Racial Disparities in Health Among College-Educated African Americans: Can Attendance at Historically Black Colleges or Universities Reduce the Risk of Metabolic Syndrome in Midlife?

Commentary on "Racial and ethnic diversity in academic nursing leadership: A cross-sectional analysis" by Travers and colleagues (2024)

The purpose of this commentary is to highlight key points made by Travers and colleagues (2024) in their study entitled, "Racial and ethnic diversity in academic nursing leadership: A cross-sectional analysis" and provide additional recommendations for future research and policy related to diversity in academic nursing leadership. While there is a significant underrepresentation of racial and ethnic minoritized populations in academic leadership in nursing, the level of underrepresentation and contributors to underrepresentation are not the same across racial and ethnic minoritized populations. As we design strategies to promote diversity in academic nursing it is important to benchmark efforts to ensure representation from groups who experience the most significant health inequities, create tailored strategies that consider the unique historical and contemporary barriers to leadership in academic nursing across and within minoritized groups, and build upon evidence-based strategies, especially the important role that minority serving institutions have played.

Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease: Development of a Situation-Specific Theory for African American Emerging Adults

BACKGROUND

Emerging adulthood (18-25 years old) is a distinct developmental period in which multiple life transitions pose barriers to engaging in healthy lifestyle behaviors that reduce cardiovascular disease risk. There is limited theory-based research on African American emerging adults.

OBJECTIVE

This article introduces a synthesized empirically testable situation-specific theory for cardiovascular disease prevention in African American emerging adults.

METHODOLOGY

Im and Meleis' integrative approach was used to develop the situation-specific theory.

RESULTS

Unlocking Population-Specific Treatments to Render Equitable Approach and Management in Cardiovascular Disease is a situation-specific theory developed based on theoretical and empirical evidence and theorists' research and clinical practice experiences.

DISCUSSION

African American emerging adults have multifaceted factors that influence health behaviors and healthcare needs. Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease has the potential to inform theory-guided clinical practice and nursing research. Recommendations for integration in nursing practice, research, and policy advocacy are presented. Further critique and testing of the theory are required.

"We adjusted for race": now what? A systematic review of utilization and reporting of race in American Journal of Epidemiology and Epidemiology, 2020-2021

Race is a social construct, commonly used in epidemiologic research to adjust for confounding. However, adjustment of race may mask racial disparities, thereby perpetuating structural racism. We conducted a systematic review of articles published in Epidemiology and American Journal of Epidemiology between 2020 and 2021 to (1) understand how race, ethnicity, and similar social constructs were operationalized, used, and reported; and (2) characterize good and poor practices of utilization and reporting of race data on the basis of the extent to which they reveal or mask systemic racism. Original research articles were considered for full review and data extraction if race data were used in the study analysis. We extracted how race was categorized, used-as a descriptor, confounder, or for effect measure modification (EMM)-and reported if the authors discussed racial disparities and systemic bias-related mechanisms responsible for perpetuating the disparities. Of the 561 articles, 299 had race data available and 192 (34.2%) used race data in analyses. Among the 160 US-based studies, 81 different racial categorizations were used. Race was most often used as a confounder (52%), followed by effect measure modifier (33%), and descriptive variable (12%). Fewer than 1 in 4 articles (22.9%) exhibited good practices (EMM along with discussing disparities and mechanisms), 63.5% of the articles exhibited poor practices (confounding only or not discussing mechanisms), and 13.5% were considered neither poor nor good practices. We discuss implications and provide 13 recommendations for operationalization, utilization, and reporting of race in epidemiologic and public health research.

Racial differences in associations between adverse childhood experiences and physical, mental, and behavioral health

Purpose

Adverse childhood experiences (ACEs) are associated with poor adulthood health. Multiracial people have elevated mean ACEs scores and risk of several outcomes. We aimed to determine whether this group should be targeted for prevention efforts.

Methods

We analyzed three waves (1994-2009) of the National Longitudinal Study of Adolescent to Adult Health (n = 12,372) in 2023, estimating associations between four or more ACEs and physical (metabolic syndrome, hypertension, asthma), mental (anxiety, depression), and behavioral (suicidal ideation, drug use) outcomes. We estimated adjusted risk ratios for each outcome in modified Poisson models interacting race and ACEs. We used the interaction contrast to estimate race-specific excess cases per 1000 relative to Multiracial participants.

Results

Excess case estimates of asthma were smaller for White (-123 cases, 95% CI: -251, -4), Black (-141, 95% CI: -285, -6), and Asian (-169, 95% CI: -334, -7) participants compared to Multiracial participants. Black (-100, 95% CI: -189, -10), Asian (-163, 95% CI: -247, -79) and Indigenous (-144, 95% CI: -252, -42) participants had fewer excess cases of and weaker relative scale association with anxiety compared to Multiracial participants.

Conclusions

Adjusted associations with asthma and anxiety appear stronger for Multiracial people. Existing ACEs prevention strategies should be tailored to support Multiracial youth and families.

Racial Differences in Associations Between Adverse Childhood Experiences and Physical, Mental, and Behavioral Health

Introduction

Adverse childhood experiences (ACEs) are associated with poor adulthood health, with individuals experiencing multiple ACEs at greatest risk. Multiracial people have high mean ACEs scores and elevated risk of several outcomes, but are infrequently the focus of health equity research. This study aimed to determine whether this group should be targeted for prevention efforts.

Methods

We analyzed Waves 1 (1994-95), 3 (2001-02), and 4 (2008-09) of the National Longitudinal Study of Adolescent to Adult Health (n = 12,372) in 2023, estimating associations between four or more ACEs and physical (metabolic syndrome, hypertension, asthma), mental (anxiety, depression), and behavioral (suicidal ideation, drug use) outcomes. We estimated risk ratios for each outcome in modified Poisson models with a race × ACEs interaction, adjusted for hypothesized confounders of the ACE-outcome relationships. We used the interaction contrast to estimate excess cases per 1,000 individuals for each group relative to Multiracial participants.

Results

Excess case estimates of asthma were significantly smaller for White (-123 cases, 95% CI: -251, -4), Black (-141, 95% CI: -285, -6), and Asian (-169, 95% CI: -334, -7) participants compared to Multiracial participants. Black (-100, 95% CI: -189, -10), Asian (-163, 95% CI: -247, -79) and Indigenous (-144, 95% CI: -252, -42) participants had significantly fewer excess cases of and weaker (p < 0.001) relative scale association with anxiety compared to Multiracial participants.

Conclusions

Adjusted associations between ACEs and asthma or anxiety appear stronger for Multiracial people than other groups. ACEs are universally harmful but may contribute disproportionately to morbidity in this population.

Estimating the Long-Term Causal Effects of Attending Historically Black Colleges or Universities on Depressive Symptoms

Racism is embedded in society, and higher education is an important structure for patterning economic and health outcomes. Historically Black Colleges and Universities (HBCUs) were founded on antiracism while predominantly White institutions (PWIs) were often founded on white supremacy. This contrast provides an opportunity to study the association between structural racism and health among Black Americans. We used the National Longitudinal Study of Adolescent to Adult Health (Add Health) to estimate the long-term causal effect of attending an HBCU (vs. PWI) on depressive symptoms among Black students in the United States from 1994-2018. While we found no overall association with attending an HBCU (vs. PWI) on depressive symptoms, we found that this association varied by baseline mental health and region, and across time. For example, among those who attended high school outside of the South, HBCU attendance was protective against depressive symptoms 7 years later, and the association was strongest for those with higher baseline depressive symptoms. We recommend equitable state and federal funding for HBCUs, and that PWIs implement and evaluate antiracist policies to improve mental health of Black students.

Understanding Openness to Involvement in Sexual Health Care Research: Narratives from a Sample of Black College Women in the United States

Little is known about Black college women's openness to participating in sexual health care research. Guided by literature on Black feminism, the current study involved qualitative interviews with 39 Black Women (aged 19-25, mean age 20.7) from one historically Black university and one predominantly white university who answered questions about participating in research on the sexual health of Black women. Results from our thematic analysis found that participants were willing to participate in research when they were recruited by trusted community members, particularly Black female researchers. The women were willing to participate because they saw the value in having Black women's perspectives on sexual health research and improving Black women's lives. We found that participants believed that non-Black women researchers should receive training to increase understanding of the issues facing Black women and create safe and judgment-free spaces to engage Black Women in sexual health research. Participants wanted non-Black female and all male researchers to demonstrate a genuine interest in their lives as Black women. The findings highlight the importance of listening to the perspectives of participants and their experiences with sexual health care providers.

Education in the Jim Crow South and Black-White inequities in allostatic load among older adults

In the U.S., Black adults consistently have higher allostatic load – an indicator of physiological dysregulation – than White adults. Education is considered a likely mechanism given racial differences in attainment, but evidence is mixed. This may be due, in part, to data limitations that have made it difficult for scholars to account for the structurally rooted systemic racism that shaped the U.S. education system and led to large racial inequities in school term length and school attendance among older adults who grew up in the Jim Crow South. Our study addresses this limitation by linking historical data on Black and White segregated school systems in the U.S. South from 1919 to 1954 to the Health and Retirement Study (HRS) to determine if a new measure of educational attainment that accounts for structural racism that led to differences in the number of school days attended by Black and White students across years and states better explains Black-White inequities in allostatic load among older adults who attended school during Jim Crow. We restrict our sample to HRS respondents racialized as White or Black, who resided in the South when they were school-aged, completed primary/secondary school between 1919 and 1954, and provided a measure of allostatic load (n = 1932). We find that our new measure of schooling – duration in school – reduced the Black-White inequity in allostatic load more so than self-reported years of schooling whether we measured allostatic load continuously (34% vs 16%) or categorically (45% vs 20%). Our findings highlight the importance of identifying and using historically informed measures of schooling that account for structurally rooted systemic racism when trying to understand how education shapes the health of individuals racialized as Black in the United States.

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U.S. Black adults show greater physiological dysregulation than White adults.

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Mixed evidence as to whether education explains this inequity.

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May be due to unmeasured structurally rooted systematic racism in early schooling.

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Our education measure accounts for race inequity in term length and days attended.

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This measure explains Black-White inequity in allostatic load.

The status of climate studies in the United States and Canadian dental schools: Deans' perspectives

OBJECTIVES

Institutions with a positive cultural climate make community members from all backgrounds valued and included, and treated equitably. Such an environment is optimally suited to prepare future dentists well for leading a diverse team of staff members and addressing the oral health care needs of increasingly more diverse patient populations. The objectives were to assess how many United States and Canadian dental schools had participated in a climate study at their parent institution and/or had conducted their own climate study, which topics these studies had addressed, how they collected their data, from whom they collected data, and how the findings affected these academic units.

METHODS

In January 2020, 54 of the 78 dental school deans in the United States and Canada responded to a web-based survey (response rate: 69%).

RESULTS

Forty-six parent institutions (85%) and 27 dental schools (50%) had conducted climate studies. Eighty-seven percent of parent institutions assessed the climate overall and the climate for specific groups (70%), such as for persons from underrepresented minority backgrounds (67%) or different religious backgrounds (59%). Most parent institution and dental school studies utilized surveys to collect data from faculty (parent institutions: 76%/dental schools: 96%), staff (74%/93%), administrators (72%/93%), and students (72%/89%). Overall, climate study results positively affected parent institutions' and dental schools' humanistic environment (61%/63%) and the recruitment of faculty (46%/50%), students (46%/46%), and staff (41%/43%).

CONCLUSIONS

Climate studies are a widely accepted practice at dental schools and their parent institutions. Their results can play a vital role in shaping the climate of these academic units by fostering efforts to increase diversity, equity, and inclusion.