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Wright GC, Mysler E, Kwok K, Cadatal MJ, Germino R, Yndestad A, Kinch CD, Ogdie A. Impact of Race on the Efficacy and Safety of Tofacitinib in Rheumatoid Arthritis: Post Hoc Analysis of Pooled Clinical Trials. Rheumatol Ther 2024; 11:1135-1164. [PMID: 38958913 PMCID: PMC11422414 DOI: 10.1007/s40744-024-00677-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/03/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Racial disparities in disease activity, clinical outcomes, and treatment survival persist despite advancements in rheumatoid arthritis (RA) therapies and clinical management. In this post hoc analysis of pooled data from the tofacitinib global clinical program, we evaluated the impact of race on the efficacy and safety of tofacitinib in patients with RA. METHODS Data were pooled from 15 phase 2-3b/4 studies of patients with RA treated with tofacitinib 5 or 10 mg twice daily, adalimumab, or placebo. Outcomes were stratified by self-reported patient race (White/Black/Asian/Other). Efficacy outcomes to month 12 included: American College of Rheumatology (ACR)20/50/70 responses, Clinical Disease Activity Index (CDAI)/Disease Activity Score in 28 joints, erythrocyte sedimentation rate [DAS28-4(ESR)] low disease activity (LDA) rates, least squares (LS) mean change from baseline (∆) in CDAI, DAS28-4 (ESR), Health Assessment Questionnaire-Disability Index (HAQ-DI), and Pain [Visual Analog Scale (VAS)]. Odds ratios (ORs; 95% CI) versus placebo, and placebo-adjusted ∆LS means were calculated for active treatments using logistic regression model and mixed-effect model of repeated measurements, respectively. Safety outcomes were assessed throughout. RESULTS A total of 6355 patients were included (White, 4145; Black, 213; Asian, 1348; Other, 649). For tofacitinib-treated patients, ORs for ACR20/50/70 responses and CDAI/DAS28-4(ESR) LDA rates through month 3 were generally numerically higher for White/Asian/Other versus Black patients. Across active treatments, trends toward higher placebo-adjusted improvements from baseline in CDAI, DAS28-4 (ESR), HAQ-DI, and Pain (VAS) were observed in Asian/Other versus White/Black patients. Numerically higher placebo responses in Black versus White/Asian/Other patients were generally observed across outcomes through month 12. Safety outcomes were mostly similar across treatment/racial groups. CONCLUSIONS In patients with RA, tofacitinib was efficacious across racial groups with similar safety outcomes; observed racial differences potentially reflect patient demographics or regional practice disparities. TRIAL REGISTRATION NUMBERS ClinicalTrials.gov identifiers: NCT00147498; NCT00413660; NCT00550446; NCT00603512; NCT00687193; NCT01164579; NCT00976599; NCT01359150; NCT00960440; NCT00847613; NCT00814307; NCT00856544; NCT00853385; NCT01039688; NCT02187055.
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Affiliation(s)
- Grace C Wright
- Grace C. Wright MD PC and Association of Women in Rheumatology, New York, NY, USA
| | - Eduardo Mysler
- Division of Rheumatology, Organización Médica de Investigación, Buenos Aires, Argentina
| | - Kenneth Kwok
- Inflammation and Immunology, Pfizer Inc, New York, NY, USA
| | | | | | - Arne Yndestad
- Inflammation and Immunology, Pfizer Inc, Oslo, Norway
| | - Cassandra D Kinch
- Inflammation and Immunology, Pfizer Canada ULC, Kirkland, QC, Canada.
| | - Alexis Ogdie
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Rosenthal M, Stolz A, Haskin L, Leung SYJ, Wong C, O'Grady T, Swain CA, Kaufman S. Prevalence of Repeat Prenatal HIV Screening in New York State. J Womens Health (Larchmt) 2024; 33:1240-1247. [PMID: 38864110 DOI: 10.1089/jwh.2023.0835] [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: 06/13/2024] Open
Abstract
Description: New York State Department of Health (NYSDOH) recommends that all pregnant patients receive human immunodeficiency virus (HIV) screening during pregnancy. This study assessed the prevalence of repeat prenatal HIV testing and factors associated with receipt of the recommended tests. Methods: Data from the NYSDOH newborn screening program were used to randomly select pregnant persons without HIV who delivered a liveborn infant in 2017. Receipt of repeat testing was defined as an initial HIV test in the first or second trimesters and the final in the third trimester (relaxed); or an initial test in the first trimester and the final in the third trimester (strict). Relative risks (RRs) and 95% confidence intervals were calculated in bivariate analyses. Adjusted RRs were calculated to determine associations between demographic and clinical factors and receipt of repeat HIV testing. Results: The cohort included 2,225 individuals. Roughly one quarter (24%) received the recommended tests in the first or second and third trimesters and 17% received them in the first and third trimesters. Individuals who reported Hispanic or Asian race/ethnicities, had government-funded insurance, started prenatal care in the first trimester, delivered in New York City, or received prenatal hepatitis C virus screening were significantly more likely to receive repeat testing using either definition. Conclusions: Despite the benefits and cost-effectiveness, the prevalence of repeat prenatal HIV screening during the third trimester remains persistently low. Improved messaging and targeted education and resources to assist prenatal providers could reinforce the importance of repeat testing and reduce residual perinatal HIV transmission.
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Affiliation(s)
- Mark Rosenthal
- Division of HIV/STI Epidemiology, Evaluation, and Partner Services, New York State Department of Health, Albany, New York, USA
| | - Amanda Stolz
- Division of HIV/STI Epidemiology, Evaluation, and Partner Services, New York State Department of Health, Albany, New York, USA
| | - Lisa Haskin
- Division of HIV and Hepatitis Health care, New York State Department of Health, AIDS Institute, Albany, New York, USA
| | - Shu-Yin John Leung
- Office of Program Evaluation and Research, New York State Department of Health, AIDS Institute, Albany, New York, USA
| | - Calvin Wong
- Division of HIV/STI Epidemiology, Evaluation, and Partner Services, New York State Department of Health, Albany, New York, USA
| | - Thomas O'Grady
- Division of HIV/STI Epidemiology, Evaluation, and Partner Services, New York State Department of Health, Albany, New York, USA
- University at Albany School of Public Health, Albany, New York, USA
| | - Carol-Ann Swain
- Division of HIV/STI Epidemiology, Evaluation, and Partner Services, New York State Department of Health, Albany, New York, USA
| | - Suzanne Kaufman
- Division of HIV and Hepatitis Health care, New York State Department of Health, AIDS Institute, Albany, New York, USA
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Kyalwazi AN, Woods-Giscombe CL, Johnson MP, Jones C, Hayes SN, Cooper LA, Patten CA, Brewer LC. Associations Between the Superwoman Schema, Stress, and Cardiovascular Health Among African-American Women. Ann Behav Med 2024:kaae047. [PMID: 39216076 DOI: 10.1093/abm/kaae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND African-American (AA) women are less likely to achieve ideal cardiovascular (CV) health compared with women of other racial/ethnic subgroups, primarily due to structural and psychosocial barriers. A potential psychosocial construct relevant to ideal CV health is the superwoman schema (SWS). PURPOSE We explored whether the SWS was associated with perceived stress, CV risk factors, and overall CV health among AA women. METHODS This cross-sectional analysis of the FAITH! Heart Health+ Study was conducted among AA women with high cardiometabolic risk. Pearson correlation evaluated associations between SWS and CV risk factors (e.g., stress, hypertension, diabetes, etc.). The 35-item SWS questionnaire includes five domains. Stress was measured by the 8-item Global Perceived Stress Scale (GPSS). CV health was assessed using the American Heart Association Life's Simple 7 (LS7) rubric of health behaviors/biometrics. Data acquisition spanned from February to August 2022. RESULTS The 38 women included in the analysis (mean age 54.3 [SD 11.5] years) had a high CV risk factor burden (71.1% hypertension, 76.3% overweight/obesity, 28.9% diabetes, 39.5% hyperlipidemia). Mean GPSS level was 7.7 (SD 5.2), CV health score 6.7 (SD 1.8), and SWS score 60.3 (SD 18.0). Feeling an "obligation to help others" and "obligation to present an image of strength" had strongest correlations with GPSS score among all SWS domains (r = 0.51; p = .002 and r = 0.39; p = .02, respectively). Correlation among the SWS domains and traditional CV risk factors was not statistically significant. CONCLUSION Our findings suggest that an obligation to help others and to project an image of strength could be contributing to stress among AA women.
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Affiliation(s)
| | | | - Matthew P Johnson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
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Farr AM, Carter JS, Webber-Ritchey K. Relationships Among the Endorsement of Superwoman Schema and Health Outcomes. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00259-4. [PMID: 39182515 DOI: 10.1016/j.jogn.2024.07.005] [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: 03/05/2024] [Revised: 07/18/2024] [Accepted: 07/28/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVE To examine associations among endorsement of elements of the superwoman schema (the obligation to manifest strength and the obligation to help others) and health outcomes and to test if stress mediates the association between the obligation to manifest strength and depression in adult Black women. DESIGN Cross-sectional design. SETTING Community space in the Chicago metropolitan area. PARTICIPANTS Ninety-one adult Black women. METHODS Participants completed questionnaires to assess endorsement of superwoman schema roles, physical activity, healthy eating, weight satisfaction, depression, and stress. Height and weight were collected by research assistants. We used descriptive statistics, bivariate correlations, multiple regression models, and linear mediation analysis to analyze data. RESULTS Higher levels of obligation to suppress emotions were associated with lower physical activity, r(88) = -0.25, p < .05. Obligation to manifest strength was associated with higher levels of stress, r(79) = 0.53, p < .01, and symptoms of depression, r(71) = 0.36, p < .01. Stress mediated the relationship between the obligation to manifest strength and depression with a significant indirect effect, b = 0.37, SE = 0.10, 95% confidence interval [0.20, 0.60]. CONCLUSION Our findings offer insight into the psychological and social processes that affect Black women and may aid in the development of culturally responsive prevention and intervention programs at individual and community levels to reduce chronic diseases.
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Warren KF, Dail RB, Dawson RM, Boghossian NS, Felder TM. When a baby is born, so is a parent: Understanding the effects of preterm birth on Black parents through the lens of the NIMHD framework. Nurs Outlook 2024; 72:102246. [PMID: 39116649 DOI: 10.1016/j.outlook.2024.102246] [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: 01/29/2024] [Revised: 06/29/2024] [Accepted: 07/06/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The rate of preterm birth (PTB) is high in the United States and Black infants remain disproportionately affected, with the disparity between Black and White infant deaths greater today than it was under antebellum slavery. PURPOSE The National Institute on Minority Health and Disparities Research Framework reflects a unique set of determinants relevant to the understanding and promotion of minority health. METHODS We have applied this framework to better understand the effects of PTB on Black parents and the distribution of the social determinants of health, including structural determinants and root causes of inequities. DISCUSSION This adaptation shows the intersection in maternal and infant health that shapes individuals' experiences, drives disparities and impacts perinatal outcomes in critical periods over the lifecourse. CONCLUSION In our efforts to achieve health equity, it is imperative that we study the underlying mechanisms and recognize that policies, institutional structures, and social factors are drivers of racism.
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Affiliation(s)
- Karen F Warren
- University of South Carolina, College of Nursing, Columbia, SC.
| | - Robin B Dail
- University of South Carolina, College of Nursing, Columbia, SC
| | - Robin M Dawson
- University of South Carolina, College of Nursing, Columbia, SC
| | - Nansi S Boghossian
- University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Tisha M Felder
- University of South Carolina, College of Nursing, Columbia, SC
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Kipp C, Wilson DK, Brown A, Quattlebaum M, Loncar H, Sweeney AM, Abshire DA. Compounding effects of stress on diet, physical activity, and wellbeing among African American parents: a qualitative study to inform the LEADS health promotion trial. J Behav Med 2024; 47:647-661. [PMID: 38460063 DOI: 10.1007/s10865-024-00477-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/01/2024] [Indexed: 03/11/2024]
Abstract
The purpose of the study was to conduct in-depth qualitative interviews to understand the lived experiences of African American parents of overweight adolescents who had previously participated in a family-based weight loss program and to utilize these insights to inform the essential elements of the LEADS trial, an integrated resilience stress management and health promotion intervention. Participants (N = 30) were African American parents and/or caregivers (96.7% female; Mage = 49.73, SD = 10.88; MBMI = 37.63, SD = 8.21) of adolescents with overweight and/or obesity. Interviews were transcribed and coded using inductive and deductive approaches for themes by two independent coders. Inter-rater reliability was acceptable (r = 0.70-0.80) and discrepancies were resolved to 100% agreement. Prominent stress themes included caregiver responsibilities, work, interpersonal family conflict, and physical and emotional consequences of chronic stress. Participants also noted decreases in physical activity and poor food choices due to stress. Coping mechanisms included prayer/meditation, church social support, and talking with family/partner. Results highlight the importance of mitigating stress among African American parents through stress management and cultural/familial resilience approaches to increase the likelihood of engagement in behavioral strategies in health promotion programs. Future studies should assess the utility of incorporating stress management components and health promotion techniques to improve health outcomes among African American families.
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Affiliation(s)
- Colby Kipp
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Asia Brown
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Mary Quattlebaum
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Haylee Loncar
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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Harris M, Sherrod D, Walsh JL, Hunt BR, Jacobs J, Valencia J, Baumer-Mouradian S, Quinn KG. The Influence of Racism in Healthcare: COVID-19 Vaccine Hesitancy Among Black Mothers in Chicago. J Racial Ethn Health Disparities 2024; 11:2425-2434. [PMID: 37531019 DOI: 10.1007/s40615-023-01708-0] [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: 04/30/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 08/03/2023]
Abstract
Black mothers and children experience significant health disparities in the USA. These health disparities have been attributed, in part, to experiencing racism in healthcare. This study aimed to explore how experiences of healthcare discrimination and mistreatment experienced by Black mothers may influence COVID-19 vaccine beliefs and decision-making for themselves and their families. From April 2021 to November 2021, we conducted 50 semi-structured interviews among Chicago residents. Ten participants self-identified as female and with reported children; these data were extracted from the larger sample for data analysis. Interview content included perceptions and experiences with the COVID-19 vaccine and experiences with healthcare discrimination, mistreatment, and medical mistrust. Interview transcripts were transcribed verbatim and coded using the MAXQDA 2022 qualitative software. Themes were identified using a team-based thematic analysis to understand how experiences of racism in healthcare may influence COVID-19 vaccine decision-making. Four themes were generated from the data: (1) experiences of healthcare discrimination and mistreatment, (2) distrust and fears of experimentation, (3) the influence of discrimination and distrust on COVID-19 vaccine decision-making, and (4) overcoming vaccine hesitancy. The results of this study highlight the current literature; Black mothers experience racism and discrimination in healthcare when seeking care for themselves and their children. It is evident in their stories that medical racism and historical medical abuse influence vaccine decision-making. Therefore, healthcare and public health initiatives should be intentional in addressing past and present racism in healthcare to improve vaccine distrust.
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Affiliation(s)
- Melissa Harris
- Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Darielle Sherrod
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bijou R Hunt
- Sinai Health System, Sinai Infectious Disease Center, Chicago, IL, USA
| | - Jacquelyn Jacobs
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jesus Valencia
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
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Raiford JL, DiNenno E, Beer L, Bowman S, Johnson Lyons S, Anderson SKE, Powell N, Nickson R, Hall G, Neblett Fanfair R. CDC Prioritizes HIV Prevention and Treatment to Reduce HIV Disparities Among Cis-Gender Black Women. J Womens Health (Larchmt) 2024; 33:993-1009. [PMID: 38968401 DOI: 10.1089/jwh.2024.0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024] Open
Abstract
To succeed in ending the HIV epidemic in the United States, the Centers for Disease Control and Prevention (CDC) focuses on delivering combinations of scientifically proven, cost-effective, and scalable interventions to priority populations. Systemic factors continue to contribute to persistent health disparities and disproportionately higher rates of HIV diagnosis in some communities. The National HIV/AIDS Strategy has designated cis-gender Black women (CgBW) as a priority population to address the racial and ethnic inequities in HIV. This report presents the portfolio of projects, programs, and initiatives funded by the CDC's Division of HIV Prevention (DHP) to address disparities in HIV and improve health and QOL among CgBW. These funded activities include the development, planning, and implementation of HIV prevention programs, mass media campaigns, and behavioral interventions focused on CgBW. This report also summarizes DHP's community engagement, capacity building, and partnership efforts, and highlights research and surveillance activities focusing on CgBW. Finally, this report outlines future directions for CDC's efforts to improve access to HIV testing, treatment, and prevention for CgBW in the United States.
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Affiliation(s)
- Jerris L Raiford
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth DiNenno
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sloane Bowman
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shacara Johnson Lyons
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stefanie K E Anderson
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nakesha Powell
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rhondette Nickson
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Grace Hall
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robyn Neblett Fanfair
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Rokicki S, McConnell M. Racial and Socioeconomic Disparities in Preconception Health Risk Factors and Access to Care. J Womens Health (Larchmt) 2024; 33:1063-1071. [PMID: 38563909 DOI: 10.1089/jwh.2023.0560] [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: 04/04/2024] Open
Abstract
Background: Black birthing people have significantly higher risks of maternal mortality and morbidity compared with White people. Preconception chronic conditions increase the risk of adverse pregnancy outcomes, yet little is known about disparities in preconception health. This study applies an intersectional framework to examine the simultaneous contributions of racial marginalization and economic deprivation in determining disparities in preconception risk factors and access to care. Methods: Using data from the Pregnancy Risk Assessment Monitoring System, 2016-2020 (N = 123,697), we evaluated disparities by race and income in self-reported preconception hypertension, diabetes, obesity, depression, and smoking, as well as preconception insurance coverage and utilization of health care. We estimated linear regression models and calculated predicted probabilities. Results: Black respondents experienced higher probabilities of preconception obesity and high blood pressure at every income level compared with White respondents. Higher income did not attenuate the probability of obesity for Black respondents (linear trend p = 0.21), as it did for White respondents (p < 0.001). Conversely, while White respondents with low income were at higher risk of preconception depression and smoking than their Black counterparts, higher income was strongly associated with reduced risk, with significantly steeper reductions for White compared with Black respondents (difference in trends p < 0.001 for both risk factors). White respondents had higher probabilities of utilizing preconception care across all income levels, despite similar probabilities of insurance coverage. Conclusions: Higher income does not protect against the risk of preconception obesity and other preconception risk factors for Black birthing people as it does for White birthing people. Results point to the need to consider multiple forms of intersecting structural factors in policy and intervention research to improve preconception and maternal health.
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Affiliation(s)
- Slawa Rokicki
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Margaret McConnell
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Yang H, Zhou S, Rao Z, Zhao C, Cui E, Shenoy C, Blaes AH, Paidimukkala N, Wang J, Hou J, Zhang R. Multi-modality risk prediction of cardiovascular diseases for breast cancer cohort in the All of Us Research Program. J Am Med Inform Assoc 2024:ocae199. [PMID: 39058572 DOI: 10.1093/jamia/ocae199] [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: 04/09/2024] [Revised: 06/18/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE This study leverages the rich diversity of the All of Us Research Program (All of Us)'s dataset to devise a predictive model for cardiovascular disease (CVD) in breast cancer (BC) survivors. Central to this endeavor is the creation of a robust data integration pipeline that synthesizes electronic health records (EHRs), patient surveys, and genomic data, while upholding fairness across demographic variables. MATERIALS AND METHODS We have developed a universal data wrangling pipeline to process and merge heterogeneous data sources of the All of Us dataset, address missingness and variance in data, and align disparate data modalities into a coherent framework for analysis. Utilizing a composite feature set including EHR, lifestyle, and social determinants of health (SDoH) data, we then employed Adaptive Lasso and Random Forest regression models to predict 6 CVD outcomes. The models were evaluated using the c-index and time-dependent Area Under the Receiver Operating Characteristic Curve over a 10-year period. RESULTS The Adaptive Lasso model showed consistent performance across most CVD outcomes, while the Random Forest model excelled particularly in predicting outcomes like transient ischemic attack when incorporating the full multi-model feature set. Feature importance analysis revealed age and previous coronary events as dominant predictors across CVD outcomes, with SDoH clustering labels highlighting the nuanced impact of social factors. DISCUSSION The development of both Cox-based predictive model and Random Forest Regression model represents the extensive application of the All of Us, in integrating EHR and patient surveys to enhance precision medicine. And the inclusion of SDoH clustering labels revealed the significant impact of sociobehavioral factors on patient outcomes, emphasizing the importance of comprehensive health determinants in predictive models. Despite these advancements, limitations include the exclusion of genetic data, broad categorization of CVD conditions, and the need for fairness analyses to ensure equitable model performance across diverse populations. Future work should refine clinical and social variable measurements, incorporate advanced imputation techniques, and explore additional predictive algorithms to enhance model precision and fairness. CONCLUSION This study demonstrates the liability of the All of Us's diverse dataset in developing a multi-modality predictive model for CVD in BC survivors risk stratification in oncological survivorship. The data integration pipeline and subsequent predictive models establish a methodological foundation for future research into personalized healthcare.
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Affiliation(s)
- Han Yang
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN 55455, United States
| | - Sicheng Zhou
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN 55455, United States
| | - Zexi Rao
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN 55455, United States
| | - Chen Zhao
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN 55455, United States
| | - Erjia Cui
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN 55455, United States
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN 55455, United States
| | - Anne H Blaes
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55455, United States
| | - Nishitha Paidimukkala
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN 55455, United States
| | - Jinhua Wang
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, United States
| | - Jue Hou
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN 55455, United States
| | - Rui Zhang
- Division of Computational Health Sciences, Department of Surgery, University of Minnesota, Minneapolis, MN 55455, United States
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Dong L, Bogart LM, Mutchler MG, Klein DJ, Ghosh-Dastidar MB, Lawrence SJ, Goggin K, Wagner GJ. Sleep Disturbance Mediates the Associations Between HIV Stigma and Mental and Physical Health Among Black Adults with HIV. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02083-0. [PMID: 38990469 DOI: 10.1007/s40615-024-02083-0] [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: 01/24/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES Black Americans have been disproportionally affected by the HIV epidemic, and experience significant disparities in sleep health, mental health, and physical health domains. Using longitudinal data from a sample of Black adults with HIV, the current study examined the associations between stigma and mental and physical health outcomes and how sleep disturbance may play a mediating role. METHODS Data were drawn from a recent randomized controlled trial. Questionnaires were used to examine internalized and anticipated HIV stigma, perceived discrimination (enacted stigma) based on multiple social identities (i.e., HIV-serostatus, race, sexual orientation), sleep disturbance, mental health problems (depressive and posttraumatic stress disorder [PTSD] symptoms), and mental and physical health-related quality of life (HRQOL) at baseline, 7-month follow-up, and 13-month follow-up assessments. Linear mixed modeling was used to examine main effects of stigma on health outcomes; causal mediation analysis was used to estimate indirect paths through sleep disturbance. RESULTS Internalized and anticipated HIV stigma and multiple discrimination were associated with more sleep disturbance, more depressive and PTSD symptoms, and poorer mental and physical HRQOL. Results also indicated significant indirect paths (i.e., mediation) through greater sleep disturbance between HIV-related stigma and discrimination and mental health and health-related quality of life. CONCLUSIONS Results support that sleep disturbance is a mediating pathway through which different forms of stigmas impact health outcomes. Sleep may be an intervention target to help improve mental and physical well-being and reduce health disparities among racial and ethnic minority people with HIV.
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Affiliation(s)
- Lu Dong
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA.
| | - Laura M Bogart
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Matt G Mutchler
- APLA Health, Los Angeles, CA, USA
- School of Public Health and Health Sciences, California State University, Dominguez Hills, Carson, CA, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
| | | | | | - Kathy Goggin
- Children's Mercy Kansas City and University of Missouri-Kansas City Schools of Medicine and Pharmacy, Kansas City, MO, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Glenn J Wagner
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
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12
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Middleweek B, Klinger L. 'I just LOVE data': perceptions and practices of data sharing and privacy among users of the Lioness. CULTURE, HEALTH & SEXUALITY 2024:1-19. [PMID: 38970796 DOI: 10.1080/13691058.2024.2369596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/14/2024] [Indexed: 07/08/2024]
Abstract
High profile data breaches and the proliferation of self-tracking technologies generating bio-feedback data have raised concerns about data privacy and data sharing practices among users of these devices. However, our understanding of how self-trackers in sexual health populations, where the data may be sensitive, personal, and stigmatising, perceive data privacy and sharing is limited. This study combined industry consultation with a survey of users of the world's first biofeedback smart vibrator, the Lioness, that enables users to monitor and analyse their sexual response intensity and orgasm duration over time. We found users of the Lioness are motivated to self-track by both individual and altruistic goals: to learn more about their bodies, and to contribute to research that leads to better sexual health outcomes. Perceptions of data privacy and data sharing were shaped by an eagerness to collaborate with sexual health researchers to challenge traditional male-centric perspectives in biomedical research on women's sexual health, where gender plays a crucial role in defining healthcare systems and outcomes. This study extends our understanding of the non-digital aspects of self-tracking by emphasising the role of gender and inclusive healthcare advocacy in shaping perceptions of data privacy and sharing within sexual health populations.
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Affiliation(s)
- Belinda Middleweek
- School of Communication, University of Technology Sydney, Sydney, Australia
| | - Liz Klinger
- Smartbod Incorporated DBA Lioness, Oakland, CA, USA
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13
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Herzberg MP, Smyser CD. Prenatal Social Determinants of Health: Narrative review of maternal environments and neonatal brain development. Pediatr Res 2024:10.1038/s41390-024-03345-7. [PMID: 38961164 DOI: 10.1038/s41390-024-03345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024]
Abstract
The Social Determinants of Health, a set of social factors including socioeconomic status, community context, and neighborhood safety among others, are well-known predictors of mental and physical health across the lifespan. Recent research has begun to establish the importance of these social factors at the earliest points of brain development, including during the prenatal period. Prenatal socioeconomic status, perceived stress, and neighborhood safety have all been reported to impact neonatal brain structure and function, with exploratory work suggesting subsequent effects on infant and child behavior. Secondary effects of the Social Determinants of Health, such as maternal sleep and psychopathology during pregnancy, have also been established as important predictors of infant brain development. This research not only establishes prenatal Social Determinants of Health as important predictors of future outcomes but may be effectively applied even before birth. Future research replicating and extending the effects in this nascent literature has great potential to produce more specific and mechanistic understanding of the social factors that shape early neurobehavioral development. IMPACT: This review synthesizes the research to date examining the effects of the Social Determinants of Health during the prenatal period and neonatal brain outcomes. Structural, functional, and diffusion-based imaging methodologies are included along with the limited literature assessing subsequent infant behavior. The degree to which results converge between studies is discussed, in combination with the methodological and sampling considerations that may contribute to divergence in study results. Several future directions are identified, including new theoretical approaches to assessing the impact of the Social Determinants of Health during the perinatal period.
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Affiliation(s)
- Max P Herzberg
- Department of Psychiatry, Washington University in St. Louis, Saint Louis, MO, USA
| | - Christopher D Smyser
- Department of Neurology, Pediatrics, and Radiology, Washington University in St. Louis, Saint Louis, MO, USA.
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14
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Boakye PN, Prendergast N. "There is nothing to protect us from dying": Black women's perceived sense of safety accessing pregnancy and intrapartum care. Nurs Inq 2024; 31:e12638. [PMID: 38534008 DOI: 10.1111/nin.12638] [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] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
Pregnancy and childbirth have become a dangerous journey for Black women as harrowing stories of death and near-death experiences resonate within Black communities. While the causes of pregnancy-related morbidity and mortality are well documented, little is known about how Black Canadian women feel protected from undesirable maternal health outcomes when accessing and receiving pregnancy and intrapartum care. This critical qualitative inquiry sheds light on Black women's perceived sense of safety in accessing pregnancy and intrapartum care. Twenty-four in-depth interviews were conducted with Black women who were pregnant or had given birth. Five interconnected themes were generated through thematic analysis: (1) There is a lot of prejudice towards us, (2) We are treated as sick bodies, (3) There is a lot of stereotypes towards us, (4) Our care is lacking in quality, and (5) We feel unsafe in the healthcare system. These themes highlight the perils faced by Black women accessing pregnancy and intrapartum care. The right to safe motherhood and equitable care for Black women should be a national priority in Canada to avert a looming crisis.
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Affiliation(s)
- Priscilla N Boakye
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Nadia Prendergast
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
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15
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Graybeal AJ, Compton AT, Swafford SH, Brandner CF, Thorsen T, Renna ME, Stavres J. Measurements of Abdominal Obesity are Associated with Metabolic Syndrome Severity Independent of Hypertensive Phenotype in White but not Black Young Adults. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02051-8. [PMID: 38902464 DOI: 10.1007/s40615-024-02051-8] [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: 01/29/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE This study sought to determine if metabolic syndrome severity (MetSindex) was differentially associated with abdominal obesity based on waist circumference (WC) site and the presentation of hypertensive phenotypes in a group of young White and Black adults. METHODS A total of 139 young adult (22.5 ± 3.3 years) non-Hispanic White (n = 73) and non-Hispanic Black (n = 66) males and females (M 53, 86 F) completed this cross-sectional evaluation. Participants had their WC measured at three distinct locations along the abdomen which were used to calculate waist-to-hip and waist-to-height ratios. Systolic (SBP) and diastolic blood pressure (DBP) were collected and used to calculate mean arterial pressure (MAP). In addition to traditional metabolic syndrome (MetS) risk factors, BP values were individually used to produce three separate MetSindex scores representing three specific hypertensive phenotypes (MetSSBP, MetSDBP, MetSMAP), and each of these were evaluated against each abdominal obesity estimate. RESULTS MetSDBP and MetSSBP were significantly higher than all other indices for females (all p ≤ 0.002) and males (all p < 0.001), respectively. MetSDBP was significantly higher than MetSMAP for White females (p = 0.039), and MetSSBP was significantly higher than MetSDBP and MetSMAP (both p < 0.001) for Black males. Standalone and joint estimates of abdominal obesity were uniquely associated with MetSindex across hypertensive phenotypes for White, but not Black males and females. CONCLUSIONS Specific hypertensive phenotypes may differentially determine MetSindex, but these estimates are not associated with abdominal obesity in young Black adults regardless of measurement location. Healthcare professionals should address this disparity by providing more comprehensive MetS screening procedures for young Black adults. CLINICAL TRIALS REGISTRATION NCT05885672.
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Affiliation(s)
- Austin J Graybeal
- School of Kinesiology and Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, 39406, USA.
| | - Abby T Compton
- School of Kinesiology and Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, 39406, USA
| | - Sydney H Swafford
- School of Kinesiology and Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, 39406, USA
| | - Caleb F Brandner
- Department of Kinesiology and Health, Iowa State University, Ames, IA, 50011, USA
| | - Tanner Thorsen
- School of Kinesiology and Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, 39406, USA
| | - Megan E Renna
- School of Psychology, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, 39406, USA
| | - Jon Stavres
- School of Kinesiology and Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, 39406, USA
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16
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Schroeder J, Polemi KM, Tapaswi A, Svoboda LK, Sexton JZ, Colacino JA. Investigating phenotypic plasticity due to toxicants with exposure disparities in primary human breast cells in vitro. Front Oncol 2024; 14:1411295. [PMID: 38915368 PMCID: PMC11194339 DOI: 10.3389/fonc.2024.1411295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/20/2024] [Indexed: 06/26/2024] Open
Abstract
Introduction Breast cancer is the second most diagnosed cancer, as well as the primary cause of cancer death in women worldwide. Of the different breast cancer subtypes, triple-negative breast cancer (TNBC) is particularly aggressive and is associated with poor prognosis. Black women are two to three times more likely to be diagnosed with TNBCs than white women. Recent experimental evidence suggests that basal-like TNBCs may derive from luminal cells which acquire basal characteristics through phenotypic plasticity, a newly recognized hallmark of cancer. Whether chemical exposures can promote phenotypic plasticity in breast cells is poorly understood. Methods To investigate further, we developed a high-content immunocytochemistry assay using normal human breast cells to test whether chemical exposures can impact luminal/basal plasticity by unbiased quantification of keratin 14 (KRT14), a basal-myoepithelial marker; keratin 8 (KRT8), a luminal-epithelial marker; and Hoechst 33342, a DNA marker. Six cell lines established from healthy tissue from donors to the Susan G. Komen Normal Tissue Bank were exposed for 48 hours to three different concentrations (0.1μM, 1μM, and 10μM) of eight ubiquitous chemicals (arsenic, BPA, BPS, cadmium, copper, DDE, lead, and PFNA), with documented exposure disparities in US Black women, in triplicate. Automated fluorescence image quantification was performed using Cell Profiler software, and a random-forest classifier was trained to classify individual cells as KRT8 positive, KRT14 positive, or hybrid (both KRT8 and KRT14 positive) using Cell Profiler Analyst. Results and discussion Results demonstrated significant concentration-dependent increases in hybrid populations in response to BPA, BPS, DDE, and PFNA. The increase in hybrid populations expressing both KRT14 and KRT8 is indicative of a phenotypically plastic progenitor-like population in line with known theories of carcinogenesis. Furthermore, BPA, BPS, DDE, and copper produced significant increases in cell proliferation, which could be indicative of a more malignant phenotype. These results further elucidate the relationship between chemical exposure and breast phenotypic plasticity and highlight potential environmental factors that may impact TNBC risk.
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Affiliation(s)
- Jade Schroeder
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Katelyn M. Polemi
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Anagha Tapaswi
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Laurie K. Svoboda
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, United States
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, United States
| | - Jonathan Z. Sexton
- Department of Medicinal Chemistry, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Justin A. Colacino
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, United States
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI, United States
- Program in the Environment, University of Michigan, Ann Arbor, MI, United States
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17
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Adebola A, Adaeze A, Adeyimika D, Lovoria WB, Gia MM. Experiences and Challenges of African American and Sub-Saharan African Immigrant Black Women in Completing Pap Screening: a Mixed Methods Study. J Racial Ethn Health Disparities 2024; 11:1405-1417. [PMID: 37129785 PMCID: PMC10620103 DOI: 10.1007/s40615-023-01617-2] [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: 01/25/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Understanding Black women's Papanicolaou (Pap) screening experiences can inform efforts to reduce cancer disparities. This study examined experiences among both US-born US Black women and Sub-Saharan African immigrant women. METHOD Using a convergent parallel mixed methods design, Black women born in the USA and in Sub-Saharan Africa age 21-65 years were recruited to participate in focus groups and complete a 25-item survey about patient-centered communication and perceived racial discrimination. Qualitative and quantitative data were integrated to provide a fuller understanding of results. RESULTS Of the 37 participants, 14 were US-born and 23 were Sub-Saharan African-born Black women. The mean age was 40.0 ± 11.0, and 83.8% had received at least one Pap test. Five themes regarding factors that impact screening uptake emerged from the focus groups: (1) positive and negative experiences with providers; (2) provider communication and interaction; (3) individual barriers to screening uptake, (4) implicit bias, discrimination, and stereotypical views among providers, and (5) language barrier. Survey and focus group findings diverged on several points. While focus group themes captured both positive and negative experiences with provider communication, survey results indicated that most of both US-born and Sub-Saharan African-born women experienced positive patient-centered communication with health care providers. Additionally, during focus group sessions many participants described experiences of discrimination in health care settings, but less than a third reported this in the survey. CONCLUSION Black women's health care experiences affect Pap screening uptake. Poor communication and perceived discrimination during health care encounters highlight areas for needed service improvement to reduce cervical cancer disparities.
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Affiliation(s)
- Adegboyega Adebola
- College of Nursing, University of Kentucky, Lexington, KY, 40536-0232, USA.
| | - Aroh Adaeze
- College of Public Health, Slippery Rock University, Slippery Rock, PA, USA
| | - Desmennu Adeyimika
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Williams B Lovoria
- College of Nursing, University of Kentucky, Lexington, KY, 40536-0232, USA
| | - Mudd-Martin Gia
- College of Nursing, University of Kentucky, Lexington, KY, 40536-0232, USA
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18
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Parks AK, Hayman LL. Unveiling the Strong Black Woman Schema-Evolution and Impact: A Systematic Review. Clin Nurs Res 2024; 33:395-404. [PMID: 38439544 DOI: 10.1177/10547738241234425] [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: 03/06/2024]
Abstract
The Strong Black Woman (SBW) schema is described as a statue of unrelenting strength, resilience, and self-sufficiency, serving as a shield of protection and cultural adaptation to suppress and control manifestations of racial and gender oppression. Stemming from superwoman syndrome, a conceptual model exploring the multifactorial roles women hold and their impact, the SBW extends beyond gender roles to the sociopolitical context of the Black woman's lived experience. Endorsement of the SBW posits risk for health disparities including stress, anxiety, depression, and obesity. This review was conducted to explore the SBW schema and experiences of Black women who endorse it, to delineate how Black women describe themselves in relation to the SBW persona, and to inform further inquiry, nursing practice, and clinical approaches to improving health outcomes of this population. A systematic review of qualitative studies was conducted with a literature search from CINAHL, APA PsycINFO, MEDLINE, PubMed, and SocINDEX databases yielding seven relevant papers for this analysis. Studies using the superwoman schema and the SBW schema with participants who identified as Black women were included in the review. Consistent with the SBW phenomenon, many participants described examples and consequences of being an SBW. While most women identified with SBW, not all endorsed the persona entirely, challenging its ideal and reinforcing positive self-care. Themes include (a) Strength by nature, not choice, (b) Suppressed emotion, (c) Success over everything, and (d) Prioritizing others over self. Additional emerging themes are also included. Black women increasingly recognize the negative impacts of the SBW schema, pinpointing how their internal feelings manifest in their external world. The conceptual framework itself is an anomaly, incongruently impacting both the mental and physical health of Black women, further contributing to the long-term health and sociopolitical disparities that Black women experience. Simply acknowledging and understanding these experiences by healthcare practitioners are not enough to prevent or eliminate the risks involved with the endorsement of the SBW schema but rather intentionally addressing these as a contributing social determinant of health that predisposes them to long-term chronic conditions.
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19
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Shara N, Mirabal-Beltran R, Talmadge B, Falah N, Ahmad M, Dempers R, Crovatt S, Eisenberg S, Anderson K. Use of Machine Learning for Early Detection of Maternal Cardiovascular Conditions: Retrospective Study Using Electronic Health Record Data. JMIR Cardio 2024; 8:e53091. [PMID: 38648629 DOI: 10.2196/53091] [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: 09/29/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Cardiovascular conditions (eg, cardiac and coronary conditions, hypertensive disorders of pregnancy, and cardiomyopathies) were the leading cause of maternal mortality between 2017 and 2019. The United States has the highest maternal mortality rate of any high-income nation, disproportionately impacting those who identify as non-Hispanic Black or Hispanic. Novel clinical approaches to the detection and diagnosis of cardiovascular conditions are therefore imperative. Emerging research is demonstrating that machine learning (ML) is a promising tool for detecting patients at increased risk for hypertensive disorders during pregnancy. However, additional studies are required to determine how integrating ML and big data, such as electronic health records (EHRs), can improve the identification of obstetric patients at higher risk of cardiovascular conditions. OBJECTIVE This study aimed to evaluate the capability and timing of a proprietary ML algorithm, Healthy Outcomes for all Pregnancy Experiences-Cardiovascular-Risk Assessment Technology (HOPE-CAT), to detect maternal-related cardiovascular conditions and outcomes. METHODS Retrospective data from the EHRs of a large health care system were investigated by HOPE-CAT in a virtual server environment. Deidentification of EHR data and standardization enabled HOPE-CAT to analyze data without pre-existing biases. The ML algorithm assessed risk factors selected by clinical experts in cardio-obstetrics, and the algorithm was iteratively trained using relevant literature and current standards of risk identification. After refinement of the algorithm's learned risk factors, risk profiles were generated for every patient including a designation of standard versus high risk. The profiles were individually paired with clinical outcomes pertaining to cardiovascular pregnancy conditions and complications, wherein a delta was calculated between the date of the risk profile and the actual diagnosis or intervention in the EHR. RESULTS In total, 604 pregnancies resulting in birth had records or diagnoses that could be compared against the risk profile; the majority of patients identified as Black (n=482, 79.8%) and aged between 21 and 34 years (n=509, 84.4%). Preeclampsia (n=547, 90.6%) was the most common condition, followed by thromboembolism (n=16, 2.7%) and acute kidney disease or failure (n=13, 2.2%). The average delta was 56.8 (SD 69.7) days between the identification of risk factors by HOPE-CAT and the first date of diagnosis or intervention of a related condition reported in the EHR. HOPE-CAT showed the strongest performance in early risk detection of myocardial infarction at a delta of 65.7 (SD 81.4) days. CONCLUSIONS This study provides additional evidence to support ML in obstetrical patients to enhance the early detection of cardiovascular conditions during pregnancy. ML can synthesize multiday patient presentations to enhance provider decision-making and potentially reduce maternal health disparities.
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Affiliation(s)
- Nawar Shara
- MedStar Health Research Institute, Hyattesville, MD, United States
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, DC, United States
| | | | | | - Noor Falah
- MedStar Health Research Institute, Hyattesville, MD, United States
| | - Maryam Ahmad
- MedStar Health Research Institute, Hyattesville, MD, United States
| | | | | | | | - Kelley Anderson
- School of Nursing, Georgetown University, Washington, DC, United States
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20
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St Vil NM, Haley DF, Montgomery B, Williams M, Watson L, Zhang S, Wingood GM. An Exploration of Geographic Access to Substance Use Treatment Programs and Violence Against Women. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241246000. [PMID: 38605583 DOI: 10.1177/08862605241246000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Violence against women (VAW) is a significant public health and human rights issue, with an estimated 736 million women globally experiencing VAW. Consistent evidence demonstrates that substance use is associated with VAW and that participation in substance use treatment programs is associated with reduction in substance use-related violence. While evidence demonstrates the ability to address VAW through substance use treatment programs, less attention has been paid to geographic access to substance use programs. If these programs are geographically inaccessible, particularly to marginalized populations, many people will not get the help they need. This study seeks to explore the relationship between geographic access to substance use treatment programs on VAW. Using data from the HIV Prevention Trials Network (HPTN) 064 study, longitudinal multilevel models were used to assess the relationship between neighborhood-level social determinants, with a specific focus on geographic access to Substance Abuse and Mental Health Services Administration (SAMHSA) certified drug and alcohol treatment programs and VAW. The study included 1910 women, ages 18 to 44, living in select geographic areas with high-ranked prevalence of HIV and poverty. The findings of this study indicate that among women who reside in census tracts with high prevalence rates of HIV: (1) substance use increases VAW; (2) VAW decreases as geographic access to SAMHSA-certified drug and alcohol treatment facilities increases; and (3) when looking at specific types of VAW, emotional and physical abuse decreases as geographic access to substance use treatment increases. Policies and programs to increase access to substance use treatment should be explored and evaluated, and more programs are needed that address the intersectionality of substance use and VAW.
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Affiliation(s)
| | | | | | | | | | - Shuaiqi Zhang
- Statistical Center for HIV/AIDS Research and Prevention, Seattle, WA, USA
| | - Gina M Wingood
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
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21
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Davidson-Turner KJ, Farina MP, Hayward MD. Racial/Ethnic differences in inflammation levels among older adults 56+: an examination of sociodemographic differences across inflammation measure. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2024; 69:75-89. [PMID: 38807566 PMCID: PMC11257156 DOI: 10.1080/19485565.2024.2356672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Chronic inflammation is a key biological risk factor for many widespread adult health conditions. This study examines racial/ethnic differences in inflammation across several inflammatory markers, including selected cytokines that are identified as important for aging and age-related health outcomes. METHODS Data came from the 2016 Venous Blood Collection Subsample of the Health and Retirement Study. Using logistic regression models, we compared high-risk categories of C-reactive protein and cytokine markers (IL-6, IL-10, IL-1RA, TNFR1, and TGF-Beta), across race/ethnicity and whether these differences persisted among men and women. RESULTS The findings provided evidence of significant race/ethnic differences in inflammatory measures, but the patterns differed across marker types. CONCLUSIONS These findings emphasize that race/ethnic differences are not consistently captured across markers of inflammation and that researchers should proceed with caution when using individual markers of inflammation in an effort to not overlook potential racial/ethnic differences in biological risk.
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Affiliation(s)
- KJ Davidson-Turner
- Department of Sociology, University of Texas at Austin, Austin, Texas, USA
| | - Mateo P. Farina
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Mark D. Hayward
- Department of Sociology, University of Texas at Austin, Austin, Texas, USA
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22
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Hale FB, Harris AL. Understanding the Psychological Risks to Maternal Mental Health, Maternal-Infant Bonding, and Infant Development During the COVID-19 Pandemic. Nurs Womens Health 2024; 28:152-158. [PMID: 38373696 DOI: 10.1016/j.nwh.2023.10.004] [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: 09/07/2023] [Revised: 10/27/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024]
Abstract
This short review summarizes two recent U.S.-based studies in which researchers evaluated the impact of the COVID-19 pandemic on postpartum outcomes. The first study examined the neurodevelopmental status of infants born to women infected with SARS-CoV-2, and the second examined psychological risks to maternal-infant bonding. Results indicated that pandemic-related stressors likely contributed to diminished maternal-infant health outcomes. It is imperative that nurses stay informed on the latest science exploring the impact the pandemic has had on the health and well-being of pregnant persons and infants.
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Cummings T, Skelton KR. Reducing CVD health disparities in Black women through addressing social determinants of health (SDOH): a scoping review. Women Health 2024; 64:350-364. [PMID: 38616625 DOI: 10.1080/03630242.2024.2337719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/27/2024] [Indexed: 04/16/2024]
Abstract
Cardiovascular disease (CVD) disparities among Black American women can be linked directly to social determinants of health (SDOH). This scoping review examines the breadth and depth of existing literature on CVD risk reduction interventions in young-to-middle-aged women that address SDOH. We searched PubMed, CINAHL, Scopus and Google Scholar for relevant peer-reviewed articles published in English. We included studies if they reported on the feasibility, acceptability, or findings of a CVD risk reduction intervention, addressed at least one SDOH domain, and included Black women 18-45 years of age. Of the 2,533 studies screened, 5 studies were eligible for inclusion. Specific SDOH domains addressed included: social and community context and health-care access and quality. All but one study reported culturally tailored intervention components. Feasibility and acceptability of culturally tailored interventions was high among included studies examining this outcome. Recommendations for future research focused on the need for additional interventions that were culturally tailored to young- and middle-aged Black women. Future research should work to address existing evidence gaps via development and implementation of culturally tailored, CVD risk reduction and disease prevention interventions for young-to-middle-aged Black women that focus addressing SDOH, as these types of interventions demonstrate promise for reducing CVD health disparities among Black women.
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Affiliation(s)
- Tyesha Cummings
- Department of Health Sciences, Towson University, Towson, Maryland, USA
| | - Kara R Skelton
- Department of Health Sciences, Towson University, Towson, Maryland, USA
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Williams BR, Brady SS, Levin EC, Brown O, Lipman TH, Klusaritz H, Nodora J, Coyne-Beasley T, Putnam S, Gahagan S, Burgio KL. Black women's perspectives on bladder health: Social-ecological and life course contexts. Neurourol Urodyn 2024; 43:849-861. [PMID: 38451032 PMCID: PMC11138321 DOI: 10.1002/nau.25437] [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: 11/06/2023] [Revised: 01/21/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
AIMS This paper explores Black women's perspectives on bladder health using a social-ecological conceptual framework and life course perspective. METHODS We conducted a directed content analysis of data from the Study of Habits, Attitudes, Realities, and Experiences (SHARE), a focus group study by the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. Analysis was conducted on data from five focus groups and a member-checking session where all participants self-identified as Black or African American. RESULTS Forty-two participants aged 11-14 or 45+ years reported life course experiences with their bladder. The intersection of race and gender was the lens through which participants viewed bladder health. Participants' accounts of their perspectives on bladder health explicitly and implicitly revealed structural racism as an explanatory overarching theme. Participants described (a) historically-rooted and still pervasive practices of discrimination and segregation, engendering inequitable access to quality medical care and public facilities, (b) institutional barriers to toileting autonomy in educational and occupational settings, promoting unhealthy voiding habits, (c) internalized expectations of Black women's stereotyped role as family caregiver, compromising caregiver health, (d) lack of reliable information on bladder health, leading to unhealthy bladder behaviors, and (e) potentially stress-related comorbid chronic conditions and associated medication use, causing or exacerbating bladder problems. CONCLUSIONS Bladder health promotion interventions should address social-ecological and life course factors shaping Black women's bladder health, including social and structural barriers to accessing equitable health information and medical care.
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Affiliation(s)
- Beverly R Williams
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama, USA
| | - Sonya S Brady
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Elise C Levin
- Division of Community Health Services, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Terri H Lipman
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Heather Klusaritz
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jesse Nodora
- Division of Applied Sciences, Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Tamera Coyne-Beasley
- Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Sara Putnam
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sheila Gahagan
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Kathryn L Burgio
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama, USA
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Ben-Umeh KC, Kim J. Income disparities in COVID-19 vaccine and booster uptake in the United States: An analysis of cross-sectional data from the Medical Expenditure Panel Survey. PLoS One 2024; 19:e0298825. [PMID: 38377073 PMCID: PMC10878507 DOI: 10.1371/journal.pone.0298825] [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: 11/13/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
COVID-19 vaccination has significantly decreased morbidity, hospitalizations, and death during the pandemic. However, disparities in vaccination uptake threatens to stymie the progress made in safeguarding the health of Americans. Using a nationally representative adult (≥18 years old) sample from the 2021 Medical Expenditure Panel Survey (MEPS), we aimed to explore disparities in COVID-19 vaccine and booster uptake by income levels. To reflect the nature of the survey, a weighted logistic regression analysis was used to explore factors associated with COVID-19 vaccine and booster uptake. A total of 241,645,704 (unweighted n = 21,554) adults were included in the analysis. Average (SD) age of the population was 49 (18) years old, and 51% were female. There were disparities in COVID-19 vaccine and booster uptake by income groups. All other income groups were less likely to receive COVID-19 vaccines and booster shot than those in the high-income group. Those in the poor income group had 55% lower odds of being vaccinated for COVID-19 (aOR = 0.45, p<0.01). Considering the female population only, women with lower incomes may have greater disparities in access to COVID-19 vaccines than do males with lower incomes. Disparities in COVID-19 vaccination by income may have even greater implications as the updated vaccines are rolled out in the US without the government covering the cost as before.
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Affiliation(s)
- Kenechukwu C. Ben-Umeh
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, United States of America
| | - Jaewhan Kim
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah, United States of America
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Dickins KA. A Call for Research with Racially and Ethnically Minoritized Women During Life Transitions. J Womens Health (Larchmt) 2024; 33:109-110. [PMID: 37856170 DOI: 10.1089/jwh.2023.0745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Affiliation(s)
- Kirsten A Dickins
- Rush University College of Nursing Department of Community, Systems and Mental Health Nursing, Chicago, Illinois, USA
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Dickins KA. Improving Traumatic Stress with Justice-Impacted Women and Women Experiencing Homelessness: A Pilot Study of Narrative Exposure Therapy. Issues Ment Health Nurs 2024; 45:121-141. [PMID: 37616593 DOI: 10.1080/01612840.2023.2238091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
OBJECTIVE We sought to investigate the feasibility, acceptability, and impact of a brief, manualized trauma-focused intervention aimed at improving PTSD symptoms in persons with complex PTSD, Narrative Exposure Therapy (NET). DESIGN Using a mixed methods approach, we tested the feasibility, acceptability, and impact of NET in a sample of trauma-affected women in traumatogenic circumstances: justice-impacted women in prison and women experiencing homelessness in a shelter. We quantitatively assessed data using a single sample, pre-/post-intervention design. We qualitatively assessed self-described symptom change and opportunities for intervention adaptation using a content analysis approach. METHODS Sixteen trauma-affected participants completed the intervention protocol. NET interventionists included one nurse practitioner, one registered nurse, and one nursing student. All NET participants attended pre-/post-intervention visits and active NET sessions. In-depth interviews were conducted at pre- and post-intervention, alongside a diagnostic battery. RESULTS NET was both highly feasible and acceptable among participants. Participants significantly improved on the intervention-specific outcome of PTSD symptoms, as well as somatic symptom burden, with large effect sizes. Participants also improved on subjective self-described symptom change. Participants offered recommendations regarding opportunities to enhance population-specific intervention acceptability. CONCLUSIONS Results from this pilot study are consistent with previous evidence demonstrating that NET facilitates improvements in women with traumatic stress. Findings of high feasibility, acceptability, and impact supports the use of NET in JW and WEH. Integrating participant recommendations to optimize acceptability may further support scalability and reach of NET. Replication with a larger sample and within a randomized controlled design is required to definitively determine effectiveness.
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Affiliation(s)
- Kirsten A Dickins
- Department of Community, System and Mental Health Nursing, Rush University Medical Center, Chicago, Illinois, USA
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Wade JM, Frederick H, Lowe S, Yarrell E, Taylor A, Parker S. Exploring the racial gradient in reproductive health: an examination of challenges to sexual health care faced by black female college students. ETHNICITY & HEALTH 2024; 29:199-207. [PMID: 37941107 DOI: 10.1080/13557858.2023.2279929] [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: 04/18/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES This study identifies and analyzes barriers to sexual and gynecological health care Black women face at a Historically Black College or University (HBCU) and a Predominantly White Institution (PWI) in southeastern America. DESIGN Participants identified as Black women who were sexually active, age 18-25, and undergraduate students. The research team conducted in-depth interviews across two campuses via Zoom. Interviews were coded using inductive thematic analysis. RESULTS We derived six specific themes that summarize Black female college students' barriers to care: Patient-provider Interactions, Economic Determinants of Health, Social Support, Access to Care, Lack of Primary Care, and No Challenges. CONCLUSION Reproductive and sexual health disparities can be mitigated with attention to diversity in medical school, affordable care, and teaching young women to prioritize their care for long-term reproductive health.
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Affiliation(s)
| | | | - Serena Lowe
- North Carolina A&T State University, Greensboro, NC, USA
| | - Eryn Yarrell
- North Carolina A&T State University, Greensboro, NC, USA
| | - Aigné Taylor
- North Carolina A&T State University, Greensboro, NC, USA
| | - Sharon Parker
- North Carolina A&T State University, Greensboro, NC, USA
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Barr E, Popkin R, Roodzant E, Jaworski B, Temkin SM. Gender as a social and structural variable: research perspectives from the National Institutes of Health (NIH). Transl Behav Med 2024; 14:13-22. [PMID: 37074158 DOI: 10.1093/tbm/ibad014] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Gender is a social and structural variable that encompasses multiple domains, each of which influences health: gender identity and expression, gender roles and norms, gendered power relations, and gender equality and equity. As such, gender has far-reaching impacts on health. Additional research is needed to continue delineating and untangling the effects of gender from the effects of sex and other biological variables. The National Institutes of Health (NIH) vision for women's health is a world in which the influence of sex and/or gender are integrated into the health research enterprise. However, much of the NIH-supported research on gender and health has, to date, been limited to a small number of conditions (e.g., HIV, mental health, pregnancy) and locations (e.g., sub-Saharan Africa; India). Opportunities exist to support transdisciplinary knowledge transfer and interdisciplinary knowledge building by advancing health-related social science research that incorporates best practices from disciplines that have well-established methods, theories, and frameworks for examining the health impacts of gender and other social, cultural, and structural variables.
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Affiliation(s)
- Elizabeth Barr
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Ronna Popkin
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Population Dynamics Branch, National Institutes of Health, Bethesda, MD, USA
| | - Erik Roodzant
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
- Booz Allen Hamilton, McLean, VA, USA
| | - Beth Jaworski
- Office of Behavioral and Social Sciences Research, National Institutes of Health, USA
- Booz Allen Hamilton, McLean, VA, USA
| | - Sarah M Temkin
- Office of Research on Women's Health, National Institutes of Health, USA
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Karim S, Liu J, Wilcox S, Cai B, Merchant AT. Association Between Physical Activity During Pregnancy and Perinatal Depressive Symptoms in Pregnant Individuals With Overweight and Obesity. Womens Health Issues 2024; 34:72-79. [PMID: 37940507 PMCID: PMC10843526 DOI: 10.1016/j.whi.2023.09.002] [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: 01/25/2023] [Revised: 09/01/2023] [Accepted: 09/21/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Current research on the association between physical activity and perinatal depression is inconclusive. This study examined the association between objectively measured physical activity during pregnancy and perinatal depressive symptoms among individuals with overweight and obesity. METHODS Data came from the Health in Pregnancy and Postpartum study (N = 205). Physical activity was measured using the SenseWear Armband at 16 weeks' or fewer and 32 weeks' gestation and categorized into 1) never meeting 2018 physical activity guidelines, 2) meeting the guidelines at one time point, or 3) meeting the guidelines at both time points. Antenatal depressive symptoms were assessed at 32 weeks' gestation, and postpartum depressive symptoms were assessed at 6 and 12 months postpartum using the Edinburgh Postnatal Depression Scale. A score of 10 or higher was defined as probable at least minor depression (hereafter, probable depression). RESULTS Nearly one-half of the participants (45.4%) met physical activity guidelines both in early and late pregnancy. Pregnant individuals who met physical activity guidelines at one (adjusted odds ratio, 0.07; 95% confidence interval, 0.01-0.76) or both time points (adjusted odds ratio, 0.08; 95% confidence interval, 0.01-0.69) during pregnancy had lower odds of probable depression at 6 months postpartum than individuals who never met physical activity guidelines during pregnancy. No significant associations were found between prenatal physical activity and probable antenatal or postpartum depression at 12 months. CONCLUSIONS Antenatal physical activity was associated with lower odds of probable depression at 6 months after childbirth. Physicians should use evidence-based strategies to encourage pregnant people, especially those who are at risk for postpartum depression, to meet physical activity guidelines.
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Affiliation(s)
- Sabrina Karim
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Institute for Families in Society, College of Social Work, University of South Carolina, Columbia, South Carolina
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
| | - Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Shigeta H, Ozaki A, Tanimoto T. Racial Disparities and Survival Outcomes in Breast Cancer. JAMA Oncol 2024; 10:140-141. [PMID: 37917068 DOI: 10.1001/jamaoncol.2023.4828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
- Haruki Shigeta
- Medical Governance Research Institute, Minato City, Tokyo, Japan
- Tohoku University School of Medicine, Sendai City, Miyagi, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato City, Tokyo, Japan
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City, Fukushima, Japan
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato City, Tokyo, Japan
- Department of Internal Medicine, Navitas Clinic, Tachikawa City, Tokyo, Japan
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Suntai Z, Noh H, Lee L, Bell JG, Lippe MP, Lee HY. Quality of Care at the End of Life: Applying the Intersection of Race and Gender. THE GERONTOLOGIST 2024; 64:gnad012. [PMID: 36786381 DOI: 10.1093/geront/gnad012] [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: 08/30/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Research on racial and gender disparities in end-of-life care quality has burgeoned over the past few decades, but few studies have incorporated the theory of intersectionality, which posits that membership in 2 or more vulnerable groups may result in increased hardships across the life span. As such, this study aimed to examine the intersectional effect of race and gender on the quality of care received at the end of life among older adults. RESEARCH DESIGN AND METHODS Data were derived from the combined Round 3 to Round 10 of the National Health and Aging Trends Study. For multivariate analyses, 2 logistic regression models were run; Model 1 included the main effects of race and gender and Model 2 included an interaction term for race and gender. RESULTS Results revealed that White men were the most likely to have excellent or good care at the end of life, followed by White women, Black men, and Black women, who were the least likely to have excellent or good care at the end of life. DISCUSSION AND IMPLICATIONS These results point to a significant disadvantage for Black women, who had worse end-of-life care quality than their gender and racial peers. Practice interventions may include cultural humility training and a cultural match between patients and providers. From a policy standpoint, a universal health insurance plan would reduce the gap in end-of-life service access and quality for Black women, who are less likely to have supplemental health care coverage.
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Affiliation(s)
- Zainab Suntai
- Diana R. Garland School of Social Work, Baylor University, Waco, Texas, USA
| | - Hyunjin Noh
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
| | - Lewis Lee
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
| | - John Gregory Bell
- College of Community Health Sciences, University of Alabama, Tuscaloosa, Alabama, USA
| | - Megan P Lippe
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Hee Yun Lee
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
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Lucas A, Mlawer S, Weaver K, Caldwell J, Baig A, Zasadazinski L, Saunders M. Chicago Neighborhood Context and Racial/Ethnic Disparities in Maternal Diabetes. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01892-z. [PMID: 38157197 PMCID: PMC11229170 DOI: 10.1007/s40615-023-01892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To determine if rates of maternal diabetes vary by race, ethnicity, and neighborhood hardship. METHODS We conducted a secondary analysis of live births in Chicago from 2010 to 2017. Our sample was restricted to Non-Hispanic White, Non-Hispanic Black, Mexican, Non-Hispanic Asian, and Other Hispanic mothers between the ages of 15 and 50, with singleton births. The addresses of mothers were geocoded to specific neighborhoods, which we stratified into tertiles using the Economic Hardship Index. We used generalized logit mixed models to examine the interaction between race/ethnicity, neighborhood economic hardship, and maternal diabetes. RESULTS In our cohort of 299,053 mothers, 4.75% were diagnosed with gestational diabetes. Asian mothers had the highest frequency of gestational diabetes (8.3%), followed by Mexican mothers (6.8%). Within their respective racial/ethnic groups, Asian and Mexican mothers living in medium hardship neighborhoods had the highest odds of gestational diabetes compared to the reference group (OR 2.80, 95%CI 2.53, 3.19; OR 2.30, 95%CI 2.12, 2.49 respectively). Overall rates of preexisting diabetes were 0.9% and were highest among Mexican and Black mothers (1.26% and 1.06%, respectively). Asian mothers in medium hardship neighborhoods had the greatest odds of preexisting diabetes, among all Asian mothers and compared to the reference (OR 4.71 95% CI 3.60, 6.16). CONCLUSIONS For racial and ethnic minoritized mothers, gestational and preexisting diabetes do not increase in a step-wise fashion with neighborhood hardship; rates were often higher in low and medium hardship neighborhoods.
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Affiliation(s)
- Anika Lucas
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Durham Veterans Affairs Medical Center, Durham, NC, USA.
| | - Sophia Mlawer
- Data Science and Analytics, University of Chicago Medicine, Chicago, IL, USA
| | | | - Julia Caldwell
- Department of Public Health Los Angeles County, Los Angeles, CA, USA
| | - Arshiya Baig
- General Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
| | | | - Milda Saunders
- General Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
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Hayes C, Gupta T. Falling life expectancy among US men. BMJ 2023; 383:2937. [PMID: 38154830 DOI: 10.1136/bmj.p2937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
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Ripon RK, Rimti FH, Kercy M, Hossain S, Motahara U, Hossain MS, Sikder MT. A trend analysis of Black American women with cardiovascular disease and chronic medical conditions, sociodemographic factors from NHANES From 2011 to 2020. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002521. [PMID: 38109309 PMCID: PMC10727433 DOI: 10.1371/journal.pgph.0002521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 09/19/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Significant racial and gender differences exist in the prevalence of CVD in the United States. The goal of this study is to evaluate the prevalence of CVD among Black American women, the relationship between CVD and some medical conditions, and significant sociodemographic factors. METHODS The researchers in this study used data from four cycles of the NHANES, carried out by the NCHS. 2011 to 2012, 2013 to 2014, 2015 to 2016, and 2017 to 2020 were the cycles that were chosen. The researchers used the survey package in the R programming language to examine the data. RESULTS People with CVD problems 20 years of age and older were included in the analyses. Black American women experienced a considerable prevalence of CVD from 2011 to 2020. These women were more likely to report having completed no more schooling than the ninth grade, being widowed/divorced/separated, and having undergone a hysterectomy, as well as having a history of diabetes, asthma, obesity, arthritis, and depression. Black American women with CVD had a 3.8-fold increased risk of diabetes and a 5.6-fold increased risk of arthritis. CONCLUSION This study shows that Black American women with CVD are more likely to have chronic illnesses such as hysterectomy, diabetes, asthma, obesity, arthritis, and depression. Black American women's cardiovascular risk profiles can be updated using the data from this study.
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Affiliation(s)
- Rezaul Karim Ripon
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
- McHigher Center for Health Research, Boston, Massachusetts, United States of America
| | | | - Mickelder Kercy
- The City University of New York, New York, New York, United States of America
| | - Shahriar Hossain
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
- McHigher Center for Health Research, Boston, Massachusetts, United States of America
| | - Umma Motahara
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Md. Sharif Hossain
- McHigher Center for Health Research, Boston, Massachusetts, United States of America
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Md. Tajuddin Sikder
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
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Walton QL, Coats JV, Skrine Jeffers K, Blakey JM, Hood AN, Washington T. Mind, body, and spirit: a constructivist grounded theory study of wellness among middle-class Black women. Int J Qual Stud Health Well-being 2023; 18:2278288. [PMID: 37979186 PMCID: PMC11000677 DOI: 10.1080/17482631.2023.2278288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023] Open
Abstract
Previous studies show that Black women in the United States experience disproportionately poorer health outcomes compared to women of other racial/ethnic groups. Recently the focus is on improving the health of Black women in the United States. However, there is little empirical evidence on what Black women need to improve their health to be well. The goal of this constructivist grounded theory was to increase the understanding of wellness among middle-class Black women (N = 30) in a large Midwestern city in the United States through an intersectional lens. The findings show that the connection and balance between mind, body, and spirit was the core experience of wellness among middle-class Black women. Mind, body, and spirit was described in three ways-(a) mentally managing, (b) physically caring for my body, and (c) connecting spiritually-with the women also noting the barriers and facilitators they endured to be well. Each of these categories highlight the tension middle-class Black women experience with trying to be well. Implications for future practice and research with middle-class Black women are discussed.
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Affiliation(s)
- Quenette L. Walton
- Graduate College of Social Work, University of Houston, Houston, TX, USA
| | - Jacquelyn V. Coats
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Kia Skrine Jeffers
- School of Nursing, Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Joan M. Blakey
- School of Social Work, University of Minnesota, St. Paul, MN, USA
| | - Alexandra N. Hood
- Graduate College of Social Work, University of Houston, Houston, TX, USA
| | - Tyreasa Washington
- Department of Social Work, University of North Carolina at Greensboro, Greensboro, NC, USA, and Child Trends, Bethesda, MD, USA
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Raisi-Estabragh Z, Kobo O, López-Fernández T, Qadir HA, Chew NWS, Wojakowski W, Abhishek A, Miller RJ, Mamas MA. Social disparities in cardiovascular mortality of patients with cancer in the USA between 1999 and 2019. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200218. [PMID: 37841449 PMCID: PMC10568337 DOI: 10.1016/j.ijcrp.2023.200218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/30/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023]
Abstract
Background Temporal trends of the impact of social determinants on cardiovascular outcomes of cancer patients has not been previously studied. Objectives This study examined social disparities in cardiovascular mortality of people with and without cancer in the US population between 1999 and 2019. Methods Primary cardiovascular deaths were identified from the Multiple Cause of Death database and grouped by cancer status. The cancer cohort was subcategorized into breast, lung, prostate, colorectal, and haematological. The number of cardiovascular deaths, crude cardiovascular mortality rate, cardiovascular age-adjusted mortality rate (AAMR), and percentage change in cardiovascular AAMR were calculated by cancer status and cancer type, and stratified by sex, race, ethnicity, and urban-rural setting. Results 17.9 million cardiovascular deaths were analysed. Of these, 572,222 occurred in patients with a record of cancer. The cancer cohort were older and included more men and White racial groups. Regardless of cancer status, cardiovascular AAMR was higher in men, rural settings, and Black or African American races. Cardiovascular AAMR declined over time, with greater reduction in those with cancer (-51.6% vs -38.3%); the greatest reductions were in colorectal (-68.4%), prostate (-60.0%), and breast (-58.8%) cancers. Sex, race, and ethnic disparities reduced over time, with greater narrowing in the cancer cohort. There was increase in urban-rural disparities, which appeared greater in those with cancer. Conclusions While most social disparities narrowed over time, urban-rural disparities widened, with greater increase in those with cancer. Healthcare plans should incorporate strategies for reduction of health inequality equitable access to cardio-oncology services.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Centre for Advanced Cardiovascular Imaging, Queen Mary University London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, EC1A 7BE, London, UK
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - Husam Abdel Qadir
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas WS. Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Wojtek Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Abhishek Abhishek
- Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom
| | - Robert J.H. Miller
- Libin Cardiovascular Institute of Alberta and University of Calgary, Calgary, AB, Canada
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
- Institute of Population Health, University of Manchester, Manchester, UK
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Kuriloff M, Patel E, Mueller A, Dada T, Duncan C, Arnolds D, Rana S. COVID-19 and obstetric outcomes: a single-center retrospective experience in a predominantly Black population. J Matern Fetal Neonatal Med 2023; 36:2196364. [PMID: 37005011 DOI: 10.1080/14767058.2023.2196364] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Objective: This retrospective, single-center case series was designed to characterize the effects of perinatal COVID-19 diagnosis on obstetric and neonatal outcomes in a predominantly high-risk, urban Black population.Study Design: Data were collected via retrospective chart review on all COVID-19-positive obstetric patients and their neonates who presented to the University of Chicago Medical Center between March 2020 and November 2020, before the availability of the COVID-19 vaccine. Patient demographics, delivery outcomes, COVID-19 symptoms, treatment, and outcomes were analyzed.Results: A total of 56 COVID-19-positive obstetric patients were included in the study, of which four were lost to follow-up before delivery. The median age of patients was 27 years (IQR 23, 32), with 73.2% publicly insured and 66.1% Black. Patients had a median body mass index (BMI) of 31.6 kg/m2 (IQR 25.9, 35.5). 3.6% of patients had chronic hypertension, 12.5% had diabetes, and 16.1% had asthma. Perinatal complications were common. Twenty-six patients (50.0%) had a diagnosis of a hypertensive disorder of pregnancy (HDP). 28.8% had gestational hypertension, and 21.2% had preeclampsia (with and without severe features). The rate of maternal ICU admission was 3.6%. Furthermore, 23.5% of patients delivered preterm (<37 weeks gestation), and 50.9% of infants were admitted to the Neonatal Intensive Care Unit (NICU).Conclusion: In our study of a predominantly Black, publicly-insured, unvaccinated group of COVID-19-positive pregnant patients, we found high rates of hypertensive disorders of pregnancy, preterm delivery, and NICU admission compared to rates reported in existing literature before widespread vaccine availability. Our findings suggest that SARS-CoV-2 infection during pregnancy, irrespective of maternal disease severity, may exacerbate existing obstetric health disparities by disproportionately impacting Black, publicly insured patients. Larger comparative studies are needed to better characterize possible racial and socioeconomic disparities in obstetric outcomes in the setting of SARS-CoV-2 infection during pregnancy. These studies should examine the pathophysiology of SARS-CoV-2 infection during pregnancy, as well as potential associations between adverse perinatal outcomes and disparities in access to care, COVID-19 vaccination, and other social determinants of health amongst more vulnerable populations infected with SARS-CoV-2 during pregnancy.
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Affiliation(s)
- Melissa Kuriloff
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Easha Patel
- Division of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Colleen Duncan
- Division of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - David Arnolds
- Department of Anaesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarosh Rana
- Division of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
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Goh E, Bunning B, Khoong E, Gallo R, Milstein A, Centola D, Chen JH. ChatGPT Influence on Medical Decision-Making, Bias, and Equity: A Randomized Study of Clinicians Evaluating Clinical Vignettes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.24.23298844. [PMID: 38076944 PMCID: PMC10705632 DOI: 10.1101/2023.11.24.23298844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
In a randomized, pre-post intervention study, we evaluated the influence of a large language model (LLM) generative AI system on accuracy of physician decision-making and bias in healthcare. 50 US-licensed physicians reviewed a video clinical vignette, featuring actors representing different demographics (a White male or a Black female) with chest pain. Participants were asked to answer clinical questions around triage, risk, and treatment based on these vignettes, then asked to reconsider after receiving advice generated by ChatGPT+ (GPT4). The primary outcome was the accuracy of clinical decisions based on pre-established evidence-based guidelines. Results showed that physicians are willing to change their initial clinical impressions given AI assistance, and that this led to a significant improvement in clinical decision-making accuracy in a chest pain evaluation scenario without introducing or exacerbating existing race or gender biases. A survey of physician participants indicates that the majority expect LLM tools to play a significant role in clinical decision making.
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Affiliation(s)
- Ethan Goh
- Stanford Biomedical Informatics Research, Stanford University, Stanford, CA
- Stanford Clinical Excellence Research Center, Stanford University, Stanford, CA
| | - Bryan Bunning
- Stanford Biomedical Informatics Research, Stanford University, Stanford, CA
| | - Elaine Khoong
- UCSF Center for Vulnerable Populations at San Francisco General Hospital, SF, CA
| | - Robert Gallo
- Stanford Biomedical Informatics Research, Stanford University, Stanford, CA
- Center for Innovation to Implementation, VA Palo Alto Health Care System, PA, CA
| | - Arnold Milstein
- Stanford Clinical Excellence Research Center, Stanford University, Stanford, CA
| | - Damon Centola
- Communication, Sociology and Engineering, University of Pennsylvania, PA
| | - Jonathan H Chen
- Stanford Biomedical Informatics Research, Stanford University, Stanford, CA
- Division of Hospital Medicine, Stanford University, Stanford, CA
- Stanford Clinical Excellence Research Center, Stanford University, Stanford, CA
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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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Llanos AAM, Rockson A, Getz K, Greenberg P, Portillo E, McDonald JA, Teteh DK, Villasenor J, Lozada C, Franklin J, More V, Rivera-Núñez Z, Kinkade CW, Barrett ES. Assessment of personal care product use and perceptions of use in a sample of US adults affiliated with a university in the Northeast. ENVIRONMENTAL RESEARCH 2023; 236:116719. [PMID: 37481059 PMCID: PMC10592243 DOI: 10.1016/j.envres.2023.116719] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 07/24/2023]
Abstract
Evidence supports unequal burdens of chemical exposures from personal care products (PCPs) among some groups, namely femme-identifying and racial and ethnic minorities. In this study, we implemented an online questionnaire to assess PCP purchasing and usage behaviors and perceptions of use among a sample of US adults recruited at a Northeastern university. We collected PCP use across seven product categories (hair, beauty, skincare, perfumes/colognes, feminine hygiene, oral care, other), and behaviors, attitudes, and perceptions of use and safety across sociodemographic factors to evaluate relationships between sociodemographic factors and the total number of products used within the prior 24-48 h using multivariable models. We also summarized participants' perceptions and attitudes. Among 591 adults (20.0% Asian American/Pacific Islander [AAPI], 5.9% Hispanic, 9.6% non-Hispanic Black [NHB], 54.6% non-Hispanic White [NHW], and 9.9% multiracial or other), the average number of PCPs used within the prior 24-48 h was 15.6 ± 7.7. PCP use was greater among females than males (19.0 vs. 7.9, P < 0.01) and varied by race and ethnicity among females. Relative to NHWs, AAPI females used fewer hair products (2.5 vs. 3.1) and more feminine hygiene products (1.5 vs. 1.1), NHB females used more hair products (3.8 vs. 3.1), perfumes (1.0 vs. 0.6), oral care (2.3 vs. 1.9), and feminine hygiene products (1.8 vs. 1.1), and multiracial or other females used more oral care (2.2 vs. 1.9) and feminine hygiene products (1.5 vs. 1.1) (P-values <0.05). Generally, study participants reported moderate concern about exposures and health effects from using PCPs, with few differences by gender, race, and ethnicity. These findings add to the extant literature on PCP use across sociodemographic characteristics. Improving the understanding of patterns of use for specific products and their chemical ingredients is critical for developing interventions to reduce these exposures, especially in vulnerable groups with an unequal burden of exposure.
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Affiliation(s)
- Adana A M Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA.
| | - Amber Rockson
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Kylie Getz
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Patricia Greenberg
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Eva Portillo
- Biostatistics Epidemiology Summer Training (BEST) Diversity Program, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Jasmine A McDonald
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Dede K Teteh
- Department of Health Sciences, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA, USA
| | - Justin Villasenor
- Biostatistics Epidemiology Summer Training (BEST) Diversity Program, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Carolina Lozada
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Jamirra Franklin
- Environmental and Health Sciences Department, Spelman College, Atlanta, GA, USA
| | - Vaishnavi More
- Department of Nursing and Health Sciences, The College of New Jersey, Ewing, NJ, USA
| | - Zorimar Rivera-Núñez
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA; Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
| | - Carolyn W Kinkade
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
| | - Emily S Barrett
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA; Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
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Krishnan JK, Mallya SG, Nahid M, Baugh AD, Han MK, Aronson KI, Goyal P, Pinheiro LC, Banerjee S, Martinez FJ, Safford MM. Disparities in Guideline Concordant Statin Treatment in Individuals With Chronic Obstructive Pulmonary Disease. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2023; 10:369-379. [PMID: 37410623 PMCID: PMC10699489 DOI: 10.15326/jcopdf.2023.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
Rationale Cardiovascular disease (CVD) affects the prognosis of patients with chronic obstructive pulmonary disease (COPD). Black women with COPD have a disproportionate risk of CVD-related mortality, yet disparities in CVD prevention in COPD are unknown. Objectives We aimed to identify race-sex differences in the receipt of statin treatment for CVD prevention, and whether these differences were explained by factors influencing health care utilization in the REasons for Geographic And Racial Differences in Stroke (REGARDS) COPD study sub-cohort. Methods We conducted a cross-sectional analysis among REGARDS Medicare beneficiaries with COPD. Our primary outcome was the presence of statin on in-home pill bottle review among individuals with an indication. Prevalence ratios (PR) for statin treatment among race-sex groups compared to White men were estimated using Poisson regression with robust variance. We then adjusted for covariates previously shown to impact health care utilization. Results Of the 2032 members within the COPD sub-cohort with sufficient data, 1435 participants (19% Black women, 14% Black men, 28% White women, and 39% White men) had a statin indication. All race-sex groups were less likely to receive statins than White men in unadjusted models. After adjusting for covariates that influence health care utilization, Black women (PR 0.76, 95% confidence interval [CI] 0.67 to 0.86) and White women (PR 0.84 95% CI 0.76 to 0.91) remained less likely to be treated compared to White men. Conclusions All race-sex groups were less likely to receive statin treatment in the REGARDS COPD sub-cohort compared to White men. This difference persisted in women after controlling for individual health care utilization factors, suggesting structural interventions are needed.
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Affiliation(s)
- Jamuna K. Krishnan
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Sonal G. Mallya
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Musarrat Nahid
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Aaron D. Baugh
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, California, United States
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Kerri I. Aronson
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Parag Goyal
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States
- Division of Cardiology, Weill Cornell Medicine, New York, New York, United States
| | - Laura C. Pinheiro
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Samprit Banerjee
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Monika M. Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States
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Eapen D, Mbango C, Daniels G, Mathew Joseph N, Mary A, Mathews N, Carr KK, Wells C, Suriaga A, Saint Fleur A. Recommendations to improve maternal health equity among Black women in "The South": A position paper from the SNRS minority health research interest & implementation group. Res Nurs Health 2023; 46:457-461. [PMID: 37525299 DOI: 10.1002/nur.22332] [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: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
Black women in the United States experience a higher maternal mortality rate compared to other racial groups. The maternal mortality rate among non-Hispanic Black women is 3.5 times that of non-Hispanic White women and is higher in the South compared to other regions. The majority of pregnancy-related deaths in Black women are deemed to be preventable. Healthy People 2030 directs healthcare providers to advance health equity through societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. The Southern Nursing Research Society has put forward this position paper to provide recommendations to improve maternal health equity among Black women. Recommendations for nurses, multidisciplinary healthcare providers, policymakers, and researchers are discussed.
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Affiliation(s)
- Doncy Eapen
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Catherine Mbango
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Glenda Daniels
- Harris College of Nursing & Health Sciences, Texas Christian University, Fort Worth, Texas, USA
| | - Nitha Mathew Joseph
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Annapoorna Mary
- Loewenberg College of Nursing, The University of Memphis, Memphis, Tennessee, USA
| | - Nisha Mathews
- College of Human Sciences and Humanities, University of Houston-Clear Lake (Pearland), Pearland, Texas, USA
| | - Kathryn Kravetz Carr
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Cheryl Wells
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Armiel Suriaga
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
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Graybeal AJ, Brandner CF, Aultman R, Ojo DE, Braun-Trocchio R. Differences in Perceptual and Attitudinal Body Image Between White and African-American Adults Matched for Sex, Age, and Body Composition. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01799-9. [PMID: 37749440 DOI: 10.1007/s40615-023-01799-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the differences in perceptual and attitudinal body image between White and African-American males and females matched for sex, age, BMI, and other body composition components using a combination of 3-dimensional mobile digital imaging analysis (DIA) and the Multidimensional Body-Self Relations Questionnaire-Appearance Scale (MBSRQ-AS). METHODS One-hundred non-Hispanic White (n=50) and non-Hispanic African-American (n=50) adults (M=34, F=66) matched for sex, age, BMI, and body composition components completed this cross-sectional study. Participants underwent several anthropometric assessments, completed the MBSRQ-AS, and rated their perceived appearance, ideal appearance, and the appearance they believed a partner would find societally attractive using a state of the art mobile 3-dimensional DIA produced using broad developmental populations. Body image distortion was measured as the perceived minus actual appearance, and body image dissatisfaction was defined as the ideal appearance and appearance a partner would find attractive minus the perceived appearance. RESULTS Using the DIA, only African-American females demonstrated significant body image distortion (p<0.001); reporting perceived appearances significantly lower their than their actual. Further, AA females demonstrated significantly larger differences between their ideal and perceived appearance (p=0.009), perceived larger bodies as more attractive to a potential partner (p=0.009), and reported higher ratings of appearance evaluation (p=0.001) and body area satisfaction (p=0.011) compared to White females. CONCLUSIONS After accounting for all anthropometric determinants of body image, perceptual and attitudinal body image differs between White and African-American adults with differences supporting larger body size acceptance for African-American individuals, particularly African-American females.
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Affiliation(s)
- Austin J Graybeal
- School of Kinesiology & Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, 39406, USA.
| | - Caleb F Brandner
- School of Kinesiology & Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, 39406, USA
| | - Ryan Aultman
- School of Kinesiology & Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, 39406, USA
| | - Desiree E Ojo
- University of Incarnate Word School of Osteopathic Medicine, San Antonio, TX, 78235, USA
| | - Robyn Braun-Trocchio
- Department of Kinesiology, Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, TX, 76129, USA
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Raisi‐Estabragh Z, Kobo O, Mieres JH, Bullock‐Palmer RP, Van Spall HG, Breathett K, Mamas MA. Racial Disparities in Obesity-Related Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020. J Am Heart Assoc 2023; 12:e028409. [PMID: 37671611 PMCID: PMC10547286 DOI: 10.1161/jaha.122.028409] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/07/2023] [Indexed: 09/07/2023]
Abstract
Background Obesity is a major risk factor for cardiovascular disease, with differential impact across populations. This descriptive epidemiologic study outlines trends and disparities in obesity-related cardiovascular mortality in the US population between 1999 and 2020. Methods and Results The Multiple Cause of Death database was used to identify adults with primary cardiovascular death and obesity recorded as a contributing cause of death. Cardiovascular deaths were grouped into ischemic heart disease, heart failure, hypertensive disease, cerebrovascular disease, and other. Absolute, crude, and age-adjusted mortality rates (AAMRs) were calculated by racial group, considering temporal trends and variation by sex, age, and residence (urban versus rural). Analysis of 281 135 obesity-related cardiovascular deaths demonstrated a 3-fold increase in AAMRs from 1999 to 2020 (2.2-6.6 per 100 000 population). Black individuals had the highest AAMRs. American Indian or Alaska Native individuals had the greatest temporal increase in AAMRs (+415%). Ischemic heart disease was the most common primary cause of death. The second most common cause of death was hypertensive disease, which was most common in the Black racial group (31%). Among Black individuals, women had higher AAMRs than men; across all other racial groups, men had a greater proportion of obesity-related cardiovascular mortality cases and higher AAMRs. Black individuals had greater AAMRs in urban compared with rural settings; the reverse was observed for all other races. Conclusions Obesity-related cardiovascular mortality is increasing with differential trends by race, sex, and place of residence.
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Affiliation(s)
- Zahra Raisi‐Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Centre for Advanced Cardiovascular ImagingQueen Mary UniversityLondonUnited Kingdom
- Barts Heart Centre, St. Bartholomew’s HospitalBarts Health NHS Trust, West SmithfieldLondonUnited Kingdom
| | - Ofer Kobo
- Keele Cardiovascular Research GroupKeele UniversityKeeleUnited Kingdom
- Department of CardiologyHillel Yaffe Medical CenterHaderaIsrael
| | - Jennifer H. Mieres
- Department of Cardiology, Hofstra Northwell School of MedicineHofstra University, Lake SuccessNew YorkNYUSA
| | | | - Harriette G.C. Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence, and Impact, Population Health Research InstituteResearch Institute of St. Joe’s, McMaster UniversityHamiltonOntarioCanada
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Department of MedicineIndiana UniversityIndianapolisINUSA
| | - Mamas A. Mamas
- Keele Cardiovascular Research GroupKeele UniversityKeeleUnited Kingdom
- Institute of Population HealthUniversity of ManchesterManchesterUnited Kingdom
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Chandler R, Farinu OTO, Guillaume D, Francis S, Parker AG, Shah K, Hernandez ND. Digital Health App to Address Disparate HIV Outcomes Among Black Women Living in Metro-Atlanta: Protocol for a Multiphase, Mixed Methods Pilot Feasibility Study. JMIR Res Protoc 2023; 12:e42712. [PMID: 37713259 PMCID: PMC10541635 DOI: 10.2196/42712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/28/2023] [Accepted: 05/03/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Cisgender Black women in the southern United States are at heightened risk for HIV and adverse sexual and reproductive health outcomes. Mobile health interventions that target HIV risk while being adapted to the needs and lived experiences of Black women are remarkably limited. OBJECTIVE The study aims to refine SavvyHER, a mobile app for HIV prevention, with Black women residing in high HIV incidence areas of Georgia and evaluate the feasibility, acceptability, and usability of SavvyHER. This paper describes the procedures implemented to conduct this research. METHODS Community-based participatory research tenets guide this multiphase study to finalize the development of what we hypothesize will be an effective, sustainable, and culturally relevant HIV prevention and optimal sexual health and reproductive wellness app for Black women. This multiphased, mixed methods study consists of 3 phases. The first phase entails focus groups with Black women to understand their preferences for the functionality and design of a beta prototype version of SavvyHER. In the second phase, an app usability pretest (N=10) will be used to refine and optimize the SavvyHER app. The final phase will entail a pilot randomized controlled trial (N=60) to evaluate the app's feasibility and usability in preparation for a larger trial. RESULTS Findings from preliminary focus groups revealed educational content, app aesthetics, privacy considerations, and marketing preferred by Black women, thus informing the first functional SavvyHER prototype. As we adapt and test the feasibility of SavvyHER, we hypothesize that the app will be an effective, sustainable, and culturally relevant HIV prevention, sexual health, and reproductive wellness tool for Black women. CONCLUSIONS The findings from this research substantiate the importance of developing health interventions curated for and by Black women to address critical HIV disparities. The knowledge gained from this research can reduce HIV disparities among Black women through a targeted intervention that centers on their health needs and priorities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42712.
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Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Oluyemi T O Farinu
- Department of Sociology, Georgia State University, Atlanta, GA, United States
| | - Dominique Guillaume
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Sherilyn Francis
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Andrea G Parker
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Kewal Shah
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Natalie D Hernandez
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
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O'Farrell KD, Gonzalez-Pons KM, Gren LH, Frost CJ. Examining and promoting women's health through a descriptive analysis of a novel health tool: the 'Circle of Health'. Women Health 2023; 63:648-657. [PMID: 37655534 DOI: 10.1080/03630242.2023.2250873] [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: 04/23/2022] [Revised: 06/30/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
A comprehensive perspective of women's health increases healthy equity and broadens the spectrum of care for women. The Circle of Health, a holistic health assessment tool, was created by the National Centers of Excellence in Women's Health (NCEWH). This initiative focuses on advancing women's health needs by empowering them to actively engage about their own health care. The tool includes surveys for seven distinct domains of health: physical, social, emotional, intellectual, environmental, financial, and spiritual. The present study reports comprehensive health findings for a sample of 169 females from Region VIII with data collected from February 2014 to April 2019. The Circle of Health tool highlights distinct health needs across the seven domains. For the present sample of mostly female college students, areas of concern included the emotional, financial, and environmental health domains. Further research is needed to examine the holistic health of women from diverse cultural, racial, age, and socioeconomic backgrounds. The Circle of Health tool describes health, for both women and their health providers, more holistically and encourages an integrative model of care.
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Affiliation(s)
- Katelyn D O'Farrell
- Department of Health and Kinesiology, University of Utah College of Health, Salt Lake City, Utah US
| | | | - Lisa H Gren
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah US
| | - Caren J Frost
- University of Utah College of Social Work, Salt Lake City, Utah US
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Fields ND, Choi D, Patel SA. Social and economic factors and black-white disparities in cardiovascular health: A decomposition analysis. SSM Popul Health 2023; 23:101485. [PMID: 37635988 PMCID: PMC10448210 DOI: 10.1016/j.ssmph.2023.101485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/29/2023] Open
Abstract
Background Cardiovascular health (CVH) in Black adults, and particularly in Black women, has lagged behind White adults for decades and contributes to higher mortality rates for Black adults. We quantified the contribution of five social and economic factors to observed racial disparities in CVH by gender. Methods We analyzed data from N = 8,019 adults aged ≥20 years free of cardiovascular disease assessed in the National Health and Nutrition Examination Survey, 2011-2018. Social and economic factors included self-reported education, income, employment, food security, and marital status. CVH was measured using eight behavioral and clinical indicators. We utilized Kitagawa-Blinder-Oaxaca decomposition to quantify gendered racial differences in CVH accounted for by these factors. Results Black women (mean CVH = 79.3) had a lower age-adjusted CVH score compared to White women (mean CVH = 82.3) (mean difference [MD] = -3.01; 95% CI: -5.18, -0.84). Social and economic factors accounted for a 3.26-point disadvantage (95% CI: -4.12, -2.40) and a 0.25-point CVH score advantage due to factors not accounted for in the model. In women, income had the largest coefficient associated with CVH score (b = -1.48; 95% CI: -2.04, -0.92). Among men, social and economic factors accounted for a 2.27-point disadvantage (95% CI: -2.97, -1.56) with educational attainment being the largest coefficient associated with CVH score (b = -1.55; 95% CI: -2.03, -1.06). However, the disadvantage in men was offset by a 1.99 CVH score advantage that was not accounted for by factors in the model resulting in no racial difference in age-adjusted CVH score (MD = -0.28; 95% CI: -3.78, 3.22). Conclusions Racial differences in social and economic factors may contribute a large portion to the observed disparity in CVH between U.S. Black and White women.
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Affiliation(s)
- Nicole D. Fields
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Daesung Choi
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shivani A. Patel
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Josiah N, Russell N, DeVaughn L, Dorcelly N, Charles M, Shoola H, Ballard M, Baptiste D. Implicit bias, neuroscience and reproductive health amid increasing maternal mortality rates among Black birthing women. Nurs Open 2023; 10:5780-5783. [PMID: 37327404 PMCID: PMC10416051 DOI: 10.1002/nop2.1759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/30/2023] [Indexed: 06/18/2023] Open
Affiliation(s)
- Nia Josiah
- Columbia University School of NursingNew YorkNew YorkUSA
- Substance Abuse and Mental Health Services AdministrationRockvilleMarylandUnited States
| | - Niarah Russell
- Columbia University School of NursingNew YorkNew YorkUSA
| | | | | | | | - Hakeem Shoola
- Columbia University School of NursingNew YorkNew YorkUSA
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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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