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Anim SB, Spurlark R, Turkson-Ocran RA, Bohr N, Soco C, Simonovich SD. A Systematic Review of the Relationship Between Discrimination, Racism, and Type 2 Diabetes Healthcare Outcomes for Black Americans. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01751-x. [PMID: 37580438 DOI: 10.1007/s40615-023-01751-x] [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: 05/15/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Disparities in type 2 diabetes (T2DM) risk, care, and complications impact Black Americans more than that of their White counterparts. This study aims to examine the association between discrimination, racism, and T2DM care and outcomes in Black Americans. METHOD The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS A total of six original research articles met the inclusion criteria, comprising three quantitative and three qualitative studies. Overall, the systematic review findings revealed that among Black Americans, perceived interpersonal discrimination and racism by healthcare professionals are associated with patients' behaviors that impact T2DM outcomes. The findings also revealed that provider-level factors such as communication, provider assumptions and attitudes, information sharing, shared decision-making, and disease management behaviors might influence T2DM outcomes in this population. DISCUSSION Better T2DM-related outcomes depend on optimal disease control through adequate disease management. Building a therapeutic and culturally appropriate relationship free of discrimination and racism is vital for optimal disease management and decreasing health disparities in this patient population. CONCLUSION Perceived interpersonal racism and discrimination by healthcare providers, among other sociocultural factors, play a crucial role in influencing some patient behaviors that affect T2DM health outcomes in this population. Efforts to decrease health disparities in this specific community should also focus on interventions addressing provider-level factors and behaviors perceived as racist or discriminatory.
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Affiliation(s)
- Sandra B Anim
- DePaul University School of Nursing, Chicago, IL, USA
| | | | | | | | - Cheryl Soco
- DePaul University School of Nursing, Chicago, IL, USA
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Moore KR, Stotz SA, Terry MA, Seely EW, Gonzales K, Marshall G, Nadeau KJ, Akers A, Garcia-Reyes Y, Charron-Prochownik D. Respecting tribal voices in the development of a gestational diabetes risk reduction preconception counseling program for American Indian/Alaska Native adolescent females: a qualitative study. BMC Pregnancy Childbirth 2023; 23:552. [PMID: 37528363 PMCID: PMC10392008 DOI: 10.1186/s12884-023-05850-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/12/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND American Indians and Alaska Natives (AI/AN) are disproportionately affected by adolescent obesity, adolescent pregnancy and gestational diabetes mellitus (GDM). GDM is associated with increased risk for perinatal death, obesity, and subsequent type 2 diabetes (T2D) for the offspring. Moreover, mothers with GDM are also at increased risk for T2D post-partum. Yet few lifestyle interventions exist to reduce GDM risk prior to pregnancy. We describe the process of adapting an existing validated preconception counseling intervention for AI/AN adolescent girls at-risk for GDM and their mothers. Perspectives and recommendations were gathered from a diverse array of stakeholders to assure the new program called Stopping GDM was culturally responsive and developed with tribal voices and perspectives represented. METHODS We conducted focus groups and individual interviews with multiple AI/AN stakeholders (n = 55). Focus groups and interviews were digitally recorded, transcribed verbatim, and analyzed using a thematic content approach to construct cross-cutting themes across the focus groups and interviews. RESULTS Four key themes emerged reflecting issues important to planning a reproductive health intervention: 1) Limited awareness, knowledge, and health education resources about GDM; 2) The importance of acknowledging traditional AI/AN values and the diversity of traditions and culture among AI/AN tribes; 3) The need to cultivate healthy decision-making skills and empower girls to make safe and healthy choices; and 4) Lack of communication about reproductive health between AI/AN mothers and daughters and between AI/AN women and health care professionals. CONCLUSION Findings have been used to inform the cultural tailoring and adaptation of an existing preconception counseling program, originally designed for non-AI/AN adolescent girls with diabetes, for AI/AN adolescents at-risk for GDM in future pregnancies.
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Affiliation(s)
- Kelly R Moore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah A Stotz
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Martha Ann Terry
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ellen W Seely
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelly Gonzales
- School of Public Health, Oregon Health & Science University - Portland State University, Portland, OR, USA
| | | | - Kristen J Nadeau
- Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Denise Charron-Prochownik
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
- Department of Health Promotion and Development, Professor Nursing and School of Public Health, School of Nursing, University of Pittsburgh, 440 Victoria Bldg, Pittsburgh, USA.
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Marrs JC, Formea CM, Abdalla M, Brual RL, Crowe SJ, Freibert KH, Herink MC, Hoffman AR, Philbrick AM, Prescott GM, Shahdoost Moghadam S, Zhou C. Call to action: Clinical pharmacist roles and opportunities in health disparities research. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2023. [DOI: 10.1002/jac5.1764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Joel C. Marrs
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | - Maha Abdalla
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | | | | | | | | | | | | | - Crystal Zhou
- American College of Clinical Pharmacy Lenexa Kansas USA
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Akinade T, Kheyfets A, Piverger N, Layne TM, Howell EA, Janevic T. The influence of racial-ethnic discrimination on women's health care outcomes: A mixed methods systematic review. Soc Sci Med 2023; 316:114983. [PMID: 35534346 DOI: 10.1016/j.socscimed.2022.114983] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/29/2022] [Accepted: 04/15/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND In the U.S, a wide body of evidence has documented significant racial-ethnic disparities in women's health, and growing attention has focused on discrimination in health care as an underlying cause. Yet, there are knowledge gaps on how experiences of racial-ethnic health care discrimination across the life course influence the health of women of color. Our objective was to summarize existing literature on the impact of racial-ethnic health care discrimination on health care outcomes for women of color to examine multiple health care areas encountered across the life course. METHODS We systematically searched three databases and conducted study screening, data extraction, and quality assessment. We included quantitative and qualitative peer-reviewed literature on racial-ethnic health care discrimination towards women of color, focusing on studies that measured patient-perceived discrimination or differential treatment resulting from implicit provider bias. Results were summarized through narrative synthesis. RESULTS In total, 84 articles were included spanning different health care domains, such as perinatal and cancer care. Qualitative studies demonstrated the existence of racial-ethnic discrimination across care domains. Most quantitative studies reported a mix of positive and null associations between discrimination and adverse health care outcomes, with variation by the type of health care outcome. For instance, over three-quarters of the studies exploring associations between discrimination/bias and health care-related behaviors or beliefs found significant associations, whereas around two-thirds of the studies on clinical interventions found no significant associations. CONCLUSIONS This review shows substantial evidence on the existence of racial-ethnic discrimination in health care and its impact on women of color in the U.S. However, the evidence on how this phenomenon influences health care outcomes varies in strength by the type of outcome investigated. High-quality, targeted research using validated measures that is grounded in theoretical frameworks on racism is needed. This systematic review was registered [PROSPERO ID: CRD42018105448].
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Affiliation(s)
- Temitope Akinade
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
| | - Anna Kheyfets
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
| | - Naissa Piverger
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
| | - Tracy M Layne
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Teresa Janevic
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
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Anderson E, Twiggs C, Goins RT, Astleford N, Winchester B. Nephrology and Palliative Care Providers' Beliefs in Engaging American Indian Patients in Palliative Care Conversations. J Palliat Med 2022; 25:1810-1817. [PMID: 35617692 DOI: 10.1089/jpm.2021.0612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: American Indians with chronic kidney disease are twice as likely to develop end-stage renal disease. Palliative care is underused by American Indian patients, although studies show it is not due to an unwillingness to engage in conversations about end of life. Objectives: The aim of our study was to explore the experiences and beliefs of Nephrology and palliative care providers of one tribal community with respect to engaging patients and family members in palliative care. Design: Using an interview guide, individual, in-depth interviews were conducted between March and August 2019 with eligible participants. We used constant comparative analysis of interview transcripts. Setting and Subjects: Our study sample included eight participants, including four Nephrology providers and four palliative care providers. Results: We identified five themes, including (1) providers' stereotypes, (2) patients' mistrust of providers, (3) patients' end-of-life preferences, (4) available community resources, and (5) patients' family dynamics. Negative stereotypes were present in every theme, although most participants did not acknowledge the role stereotypes played in establishing trust and building therapeutic relationships conducive to end-of-life discussions. Conclusion: Providers serving American Indian patients with kidney disease should consider training in trauma informed care and cultural sensitivity. Negative stereotypes of American Indian patients may impact provider's ability to build trust, a key component of end-of-life conversations, and contribute to misperceptions related to family dynamics, end-of-life preferences, and available community resources.
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Affiliation(s)
- Elizabeth Anderson
- Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, USA
| | - Caroline Twiggs
- Mars Hill University, Community Engagement, Mars Hill, North Carolina, USA
| | - R Turner Goins
- Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, USA
| | - Nina Astleford
- Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, USA
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Thorburn S, Lindly OJ. A systematic search and review of the discrimination in health care measure, and its adaptations. PATIENT EDUCATION AND COUNSELING 2022; 105:1703-1713. [PMID: 34688522 PMCID: PMC9576001 DOI: 10.1016/j.pec.2021.10.008] [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: 10/06/2020] [Revised: 05/25/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Discrimination occurs in health care settings contributing to health inequities. Yet guidance on how best to measure discrimination in health care is still limited. OBJECTIVES We sought to (1) identify and describe the characteristics of published studies that used the Discrimination in Health Care Measure, a scale first published in 2001; (2) review how the measure has been used or adapted and summarize the measure's published psychometric properties and its variations; and (3) summarize associations between the measure and health-related variables. METHODS We performed a systematic search and review of the measure by searching PsycINFO, PubMed, Sociological Abstracts, and Web of Science from January 1, 2001 through January 31, 2017. We screened 260 unique articles, identified 22 eligible articles, and completed a narrative synthesis. RESULTS Most studies measured race or ethnicity-based discrimination. All studies made minor revisions to the measure, and most reported high reliabilities. Discrimination in health care, using this measure, was associated with adverse health outcomes. DISCUSSION AND PRACTICE IMPLICATIONS Study results indicate that the measure is easy to use and adapt. Researchers should consider using the Discrimination in Health Care Measure when designing studies that will examine individuals' discriminatory experiences when receiving health care.
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Affiliation(s)
- Sheryl Thorburn
- School of Social and Behavioral Health Sciences, Oregon State University, United States
| | - Olivia J Lindly
- Department of Health Sciences, Northern Arizona University, United States.
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Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health 2022; 22:988. [PMID: 35578322 PMCID: PMC9112453 DOI: 10.1186/s12889-022-13122-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Racism constitutes a barrier towards achieving equitable healthcare as documented in research showing unequal processes of delivering, accessing, and receiving healthcare across countries and healthcare indicators. This review summarizes studies examining how racism is discussed and produced in the process of delivering, accessing and receiving healthcare across various national contexts. METHOD The PRISMA guidelines for scoping reviews were followed and databases were searched for peer reviewed empirical articles in English across national contexts. No starting date limitation was applied for this review. The end date was December 1, 2020. The review scoped 213 articles. The results were summarized, coded and thematically categorized in regards to the aim. RESULTS The review yielded the following categories: healthcare users' experiences of racism in healthcare; healthcare staff's experiences of racism; healthcare staff's racial attitudes and beliefs; effects of racism in healthcare on various treatment choices; healthcare staff's reflections on racism in healthcare and; antiracist training in healthcare. Racialized minorities experience inadequate healthcare and being dismissed in healthcare interactions. Experiences of racism are associated with lack of trust and delay in seeking healthcare. Racialized minority healthcare staff experience racism in their workplace from healthcare users and colleagues and lack of organizational support in managing racism. Research on healthcare staff's racial attitudes and beliefs demonstrate a range of negative stereotypes regarding racialized minority healthcare users who are viewed as difficult. Research on implicit racial bias illustrates that healthcare staff exhibit racial bias in favor of majority group. Healthcare staff's racial bias may influence medical decisions negatively. Studies examining healthcare staff's reflections on racism and antiracist training show that healthcare staff tend to construct healthcare as impartial and that healthcare staff do not readily discuss racism in their workplace. CONCLUSIONS The USA dominates the research. It is imperative that research covers other geo-political contexts. Research on racism in healthcare is mainly descriptive, atheoretical, uses racial categories uncritically and tends to ignore racialization processes making it difficult to conceptualize racism. Sociological research on racism could inform research on racism as it theoretically explains racism's structural embeddedness, which could aid in tackling racism to provide good quality care.
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Affiliation(s)
- Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden.
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Beth Maina Ahlberg
- Department of Sociology, Uppsala University, Uppsala, Sweden.,Skaraborg Institute for Research and Development, Skövde, Sweden
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Bond J, Julion WA, Reed M. Racial Discrimination and Race-Based Biases on Orthopedic-Related Outcomes: An Integrative Review. Orthop Nurs 2022; 41:103-115. [PMID: 35358128 DOI: 10.1097/nor.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Musculoskeletal diseases often lead to functional limitations and debility. The burden of these debilitating diseases is not balanced across race and ethnicity. The Institute of Medicine (now referred to as the National Academy of Medicine) identified racial discrimination as a substantive cause of race-based health disparities for racial and ethnic minority groups. The purpose of this integrative review is to summarize the evidence on the relationship among racial discrimination, race-based implicit biases and other types of biases (e.g., gender and appearance), and orthopaedic-related outcomes. Nine studies met inclusion criteria and were included in this review. The orthopaedic outcomes addressed across the nine studies were osteoarthritis, rheumatoid arthritis, low back pain, pain tolerance, disability, and likelihood of being recommended for a total knee arthroplasty. The results reveal that experiences of racial discrimination, race-based implicit biases, and other types of biases contribute to unsatisfactory orthopaedic-related outcomes for minority groups. Orthopaedic nurses can leverage their expertise to address these disparities in orthopaedic-related outcomes across minority groups.
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Affiliation(s)
- Jerenda Bond
- Jerenda Bond, PT, DPT, Graduate College, Rush University, Chicago, IL
- Wrenetha A. Julion, PhD, MPH, RN, CNL, FAAN, Associate Dean for Equity and Inclusion, Professor, Department of Women, Children and Family Nursing, College of Nursing, Rush University, Chicago, IL
- Monique Reed, PhD, MS, RN, FAAN, Associate Professor, Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL
| | - Wrenetha A Julion
- Jerenda Bond, PT, DPT, Graduate College, Rush University, Chicago, IL
- Wrenetha A. Julion, PhD, MPH, RN, CNL, FAAN, Associate Dean for Equity and Inclusion, Professor, Department of Women, Children and Family Nursing, College of Nursing, Rush University, Chicago, IL
- Monique Reed, PhD, MS, RN, FAAN, Associate Professor, Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL
| | - Monique Reed
- Jerenda Bond, PT, DPT, Graduate College, Rush University, Chicago, IL
- Wrenetha A. Julion, PhD, MPH, RN, CNL, FAAN, Associate Dean for Equity and Inclusion, Professor, Department of Women, Children and Family Nursing, College of Nursing, Rush University, Chicago, IL
- Monique Reed, PhD, MS, RN, FAAN, Associate Professor, Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL
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Kamody RC, Grilo CM, Vásquez E, Udo T. Diabetes prevalence among diverse Hispanic populations: considering nativity, ethnic discrimination, acculturation, and BMI. Eat Weight Disord 2021; 26:2673-2682. [PMID: 33594660 DOI: 10.1007/s40519-021-01138-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To compare prevalence of self-reported diabetes between U.S. state-born, Puerto Rico-born, Mexico-born, Cuba-born, and South/Central America-born Hispanic groups, and examine whether risk for diabetes differs by country of origin and experiences with discrimination when accounting for BMI. METHODS Data from 6223 Hispanic respondents from the nationally representative NESARC-III study was used. Sociodemographic characteristics were compared across nativity groups, and adjusted odds of self-reported diabetes diagnosis (past year) tested. Differences by perceived discrimination (using endorsement of individual items assessing specific experiences) and by nativity were examined when accounting for sociodemographic characteristics, acculturation, and BMI. RESULTS Prevalence of self-reported diabetes diagnosis was significantly higher among the Puerto Rico-born Hispanics, and remained significantly elevated when adjusting for perceived discrimination, acculturation, and health risk behaviors. When adjusting further for BMI, there were no significant differences in the odds of diabetes by nativity. Prevalence of lifetime perceived discrimination was significantly lower among Cuba-born Hispanics. Mean BMI was significantly lower in South/Central America-born Hispanic individuals relative to U.S. state-, Mexico-, and Puerto Rico-born Hispanic groups. Higher BMI was associated with significantly greater risk of diabetes diagnosis across groups. CONCLUSION Marked heterogeneity exists in prevalence and in factors associated with diabetes risk and weight status across Hispanic groups in the U.S. Experiences with discrimination may play an important role in accounting for these differences. This should be considered when planning future research to inform the most optimal patient-centered prevention efforts. LEVEL OF EVIDENCE Level III, Evidence obtained from well-designed cohort analytic study.
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Affiliation(s)
- Rebecca C Kamody
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Child Study Center, Yale University School of Medicine, 350 George Street, New Haven, CT, 06511, USA.
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Elizabeth Vásquez
- Department of Epidemiology & Biostatistics, School of Public Health, University of Albany, State University of New York, Albany, NY, USA
| | - Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University of Albany, State University of New York, Albany, NY, USA
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Gonzales KL, Jiang L, Garcia-Alexander G, Jacob MM, Chang J, Williams DR, Bullock A, Manson SM. Perceived Discrimination, Retention, and Diabetes Risk Among American Indians and Alaska Natives in a Diabetes Lifestyle Intervention. J Aging Health 2021; 33:18S-30S. [PMID: 34167349 PMCID: PMC8647809 DOI: 10.1177/08982643211013188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: To examine the association of perceived discrimination with participant retention and diabetes risk among American Indians and Alaska Natives. Methods: Data were drawn from the Special Diabetes Program for Indians-Diabetes Prevention Demonstration Project (N = 2553). Results: Perceived discrimination was significantly and negatively associated with short-term and long-term retention and diabetes risk without adjusting. After controlling for socioeconomic characteristics and clinical outcomes, perceived discrimination was not associated with retention but was significantly associated with less improvement in body mass index (BMI) and high-density lipoprotein (HDL) cholesterol. Every unit increase in the perceived discrimination score was associated with 0.14 kg/m2 less BMI reduction (95% CI: [0.02, 0.26], p = 0.0183) and 1.06 mg/dl lower HDL at baseline (95% CI: [0.36, 1.76], p = 0.0028). Discussion: Among racialized groups, improving retention and health in lifestyle interventions may require investigating perceived discrimination and the broader context of structural racism and colonialism.
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Affiliation(s)
- Kelly L. Gonzales
- Oregon Health & Science University-Portland State University joint School of Public Health, Portland, OR, USA
| | - Luohua Jiang
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | | | | | - Jenny Chang
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | - David R. Williams
- Florence Sprague Norman and Laura Smart Norman Professor of Public Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD, USA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Gil-Salmerón A, Katsas K, Riza E, Karnaki P, Linos A. Access to Healthcare for Migrant Patients in Europe: Healthcare Discrimination and Translation Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157901. [PMID: 34360197 PMCID: PMC8345338 DOI: 10.3390/ijerph18157901] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Abstract
Background: Discrimination based on ethnicity and the lack of translation services in healthcare have been identified as main barriers to healthcare access. However, the actual experiences of migrant patients in Europe are rarely present in the literature. Objectives: The aim of this study was to assess healthcare discrimination as perceived by migrants themselves and the availability of translation services in the healthcare systems of Europe. Methods: A total of 1407 migrants in 10 European Union countries (consortium members of the Mig-HealthCare project) were surveyed concerning healthcare discrimination, access to healthcare services, and need of translation services using an interviewer-administered questionnaire. Migrants in three countries were excluded from the analysis, due to small sample size, and the new sample consisted of N = 1294 migrants. Descriptive statistics and multivariable regression analyses were conducted to investigate the risk factors on perceived healthcare discrimination for migrants and refugees in the EU. Results: Mean age was 32 (±11) years and 816 (63.26%) participants were males. The majority came from Syria, Afghanistan, Iraq, Nigeria, and Iran. Older migrants reported better treatment experience. Migrants in Italy (0.191; 95% CI [0.029, 0.352]) and Austria (0.167; 95% CI [0.012, 0.323]) scored higher in the Discrimination Scale to Medical Settings (DMS) compared with Spain. Additionally, migrants with better mental health scored lower in the DMS scale (0.994; 95% CI [0.993, 0.996]), while those with no legal permission in Greece tended to perceive more healthcare discrimination compared with migrants with some kind of permission (1.384; 95% CI [1.189, 1.611]), as opposed to Austria (0.763; 95% CI [0.632, 0.922]). Female migrants had higher odds of needing healthcare assistance but not being able to access them compared with males (1.613; 95% CI [1.183, 2.199]). Finally, migrants with chronic problems had the highest odds of needing and not having access to healthcare services compared with migrants who had other health problems (3.292; 95% CI [1.585, 6.837]). Conclusions: Development of culturally sensitive and linguistically diverse healthcare services should be one of the main aims of relevant health policies and strategies at the European level in order to respond to the unmet needs of the migrant population.
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Affiliation(s)
- Alejandro Gil-Salmerón
- Polibienestar Research Institute, University of Valencia, 46010 Valencia, Spain
- International Foundation for Integrated Care, Oxford OX2 6UD, UK
- Correspondence:
| | - Konstantinos Katsas
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15125 Marousi, Greece; (K.K.); (P.K.); (A.L.)
| | - Elena Riza
- Department of Hygiene Epidemiology, Medical Statistics Medical School National, Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Pania Karnaki
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15125 Marousi, Greece; (K.K.); (P.K.); (A.L.)
| | - Athena Linos
- Institute of Preventive Medicine Environmental and Occupational Health Prolepsis, 15125 Marousi, Greece; (K.K.); (P.K.); (A.L.)
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12
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Greenfield BL, Elm JHL, Hallgren KA. Understanding measures of racial discrimination and microaggressions among American Indian and Alaska Native college students in the Southwest United States. BMC Public Health 2021; 21:1099. [PMID: 34107882 PMCID: PMC8190861 DOI: 10.1186/s12889-021-11036-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Racial discrimination, including microaggressions, contributes to health inequities, yet research on discrimination and microaggressions has focused on single measures without adequate psychometric evaluation. To address this gap, we examined the psychometric performance of three discrimination/microaggression measures among American Indian and Alaska Native (AI/AN) college students in a large Southwestern city. METHODS Students (N = 347; 65% female; ages 18-65) completed the revised-Everyday Discrimination Scale, Microaggressions Distress Scale, and Experiences of Discrimination measure. The psychometric performance of these measures was evaluated using item response theory and confirmatory factor analyses. Associations of these measures with age, gender, household income, substance use, and self-rated physical health were examined. RESULTS Discrimination and microaggression items varied from infrequently to almost universally endorsed and each measure was unidimensional and moderately correlated with the other two measures. Most items contributed information about the overall severity of discrimination and collectively provided information across a continuum from everyday microaggressions to physical assault. Greater exposure to discrimination on each measure had small but significant associations with more substance use, lower income, and poorer self-rated physical health. The Experiences of Discrimination measure included more severe forms of discrimination, while the revised-Everyday Discrimination Scale and the Microaggressions Distress Scale represented a wider range of severity. CONCLUSIONS In clinical practice, these measures can index varying levels of discrimination for AI/ANs, particularly for those in higher educational settings. This study also informs the measurement of racial discrimination and microaggressions more broadly.
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Affiliation(s)
- Brenna L Greenfield
- Department of Family Medicine & Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, 1035 University Drive, Duluth, MN, 55812, USA.
| | - Jessica H L Elm
- Great Lakes Hub, Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kevin A Hallgren
- Department of Psychiatry & Behavioral Sciences, University of Washington, Box 356560, 1959 NE Pacific Street, Seattle, Washington, 98195, USA
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Payne-Sturges DC, Gee GC, Cory-Slechta DA. Confronting Racism in Environmental Health Sciences: Moving the Science Forward for Eliminating Racial Inequities. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:55002. [PMID: 33945300 PMCID: PMC8096378 DOI: 10.1289/ehp8186] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND The twin pandemics of COVID-19 and systemic racism during 2020 have forced a conversation across many segments of our society, including the environmental health sciences (EHS) research community. We have seen the proliferation of statements of solidarity with the Black Lives Matter movement and commitments to fight racism and health inequities from academia, nonprofit organizations, governmental agencies, and private corporations. Actions must now arise from these promises. As public health and EHS scientists, we must examine the systems that produce and perpetuate inequities in exposure to environmental pollutants and associated health effects. OBJECTIVES We outline five recommendations the EHS research community can implement to confront racism and move our science forward for eliminating racial inequities in environmental health. DISCUSSION Race is best considered a political label that promotes inequality. Thus, we should be wary of equating race with biology. Further, EHS researchers should seriously consider racism as a plausible explanation of racial disparities in health and consider structural racism as a factor in environmental health risk/impact assessments, as well as multiple explanations for racial differences in environmental exposures and health outcomes. Last, the EHS research community should develop metrics to measure racism and a set of guidelines on the use and interpretation of race and ethnicity within the environmental sciences. Numerous guidelines exist in other disciplines that can serve as models. By taking action on each of these recommendations, we can make significant progress toward eliminating racial disparities. https://doi.org/10.1289/EHP8186.
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Affiliation(s)
- Devon C. Payne-Sturges
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Gilbert C. Gee
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
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Powers MA, Bardsley JK, Cypress M, Funnell MM, Harms D, Hess-Fischl A, Hooks B, Isaacs D, Mandel ED, Maryniuk MD, Norton A, Rinker J, Siminerio LM, Uelmen S. Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care and Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. J Acad Nutr Diet 2021; 121:773-788.e9. [DOI: 10.1016/j.jand.2020.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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15
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Lewis ME, Volpert-Esmond HI, Deen JF, Modde E, Warne D. Stress and Cardiometabolic Disease Risk for Indigenous Populations throughout the Lifespan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1821. [PMID: 33668461 PMCID: PMC7918141 DOI: 10.3390/ijerph18041821] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Indigenous people experience the greatest cardiometabolic disease disparity in the Unites States, yet high cardiometabolic disease risk factors do not fully explain the extent of the cardiometabolic disease disparity for Indigenous people. Stress, trauma, and racism occur at high rates within Indigenous communities and have not been well explored as significant contributors to cardiometabolic disease disparities despite emerging literature, and therefore will be described here. METHODS This descriptive study explores the relationship between cardiometabolic disease risks and Indigenous-specific stressors (e.g., early childhood stress and trauma, adulthood stress and trauma, and historical and intergenerational trauma) using current literature. Indigenous-specific protective factors against cardiometabolic disease are also reviewed. RESULTS Increasing research indicates that there is a relationship between Indigenous-specific stressful and traumatic life experiences and increased cardiometabolic disease risk. Mental health and psychophysiology play an important role in this relationship. Effective interventions to reduce cardiometabolic disease risk in Indigenous communities focus on ameliorating the negative effects of these stressors through the use of culturally specific health behaviors and activities. CONCLUSIONS There is increasing evidence that cultural connection and enculturation are protective factors for cardiometabolic disease, and may be galvanized through Indigenous-led training, research, and policy change.
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Affiliation(s)
- Melissa E. Lewis
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO 65212, USA;
| | | | - Jason F. Deen
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA;
| | - Elizabeth Modde
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO 65212, USA;
| | - Donald Warne
- Family & Community Medicine Department, University of North Dakota, Grand Forks, ND 58202, USA;
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16
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Powers MA, Bardsley JK, Cypress M, Funnell MM, Harms D, Hess-Fischl A, Hooks B, Isaacs D, Mandel ED, Maryniuk MD, Norton A, Rinker J, Siminerio LM, Uelmen S. Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Sci Diabetes Self Manag Care 2021; 47:54-73. [PMID: 34078207 DOI: 10.1177/0145721720987936] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Joan K Bardsley
- Medstar Health Research Institute, MedStar Diabetes Institute and MedStar Health System Nursing, Hyattsville, Maryland
| | | | | | - Dixie Harms
- MercyOne Clive Internal Medicine, Clive, Iowa
| | - Amy Hess-Fischl
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, Illinois
| | | | - Diana Isaacs
- Cleveland Clinic Diabetes Center, Cleveland, Ohio
| | | | | | | | - Joanne Rinker
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
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17
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Abstract
PURPOSE OF REVIEW Even with insurance coverage increasing over time among the population with diabetes, a large proportion continues to have poorly controlled disease. The purpose of this narrative literature review is to describe the social determinants of poor management of type 2 diabetes among the insured population and illustrate drivers of poor outcomes beyond insurance coverage. RECENT FINDINGS Despite the provision of health insurance, social determinants play a significant role in shaping diabetes outcomes, especially for economic instability (employment, out-of-pocket expenses associated with diabetes management), food insecurity, education and literacy, access to quality health care (health systems designed to effectively manage chronic disease), neighborhood and the built environment (segregated neighborhoods, socioeconomic conditions of communities, housing), and social and community context (discrimination, social support). Multiple social determinants shape poor diabetes outcomes among the insured. These determinants are now being further exacerbated by the COVID-19 pandemic, which has created the worst economic crisis for US families since the Great Depression. The evidence of this review points to the imperative need for more multilevel intervention approaches to address these determinants in the management of diabetes.
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Affiliation(s)
- Minal R Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH 1, Room 3810, Ann Arbor, MI, 48109-2029, USA.
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Abstract
Racism is an important determinant of health and health disparities, but few strategies have been successful in eliminating racial discrimination from medical practice. This article proposes a novel antiracist approach to clinical care that acknowledges the racism shaping the clinical encounter and historical arc of racial oppression embedded in health care. Although preliminary, this approach can be easily implemented into clinical care and may reduce the harm done by racism. It could also serve as a template for antiracist service provision in other sectors, such as education and law enforcement.
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Affiliation(s)
- Rupinder Kaur Legha
- UCLA Center for Health Services and Society, 10920 Wilshire Boulevard, Suite 300, Los Angeles, CA 90024, USA.
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, UCLA, UCLA's Center for Health Services and Society, 10920 Wilshire Boulevard, Suite 300, Los Angeles, CA 90024, USA
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Sinclair K, Carty C, Gonzales K, Nikolaus C, Gillespie L, Buchwald D. Strong Men, Strong Communities: Design of a Randomized Controlled Trial of a Diabetes Prevention Intervention for American Indian and Alaska Native Men. Am J Mens Health 2020; 14:1557988320945457. [PMID: 32757825 PMCID: PMC7412907 DOI: 10.1177/1557988320945457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 01/04/2023] Open
Abstract
Type 2 diabetes is a serious global epidemic that disproportionately affects disadvantaged populations. American Indians and Alaska Natives (AIs/ANs) have the highest rates of diabetes in the nation with a prevalence of 14.7% in 2018, more than twice that of non-Hispanic Whites. AI/AN men have the highest prevalence of diagnosed type 2 diabetes (14.5%) compared to non-Hispanic Black (11.4%), non-Hispanic Asian (10.0%), and non-Hispanic White (8.6%) men. Several landmark clinical trials have shown that lifestyle interventions can effectively prevent or delay the onset of diabetes among those at risk, including in AIs/ANs. Despite positive outcomes for AIs/ANs in these studies, very few were men. To date, there have been no concerted efforts to recruit and retain AI/AN men in interventions that promote weight loss and healthy lifestyles to prevent diabetes, and they remain underrepresented in these types of studies. This article describes the design and methods of the first randomized controlled trial of a diabetes prevention program with a study sample comprised entirely of AI/AN men. Research to date has demonstrated suboptimal patterns of recruitment and retention of AI/AN men, resulting in their virtual absence in health and intervention research. Effective methods to recruit and retain AI/AN men, and potential benefit gained from participation in diabetes prevention research, are unknown for this population who experience a high prevalence of type 2 diabetes. The study design presented in this article offers promising insights to help remedy these important shortcomings in the science of recruitment and retention of AI/AN men in research.
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Affiliation(s)
- Ka‘imi Sinclair
- College of Nursing, Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA, USA
| | - Cara Carty
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA, USA
| | - Kelly Gonzales
- Portland State University-Oregon Health Sciences University Joint School of Public Health, Portland, OR, USA
| | - Cassandra Nikolaus
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA, USA
| | - Lucas Gillespie
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA, USA
| | - Dedra Buchwald
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA, USA
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Powers MA, Bardsley JK, Cypress M, Funnell MM, Harms D, Hess-Fischl A, Hooks B, Isaacs D, Mandel ED, Maryniuk MD, Norton A, Rinker J, Siminerio LM, Uelmen S. Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care 2020; 43:1636-1649. [PMID: 32513817 DOI: 10.2337/dci20-0023] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Joan K Bardsley
- Medstar Health Research Institute, MedStar Diabetes Institute, and MedStar Health System Nursing, Hyattsville, MD
| | | | | | | | - Amy Hess-Fischl
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL
| | | | | | | | | | | | - Joanne Rinker
- Association of Diabetes Care & Education Specialists, Chicago, IL
| | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, IL
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21
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Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. J Am Pharm Assoc (2003) 2020; 60:e1-e18. [PMID: 32527704 DOI: 10.1016/j.japh.2020.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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22
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Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the Association of Diabetes Care and Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. JAAPA 2020; 33:1-20. [PMID: 32516163 DOI: 10.1097/01.jaa.0000668828.47294.2a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Diabetes Self-management Education and Support in Adults with Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care and Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. J Am Assoc Nurse Pract 2020; 33:1314-1331. [PMID: 32530872 DOI: 10.1097/jxx.0000000000000473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/26/2022]
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24
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Powers MA, Bardsley JK, Cypress M, Funnell MM, Harms D, Hess-Fischl A, Hooks B, Isaacs D, Mandel ED, Maryniuk MD, Norton A, Rinker J, Siminerio LM, Uelmen S. Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. DIABETES EDUCATOR 2020; 46:350-369. [PMID: 32510275 DOI: 10.1177/0145721720930959] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Joan K Bardsley
- Medstar Health Research Institute, MedStar Diabetes Institute and MedStar Health System Nursing, Hyattsville, Maryland
| | | | | | - Dixie Harms
- MercyOne Clive Internal Medicine, Clive, Iowa
| | - Amy Hess-Fischl
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, Illinois
| | | | - Diana Isaacs
- Cleveland Clinic Diabetes Center, Cleveland, Ohio
| | | | | | | | - Joanne Rinker
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
| | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
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25
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Terry MA, Stotz SA, Charron-Prochownik D, Beirne S, Gonzales K, Marshall G, Moore KR. Recommendations from an expert panel of health professionals regarding a gestational diabetes risk reduction intervention for American Indian/Alaska Native Teens. Pediatr Diabetes 2020; 21:415-421. [PMID: 32011043 DOI: 10.1111/pedi.12990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/18/2019] [Accepted: 01/24/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND American Indian/Alaska Native (AI/AN) adolescents are at higher risk for gestational diabetes (GDM), type 2 diabetes, and pregnancy complications than the general population. OBJECTIVE To inform cultural adaptation of a validated evidence-based intervention (VEBI) originally designed to deliver preconception counseling and diabetes education to non-AI/AN teens with diabetes. DESIGN Qualitative data were collected using focus group and individual interview methods with health care professionals and experts (n = 16) in AI/AN health, GDM, adolescent health, and/or mother-daughter communication. A semistructured discussion guide elicited responses about provision of care for AI/AN girls at risk for GDM, experience with successful programs for AI/AN teens, comfort of mother/daughter dyads in talking about diabetes and reproductive health and reactions to video clips and booklet selections from the VEBI. All interviews were recorded and transcribed verbatim, and data analysis included inductive coding and identification of emergent themes. RESULTS Providers felt teens and their moms would be comfortable talking about the VEBI topics and that teens who did not feel comfortable talking to their mom would likely rely on another adult female. Participants suggested including: AI/AN images/motifs, education with a community focus, and avoiding directive language. Concerns included: socioeconomic issues that affect AI/AN people such as: food and housing insecurity, abuse, and historical trauma. CONCLUSIONS Perspectives from these participants have been used to guide the development of a culturally tailored GDM risk reduction program for AI/AN girls. This program will be available to health care providers who serve the AI/AN population.
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Affiliation(s)
- Martha A Terry
- Behavioral & Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah A Stotz
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Denise Charron-Prochownik
- Health Promotion and Development, School of Nursing, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sandra Beirne
- Northern Navajo Medical Center, Shiprock, New Mexico
| | - Kelly Gonzales
- School of Public Health, Portland State University, Portland, Oregon
| | | | - Kelly R Moore
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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26
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Elm JHL, Walls ML, Aronson BD. Sources of Stress Among Midwest American Indian Adults with Type 2 Diabetes. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2020; 26:33-62. [PMID: 30690701 DOI: 10.5820/aian.2601.2019.33] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite alarming health disparities among American Indians (AIs) and acknowledgement that stressors negatively influence health, conceptualization of the full spectrum of stressors that impact Indigenous communities is underdeveloped. To address this gap, we analyze focus group transcripts of AI adults with type 2 diabetes from five tribal communities and classify stressors using an inductive/deductive analytical approach. A Continuum of American Indian Stressor Model was constructed from categorization of nineteen stressor categories within four domains. We further identified poverty, genocide, and colonization as fundamental causes of contemporary stress and health outcomes for AIs and conclude that stressors are generally experienced as chronic, regardless of the duration of the stressor. This work on AI-specific stressors informs future health research on the stress burden in AI communities and identifies target points for intervention and health promotion.
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27
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Redmond N, Aminawung JA, Morse DS, Zaller N, Shavit S, Wang EA. Perceived Discrimination Based on Criminal Record in Healthcare Settings and Self-Reported Health Status among Formerly Incarcerated Individuals. J Urban Health 2020; 97:105-111. [PMID: 31628588 PMCID: PMC7010870 DOI: 10.1007/s11524-019-00382-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Perceived discrimination based on criminal record is associated with social determinants of health such as housing and employment. However, there is limited data on discrimination based on criminal record within health care settings. We examined how perceived discrimination based on criminal record within health care settings, among individuals with a history of incarceration, was associated with self-reported general health status. We used data from individuals recruited from 11 sites within the Transitions Clinic Network (TCN) who were released from prison within the prior 6 months, had a chronic health condition and/or were age 50 or older, and had complete information on demographics, medical history, self-reported general health status, and self-reported perceived discrimination (n = 743).Study participants were mostly of minority racial and ethnic background (76%), and had a high prevalence of self-reported chronic health conditions with half reporting mental health conditions and substance use disorders (52% and 50%, respectively), and 85% reporting one or more chronic medical conditions. Over a quarter (27%, n = 203) reported perceived discrimination by health care providers due to criminal record with a higher proportion of individuals with fair or poor health reporting discrimination compared to those in good or excellent health (33% vs. 23%; p = .002). After adjusting for age and reported chronic conditions, participants reporting discrimination due to criminal record had 43% increased odds of reporting fair/poor health (AOR 1.43, 95% CI 1.01-2.03). Race and ethnicity did not modify this relationship.Participants reporting discrimination due to criminal record had increased odds of reporting fair/poor health. The association between perceived discrimination by health care providers due to criminal record and health should be explored in future longitudinal studies among individuals at high risk of incarceration.Clinical Trial Registration: NCT01863290.
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Affiliation(s)
- Nicole Redmond
- Division of Cardiovascular Sciences (DCVS), Clinical Applications and Prevention Branch (CAPB), National Heart, Lung, and Blood Institute (NHLBI), 6701 Rockledge Drive, Suite 10218, Bethesda, MD, 20892-7936, USA.
| | - Jenerius A Aminawung
- General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Diane S Morse
- University of Rochester School of Medicine, Rochester, NY, USA
| | - Nickolas Zaller
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Shira Shavit
- School of Medicine, University of California-San Francisco (UCSF), San Francisco, CA, USA
| | - Emily A Wang
- General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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28
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Stanley LR, Swaim RC, Kaholokula JK, Kelly KJ, Belcourt A, Allen J. The Imperative for Research to Promote Health Equity in Indigenous Communities. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:13-21. [PMID: 29110278 PMCID: PMC5936666 DOI: 10.1007/s11121-017-0850-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Health disparities exact a devastating toll upon Indigenous people in the USA. However, there has been scant research investment to develop strategies to address these inequities in Indigenous health. We present a case for increased health promotion, prevention, and treatment research with Indigenous populations, providing context to the recent NIH investment in the Intervention Research to Improve Native American Health (IRINAH) network. We discuss the disproportionate costs and consequences of disparities borne by Indigenous groups, the limited evidence base on effective intervention for this population, how population uniqueness often makes transfer of existing intervention models difficult, and additional challenges in creating interventions for Indigenous settings. Given the history of colonial disruption that has included genocide, forced removal from lands, damaging federal, state and local policies and practices, environmental contamination, and most recently, climate change, we conclude research that moves beyond minor transformations of existing majority population focused interventions, but instead truly respects Indigenous wisdom, knowledge, traditions, and aspirations is needed, and that investment in intervention science to address Indigenous health disparities represent a moral imperative.
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Affiliation(s)
- Linda R Stanley
- Tri-Ethnic Center for Prevention Research, Colorado State University, Sage Hall, 1879 Campus Delivery, Fort Collins, CO, 80523-1879, USA.
| | - Randall C Swaim
- Tri-Ethnic Center for Prevention Research, Colorado State University, Sage Hall, 1879 Campus Delivery, Fort Collins, CO, 80523-1879, USA
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, 96813, USA
| | - Kathleen J Kelly
- Department of Marketing, Colorado State University, 1278 Campus Delivery, Fort Collins, CO, 80523, USA
| | - Annie Belcourt
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, 59812, USA
| | - James Allen
- Department of Biobehavioral Health and Population Sciences, University of Minnesota-Duluth, Duluth, MN, 55812, USA
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29
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López-Cevallos DF, Harvey SM. Psychometric Properties of a Healthcare Discrimination Scale Among Young-Adult Latinos. J Racial Ethn Health Disparities 2019; 6:618-624. [PMID: 30618005 DOI: 10.1007/s40615-018-00560-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A growing body of research has found that healthcare discrimination is a significant barrier in accessing healthcare among Latino patients. Despite evidence of the effects of perceived discrimination among Latinos, psychometric testing of scales used in previous research is limited. The present study explored the psychometric properties of a healthcare discrimination scale (HDS) among young-adult Latinos. METHODS We used data from a cross-sectional study of young-adult Latinos, primarily of Mexican heritage, living in rural Oregon. Bilingual, bicultural staff members conducted computer-assisted personal interviews matched by gender with 313 individuals who completed the interview in Spanish (n = 137) or English (n = 176). The interview guide included questions for the HDS and the experiences of discrimination (EOD) and acculturation scales, and satisfaction with healthcare services. Psychometric testing included exploratory factor analysis, internal consistency, split-half reliability, and convergent, discriminant, and predictive validity. RESULTS The HDS scale had high internal consistency (Cronbach's α = 0.92), was strongly correlated with the EOD scale (r = 0.70, p < 0.001), and weakly correlated with the acculturation scale (r = 0.17, p < 0.01). Discriminant validity was stronger among English speakers (r = - 0.06, p = 0.422). Split-half reliability was 0.87 (p < 0.001). Confirmatory factor analysis yielded a one-factor solution for both Spanish and English language respondents. The HDS was significantly associated with satisfaction with healthcare services, indicative of good predictive validity. CONCLUSIONS These results suggest that the healthcare discrimination scale is a valid and reliable tool to use among Spanish and English-speaking young-adult Latinos. Further testing is needed among Latinos of other ages and background groups.
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Affiliation(s)
- Daniel F López-Cevallos
- School of Language, Culture, and Society, College of Liberal Arts, Oregon State University, 262 Waldo Hall, Corvallis, OR, 97331, USA.
| | - S Marie Harvey
- College of Public Health and Human Sciences, Oregon State University, Women's Building 124, Corvallis, OR, 97331, USA
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Haire-Joshu D, Hill-Briggs F. The Next Generation of Diabetes Translation: A Path to Health Equity. Annu Rev Public Health 2019; 40:391-410. [PMID: 30601723 DOI: 10.1146/annurev-publhealth-040218-044158] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Disparities in diabetes burden exist in large part because of the social determinants of health (SDOH). Translation research and practice addressing health equity in diabetes have generally focused on changing individual behavior or providing supportive approaches to compensate for, rather than directly target, SDOH. The purpose of this article is to propose a pathway for addressing SDOH as root causes of diabetes disparities and as an essential target for the next generation of interventions needed to achieve health equity in diabetes prevention and treatment. This review describes ( a) the current burden of diabetes disparities, ( b) the influence of SDOH on diabetes disparities, ( c) gaps in and implications of current translation research, and ( d) approaches to achieving health equity in the next generation of diabetes translation.
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Affiliation(s)
- Debra Haire-Joshu
- Public Health and Medicine, Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA;
| | - Felicia Hill-Briggs
- Departments of Medicine; Health, Behavior and Society; and Acute and Chronic Care; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;
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DallaPiazza M, Padilla-Register M, Dwarakanath M, Obamedo E, Hill J, Soto-Greene ML. Exploring Racism and Health: An Intensive Interactive Session for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10783. [PMID: 30800983 PMCID: PMC6354798 DOI: 10.15766/mep_2374-8265.10783] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/10/2018] [Indexed: 05/14/2023]
Abstract
Introduction Growing recognition of the deleterious effects of racism on health has led to calls for increased education on racism for health care professionals. As part of a larger curriculum on health equity and social justice, we developed a new educational session on racism for first-year medical students consisting of a lecture followed by a case-based small-group discussion. Methods Over the academic years of 2016-2017, 2017-2018, and 2018-2019, a total of 536 first-year medical students participated in this mandatory session. The course materials were developed as a collaboration between faculty and students. The lecture was delivered in a large-group format; the small-group case-based discussion consisted of 10-12 students with one upper-level student facilitator. Results The majority of respondents for the course evaluation felt that the course had met its stated objectives, and many commented that they had an increased awareness of the role of racism in shaping health. Students felt that the small-group activity was especially powerful for learning about racism. Discussion Active student involvement in curriculum development and small-group facilitation was critical for successful buy-in from students. Additional content on bias, stereotyping, and health care disparities will be the focus of faculty development programs and will also be integrated into the clerkships to build on these important topics as students are immersed in clinical care.
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Affiliation(s)
- Michelle DallaPiazza
- Assistant Professor, Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School
| | | | - Megana Dwarakanath
- Resident,, Department of Pediatrics, University of New Mexico School of Medicine
| | | | - James Hill
- Associate Dean of Students, Department of Psychiatry, Rutgers New Jersey Medical School
| | - Maria L. Soto-Greene
- Professor of Medicine, Rutgers New Jersey Medical School; Vice Dean, Rutgers New Jersey Medical School; Director, Hispanic Center of Excellence, Rutgers New Jersey Medical School
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Brodt E, Bruegl A, Thayer EK, Eiff MP, Gonzales K, Crespo C, Spector D, Kamaka M, Carpenter DA, Carney PA. Concerning trends in allopathic medical school faculty rank for Indigenous people: 2014-2016. MEDICAL EDUCATION ONLINE 2018; 23:1508267. [PMID: 30103656 PMCID: PMC6095016 DOI: 10.1080/10872981.2018.1508267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/29/2018] [Accepted: 07/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Trends in faculty rank according to racial and ethnic composition have not been reviewed in over a decade. OBJECTIVE To study trends in faculty rank according to racial and ethnicity with a specific focus on Indigenous faculty, which has been understudied. METHODS Data from the Association of American Medical Colleges' Faculty Administrative Management Online User System was used to study trends in race/ethnicity faculty composition and rank between 2014 and 2016, which included information on 481,753 faculty members from 141 US allopathic medical schools. RESULTS The majority of medical school faculty were White, 62.4% (n = 300,642). Asian composition represented 14.7% (n = 70,647). Hispanic, Latino, or of Spanish Origin; Multiple Race-Hispanic; Multiple Race-Non-Hispanic; and Black/African American faculty represented 2.2%, 2.3%, 3.0%, and 3.0%, respectively. Indigenous faculty members, defined as American Indian/Alaska Native (AIAN), Native Hawaiian or Other Pacific Islander (NHPI), represented the smallest percentage of faculty at 0.11% and 0.18%, respectively. White faculty predominated the full professor rank at 27.5% in 2016 with a slight decrease between 2014 and 2016. Indigenous faculty represented the lowest percent of full professor faculty at 5.2% in 2016 for AIAN faculty and a decline from 4.6% to 1.6% between 2014 and 2016 for NHPI faculty (p < 0.001). CONCLUSIONS While US medical school faculty are becoming more racially and ethnically diverse, representation of AIAN faculty is not improving and is decreasing significantly among NHPI faculty. Little progress has been made in eliminating health disparities among Indigenous people. Diversifying the medical workforce could better meet the needs of communities that historically and currently experience a disproportionate disease burden.
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Affiliation(s)
- Erik Brodt
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amanda Bruegl
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Erin K. Thayer
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - M. Patrice Eiff
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kelly Gonzales
- Community Health Program, School of Public Health, Oregon Health & Science and Portland State University, Portland, OR, USA
| | - Carlos Crespo
- Community Health Program, Undergraduate Training Biomedical Research, Oregon Health & Science University and Portland State University, School of Public Health, Portland, OR, USA
| | - Dove Spector
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Martina Kamaka
- Department of Native Hawaiian Health, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Dee-Ann Carpenter
- Department of Native Hawaiian Health, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Patricia A. Carney
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Gonzales KL, Garcia GE, Jacob MM, Muller C, Nelson L, Manson SM. Patient-provider relationship and perceived provider weight bias among American Indians and Alaska Natives. Obes Sci Pract 2018; 4:76-84. [PMID: 29479467 PMCID: PMC5818742 DOI: 10.1002/osp4.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 12/25/2022] Open
Abstract
Objective The objective of this study was to examine patient-provider relationships among American Indians and Alaska Native (AI/AN) patients by examining associations between patient activation, perceived provider weight bias and working alliance. Patient activation is generally defined as having the knowledge, skills and confidence to manage one's health. Methods Among a sample of 87 AI/AN adults presenting for general medical care at an urban clinic in the north-west region of the USA, ordinary least squares regression analysis was completed to examine associations. Results Better working alliance scores were associated with increased patient activation, while perceived provider weight bias was associated with reduced patient activation. In addition, those with class II obesity had decreased patient activation. Conclusion These findings point to the importance of a positive patient-provider relationship in AI/ANs. Optimal patient engagement and subsequent health outcomes warrant additional consideration of patients' perceptions of provider weight bias within the context of health promotion and interventions.
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Affiliation(s)
- K. L. Gonzales
- Oregon Health Sciences University‐Portland State University School of Public HealthPortland State UniversityPortlandORUSA
| | - G. E. Garcia
- Department of SociologyPortland State UniversityPortlandORUSA
| | - M. M. Jacob
- Department of Education Studies, College of EducationUniversity of OregonEugeneORUSA
| | - C. Muller
- Initiative for Research and Education to Advance Community HealthWashington State UniversitySeattleWAUSA
| | - L. Nelson
- Initiative for Research and Education to Advance Community HealthWashington State UniversitySeattleWAUSA
| | - S. M. Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado DenverAuroraCOUSA
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Ben J, Cormack D, Harris R, Paradies Y. Racism and health service utilisation: A systematic review and meta-analysis. PLoS One 2017; 12:e0189900. [PMID: 29253855 PMCID: PMC5734775 DOI: 10.1371/journal.pone.0189900] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/04/2017] [Indexed: 11/18/2022] Open
Abstract
Although racism has been posited as driver of racial/ethnic inequities in healthcare, the relationship between racism and health service use and experience has yet to be systematically reviewed or meta-analysed. This paper presents a systematic review and meta-analysis of quantitative empirical studies that report associations between self-reported racism and various measures of healthcare service utilisation. Data were reviewed and extracted from 83 papers reporting 70 studies. Studies included 250,850 participants and were conducted predominately in the U.S. The meta-analysis included 59 papers reporting 52 studies, which were analysed using random effects models and mean weighted effect sizes. Racism was associated with more negative patient experiences of health services (HSU-E) (OR = 0.351 (95% CI [0.236,0.521], k = 19), including lower levels of healthcare-related trust, satisfaction, and communication. Racism was not associated with health service use (HSU-U) as an outcome group, and was not associated with most individual HSU-U outcomes, including having had examinations, health service visits and admissions to health professionals and services. Racism was associated with health service use outcomes such as delaying/not getting healthcare, and lack of adherence to treatment uptake, although these effects may be influenced by a small sample of studies, and publication bias, respectively. Limitations to the literature reviewed in terms of study designs, sampling methods and measurements are discussed along with suggested future directions in the field.
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Affiliation(s)
- Jehonathan Ben
- Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
| | - Donna Cormack
- Eru Pōmare Māori Health Research Centre, Department of Public Health, University of Otago, Wellington South, New Zealand
| | - Ricci Harris
- Eru Pōmare Māori Health Research Centre, Department of Public Health, University of Otago, Wellington South, New Zealand
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
- * E-mail:
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Sittner KJ, Greenfield BL, Walls ML. Microaggressions, diabetes distress, and self-care behaviors in a sample of American Indian adults with type 2 diabetes. J Behav Med 2017; 41:122-129. [PMID: 29116568 DOI: 10.1007/s10865-017-9898-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 10/30/2017] [Indexed: 12/29/2022]
Abstract
American Indian/Alaska Native people experience the highest age-adjusted prevalence of type 2 diabetes of any racial group in the United States, as well as high rates of related health problems. Chronic stressors such as perceived discrimination are important contributors to these persistent health disparities. The current study used structural equation modeling to examine the relationships between racial microaggressions, diabetes distress, and self-care behaviors (diet and exercise) in a sample of 192 American Indians with type 2 diabetes from the northern United States. We found that microaggressions was positively associated with diabetes distress and that microaggressions had an indirect link to self-care via diabetes distress. Diabetes distress is an important mechanism linking microaggressions to self-care behaviors, which are critical to successful disease management and the reduction of complications. The amelioration of diabetes distress could improve self-care even in the presence of pervasive, chronic social stressors such as microaggressions.
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Affiliation(s)
- Kelley J Sittner
- Department of Sociology, Oklahoma State University, 431 Murray Hall, Stillwater, OK, 74078, USA.
| | - Brenna L Greenfield
- Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School, Duluth Campus, 1035 University Drive, Duluth, MN, 55812, USA
| | - Melissa L Walls
- Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School, Duluth Campus, 1035 University Drive, Duluth, MN, 55812, USA
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Pickner WJ, Ziegler KM, Hanson JD, Payne NR, Zook HG, Kharbanda AB, Weber TL, Russo JN, Puumala SE. Community Perspectives on Emergency Department Use and Care for American Indian Children. J Racial Ethn Health Disparities 2017; 5:939-946. [PMID: 29101687 DOI: 10.1007/s40615-017-0442-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/21/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
Abstract
Emergency department (ED) utilization by American Indian (AI) children is among the highest in the nation. Numerous health disparities have been well documented in AI children, but limited information is available on parental experiences of care for AI children in the ED. Our objective was to understand parental attitudes towards ED care for AI children. Focus groups were held with AI parents/caregivers at five sites in the Upper Midwest. Traditional content analysis was used to identify themes. A total of 70 parents participated in ten focus groups. Three main themes were identified: healthcare environment, access to care, and interaction with providers. Healthcare environment issues included availability of specialists, wait times, and child-friendly areas. Transportation and financial considerations were major topics in access to care. Issues in interaction with providers included discrimination, stereotyping, and trust. This is one of the first studies to assess parent perspectives on ED use for AI children. Obtaining parental perspectives on ED experiences is critical to improve patient care and provide important information for ED providers.
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Affiliation(s)
- Wyatt J Pickner
- Population Health, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA.,Department of Health Services, Community-Oriented Public Health Program, University of Washington School of Public Health, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA, 98195-7660, USA
| | - Katherine M Ziegler
- Population Health, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA.,Department of Epidemiology, Colorado School of Public Health at the University of Colorado at Denver, 13001 E. 17th Place, B119 Bldg 500, 3rd Floor West Wing, Aurora, CO, 80045, USA
| | - Jessica D Hanson
- Population Health, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA
| | - Nathaniel R Payne
- Quality Improvement, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN, 55404, USA
| | - Heather G Zook
- Quality Improvement, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN, 55404, USA.,Evaluation Division, Professional Data Analysts, Inc, 219 Main St. SE, Suite 302, Minneapolis, MN, 55414, USA
| | - Anupam B Kharbanda
- Department of Emergency Medicine, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN, 55404, USA
| | - Tess L Weber
- Population Health, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA
| | - Jaymi N Russo
- Population Health, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA
| | - Susan E Puumala
- Population Health, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA. .,Department of Pediatrics, University of South Dakota Sanford School of Medicine, 1400 W 22nd St, Sioux Falls, SD, 57105, USA.
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Moving beyond the individual: Community-level prejudice and health. Soc Sci Med 2017; 183:169-172. [DOI: 10.1016/j.socscimed.2017.04.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 01/01/2023]
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Abstract
BACKGROUND American Indian children have high rates of emergency department (ED) use and face potential discrimination in health care settings. OBJECTIVE Our goal was to assess both implicit and explicit racial bias and examine their relationship with clinical care. RESEARCH DESIGN We performed a cross-sectional survey of care providers at 5 hospitals in the Upper Midwest. Questions included American Indian stereotypes (explicit attitudes), clinical vignettes, and the Implicit Association Test. Two Implicit Association Tests were created to assess implicit bias toward the child or the parent/caregiver. Differences were assessed using linear and logistic regression models with a random effect for study site. RESULTS A total of 154 care providers completed the survey. Agreement with negative American Indian stereotypes was 22%-32%. Overall, 84% of providers had an implicit preference for non-Hispanic white adults or children. Older providers (50 y and above) had lower implicit bias than those middle aged (30-49 y) (P=0.01). American Indian children were seen as increasingly challenging (P=0.04) and parents/caregivers less compliant (P=0.002) as the proportion of American Indian children seen in the ED increased. Responses to the vignettes were not related to implicit or explicit bias. CONCLUSIONS The majority of ED care providers had an implicit preference for non-Hispanic white children or adults compared with those who were American Indian. Provider agreement with negative American Indian stereotypes differed by practice and respondents' characteristics. These findings require additional study to determine how these implicit and explicit biases influence health care or outcomes disparities.
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Thayer ZM, Blair IV, Buchwald DS, Manson SM. Racial discrimination associated with higher diastolic blood pressure in a sample of American Indian adults. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2017; 163:122-128. [PMID: 28198537 DOI: 10.1002/ajpa.23190] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/18/2017] [Accepted: 01/29/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Hypertension prevalence is high among American Indians (AIs). AIs experience a substantial burden of interpersonal racial discrimination, which in other populations has been associated with higher blood pressure. The purpose of this study is to understand whether racial discrimination experiences are associated with higher blood pressure in AIs. MATERIALS AND METHODS We used the Everyday Discrimination Scale to evaluate the relationship between discrimination and measured blood pressure among 77 AIs from two reservation communities in the Northern Plains. We used multivariate linear regression to evaluate the association of racial discrimination with systolic and diastolic blood pressure, respectively. Racial discrimination, systolic blood pressure, and diastolic blood pressure were analyzed as continuous variables. All analyses adjusted for sex, waist circumference, age, posttraumatic stress disorder status, and education. RESULTS We found that 61% of participants experienced discrimination that they attributed to their race or ancestry. Racial discrimination was associated with significantly higher diastolic blood pressure (β = 0.22, SE = 0.09, p = .02), and with a similar non-significant trend toward higher systolic blood pressure (β = 0.25, SE = 0.15, p = .09). CONCLUSION The results of this analysis suggest that racial discrimination may contribute to higher diastolic blood pressure within Native communities. These findings highlight one pathway through which the social environment can shape patterns of biology and health in AI and other socially and politically marginalized groups.
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Affiliation(s)
| | - Irene V Blair
- Department of Psychology and Neuroscience, University of Colorado Boulder, CO, 80309
| | - Dedra S Buchwald
- Elson S Floyd College of Medicine, Washington State University, WA, 99163
| | - Spero M Manson
- Center for American Indian and Alaska Native Health, University of Colorado Denver, CO, 80204
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Dawson AZ, Walker RJ, Campbell JA, Egede LE. Validation of theoretical pathway between discrimination, diabetes self-care and glycemic control. J Diabetes Complications 2016; 30:858-63. [PMID: 27068266 PMCID: PMC7061439 DOI: 10.1016/j.jdiacomp.2016.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 11/17/2022]
Abstract
AIMS This study examined the mechanisms through which discrimination influences diabetes self-care and glycemic control in patients with diabetes by using structured equation modeling. METHODS 615 patients were recruited from two adult primary care clinics in the southeastern United States. Measures were based on a theoretical model and included perceived discrimination, social support, social cohesion, and perceived stress. Structured equation modeling examined the relationship with diabetes self-care and glycemic control. RESULTS The final model (chi2(211)=328.82, p<0.0001, R(2)=0.99, RMSEA=0.03 and CFI=0.98) shows that higher stress is directly significantly related to a decreased self-care (r=-0.59, p <0.001) and increased HbA1c (r=0.27, p<0.05). There was no significant direct association between discrimination, social support or social cohesion, and glycemic control or self-care. There was, however, a direct significant association between increased discrimination (r=0.46, p<0.001), decreased social support (r=-0.34, p<0.001), increased social cohesion (r=0.14, p<0.05) and increased stress. CONCLUSIONS These results support the hypothesized pathway of discrimination on health outcomes, showing both a direct and indirect influence through stress on HbA1c in adults with diabetes. Understanding the pathways through which discrimination influences diabetes outcomes is important for providing more comprehensive and effective care. These results suggest future interventions targeting patients with diabetes should take discrimination-induced stress into account.
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Affiliation(s)
- Aprill Z Dawson
- Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA.
| | - Rebekah J Walker
- Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC, USA.
| | - Jennifer A Campbell
- Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA.
| | - Leonard E Egede
- Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA.
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Cunningham JK, Solomon TA, Muramoto ML. Alcohol use among Native Americans compared to whites: Examining the veracity of the 'Native American elevated alcohol consumption' belief. Drug Alcohol Depend 2016; 160:65-75. [PMID: 26868862 DOI: 10.1016/j.drugalcdep.2015.12.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 12/10/2015] [Accepted: 12/12/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study uses national survey data to examine the veracity of the longstanding belief that, compared to whites, Native Americans (NA) have elevated alcohol consumption. METHODS The primary data source was the National Survey on Drug Use and Health (NSDUH) from 2009 to 2013: whites (n=171,858) and NA (n=4,201). Analyses using logistic regression with demographic covariate adjustment were conducted to assess differences in the odds of NA and whites being alcohol abstinent, light/moderate drinkers (no binge/heavy consumption), binge drinkers (5+ drinks on an occasion 1-4 days), or heavy drinkers (5+ drinks on an occasion 5+ days) in the past month. Complementary alcohol abstinence, light/moderate drinking and excessive drinking analyses were conducted using Behavioral Risk Factor Surveillance System (BRFSS) data from 2011 to 2013: whites (n=1,130,658) and NA (n=21,589). RESULTS In the NSDUH analyses, the majority of NA, 59.9% (95% CI: 56.7-63.1), abstained, whereas a minority of whites, 43.1% (CI: 42.6-43.6), abstained-adjusted odds ratio (AOR): 0.64 (CI: 0.56-0.73). Approximately 14.5% (CI: 12.0-17.4) of NA were light/moderate-only drinkers, versus 32.7% (CI: 32.2-33.2) of whites (AOR: 1.90; CI: 1.51-2.39). NA and white binge drinking estimates were similar-17.3% (CI: 15.0-19.8) and 16.7% (CI: 16.4-17.0), respectively (AOR: 1.00; CI: 0.83-1.20). The two populations' heavy drinking estimates were also similar-8.3% (CI: 6.7-10.2) and 7.5% (CI: 7.3-7.7), respectively (AOR: 1.06; CI: 0.85-1.32). Results from the BRFSS analyses generally corroborated those from NSDUH. CONCLUSIONS In contrast to the 'Native American elevated alcohol consumption' belief, Native Americans compared to whites had lower or comparable rates across the range of alcohol measures examined.
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Affiliation(s)
- James K Cunningham
- Department of Family and Community Medicine, The University of Arizona, 1450 N. Cherry Avenue, Tucson, AZ 85719, United States; Native American Research and Training Center, The University of Arizona, 1642 East Helen Street, Tucson, AZ 85719, United States.
| | - Teshia A Solomon
- Department of Family and Community Medicine, The University of Arizona, 1450 N. Cherry Avenue, Tucson, AZ 85719, United States; Native American Research and Training Center, The University of Arizona, 1642 East Helen Street, Tucson, AZ 85719, United States.
| | - Myra L Muramoto
- Department of Family and Community Medicine, The University of Arizona, 1450 N. Cherry Avenue, Tucson, AZ 85719, United States.
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