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Goetz SMM, Lucas T, Granger DA. Salivary uric acid dynamics are associated with stress response hormones among African Americans in an urban sample. Psychoneuroendocrinology 2024; 168:107120. [PMID: 39002453 DOI: 10.1016/j.psyneuen.2024.107120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/20/2024] [Accepted: 06/27/2024] [Indexed: 07/15/2024]
Abstract
Acute physiological responses to psychosocial stressors are a potential pathway underlying racial disparities in stress-related illnesses. Uric acid (UA) is a potent antioxidant that has been linked to disparities in stress-related illnesses, and recent research has shown that UA is responsive to acute social stress. However, an examination of the relationships between the purinergic system and other commonly measured stress systems is lacking. Here, we measure and characterize associations of salivary uric acid (sUA) with markers of hypothalamic-pituitary-adrenal (HPA) axis activation, sympathetic-adreno-medullar (SAM) axis activation, and acute inflammation. A community sample of 103 African Americans (33 male, 70 female) completed the Trier Social Stress Test to induce social-evaluative threat. Passive drool collected before, during, and after the stressor task provided salivary reactivity measures of UA (sUA), cortisol, dehydroepiandrosterone sulfate (DHEAS), salivary alpha amylase (sAA - a surrogate marker of SAM activity) and C-reactive protein (sCRP). Multiple regressions revealed that total activation of cortisol, DHEAS, and sCRP were each positively associated with higher total activation of sUA. Additionally, DHEAS reactivity was positively associated with sUA reactivity. Relationships between HPA-axis markers and sUA were especially observed among younger and male participants. Overall, findings suggest potential coordination of stress systems with sUA in response to acute stress, which may further the contributions of biological stress processes to racial health disparities.
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Affiliation(s)
- Stefan M M Goetz
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI 48502, USA.
| | - Todd Lucas
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI 48502, USA.
| | - Douglas A Granger
- Department of Psychological Science, School of Social Ecology, University of California at Irvine, Irvine, CA 92697-1075, USA; Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, 4201 SBSG, Irvine, CA 92697-7085, USA; John Hopkins University School of Medicine, 615 North Wolfe St., Baltimore, MD 21205, USA.
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Cho S, Gallagher RT. The Concealment of Health Information at the Intersection of Sexual Orientation and Race. LGBT Health 2024. [PMID: 38968344 DOI: 10.1089/lgbt.2023.0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024] Open
Abstract
Purpose: Sexually and racially minoritized people often have mistrust toward the healthcare system due to both perceived and actual experiences of discrimination. This may result in increased privacy concerns and a reluctance to share health-related information with health care providers. Drawing upon minority stress and an intersectionality framework, this study examines how rates of concealing health information differ between non-Hispanic White heterosexual people, non-Hispanic White lesbian, gay, and bisexual (LGB) people, racially minoritized heterosexual people, and those who are both sexually and racially minoritized. Methods: Using nationally representative cross-sectional data from the Health Information National Trends Survey from 2017 and 2018 (n = 4575), we fit logistic regression models to examine (1) whether sexually and racially minoritized people conceal health information from their providers more than their counterparts and (2) whether this tendency increases for those with multiple marginalized identities. Furthermore, we fit linear regression models to examine whether and how concealing health information from providers are linked to health outcomes. Results: Sexually and racially minoritized people had higher odds of concealing health information from providers than their counterparts. Those with multiple marginalized identities had even higher odds of withholding health information than other groups. Finally, we found a significant negative association between concealing health information and mental health. Conclusion: Our findings underscore the need to consider how the intersection of multiple marginalized identities shape health experiences and concerns over privacy in health care matters. We call for further research to better understand the complex dynamics of patient-provider relationships for marginalized populations.
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Affiliation(s)
- Soocheol Cho
- Department of Sociology, Indiana University, Bloomington, Indiana, USA
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3
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Mitchell AK, Ehrenkranz R, Franzen S, Han SH, Shakur M, McGowan M, Massett HA. Analysis of eligibility criteria in Alzheimer's and related dementias clinical trials. Sci Rep 2024; 14:15036. [PMID: 38951633 PMCID: PMC11217383 DOI: 10.1038/s41598-024-65767-x] [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: 02/06/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024] Open
Abstract
Overly restrictive clinical trial eligibility criteria can reduce generalizability, slow enrollment, and disproportionately exclude historically underrepresented populations. The eligibility criteria for 196 Alzheimer's Disease and Related Dementias (AD/ADRD) trials funded by the National Institute on Aging were analyzed to identify common criteria and their potential to disproportionately exclude participants by race/ethnicity. The trials were categorized by type (48 Phase I/II pharmacological, 7 Phase III/IV pharmacological, 128 non-pharmacological, 7 diagnostic, and 6 neuropsychiatric) and target population (51 AD/ADRD, 58 Mild Cognitive Impairment, 25 at-risk, and 62 cognitively normal). Eligibility criteria were coded into the following categories: Medical, Neurologic, Psychiatric, and Procedural. A literature search was conducted to describe the prevalence of disparities for eligibility criteria for African Americans/Black (AA/B), Hispanic/Latino (H/L), American Indian/Alaska Native (AI/AN) and Native Hawaiian/Pacific Islander (NH/PI) populations. The trials had a median of 15 criteria. The most frequent criterion were age cutoffs (87% of trials), specified neurologic (65%), and psychiatric disorders (61%). Underrepresented groups could be disproportionately excluded by 16 eligibility categories; 42% of trials specified English-speakers only in their criteria. Most trials (82%) contain poorly operationalized criteria (i.e., criteria not well defined that can have multiple interpretations/means of implementation) and criteria that may reduce racial/ethnic enrollment diversity.
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Affiliation(s)
| | | | - Sanne Franzen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sae H Han
- Kelly Government, Kelly Services, Inc., Rockville, MD, 20852, USA
| | - Mujaahida Shakur
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Ave., Ste 2S-603, Bethesda, MD, 20814, USA
| | - Melissa McGowan
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Ave., Ste 2S-603, Bethesda, MD, 20814, USA
| | - Holly A Massett
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Ave., Ste 2S-603, Bethesda, MD, 20814, USA.
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Hurd NM. Promoting Positive Development Among Racially and Ethnically Marginalized Youth: Advancing a Novel Model of Natural Mentoring. Annu Rev Clin Psychol 2024; 20:259-284. [PMID: 38346288 DOI: 10.1146/annurev-clinpsy-080822-045011] [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: 02/15/2024]
Abstract
Racism and other forms of oppression threaten the well-being of racially and ethnically marginalized youth. Models of risk and resilience for marginalized youth have stressed the importance of addressing contextual and structural risk while emphasizing promotive factors such as cultural capital within their communities. Increasingly, research has focused on collective antiracist action as a form of coping with structural oppression. Importantly, supportive intergenerational relationships that develop within youths' everyday contexts may play a key role in catalyzing and reinforcing youths' engagement in antiracist action. This review advances a novel model for understanding how supportive nonparental adults from youths' everyday lives (i.e., natural mentors) influence youths' positive developmental outcomes and participation in antiracist action and how collective antiracist action, in turn, fosters liberation and racial justice. The creation of a more just and equitable society contributes to positive development among racially and ethnically marginalized youth.
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Affiliation(s)
- Noelle M Hurd
- Department of Psychology, University of Virginia, Charlottesville, Virginia, USA;
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Strayhorn-Carter SM, Batai K, Gachupin FC. Types of Racism and Health Disparities and Inequalities among Cancer Patients: An Editorial Reflection of Articles in This Special Issue of IJERPH. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:785. [PMID: 38929031 PMCID: PMC11203658 DOI: 10.3390/ijerph21060785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Racism has been a long-standing influential factor that has negatively impacted both past and current health disparities within the United Sates population. Existing problems of racism and its impact on both health disparities and health inequalities were only amplified during the COVID-19 pandemic. The pandemic allowed both clinicians and researchers to recognize a growing list of health concerns at the macro-, meso-, and micro-level among underserved racially minoritized patients with specific chronic illnesses such as cancer. Based on these concerns, this Special Issue was designed to highlight the challenges of cancer screening, cancer treatment, and cancer-centered educational outreach among racially minoritized communities.
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Affiliation(s)
- Shaila M. Strayhorn-Carter
- Department of Public Health, School of Health & Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC 28403, USA;
| | - Ken Batai
- Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Francine C. Gachupin
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ 85721, USA;
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Nordyke K, Kressin A, Holtz ML, Robinson R. The Impact of Racism on Healthcare Experiences and Well-Being: a Qualitative Study Based on Focus Group Discussions with Communities of Color. J Racial Ethn Health Disparities 2024; 11:1246-1253. [PMID: 37615901 DOI: 10.1007/s40615-023-01603-8] [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: 02/07/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Connections between race and health are discussed, and racism has been called out as a root cause of health disparities. The impacts of systemic racism are not fully understood and should be considered in order to advance health equity. The aim of the study is to explore the impact of racism on healthcare experiences and well-being for communities of color. METHODS Individuals from a Northeast region of Wisconsin, who self-identified as Somali, Hmong, Black/African American, Hispanic/Latino/a, and First Nations/Native American/Indigenous, were invited to participate in focus group discussions, and informed consent was obtained from all participants (25 adults, 17 females, and 8 males). Focus groups were planned so participants from the same self-identified communities were together, and five virtual focus group discussions were carried out. A qualitative content analysis approach was used to gain a deeper understanding of the content. RESULTS There was a range of experiences; however, everyone experienced the negative impacts of racism. Three categories, representing areas impacted by racism, and a final theme, describing the overall impact on healthcare experiences and well-being, were created. Dealing with systemic racism means that "backgrounds and values," "resources," and "prejudices" (categories) require constant attention, maneuvering, and "juggling the impacts of racism diminishes access to healthcare and well-being for communities of color" (theme). DISCUSSION Systemic racism negatively impacts access to healthcare and well-being for communities of color perpetuating health disparities. Planning and policy should include a focus on health equity and target systemic racism in order to diminish health disparities.
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Gaydosh L, Harris KM. Institutional Context Shapes the Physical Health of College Graduates Differently for U.S. White, Black, and Hispanic Adults. Demography 2024; 61:933-966. [PMID: 38809598 DOI: 10.1215/00703370-11380743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Greater educational attainment is generally associated with healthier and longer lives. However, important heterogeneity in who benefits from educational attainment, how much, and why remains underexplored. In particular, in the United States, the physical health returns to educational attainment are not as large for minoritized racial and ethnic groups compared with individuals racialized as White. Yet, our current understanding of ethnoracial differences in educational health disparities is limited by an almost exclusive focus on the quantity of education attained without sufficient attention to heterogeneity within educational attainment categories, such as different institution types among college graduates. Using biomarker data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we test whether the physical health of college graduates in early adulthood (aged 24-32) varies by institution type and for White, Black, and Hispanic adults. In considering the role of the college context, we conceptualize postsecondary institutions as horizontally stratified and racialized institutional spaces with different implications for the health of their graduates. Finally, we quantify the role of differential attendance at and returns to postsecondary institution type in shaping ethnoracialized health disparities among college graduates in early adulthood.
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Affiliation(s)
- Lauren Gaydosh
- Department of Sociology and Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - Kathleen Mullan Harris
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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McGee EE, Zeleznik OA, Balasubramanian R, Hu J, Rosner BA, Wactawski-Wende J, Clish CB, Avila-Pacheco J, Willett WC, Rexrode KM, Tamimi RM, Eliassen AH. Differences in metabolomic profiles between Black and White women in the U.S.: Analyses from two prospective cohorts. Eur J Epidemiol 2024; 39:653-665. [PMID: 38703248 DOI: 10.1007/s10654-024-01111-x] [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: 11/22/2023] [Accepted: 02/26/2024] [Indexed: 05/06/2024]
Abstract
There is growing interest in incorporating metabolomics into public health practice. However, Black women are under-represented in many metabolomics studies. If metabolomic profiles differ between Black and White women, this under-representation may exacerbate existing Black-White health disparities. We therefore aimed to estimate metabolomic differences between Black and White women in the U.S. We leveraged data from two prospective cohorts: the Nurses' Health Study (NHS; n = 2077) and Women's Health Initiative (WHI; n = 2128). The WHI served as the replication cohort. Plasma metabolites (n = 334) were measured via liquid chromatography-tandem mass spectrometry. Observed metabolomic differences were estimated using linear regression and metabolite set enrichment analyses. Residual metabolomic differences in a hypothetical population in which the distributions of 14 risk factors were equalized across racial groups were estimated using inverse odds ratio weighting. In the NHS, Black-White differences were observed for most metabolites (75 metabolites with observed differences ≥ |0.50| standard deviations). Black women had lower average levels than White women for most metabolites (e.g., for N6, N6-dimethlylysine, mean Black-White difference = - 0.98 standard deviations; 95% CI: - 1.11, - 0.84). In metabolite set enrichment analyses, Black women had lower levels of triglycerides, phosphatidylcholines, lysophosphatidylethanolamines, phosphatidylethanolamines, and organoheterocyclic compounds, but higher levels of phosphatidylethanolamine plasmalogens, phosphatidylcholine plasmalogens, cholesteryl esters, and carnitines. In a hypothetical population in which distributions of 14 risk factors were equalized, Black-White metabolomic differences persisted. Most results replicated in the WHI (88% of 272 metabolites available for replication). Substantial differences in metabolomic profiles exist between Black and White women. Future studies should prioritize racial representation.
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Affiliation(s)
- Emma E McGee
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA.
| | - Oana A Zeleznik
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Raji Balasubramanian
- Division of Women's Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jie Hu
- Division of Women's Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Bernard A Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Clary B Clish
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Julian Avila-Pacheco
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Walter C Willett
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kathryn M Rexrode
- Division of Women's Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medical College, New York, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Wilson EJ, Primgaard AR, Hambrick EP, Marszalek JM, Berkley-Patton J, Nilsson JE, Bennett KK. Rumination mediates associations between microaggressions and sleep quality in Black Americans: the toll of racial microstressors. J Behav Med 2024; 47:515-530. [PMID: 38281260 PMCID: PMC11031310 DOI: 10.1007/s10865-023-00464-0] [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: 05/22/2023] [Accepted: 12/08/2023] [Indexed: 01/30/2024]
Abstract
Disparities in health outcomes between Black and White Americans are well-documented, including sleep quality, and disparities in sleep may lead to disparities in health over the life course. A meta-model indicates that cognitive processes may underly the connection between race and poor sleep quality, and ultimately, health disparities. That is, there are race-specific stressors that disproportionately affect Black Americans, which are associated with poor health through biological, cognitive, and behavioral mechanisms (e.g., sleep). Among these race-specific stressors is discrimination, which has been linked to poor sleep quality, and there is a body of literature connecting perseverative cognition (e.g., rumination and worry or vigilance) to poor sleep. Microaggressions, a more subtle but pervasive form of discrimination, are another race-specific stressor. Although less research has considered the connection of microaggressions to perseverative cognition, there are some studies linking microaggressions to health outcomes and sleep. Therefore, using a cross-sectional survey, we tested the following hypotheses: racism-related vigilance and rumination would mediate the relationship between discrimination and poor sleep as well as between microaggressions and poor sleep among Black Americans (N = 223; mean age = 35.77 years, 53.8% men, 86% employed, 66.8% with college degree or higher education). Results of seven parallel mediation models showed that neither rumination nor racism-related vigilance mediated a relationship between discrimination and poor sleep quality. However, rumination partially mediated relationships between the six microaggression sub-scales and poor sleep quality: there were significant indirect effects for Foreigner/Not Belonging (β = .13, SE = 0.03, 95% CI 0.08, 0.20), Criminality (β = .11, SE = 0.03, 95% CI 0.05, 0.17), Sexualization (β = .10, SE = 0.03, 95% CI 0.05, 0.17), Low-Achieving/Undesirable (β = .10, SE = 0.03, 95% CI 0.05, 0.15), Invisibility (β = .15, SE = 0.04, 95% CI 0.08, 0.23), and Environmental Invalidations (β = .15, SE = 0.04, 95% CI 0.08, 0.23). Overall, these findings indicate support for the meta-model, demonstrating a specific pathway from racial microstressors to poor sleep quality. Furthermore, these results suggest the importance of developing clinical and community approaches to address the impact of microaggressions on Black Americans' sleep quality.
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Affiliation(s)
- Elizabeth J Wilson
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA.
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Anahi R Primgaard
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Erin P Hambrick
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jacob M Marszalek
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jannette Berkley-Patton
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Johanna E Nilsson
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kymberley K Bennett
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
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Glicksman A, Rodriguez M, Ring L, Lai P, Liebman M. Use of Long-Term Care Services by Older Persons with Limited English Proficiency. J Aging Soc Policy 2024:1-19. [PMID: 38801256 DOI: 10.1080/08959420.2024.2347807] [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: 04/17/2023] [Accepted: 11/16/2023] [Indexed: 05/29/2024]
Abstract
Older migrants face special difficulties in the access and use of long-term care services and supports (LTSS). Our study was designed to examine how older persons with limited English proficiency (LEP) in two groups of migrants (Spanish or Chinese speaking) interact with the LTSS system. Focus groups were used to elicit information from members of these groups. We discovered Chinese elders were likely to believe that the LTSS services could, if managed properly, meet their needs, while the Spanish speakers were more skeptical. These differences were associated with the presence of trusted intermediaries among the Chinese elders who could represent their interests, while most Spanish speakers did not report having such intermediaries. In this way, trust, or lack of it, was uncovered as the key element defining older adults' interactions with the formal health and social service systems. Findings will be used to develop a modeling method that will allow us to analyze results in a manner that can be extended to use with other migrant groups.
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Affiliation(s)
- Allen Glicksman
- Research Department, Philadelphia Corporation for Aging NewCourtland, Philadelphia, PA, USA
| | | | - Lauren Ring
- Research Department, Philadelphia Corporation for Aging NewCourtland, Philadelphia, PA, USA
| | - Philip Lai
- Philadelphia Senior Center, Philadelphia, PA, USA
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Abdallah K, Udaipuria S, Murden R, McKinnon II, Erving CL, Fields N, Moore R, Booker B, Burey T, Dunlop-Thomas C, Drenkard C, Johnson DA, Vaccarino V, Lim SS, Lewis TT. Financial Hardship and Sleep Quality Among Black American Women With and Without Systemic Lupus Erythematosus. Psychosom Med 2024; 86:315-323. [PMID: 38724039 PMCID: PMC11090455 DOI: 10.1097/psy.0000000000001296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
OBJECTIVE To compare dimensions of financial hardship and self-reported sleep quality among Black women with versus without systemic lupus erythematosus (SLE). METHODS Participants were 402 Black women (50% with validated diagnosis of SLE) living in Georgia between 2017 and 2020. Black women with SLE were recruited from a population-based cohort established in Atlanta, and Black women without SLE were recruited to be of comparable age and from the same geographic areas as SLE women. Financial hardship was measured using three different scales: financial adjustments, financial setbacks, and financial strain. Sleep was assessed continuously using the Pittsburgh Sleep Quality Index (PSQI) scale. Each dimension of financial hardship was analyzed separately in SLE-stratified multivariable linear regression models and adjusted by sociodemographic and health status factors. RESULTS Dimensions of financial hardship were similarly distributed across the two groups. Sleep quality was worse in Black women with, versus without, SLE (p < .001). Among Black women with SLE, financial adjustment was positively associated with a 0.40-unit increase in poor sleep quality (95% CI = 0.12-0.67, p = .005). When accounting for cognitive depressive symptoms, financial setbacks and strain were somewhat attenuated for Black women with SLE. Overall, no associations between financial hardships and sleep quality were observed for the women without SLE. CONCLUSIONS Black women with SLE who experience financial hardships may be more at risk for poor sleep quality than Black women without SLE. Economic interventions targeting this population may help improve their overall health and quality of life.
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Affiliation(s)
- Khadijah Abdallah
- From the Department of Epidemiology (Abdallah, Udaipuria, Murden, McKinnon, Fields, Booker, Burey, Dunlop-Thomas, Drenkard, Johnson, Vaccarino, Lim, Lewis), Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Sociology (Erving), Population Research Center, University of Texas, Austin, Texas; Dornsife School of Public Health (Moore), Drexel University, Philadelphia, Pennsylvania; Division of Rheumatology (Drenkard), Emory University; and Division of Rheumatology (Lim), Grady Health System, Atlanta, Georgia
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Colburn DA. The Impact of Telehealth Expansion on Health Care Utilization, Access, and Outcomes During the Pandemic: A Systematic Review. Telemed J E Health 2024; 30:1401-1410. [PMID: 38100326 DOI: 10.1089/tmj.2023.0440] [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: 12/17/2023] Open
Abstract
Introduction: The COVID-19 pandemic brought unprecedented change to the health care industry, including a large and rapid shift to providing care through telehealth technologies. Although the expansion of telehealth services was successful in continuing to provide patients with care while preventing the spread of disease, it is less clear how patient sociodemographic characteristics influenced telehealth use during this time. This study aims to systematically review the published literature on demographic differences in telehealth access, utilization, and health outcomes among a variety of adult patient types in the United States. Methods: Litcovid, PubMed, Web of Science, and MEDLINE databases were searched, resulting in a final sample of n = 32 studies. Results: Results found that studies could be categorized as addressing at least one of eight different areas of inquiry: sociodemographic differences in telehealth use (1) during and (2) before the pandemic, telehealth use versus nonuse (3) during and (4) before the pandemic, (5) telehealth modality, (6) satisfaction with telehealth, (7) outcomes associated with telehealth use, and (8) perceived or actual access to telehealth services. Discussion: Findings are robust across included studies with respect to racial, age, and socioeconomic differences in telehealth utilization and health outcomes, reflecting sociodemographic differences in health care access, utilization, and outcomes more broadly that persist despite this expansion of telehealth services owing to COVID-19. Additional findings across studies are summarized and areas for future research are discussed.
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Affiliation(s)
- Deirdre A Colburn
- Crimes against Children Research Center, University of New Hampshire, Durham, New Hampshire, USA
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Adesogan O, Lavner JA, Carter SE, Beach SRH. Stress Accumulation, Depressive Symptoms, and Sleep Problems among Black Americans in the Rural South. Clin Psychol Sci 2024; 12:421-434. [PMID: 38859912 PMCID: PMC11164549 DOI: 10.1177/21677026231170839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Centuries of systemic racism in the United States have led to Black Americans facing a disproportionate amount of life stressors. These stressors can have negative effects on mental and physical health, contributing to inequities throughout the lifespan. The current study used longitudinal data from 692 Black adults in the rural South to examine the ways in which neighborhood stress, financial strain, and interpersonal experiences of racial discrimination operate independently and in tandem to impact depressive symptoms and sleep problems over time. Findings provided strong support for univariate and additive stress effects and modest support for multiplicative stress effects. Results underscore how multiple stressors stemming from systemic racism can undermine health among Black Americans and highlight the need for further research on factors that promote well-being in the face of these stressors.
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Affiliation(s)
| | | | | | - Steven R. H. Beach
- Department of Psychology and Center for Family Research, University of Georgia
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14
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Kowal DR. Regression with race-modifiers: towards equity and interpretability. RESEARCH SQUARE 2024:rs.3.rs-4158747. [PMID: 38645193 PMCID: PMC11030512 DOI: 10.21203/rs.3.rs-4158747/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
The pervasive effects of structural racism and racial discrimination are well-established and offer strong evidence that the effects of many important variables on health and life outcomes vary by race. Alarmingly, standard practices for statistical regression analysis introduce racial biases into the estimation and presentation of these race-modified effects. We introduce abundance-based constraints (ABCs) to eliminate these racial biases. ABCs offer a remarkable invariance property: estimates and inference for main effects are nearly unchanged by the inclusion of race-modifiers. Thus, quantitative researchers can estimate race-specific effects "for free"-without sacrificing parameter interpretability, equitability, or statistical efficiency. The benefits extend to prominent statistical learning techniques, especially regularization and selection. We leverage these tools to estimate the joint effects of environmental, social, and other factors on 4th end-of-grade readings scores for students in North Carolina (n = 27, 638) and identify race-modified effects for racial (residential) isolation, PM2.5 exposure, and mother's age at birth.
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Affiliation(s)
- Daniel R. Kowal
- Department of Statistics, Rice University, Houston, TX 77005
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15
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Kowala DR. Regression with race-modifiers: towards equity and interpretability. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.04.23300033. [PMID: 38464140 PMCID: PMC10925363 DOI: 10.1101/2024.01.04.23300033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
The pervasive effects of structural racism and racial discrimination are well-established and offer strong evidence that the effects of many important variables on health and life outcomes vary by race. Alarmingly, standard practices for statistical regression analysis introduce racial biases into the estimation and presentation of these race-modified effects. We introduce abundance-based constraints (ABCs) to eliminate these racial biases. ABCs offer a remarkable invariance property: estimates and inference for main effects are nearly unchanged by the inclusion of race-modifiers. Thus, quantitative researchers can estimate race-specific effects "for free"-without sacrificing parameter interpretability, equitability, or statistical efficiency. The benefits extend to prominent statistical learning techniques, especially regularization and selection. We leverage these tools to estimate the joint effects of environmental, social, and other factors on 4th end-of-grade readings scores for students in North Carolina (n = 27, 638) and identify race-modified effects for racial (residential) isolation, PM2.5 exposure, and mother's age at birth.
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Affiliation(s)
- Daniel R Kowala
- Department of Statistics, Rice University, Houston, TX 77005
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16
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Louie P, DeAngelis RT. Fear of a Black Neighborhood: Anti-Black Racism and the Health of White Americans. SOCIAL FORCES; A SCIENTIFIC MEDIUM OF SOCIAL STUDY AND INTERPRETATION 2024; 102:817-838. [PMID: 38229931 PMCID: PMC10789170 DOI: 10.1093/sf/soad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 01/18/2024]
Abstract
Does anti-Black racism harm White Americans? We advance hypotheses that address this question within the neighborhood context. Hypotheses are tested with neighborhood and survey data from a probability sample of White residents of Nashville, Tennessee. We find that regardless of neighborhood crime rates or socioeconomic compositions, Whites report heightened perceptions of crime and danger in their neighborhoods as the proportion of Black residents increases. Perceived neighborhood danger, in turn, predicts increased symptoms of psychophysiological distress. When stratified by socioeconomic status (SES), however, low-SES Whites also report perceptions of higher status when living near more Black neighbors, which entirely offsets their distress. We conclude that although anti-Black racism can ironically harm the health of White Americans, compensatory racist ideologies can also offset these harms, particularly for lower-status Whites. We situate our findings within broader discussions of anti-Black racism, residential segregation, and psychiatric disorders commonly observed among White Americans.
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17
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Souza IMD, Araújo EMD, Silva Filho AMD. Incomplete recording of race/colour in health information systems in Brazil: time trend, 2009-2018. CIENCIA & SAUDE COLETIVA 2024; 29:e05092023. [PMID: 38451645 DOI: 10.1590/1413-81232024293.05092023] [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: 04/05/2023] [Accepted: 12/04/2023] [Indexed: 03/08/2024] Open
Abstract
This ecological study of time trends and multiple groups evaluated incompleteness in the race/colour field of Brazilian health information system records and the related time trend, 2009-2018, for the diseases and disorders most prevalent in the black population. The Romero and Cunha (2006) classification was applied in order to examine incompleteness using secondary data from Brazil's National Notifiable Diseases System, Hospital Information System and Mortality Information System, by administrative regions of Brazil, while percentage underreporting and time trend were calculated using simple linear regression models with Prais-Winsten correction (p-value<0.05). All records scored poorly except those for mortality from external causes (excellent), tuberculosis (good) and infant mortality (fair). An overall downward trend was observed in percentage incompleteness. Analysis by region found highest mean incompleteness in the North (30.5%), Northeast (33.3%) and Midwest (33.0%) regions. The Southeast and Northeast regions showed the strongest downward trends. The findings intended to increase visibility on the implications of the race/color field for health equity.
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Affiliation(s)
- Ionara Magalhães de Souza
- Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia. Av. Carlos Amaral, R. do Cajueiro, 1015. 44574-490 Santo Antônio de Jesus BA Brasil.
| | - Edna Maria de Araújo
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Estadual de Feira de Santana (UEFS). Novo Horizonte BA Brasil
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18
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Ilea P, Ilea I. Administrative burden for patients in U.S. health care settings Post-Affordable Care Act: A scoping review. Soc Sci Med 2024; 345:116686. [PMID: 38368662 DOI: 10.1016/j.socscimed.2024.116686] [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: 08/14/2023] [Revised: 01/20/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024]
Abstract
Administrative burdens are the costs associated with receiving a service or accessing a program. Based on the Herd & Moynihan framework, they occur in three subcategories: learning costs, compliance costs, and psychological costs. Administrative burdens manifest inequitably, more significantly impacting vulnerable populations. Administrative burdens may impact the health of those trying to access services, and in some cases block access to health-promoting services entirely. This scoping review examined studies focused on the impact on patients of administrative burden administrative burden in health care settings in the U.S. following the passage of the Affordable Care Act. We queried databases for empirical literature capturing patient administrative burden, retrieving 1578 records, with 31 articles ultimately eligible for inclusion. Of the 31 included studies, 18 used quantitative methods, nine used qualitative methods, three used mixed methods, and one was a case study. In terms of administrative burden subcategories, most patient outcomes reported were learning (22 studies) and compliance costs (26 studies). Psychological costs were the most rarely reported; all four studies describing psychological costs were qualitative in nature. Only twelve studies connected patient demographic data with administrative burden data, despite previous research suggesting an inequitable burden impact. Additionally, twenty-eight studies assessed administrative burden and only three attempted to reduce it via an intervention, resulting in a lack of data on intervention design and efficacy.
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Affiliation(s)
- Passion Ilea
- Portland State University, School of Social Work, 1800 SW 6th Avenue, Portland, OR, 97201, 503.725.4040, USA.
| | - Ian Ilea
- The Center to Improve Veteran Involvement in Care, Portland VA Research Foundation, USA
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19
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Louie P, Brown HRH, Cobb RJ, Sheehan C. Are Interracial Couples at Higher Risk of Multiple Chronic Conditions? Evidence from a Nationally Representative Sample. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01952-y. [PMID: 38381328 DOI: 10.1007/s40615-024-01952-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: 10/25/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/22/2024]
Abstract
Interracial relationships are becoming increasingly common in the United States, yet the physical health status of individuals in interracial relationships is not well understood. Using 18 years of pooled data from the National Health Interview Study (2001-2018) (N = 264, 891), we compared the odds of having multiple chronic conditions (MCC) among adults in interracial and same-race unions. We anticipate that individuals in interracial relationships may be at higher risk of MCC than individuals in same-race relationships due to increased exposure to stressors associated with crossing racial boundaries. Findings indicate that the implications of interracial relationships on MCC depended on the racial composition of the couple. We found that White-Black couples had higher odds of MCC than both White-White and Black-Black couples, but Asian-Black and Hispanic-Black couples did not differ from their same-race couple counterparts, indicating a pronounced and unique health disadvantage for White adults paired with Black adults. We also found that Asian-White and Hispanic-White couples had higher odds of MCC relative to their same-race counterparts. In addition, minority-minority couples generally did not differ from their same-race minority couple counterparts in terms of MCC. The results of the study provide new insights into how the racial composition of interracial unions impacts health and how a closer proximity to Whiteness may be a health risk for some minority groups.
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Affiliation(s)
- Patricia Louie
- Department of Sociology, University of Washington, Seattle, WA, USA.
| | - Hana R H Brown
- Department of Sociology, University of Washington, Seattle, WA, USA
| | - Ryon J Cobb
- Department of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Connor Sheehan
- T. Denny Sanford School of Social and Family Dynamics, Tempe, AZ, USA
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20
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Ekezie W, Cassambai S, Czyznikowska B, Curtis F, O'Mahoney LL, Willis A, Chudasama Y, Khunti K, Farooqi A. Health and social care experience and research perception of different ethnic minority populations in the East Midlands, United Kingdom (REPRESENT study). Health Expect 2024; 27:e13944. [PMID: 39102736 PMCID: PMC10733974 DOI: 10.1111/hex.13944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Ethnic minority populations experience significant health and social care disparities; despite experiencing a greater burden of diseases, these groups are underrepresented in health and social care research. Consequently, related research can be less applicable to these population groups. The REPRESENT study aims to explore the health and social care experiences of ethnic minorities and other minoritised populations, their research interests and appropriate research practices. METHODS Focus groups and semistructured interviews were conducted between May and September 2022 with members of a number of ethnic minority communities in England. Data were audio recorded, transcribed and thematically coded using NVivo 12. Rigour was determined through extensive sampling, iterative data collection and analysis. FINDINGS Fifty-two ethnic minority members were engaged in group interviews and one-to-one interviews. Participants included representatives of the following groups: African Caribbean, Eastern European, Gypsy Travellers, Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual+, Refugee/Asylum Seekers, Somali and South Asian communities. Interviews were also conducted with ethnic minority healthcare providers and researchers. Three overarching categories were identified: health information, medical service experiences, health and social care concerns and health research. Health and social care services challenges were mostly attributed to discrimination, delayed services, poor cultural relevance and language and cultural barriers. The most influential information sources were local community organisations and word-of-mouth. The main health and social care concerns were chronic long-term health conditions, mental health, maternal health and child development. Recommendations for research involved understanding the motivations for participation, improving communication and empowering communities. Top research priorities were long-term health conditions, health promotion and education, early care interventions and understanding community needs. INTERPRETATION Discrimination and bias in health and social care provision have severe implications for worsening ethnic health inequalities. Healthcare commissioning authorities and policymakers can leverage the preference of ethnic minority groups for pharmacy services and community organisations to improve access to care. Improving research interest and engagement requires understanding individual community needs, community sensitivity, research relevance and cultural appropriateness. PATIENT OR PUBLIC CONTRIBUTION Members of ethnic minority Patient and Public Involvement and Engagement group and Community Advisory Board supported the REPRESENT study design, conceptualisation and report development.
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Affiliation(s)
- Winifred Ekezie
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
- Department of Sociology and PolicyAston UniversityBirminghamUK
| | - Shabana Cassambai
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
| | - Barbara Czyznikowska
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
| | - Ffion Curtis
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
- Liverpool Reviews and Implementation Group (LRiG)University of Liverpool, Institute of Population HealthLiverpoolUK
| | - Lauren L. O'Mahoney
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Andrew Willis
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
- HRB Clinical Research Facility & School of Public HealthUniversity College CorkIreland
| | - Yogini Chudasama
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Leicester Real World EvidenceUniversity of LeicesterLeicesterUK
| | - Kamlesh Khunti
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
- Leicester Real World EvidenceUniversity of LeicesterLeicesterUK
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21
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Thompson T, Coats J, Croston M, Motley RO, Thompson VS, James AS, Johnson LP. "We need a little strength as well": Examining the social context of informal caregivers for Black women with breast cancer. Soc Sci Med 2024; 342:116528. [PMID: 38215642 DOI: 10.1016/j.socscimed.2023.116528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 12/06/2023] [Accepted: 12/16/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Informal caregivers (e.g., partners, other family members, friends) often provide social support to Black women with breast cancer, and caregivers find both benefits and challenges in their caregiving role. METHODS In this qualitative study, twenty-four caregivers for Black women with breast cancer participated in focus groups and interviews. Participants responded to a brief close-ended questionnaire as well as semi-structured questions about their experiences as cancer caregivers. Demographic information was collected, and relationship satisfaction was measured by the Relationship Assessment Scale-General scale (RAS-G). Focus groups and interviews were recorded, transcribed verbatim, and coded by two independent coders. Using an iterative, discussion-based process, the study team developed and refined themes. RESULTS All caregivers described themselves as Black/African American, and the majority identified as female (79%). The mean RAS-G score was 4.5 (SD = 0.5), indicating high levels of relationship satisfaction. Qualitative themes included using a range of strategies to provide emotional support; shifting between roles; needing time and space; and trying to stay strong. Several female caregivers described how the cumulative experiences of providing care for multiple family members and friends could be draining, as could their own experiences in the patient role. CONCLUSIONS These findings show a complex, multilayered social context that affects both the patient-caregiver relationship and the health and wellbeing of caregivers. Clinicians providing treatment and support for Black women with breast cancer should be mindful of how the health context of the family may affect patient and caregiver outcomes.
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Phillips A. Call to action on diabetes care: reaching communities facing health inequalities, health inequities and deprivation. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:16-20. [PMID: 38194328 DOI: 10.12968/bjon.2024.33.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
This article presents evidence and policy on the importance of reaching out into local communities with inclusive approaches to try to reduce and prevent inequities and inequalities in diabetes care. The global emergency diabetes is causing and the risks and disproportionately high ethnic disparities are investigated. The article includes some suggestions on changing approaches to reduce health inequalities to enable diabetes care to become more accessible for those who need it the most.
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Affiliation(s)
- Anne Phillips
- Professor in Diabetes Care, Birmingham City University
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23
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Lafortune P, Zahid K, Ploszaj M, Awadalla E, Carroll TP, Geraghty P. Testing Alpha-1 Antitrypsin Deficiency in Black Populations. Adv Respir Med 2023; 92:1-12. [PMID: 38392031 PMCID: PMC10886060 DOI: 10.3390/arm92010001] [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: 11/09/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 02/24/2024]
Abstract
Alpha-1 antitrypsin (AAT) deficiency (AATD) is an under-recognized hereditary disorder and a significant cause of chronic obstructive pulmonary disease (COPD), a disease that contributes to global mortality. AAT is encoded by the SERPINA1 gene, and severe mutation variants of this gene increase the risk of developing COPD. AATD is more frequently screened for in non-Hispanic White populations. However, AATD is also observed in other ethnic groups and very few studies have documented the mutation frequency in these other ethnic populations. Here, we review the current literature on AATD and allele frequency primarily in Black populations and discuss the possible clinical outcomes of low screening rates in a population that experiences poor health outcomes and whether the low frequency of AATD is related to a lack of screening in this population or a truly low frequency of mutations causing AATD. This review also outlines the harmful SERPINA1 variants, the current epidemiology knowledge of AATD, health inequity in Black populations, AATD prevalence in Black populations, the clinical implications of low screening of AATD in this population, and the possible dangers of not diagnosing or treating AATD.
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Affiliation(s)
- Pascale Lafortune
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (P.L.); (K.Z.); (M.P.); (E.A.)
| | - Kanza Zahid
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (P.L.); (K.Z.); (M.P.); (E.A.)
| | - Magdalena Ploszaj
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (P.L.); (K.Z.); (M.P.); (E.A.)
| | - Emilio Awadalla
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (P.L.); (K.Z.); (M.P.); (E.A.)
| | - Tomás P. Carroll
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
- Alpha-1 Foundation Ireland, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
| | - Patrick Geraghty
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (P.L.); (K.Z.); (M.P.); (E.A.)
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Alghamdi NA, Dunn K, Cairns D, Melville C. Utilising quantitative methods to study the intersectionality of multiple social disadvantages in women with common mental disorders: a systematic review. Int J Equity Health 2023; 22:264. [PMID: 38110942 PMCID: PMC10729432 DOI: 10.1186/s12939-023-02061-8] [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: 11/29/2022] [Accepted: 11/14/2023] [Indexed: 12/20/2023] Open
Abstract
Women are at greater risk of common mental disorders. The intersectionality concept provides a framework to examine the effects of multiple social disadvantages on women's mental health. We conducted a systematic review to collect and analyse information to identify the quantitative methodologies and study designs used in intersectional research to examine women's mental health and multiple social disadvantages. Included studies used accepted statistical methods to explore the intersectional effects of gender and one or more types of social disadvantage from the PROGRESS-Plus inequity framework: a place of residence, race/ethnicity, occupation, gender/ sex, religion, education, socioeconomic status, social capital (O'Neill et al. J Clin Epidemiol 67:56-64, 2014). The scope of this systematic review was limited to studies that analysed common mental disorders in women and men comparatively. Studies focusing on only one gender were excluded, ensuring a comprehensive comparative analysis of the intersection of social disadvantages in mental health.Twelve papers were included in the narrative synthesis (Table 1). Eight of the included papers (67%) reported an intersectional effect of gender and one or more additional types of social disadvantage. The multiplicative effect of gender and socioeconomic status on the risk of common mental disorders was the most commonly reported interaction. This systematic review shows that multiplicative and simultaneous interactions of multiple social disadvantage increase the risk of common mental disorders experienced by women. Moreover, it underlines the potential for quantitative research methods to complement qualitative intersectionality research on gender and mental health. The findings of this systematic review highlight the importance of multiple social disadvantage in understanding the increased risk of mental health experienced by women.
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Affiliation(s)
- Nadia Alhamd Alghamdi
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- School of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Kirsty Dunn
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- School of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Deborah Cairns
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- School of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
- School of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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Hamlat EJ, Neilands TB, Laraia B, Zhang J, Lu AT, Lin J, Horvath S, Epel ES. Early life adversity predicts an accelerated cellular aging phenotype through early timing of puberty. Psychol Med 2023; 53:7720-7728. [PMID: 37325994 PMCID: PMC11131158 DOI: 10.1017/s0033291723001629] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND The current study examined if early adversity was associated with accelerated biological aging, and if effects were mediated by the timing of puberty. METHODS In early mid-life, 187 Black and 198 White (Mage = 39.4, s.d.age = 1.2) women reported on early abuse and age at first menstruation (menarche). Women provided saliva and blood to assess epigenetic aging, telomere length, and C-reactive protein. Using structural equation modeling, we created a latent variable of biological aging using epigenetic aging, telomere length, and C-reactive protein as indicators, and a latent variable of early abuse using indicators of abuse/threat events before age 13, physical abuse, and sexual abuse. We estimated the indirect effects of early abuse and of race on accelerated aging through age at menarche. Race was used as a proxy for adversity in the form of systemic racism. RESULTS There was an indirect effect of early adversity on accelerated aging through age at menarche (b = 0.19, 95% CI 0.03-0.44), in that women who experienced more adversity were younger at menarche, which was associated with greater accelerated aging. There was also an indirect effect of race on accelerated aging through age at menarche (b = 0.25, 95% CI 0.04-0.52), in that Black women were younger at menarche, which led to greater accelerated aging. CONCLUSIONS Early abuse and being Black in the USA may both induce a phenotype of accelerated aging. Early adversity may begin to accelerate aging during childhood, in the form of early pubertal timing.
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Affiliation(s)
- Elissa J. Hamlat
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Torsten B. Neilands
- Division of Prevention Science | Department of Medicine, University of California, San Francisco, CA, USA
| | - Barbara Laraia
- School of Public Health, University of California, Berkeley, CA, USA
| | - Joshua Zhang
- Department of Human Genetics, University of California, Los Angeles, CA, USA
| | - Ake T. Lu
- Department of Human Genetics, University of California, Los Angeles, CA, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
| | - Steve Horvath
- Department of Human Genetics, University of California, Los Angeles, CA, USA
- Department of Biostatistics, University of California, Los Angeles, CA, USA
- Altos Labs, San Diego, CA, USA
| | - Elissa S. Epel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
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Hardin J, Mourad A, Desy J, Paget M, Ma I, Traboulsi D, Johnson NA, Ali AA, Parsons L, Harvey A, Weeks S, McLaughlin K. Mitigating diagnostic performance bias in a skin-tone balanced dermatology curriculum. CLINICAL TEACHER 2023; 20:e13613. [PMID: 37649356 DOI: 10.1111/tct.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/10/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Individuals with skin of colour (SoC) have delayed diagnosis and poorer outcomes when presenting with some dermatologic conditions when compared to individuals with light skin (LS). The objective of this study was to determine if diagnostic performance bias can be mitigated by a skin-tone balanced dermatology curriculum. METHODOLOGY A prospective randomised intervention study occurred over 2 weeks in 2020 at a Canadian medical school. A convenience sample of all first-year medical students (n = 167) was chosen. In week 1, all participants had access to dermatology podcasts and were randomly allocated to receive non-analytic training (NAT; online patient 'cards') on either SoC cases or LS cases. In week 2, all participants received combined training (CT; NAT and analytic training through workshops on how to apply dermatology diagnostic rules for all skin tones). Participating students completed two formative assessments after weeks 1 and 2. RESULTS Ninety-two students participated in the study. After week 1, both groups had a lower diagnostic performance on SoC (p = 0.0002 and p = 0.002 for students who trained on LS 'cards' and SoC 'cards', respectively). There was a significant decrease in mean skin tone difference in both groups after week 2 (initial training on SoC: 5.8% (SD 12.2) pre, -1.4% (14.7) post, p = 0.007; initial training on LS: 7.8% (15.4) pre, -4.0% (11.8%) post, p = 0.0001). Five students participated in a post-study survey in 2023, and all found the curriculum enhanced their diagnostic skills in SoC. CONCLUSIONS SoC performance biases of medical students disappeared after CT in a skin tone-balanced dermatology curriculum.
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Affiliation(s)
- Jori Hardin
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ahmed Mourad
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Janeve Desy
- Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mike Paget
- Section of Academic Technologies, Undergraduate Medical Education, University of Calgary, Calgary, Alberta, Canada
| | - Irene Ma
- Section of Academic Technologies, Undergraduate Medical Education, University of Calgary, Calgary, Alberta, Canada
| | - Danya Traboulsi
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole A Johnson
- Section of Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Asma Amir Ali
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Laurie Parsons
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adrian Harvey
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Weeks
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kevin McLaughlin
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Daniels KP, D Thomas M, Chae DH, Allen AM. Black Mothers' Concern for Their Children as a Measure of Vicarious Racism-Related Vigilance and Allostatic Load. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:520-536. [PMID: 37332176 DOI: 10.1177/00221465231175942] [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] [Indexed: 06/20/2023]
Abstract
This study investigates the relationship between allostatic load and a novel form of altruistic racism-related fear, or concern for how racism might harm another, which we term vicarious racism-related vigilance. Using a subsample of Black mothers from the African American Women's Heart & Health Study (N = 140), which includes detailed health and survey data on a community sample of Black women in the San Francisco Bay Area, this study investigates the relationship between Black mothers' experiences with racism-related vigilance as it relates to their children and allostatic load-a multisystem metric of underlying health across multiple biological systems. Findings indicate that vicarious racism-related vigilance was positively associated with allostatic load (i.e., worse health). Findings highlight the salience of vicarious racism-related vigilance for the health of Black mothers, underscoring how intersections between race, gender, and parenthood result in susceptibility to unique forms of health-harming stress.
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Borchert RJ, Azevedo T, Badhwar A, Bernal J, Betts M, Bruffaerts R, Burkhart MC, Dewachter I, Gellersen HM, Low A, Lourida I, Machado L, Madan CR, Malpetti M, Mejia J, Michopoulou S, Muñoz-Neira C, Pepys J, Peres M, Phillips V, Ramanan S, Tamburin S, Tantiangco HM, Thakur L, Tomassini A, Vipin A, Tang E, Newby D, Ranson JM, Llewellyn DJ, Veldsman M, Rittman T. Artificial intelligence for diagnostic and prognostic neuroimaging in dementia: A systematic review. Alzheimers Dement 2023; 19:5885-5904. [PMID: 37563912 DOI: 10.1002/alz.13412] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Artificial intelligence (AI) and neuroimaging offer new opportunities for diagnosis and prognosis of dementia. METHODS We systematically reviewed studies reporting AI for neuroimaging in diagnosis and/or prognosis of cognitive neurodegenerative diseases. RESULTS A total of 255 studies were identified. Most studies relied on the Alzheimer's Disease Neuroimaging Initiative dataset. Algorithmic classifiers were the most commonly used AI method (48%) and discriminative models performed best for differentiating Alzheimer's disease from controls. The accuracy of algorithms varied with the patient cohort, imaging modalities, and stratifiers used. Few studies performed validation in an independent cohort. DISCUSSION The literature has several methodological limitations including lack of sufficient algorithm development descriptions and standard definitions. We make recommendations to improve model validation including addressing key clinical questions, providing sufficient description of AI methods and validating findings in independent datasets. Collaborative approaches between experts in AI and medicine will help achieve the promising potential of AI tools in practice. HIGHLIGHTS There has been a rapid expansion in the use of machine learning for diagnosis and prognosis in neurodegenerative disease Most studies (71%) relied on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset with no other individual dataset used more than five times There has been a recent rise in the use of more complex discriminative models (e.g., neural networks) that performed better than other classifiers for classification of AD vs healthy controls We make recommendations to address methodological considerations, addressing key clinical questions, and validation We also make recommendations for the field more broadly to standardize outcome measures, address gaps in the literature, and monitor sources of bias.
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Affiliation(s)
- Robin J Borchert
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Tiago Azevedo
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - AmanPreet Badhwar
- Department of Pharmacology and Physiology, University of Montreal, Montreal, Canada
- Centre de recherche de l'Institut Universitaire de Gériatrie (CRIUGM), Montreal, Canada
| | - Jose Bernal
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Matthew Betts
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences, University of Magdeburg, Magdeburg, Germany
| | - Rose Bruffaerts
- Computational Neurology, Experimental Neurobiology Unit, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | | | - Ilse Dewachter
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Helena M Gellersen
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Audrey Low
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Luiza Machado
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Jhony Mejia
- Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Sofia Michopoulou
- Imaging Physics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carlos Muñoz-Neira
- Research into Memory, Brain sciences and dementia Group (ReMemBr Group), Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Artificial Intelligence & Computational Neuroscience Group (AICN Group), Sheffield Institute for Translational Neuroscience (SITraN), Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Jack Pepys
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Marion Peres
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Siddharth Ramanan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Lokendra Thakur
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, UK
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro Tomassini
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | | | - Eugene Tang
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Danielle Newby
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - David J Llewellyn
- University of Exeter Medical School, Exeter, UK
- Alan Turing Institute, London, UK
| | - Michele Veldsman
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Gilbert KL, Shaw M, Siddiqi A, Goodman MS. Achieving the Health Equity Agenda Through Transformative Community-Engaged Strategies. Prev Chronic Dis 2023; 20:E99. [PMID: 37943729 PMCID: PMC10684278 DOI: 10.5888/pcd20.230077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Affiliation(s)
- Keon L Gilbert
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO 63104
- Brookings Institution, Washington, DC
| | - Mary Shaw
- Jackson State University, Department of Behavioral & Environmental Health, College of Health Sciences, Jackson, Mississippi
| | - Arjumand Siddiqi
- University of Toronto, Dalla Lana School of Public Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melody S Goodman
- New York University, School of Global Public Health, New York, New York
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Borrell LN, Crawford ND. Racial and Ethnic Inequities in Health: Examining the Contributions of the American Journal of Epidemiology to Advancing the Science. Am J Epidemiol 2023; 192:1827-1834. [PMID: 35380604 DOI: 10.1093/aje/kwac069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/10/2022] [Accepted: 04/01/2022] [Indexed: 11/12/2022] Open
Abstract
The perverseness of racial and ethnic inequities in the United States continues to implore the investigation of their causes. While there have been improvements in the health of the US population, these improvements have not been equally distributed. To commemorate the 100th anniversary of the American Journal of Epidemiology, in this commentary, we aim to highlight the Journal's contributions to: 1) the definition and use of race and ethnicity in research, and 2) understanding racial and ethnic inequities, both empirically and methodologically, over the past decade. We commend the Journal for its contributions and for spearheading many of the challenges related to measuring and interpreting racial and ethnic data for the past 20 years. We identify 3 additional areas in which the Journal could make further impact to address racial and ethnic inequities: 1) devote a section in every issue of the Journal to scientific papers that make substantive epidemiologic or methodological contributions to racial and ethnic inequities in health; 2) update the Journal's guidelines for authors to include justifying the use of race and ethnicity; and 3) diversify the field of epidemiology by bringing a new cadre of scholars from minoritized racial and ethnic groups who represent the most affected communities into the research process.
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Applebaum JW, McDonald SE, Widmeyer M, Fabelo HE, Cook RL. The impact of pet ownership on healthcare access and utilization among people with HIV. PLoS One 2023; 18:e0292658. [PMID: 37910449 PMCID: PMC10619778 DOI: 10.1371/journal.pone.0292658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
Though bonds with pets can be health-promoting for people with HIV (PWH), recent studies indicate that owning pets may complicate healthcare access, especially for those with fewer economic resources, poorer social support, and a strong human-animal bond. In this study, we make a case for considering pets to be an important element of the social environment that can influence healthcare access and utilization among PWH. Pet-owning PWH (n = 204) were recruited at healthcare and community sites throughout Florida as part of a larger survey study (the “Florida Cohort”). We developed a 12-item index of pet-related barriers to healthcare, which was designed to assess whether the participants experienced or anticipated any barriers to accessing and/or utilizing timely healthcare or health-related services due to pet caregiving or concerns about pet welfare. We estimated a series of regression models (negative binomial, logistic regression) to assess the effects of comfort from companion animals, human social support, healthcare needs, and sociodemographic characteristics on 1) the total number of pet-related healthcare barriers endorsed, 2) previously experienced pet-related healthcare barriers, and 3) anticipated pet-related healthcare barriers. Thirty-six percent of the sample reported at least one experienced or anticipated pet-related barrier to their healthcare; 17% reported previous healthcare barriers and 31% anticipated future healthcare barriers. Greater comfort from companion animals, greater healthcare needs, and poorer social support were associated with a greater probability of experiencing or anticipating any pet-related healthcare barriers. Those who identified racially as Black were less likely to anticipate future healthcare barriers than those who were White. Income was associated with pet-related healthcare barriers in all models. Given the importance of health maintenance for PWH and previous research suggesting pets may be an important emotional support for this population, social safety net programs and community partnerships that support multispecies families are strongly recommended.
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Affiliation(s)
- Jennifer W. Applebaum
- Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America
| | - Shelby E. McDonald
- Community Research and Evaluation, Denver Zoological Foundation, Denver, Colorado, United States of America
| | - Maya Widmeyer
- Unconditional Love, Inc., Melbourne, Florida, United States of America
| | - Humberto E. Fabelo
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United Stated of America
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Hill-Jarrett TG. The Black radical imagination: a space of hope and possible futures. Front Neurol 2023; 14:1241922. [PMID: 37808484 PMCID: PMC10557459 DOI: 10.3389/fneur.2023.1241922] [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: 06/17/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
The radical imagination entails stepping outside the confines of the now and into the expansiveness of what could be. It has been described as the ability to dream of possible futures and bring these possibilities back to the present to drive social transformation. This perspective paper seeks to provide an overview of the radical imagination and its intersections with Afrofuturism, a framework and artistic epistemology that expresses the Black cultural experience through a space of hope where Blackness is integral. In this paper, I propose three processes that comprise the radical imagination: (1) imagining alternative Black futures, (2) radical hope, and (3) collective courage. I consider the neural networks that underlie each process and consider how the Black radical imagination is a portal through which aging Black adults experience hope and envision futures that drive social change. I conclude with considerations of what brain health and healing justice looks like for aging Black Americans- specifically, how invocation of the Black radical imagination may have positive brain health effects for a demographic group at increased risk for Alzheimer's disease and related dementias.
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Affiliation(s)
- Tanisha G. Hill-Jarrett
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Memory and Aging Center, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Birditt KS, Turkelson A, Javaid S, Gonzalez R, Antonucci T. Implications of Cumulative Life Event Stress for Daily Stress Exposure and Cardiovascular Reactivity Among Black and White Americans. J Gerontol B Psychol Sci Soc Sci 2023; 78:1224-1235. [PMID: 37057965 PMCID: PMC10292837 DOI: 10.1093/geronb/gbad054] [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: 04/28/2022] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES Daily stress and cardiovascular reactivity may be important mechanisms linking cumulative life event stress with cardiovascular health and may help to explain racial health disparities. However, studies have yet to examine links between exposure to life event stress, daily stress exposure, and cardiovascular reactivity. This study assessed links between trajectories of life event stress exposure, daily stressors, and cardiovascular reactivity among Black and White individuals. METHODS Participants are from the Stress and Well-being in Everyday Life Study in which 238 individuals (109 Black 129 White; ages 33-93), drawn from the longitudinal Social Relations Study, reported life event stress in 1992, 2005, 2015, and 2018. Of those individuals, 169 completed an ecological momentary assessment study in which they reported stress exposure every 3 hr, and 164 wore a heart rate monitor for up to 5 days. RESULTS Latent class growth curve models revealed 2 longitudinal trajectories of life event stress: moderate-increasing and low-decreasing. Individuals in the moderate-increasing stress trajectory reported greater daily stress exposure and links did not vary by race. Black individuals in the low-decreasing trajectory and White individuals in the moderate-increasing trajectory showed positive associations between daily stress and heart rate (i.e., were reactive to daily stress exposure). The link between daily stress and heart rate was not significant among Black individuals in the moderate-increasing trajectory and White individuals in the low-decreasing trajectory. DISCUSSION Individuals who experience more life events across the adult life course report greater daily stress exposure which has important implications for daily cardiovascular health. Black individuals with moderate-increasing life event stress show evidence of blunted daily stress reactivity (nonsignificant association between daily stress and heart rate) whereas Black individuals with low-decreasing life event stress show evidence of stress reactivity (positive association between daily stress and heart rate). White individuals showed the opposite pattern (albeit marginally). These findings expand the weathering hypothesis and indicate that chronic life event stress may be associated with blunted stress reactivity among Black individuals.
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Affiliation(s)
- Kira S Birditt
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela Turkelson
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah Javaid
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Gonzalez
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Toni Antonucci
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
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Hummer RA. Race and Ethnicity, Racism, and Population Health in the United States: The Straightforward, the Complex, Innovations, and the Future. Demography 2023; 60:633-657. [PMID: 37158783 PMCID: PMC10731781 DOI: 10.1215/00703370-10747542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
For far too long, U.S. racialized groups have experienced human suffering and loss of life far too often and early. Thus, it is critical that the population sciences community does its part to improve the science, education, and policy in this area of study and help to eliminate ethnoracial disparities in population health. My 2022 PAA Presidential Address focuses on race and ethnicity, racism, and U.S. population health in the United States and is organized into five sections. First, I provide a descriptive overview of ethnoracial disparities in U.S. population health. Second, I emphasize the often overlooked scientific value of such descriptive work and demonstrate how such seemingly straightforward description is complicated by issues of population heterogeneity, time and space, and the complexity of human health. Third, I make the case that the population sciences have generally been far too slow in incorporating the role of racism into explanations for ethnoracial health disparities and lay out a conceptual framework for doing so. Fourth, I discuss how my research team is designing, collecting, and disseminating data for the scientific community that will have potential to, among many other purposes, create a better understanding of ethnoracial health disparities and the role of racism in producing such disparities. Finally, I close by suggesting some policy- and education-related efforts that are needed to address racism and population health within U.S. institutions.
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Affiliation(s)
- Robert A Hummer
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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35
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Mann ES, Berkowitz D. The Biomedical Subjectification of Women of Advanced Maternal Age: Reproductive Risk, Privilege, and the Illusion of Control. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:192-208. [PMID: 36440586 DOI: 10.1177/00221465221136252] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The United States is experiencing a demographic transition toward older motherhood. Biomedicine classifies pregnancies among all women of advanced maternal age (AMA) as high-risk; paradoxically, women having first births at AMA are typically economically and racially privileged, which can reduce the risk of risks. This article examines the implications of the biomedicalization of AMA for first-time mothers, age 35 and older, using qualitative interviews. We find participants had substantial cultural health capital, which informed their critiques of AMA and the medical model of birth. When they found themselves subjected to biomedical protocols and concerned about reproductive risk as their pregnancies progressed, their subsequent biomedical subjectification compelled most to accept biomedical interventions. Consequently, some participants had traumatic birth experiences. Our findings illustrate that while first-time mothers of AMA anticipated that they would have more control over the birth process because of their advantages, ultimately, most did not.
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Lee J, Sol K, Zaheed A, Morris E, Meister L, Palms J, Zahodne L. Coping Styles and Cognitive Function in Older Non-Hispanic Black and White Adults. J Gerontol B Psychol Sci Soc Sci 2023; 78:789-798. [PMID: 36630289 PMCID: PMC10174202 DOI: 10.1093/geronb/gbad005] [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: 07/12/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Coping styles refer to cognitive and behavioral patterns used to manage the demands of stressors, and effective coping represents a psychological resource. Some studies have linked coping styles to executive functioning, but less is known about coping styles and their associations with cognition across social groups known to differ in stress exposure and dementia risk. This study aimed to characterize associations between coping styles and cognitive functioning across non-Hispanic Black and non-Hispanic White older adults. METHODS Participants were drawn from the Michigan Cognitive Aging Project (N = 453; age mean (SD) = 63.6 (3.2); 53% non-Hispanic Black). Problem-focused and emotion-focused coping were measured using the Coping Orientation to Problems Experienced Inventory. Global cognition was a composite of 5 cognitive domain scores derived from comprehensive neuropsychological tests. Cross-sectional associations between coping styles and cognition were examined using race-stratified regressions controlling for demographic and health covariates. RESULTS Black older adults reported more emotion-focused coping than White older adults, but there were no race differences in problem-focused coping. Among Black older adults, less problem-focused coping and more emotion-focused coping were each associated with worse cognition. Among White older adults, emotion-focused coping was marginally linked to cognition. DISCUSSION Greater emotion-focused coping among Black older adults may reflect greater exposure to stressors that are uncontrollable. Patterns of racial differences in coping-cognition links are in line with the social vulnerabilities hypothesis. Coping style may be a particularly important psychosocial resource for cognitive health among Black older adults that could be incorporated into culturally relevant interventions.
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Affiliation(s)
- Ji Hyun Lee
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ketlyne Sol
- Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Afsara B Zaheed
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily P Morris
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey M Meister
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jordan D Palms
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
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Desai MU, Paranamana N, Dovidio JF, Davidson L, Stanhope V. System-Centered Care: How Bureaucracy and Racialization Decenter Attempts at Person-Centered Mental Health Care. Clin Psychol Sci 2023; 11:476-489. [PMID: 37333799 PMCID: PMC10275339 DOI: 10.1177/21677026221133053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
This article presents a study exploring structural biases within mental health organizations, in the context of person-centered care-an emerging framework for health systems globally. Findings revealed how surrounding institutional structures conditioned a powerful influence on clinical operations, in which there is a risk for clients to be systemically seen as a non-person, that is, as a racialized or bureaucratic object. Specifically, the article elucidates how racial profiles could become determinants of care within institutions; and how another, covert form of institutional objectification could emerge, in which clients became reduced to unseen bureaucratic objects. Findings illuminated a basic psychosocial process through which staff could become unwitting carriers of systemic agenda and intentionality-a type of "bureaucra-think"-and also how some providers pushed against this climate. These findings, and emergent novel concepts, add to the severely limited research on institutional bias and racism within psychological science.
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Affiliation(s)
- Miraj U Desai
- Program for Recovery and Community Health, Yale School of Medicine
- Yale University South Asian Studies Council
| | | | - John F Dovidio
- Yale University, Departments of Psychology and Epidemiology
- Yale Institution for Social and Policy Studies
| | - Larry Davidson
- Program for Recovery and Community Health, Yale School of Medicine
- Yale Institution for Social and Policy Studies
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38
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Geronimus AT, Bound J, Hughes L. Trend Toward Older Maternal Age Contributed To Growing Racial Inequity In Very-Low-Birthweight Infants In The US. Health Aff (Millwood) 2023; 42:674-682. [PMID: 37126758 PMCID: PMC10559944 DOI: 10.1377/hlthaff.2022.01066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In 2016 the Centers for Disease Control and Prevention reported that for the first time, US women in their thirties were bearing more children than those in their twenties. Analyzing US vital statistics data from the period 1989-2019, we simulated the effect that the distributional shift to older maternal ages at first birth had on health inequity between Black and White infants. Net of maternal socioeconomic indicators, this shift increased the relative odds that White women gave birth to very-low-birthweight (VLBW) infants by 10 percent, versus 19 percent for Black women, largely accounting for the rise in VLBW and the increase in racial inequity seen in the years analyzed. Reductions in infant mortality over the period were dampened by the maternal age shift, especially among Black babies, exacerbating Black-White inequity. Policy implications for promoting reproductive justice include universal tertiary care access, increasing the supply and distribution of maternity care providers, addressing the holistic needs of mothers throughout pregnancy and postpartum, and expanding family support policies. Conceptually, we recommend centering the realities of pregnancy and parenting from the perspective of the populations at highest risk-centering on the margins-and taking into account their implications for maternal weathering (accelerated deterioration due to disparate impacts of structural racism).
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Clark EM, Ma L, Williams BR, Ghosh D, Park CL, Schulz E, Woodard N, Knott CL. A longitudinal study of social, religious, and spiritual capital and physical and emotional functioning in a national sample of African-Americans. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:978-997. [PMID: 36115065 PMCID: PMC10006284 DOI: 10.1002/jcop.22936] [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: 03/29/2022] [Revised: 07/12/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
The present study builds on prior research by examining the moderating relationships between different types of capital on physical functioning, emotional functioning, and depressive symptoms using a 2.5-year longitudinal design with a national sample of African-American adults. Results indicated a significant T1 social capital × T1 religious capital interaction such that among low T1 religious capital participants, those with high T1 social capital had lower T2 physical functioning than those with lower T1 social capital. There was also a marginally significant T1 social capital × T1 spiritual capital interaction suggesting that among low T1 spiritual capital participants, those with higher T1 social capital reported a decline in depressive symptoms compared to those with lower T1 social capital. Future research and implications for intervention and policy development are discussed.
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Affiliation(s)
- Eddie M Clark
- Department of Psychology, Department of Psychology, Saint Louis University, St. Louis, Missouri, USA
| | - Lijing Ma
- Department of Psychology, University of San Fransciso, USA
| | - Beverly R Williams
- Department of Medicine, University of Alabama - Birmingham, Birmingham, Alabama, USA
| | - Debarchana Ghosh
- Department of Geography, University of Connecticut, Storrs, Connecticut, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Emily Schulz
- Department of Occupational Therapy, University of Northern Arizona, Flagstaff, Arizona, USA
| | - Nathaniel Woodard
- Department of Behavioral and Community Health, University of Maryland, College Park, Maryland, USA
| | - Cheryl L Knott
- Department of Behavioral and Community Health, University of Maryland, College Park, Maryland, USA
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Race/Ethnicity may be an Important Predictor of Life Expectancy in Localized Prostate Cancer Patients: Novel Analyses Using Social Security Administration Life Tables. J Racial Ethn Health Disparities 2023; 10:708-717. [PMID: 35182370 PMCID: PMC9988799 DOI: 10.1007/s40615-022-01257-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To test the effect of race/ethnicity on Social Security Administration (SSA) life tables' life expectancy (LE) predictions in localized prostate cancer (PCa) patients treated with either radical prostatectomy (RP) or external beam radiotherapy (EBRT). We hypothesized that LE will be affected by race/ethnicity. PATIENTS AND METHODS We relied on the 2004-2006 Surveillance, Epidemiology, and End Results database to identify D'Amico intermediate- and high-risk PCa patients treated with either RP or EBRT. SSA life tables were used to compute 10-year LE predictions and were compared to OS. Stratification was performed according to treatment type (RP/EBRT) and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic/Latino, and Asian). RESULTS Of 55,383 assessable patients, 40,490 were non-Hispanic White (RP 49.3% vs. EBRT 50.7%), 7194 non-Hispanic Black (RP 41.3% vs. EBRT 50.7%), 4716 Hispanic/Latino (RP 51.0% vs. EBRT 49.0%) and 2983 were Asian (RP 41.6% vs. EBRT 58.4%). In both RP and EBRT patients, OS exceeded life tables' LE predictions, except for non-Hispanic Blacks. However, in RP patients, the magnitude of the difference was greater than in EBRT. Moreover, in RP patients, OS of non-Hispanic Blacks virtually perfectly followed predicted LE. Conversely, in EBRT patients, the OS of non-Hispanic Black patients was worse than predicted LE. CONCLUSIONS When comparing SEER-derived observed OS with SSA life table-derived predicted life expectancy, we recorded a survival disadvantage in non-Hispanic Black RP and EBRT patients, which was not the case in the three other races/ethnicities (non-Hispanic Whites, Hispanic/Latinos, and Asians). This discrepancy should ideally be confirmed within different registries, countries, and tumor entities. Furthermore, the source of these discrepant survival outcomes should be investigated and addressed by health care politics.
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Greene AC, Wong WG, Perez Holguin RA, Patel A, Pameijer CR, Shen C. The Association of Guideline-Concordant Sentinel Lymph Node Biopsy for Melanoma at Minority-Serving Hospitals. Ann Surg Oncol 2023; 30:3634-3645. [PMID: 36935433 DOI: 10.1245/s10434-023-13341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/19/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Minority-serving hospitals (MSHs) have been associated with lower guideline adherence and worse outcomes for various cancers. However, the relationship among MSH status, concordance with sentinel lymph node biopsy (SLNB) guidelines, and overall survival (OS) for patients with cutaneous melanoma is not well studied. METHODS The National Cancer Database was queried for patients diagnosed with T1a*, T2, and T3 melanoma between 2012 and 2017. MSHs were defined as the top decile of institutions ranked by the proportion of minorities treated for melanoma. Based on National Comprehensive Cancer Network guidelines, guideline-concordant care (GCC) was defined as not undergoing SLNB if thickness was < 0.76 mm without ulceration, mitosis ≥ 1/mm2, or lymphovascular invasion (T1a*), and performing SLNB for patients with intermediate thickness melanomas between 1.0 and 4.0 mm (T2/T3). Multivariable logistic regressions examined associations with GCC. The Kaplan-Meier method and log-rank tests were used to evaluate OS between MSH and non-MSH facilities. RESULTS Overall, 5.9% (N = 2182/36,934) of the overall cohort and 37.8% of minorities (n = 199/527) were managed at MSHs. GCC rates were 89.5% (n = 33,065/36,934) in the overall cohort and 85.4% (n = 450/527) in the minority subgroup. Patients in the overall cohort (odds ratio [OR] 0.85; p = 0.02) and the minority subgroup (OR 0.55; p = 0.02) were less likely to obtain GCC if they received their care at MSHs compared with non-MSHs. Minority patients receiving care at MSHs had a decreased survival compared with those treated at non-MSHs (p = 0.002). CONCLUSIONS Adherence to SLNB guidelines for melanoma was lower at MSHs. Continued focus is needed on equity in melanoma care for minority patients in the United States.
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Affiliation(s)
- Alicia C Greene
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - William G Wong
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Rolfy A Perez Holguin
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Akshilkumar Patel
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Colette R Pameijer
- Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Chan Shen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA. .,Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
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Padamsee TJ, Muraveva A, Meadows RJ, Hils M, Yee LD, Wills CE, Paskett ED. Racial differences in prevention decision making among U.S. women at high risk of breast cancer: A qualitative study. PLoS One 2023; 18:e0278742. [PMID: 36857397 PMCID: PMC9977014 DOI: 10.1371/journal.pone.0278742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/19/2022] [Indexed: 03/02/2023] Open
Abstract
PURPOSE Women at high risk of breast cancer face complex decisions about how to manage those risks. Substantial gaps in current knowledge include how women make these decisions and how decision making may differ across sub-populations. Among these critical gaps are the questions of (a) whether racial differences exist between the experiences of high-risk women navigating breast cancer risk, and (b) what consequences those racial differences might have on women's ability to manage their cancer risks. The present study is designed to address these questions directly. METHODS Fifty semi-structured interviews were conducted with high-risk Black (n = 20) and white women (n = 30) between May 2015 and March 2016 in person in Ohio and by phone. Transcribed data were analyzed using grounded theory methods. MAIN FINDINGS Our analyses suggest that many of the core decision-making dynamics high-risk women navigate differ by race. The experiences of white and Black women in our study differ in terms of (a) contextualizing risk-how women make sense of their own breast cancer risk, the degree to which they worry about risk, and how they prioritize risk within the contexts of their broader lives; (b) conceptualizing risk management-how, how much, and from whom women learn about and conceptualize their options for preventing cancer and/or ensuring that cancer gets diagnosed early; and (c) constraints-the external barriers women face throughout their decision-making and risk-management processes. In sum, the Black women we interviewed reported feeling less well-situated to consider and cope actively with breast cancer risk, less well-informed about risk-management options, and more constrained in their use of these options. CONCLUSIONS High-risk women's accounts of the complex dynamics that shape breast cancer prevention decisions suggest that these dynamics vary substantially by race, such that Black women may experience disadvantages relative to whites.
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Affiliation(s)
- Tasleem J. Padamsee
- Division of Health Services Management and Policy at the Ohio State University College of Public Health, and Faculty Affiliate of the James Comprehensive Cancer Center, Columbus, OH, United States of America
- * E-mail:
| | - Anna Muraveva
- Division of Health Services Management and Policy at the Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Rachel J. Meadows
- Center for Epidemiology & Healthcare Delivery Research JPS Health Network, Ft. Worth, TX, United States of America
| | - Megan Hils
- Division of Health Services Management and Policy at the Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Lisa D. Yee
- City of Hope National Medical Center, Duarte, CA, United States of America
| | - Celia E. Wills
- The Ohio State University College of Nursing, Columbus, OH, United States of America
| | - Electra D. Paskett
- The Ohio State University College of Medicine and James Comprehensive Cancer Center, Columbus, OH, United States of America
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Kramer EB, Knight EL, Bryan AD. Cooking Interventions for Improving Diet Quality Among Black Americans: A Randomized Controlled Trial. Ann Behav Med 2023; 57:323-333. [PMID: 36734623 DOI: 10.1093/abm/kaac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Non-Hispanic Black Americans experience the highest, and most rapidly increasing, rates of obesity. Despite evidence that this is at least somewhat related to poor diet quality, we have yet to identify effective interventions for improving diet quality long-term. Restrictive diets can be ineffective and often harmful. In contrast, there is a well-established connection between home cooking and lower body mass index, better diet quality, and improved health. PURPOSE The present study applied the Theory of Planned Behavior (TPB) to examine the effect of an intervention delivering cooking instruction, rather than nutrition information, on beliefs, attitudes, and behaviors pertaining to diet quality and cooking among Black adults in the USA. METHODS An online sample of Black Americans (N = 147), ages 18-76 (M = 30.69, SD = 10.42) were recruited via Prolific and randomized to view either a cooking tutorial video or a "standard of care" control webpage followed by either an implementation intentions (II) writing activity or a "freestyle" control writing activity. Cognitions and behavior related to healthy eating and cooking were measured at baseline, post-intervention, and 1-week follow-up. RESULTS Results of mixed-effects modeling indicated that participants randomized to the video condition reported significantly greater post-intervention intentions to cook (p < .001), which positively correlated with cooking behavior over the subsequent week (p < .01). There was no effect of the II intervention on subsequent-week behavior (ps > .413). Importantly, 75% (n = 105) indicated experiencing food insecurity at the time of data collection. CONCLUSIONS These results highlight a promising pathway for improving nutrition and diet-related health outcomes among Black Americans while highlighting that any intervention must account for food insecurity in this population.
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Affiliation(s)
- Emily B Kramer
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO 80309-0345, USA
| | - Erik L Knight
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO 80309-0345, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO 80309-0345, USA.,Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
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Trowbridge J, Goin DE, Abrahamsson D, Sklar R, Woodruff TJ. Fossil fuel is the common denominator between climate change and petrochemical exposures, and effects on women and children's health. Int J Gynaecol Obstet 2023; 160:368-371. [PMID: 36069123 PMCID: PMC9851939 DOI: 10.1002/ijgo.14408] [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: 04/18/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 01/22/2023]
Abstract
SynopsisFossil fuels contribute to climate change and petrochemicals, both of which increase maternal and child disease. Reducing fossil fuels can reap a double benefit for climate change and improved health.
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Affiliation(s)
- Jessica Trowbridge
- Program on Reproductive Health and the Environment, Dept Ob/Gyn & RS, San Francisco, California, USA
| | - Dana E Goin
- Program on Reproductive Health and the Environment, Dept Ob/Gyn & RS, San Francisco, California, USA
| | - Dimitri Abrahamsson
- Program on Reproductive Health and the Environment, Dept Ob/Gyn & RS, San Francisco, California, USA
| | - Rachel Sklar
- Program on Reproductive Health and the Environment, Dept Ob/Gyn & RS, San Francisco, California, USA
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, Dept Ob/Gyn & RS, San Francisco, California, USA
- Environmental Reserach and Translation for Health (EaRTH) Center, University of California San Francisco, San Francisco, California, USA
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Myers PL, Chung KC. Role of Health Equity Research and Policy for Diverse Populations Requiring Hand Surgery Care. Hand Clin 2023; 39:17-24. [PMID: 36402522 DOI: 10.1016/j.hcl.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health equity requires allocation of resources to eliminate the systematic disparities in health, imposed on marginalized groups, which adversely impact outcomes. A socioecological approach is implemented to elucidate the role of health equity research and policy for underrepresented minority and socioeconomically disadvantaged populations. Through investigation of the individual, community, institution, and public policy, we investigate problems and propose solutions to ensure fair and just treatment of all patients requiring hand surgery.
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Affiliation(s)
- Paige L Myers
- Department of Surgery, Section of Plastic Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Kevin C Chung
- Department of Surgery, Section of Plastic Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Adinkrah E, Najand B, Young-Brinn A. Parental Education and Adolescents' Asthma: The Role of Ethnicity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020267. [PMID: 36832395 PMCID: PMC9955909 DOI: 10.3390/children10020267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
While high parental education is associated with better health, this association may be weaker for ethnic minority than for ethnic majority families. It is unknown whether the association between parental education and adolescents' asthma also varies by ethnicity. AIM To study the association between parental education and adolescents' asthma overall and by ethnicity. METHODS The current study used data from the Population Assessment of Tobacco and Health (PATH)-Adolescents study. All participants were 12 to 17-year-old non-smokers (n = 8652). The outcome of interest was adolescents' asthma. The predictor of interest was baseline parental education, the covariates were age, sex, and number of parents present at baseline, and the moderator was ethnicity. RESULTS According to logistic regression analyses, higher parental education was predictive of adolescents' asthma; however, this association was weaker for Latino than non-Latino adolescents (OR 1.771; CI 1.282-2.446). We did not find a significant difference in the effect of parental education on asthma of White and African American adolescents. Our stratified models also showed that higher parental education was associated with lower asthma for non-Latino but not for Latino adolescents. CONCLUSION The effect of high parental education on adolescents' asthma prevalence differs between Latino and non-Latino families, with Latino families showing weaker protective effects of parental education on adolescents' asthma. Future research should test the role of exposure to environmental pollutants, neighborhood quality, and prevalence of smoking in social network members as well as other contextual factors at home, in school, and in the neighborhood that may increase prevalence of asthma in Latino adolescents regardless of their parental education. Given that these potential causes are multi-level, potential causes of such disparities should be tested in future multi-level research.
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Affiliation(s)
- Edward Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Marginalization-Related Diminished Returns Center, Los Angeles, CA 90059, USA
- Correspondence:
| | - Babak Najand
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Angela Young-Brinn
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Marginalization-Related Diminished Returns Center, Los Angeles, CA 90059, USA
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Adinkrah E, Najand B, Young-Brinn A. Race and Ethnic Differences in the Protective Effect of Parental Educational Attainment on Subsequent Perceived Tobacco Norms among US Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2517. [PMID: 36767881 PMCID: PMC9916299 DOI: 10.3390/ijerph20032517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/10/2022] [Accepted: 12/27/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Although parental educational attainment is known to be associated with a lower prevalence of behaviors such as tobacco use, these effects are shown to be weaker for Black than White youth. It is important to study whether this difference is due to higher perceived tobacco use norms for Black youth. AIM To study the association between parental educational attainment and perceived tobacco use norms overall and by race/ethnicity among youth in the US. METHODS The current study used four years of follow-up data from the Population Assessment of Tobacco and Health (PATH-Youth) study conducted between 2013 and 2017. All participants were 12- to 17-year-old non-smokers at baseline and were successfully followed for four years (n = 4329). The outcome of interest was perceived tobacco use norms risk at year four. The predictor of interest was baseline parental educational attainment, the moderator was race/ethnicity, and the covariates were age, sex, and parental marital status at baseline. RESULTS Our linear regressions in the pooled sample showed that higher parental educational attainment at baseline was predictive of perceived disapproval of tobacco use at year four; however, this association was weaker for Latino than non-Latino youth. Our stratified models also showed that higher parental educational attainment was associated with perceived tobacco use norms for non-Latino but not for Latino youth. CONCLUSION The effect of high parental educational attainment on anti-tobacco norms differs between Latino and non-Latino youth. Latino youth with highly educated parents remain at risk of tobacco use, while non-Latino youth with highly educated parents show low susceptibility to tobacco use.
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Affiliation(s)
- Edward Adinkrah
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Babak Najand
- Marginalization-Related Diminished Returns, Los Angeles, CA 90059, USA
| | - Angela Young-Brinn
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Marginalization-Related Diminished Returns, Los Angeles, CA 90059, USA
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Denney JT, Zamora-Kapoor A, Hansen DA, Whitney P. Race/ethnicity, sleep duration, and mortality risk in the United States. SSM Popul Health 2023; 21:101350. [PMID: 36785549 PMCID: PMC9920264 DOI: 10.1016/j.ssmph.2023.101350] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/30/2023] Open
Abstract
Current evidence and professional guidance recommend sleeping between 7 and 9 h in a 24-h period for optimal health. The present study examines the association between sleep duration and mortality and assesses whether this association varies by racial/ethnic identity for a large and diverse sample of United States adults. We use data on 274,836 adults, aged 25 and older, from the 2004-2014 waves of the National Health Interview Survey (NHIS) linked to prospective mortality through 2015 (23,382 deaths). Cox proportional hazards models were used in multi-variable regressions to estimate hazard ratios for mortality by sleep duration and racial/ethnic identity, controlling for sociodemographic, socioeconomic, and psychological distress variables. We find elevated risks of mortality from any cause for adults who sleep less than 5 h or more than 9 h in a 24-h period after all adjustments. Further, we find evidence that these elevated risks for mortality are more pronounced for some racial/ethnic groups and less pronounced for others. Improved understanding of differences in sleep duration and sleep health can facilitate more effective and culturally-tailored interventions around sleep health, improving overall well-being and enhancing longevity.
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Moody MD, Browning WR, Hossain M, Clay OJ. Vicarious experiences of major discrimination, anxiety symptoms, and mental health care utilization among Black Adults. Soc Sci Med 2023; 316:114997. [PMID: 35534345 DOI: 10.1016/j.socscimed.2022.114997] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The adverse mental health consequences of discrimination among Black adults, such as anxiety symptoms, are well documented. Prior research establishes anxiety as a risk factor for suboptimal health outcomes among Black adults. Most discrimination and mental health studies, however, have focused on the effects of personal experiences of discrimination. Moreover, of the studies that examine the mental health effects of vicarious exposure to discrimination, few investigate this relationship from a stress and coping perspective beyond the life stages of childhood and adolescence. Thus, the purpose of this study was to assess the effects of vicarious and personal experiences of discrimination on the subjective well-being of Black adults, while observing the potentially moderating effects of utilizing mental health care. METHODS A subsample of Black adults (N = 627) between the ages of 22-69 years old were drawn from the Nashville Stress and Health Study and analyzed to assess within-group variation. Multivariate linear regression was employed to examine the association between vicarious experiences of major discrimination and self-reported anxiety symptoms. Additionally, we evaluated the moderating effects of lifetime utilization of mental health services on the relationship between discrimination and symptoms of anxiety. RESULTS Findings revealed that vicarious experiences of major discrimination and personal experiences of everyday discrimination were both associated with higher levels of anxiety symptoms among the participants. Additionally, lifetime utilization of mental health care moderated the effects of vicarious and personal experiences of discrimination. CONCLUSIONS The secondhand consequences of discrimination must be considered while assessing the racism-related stress experience. Results from this investigation suggest that mental health treatment should be included in programs targeted to reduce the negative effects of discrimination among Black adults. Additionally, culturally-specific strategies should be considered for addressing racism-related adversity.
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Affiliation(s)
- Myles D Moody
- Department of Sociology, University of Alabama-Birmingham, Heritage Hall, Rm. 460, 1401 University Blvd, Birmingham, AL, 35233, USA.
| | - Wesley R Browning
- Department of Psychology, University of Alabama-Birmingham, Campbell Hall, Rm. 415, 1300 University Blvd, Birmingham, AL, 35233, USA
| | - Monir Hossain
- Department of Sociology, University of Alabama-Birmingham, Heritage Hall, Rm. 460, 1401 University Blvd, Birmingham, AL, 35233, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama-Birmingham, Campbell Hall, Rm. 415, 1300 University Blvd, Birmingham, AL, 35233, USA
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Sadeh N, Bounoua N. Race moderates the impact of intolerance of uncertainty on mental health symptoms in Black and White community adults. J Anxiety Disord 2023; 93:102657. [PMID: 36455413 PMCID: PMC9839518 DOI: 10.1016/j.janxdis.2022.102657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/20/2022] [Accepted: 11/22/2022] [Indexed: 11/24/2022]
Abstract
Racism increases the amount of uncertainty in daily life, which may differentially affect the mental health of individuals from racial minority groups who score high on trait intolerance of uncertainty (IU), or the tendency to experience uncertainty as highly aversive. We examined associations between trait IU and current symptoms of common mental disorders in community samples of Black (N = 125) and White (N = 125) adults ages 18-55 who were matched on age, gender, and educational attainment. Given that data were collected between 2017 and 2021, we also examined pandemic exposure as a moderator of these associations. No mean differences emerged between Black and White adults on trait IU measured with the Intolerance of Uncertainty Scale-12 or on current psychiatric symptoms assessed with the Structured Clinical Interview for DSM-5. Trait IU was more strongly associated with current psychiatric symptoms in Black than White adults, a racial difference that dissipated following pandemic exposure. Present results extend prior work by suggesting the dispositional tendency to find uncertainty aversive is a stronger predictor of mental health symptoms in Black than White adults outside the context of pandemic-related stress. Implications of these findings for understanding the impact of racial- and pandemic-related environmental uncertainty on mental health is discussed.
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Affiliation(s)
- Naomi Sadeh
- University of Delaware, Department of Psychological and Brain Sciences, USA.
| | - Nadia Bounoua
- University of Delaware, Department of Psychological and Brain Sciences, USA
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