.45-6.08]). CONCLUSIONS Low nSC was associated with higher SPD in the overall population and the magnitude of the association was higher in Asian men, participants who reported good health, older participants, and Hispanic/Latinx adults with higher household incomes. Future research should continue to examine how neighborhood contexts can affect health across various sociodemographic groups, especially among groups with multiple marginalized social identities.
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Affiliation(s)
- Lauren R Gullett
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, 111 TW Alexander Drive, MD A3-05, Research Triangle Park, NC, 27709, USA
| | - Dana M Alhasan
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, 111 TW Alexander Drive, MD A3-05, Research Triangle Park, NC, 27709, USA
| | - Symielle A Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, 111 TW Alexander Drive, MD A3-05, Research Triangle Park, NC, 27709, USA
| | - W Braxton Jackson
- Social and Scientific Systems, Inc., a DLH Holdings Company, NC, Durham, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, 111 TW Alexander Drive, MD A3-05, Research Triangle Park, NC, 27709, USA. .,Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
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12
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Patient Health Literacy and Communication with Providers Among Women Living with HIV: A Mixed Methods Study. AIDS Behav 2022; 26:1422-1430. [PMID: 34642834 PMCID: PMC9001740 DOI: 10.1007/s10461-021-03496-2] [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: 10/08/2021] [Indexed: 10/20/2022]
Abstract
In this mixed-methods study, we examine the relationship between provider communication and patient health literacy on HIV continuum of care outcomes among women living with HIV in the United States. We thematically coded qualitative data from focus groups and interviews (N = 92) and conducted mediation analyses with quantitative survey data (N = 1455) collected from Women's Interagency HIV Study participants. Four qualitative themes related to provider communication emerged: importance of respect and non-verbal cues; providers' expressions of condescension and judgement; patient health literacy; and unclear, insufficient provider communication resulting in diminished trust. Quantitative mediation analyses suggest that higher health literacy is associated with higher perceived patient-provider interaction quality, which in turn is associated with higher levels of trust in HIV providers, improved antiretroviral medication adherence, and reduced missed clinical visits. Findings indicate that enhancing provider communication and bolstering patient health literacy could have a positive impact on the HIV continuum of care.
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13
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Emezue CN, Udmuangpia T. Authentic Empathy and the Role of Victim Service Providers in (De)stigmatizing Male Sexual Victimization. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP3832-NP3855. [PMID: 32842841 DOI: 10.1177/0886260520948150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Male victims of rape and sexual violence (SV) constitute a highly stigmatized group who doubly suffer the trauma of SV and hegemonic notions of real masculinity that punishes weakness and vulnerability in men. This double exposure produces a stigmatizing identity (i.e., male victim stigma) that is embedded in grand narratives about male SV. However, helping professionals have been implicated in this (de)stigmatizing process. Few studies describe the role victim service providers (VSPs) play as (de)stigmatizing agents. This study is among the first to explore VSP narratives on their stigma awareness and stigma management practices. Story-focused interview methods elicited responses from 11 VSPs (nine females and two males, age: 29-65 years) across the United States representing diverse victim-serving professions. Interviews were face-to-face or by phone, lasting between 45 and 90 minutes. Interviews were transcribed verbatim and analyzed using power-sensitive Foucauldian discourse analysis (or FDA, suitable for analyzing language and meanings linked to power dynamics). Our analysis was guided by a meaning-forming social constructionist approach. With some narrative convergence and disconvergence, three strings of narratives with supporting excerpts were identified, namely (a) stigma awareness shaped by discursive and material forces, (b) labeling as a (de)stigmatizing tool, and (c) connecting through authentic empathy (AE). The concept of AE is recommended as a possible model of care and stigma management approach in therapeutic spaces. We define AE as an aptitude to credibly provide nonjudgmental, stigma-free care, based on personal histories with trauma, membership in a stigmatized group, or an earned involvement with members of the same group. Findings bear implications for stigma-informed practices and future research to address the unique unmet needs of stigmatized male victims.
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14
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Budhwani H, De P, Sun R. Perceived Stigma in Health Care Settings Mediates the Relationships Between Depression, Diabetes, and Hypertension. Popul Health Manag 2022; 25:164-171. [PMID: 35442794 PMCID: PMC9058871 DOI: 10.1089/pop.2021.0268] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Stigma is one of the most harmful forces affecting population health. When stigma exists in clinical settings, environments that should be pro-patient and stigma-free, stigma may become internalized and affect patients' well-being. Informed by prior stigma research and the Intergroup Contact Theory, the authors elucidate statistical relationships between patients' perceptions of clinic-based stigma and stigma's impact on health among New York City's diverse residents. The authors hypothesize that perceiving stigma in clinical settings would mediate the relationships between depression, general health, diabetes, and hypertension; they tested this through multiple logistic regressions conducted on pooled data from the New York City Community Health Survey (N = 18,596, 2016-2017). Among women, depression was associated with stigma (α = 4.07, P < 0.01), hypertension (γ = 2.31, P < 0.01), diabetes (γ = 2.18, P < 0.01), and poor general health (γ = 6.34, P < 0.01). Among men, depression was associated with stigma (α = 3.7, P < 0.01), hypertension (γ = 2.35, P < 0.01), diabetes (γ = 1.86, P < 0.01), and poor general health (γ = 5.14, P < 0.01). Overall, perceived stigma in clinics significantly increased adjusted odds of self-reporting poor general health (adjusted ORs [AOR] = 1.87 men; AOR = 2.05 women). Findings contribute to the literature on the Intergroup Contact Theory, which suggests that stigma should be low in diverse communities; findings indicate that stigma may be a mediator, justifying inclusion in epidemiological and health services research. In addition, study outcomes suggest that depression may be associated with clinic-based stigma, and this stigma has deleterious effects on physical health. Thus, clinicians should emphasize stigma reduction in their facilities, potentially through the adoption of trauma-informed approaches or delivery of care using non-stigmatizing communication strategies, such as Motivational Interviewing.
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Affiliation(s)
- Henna Budhwani
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Prabal De
- City College and The Graduate Center, City University of New York, New York, New York, USA
| | - Ruoyan Sun
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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15
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Bulls HW, Chu E, Goodin BR, Liebschutz JM, Wozniak A, Schenker Y, Merlin JS. Framework for opioid stigma in cancer pain. Pain 2022; 163:e182-e189. [PMID: 34010940 PMCID: PMC8589872 DOI: 10.1097/j.pain.0000000000002343] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
ABSTRACT Millions of patients with cancer pain are treated with prescription opioids each year. However, efforts to mitigate the ongoing opioid crisis result in unintended consequences with opioid pain management, including opioid stigma. Emerging research indicates that opioid stigma is problematic in patients with cancer, but few studies have examined contributors to and impacts of opioid stigma in this population. To guide future research in this area, we propose a conceptual framework-the opioid stigma framework (OSF)-with which to understand and improve opioid stigma in patients with cancer pain. Development of the OSF was guided by a literature review of stigma in health-related conditions, adaptation of the existing Health Stigma and Discrimination Framework, a topical review of challenges related to opioid cancer pain management, and author expertise in cancer, pain, and opioid prescribing. The proposed OSF highlights 5 domains: (1) contributors to opioid stigma, or factors that increase the likelihood that a patient will experience opioid stigma; (2) intersecting stigmas, or the convergence of multiple stigmatized identities within a patient; (3) stigma manifestations, or the ways opioid stigma is manifested in patients, clinicians, and the community; (4) proximal outcomes, or the immediate consequences of opioid stigma in patients; and (5) long-term impacts in patients. The OSF provides 2 main avenues to facilitate future research: (1) providing a framework to explore the mechanisms that underlie opioid stigma and its impact on cancer pain management and (2) supporting the development of targeted, tailored interventions to eliminate opioid stigma.
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Affiliation(s)
- Hailey W. Bulls
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Edward Chu
- Department of Medicine & Molecular Pharmacology, Albert
Einsten Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Jane M. Liebschutz
- Division of General Internal Medicine, Center for Research
on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Antoinette Wozniak
- Division of Hematology/Oncology, Department of Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica S. Merlin
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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16
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Budhwani H, Yigit I, Ofotokun I, Konkle-Parker DJ, Cohen MH, Wingood GM, Metsch LR, Adimora AA, Taylor TN, Wilson TE, Weiser SD, Kempf MC, Sosanya O, Gange S, Kassaye S, Turan B, Turan JM. Examining the Relationships Between Experienced and Anticipated Stigma in Health Care Settings, Patient-Provider Race Concordance, and Trust in Providers Among Women Living with HIV. AIDS Patient Care STDS 2021; 35:441-448. [PMID: 34739336 PMCID: PMC8817693 DOI: 10.1089/apc.2021.0096] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Stigma in health care settings can have negative consequences on women living with HIV, such as increasing the likelihood of missed visits and reducing trust in their clinical providers. Informed by prior stigma research and considering knowledge gaps related to the effect of patient-provider race concordance, we conducted this study to assess if patient-provider race concordance moderates the expected association between HIV-related stigma in health care settings and patients' trust in their providers. Moderation analyses were conducted using Women's Interagency HIV Study data (N = 931). We found significant main effects for patient-provider race concordance. Higher experienced stigma was associated with lower trust in providers in all patient-provider race combinations [White-White: B = -0.89, standard error (SE) = 0.14, p = 0.000, 95% confidence interval, CI (-1.161 to -0.624); Black patient-White provider: B = -0.19, SE = 0.06, p = 0.003, 95% CI (-0.309 to -0.062); and Black-Black: B = -0.30, SE = 0.14, p = 0.037, 95% CI (-0.575 to -0.017)]. Higher anticipated stigma was also associated with lower trust in providers [White-White: B = -0.42, SE = 0.07, p = 0.000, 95% CI (-0.552 to -0.289); Black patient-White provider: B = -0.17, SE = 0.03, p = 0.000, 95% CI (-0.232 to -0.106); and Black-Black: B = -0.18, SE = 0.06, p = 0.002, 95% CI (-0.293 to -0.066)]. Significant interaction effects indicated that the negative associations between experienced and anticipated HIV-related stigma and trust in providers were stronger for the White-White combination compared with the others. Thus, we found that significant relationships between HIV-related experienced and anticipated stigma in health care settings and trust in providers exist and that these associations vary across different patient-provider race combinations. Given that reduced trust in providers is associated with antiretroviral medication nonadherence and higher rates of missed clinical visits, interventions to address HIV-related stigma in health care settings may improve continuum of care outcomes.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | | | - Igho Ofotokun
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | | | | | - Adaora A Adimora
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tonya N Taylor
- Downstate Health Sciences University, Brooklyn, New York, USA
| | - Tracey E Wilson
- Downstate Health Sciences University, Brooklyn, New York, USA
| | - Sheri D Weiser
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | - Seble Kassaye
- Georgetown University, Washington, District of Columbia, USA
| | | | - Janet M Turan
- University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
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17
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Cassiani-Miranda CA, Campo-Arias A, Tirado-Otálvaro AF, Botero-Tobón LA, Upegui-Arango LD, Rodríguez-Verdugo MS, Botero-Tobón ME, Arismendy-López YA, Robles-Fonnegra WA, Niño L, Scoppetta O. Stigmatisation associated with COVID-19 in the general Colombian population. Int J Soc Psychiatry 2021; 67:728-736. [PMID: 33161822 PMCID: PMC7655501 DOI: 10.1177/0020764020972445] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND As the COVID-19 pandemic progresses, the fear of infection increases and, with it, the stigma-discrimination, which makes it an additional problem of the epidemic. However, studies about stigma associated with coronavirus are scarce worldwide. AIMS To determine the association between stigmatisation and fear of COVID-19 in the general population of Colombia. METHOD A cross-sectional study was carried out. A total of 1,687 adults between 18 and 76 years old (M = 36.3; SD = 12.5), 41.1% health workers, filled out an online questionnaire on Stigma-Discrimination and the COVID-5 Fear Scale, adapted by the research team. RESULTS The proportion of high fear of COVID-19 was 34.1%; When comparing the affirmative answers to the questionnaire on stigma-discrimination towards COVID-19, it was found that the difference was significantly higher in the general population compared to health workers in most of the questions evaluated, which indicates a high level of stigmatisation in that group. An association between high fear of COVID-19 and stigma was evidenced in 63.6% of the questions in the questionnaire. CONCLUSION Stigma-discrimination towards COVID-19 is frequent in the Colombian population and is associated with high levels of fear towards said disease, mainly people who are not health workers.
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Affiliation(s)
- Carlos Arturo Cassiani-Miranda
- Faculty of Health Sciences, Medicine Program, UDES Neuroscience Research Group Universidad de Santander, Bucaramanga, Colombia.,International Network for Stigma Reduction (RED_ESTIGMA)
| | - Adalberto Campo-Arias
- International Network for Stigma Reduction (RED_ESTIGMA).,Faculty of Health Sciences, Medicine Program, Health Psychology and Psychiatry Research Group, Universidad del Magdalena, Santa Marta, Colombia
| | - Andrés Felipe Tirado-Otálvaro
- International Network for Stigma Reduction (RED_ESTIGMA).,Faculty of Nursing, Care Research Group, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - Luz Dary Upegui-Arango
- International Network for Stigma Reduction (RED_ESTIGMA).,Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany
| | - María Soledad Rodríguez-Verdugo
- International Network for Stigma Reduction (RED_ESTIGMA).,Mental Health and Addiction Department, Universidad de Sonora, Sonora, México
| | | | - Yinneth Andrea Arismendy-López
- Faculty of Health Sciences, Medicine Program, UDES Neuroscience Research Group Universidad de Santander, Bucaramanga, Colombia.,International Network for Stigma Reduction (RED_ESTIGMA)
| | | | - Levinson Niño
- International Network for Stigma Reduction (RED_ESTIGMA).,Center for Innovation Culture and Society (CENICS)
| | - Orlando Scoppetta
- Faculty of Psychology, GAEM Group (Research Methods Applied to Behavioral Sciences), Universidad Católica de Colombia, Bogotá, Colombia
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18
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Friedman SR, Mateu-Gelabert P, Nikolopoulos GK, Cerdá M, Rossi D, Jordan AE, Townsend T, Khan MR, Perlman DC. Big Events theory and measures may help explain emerging long-term effects of current crises. Glob Public Health 2021; 16:1167-1186. [PMID: 33843462 PMCID: PMC8338763 DOI: 10.1080/17441692.2021.1903528] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/25/2021] [Indexed: 12/17/2022]
Abstract
Big Events are periods during which abnormal large-scale events like war, economic collapse, revolts, or pandemics disrupt daily life and expectations about the future. They can lead to rapid change in health-related norms, beliefs, social networks and behavioural practices. The world is undergoing such Big Events through the interaction of COVID-19, a large economic downturn, massive social unrest in many countries, and ever-worsening effects of global climate change. Previous research, mainly on HIV/AIDS, suggests that the health effects of Big Events can be profound, but are contingent: Sometimes Big Events led to enormous outbreaks of HIV and associated diseases and conditions such as injection drug use, sex trading, and tuberculosis, but in other circumstances, Big Events did not do so. This paper discusses and presents hypotheses about pathways through which the current Big Events might lead to better or worse short and long term outcomes for various health conditions and diseases; considers how pre-existing societal conditions and changing 'pathway' variables can influence the impact of Big Events; discusses how to measure these pathways; and suggests ways in which research and surveillance might be conducted to improve human capacity to prevent or mitigate the effects of Big Events on human health.
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Affiliation(s)
| | - Pedro Mateu-Gelabert
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | | | | | - Diana Rossi
- Intercambios Civil Association and University of Buenos Aires, Buenos Aires, Argentina
| | - Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | | | - Maria R Khan
- NYU Grossman School of Medicine, New York, NY, USA
| | - David C Perlman
- Mount Sinai Beth Israel and Center for Drug Use and HIV Research, New York, NY, USA
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19
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Hochstatter KR, Akhtar WZ, El-Bassel N, Westergaard RP, Burns ME. Racial disparities in use of non-emergency outpatient care by Medicaid-eligible adults after release from prison: Wisconsin, 2015-2017. J Subst Abuse Treat 2021; 126:108484. [PMID: 34052054 DOI: 10.1016/j.jsat.2021.108484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/01/2021] [Accepted: 05/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Black individuals with substance use disorders (SUD) are less likely to receive effective treatment and more likely to be incarcerated compared to White individuals. Despite this, research documenting racial disparities in healthcare use among people with SUD releasing from prison is limited. OBJECTIVES The goals of this study are to: 1) assess racial disparities in Medicaid enrollment among individuals released from prison with a history of substance use; and 2) characterize racial disparities in outpatient service use, emergency department (ED) use, and receipt of medication for opioid use disorder (MOUD) among those who do enroll in Medicaid. METHODS This study included individuals with a history of substance use that were released from Wisconsin state correctional facilities from April 2015 through June 2017. Medicaid enrollment and claims data were analyzed to compare healthcare utilization 6 months post-release between individuals identifying as Black, White, or other races. The total sample included 15,621 prison releases among 14,400 unique persons with a history of substance abuse. RESULTS Among the 15,621 prison releases, 10,836 (69.4%) were enrolled in Medicaid in the month of release. The proportion of prison releases among individuals of other races who enrolled in Medicaid (506/934, 54.2%) was significantly lower than the proportion among Black individuals (3679/5306, 69.3%) and White individuals (6651/9381, 70.9%). Among the subset of 7685 releases enrolled in Medicaid for 6 months post-release, 5040 (65.6%) had an outpatient visit within 6 months; 73.9% of White, 51.3% of Black, and 66.9% of other individuals. Relative to White individuals, Black individuals were 0.324 times less likely (P < 0.001) and individuals of other races were 0.591 times less likely (P = 0.004) to have an outpatient visit. Of the 7685 releases, 1016 (13.2%) had an ED visit within 6 months; 12.0% of White, 13.8% of Black and 25.1% of other individuals. Relative to White individuals, Black individuals were 1.23 times more likely (P = 0.019) and individuals of other races were 2.64 times more likely (P < 0.001) to have an ED visit. Black individuals were 0.100 times less likely (P < 0.001) and individuals of other races were 0.435 times less likely (P = 0.016) to receive MOUD post-release compared to White individuals. CONCLUSIONS Black adults with a history of substance use are significantly less likely than White adults to use non-emergency outpatient services after release from incarceration. Improving equitable access to outpatient services is needed to reduce health disparities across racial groups.
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Affiliation(s)
- Karli R Hochstatter
- Columbia University, School of Social Work, New York, NY, United States of America.
| | - Wajiha Z Akhtar
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Nabila El-Bassel
- Columbia University, School of Social Work, New York, NY, United States of America
| | - Ryan P Westergaard
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States of America; Division of Communicable Diseases, Wisconsin Department of Health Services, Madison, WI, United States of America
| | - Marguerite E Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States of America
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20
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Healthy Choices Intervention is Associated with Reductions in Stigma Among Youth Living with HIV in the United States (ATN 129). AIDS Behav 2021; 25:1094-1102. [PMID: 33098483 PMCID: PMC7979460 DOI: 10.1007/s10461-020-03071-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 01/05/2023]
Abstract
Considering the lack of validated stigma reduction interventions for youth living with HIV (YLWH), we evaluated effects of the Healthy Choices intervention on HIV-related stigma among YLWH. We analyzed data from the Adolescent Medicine Trials Network protocol 129, multi-site randomized controlled trial, applying latent growth curve modeling with two linear slopes estimating changes in Berger's Stigma Scale pre-intervention, 16, 28, and 52 weeks post-intervention, as well as the trajectory of stigma scores over the follow-up period (N = 183). Expected value for the growth intercept was statistically significant (Bintercept = 2.53; 95% CI 2.32, 2.73; p < 0.001), as were differences in the change from baseline to 16-week follow-up (Bintercept slope1 = - 0.02; 95% CI - 0.04, 0.01; p = 0.034). Expected value of the slope factor measuring growth over the follow-up period was non-significant suggesting that stigma scores were stable from 28 to 52 weeks. Our findings warrant replication and additional research comparing effects of this intervention to counterfactual controls.
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21
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De PK. Beyond race: Impacts of non-racial perceived discrimination on health access and outcomes in New York City. PLoS One 2020; 15:e0239482. [PMID: 32970711 PMCID: PMC7514095 DOI: 10.1371/journal.pone.0239482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND I investigate the association of perceived discrimination based both on race and other attributes such as age, gender, and insurance status on self-reported health access and health outcomes in a diverse and densely populated metropolitan area. METHODS Restricted data from the 2016 round of the New York City Community Health Survey was used to create prevalence estimates for both racial and non-racial discrimination. Logistic regression models were used to estimate the association of these discrimination measures with health access and health outcome variables. RESULTS Among residents who perceived discrimination receiving health care during the previous year, 15% reported the reason behind such discrimination to race, while the rest chose other reasons. Among the non-race based categories, 34% reported the reason behind such discrimination to be insurance status, followed by other reasons (26.83%) and income (11.76%). Non-racial discrimination was significantly associated with the adjusted odds of not receiving care when needed (AOR = 6.96; CI: [5.00 9.70]), and seeking informal care (AOR = 2.24; CI: [1.13 4.48] respectively, after adjusting for insurance status, age, gender, marital status, race/ethnicity, nativity, and poverty. It was also associated with higher adjusted odds of reporting poor health (AOR = 2.49; CI: [1.65 3.75]) and being diagnosed with hypertension (AOR = 1.75; CI: [1.21 2.52]), and diabetes (AOR = 1.84; CI: [1.22 2.77]) respectively. CONCLUSIONS Perceived discrimination in health care exists in multiple forms. Non-racial discrimination was strongly associated with worse health access and outcomes, and such experiences may contribute to health disparities between different socioeconomic groups.
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Affiliation(s)
- Prabal K. De
- Department of Economics and Business, City College, City University of New York, New York, NY, United States of America
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Hearld KR, Budhwani H, Martínez-Órdenes M, Altaf A, Hasbun J, Waters J. Female Sex Workers' Experiences of Violence and Substance Use on the Haitian, Dominican Republic Border. Ann Glob Health 2020; 86:105. [PMID: 32874936 PMCID: PMC7442172 DOI: 10.5334/aogh.2889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Female sex workers (FSW) are socially and economically marginalized, and this vulnerability can be exacerbated when they hold the intersectional identity of also being an immigrant, such as in the case of Haitian FSWs in the Dominican Republic. Objective Considering that half of migratory young women and girls relocating across the Latin American and Caribbean region do so without their families, increasing the likelihood of experiencing abuses, our primary objective was to test the hypothesis that Haitian FSWs in the Dominican Republic have higher odds of being physically abused by sexual partners compared to Haitian FSWs in Haiti. Methods We conducted bivariate analyses and multivariate analyses on 2014 Hispaniola Sex Workers Study (N = 232). Findings Approximately 80% of Haitian FSWs in the Dominican Republic reported experiencing violence by a regular partner (80.3%), compared with 60.0% of Haitian FSWs in Haiti (χ2 = 11.34, p < 0.001). Controlling for socio-demographics, substance use, childhood abuse, and sexual behaviors, Haitian FSWs in Haiti maintained lower odds of experiencing violence by a regular partner (OR:0.37, p < 0.01) and higher odds of experiencing violence from a coworker (OR:6.38, p < 0.001) compared to FSWs in the Dominican Republic. Using sex to avoid arrest is associated with higher odds of experiencing violence by a client and violence by a coworker (OR:2.18, p < 0.05; OR:3.74, p < 0.001; respectively). Accepting payment in the form of drugs/alcohol is associated with higher odds of experiencing physical violence by a regular partner but lower odds of experiencing violence by a client (OR:3.99, p < 0.05; OR:0.43, p < 0.05; respectively). Conclusions Assuming health is a human right, then practitioners and scholars must actively collaborate to fortify vulnerable populations against injurious structural and sociocultural forces examining the intersectionality and compound effects of multiple stigmatized identities, in this study being an FSW and an immigrant, that moderate the potential positive effects of public health interventions.
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Affiliation(s)
| | | | | | | | | | - John Waters
- Caribbean Vulnerable Communities Coalition, JM
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Gell-Redman M, Shi L, Zhang D, Mungaray AB. Access to Health Care and Mental Health Among Latino Students in San Diego. Health Equity 2020; 4:255-259. [PMID: 32587939 PMCID: PMC7310208 DOI: 10.1089/heq.2019.0115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 01/05/2023] Open
Abstract
Purpose: Depression during adolescence has important consequences, and Latino adolescents face different mental health challenges compared with peers from other ethnic groups. In this article we investigate whether access to a primary care physician affects the mental health of Latino high school students. Methods: Our data are drawn from a unique sample survey conducted in San Diego County in 2016. Classrooms were randomly selected from six area high schools, and students currently attending school were recruited to complete the survey in class. Self-reported depression screener (Patient Health Questionnaire-2) and loneliness were collected as outcome variables, and access to a primary care physician was the main independent variable. Results: Our multilevel logistic regression linking access to a physician and being at risk for major depression resulted in an odds ratio (OR) of 0.316 (95% confidence interval [CI]: 0.184-0.544), whereas the multilevel logistic regression relating access to a physician and feeling lonely resulted an OR of 0.371 (95% CI: 0.215-0.639). Conclusion: This study provides evidence from a novel setting to demonstrate the link between mental health and access to health services within a minority population. Because many of the Latino adolescents in our sample come from mixed status families, this finding is particularly important in the current policy climate of the United States, in which the future of access to health care for many immigrant families is highly uncertain.
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Affiliation(s)
- Micah Gell-Redman
- Department of Health Policy and Management, University of Georgia, Athens, Georgia, USA.,Department of International Affairs, University of Georgia, Athens, Georgia, USA
| | - Lu Shi
- College of Health, Education and Human Development, Clemson University, Clemson, South Carolina, USA
| | - Donglan Zhang
- Department of Health Policy and Management, University of Georgia, Athens, Georgia, USA
| | - Ana Barbara Mungaray
- Facultad de Economía y Relaciones Internacionales, Universidad Autonoma de Baja California, Tijuana, Mexico
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Budhwani H, Sun R. Creating COVID-19 Stigma by Referencing the Novel Coronavirus as the "Chinese virus" on Twitter: Quantitative Analysis of Social Media Data. J Med Internet Res 2020; 22:e19301. [PMID: 32343669 PMCID: PMC7205030 DOI: 10.2196/19301] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 12/31/2022] Open
Abstract
Background Stigma is the deleterious, structural force that devalues members of groups that hold undesirable characteristics. Since stigma is created and reinforced by society—through in-person and online social interactions—referencing the novel coronavirus as the “Chinese virus” or “China virus” has the potential to create and perpetuate stigma. Objective The aim of this study was to assess if there was an increase in the prevalence and frequency of the phrases “Chinese virus” and “China virus” on Twitter after the March 16, 2020, US presidential reference of this term. Methods Using the Sysomos software (Sysomos, Inc), we extracted tweets from the United States using a list of keywords that were derivatives of “Chinese virus.” We compared tweets at the national and state levels posted between March 9 and March 15 (preperiod) with those posted between March 19 and March 25 (postperiod). We used Stata 16 (StataCorp) for quantitative analysis, and Python (Python Software Foundation) to plot a state-level heat map. Results A total of 16,535 “Chinese virus” or “China virus” tweets were identified in the preperiod, and 177,327 tweets were identified in the postperiod, illustrating a nearly ten-fold increase at the national level. All 50 states witnessed an increase in the number of tweets exclusively mentioning “Chinese virus” or “China virus” instead of coronavirus disease (COVID-19) or coronavirus. On average, 0.38 tweets referencing “Chinese virus” or “China virus” were posted per 10,000 people at the state level in the preperiod, and 4.08 of these stigmatizing tweets were posted in the postperiod, also indicating a ten-fold increase. The 5 states with the highest number of postperiod “Chinese virus” tweets were Pennsylvania (n=5249), New York (n=11,754), Florida (n=13,070), Texas (n=14,861), and California (n=19,442). Adjusting for population size, the 5 states with the highest prevalence of postperiod “Chinese virus” tweets were Arizona (5.85), New York (6.04), Florida (6.09), Nevada (7.72), and Wyoming (8.76). The 5 states with the largest increase in pre- to postperiod “Chinese virus” tweets were Kansas (n=697/58, 1202%), South Dakota (n=185/15, 1233%), Mississippi (n=749/54, 1387%), New Hampshire (n=582/41, 1420%), and Idaho (n=670/46, 1457%). Conclusions The rise in tweets referencing “Chinese virus” or “China virus,” along with the content of these tweets, indicate that knowledge translation may be occurring online and COVID-19 stigma is likely being perpetuated on Twitter.
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Affiliation(s)
- Henna Budhwani
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ruoyan Sun
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
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