1
|
Okuzono SS, Wilson J, Slopen N. Resilience in development: Neighborhood context, experiences of discrimination, and children's mental health. Dev Psychopathol 2023; 35:2551-2559. [PMID: 37641977 DOI: 10.1017/s0954579423001025] [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: 08/31/2023]
Abstract
An understanding of child psychopathology and resilience requires attention to the nested and interconnected systems and contexts that shape children's experiences and health outcomes. In this study, we draw on data from the National Survey of Children's Health, 2016 to 2021 (n = 182,375 children, ages 3- to 17 years) to examine associations between community social capital and neighborhood resources and children's internalizing and externalizing problems, and whether these associations were moderated by experiences of racial discrimination. Study outcomes were caregiver-report of current internalizing and externalizing problems. Using logistic regression models adjusted for sociodemographic characteristics of the child and household, higher levels of community social capital were associated with a lower risk of children's depression, anxiety, and behaviors. Notably, we observed similar associations between neighborhood resources and child mental health for depression only. In models stratified by the child's experience of racial/ethnic discrimination, the protective benefits of community social capital were specific to those children who did not experience racial discrimination. Our results illustrate heterogeneous associations between community social capital and children's mental health that differ based on interpersonal experiences of racial/ethnic discrimination, illustrating the importance of a multilevel framework to promote child wellbeing.
Collapse
Affiliation(s)
- Sakurako S Okuzono
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joseph Wilson
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Center on the Developing Child, Cambridge, MA, USA
| |
Collapse
|
2
|
Pantha S, Jones M, Gartoulla P, Gray R. A Systematic Review to Inform the Development of a Reporting Guideline for Concept Mapping Research. Methods Protoc 2023; 6:101. [PMID: 37888033 PMCID: PMC10609252 DOI: 10.3390/mps6050101] [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: 07/02/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Concept mapping is a phased, mixed-method approach that is increasingly used in health research to develop an understanding of complex phenomena. The six phases of concept mapping are preparation, idea generation, structuring (clustering and prioritization), data analysis, interpretation, and utilization of the map. The reporting of concept mapping research requires the development of a specific reporting guideline. We conducted a systematic review to identify candidate reporting items for inclusion in a reporting guideline. Three databases (MEDLINE, CINAHL, and PsycInfo) were searched to identify studies that used concept mapping methodology. We included 75 concept mapping studies published since 2019 from which we extracted information about the quality of reporting. A third of the studies focused on public health. We identified 71 candidate items that relate to the quality of reporting concept mapping research. The rationale for the study, the focus prompt, procedures for brainstorming, and structuring statements were consistently reported across the included studies. The process for developing the focus prompt, the rationale for the size of the stakeholder groups, and the process for determining the final concept map were generally not reported. The findings from the review will be used to inform the development of our reporting guideline for concept mapping research.
Collapse
Affiliation(s)
- Sandesh Pantha
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia;
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Campus, Whyalla Norrie, SA 5608, Australia;
| | - Pragya Gartoulla
- Australian Institute of Family Studies, Melbourne, VIC 3000, Australia;
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia;
| |
Collapse
|
3
|
Ramsoondar N, Anawati A, Cameron E. Racism as a determinant of health and health care: Rapid evidence narrative from the SAFE for Health Institutions project. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:594-598. [PMID: 37704247 PMCID: PMC10498908 DOI: 10.46747/cfp.6909594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Affiliation(s)
- Nusha Ramsoondar
- Medical student at the Northern Ontario School of Medicine (NOSM) University in Thunder Bay, Ont
| | - Alex Anawati
- Associate Professor, co-lead of the SAFE (Social Accountability as the Framework for Engagement) for Health Institutions project, and Physician Clinical Lead for Leadership, Advocacy, and Policy in the Centre for Social Accountability at NOSM University and Health Sciences North in Sudbury, Ont; and has been a member of the College of Family Physicians of Canada's Social Accountability Working Group
| | - Erin Cameron
- Associate Professor, co-lead of the SAFE for Health Institutions project, and Director of the Centre for Social Accountability at NOSM University
| |
Collapse
|
4
|
Ramsoondar N, Anawati A, Cameron E. Le racisme comme déterminant de la santé et des soins de santé. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:601-605. [PMID: 37704242 PMCID: PMC10498905 DOI: 10.46747/cfp.6909601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Affiliation(s)
- Nusha Ramsoondar
- Étudiante en médecine à l'École de médecine du Nord de l'Ontario (NOSM), à Thunder Bay (Ontario)
| | - Alex Anawati
- Professeur agrégé, codirecteur du projet SAFE (Responsabilité sociale comme référentiel pour la mobilisation) à l'intention des établissements de santé, médecin clinicien responsable du Leadership, de la défense des intérêts et des politiques au Centre pour la responsabilité sociale de l'Université NOSM et de Health Sciences North à Sudbury (Ontario), et il était membre du Groupe de travail sur la responsabilité sociale du Collège des médecins de famille du Canada
| | - Erin Cameron
- Professeure agrégée et codirectrice du projet SAFE à l'intention des établissements de santé et directrice du Centre pour la responsabilité sociale de l'Université NOSM
| |
Collapse
|
5
|
Gregg JT, Himes BE, Asselbergs FW, Moore JH. Improving Genetic Association Studies with a Novel Methodology that Unveils the Hidden Complexity of All-Cause Heart Failure. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.02.23293567. [PMID: 37577697 PMCID: PMC10418568 DOI: 10.1101/2023.08.02.23293567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Motivation Genome-Wide Association Studies (GWAS) commonly assume phenotypic and genetic homogeneity that is not present in complex conditions. We designed Transformative Regression Analysis of Combined Effects (TRACE), a GWAS methodology that better accounts for clinical phenotype heterogeneity and identifies gene-by-environment (GxE) interactions. We demonstrated with UK Biobank (UKB) data that TRACE increased the variance explained in All-Cause Heart Failure (AHF) via the discovery of novel single nucleotide polymorphism (SNP) and SNP-by-environment (i.e. GxE) interaction associations. First, we transformed 312 AHF-related ICD10 codes (including AHF) into continuous low-dimensional features (i.e., latent phenotypes) for a more nuanced disease representation. Then, we ran a standard GWAS on our latent phenotypes to discover main effects and identified GxE interactions with target encoding. Genes near associated SNPs subsequently underwent enrichment analysis to explore potential functional mechanisms underlying associations. Latent phenotypes were regressed against their SNP hits and the estimated latent phenotype values were used to measure the amount of AHF variance explained. Results Our method identified over 100 main GWAS effects that were consistent with prior studies and hundreds of novel gene-by-smoking interactions, which collectively accounted for approximately 10% of AHF variance. This represents an improvement over traditional GWAS whose results account for a negligible proportion of AHF variance. Enrichment analyses suggested that hundreds of miRNAs mediated the SNP effect on various AHF-related biological pathways. The TRACE framework can be applied to decode the genetics of other complex diseases. Availability All code is available at https://github.com/EpistasisLab/latent_phenotype_project.
Collapse
Affiliation(s)
- John T. Gregg
- Department of Biostatistics Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Blanca E. Himes
- Department of Biostatistics Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jason H. Moore
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
6
|
Garasia S, Bishop V, Clayton S, Pinnington G, Arinze C, Jalil E. Health outcomes, health services utilization, and costs consequences of medicare uninsurance among migrants in Canada: a systematic review. BMC Health Serv Res 2023; 23:427. [PMID: 37138351 PMCID: PMC10154752 DOI: 10.1186/s12913-023-09417-4] [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: 01/25/2022] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Medically uninsured groups, many of them migrants, reportedly delay using healthcare services due to costs and often face preventable health consequences. This systematic review sought to assess quantitative evidence on health outcomes, health services use, and health care costs among uninsured migrant populations in Canada. METHODS OVID MEDLINE, Embase, Global Health, EconLit, and grey literature were searched to identify relevant literature published up until March 2021. The Cochrane Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool was used to assess the quality of studies. RESULTS Ten studies were included. Data showed that there are differences among insured and uninsured groups in reported health outcomes and health services use. No quantitative studies on economic costs were captured. CONCLUSIONS Our findings indicate a need to review policies regarding accessible and affordable health care for migrants. Increasing funding to community health centers may improve service utilization and health outcomes among this population.
Collapse
Affiliation(s)
- Sophiya Garasia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.
| | - Valerie Bishop
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Stephanie Clayton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Genevieve Pinnington
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Chika Arinze
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Ezza Jalil
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| |
Collapse
|
7
|
Hilario C, Louie-Poon S, Taylor M, Gill GK, Kennedy M. Racism in Health Services for Adolescents: A Scoping Review. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2023:27551938231162560. [PMID: 36927090 DOI: 10.1177/27551938231162560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Addressing racism within health systems and services is critical to addressing health vulnerabilities and promoting health equity for racialized populations. Currently, there is limited knowledge about the ways in which racism affects health services for adolescents. A scoping review was undertaken following the Joanna Briggs Institute Manual for Evidence Synthesis methodology and guided by the research questions: (1) What are the characteristics of the literature examining racism in health service use for adolescents? (2) What are the foci of the literature on systemic racism and health services for adolescents? A systematic literature search was conducted in April 2021 to identify all relevant published studies. The search identified 3049 unique articles, with a total of 13 articles included in this review. Multiple levels of racism were examined in the included articles across various health care settings. Five foci were identified: racism prevention, missed care, quality of care, racial bias, and experiences of racism. Our review indicates a current emphasis on interpersonal racism within this field of study, with emergent discussion of the impact of systemic racism. However, greater attention is needed that would investigate multiple forms of racism (institutional, interpersonal, internalized) in relation to specific contexts and adolescent populations.
Collapse
Affiliation(s)
- Carla Hilario
- School of Nursing, 70410University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Samantha Louie-Poon
- School of Nursing, 70410University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Mischa Taylor
- School of Nursing, 70410University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Gurjeet K Gill
- School of Nursing, 70410University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Megan Kennedy
- School of Nursing, 70410University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| |
Collapse
|
8
|
Watkins S, Isichei O, Gentles TL, Brown R, Percival T, Sadler L, Gorinski R, Crengle S, Cloete E, de Laat MWM, Bloomfield FH, Ward K. What is Known About Critical Congenital Heart Disease Diagnosis and Management Experiences from the Perspectives of Family and Healthcare Providers? A Systematic Integrative Literature Review. Pediatr Cardiol 2023; 44:280-296. [PMID: 36125507 PMCID: PMC9895021 DOI: 10.1007/s00246-022-03006-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/06/2022] [Indexed: 02/06/2023]
Abstract
The experience of diagnosis, decision-making and management in critical congenital heart disease is layered with complexity for both families and clinicians. We synthesise the current evidence regarding the family and healthcare provider experience of critical congenital heart disease diagnosis and management. A systematic integrative literature review was conducted by keyword search of online databases, MEDLINE (Ovid), PsycINFO, Cochrane, cumulative index to nursing and allied health literature (CINAHL Plus) and two journals, the Journal of Indigenous Research and Midwifery Journal from 1990. Inclusion and exclusion criteria were applied to search results with citation mining of final included papers to ensure completeness. Two researchers assessed study quality combining three tools. A third researcher reviewed papers where no consensus was reached. Data was coded and analysed in four phases resulting in final refined themes to summarise the findings. Of 1817 unique papers, 22 met the inclusion criteria. The overall quality of the included studies was generally good, apart from three of fair quality. There is little information on the experience of the healthcare provider. Thematic analysis identified three themes relating to the family experience: (1) The diagnosis and treatment of a critical congenital heart disease child significantly impacts parental health and wellbeing. (2) The way that healthcare and information is provided influences parental response and adaptation, and (3) parental responses and adaptation can be influenced by how and when support occurs. The experience of diagnosis and management of a critical congenital heart disease child is stressful and life-changing for families. Further research is needed into the experience of minority and socially deprived families, and of the healthcare provider, to inform potential interventions at the healthcare provider and institutional levels to improve family experience and support.
Collapse
Affiliation(s)
- S. Watkins
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - O. Isichei
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | | | - R. Brown
- National Hauora Coalition, Auckland, New Zealand
| | - T. Percival
- Department of Paediatrics, The University of Auckland, Auckland, New Zealand
| | | | - R. Gorinski
- Heart Kids New Zealand, Tamariki Manawa Maia, Auckland, New Zealand
| | - S. Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - E. Cloete
- Te Whatu Ora, Christchurch, New Zealand
| | | | - F. H. Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - K. Ward
- School of Nursing, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
9
|
Fricke M, Beach Ducharme D, Beavis A, Flett P, Oosman S. Addressing racism in the workplace through simulation: So much to unlearn. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1126085. [PMID: 37064598 PMCID: PMC10097889 DOI: 10.3389/fresc.2023.1126085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/13/2023] [Indexed: 04/18/2023]
Abstract
Introduction Racism exists in the healthcare system and is a root cause of health inequities among Indigenous Peoples. When microaggressions of racism are carried out by healthcare providers, therapeutic trust may be broken and quality of care may be impacted. Anti-racism response training is considered best practice in recognizing and addressing racism. The objective of this study was to evaluate the impact of a virtual (synchronous) anti-racism response training workshop among a group of rehabilitation therapists from across Canada. Methods A 90-minute virtual anti-racism simulation workshop for rehabilitation therapists was developed and delivered virtually four times across Canada between 2020 and 2021. Following an introduction and pre-briefing, role-playing among participants was used to address microaggressive Indigenous-specific racism, followed by an in-depth debriefing with trained facilitators. A post-workshop survey was conducted to evaluate this anti-racism simulation workshop and assess the impact on participating occupational therapists (OTs) and physiotherapists (PTs). Following each simulation workshop, participants were invited to complete an anonymous post-activity survey (n = 20; 50% OTs, 45% PTs). Open text responses were analyzed thematically from the perspective of critical race theory. Results The majority of the participants self-identified as women (95%); white (90%); mid-career (52%); and had never personally experienced racism (70%). All participants agreed that the workshop gave them ideas on how to start dismantling racism in their workplace. Thematic analysis resulted in four themes: so much to unlearn, remain humble, resist the silence, and discomfort is okay. Discussion Despite feelings of discomfort, OTs and PTs appreciated anti-racism skills-based training and recognized the importance of taking action on racism in the workplace. Findings from this study support online (synchronous) anti-racism training as a viable and effective means of creating space for rehabilitation professionals to lean into brave conversations that are necessary for developing strategies to address racial microaggressions impacting Indigenous persons in the workplace. We believe that these small steps of preparing and practicing anti-racism strategies among rehabilitation therapists are essential to achieving a collective goal of dismantling racism in the health system.
Collapse
Affiliation(s)
- Moni Fricke
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
- Global Health Division, Canadian Physiotherapy Association, Ottawa, ON, Canada
- Correspondence: Moni Fricke
| | - Debra Beach Ducharme
- Ongomiizwin Indigenous Institute of Health and Healing, University of Manitoba, Winnipeg, MB, Canada
| | - Allana Beavis
- Global Health Division, Canadian Physiotherapy Association, Ottawa, ON, Canada
- Community Therapy Services Inc., Winnipeg, MB, Canada
| | - Priscilla Flett
- Global Health Division, Canadian Physiotherapy Association, Ottawa, ON, Canada
| | - Sarah Oosman
- Global Health Division, Canadian Physiotherapy Association, Ottawa, ON, Canada
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| |
Collapse
|
10
|
Rishworth A, Cao T, Niraula A, Wilson K. Health Care Use and Barriers to Care for Chronic Inflammatory Diseases (CID) among First and Second Generation South Asian Immigrant Children and Parents in Ontario Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14608. [PMID: 36361486 PMCID: PMC9655293 DOI: 10.3390/ijerph192114608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Although immigrants are disproportionately impacted by growing chronic inflammatory disease (CIDs) rates, yet suffer barriers to access health care, little attention has been given to their primary healthcare or specialist healthcare access as it relates to complex, chronic diseases in Canada, a country with universal health care. This study aims to investigate CID health care use and barriers to care among first- and second-generation immigrant South Asian children and parents in the Greater Toronto Area, Ontario. Drawing on analysis of 24 in depth interviews with children and parents (14 children, 10 parents), the results reveal that although CIDs disproportionately affects South Asian immigrants, they encounter health system, geographic, interpersonal, and knowledge barriers to access requisite care. These barriers exist despite participants having a GP, and are compounded further by limited familial systems, culturally insensitive care, and structural inequities that in some instances make parents choose between health access or other basic needs. Although all participants recognized the importance of specialized care, only 11 participants regularly accessed specialized care, creating new schisms in CID management. The findings suggest that a multisectoral approach that address individual and structural level socio-structural drivers of health inequities are needed to create more equitable healthcare access.
Collapse
Affiliation(s)
- Andrea Rishworth
- Department of Geography, Geomatics and Environment, Faculty Geography, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
| | - Tiffany Cao
- Department of Geography, Geomatics and Environment, Faculty Geography, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
| | - Ashika Niraula
- CERC in Migration and Integration, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Kathi Wilson
- Department of Geography, Geomatics and Environment, Faculty Geography, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
| |
Collapse
|
11
|
Agénor M, Geffen SR, Zubizarreta D, Jones R, Giraldo S, McGuirk A, Caballero M, Gordon AR. Experiences of and resistance to multiple discrimination in health care settings among transmasculine people of color. BMC Health Serv Res 2022; 22:369. [PMID: 35307008 PMCID: PMC8935683 DOI: 10.1186/s12913-022-07729-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/03/2022] [Indexed: 12/09/2023] Open
Abstract
BACKGROUND Research shows that transmasculine people experience discrimination based on their gender identity and/or expression (i.e., cissexism) while obtaining health care. However, studies examining the experience of other forms of discrimination in health care settings among diverse subgroups of transmasculine individuals, including those from minoritized racial/ethnic backgrounds, are very limited. METHODS Guided by intersectionality, we designed a qualitative research study to explore how transmasculine people of color experience-and resist-multiple, intersecting forms of discrimination in health care settings. Guided by a purposive sampling strategy, we selected 19 transmasculine young adults of color aged 18-25 years to participate in 5 mini-focus groups conducted between February and May 2019 in Boston, MA. Focus group transcripts were analyzed using a template style approach to thematic analysis that involved both deductive and inductive coding using a codebook. Coded text fragments pertaining to participants' experiences of health care discrimination were clustered into themes and sub-themes. RESULTS Transmasculine people of color described experiencing notable challenges accessing physical and mental health care as a result of structural barriers to identifying health care providers with expertise in transgender health, finding providers who share one or more of their social positions and lived experiences, and accessing financial resources to cover high health care costs. Further, participants discussed anticipating and experiencing multiple forms of interpersonal discrimination-both independently and simultaneously-in health care settings, including cissexism, racism, weight-based discrimination, and ableism. Moreover, participants described the negative impact of anticipating and experiencing multiple interpersonal health care discrimination on their health care utilization, quality of care, and mental and physical health. Lastly, participants discussed using various strategies to resist the multiple, intersecting forms of discrimination they encounter in health care settings, including setting boundaries with health care providers, seeking care from competent providers with shared social positions, engaging in self-advocacy, drawing on peer support during health care visits, and obtaining health information through their social networks. DISCUSSION Efforts are needed to address cissexism, racism, weight-based discrimination, ableism, and other intersecting forms of discrimination in clinical encounters, health care institutions and systems, and society in general to advance the health of transmasculine people of color and other multiply marginalized groups.
Collapse
Affiliation(s)
- Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Sophia R Geffen
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Center for Health Equity Education and Advocacy, Cambridge Health Alliance, Cambridge, MA, USA
| | - Dougie Zubizarreta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Raquel Jones
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Shane Giraldo
- Department of Sociology, Simmons University, Boston, MA, USA
- Youth Community Advisory Board, Tufts University, Medford, MA, USA
| | - Allison McGuirk
- Department of Counseling Psychology, University of Wisconsin Madison, Madison, WI, USA
| | - Mateo Caballero
- Youth Community Advisory Board, Tufts University, Medford, MA, USA
- Department of Communication Studies, Northeastern University, Boston, MA, USA
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
12
|
Beech BM, Ford C, Thorpe RJ, Bruce MA, Norris KC. Poverty, Racism, and the Public Health Crisis in America. Front Public Health 2021; 9:699049. [PMID: 34552904 PMCID: PMC8450438 DOI: 10.3389/fpubh.2021.699049] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/06/2021] [Indexed: 01/13/2023] Open
Abstract
The purpose of this article is to discuss poverty as a multidimensional factor influencing health. We will also explicate how racism contributes to and perpetuates the economic and financial inequality that diminishes prospects for population health improvement among marginalized racial and ethnic groups. Poverty is one of the most significant challenges for our society in this millennium. Over 40% of the world lives in poverty. The U.S. has one of the highest rates of poverty in the developed world, despite its collective wealth, and the burden falls disproportionately on communities of color. A common narrative for the relatively high prevalence of poverty among marginalized minority communities is predicated on racist notions of racial inferiority and frequent denial of the structural forms of racism and classism that have contributed to public health crises in the United States and across the globe. Importantly, poverty is much more than just a low-income household. It reflects economic well-being, the ability to negotiate society relative to education of an individual, socioeconomic or health status, as well as social exclusion based on institutional policies, practices, and behaviors. Until structural racism and economic injustice can be resolved, the use of evidence-based prevention and early intervention initiatives to mitigate untoward effects of socioeconomic deprivation in communities of color such as the use of social media/culturally concordant health education, social support, such as social networks, primary intervention strategies, and more will be critical to address the persistent racial/ethnic disparities in chronic diseases.
Collapse
Affiliation(s)
- Bettina M. Beech
- Department of Health Systems and Population Health Science, University of Houston College of Medicine, Houston, TX, United States
| | - Chandra Ford
- Department of Community Health Sciences, Center for the Study of Racism, Social Justice and Health at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Roland J. Thorpe
- Department of Health, Behavior, and Society, Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Marino A. Bruce
- Program for Research on Faith, Justice, and Health, Department of Behavioral and Social Sciences, University of Houston College of Medicine, Houston, TX, United States
| | - Keith C. Norris
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|