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James D, Horne L. Examining barriers to dental, medical, mental, and vision healthcare access, attitudes towards seeking healthcare, and internalized racism among Black Americans. Soc Sci Med 2024; 357:117193. [PMID: 39127001 DOI: 10.1016/j.socscimed.2024.117193] [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: 05/16/2024] [Revised: 07/16/2024] [Accepted: 08/04/2024] [Indexed: 08/12/2024]
Abstract
Structural barriers, which impede access to healthcare, are often seen as tangible expressions of structural racism. Those who experience more structural barriers to healthcare access are likely to experience poor health. Expanding on this notion, our research integrated the Internalized Racism Framework (James, 2022) with the Structural Vulnerability Framework (Bourgois et al., 2017; Metzl and Hansen, 2014) to explore how encountering barriers to healthcare access influences healthcare seeking attitudes across four health domains: mental, medical, dental, and vision. Our study included a sample of 780 Black American adults (average age = 37.68) who were recruited to participate in an anonymous web-based cross-sectional survey. Our findings revealed that internalized racism explained the direct effect of healthcare access structural barriers on healthcare attitudes in the mental, medical, and vision health domains, but not in the dental health domain. Specifically, the experience of more structural barriers in accessing healthcare (mental, medical, and vision) correlated with heightened internalized racism, which, in turn, was associated with more negative attitudes towards seeking (mental, medical, and vision) healthcare. Notably, our results also showed variations in the frequency and types of structural barriers encountered across the four health domains, along with differences in participants' positive healthcare seeking attitudes. Our findings underscore an urgent need for targeted interventions addressing both structural and internalized racism. Removing healthcare access barriers is crucial for fostering equitable healthcare access for Black Americans. Future research should explore additional factors influencing healthcare seeking attitudes, as well as strategies that mitigate the negative effects of racism on said attitudes.
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Affiliation(s)
- Drexler James
- Department of Psychology, University of Minnesota, USA.
| | - Lisette Horne
- Department of Psychology, University of Minnesota, USA
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2
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Zamor RL, Liberman DB, Hall JE, Rees CA, Hartford EA, Chaudhari PP, Portillo EN, Johnson MD. Collecting Sociodemographic Data in Pediatric Emergency Research: A Working Group Consensus. Pediatrics 2024; 154:e2023065277. [PMID: 39044723 PMCID: PMC11291964 DOI: 10.1542/peds.2023-065277] [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] [Received: 12/18/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 07/25/2024] Open
Abstract
Understanding and addressing health care disparities relies on collecting and reporting accurate data in clinical care and research. Data regarding a child's race, ethnicity, and language; sexual orientation and gender identity; and socioeconomic and geographic characteristics are important to ensure equity in research practices and reported outcomes. Disparities are known to exist across these sociodemographic categories. More consistent, accurate data collection could improve understanding of study results and inform approaches to resolve disparities in child health. However, published guidance on standardized collection of these data in children is limited, and given the evolving nature of sociocultural identities, requires frequent updates. The Pediatric Emergency Care Applied Research Network, a multi-institutional network dedicated to pediatric emergency research, developed a Health Disparities Working Group in 2021 to support and advance equitable pediatric emergency research. The working group, which includes clinicians involved in pediatric emergency medical care and researchers with expertise in pediatric disparities and the conduct of pediatric research, prioritized creating a guide for approaches to collecting race, ethnicity, and language; sexual orientation and gender identity; and socioeconomic and geographic data during the conduct of research in pediatric emergency care settings. Our aims with this guide are to summarize existing barriers to sociodemographic data collection in pediatric emergency research, highlight approaches to support the consistent and reproducible collection of these data, and provide rationale for suggested approaches. These approaches may help investigators collect data through a process that is inclusive, consistent across studies, and better informs efforts to reduce disparities in child health.
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Affiliation(s)
- Ronine L. Zamor
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Division of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Danica B. Liberman
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Departments of Pediatrics
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jeanine E. Hall
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Departments of Pediatrics
| | - Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Division of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Emily A. Hartford
- Division of Emergency Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Departments of Pediatrics
| | - Elyse N. Portillo
- Division of Pediatric Emergency medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Michael D. Johnson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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3
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Cai PY, Kurtz MP, Nelson CP. Urology Mythbusters: Does prevalence of vesicoureteral reflux in children vary by race? J Pediatr Urol 2024; 20:514-518. [PMID: 38383275 DOI: 10.1016/j.jpurol.2024.02.004] [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] [Received: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
In this edition of Mythbusters, we examine the premise that prevalence of vesicoureteral reflux (VUR) in children varies by race. Specifically, we consider whether there is evidence supporting the contention that VUR is more common in White children and less common in Black children. Statements regarding the lower prevalence of VUR in Black children are ubiquitous in both research papers and reviews. Many of the references cited in support of these statements do not actually support the existence of racial variation in VUR, due to uncontrolled single-arm study designs, highly selected samples at risk for bias, or simply not addressing VUR prevalence at all. There is a small group of studies which directly compared VUR prevalence among children undergoing cystography, and these studies have found VUR to be less common among Black children compared to White children. However, the results of such papers can only be considered in the context of a system in which systemic bias and racism may impact access and care delivery in profound ways. Given that race is a social construct that bears little relationship to shared genetic ancestry or underlying biological characteristics, these findings must be approached with extreme caution. The goals of pediatric urological care should be to confer equitable care to all young children regardless of race.
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Affiliation(s)
- Peter Y Cai
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Michael P Kurtz
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Caleb P Nelson
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
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Gonzalez T, Nicholas A, Olagbenro M, Feldman SR, Fleischer AB. Race and ethnicity are inadequate predictors of ambulatory visit length and utilization of preventive services. J Natl Med Assoc 2024; 116:131-138. [PMID: 38402107 DOI: 10.1016/j.jnma.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 11/22/2023] [Accepted: 12/03/2023] [Indexed: 02/26/2024]
Abstract
Health disparities can be experienced by any disadvantaged group who has limited access to healthcare or decreased quality of care. Quality of care can be measured by physician-patient communication measures such as length of visit, health outcomes, patient satisfaction, or by the services one receives such as screening or health education. This study aims to determine the relationship between length of physician-patient encounter, number of preventive services, ethnicity, and race. This study utilizes data from the National Ambulatory Medical Care Survey (NAMCS) from 2007 to 2016. Visits with a single diagnosis were selected. Visits with the five most frequent diagnoses were selected by International Classification of Diseases, Ninth or Tenth Revision (ICD-9/ICD-10) classification. The primary outcome is time spent with a physician in minutes and the number of preventive services provided represented by the Preventive Service Index (PSI). Of 255,916 visits, non-white individuals made up 16.2% (95% Confidence Interval 15.9-16.4) while Latinos represented 13.4% (95%CI 13.2-13.6) of individuals. Multivariate analysis revealed minimal differences in visit length in race and ethnic groups regardless of diagnosis. Greater PSI was associated with individuals less than 43 years old (Odds Ratio (OR) 2.0, 95% CI 1.8-2.3, p =< 0.0001), those who reside in metropolitan statistical areas (MSAs) (OR 1.2, 95% CI 1.1-1.4, p = 0.006), non-white individuals (OR 1.2, 95% CI 1.1-1.3, p = 0.004), and those with private insurance (OR 1.3, 95% CI 1.1-1.4, p =< 0.0001). Race and ethnicity do not predict length of time with a physician regardless of diagnosis. Age, race, location within a metropolitan area, and insurance are significant but minimal predictors of receiving preventive services in the rank-order leading five most frequent diagnoses. This large, population-based study highlights improvements in the distribution of healthcare services from previous studies.
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Affiliation(s)
- Tammy Gonzalez
- University of Cincinnati School of Medicine Department of Dermatology, 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Andrew Nicholas
- University of Cincinnati School of Medicine Department of Dermatology, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Matthew Olagbenro
- University of Cincinnati School of Medicine Department of Dermatology, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Steven R Feldman
- Wake Forest School of Medicine, 4618 Country Club Road, Winston Salem, NC 27104, USA
| | - Alan B Fleischer
- University of Cincinnati School of Medicine Department of Dermatology, 3230 Eden Ave, Cincinnati, OH 45267, USA
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Willis DE, Kaholokula JK, Andersen JA, Selig JP, Bogulski CA, Scott AJ, McElfish PA. Racial Misclassification, Discrimination, Consciousness, and Self-Rated Health Among Native Hawaiian and Pacific Islander Adults in the USA. J Racial Ethn Health Disparities 2024; 11:730-738. [PMID: 36892814 PMCID: PMC9997430 DOI: 10.1007/s40615-023-01556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Medical researchers have historically utilized the variable of race uncritically, rarely defining race, rarely acknowledging it as a social construct, and often omitting information about how it was measured. In this study, we use the following definition of race: "a system of structuring opportunity and assigning value based on the social interpretation of how one looks." We examine the influence of racial misclassification, racial discrimination, and racial consciousness on the self-rated health of Native Hawaiian and Pacific Islanders (NHPI) living in the United States of America (USA). METHODS Our analysis used online survey data from a subgroup of NHPI adults living in the USA (n = 252) who were oversampled as part of a larger study of US adults (N = 2022). Respondents were recruited between September 7, 2021 and October 3, 2021, from an online opt-in panel of individuals across the USA. Statistical analyses include weighted and unweighted descriptive statistics for the sample, as well as a weighted logistic regression for poor/fair self-rated health. RESULTS Odds of poor/fair self-rated health were greater for women (OR = 2.72; 95% CI [1.19, 6.21]) and those who experienced racial misclassification (OR = 2.90; 95% CI [1.20, 7.05]). No other sociodemographic, healthcare, or race-related variables were significantly associated with self-rated health in the fully adjusted results. CONCLUSIONS Findings suggest that racial misclassification may be an important correlate of self-rated health among NHPI adults in the US context.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA.
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Cari A Bogulski
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
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Padilla M, Luna-Gierke RE, Carree T, Gutierrez M, Yuan X, Dasgupta S. Racial Differences in Social Determinants of Health and Outcomes Among Hispanic/Latino Persons with HIV-United States, 2015-2020. J Racial Ethn Health Disparities 2024; 11:574-588. [PMID: 36826779 PMCID: PMC10447624 DOI: 10.1007/s40615-023-01542-4] [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: 10/20/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Hispanic/Latino people with HIV (PWH) experience disparities in health outcomes compared with other racial and ethnic groups. Disaggregated data based on race for Hispanic/Latino PWH in the United States are rarely reported, potentially masking inequities. METHODS The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV. We used weighted interview and medical record data collected from June 2015-May 2021 to examine differences in social determinants of health (SDH) and health outcomes by self-reported race among Hispanic/Latino adults with diagnosed HIV. RESULTS Compared with White Hispanic/Latino PWH, Black Hispanic/Latino PWH were more likely to be unemployed (PR, 1.4; CI, 1.2-1.8), have a disability (PR, 1.3; CI, 1.2-1.5), have experienced homelessness (PR, 1.8; CI, 1.2-2.6), and have been incarcerated (PR, 2.6; CI, 1.5-4.5). American Indian/Alaska Native (AI/AN) (PR, 1.8; CI, 1.1-2.7) and multiracial (PR, 2.0; CI, 1.4-2.9) Hispanic/Latino PWH were more likely to have experienced homelessness than White Hispanic/Latino PWH. Black (PR, 1.3; CI, 1.2-1.5) and multiracial (PR, 1.2; CI, 1.1-1.5) Hispanic/Latino PWH were more likely to be virally unsuppressed than White Hispanic/Latino PWH. CONCLUSION Black, multiracial, and AI/AN Hispanic/Latino PWH experience disparities in SDH and HIV outcomes. Lumping Hispanic/Latino people into one racial and ethnic category obscures health disparities, which might limit our progress towards reaching national HIV goals. Future studies should consider disaggregating by other factors such as Hispanic origin, place of birth, immigration status, and primary language. Doing so recognizes the diversity of the Hispanic/Latino population.
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Affiliation(s)
- Mabel Padilla
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- DHAP/NCHHSTP/CDC, 1600 Clifton Road NE MS E-46, Atlanta, GA, 30333, USA.
| | - Ruth E Luna-Gierke
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mariana Gutierrez
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Yuan
- DLH Corporation, Atlanta, GA, USA
| | - Sharoda Dasgupta
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ryu S, Hirschtick JL, Allgood KL, Orellana R, Fleischer NL. Racial discrimination in healthcare settings and mental health among a population-based sample of racial and ethnic minoritized adults with COVID-19 in Michigan. Prev Med Rep 2023; 36:102529. [PMID: 38116267 PMCID: PMC10728443 DOI: 10.1016/j.pmedr.2023.102529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023] Open
Abstract
The COVID-19 pandemic has worsened existing racial health disparities and racial discrimination in healthcare; however, little is known about how racial discrimination in healthcare settings is related to mental health during the pandemic. Using a population-based probability sample of racial and ethnic minoritized adults with a polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection in Michigan, we examined how measures of perceived racial discrimination in (1) seeking healthcare for COVID-19 (n = 1,210) and (2) receiving testing/treatment for COVID-19 (n = 1,364) were associated with binary variables of depressive and anxiety symptoms. We conducted a modified Poisson regression analysis with robust standard errors to estimate associations between each measure of racial discrimination and each mental health outcome separately, adjusting for demographic and socio-economic variables, health insurance, and pre-existing physical and psychiatric conditions. 7.3 % and 8.7 % of adults reported racial discrimination in seeking healthcare for COVID-19 and in getting testing/treatment for COVID-19, respectively. Although the overall prevalence of racial discrimination in healthcare settings was low, experiences of racial discrimination were associated with depressive symptoms. Adults who experienced racial discrimination in seeking healthcare had 1.74 times higher prevalence of reporting depressive symptoms (95 % CI:1.21-2.52) than those who did not. Moreover, adults who experienced racial discrimination in getting testing/treatment had 1.86 times higher prevalence of reporting depressive symptoms (95 % CI:1.36-2.53) than those who did not. Neither measure of racial discrimination was associated with anxiety symptoms in the adjusted models. There is a need for promoting anti-racial discrimination policies, educational programs, and awareness efforts in healthcare settings.
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Affiliation(s)
- Soomin Ryu
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Jana L. Hirschtick
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Kristi L. Allgood
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, United States of America
| | - Robert Orellana
- CDC Foundation, Atlanta, GA, United States of America
- Michigan Department of Health and Human Services, Lansing MI, United States of America
| | - Nancy L. Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
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Crowe RP, Kennel J, Fernandez AR, Burton BA, Wang HE, Van Vleet L, Bourn SS, Myers JB. Racial, Ethnic, and Socioeconomic Disparities in Out-of-Hospital Pain Management for Patients With Long Bone Fractures. Ann Emerg Med 2023; 82:535-545. [PMID: 37178100 DOI: 10.1016/j.annemergmed.2023.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/20/2023] [Accepted: 03/30/2023] [Indexed: 05/15/2023]
Abstract
STUDY OBJECTIVE To evaluate racial and ethnic disparities in out-of-hospital analgesic administration, accounting for the influence of clinical characteristics and community socioeconomic vulnerability, among a national cohort of patients with long bone fractures. METHODS Using the 2019-2020 ESO Data Collaborative, we retrospectively analyzed emergency medical services (EMS) records for 9-1-1 advanced life support transport of adult patients diagnosed with long bone fractures at the emergency department. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for out-of-hospital analgesic administration by race and ethnicity, accounting for age, sex, insurance, fracture location, transport time, pain severity, and scene Social Vulnerability Index. We reviewed a random sample of EMS narratives without analgesic administration to identify whether other clinical factors or patient preferences could explain differences in analgesic administration by race and ethnicity. RESULTS Among 35,711 patients transported by 400 EMS agencies, 81% were White, non-Hispanic, 10% were Black, non-Hispanic, and 7% were Hispanic. In crude analyses, Black, non-Hispanic patients with severe pain were less likely to receive analgesics compared with White, non-Hispanic patients (59% versus 72%; Risk Difference: -12.5%, 95% CI: -15.8% to -9.9%). After adjustment, Black, non-Hispanic patients remained less likely to receive analgesics compared with White, non-Hispanic patients (aOR:0.65, 95% CI:0.53 to 0.79). Narrative review identified similar rates of patients declining analgesics offered by EMS and analgesic contraindications across racial and ethnic groups. CONCLUSIONS Among EMS patients with long bone fractures, Black, non-Hispanic patients were substantially less likely to receive out-of-hospital analgesics compared with White, non-Hispanic patients. These disparities were not explained by differences in clinical presentations, patient preferences, or community socioeconomic conditions.
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Affiliation(s)
| | - Jamie Kennel
- Oregon Health and Science University, Portland, OR; Oregon Institute of Technology, Wilsonville, OR
| | | | | | - Henry E Wang
- Department of Emergency Medicine, The Ohio State University, Columbus, OH
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Williams JC, Andreou A, Castillo EG, Neff J, Goldenberg M, Lee CR, Aysola J, Rohrbaugh R, Isom J. Antiracist Documentation Practices - Shaping Clinical Encounters and Decision Making. N Engl J Med 2023; 389:1238-1244. [PMID: 37754291 PMCID: PMC10617745 DOI: 10.1056/nejmms2303340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
- J Corey Williams
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Ashley Andreou
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Enrico G Castillo
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Joshua Neff
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Matthew Goldenberg
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Courtney R Lee
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Jaya Aysola
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Robert Rohrbaugh
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Jessica Isom
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
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10
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Krobath DM, Cuevas AG, Allen JD, Chung M, Economos CD, Mistry J. The Influence of Contested Racial Identity and Perceived Everyday Discrimination Exposure on Body Mass Index in US Adults. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01774-4. [PMID: 37668959 DOI: 10.1007/s40615-023-01774-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
Contested racial identity-the discrepancy between one's self-identified race and socially assigned race-is a social determinant of health and may contribute to overweight and obesity. Obesity is associated with a host of short- and long-term health conditions, including cardiovascular disease, a leading cause of death. Individuals racialized as Black, Hispanic, and Latino are at the greatest risk of obesity. Previous research indicates that experiencing interpersonal discrimination is associated with higher body mass index (BMI) in adults, and individuals with a contested racial identity are disproportionately exposed to interpersonal discrimination. However, the association between BMI and contested racial identity is unknown. This cross-sectional study measured the relationship between contested racial identity and perceived everyday discrimination on BMI in a nationally representative sample of US adults. Contested racial identity was measured with a binary variable indicating agreement between participants' self-identified race and socially assigned race. Weighted unadjusted and adjusted multiple linear regression models quantified the associations between BMI and contested racial identity with and without the mean discrimination score. Covariates included nativity status, income, education, racial identity salience, gender, and age. Among 1689 participants, 18.3% had a contested racial identity. Contested identity was associated with significantly higher BMI (β = 1.01, 95% CI = 0.06, 1.92), but the relationship was attenuated when adjusting for interpersonal discrimination, suggesting that individuals with contested identity may face a greater risk of obesity due to their disproportionately high exposure to interpersonal racial discrimination. Further research is needed to elucidate the impact of racism on BMI and obesity risk.
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Affiliation(s)
- Danielle M Krobath
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA.
- Eliot-Pearson Department of Child Study and Human Development, Tufts University, 105 College Ave, Medford, MA, 02155, USA.
| | - Adolfo G Cuevas
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
- Center for Anti-Racism, Social Justice, and Public Health, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
| | | | - Mei Chung
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Jayanthi Mistry
- Eliot-Pearson Department of Child Study and Human Development, Tufts University, 105 College Ave, Medford, MA, 02155, USA
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11
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Luccarelli J, Sacks CA, Snydeman C, Luccarelli C, Smith F, Beach SR, McCoy TH. Coding for Physical Restraint Status Among Hospitalized Patients: a 2019 National Inpatient Sample Analysis. J Gen Intern Med 2023; 38:2461-2469. [PMID: 37002459 PMCID: PMC10064960 DOI: 10.1007/s11606-023-08179-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/17/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND The reduction of physical restraint utilization in the hospital setting is a key goal of high-quality care, but little is known about the rate of restraint use in general hospitals in the USA. OBJECTIVE This study reports the rate of physical restraint coding among acute care hospital discharges in the USA and explores associated demographic and diagnostic factors. DESIGN The National Inpatient Sample, a de-identified all-payors database of acute care hospital discharges in the USA, was queried for patients aged 18 and older with a diagnosis code for physical restraint status in 2019. PARTICIPANTS Hospitalized patients aged 18 and older. MAIN MEASURES Demographics, discharge diagnoses, in-hospital mortality, length of stay, total hospital charges. KEY RESULTS In total, 220,470 (95% CI: 208,114 to 232,826) hospitalizations, or 0.7% of overall hospitalizations, included a discharge code for physical restraint status. There was a 700-fold difference in coding for restraint utilization based on diagnosis, with 7.4% of patients with encephalitis receiving restraint diagnosis codes compared to < 0.01% of patients with uncomplicated diabetes. In an adjusted model, male sex was associated with an odds ratio of 1.4 (95% CI: 1.4 to 1.5) for restraint utilization coding, and Black race was associated with an odds ratio of 1.3 (95% CI: 1.2 to 1.4) relative to white race. CONCLUSIONS In the general hospital setting, there is variability in physical restraint coding by sex, race, and clinical diagnosis. More research is needed into the appropriate utilization of restraints in the hospital setting and possible inequities in restraint utilization.
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Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Chana A Sacks
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine and Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Colleen Snydeman
- Patient Care Services Office of Quality & Safety, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Luccarelli
- Department of Medicine and Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Felicia Smith
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Scott R Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Thomas H McCoy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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12
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Daniels TE, Victor C, Smith EM, Belgrave C, Robinson E, Wolff JC, Hunt J, Brannan EH. Associations of Restraint and Seclusion With Race and Ethnicity on an Adolescent Inpatient Psychiatry Service. J Am Acad Child Adolesc Psychiatry 2023; 62:503-506. [PMID: 36736689 PMCID: PMC10543036 DOI: 10.1016/j.jaac.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/30/2022] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
There is limited work examining the association of race and ethnicity with restraint and seclusion (R/S) in pediatric inpatient psychiatric units. The present study assessed risk of R/S by race and ethnicity based on a retrospective review of electronic medical records (EMRs) from an adolescent inpatient psychiatric service. Demographic, diagnostic, and R/S data were analyzed for all 1,865 admissions of 1,327 patients from an adolescent unit at a child and adolescent psychiatric hospital from June 2018 to June 2021. R/S occurred in 459 of the admissions. For the purpose of patient privacy and statistical analysis, race was grouped into the following: Black or African American, other (American Indian or Alaskan Native, Asian, multiracial, other), and White. Patients identified as unknown were not included in the analysis. A binary logistic regression with a repeated subject effect regressed R/S onto race and adjusted for age, gender, and length of stay (LOS). There was an overall significant association of R/S and race (χ22 = 16.81, p < .001), but not ethnicity. In a regression model adjusted for age, gender, and LOS, patients identified as Black or African American were at significantly higher risk of R/S compared with patients identified as White (odds ratio = 1.66, p = .036). There was no significant difference in risk of R/S between patients identified as White vs other. Younger age and longer LOS were also significantly associated with R/S. These findings highlight a critical health care disparity related to race on an inpatient adolescent psychiatry service. There is likely a combination of individual and systemic factors leading to discriminatory practices in the use of R/S. Future work will assess potential associations with diagnosis and child welfare involvement and will examine additional characteristics of R/S. Focus groups held with hospital and community stakeholders will guide next steps to address these findings.
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Affiliation(s)
- Teresa E Daniels
- Warren Alpert Medical School, Brown University, Providence, Rhode Island; Initiative on Stress, Trauma, and Resilience (STAR), Warren Alpert Medical School, Brown University, Providence, Rhode Island.
| | - Colleen Victor
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eric M Smith
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Christa Belgrave
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Erica Robinson
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jennifer C Wolff
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jeffrey Hunt
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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13
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Wang C, Malaktaris A, McLean CL, Kelsven S, Chu GM, Ross KS, Endsley M, Minassian A, Liu L, Hong S, Lang AJ. Mitigating the health effects of systemic racism: Evaluation of the Race-Based Stress and Trauma Empowerment intervention. Contemp Clin Trials 2023; 127:107118. [PMID: 36796623 PMCID: PMC10389054 DOI: 10.1016/j.cct.2023.107118] [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: 10/27/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Disparities in physical and mental health among Black, Indigenous, and People of Color (BIPOC) are well-documented and mirrored in the Veteran population. Chronic stress due to racism and discrimination is one possible mechanism driving these negative health outcomes. The Race-Based Stress and Trauma Empowerment (RBSTE) group is a novel, manualized, health promotion intervention designed to address the direct and indirect impacts of racism among Veterans of Color. This paper describes the protocol of the first pilot randomized controlled trial (RCT) of RBSTE. This study will examine the feasibility, acceptability, and appropriateness of RBSTE compared to an active control (an adaptation of Present-Centered Therapy; PCT) in a Veterans Affairs (VA) healthcare setting. A secondary aim is to identify and optimize strategies for holistic evaluation. METHODS Veterans of Color (N = 48) endorsing perceived discrimination and stress will be randomized to RBSTE or PCT; both groups will be delivered in 8 weekly, 90-min virtual group sessions. Outcomes will include measures of psychological distress, discrimination and ethnoracial identity, holistic wellness, and allostatic load. Measures will be administered at baseline and post-intervention. CONCLUSION This study will inform future interventions targeting identity-based stressors and represents an important step in advancing equity for BIPOC in medicine and research. CLINICAL TRIAL REGISTRATION NUMBER NCT05422638.
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Affiliation(s)
- Clarice Wang
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.
| | - Anne Malaktaris
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA; University of California San Diego, Department of Psychiatry, 9500 Gilman Dr., La Jolla, CA 92093, USA; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.
| | - Caitlin L McLean
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA; University of California San Diego, Department of Psychiatry, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| | - Skylar Kelsven
- University of California San Diego, Department of Psychiatry, 9500 Gilman Dr., La Jolla, CA 92093, USA; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.
| | - Gage M Chu
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.
| | - Keisha S Ross
- VA St. Louis Health Care System, 915 N. Grand Blvd, St. Louis, MO 63106, USA.
| | - Maurice Endsley
- VA Northern California Health Care System, 10535 Hospital Way, Mather, CA 95655, USA.
| | - Arpi Minassian
- University of California San Diego, Department of Psychiatry, 9500 Gilman Dr., La Jolla, CA 92093, USA; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.
| | - Lin Liu
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| | - Suzi Hong
- University of California San Diego, Department of Psychiatry, 9500 Gilman Dr., La Jolla, CA 92093, USA; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| | - Ariel J Lang
- University of California San Diego, Department of Psychiatry, 9500 Gilman Dr., La Jolla, CA 92093, USA; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
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14
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Hosseinabadi-Farahani M, Arsalani N, Hosseini M, Mohammadi E, Fallahi-Khoshknab M. Nurses' experiences of discrimination in health care: A qualitative study in Iran. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:100. [PMID: 37288420 PMCID: PMC10243445 DOI: 10.4103/jehp.jehp_648_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/02/2022] [Indexed: 06/09/2023]
Abstract
BACKGROUND Justice in health is one of the main concerns of health organizations, and discrimination in health care is one of the negative outcomes to achieving this goal. Hence, a full understanding of the phenomenon of discrimination in health care and adopting strategies to eliminate it is necessary. The present study was conducted to explore and describe the experiences of nurses of discrimination in health care. MATERIALS AND METHODS The present qualitative content analysis study was conducted between 2019 and 2020. Data were collected through semi-structured interviews with 18 participants (two physicians, three nursing supervisors, two head nurses, four clinical nurses, two nursing assistants, and three hospitalized patients) in one public and one private hospital in the city of Tehran. The participants were selected by purposive sampling, which continued until saturation of data. Data obtained were analyzed using the Graneheim and Lundman method. RESULTS Four main categories and 14 subcategories were extracted from data analysis: 1) habitual discrimination (everyday discrimination in health centers, ignoring patient rights, low levels of trust in medical staff); 2) interpersonal relationships (expectations of associates, respect for colleagues and friends, the possibility of the occurrence of similar situations, reciprocating people's favors); 3) shortage of health-care resources (shortage of medical equipment, heavy workload, infrastructure of medical centers, lack of access to physicians); and 4) favoritism (ethnicity, favoritism as a common method, and favoritism as the ultimate solution to treatment problems). CONCLUSION The present study revealed certain dimensions of discrimination in health care that remain hidden in many quantitative studies. It appears that health system managers will be able to move toward eliminating discrimination in health care. Thus, designing effective models to reduce discrimination in health care based on the underlying concepts of this study is recommended.
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Affiliation(s)
| | - Narges Arsalani
- Iranian Research Center on Aging, Tarbiat Modares University, Tehran, Iran
| | - Mohammadali Hosseini
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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15
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Abuelezam NN, Cuevas A, Galea S, Hawkins SS. Socially Assigned Race and the Health of Racialized Women and Their Infants. Health Equity 2022; 6:845-851. [DOI: 10.1089/heq.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Nadia N. Abuelezam
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Adolfo Cuevas
- Community Health, Tufts University, Medford, Massachusetts, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, Massachusetts, USA
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16
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Abraham KM, Vu T, Chavis CD, Dykhuis KE, Sata MJ. An examination of predisposing and enabling factors that predict dental utilization among individuals with serious mental illness in Detroit, Michigan. Community Dent Oral Epidemiol 2022; 51:399-407. [PMID: 35607884 DOI: 10.1111/cdoe.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/14/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study evaluated which predisposing and enabling factors prospectively predicted dental utilization over 6 months among people with serious mental illness. METHODS A sample of individuals with serious mental illness (86.3% African American; 97.4% with public health insurance) was recruited from community mental health centres in Detroit, Michigan, and responded to questionnaires at baseline and at least one follow-up visit at 3 or 6 months (N = 190). Baseline assessments included demographic and clinical information, established measures of health literacy, health insurance literacy, stigma related to mental illness, experiences of racial discrimination and medical mistrust. Insurance coverage for dental care and the availability of dental services at the participants' mental health centres was recorded. At follow-up visits, participants reported healthcare utilization, including dental and primary care, since baseline. RESULTS Three factors emerged as meaningful predictors of having a dental visit in bivariate and multivariate analyses: more medical comorbidities and dental care co-located with mental health care predicted increased likelihood of a dental visit, whereas having experienced racial discrimination in a medical setting predicted lower odds of having a dental visit in the follow-up period. Co-location of dental care with mental health care was the strongest predictor of having a dental visit. CONCLUSIONS Co-locating dental care with mental health care may increase dental utilization among people with serious mental illness, possibly by mitigating known barriers to dental care for this population. Among African Americans, the co-location of dental care with mental health care may also attenuate the negative effect of prior racial discrimination in a medical setting on dental utilization.
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Affiliation(s)
| | - Tiffany Vu
- University of Detroit Mercy Detroit Michigan USA
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17
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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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18
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Granade CJ, Lindley MC, Jatlaoui T, Asif AF, Jones-Jack N. Racial and Ethnic Disparities in Adult Vaccination: A Review of the State of Evidence. Health Equity 2022; 6:206-223. [PMID: 35402775 PMCID: PMC8985539 DOI: 10.1089/heq.2021.0177] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adult vaccination coverage remains low in the United States, particularly among racial and ethnic minority populations. Objective To conduct a comprehensive literature review of research studies assessing racial and ethnic disparities in adult vaccination. Search Methods We conducted a search of PubMed, Cochrane Library, ClinicalTrials.gov, and reference lists of relevant articles. Selection Criteria Research studies were eligible for inclusion if they met the following criteria: (1) study based in the United States, (2) evaluated receipt of routine immunizations in adult populations, (3) used within-study comparison of race/ethnic groups, and (4) eligible for at least one author-defined PICO (patient, intervention, comparison, and outcome) question. Data Collection and Analysis Preliminary abstract review was conducted by two authors. Following complete abstraction of articles using a standardized template, abstraction notes and determinations were reviewed by all authors; disagreements regarding article inclusion/exclusion were resolved by majority rule. The Social Ecological Model framework was used to complete a narrative review of observational studies to summarize factors associated with disparities; a systematic review was used to evaluate eligible intervention studies. Results Ninety-five studies were included in the final analysis and summarized qualitatively within two main topic areas: (1) factors associated with documented racial-ethnic disparities in adult vaccination and (2) interventions aimed to reduce disparities or to improve vaccination coverage among racial-ethnic minority groups. Of the 12 included intervention studies, only 3 studies provided direct evidence and were of Level II, fair quality; the remaining 9 studies met the criteria for indirect evidence (Level I or II, fair or poor quality). Conclusions A considerable amount of observational research evaluating factors associated with racial and ethnic disparities in adult vaccination is available. However, intervention studies aimed at reducing these disparities are limited, are of poor quality, and insufficiently address known reasons for low vaccination uptake among racial and ethnic minority adults.
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Affiliation(s)
- Charleigh J. Granade
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan C. Lindley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tara Jatlaoui
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amimah F. Asif
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, U.S. Department of Energy, Atlanta, Georgia, USA
| | - Nkenge Jones-Jack
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abuelezam NN, Cuevas AG, Galea S, Hawkins SS. Contested racial identity and the health of women and their infants. Prev Med 2022; 155:106965. [PMID: 35065971 DOI: 10.1016/j.ypmed.2022.106965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 12/22/2021] [Accepted: 01/15/2022] [Indexed: 11/28/2022]
Abstract
Contested racial identity- self-identified race not matching socially-assigned race-may be an indication of experiences with racism. We aimed to understand the relationship between contested racial identity and women's health behaviors, health outcomes, and infant health outcomes. We used 2012-2015 Massachusetts Pregnancy Risk Assessment Monitoring System data on 5735 women linked with infants' birth certificates. We conducted regression analyses to examine associations between contested racial identity with pregnancy and infant health outcomes and further sub-analyses among women who had experienced a contested racial identity. A total of 901 (15.7%) women reported a contested racial identity. When compared to those who did not, women who had a contested racial identity had lower odds of initiating prenatal care in the first trimester (AOR: 0.76, 95% CI: 0.62, 0.95) and higher odds of smoking (AOR: 1.70, 95% CI: 1.32, 2.19). Among women who had experienced a contested racial identity, those who were socially-assigned as White had decreased odds of having a low birth weight baby (AOR: 0.52, 95% CI: 0.28, 0.99) when compared to those socially-assigned as non-White. Contested racial identity is common; it affects the behaviors that women engage in and the outcomes they experience postpartum. Further, we found that there is a potential benefit to a White social ascription. This work adds to growing evidence of the impact of racism on maternal and infant health in the United States.
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Affiliation(s)
- Nadia N Abuelezam
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA.
| | | | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
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20
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Aysola J, Clapp JT, Sullivan P, Brennan PJ, Higginbotham EJ, Kearney MD, Xu C, Thomas R, Griggs S, Abdirisak M, Hilton A, Omole T, Foster S, Mamtani M. Understanding Contributors to Racial/Ethnic Disparities in Emergency Department Throughput Times: a Sequential Mixed Methods Analysis. J Gen Intern Med 2022; 37:341-350. [PMID: 34341916 PMCID: PMC8811086 DOI: 10.1007/s11606-021-07028-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ensuring equitable care remains a critical issue for healthcare systems. Nationwide evidence highlights the persistence of healthcare disparities and the need for research-informed approaches for reducing them at the local level. OBJECTIVE To characterize key contributors in racial/ethnic disparities in emergency department (ED) throughput times. DESIGN We conducted a sequential mixed methods analysis to understand variations in ED care throughput times for patients eventually admitted to an emergency department at a single academic medical center from November 2017 to May 2018 (n=3152). We detailed patient progression from ED arrival to decision to admit and compared racial/ethnic differences in time intervals from electronic medical record time-stamp data. We then estimated the relationships between race/ethnicity and ED throughput times, adjusting for several patient-level variables and ED-level covariates. These quantitative analyses informed our qualitative study design, which included observations and semi-structured interviews with patients and physicians. KEY RESULTS Non-Hispanic Black as compared to non-Hispanic White patients waited significantly longer during the time interval from arrival to the physician's decision to admit, even after adjustment for several ED-level and patient demographic, clinical, and socioeconomic variables (Beta (average minutes) (SE): 16.35 (5.8); p value=.005). Qualitative findings suggest that the manner in which providers communicate, advocate, and prioritize patients may contribute to such disparities. When the race/ethnicity of provider and patient differed, providers were more likely to interrupt patients, ignore their requests, and make less eye contact. Conversely, if the race/ethnicity of provider and patient were similar, providers exhibited a greater level of advocacy, such as tracking down patient labs or consultants. Physicians with no significant ED throughput disparities articulated objective criteria such as triage scores for prioritizing patients. CONCLUSIONS Our findings suggest the importance of (1) understanding how our communication style and care may differ by race/ethnicity; and (2) taking advantage of structured processes designed to equalize care.
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Affiliation(s)
- Jaya Aysola
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA. .,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. .,Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.
| | - Justin T Clapp
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.,Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Patricia Sullivan
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Patrick J Brennan
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Eve J Higginbotham
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Matthew D Kearney
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Chang Xu
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Rosemary Thomas
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Sarah Griggs
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Mohamed Abdirisak
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Alec Hilton
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Toluwa Omole
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Sean Foster
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mira Mamtani
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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21
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Johnson TJ, Goyal MK, Lorch SA, Chamberlain JM, Bajaj L, Alessandrini EA, Simmons T, Casper TC, Olsen CS, Grundmeier RW, Alpern ER. Racial/Ethnic Differences in Pediatric Emergency Department Wait Times. Pediatr Emerg Care 2022; 38:e929-e935. [PMID: 34140453 PMCID: PMC8671570 DOI: 10.1097/pec.0000000000002483] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Wait time for emergency care is a quality measure that affects clinical outcomes and patient satisfaction. It is unknown if there is racial/ethnic variability in this quality measure in pediatric emergency departments (PEDs). We aim to determine whether racial/ethnic differences exist in wait times for children presenting to PEDs and examine between-site and within-site differences. METHODS We conducted a retrospective cohort study for PED encounters in 2016 using the Pediatric Emergency Care Applied Research Network Registry, an aggregated deidentified electronic health registry comprising 7 PEDs. Patient encounters were included among all patients 18 years or younger at the time of the ED visit. We evaluated differences in emergency department wait time (time from arrival to first medical evaluation) considering patient race/ethnicity as the exposure. RESULTS Of 448,563 visits, median wait time was 35 minutes (interquartile range, 17-71 minutes). Compared with non-Hispanic White (NHW) children, non-Hispanic Black (NHB), Hispanic, and other race children waited 27%, 33%, and 12% longer, respectively. These differences were attenuated after adjusting for triage acuity level, mode of arrival, sex, age, insurance, time of day, and month [adjusted median wait time ratios (95% confidence intervals): 1.11 (1.10-1.12) for NHB, 1.12 (1.11-1.13) for Hispanic, and 1.05 (1.03-1.06) for other race children compared with NHW children]. Differences in wait time for NHB and other race children were no longer significant after adjusting for clinical site. Fully adjusted median wait times among Hispanic children were longer compared with NHW children [1.04 (1.03-1.05)]. CONCLUSIONS In unadjusted analyses, non-White children experienced longer PED wait times than NHW children. After adjusting for illness severity, patient demographics, and overcrowding measures, wait times for NHB and other race children were largely determined by site of care. Hispanic children experienced longer within-site and between-site wait times compared with NHW children. Additional research is needed to understand structures and processes of care contributing to wait time differences between sites that disproportionately impact non-White patients.
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Affiliation(s)
- Tiffani J Johnson
- From the University of California, Davis Medical Center, Sacramento, CA
| | - Monika K Goyal
- Children's National Health System, The George Washington University, Washington, DC
| | - Scott A Lorch
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - James M Chamberlain
- Children's National Health System, The George Washington University, Washington, DC
| | - Lalit Bajaj
- University of Colorado, Children's Hospital, Aurora, CO
| | | | | | | | | | - Robert W Grundmeier
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth R Alpern
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
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22
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De León-Menjivar C. Understanding the Dialogical Experiences of Puerto Rican Women With Fibromyalgia: An Intersectional Analysis. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:195-201. [PMID: 34866462 DOI: 10.1177/15404153211064608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Fibromyalgia is a condition that is often misunderstood by the medical community. Misunderstandings are exacerbated when a patient is an ethnic minority, and recent literature suggests that ethnic minorities are shown to have a higher prevalence of fibromyalgia. Despite this information, many studies about fibromyalgia are conducted with Anglo-Americans while ethnic minorities are underrepresented. Methods: To address this research gap, this study uses qualitative interviews to discuss the dialogical experiences of Puerto Rican women with fibromyalgia through a combination of intersectional and rhetorical theory. These methodologies can reveal what having various identities can mean when communicating in institutional and cultural settings. Results: The data shows a significant level of gaslighting by providers, which led participants to more aggressively seek proper treatment. Cultural deference towards doctors was also noted as a practice that can backfire, especially when living with a condition that is often dismissed. Conclusion: The results indicate that when the body's truth is filtered through intersectional lenses, this truth can become distorted or lost.
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23
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McRae J, Onukwugha E. Why the Gap in Evaluating the Social Constructs and the Value of Medicines? PHARMACOECONOMICS 2021; 39:1365-1372. [PMID: 34458963 PMCID: PMC8403521 DOI: 10.1007/s40273-021-01075-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 05/07/2023]
Abstract
The compounding effects of occupying two or more social identities, such as being "Black" and "female" have been described in intersectionality theory. Intersectionality, a term coined by legal scholar and activist Kimberlé Crenshaw, is a framework to consider race and other social identities as overlapping, dynamic, and interdependent identities. Since its inception, intersectionality has made significant in-roads to inform the conceptualization and empirical investigations of race, gender, and other social identities in sociology, critical race theory, anthropology, feminist theory, and other disciplines. However, to date, cost effectiveness research has not systematically examined race intersecting with other social identities in the valuation of medicines using social theory, such as intersectionality. Consequently, cost effectiveness analysis, which is a method to study the value of medicines in diverse populations, has not been subject to sufficient examination through an intersectionality framework. In the US context, the racial injustices experienced and documented within diverse communities highlight that health outcomes cannot be examined in a vacuum; overlapping social identities such as race and class in relation to context have real effects on health behaviors, measured preferences, and economic costs. Failure to examine the effects of overlapping social identities on heterogeneity in benefits and costs can result in inadequate information for decision makers to evaluate the value of treatments. Without consideration of the overlapping social identities in diverse populations, there is a risk that cost effectiveness analysis results will not accurately reflect the value of treatments in socially disadvantaged populations. In this Current Opinion, we provide an outline for conducting socially conscious cost effectiveness analyses, using intersectionality as one example.
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Affiliation(s)
- Jacquelyn McRae
- Department of Pharmaceutical Health Services Research, University of Maryland, 220 N. Arch St, 12th Floor, Baltimore, MD, 21201, USA.
| | - Eberechukwu Onukwugha
- Department of Pharmaceutical Health Services Research, University of Maryland, 220 N. Arch St, 12th Floor, Baltimore, MD, 21201, USA
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24
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Lu Y, Wang Y, Spatz ES, Onuma O, Nasir K, Rodriguez F, Watson KE, Krumholz HM. National Trends and Disparities in Hospitalization for Acute Hypertension Among Medicare Beneficiaries (1999-2019). Circulation 2021; 144:1683-1693. [PMID: 34743531 DOI: 10.1161/circulationaha.121.057056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the past 2 decades, hypertension control in the US population has not improved and there are widening disparities. Little is known about progress in reducing hospitalizations for acute hypertension. METHODS We conducted serial cross-sectional analysis of Medicare fee-for-service beneficiaries age 65 years or older between 1999 and 2019 using Medicare denominator and inpatient files. We evaluated trends in national hospitalization rates for acute hypertension overall and by demographic and geographical subgroups. We identified all beneficiaries admitted with a primary discharge diagnosis of acute hypertension on the basis of International Classification of Diseases codes. We then used a mixed effects model with a Poisson link function and state-specific random intercepts, adjusting for age, sex, race and ethnicity, and dual-eligible status, to evaluate trends in hospitalizations. RESULTS The sample consisted of 397 238 individual Medicare fee-for-service beneficiaries. From 1999 through 2019, the annual hospitalization rates for acute hypertension increased significantly, from 51.5 to 125.9 per 100 000 beneficiary-years; the absolute increase was most pronounced among the following subgroups: adults ≥85 years (66.8-274.1), females (64.9-160.1), Black people (144.4-369.5), and Medicare/Medicaid insured (dual-eligible, 93.1-270.0). Across all subgroups, Black adults had the highest hospitalization rate in 2019, and there was a significant increase in the differences in hospitalizations between Black and White people from 1999 to 2019. Marked geographic variation was also present, with the highest hospitalization rates in the South. Among patients hospitalized for acute hypertension, the observed 30-day and 90-day all-cause mortality rates (95% CI) decreased from 2.6% (2.27-2.83) and 5.6% (5.18-5.99) to 1.7% (1.53-1.80) and 3.7% (3.45-3.84) and 30-day and 90-day all-cause readmission rates decreased from 15.7% (15.1-16.4) and 29.4% (28.6-30.2) to 11.8% (11.5-12.1) and 24.0% (23.5-24.6). CONCLUSIONS Among Medicare fee-for-service beneficiaries age 65 years or older, hospitalization rates for acute hypertension increased substantially and significantly from 1999 to 2019. Black adults had the highest hospitalization rate in 2019 across age, sex, race and ethnicity, and dual-eligible strata. There was significant national variation, with the highest rates generally in the South.
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Affiliation(s)
- Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., Y.W., E.S.S., O.O. H.M.K.).,Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (Y.L., E.S.S., O.O. H.M.K.)
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., Y.W., E.S.S., O.O. H.M.K.).,Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Y.W.)
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., Y.W., E.S.S., O.O. H.M.K.).,Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (Y.L., E.S.S., O.O. H.M.K.)
| | - Oyere Onuma
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., Y.W., E.S.S., O.O. H.M.K.).,Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (Y.L., E.S.S., O.O. H.M.K.)
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, TX (K.N.).,Center for Outcomes Research, Houston Methodist Research Institute, TX (K.N.)
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, CA (F.R.)
| | - Karol E Watson
- David Geffen School of Medicine, University of California, Los Angeles (K.E.W.)
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., Y.W., E.S.S., O.O. H.M.K.).,Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (Y.L., E.S.S., O.O. H.M.K.).,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
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25
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Mahajan S, Caraballo C, Lu Y, Valero-Elizondo J, Massey D, Annapureddy AR, Roy B, Riley C, Murugiah K, Onuma O, Nunez-Smith M, Forman HP, Nasir K, Herrin J, Krumholz HM. Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018. JAMA 2021; 326:637-648. [PMID: 34402830 PMCID: PMC8371573 DOI: 10.1001/jama.2021.9907] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/01/2021] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades. OBJECTIVE To determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among adults in the US. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional study of National Health Interview Survey data, 1999-2018, that included 596 355 adults. EXPOSURES Self-reported race, ethnicity, and income level. MAIN OUTCOMES AND MEASURES Rates and racial and ethnic differences in self-reported health status and health care access and affordability. RESULTS The study included 596 355 adults (mean [SE] age, 46.2 [0.07] years, 51.8% [SE, 0.10] women), of whom 4.7% were Asian, 11.8% were Black, 13.8% were Latino/Hispanic, and 69.7% were White. The estimated percentages of people with low income were 28.2%, 46.1%, 51.5%, and 23.9% among Asian, Black, Latino/Hispanic, and White individuals, respectively. Black individuals with low income had the highest estimated prevalence of poor or fair health status (29.1% [95% CI, 26.5%-31.7%] in 1999 and 24.9% [95% CI, 21.8%-28.3%] in 2018), while White individuals with middle and high income had the lowest (6.4% [95% CI, 5.9%-6.8%] in 1999 and 6.3% [95% CI, 5.8%-6.7%] in 2018). Black individuals had a significantly higher estimated prevalence of poor or fair health status than White individuals in 1999, regardless of income strata (P < .001 for the overall and low-income groups; P = .03 for middle and high-income group). From 1999 to 2018, racial and ethnic gaps in poor or fair health status did not change significantly, with or without income stratification, except for a significant decrease in the difference between White and Black individuals with low income (-6.7 percentage points [95% CI, -11.3 to -2.0]; P = .005); the difference in 2018 was no longer statistically significant (P = .13). Black and White individuals had the highest levels of self-reported functional limitations, which increased significantly among all groups over time. There were significant reductions in the racial and ethnic differences in some self-reported measures of health care access, but not affordability, with and without income stratification. CONCLUSIONS AND RELEVANCE In a serial cross-sectional survey study of US adults from 1999 to 2018, racial and ethnic differences in self-reported health status, access, and affordability improved in some subgroups, but largely persisted.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Amarnath R. Annapureddy
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Brita Roy
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Oyere Onuma
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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26
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Ding H, Sutton AL, Hurtado-de-Mendoza A, Sheppard VB. The role of psychosocial factors in Black women's self-efficacy in receiving genetic counseling and testing. J Genet Couns 2021; 30:1719-1726. [PMID: 34085362 DOI: 10.1002/jgc4.1439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 11/11/2022]
Abstract
Higher self-efficacy in receiving genetic counseling and testing (GCT) has been associated with greater participation in GCT for women at risk of hereditary breast and ovarian cancer (HBOC), but little is known about correlates of self-efficacy in Black women eligible for GCT. The goal of this secondary analysis was to identify sociodemographic and psychosocial factors regarding GCT. Multivariable regression analysis was conducted to assess the relationship between self-efficacy and correlates of interest. Of the 100 Black women surveyed, most women had a college degree (64%), were employed (84%), and had health insurance (93%). In the multivariable model, greater self-efficacy was associated with more positive attitudes toward GCT (Β = 0.126; CI = 0.01 to 0.25; p = 0.039), greater confidence in the Genetic Information Nondiscrimination Act (GINA) (Β = 0.250; CI = 0.04 to 0.46; p = 0.019), and lower ratings of perceived difficulty obtaining GCT (Β = -0.219; CI = -0.46 to -0.10; p = 0.003). Community-level interventions to promote self-efficacy are needed that address perceived barriers to GCT, with the goals of increasing GINA Law awareness in the general public, increasing accessibility to genetic counseling (e.g., telemedicine), and promoting more positive attitudes about GCT.
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Affiliation(s)
- Huanghe Ding
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.,Office of Health Equity and Disparities Research, VCU Massey Cancer Center, Richmond, VA, USA
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27
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Vasquez Guzman CE, Sussman AL, Kano M, Getrich CM, Williams RL. A Comparative Case Study Analysis of Cultural Competence Training at 15 U.S. Medical Schools. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:894-899. [PMID: 33637658 DOI: 10.1097/acm.0000000000004015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Twenty years have passed since the Liaison Committee on Medical Education (LCME) mandated cultural competence training at U.S. medical schools. There remain multiple challenges to implementation of this training, including curricular constraints, varying interpretations of cultural competence, and evidence supporting the efficacy of such training. This study explored how medical schools have worked to implement cultural competence training. METHOD Fifteen regionally diverse public and private U.S. medical schools participated in the study. In 2012-2014, the authors conducted 125 interviews with 52 administrators, 51 faculty or staff members, and 22 third- and fourth-year medical students, along with 29 focus groups with an additional 196 medical students. Interviews were recorded, transcribed, and imported into NVivo 10 software for qualitative data analysis. Queries captured topics related to students' preparedness to work with diverse patients, engagement with sociocultural issues, and general perception of preclinical and clinical curricula. RESULTS Three thematic areas emerged regarding cultural competence training: formal curriculum, conditions of teaching, and institutional commitment. At the formal curricular level, schools offered a range of courses collectively emphasizing communication skills, patient-centered care, and community-based projects. Conditions of teaching emphasized integration of cultural competence into the preclinical years and reflection on the delivery of content. At the institutional level, commitment to institutional diversity, development of programs, and degree of prioritization of cultural competence varied. CONCLUSIONS There is variation in how medical schools approach cultural competence. Among the 15 participating schools, longitudinal and experiential learning emerged as important, highlighting the needs beyond mere integration of cultural competence content into the formal curriculum. To determine efficacy of cultural competence programming, it is critical to conduct systematic assessment to identify and address gaps. While LCME standards have transformed aspects of medical education, further research is needed to clarify evidence-based, effective approaches to this training.
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Affiliation(s)
- Cirila Estela Vasquez Guzman
- C.E. Vasquez Guzman is a family medicine postdoctoral fellow, Oregon Health & Science University, Portland, Oregon
| | - Andrew L Sussman
- A.L. Sussman is associate professor, Comprehensive Cancer Center and Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Miria Kano
- M. Kano is assistant professor, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Christina M Getrich
- C.M. Getrich is associate professor, Department of Anthropology, University of Maryland, College Park, Maryland
| | - Robert L Williams
- R.L. Williams is Distinguished Professor, Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
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28
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Jacobson CE, Beeler WH, Griffith KA, Flotte TR, Byington CL, Jagsi R. Common pathways to Dean of Medicine at U.S. medical schools. PLoS One 2021; 16:e0249078. [PMID: 33765033 PMCID: PMC7993860 DOI: 10.1371/journal.pone.0249078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE We sought to evaluate common leadership experiences and academic achievements obtained by current U.S. Medical School Deans of Medicine (DOMs) prior to their first appointment as Dean in order to elucidate a common pathway for promotion. METHODS In April-June 2019 the authors requested a curriculum vitae from each of the 153 LCME-accredited U.S. Medical School DOMs. The authors abstracted data on prior appointments, demographics, and achievements from CVs and online databases. Differences by gender and institutional rank were then evaluated by the Fisher's exact and Wilcoxon rank sum tests. RESULTS CVs were obtained for 62% of DOMs (95 of 153), with women comprising 16% of the responding cohort (15/95). Prior to appointment as DOM, 34% of respondents had served as both permanent Department Chair and Associate Dean, 39% as permanent Department Chair but not Associate Dean, and 17% as Associate Deans but not permanent Department Chair. There was a non-significant trend for men to have been more likely to have been a permanent Department Chair (76% vs 53%, p = 0.11) and less likely to have been an Associate Dean (48% vs 67%, p = 0.26) compared to women. Responding DOMs at Top-25 research institutions were mostly male (15/16), more likely to have been appointed before 2010 (38% vs 14%, p = 0.025), and had higher H-indices (mean (SD): 73.1 (32.3) vs 33.5 (22.5), p<0.01) than non-Top-25 Deans. CONCLUSIONS The most common pathway to DOM in this study cohort was prior service as Department Chair. This suggests that diversification among Department Chair positions or expansion of search criteria to seek leaders from pools other than Department Chairs may facilitate increased diversity, equity, and inclusion among DOM overall.
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Affiliation(s)
- Clare E. Jacobson
- University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Whitney H. Beeler
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States of America
| | - Kent A. Griffith
- The Center for Cancer Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Terence R. Flotte
- School of Medicine, University of Massachusetts Medical School, Massachusetts, United States of America
| | - Carrie L. Byington
- University of California Health System, University of California, Oakland, CA, United States of America
- Department of Pediatrics, UCSF, San Francisco, CA, United States of America
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States of America
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States of America
- * E-mail:
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29
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Balter DR, Bertram A, Stewart CM, Stewart RW. Examining black and white racial disparities in emergency department consultations by age and gender. Am J Emerg Med 2021; 45:65-70. [PMID: 33677264 DOI: 10.1016/j.ajem.2021.01.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While significant racial inequities in health outcomes exist in the United States, these inequities may also exist in healthcare processes, including the Emergency Department (ED). Additionally, gender has emerged in assessing racial healthcare disparity research. This study seeks to determine the association between race and the number and type of ED consultations given to patients presenting at a safety-net, academic hospital, which includes a level-one trauma center. METHOD Retrospective data was collected on the first 2000 patients who arrived at the ED from 1/1/2015-1/7/2015, with 532 patients being excluded. Of the eligible patients, 77% (74.6% adults and 80.7% pediatric patients) were black and 23% (25.4% adults and 19.3% pediatric patients) were white. RESULTS White and black adult patients receive similar numbers of ED consultations and remained after gender stratification. White pediatric males have a 91% higher incidence of receiving an ED consultation in comparison to their white counterparts. No difference was found between black and white adult patients when assessing the risk of receiving consultations. White adult females have a 260% higher risk of receiving both types of consultations than their black counterparts. Black and white pediatric patients had the same risk of receiving consultations, however, white pediatric males have a 194% higher risk of receiving a specialty consultation as compared to their white counterparts. DISCUSSION Future work should focus on both healthcare practice improvements, as well as explanatory and preventive research practices. Healthcare practice improvements can encompass development of appropriate racial bias trainings and institutionalization of conversations about race in medicine.
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Affiliation(s)
| | - Amanda Bertram
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Schnitzer K, Merideth F, Macias-Konstantopoulos W, Hayden D, Shtasel D, Bird S. Disparities in Care: The Role of Race on the Utilization of Physical Restraints in the Emergency Setting. Acad Emerg Med 2020; 27:943-950. [PMID: 32691509 DOI: 10.1111/acem.14092] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Race-based bias in health care occurs at organizational, structural, and clinical levels and impacts emergency medical care. Limited literature exists on the role of race on patient restraint in the emergency setting. This study sought to examine the role of race in physical restraint in an emergency department (ED) at a major academic medical center. METHODS Retrospective chart analysis was performed, querying all adult ED visits over a 2-year period (2016-2018) at Massachusetts General Hospital. The associations between race and restraint and selected covariates (sex, insurance, age, diagnosis, homelessness, violence) were analyzed. RESULTS Of the 195,092 unique ED visits by 120,469 individuals over the selected period, 2,658 (1.4%) involved application of a physical restraint by health care providers. There was a significant effect of race on restraint (p < 0.0001). The risk ratio (RR) for Asian patients compared to white patients was 0.71 (95% confidence interval [CI] = 0.55 to 0.92, p = 0.009). The RR for Black patients compared to white patients was 1.22 (95% CI = 1.05 to 1.40, p = 0.007). Visits with patients having characteristics of male sex, public or no insurance, younger age, diagnoses pertaining to substance use, diagnoses pertaining to psychotic or bipolar disorders, current homelessness, and a history of violence were more likely to result in physical restraint. CONCLUSIONS There was a significant effect of race on restraint that remained when controlling for sex, insurance, age, diagnosis, homelessness, and history of violence, all of which additionally conferred independent effects on risk. These results warrant a careful examination of current practices and potential biases in utilization of restraint in emergency settings.
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Affiliation(s)
- Kristina Schnitzer
- From the, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- and, Harvard Medical School, Boston, MA, USA
| | - Flannery Merideth
- From the, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- and, Harvard Medical School, Boston, MA, USA
| | - Wendy Macias-Konstantopoulos
- and, Harvard Medical School, Boston, MA, USA
- the, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- the, Center for Social Justice and Health Equity, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas Hayden
- and, Harvard Medical School, Boston, MA, USA
- and the, Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Derri Shtasel
- From the, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- and, Harvard Medical School, Boston, MA, USA
| | - Suzanne Bird
- From the, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- and, Harvard Medical School, Boston, MA, USA
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Stewart QT, Cobb RJ, Keith VM. The color of death: race, observed skin tone, and all-cause mortality in the United States. ETHNICITY & HEALTH 2020; 25:1018-1040. [PMID: 29737188 PMCID: PMC6222008 DOI: 10.1080/13557858.2018.1469735] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
Objective: This paper examines how mortality covaries with observed skin tone among blacks and in relation to whites. Additionally, the study analyzes the extent to which social factors such as socioeconomic status affect this relationship. Design: This study uses data from the 1982 General Social Survey (N = 1,689) data linked to the National Death Index until 2008. We use this data to examine the links between race, observed skin tone among blacks, and all-cause mortality. Piecewise exponential hazard modeling was used to estimate disparities in skin tone mortality among blacks, and relative to whites. The multivariate models control for age, education, gender, region, metropolitan statistical area, marital status, labor force status, and household income. Results: Observed skin tone is a significant determinant of mortality among blacks and in relation to whites. Light skinned blacks had the lowest mortality hazards among blacks, while respondents with medium and dark brown skin experienced significantly higher mortality. The observed skin tone mortality disparities covaried with education; there are significant mortality disparities across observed skin tone groups among black respondents with high school or more education, and nonsignificant disparities among those with less education. Conclusion: It is crucial to identify the social processes driving racial disparities in health and mortality. The findings reveal that the nuanced social experiences of blacks with different observed skin tones markedly change the experience of racial inequality. Research on the nuanced social processes and biological mechanisms that connect differences in observed skin tone to mortality outcomes promises to better illuminate the experience of racial inequality and policy mechanisms we can use to undermine it.
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Affiliation(s)
- Quincy Thomas Stewart
- Sociology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Ryon J Cobb
- School of Social Work, The University of Texas, Arlington, TX, USA
| | - Verna M Keith
- Sociology, University of Alabama, Birmingham, AL, USA
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Mattes MD, Bugarski LA, Wen S, Deville C. Assessment of the Medical Schools From Which Radiation Oncology Residents Graduate and Implications for Diversifying the Workforce. Int J Radiat Oncol Biol Phys 2020; 108:879-885. [PMID: 32561501 DOI: 10.1016/j.ijrobp.2020.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/01/2020] [Accepted: 06/07/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE To identify factors predictive of a medical school graduating a high volume of future radiation oncology (RO) residents to better understand potential pathways to effectively recruit women and underrepresented minority (URM) students into RO. METHODS AND MATERIALS Demographics for US allopathic medical schools and affiliated RO departments were collected from web resources and correlated with the percentage of graduates from each school currently enrolled in RO residency in 2019, and the probability of at least 1 female or URM student from each school pursuing RO. RESULTS The median percentage of students per medical school who pursued RO residency was 0.37% (interquartile range, 0.16%-0.66%). A total of 79.7% of schools graduated at least 1 RO resident, whereas 51.7% graduated at least 1 female RO resident and 14.0% graduated at least 1 URM RO resident. The 30 schools graduating the highest percentage of RO residents accounted for 52.1% of current RO residents, only 4 of which were in the top quartile for URM enrollment. Medical students were significantly more likely to pursue RO when there was an affiliated RO department (0.42% vs 0.18%, P < .001) or RO residency program (0.51% vs 0.18%, P < .001), more total RO faculty (rs = 0.521, P < .001), female RO faculty (rs = 0.481, P < .001), and URM RO faculty (rs = 0.197, P < .001). The probability of at least 1 female student pursuing RO was also correlated with the number of female faculty in the affiliated RO department (rpb = 0.348, P = .001), and a similar correlation was observed between URM students and URM faculty (rpb = 0.312, P = .011). CONCLUSIONS Most RO residents graduate from medical schools with larger affiliated RO departments but fewer URM students. To promote greater RO diversity, outreach should be considered among schools with greater URM enrollment but fewer affiliated radiation oncologists, and among female and URM students in schools that graduate many RO residents.
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Affiliation(s)
- Malcolm D Mattes
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
| | - Luka A Bugarski
- School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Sijin Wen
- Department of Statistics, West Virginia University, Morgantown, West Virginia
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
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White K, Lawrence JA, Tchangalova N, Huang SJ, Cummings JL. Socially-assigned race and health: a scoping review with global implications for population health equity. Int J Equity Health 2020; 19:25. [PMID: 32041629 PMCID: PMC7011480 DOI: 10.1186/s12939-020-1137-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
Self-identified race/ethnicity is largely used to identify, monitor, and examine racial/ethnic inequalities. A growing body of work underscores the need to consider multiple dimensions of race - the social construction of race as a function of appearance, societal interactions, institutional dynamics, stereotypes, and social norms. One such multidimensional measure is socially-assigned race, the perception of one's race by others, that may serve as the basis for differential or unfair treatment and subsequently lead to deleterious health outcomes. We conducted a scoping review to systematically appraise the socially-assigned race and health literature. A systematic search of the PubMed, Web of Science, 28 EBSCO databases and 24 Proquest databases up to September 2019 was conducted and supplemented by a manual search of reference lists and grey literature. Quantitative and qualitative studies that examined socially-assigned race and health or health-related outcomes were considered for inclusion. Eighteen articles were included in the narrative synthesis. Self-rated health and mental health were among the most frequent outcomes studied. The majority of studies were conducted in the United States, with fewer studies conducted in New Zealand, Canada, and Latin America. While most studies demonstrate a positive association between social assignment as a disadvantaged racial or ethnic group and poorer health, some studies did not document an association. We describe key conceptual and methodological considerations that should be prioritized in future studies examining socially-assigned race and health. Socially-assigned race can provide additional insight into observed differential health outcomes among racial/ethnic groups in racialized societies based upon their lived experiences. Studies incorporating socially-assigned race warrants further investigation and may be leveraged to examine nuanced patterns of racial health advantage and disadvantage.
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Affiliation(s)
- Kellee White
- Department of Health Policy and Management, University of Maryland College Park School of Public Health, 3310B SPH Bldg 255, 4200 Valley Drive, College Park, MD, 20742, USA.
| | - Jourdyn A Lawrence
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nedelina Tchangalova
- Research and Academic Services, University of Maryland Libraries, College Park, MD, USA
| | - Shuo J Huang
- Department of Health Policy and Management, University of Maryland College Park School of Public Health, 3310B SPH Bldg 255, 4200 Valley Drive, College Park, MD, 20742, USA
| | - Jason L Cummings
- Department of Sociology and African American Studies, University of South Carolina, Columbia, SC, USA
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Brown C, Frohard-Dourlent H, Wood BA, Saewyc E, Eisenberg ME, Porta CM. "It makes such a difference": An examination of how LGBTQ youth talk about personal gender pronouns. J Am Assoc Nurse Pract 2020; 32:70-80. [PMID: 31232865 DOI: 10.1097/jxx.0000000000000217] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE The World Health Organization has developed standards for youth-friendly health services to support adolescents and encourage health care utilization among youth. Necessary building blocks for youth-friendly care include strong interpersonal relationships between youth and health care providers. Nurse practitioners (NPs) may be particularly well positioned to form these relationships. This study explored a core aspect for building youth-provider relationships. The study examined how lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents discussed use of personal pronouns (e.g., he, she, they, ze) in relation to transgender and gender diverse (TGD) people. METHODS A secondary qualitative analysis of 66 in-depth interviews with LGBTQ youth from across Minnesota, Massachusetts, and British Columbia, Canada was conducted. Results were sorted into four main themes describing different aspects of personal pronoun use as related to TGD individuals. CONCLUSIONS Stories and experiences shared by participants illustrate how to assess which pronouns to use for a given person, how to use pronouns in different contexts, why respecting pronouns is important to TGD people, and flexibility as an integral component of the learning process when it comes to appropriate pronoun use. IMPLICATIONS FOR PRACTICE Understanding how youth discuss personal pronouns could improve practice with TGD youth. Each of the four themes can be applied to clinical encounters to ensure culturally sensitive care. Practice recommendations include asking adolescents what pronouns they prefer clinic staff to use on intake forms and having NPs and clinic staff provide their own pronouns to patients in introductions.
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Affiliation(s)
- Camille Brown
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | | | - Brittany A Wood
- Graduate School of Public Health and Institute for Behavioral and Community Health, San Diego State University, San Diego, California
| | - Elizabeth Saewyc
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marla E Eisenberg
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Carolyn M Porta
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
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Socially Assigned Race and Diabetes: Findings from the Arizona Behavioral Risk Factor Surveillance System, 2013-2014. J Racial Ethn Health Disparities 2019; 6:926-934. [PMID: 31065999 DOI: 10.1007/s40615-019-00593-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/07/2019] [Accepted: 04/16/2019] [Indexed: 12/15/2022]
Abstract
Socially assigned race, the racial/ethnic categorization of individuals by others, may serve as the basis for differential or unfair treatment. Latinxs are commonly socially assigned to a race/ethnicity with which they do not self-identify. However, it is unclear the degree to which self-identified Latinxs who are socially assigned as white or Latinx may differentially predict health outcomes beyond general health status and healthcare utilization. We examine the association between socially assigned race and type 2 diabetes mellitus (T2DM). Data from the Arizona's Behavioral Risk Factor Surveillance System (2013, 2014) was used in a cross-sectional analysis (restricted to Latinxs and non-Hispanic whites; N = 8370) to examine the association between self-identified (SI) and socially assigned (SA) race/ethnicity agreement and T2DM. Latinxs were categorized according to SI-SA race/ethnicity agreement: discordant (SI-SA, different) and concordant (SI-SA, same). T2DM was based on self-reported physician diagnosis. Data were analyzed using Poisson regression models to estimate prevalence ratios (PR) and 95% confidence intervals (CI). Latinxs comprised 28.5% of our sample, of which, 18.5% was discordant and 81.5% was concordant. In fully adjusted models, concordant Latinxs were more likely to have T2DM than whites (aPR 2.01, 95% CI 1.44, 2.82). There were no significant differences in T2DM between discordant Latinxs and whites. Our results suggest that socially assigned race is an understudied determinant of health and may further understanding of the impact of racial stratification on Latinx health inequities. Additional research examining socially assigned race and other health outcomes are warranted to gain further insight of the biological impact of racialized lived experiences.
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Physician Knowledge of Human Genetic Variation, Beliefs About Race and Genetics, and Use of Race in Clinical Decision-making. J Racial Ethn Health Disparities 2018; 6:110-116. [PMID: 29926440 DOI: 10.1007/s40615-018-0505-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Race in the USA has an enduring connection to health and well-being. It is often used as a proxy for ancestry and genetic variation, although self-identified race does not establish genetic risk of disease for an individual patient. How physicians reconcile these seemingly paradoxical facts as they make clinical decisions is unknown. OBJECTIVE To examine physicians' genetic knowledge and beliefs about race with their use of race in clinical decision-making DESIGN: Cross-sectional survey of a national sample of clinically active general internists RESULTS: Seven hundred eighty-seven physicians completed the survey. Regression models indicate that genetic knowledge was not significantly associated with use of race. However, physicians who agreed with notions of race as a biological phenomenon and those who agreed that race has clinical importance were more likely to report using race in their decision-making. CONCLUSIONS Genomic and precision medicine holds considerable promise for narrowing the gap in health among racial groups in the USA. For this promise to be realized, our findings suggest that future research and education efforts related to race, genomics, and health must go beyond educating health care providers about common genetic conditions to delving into assumptions about race and genetics.
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López N, Vargas ED, Juarez M, Cacari-Stone L, Bettez S. What's Your "Street Race"? Leveraging Multidimensional Measures of Race and Intersectionality for Examining Physical and Mental Health Status Among Latinxs. SOCIOLOGY OF RACE AND ETHNICITY (THOUSAND OAKS, CALIF.) 2018; 4:49-66. [PMID: 29423428 PMCID: PMC5800755 DOI: 10.1177/2332649217708798] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Using the 2015 Latino National Health and Immigration Survey (N= 1,197) we examine the relationship between physical and mental health status and three multidimensional measures of race: 1) "street race," or how you believe other "Americans" perceive your race at the level of the street; 2) socially assigned race or what we call "ascribed race," which refers to how you believe others usually classify your race in the U.S.; and 3) "self-perceived race," or how you usually self-classify your race on questionnaires. We engage in intersectional inquiry by combining street race and gender. We find that only self-perceived race correlates with physical health and that street race is associated with mental health. We also find that men reporting their street race as Latinx1 or Arab were associated with higher odds of reporting worse mental health outcomes. One surprising finding was that, for physical health, men reporting their street race as Latinx were associated with higher odds of reporting optimal physical health. Among women, those reporting their street race as Mexican were associated with lower odds of reporting optimal physical health when compared to all other women; for mental health status, however, we found no differences among women. We argue that "street race" is a promising multidimensional measure of race for exploring inequality among Latinxs.
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Affiliation(s)
- Nancy López
- University of New Mexico, Sociology Department, MSCO5 3080, 1 University of New Mexico, Albuquerque, NM 87131, Tel: 505 277-3101
| | - Edward D Vargas
- Center for Women's Health and Health Disparities Research, University of Wisconsin-Madison, 1180 Observatory Drive, IRP 3467, Madison, WI 53705, USA
| | - Melina Juarez
- University of New Mexico, Political Science Department, MSC05 3070, 1 University of New Mexico, Albuquerque, NM 87131, 505 277-5104
| | - Lisa Cacari-Stone
- University of New Mexico, MSCO9 5070, College of Population Health, 1 University of New Mexico, Albuquerque, NM 87131, 505 272-0511
| | - Sonia Bettez
- University of New Mexico, Evaluation Lab, MSC02 1625, 1 University of New Mexico, Albuquerque, NM 87131, 505 277-4257
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Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG, Mujahid MS, Palaniappan L, Taylor HA, Willis M, Yancy CW. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e393-e423. [PMID: 29061565 DOI: 10.1161/cir.0000000000000534] [Citation(s) in RCA: 679] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Population-wide reductions in cardiovascular disease incidence and mortality have not been shared equally by African Americans. The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites. The objectives of the present scientific statement are to describe cardiovascular health in African Americans and to highlight unique considerations for disease prevention and management. METHOD The primary sources of information were identified with PubMed/Medline and online sources from the Centers for Disease Control and Prevention. RESULTS The higher prevalence of traditional cardiovascular risk factors (eg, hypertension, diabetes mellitus, obesity, and atherosclerotic cardiovascular risk) underlies the relatively earlier age of onset of cardiovascular diseases among African Americans. Hypertension in particular is highly prevalent among African Americans and contributes directly to the notable disparities in stroke, heart failure, and peripheral artery disease among African Americans. Despite the availability of effective pharmacotherapies and indications for some tailored pharmacotherapies for African Americans (eg, heart failure medications), disease management is less effective among African Americans, yielding higher mortality. Explanations for these persistent disparities in cardiovascular disease are multifactorial and span from the individual level to the social environment. CONCLUSIONS The strategies needed to promote equity in the cardiovascular health of African Americans require input from a broad set of stakeholders, including clinicians and researchers from across multiple disciplines.
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Irby-Shasanmi A, Leech TGJ. 'Because I Don't know': uncertainty and ambiguity in closed-ended reports of perceived discrimination in US health care. ETHNICITY & HEALTH 2017; 22:458-479. [PMID: 27741709 DOI: 10.1080/13557858.2016.1244659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective Surveys often ask respondents to assess discrimination in health care. Yet, patients' responses to one type of widely used measure of discrimination (single-item, personally mediated) tend to reveal prevalence rates lower than observational studies would suggest. This study examines the meaning behind respondents' closed-ended self-reports on this specific type of measure, paying special attention to the frameworks and references used within the medical setting. Design Twenty-nine respondents participated in this study. They were asked the widely used question: 'Within the past 12 months, when seeking health care do you feel your experiences were worse than, the same as, or better than people of other races?' We then conducted qualitative interviews focusing on their chosen response and past experiences. Descriptive analyses focus on both the quantitative and qualitative data, including a comparison of conveyed perceived discrimination according to the different sources of data. Results To identify discrimination, respondents drew upon observations of dynamics in the waiting room or the health providers' communication style. Our respondents were frequently ambivalent and uncertain about how their personal treatment in health care compared to people of other races. When participants were unable to make observable comparisons, they tended to assume equal treatment and report 'same as' in the close-ended reports. Conclusion Respondents' responses to single-item, closed-ended questions may be influenced by characteristics specific to the health care realm. An emphasis on privacy and assumptions about the health care field (both authority and benevolence of providers) may limit opportunities for comparison and result in assumptions of racial parity in treatment.
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Affiliation(s)
- Amy Irby-Shasanmi
- a Department of Social and Behavioral Sciences , Indiana University Purdue University, Indianapolis (IUPUI) , Indianapolis , IN , USA
| | - Tamara G J Leech
- a Department of Social and Behavioral Sciences , Indiana University Purdue University, Indianapolis (IUPUI) , Indianapolis , IN , USA
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Exploring racial influences on flu vaccine attitudes and behavior: Results of a national survey of White and African American adults. Vaccine 2017; 35:1167-1174. [PMID: 28126202 DOI: 10.1016/j.vaccine.2016.12.046] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Racial disparities in adult flu vaccination rates persist with African Americans falling below Whites in vaccine acceptance. Although the literature has examined traditional variables including barriers, access, attitudes, among others, there has been virtually no examination of the extent to which racial factors including racial consciousness, fairness, and discrimination may affect vaccine attitudes and behaviors. METHODS We contracted with GfK to conduct an online, nationally representative survey with 819 African American and 838 White respondents. Measures included risk perception, trust, vaccine attitudes, hesitancy and confidence, novel measures on racial factors, and vaccine behavior. RESULTS There were significant racial differences in vaccine attitudes, risk perception, trust, hesitancy and confidence. For both groups, racial fairness had stronger direct effects on the vaccine-related variables with more positive coefficients associated with more positive vaccine attitudes. Racial consciousness in a health care setting emerged as a more powerful influence on attitudes and beliefs, particularly for African Americans, with higher scores on racial consciousness associated with lower trust in the vaccine and the vaccine process, higher perceived vaccine risk, less knowledge of flu vaccine, greater vaccine hesitancy, and less confidence in the flu vaccine. The effect of racial fairness on vaccine behavior was mediated by trust in the flu vaccine for African Americans only (i.e., higher racial fairness increased trust in the vaccine process and thus the probability of getting a flu vaccine). The effect of racial consciousness and discrimination for African Americans on vaccine uptake was mediated by perceived vaccine risk and flu vaccine knowledge. CONCLUSIONS Racial factors can be a useful new tool for understanding and addressing attitudes toward the flu vaccine and actual vaccine behavior. These new concepts can facilitate more effective tailored and targeted vaccine communications.
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Vargas ED, Winston NC, Garcia JA, Sanchez GR. Latina/o or Mexicana/o?: The Relationship between Socially Assigned Race and Experiences with Discrimination. SOCIOLOGY OF RACE AND ETHNICITY (THOUSAND OAKS, CALIF.) 2016; 2:498-515. [PMID: 27709119 PMCID: PMC5047666 DOI: 10.1177/2332649215623789] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Discrimination based on one's racial or ethnic background is one of the oldest and most perverse practices in the United States. While much of this research has relied on self-reported racial categories, a growing body of research is attempting to measure race through socially-assigned race. Socially-assigned or ascribed race measures how individuals feel they are classified by other people. This paper draws on the socially assigned race literature and explores the impact of socially assigned race on experiences with discrimination using a 2011 nationally representative sample of Latina/os (n=1,200). While much of the current research on Latina/os has been focused on the aggregation across national origin group members, this paper marks a deviation by using socially-assigned race and national origin to understand how being ascribed as Mexican is associated with experiences of discrimination. We find evidence that being ascribed as Mexican increases the likelihood of experiencing discrimination relative to being ascribed as White or Latina/o. Furthermore, we find that being miss-classified as Mexican (ascribed as Mexican, but not of Mexican origin) is associated with a higher likelihood of experiencing discrimination compared to being ascribed as white, ascribed as Latina/o, and correctly ascribed as Mexican. We provide evidence that socially assigned race is a valuable complement to self-identified race/ethnicity for scholars interested in assessing the impact of race/ethnicity on a wide range of outcomes.
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Affiliation(s)
- Edward D. Vargas
- Center for Women’s Health and Health Disparities Research, University of Wisconsin-Madison
| | - Nadia C. Winston
- Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College
| | - John A. Garcia
- Emeritus Professor at both the (ICPSR-Institute for Social Research-ISR (the University of Michigan), and School of Government and Public Policy (University of Arizona)
| | - Gabriel R. Sanchez
- Department of Political Science and RWJF Center for Health Policy, University of New Mexico
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Muralidharan A, Austern D, Hack S, Vogt D. Deployment Experiences, Social Support, and Mental Health: Comparison of Black, White, and Hispanic U.S. Veterans Deployed to Afghanistan and Iraq. J Trauma Stress 2016; 29:273-8. [PMID: 27191777 DOI: 10.1002/jts.22104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 03/07/2016] [Accepted: 03/10/2016] [Indexed: 11/10/2022]
Abstract
Compared to their White counterparts, Black and Hispanic Vietnam-era, male, combat veterans in the United States have experienced discrimination and increased trauma exposure during deployment and exhibited higher rates of postdeployment mental health disorders. The present study examined differences in deployment experiences and postdeployment mental health among male and female Black, Hispanic, and White veterans deployed in support of Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom in Iraq. Data were drawn from a national survey of veterans (N = 924) who had returned from deployment within the last 2 years. Ethnoracial minority veterans were compared to White veterans of the same gender on deployment experiences and postdeployment mental health. The majority of comparisons did not show significant differences; however, several small group differences did emerge (.02 < η(2) < .04). Ethnoracial minority veterans reported greater perceived threat in the warzone and more family-related concerns and stressors during deployment than White veterans of the same gender. Minority female veterans reported higher levels of postdeployment symptoms of anxiety than their White counterparts, which were accounted for by differences in deployment experience. These differences call for ongoing monitoring.
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Affiliation(s)
- Anjana Muralidharan
- Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Capitol Health Care Network (VISN 5), Baltimore, Maryland, USA.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David Austern
- Veterans Affairs Maryland Healthcare System (VAMHCS), Baltimore, Maryland, USA
| | - Samantha Hack
- Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Capitol Health Care Network (VISN 5), Baltimore, Maryland, USA.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dawne Vogt
- National Center for PTSD, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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Abraído-Lanza AF, Echeverría SE, Flórez KR. Latino Immigrants, Acculturation, and Health: Promising New Directions in Research. Annu Rev Public Health 2016; 37:219-36. [PMID: 26735431 DOI: 10.1146/annurev-publhealth-032315-021545] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This article provides an analysis of novel topics emerging in recent years in research on Latino immigrants, acculturation, and health. In the past ten years, the number of studies assessing new ways to conceptualize and understand how acculturation-related processes may influence health has grown. These new frameworks draw from integrative approaches testing new ground to acknowledge the fundamental role of context and policy. We classify the emerging body of evidence according to themes that we identify as promising directions--intrapersonal, interpersonal, social environmental, community, political, and global contexts, cross-cutting themes in life course and developmental approaches, and segmented assimilation--and discuss the challenges and opportunities each theme presents. This body of work, which considers acculturation in context, points to the emergence of a new wave of research that holds great promise in driving forward the study of Latino immigrants, acculturation, and health. We provide suggestions to further advance the ideologic and methodologic rigor of this new wave.
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Affiliation(s)
- Ana F Abraído-Lanza
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032;
| | - Sandra E Echeverría
- Department of Community Health Education, School of Urban Public Health, City University of New York-Hunter College, New York, NY 10035;
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Vargas ED, Sanchez GR, Kinlock BL. The Enhanced Self-Reported Health Outcome Observed in Hispanics/Latinos Who are Socially-Assigned as White is Dependent on Nativity. J Immigr Minor Health 2015; 17:1803-10. [PMID: 25410381 PMCID: PMC4439394 DOI: 10.1007/s10903-014-0134-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A growing body of research seeks to conceptualize race as a multi-dimensional construct, attempting to move beyond a dummy variable approach to study social disparities. This research uses 'socially-assigned race', 'ascribed race', or 'what race others think you are' as opposed to self-identified race to assess self-rated health status among a representative study of the Latino population (n = 1,200). Our analysis shows how important the lived experience of Latinos and Hispanics (as measured by ascribed race and a host of control variables, including nativity and national origin) is on self-reported health. Using a series of logistic regressions, we find support for the 'white advantage' in Latino health status that is suggested in the literature, but this finding is sensitive to nativity, citizenship, and national origin. This research informs the study of racial and ethnic disparities, providing a detailed explanation for the 'white health advantage' finding within the socially-assigned race and health disparities literature.
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Affiliation(s)
- Edward D Vargas
- Center for Women's Health and Health Disparities Research, University of Wisconsin-Madison, 310 N. Midvale Blvd, Suite 201, Madison, WI, 53705, USA.
| | - Gabriel R Sanchez
- Robert Wood Johnson Foundation Center for Health Policy at the University of New Mexico, MSC02 1645, 1 University of New Mexico, 1909 Las Lomas NE, Albuquerque, NM, 87131, USA.
| | - Ballington L Kinlock
- Robert Wood Johnson Foundation Center for Health Policy, Meharry Medical College, 1005 Dr. D.B. Todd Jr., Boulevard Nashville, TN, 37208, USA.
- School of Graduate Studies and Research, Meharry Medical College, 1005 Dr. D.B. Todd Jr., Boulevard Nashville, TN, 37208, USA.
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Li CC, Matthews AK, Aranda F, Patel C, Patel M. Predictors and Consequences of Negative Patient-Provider Interactions Among a Sample of African American Sexual Minority Women. LGBT Health 2015; 2:140-6. [DOI: 10.1089/lgbt.2014.0127] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chien-Ching Li
- Department of Health Systems Management, College of Health Sciences, Rush University, Chicago, Illinois
| | - Alicia K. Matthews
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Frances Aranda
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Chirag Patel
- Department of Biology, University of Illinois at Chicago, Chicago, Illinois
| | - Maharshi Patel
- Department of Biology, University of Illinois at Chicago, Chicago, Illinois
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Abstract
OBJECTIVE Investigate determinants of receiving healthcare provider (HCP) recommendations for seasonal and H1N1 influenza vaccinations. METHODS Using a United States national sample of adults 18 + from the National 2009 H1N1 Flu Survey, multivariate regression models estimated the likelihood of receiving a HCP recommendation. Covariates included demographics, socioeconomic status, and Advisory Committee on Immunization Practices (ACIP) priority groups. RESULTS Adults age 55-64 and 65 + were more likely to report a HCP recommendation when compared to adults age 18-34 (OR: 1.483, 95%CI: 1.237-1.778 and OR: 1.738, 95%CI: 1.427-2.116, respectively). Chronically ill adults had 58.0% (95%CI: 1.414-1.765) higher odds of receiving a HCP recommendation than non-chronically ill adults. Patients visiting a doctor once and twice had 28.7% (95%CI: 0.618-0.821) and 17.1% (95%CI: 0.721-0.952) lower odds of receiving a HCP recommendation when compared to adults visiting their doctor at least four times. And, compared to Non-Hispanic Whites, Non-Hispanic Blacks had 28.4% (95%CI: 1.064-1.549) higher odds of receiving a recommendation. CONCLUSIONS ACIP priority groups experienced higher rates of recommendations compared to non-ACIP groups. Racial differences in HCP recommendations cannot explain racial disparities in flu vaccination rates.
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Affiliation(s)
- Reginald Villacorta
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Verna and Peter Dauterive Hall, 635 Downey Way, Los Angeles, CA 90089-3333, USA
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The significance of socially-assigned ethnicity for self-identified Māori accessing and engaging with primary healthcare in New Zealand. Health (London) 2015; 20:143-60. [DOI: 10.1177/1363459315568918] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite increased focus in New Zealand on reducing health inequities between Māori and New Zealand European ethnic groups, research on barriers and facilitators to primary healthcare access for Māori remains limited. In particular, there has been little interrogation of the significance of social-assignment of ethnicity for Māori in relation to engagement with predominantly non-Māori primary healthcare services and providers. A qualitative study was undertaken with a subsample (n = 40) of the broader Hauora Manawa Study to examine experiences of accessing and engaging with primary healthcare among adult urban Māori. Thematic analysis of in-depth interviews identified that participants perceived social-assignment as New Zealand European as an efficacious form of capital when interacting with predominantly non-Māori health professionals. Skin colour that was ‘white’ or was perceived to identify Māori as belonging to the ‘dominant’ New Zealand European ethnic group was reported as broadly advantageous and protective. In contrast, social-assignment as Māori was seen to be associated with risk of exposure to differential and discriminatory healthcare. Reducing the negative impacts of racialisation in a (neo)colonial society where ‘White’ cultural capital dominates requires increased recognition of the health-protective advantages of ‘White’ privilege and concomitant risks associated with socially-assigned categorisation of ethnicity as non-‘White’.
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Abstract
Racial resentment (also known as symbolic racism) is among the most widely tested measures of contemporary prejudice in political science and social psychological research over the past thirty years. Proponents argue that racial resentment reflects anti-black emotion obtained through pre-adult socialization. In light of affect-based models of substance use, this paper examined the association between racial resentment and smoking in a national sample of non-Hispanic white, black, and Hispanic respondents. Data come from the 2012 American National Election Study, which contained two measures of smoking. The results of ordinal logistic regression models indicate a positive association between racial resentment and smoking among non-Hispanic whites (N = 2133) that is not present among blacks (N = 693) or Hispanics (N = 660). Models controlled for age, education, income, gender, political ideology, region, and mode of interview. Furthermore, analyses indicated that a measure of race-related affect, admiration and sympathy towards blacks, partially mediated the association between racial resentment and smoking. For non-Hispanic whites, racial resentment appears to constitute a risk factor for smoking. Future studies should further specify the conditions linking substance use to the race-related affective component of racial resentment.
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Affiliation(s)
- Frank L Samson
- Department of Sociology, University of Miami, 5202 University Drive, 120D Merrick Building, Coral Gables, FL 33146, USA.
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Cormack DM, Harris RB, Stanley J. Investigating the relationship between socially-assigned ethnicity, racial discrimination and health advantage in New Zealand. PLoS One 2013; 8:e84039. [PMID: 24391876 PMCID: PMC3877153 DOI: 10.1371/journal.pone.0084039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 11/11/2013] [Indexed: 12/02/2022] Open
Abstract
Background While evidence of the contribution of racial discrimination to ethnic health disparities has increased significantly, there has been less research examining relationships between ascribed racial/ethnic categories and health. It has been hypothesized that in racially-stratified societies being assigned as belonging to the dominant racial/ethnic group may be associated with health advantage. This study aimed to investigate associations between socially-assigned ethnicity, self-identified ethnicity, and health, and to consider the role of self-reported experience of racial discrimination in any relationships between socially-assigned ethnicity and health. Methods The study used data from the 2006/07 New Zealand Health Survey (n = 12,488), a nationally representative cross-sectional survey of adults 15 years and over. Racial discrimination was measured as reported individual-level experiences across five domains. Health outcome measures examined were self-reported general health and psychological distress. Results The study identified varying levels of agreement between participants' self-identified and socially-assigned ethnicities. Individuals who reported both self-identifying and being socially-assigned as always belonging to the dominant European grouping tended to have more socioeconomic advantage and experience less racial discrimination. This group also had the highest odds of reporting optimal self-rated health and lower mean levels of psychological distress. These differences were attenuated in models adjusting for socioeconomic measures and individual-level racial discrimination. Conclusions The results suggest health advantage accrues to individuals who self-identify and are socially-assigned as belonging to the dominant European ethnic grouping in New Zealand, operating in part through socioeconomic advantage and lower exposure to individual-level racial discrimination. This is consistent with the broader evidence of the negative impacts of racism on health and ethnic inequalities that result from the inequitable distribution of health determinants, the harm and chronic stress linked to experiences of racial discrimination, and via the processes and consequences of racialization at a societal level.
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Affiliation(s)
- Donna M. Cormack
- Department of Public Health, University of Otago, Wellington, New Zealand
- * E-mail:
| | - Ricci B. Harris
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Dean's Department, University of Otago, Wellington, New Zealand
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