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Lui B, Khusid E, Tangel VE, Jiang SY, Abramovitz SE, Oxford CM, White RS. Disparities in postpartum readmission by patient- and hospital-level social risk factors in the United States: a retrospective multistate analysis, 2015-2020. Int J Obstet Anesth 2024; 59:103998. [PMID: 38719764 DOI: 10.1016/j.ijoa.2024.103998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Postpartum readmission is an area of focus for improving obstetric care and reducing costs. We examined disparities in all-cause 30-day postpartum readmission by patient- and hospital-level factors in the United States. METHODS We conducted a retrospective cohort study using 2015-2020 records from the State Inpatient Databases from four states. Generalized linear mixed models were constructed to estimate the effects of individual patient- and hospital-level factors on adjusted odds of 30-day readmission after controlling for confounders. Stratified analyses by delivery and anesthesia type (New York only) and interaction models were performed. RESULTS Black mothers were more likely than White mothers to be readmitted within 30-days postpartum (aOR 1.57, 95% CI 1.52 to 1.61). Mothers with public insurance had increased odds of readmission compared with those with private insurance (Medicare: aOR 2.13, 95% CI 1.95 to 2.32; Medicaid: aOR 1.14, 95% CI 1.11 to 1.17). Compared with mothers in the lowest income quartile, those in the highest quartile experienced a 14% lower odds of readmission (aOR 0.86, 95% CI 0.83 to 0.89). There were no significant associations between hospital-level characteristics and readmission. Black mothers were more likely to be readmitted regardless of delivery type and most combinations of delivery and anesthesia type. Black mothers from the highest income quartile were more likely to be readmitted than White mothers from the lowest income quartile. CONCLUSION Substantial disparities in 30-day postpartum readmissions by patient-level social factors were observed, particularly amongst Black mothers. Action is needed to address and mitigate disparities in postpartum readmission.
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Affiliation(s)
- B Lui
- Weill Cornell Medical College, Weill Cornell Medicine, New York, NY, USA
| | - E Khusid
- Weill Cornell Medical College, Weill Cornell Medicine, New York, NY, USA
| | - V E Tangel
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - S Y Jiang
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - S E Abramovitz
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - C M Oxford
- Department of Maternal and Fetal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - R S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
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Harris R, Li C, Stanley J, King PT, Priest N, Curtis E, Ameratunga S, Sorensen D, Tibble F, Tewhaiti-Smith J, Thatcher P, Araroa R, Pihema S, Lee-Kirk S, King SJR, Urlich T, Livingstone NZ, Kamau Brady S, Matehe C, Paine SJ. Racism and Health Among Aotearoa New Zealand Young People Aged 15-24 years: Analysis of Multiple National Surveys. J Adolesc Health 2024:S1054-139X(24)00230-1. [PMID: 38970605 DOI: 10.1016/j.jadohealth.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE This Aotearoa New Zealand-based study addresses a gap in literature focusing on individual experiences of racism among adolescents and young adults and its links to health. METHODS This cross-sectional study uses data from multiple instances of the New Zealand Health Survey (2002/03, 2006/07, 2011/12, 2016/17) and General Social Survey (2008-2016) restricted to participants aged 15-24 years. Prevalence of reported experiences of racism are estimated. Meta-analytic techniques to pool data and multiple regression analyses are used to examine associations between experiences of racism and outcomes measures (mental and physical health, general health and well-being, life satisfaction, inability to access health care, and identity). The study used an ethical co-design process between university researchers and a rangatahi Māori (Māori young people) partnership group. RESULTS Racism was higher among Māori, Pacific, and Asian young people compared to European young people. Racism was associated with all negative health and well-being measures examined for young people, including negative mental and physical health measures (12-Item Short Form Survey, Kessler Psychological Distress Scale), lower self-rated health, negative life satisfaction, higher unmet need for primary care, and identity measures (feelings of not belonging in New Zealand, less able to express their identity). DISCUSSION The results of this study are concerning. Non-European young people disproportionately bear the burden of racism in Aotearoa New Zealand with a potentially substantial impact on their health and well-being. This is a breach of Indigenous (for Māori) and other international human rights and should be motivation to act to eliminate racism in all its forms.
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Affiliation(s)
- Ricci Harris
- Te Rōpū Rangahau Hauora a Eru Pōmare, University of Otago, Wellington, New Zealand.
| | - Chao Li
- Te Kupenga Hauora Māori, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Paula Toko King
- Te Rōpū Rangahau Hauora a Eru Pōmare, University of Otago, Wellington, New Zealand
| | - Naomi Priest
- The Centre for Social Policy Research, Canberra, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Elana Curtis
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dakota Sorensen
- Rangatahi Partnership Group, University of Auckland, Auckland, New Zealand
| | - Fushia Tibble
- Rangatahi Partnership Group, University of Auckland, Gisborne, New Zealand
| | - Jordan Tewhaiti-Smith
- Rangatahi Partnership Group, Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Paeone Thatcher
- Rangatahi Partnership Group, University of Otago, Dunedin, New Zealand
| | | | - Sarah Pihema
- Rangatahi Partnership Group, Napier, New Zealand
| | | | | | - Tupua Urlich
- Rangatahi Partnership Group, Ngāti Kahungunu Ki Heretaunga, Auckland, New Zealand
| | | | - Soraya Kamau Brady
- Rangatahi Partnership Group, Te Paepae Ārahi Trust, 2 Face Drama, Mahia, Hawkes Bay, New Zealand
| | | | - Sarah-Jane Paine
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Nassal T, Tezcan-Güntekin H. Critical Self-reflection on Racism by Hospital Physicians in Large German Cities. A Qualitative Reconstructive Study Using Episodic Interviews. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02073-2. [PMID: 38969924 DOI: 10.1007/s40615-024-02073-2] [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: 02/21/2024] [Revised: 06/18/2024] [Accepted: 06/23/2024] [Indexed: 07/07/2024]
Abstract
Racism permeates healthcare institutions and interpersonal interactions, impacting both staff and patients. The role of doctors, given their influential position in the healthcare system, is particularly crucial in this context. Despite this, there is a scarcity of evidence regarding the manifestation of racism among healthcare professionals in Germany. Critical whiteness studies emphasize the importance of white* individuals engaging in critical self-reflection to mitigate racism. This study aimed to explore the attitudes of white* physicians in hospitals in major German cities towards racism and their critical reflection on personal attitudes and actions concerning racism in interactions with staff members and patients. Data was collected through six episodic interviews with physicians, analyzed using the reconstructive qualitative procedure of the documentary method, leading to a sense-genetic typology. The sense-genetic typology revealed three distinct attitudes towards racism: acknowledging, individualistic, and ignoring. Four types emerged concerning the self-reflection of white doctors: self-critical, socially critical, worried, and defensive. The most promising potential for interventions to reduce racism lies within the self-critical and socially critical types, both demonstrating an acknowledging attitude. Conversely, the worrying and defensive types may present challenges in deconstruction. This suggests that interventions aimed at reducing racism should be tailored and implemented with a nuanced approach.
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Affiliation(s)
- Tonia Nassal
- Department Public Health, Berlin School of Public Health: Charité - Universitätsmedizin Berlin, Alice Salomon Hochschule, Technische Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Hürrem Tezcan-Güntekin
- Department of Public Health, Berlin School of Public Health: Charité - Universitätsmedizin Berlin, Alice Salomon Hochschule, Technische Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department Public Health, Alice Salomon Hochschule Berlin, Alice-Salomon-Platz 5, 12627, Berlin, Germany
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4
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Tarrago Wangkamahdla A, Veit-Prince E, Brolan CE. "Simply put: systems failed": lessons from the Coroner's inquest into the rheumatic heart disease Doomadgee cluster. Med J Aust 2024; 221:13-16. [PMID: 38946639 DOI: 10.5694/mja2.52350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/10/2024] [Indexed: 07/02/2024]
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Tang SH, Min J, Zhang X, Uwah E, Griffis HM, Cielo CM, Fiks AG, Mindell JA, Tapia IE, Williamson AA. Incidence of pediatric narcolepsy diagnosis and management: evidence from claims data. J Clin Sleep Med 2024; 20:1141-1151. [PMID: 38450539 PMCID: PMC11217630 DOI: 10.5664/jcsm.11104] [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: 11/02/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
STUDY OBJECTIVES The purpose of this study was to characterize the incidence of pediatric narcolepsy diagnosis, subsequent care, and potential sociodemographic disparities in a large US claims database. METHODS Merative MarketScan insurance claims (n = 12,394,902) were used to identify youth (6-17 years of age) newly diagnosed with narcolepsy (International Classification of Diseases, 10th revision codes). Narcolepsy diagnosis and care 1 year postdiagnosis included polysomnography with Multiple Sleep Latency Test, pharmacological care, and clinical visits. Potential disparities were examined by insurance coverage and child race and ethnicity (Medicaid-insured only). RESULTS The incidence of narcolepsy diagnosis was 10:100,000, primarily type 2 (69.9%). Most diagnoses occurred in adolescents with no sex differences, but higher rates in Black vs White youth with Medicaid. Two thirds had a prior sleep disorder diagnosis and 21-36% had other co-occurring diagnoses. Only half (46.6%) had polysomnography with Multiple Sleep Latency Test (± 1 year postdiagnosis). Specialty care (18.9% pulmonary, 26.9% neurology) and behavioral health visits were rare (34.4%), although half were prescribed stimulant medications (51.0%). Medicaid-insured were 86% less likely than commercially insured youth to have any clinical care and 33% less likely to have polysomnography with Multiple Sleep Latency Test. CONCLUSIONS Narcolepsy diagnoses occurred in 0.01% of youth, primarily during adolescence, and at higher rates for Black vs White children with Medicaid. Only half overall had evidence of a diagnostically required polysomnography with Multiple Sleep Latency Test, underscoring potential misdiagnosis. Many patients had co-occurring conditions, but specialty and behavioral health care were limited. Results suggest misdiagnosis, underdiagnosis, and limited narcolepsy treatment, as well as possible disparities. Results highlight the need to identify determinants of evidence-based pediatric narcolepsy diagnosis and management. CITATION Tang SH, Min J, Zhang X, et al. Incidence of pediatric narcolepsy diagnosis and management: evidence from claims data. J Clin Sleep Med. 2024;20(7):1141-1151.
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Affiliation(s)
- Si Hao Tang
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jungwon Min
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Xuemei Zhang
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Christopher M Cielo
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jodi A Mindell
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Ignacio E Tapia
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Ariel A Williamson
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Ballmer Institute, University of Oregon, Portland, Oregon
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Cuevas AG, McSorley AM, Lyngdoh A, Kaba-Diakité F, Harris A, Rhodes-Bratton B, Rouhani S. Education, Income, Wealth, and Discrimination in Black-White Allostatic Load Disparities. Am J Prev Med 2024; 67:97-104. [PMID: 38458268 DOI: 10.1016/j.amepre.2024.02.021] [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: 08/25/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Allostatic load (AL) is a significant marker of aging, associated with disease and mortality. Research has elucidated the impact of education and income on AL. However, the roles of wealth and discrimination in contributing to AL and shaping AL disparities remain underexplored. This study aimed to investigate the association between wealth and AL, while also examining the independent contributions of education, income, wealth, and everyday discrimination in shaping AL disparities. METHODS Using 2016 data from the nationally representative Health and Retirement Study (N=3,866), this study employed multilinear regression analysis to quantify the association between education and income, wealth (calculated as assets minus debts), and everyday discrimination with AL. Oaxaca-Blinder decomposition analysis was conducted to determine the proportion of AL disparities between Black and White participants attributed to education and income, wealth, and everyday discrimination. Analyses were performed in 2023. RESULTS Having a college degree or more (b = -0.32; 95% CI: -0.46, -0.17), higher income (b = -0.06; 95% CI: -0.11, -0.01), and greater wealth (b = -0.11; 95% CI: -0.16, -0.07) were linked to reduced AL. Conversely, increased experiences of everyday discrimination were associated with heightened AL (b = 0.07; 95% CI: 0.01, 0.16). Collectively, differences in possessing a college degree or more, wealth, and exposure to discrimination accounted for about 18% of the observed Black-White AL disparities. CONCLUSIONS Education, income, wealth, and experiences of discrimination may independently contribute to AL and partially explain Black-White disparities in AL. There is a need to elucidate the underlying mechanisms governing these relationships, particularly wealth, and extend the research to additional social determinants of racial health disparities.
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Affiliation(s)
- Adolfo G Cuevas
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York; Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York.
| | - Anna-Michelle McSorley
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Adiammi Lyngdoh
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Fatoumata Kaba-Diakité
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Adrian Harris
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Brennan Rhodes-Bratton
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Saba Rouhani
- Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York; Department of Epidemiology, New York University School of Global Public Health, New York, New York
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7
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Kang S, Thiem KC, Huff NR, Dixon JS, Harvey EA. Black and White Adults' Racial and Gender Stereotypes of Psychopathology Symptoms in Black and White Children. Res Child Adolesc Psychopathol 2024; 52:1023-1036. [PMID: 38492192 DOI: 10.1007/s10802-024-01189-7] [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] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
Adults' judgments of children's behaviors play a critical role in assessment and treatment of childhood psychopathology. Judgments of children's psychiatric symptoms are likely influenced by racial biases, but little is known about the specific racial biases adults hold about children's psychiatric symptoms, which could play a critical role in childhood mental health disparities. This study examined one form of such biases, racial stereotypes, to determine if White and Black adults hold implicit and explicit racial stereotypes about common childhood psychopathology symptoms, and if these stereotypes vary by child gender and disorder type. Participants included 82 self-identified Black men, 84 Black woman, 1 Black transgender individual, 1 Black genderfluid individual, 81 White men, and 85 White women. Analyses of implicit stereotypes revealed that White adults associated psychopathology symptoms more strongly with Black children than did Black adults (p < .001). All adults held stronger implicit racial stereotypes for oppositional defiant disorder, anxiety, and depression than for attention-deficit/hyperactivity disorder (p < .001). For explicit stereotypes, White adults generally associated psychopathology symptoms more with Black children than did Black adults but effects varied across child gender and disorder type. As the first study to examine racial and gender stereotypes across common childhood psychopathology symptoms, these findings point to a need for further investigation of the presence and impact of racial biases in the mental healthcare system for Black youth and to identify interventions to mitigate the impacts of racial biases to inform racial equity in mental healthcare in the United States.
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Affiliation(s)
- Sungha Kang
- Department of Psychology, Loyola University Chicago, 1032 W Sheridan Rd, Chicago, IL, USA.
| | - Kelsey C Thiem
- Department of Psychology, Nebraska Wesleyan University, 5000 Sait Paul Ave, Lincoln, NE, USA
| | - Nathan R Huff
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA, USA
| | - Jasmine S Dixon
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Harvey
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA, USA
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Hayes K, Szymusiak J, McCormick A. A clinical antiracism curriculum for third-year medical students to bring antiracist principles to the bedside. J Hosp Med 2024; 19:610-615. [PMID: 38528658 DOI: 10.1002/jhm.13327] [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: 11/29/2023] [Revised: 02/07/2024] [Accepted: 02/23/2024] [Indexed: 03/27/2024]
Abstract
As medical educators, we have a responsibility to ensure our trainees are exposed to curricula dedicated to Diversity, Equity, and Inclusion (DEI), as illustrated by the Association of American Medical Colleges' recently released DEI Competencies Across the Curriculum. We designed and implemented a curriculum, Social Justice Rounds (SJR), that incorporates teaching on these topics directly into inpatient clinical work. SJR are brief team-based discussions facilitated by Pediatric Hospital Medicine faculty that focus on racism in medicine and other forms of discrimination experienced by patients and the effect it has on their interaction with the healthcare system. Medical students rotating through the Pediatrics Clerkship completed optional pre- and postclerkship surveys, which revealed statistically significant increases in students' frequency and comfort with conversations regarding DEI topics, both with the medical team and with patients. We believe that SJR provides a framework by which educators across specialties and institutions can provide trainees with foundational DEI skills.
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Affiliation(s)
- Katharina Hayes
- Department of Pediatrics, Paul C. Gaffney Division of Pediatric Hospital Medicine, UPMC Children's Hospital of Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John Szymusiak
- Department of Pediatrics, Paul C. Gaffney Division of Pediatric Hospital Medicine, UPMC Children's Hospital of Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Medicine, UPMC Montefiore Hospital, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew McCormick
- Department of Pediatrics, Paul C. Gaffney Division of Pediatric Hospital Medicine, UPMC Children's Hospital of Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Vivian EM, Chewning BA, Voils CI, Brown RL. Healthy Outcomes through Peer Educators: Feasibility of a peer support diabetes prevention programme for African-American grandmother caregivers. Diabetes Obes Metab 2024; 26:2598-2605. [PMID: 38567410 DOI: 10.1111/dom.15574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
AIM To assess the protocol feasibility and intervention acceptability of a community-based, peer support diabetes prevention programme (DPP) for African-American (AA) grandmother caregivers at risk for diabetes. MATERIALS AND METHODS Grandmother caregivers were randomized in a 2:1 ratio to DPP (active comparator) or DPP plus HOPE (Healthy Outcomes through Peer Educators; intervention). DPP + HOPE incorporated support from a peer educator who met with participants in person or by telephone every week during the 1-year intervention. Outcomes included: (1) recruitment rates, outcome assessment, and participation adherence rates assessed quantitatively; and (2) acceptability of the programme assessed through end-of-programme focus groups. RESULTS We successfully consented and enrolled 78% (n = 35) of the 45 AA grandmothers screened for eligibility. Eighty percent of participants (aged 64.4 ± 5.7 years) were retained up to Week 48 (74% for DPP [n = 17] and 92% for DPP + HOPE [n = 11]). All grandmothers identified social support, neighbourhood safety, and access to grocery stores as influences on their health behaviours. At Month 12, the active comparator (DPP) group and the intervention group (DPP + HOPE) had a mean change in body weight from baseline of -3.5 ± 5.5 (-0.68, -6.29) kg and - 4.4 ± 5.7 (-0.59, -8.2) kg, respectively. CONCLUSIONS This viable study met the aim of educating and equipping AA grandmothers with the practical and sustained support needed to work toward better health for themselves and their grandchildren, who may be at risk for diabetes. The intervention was both feasible and acceptable to participating grandmothers and their organizations.
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Affiliation(s)
- Eva M Vivian
- University of Wisconsin Madison School of Pharmacy, Madison, Wisconsin, USA
| | - Betty A Chewning
- University of Wisconsin Madison School of Pharmacy, Madison, Wisconsin, USA
| | - Corrine I Voils
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Roger L Brown
- University of Wisconsin School of Nursing and School of Medicine and Public Health, Madison, Wisconsin, USA
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Buckner JD, Sullivan JM, Thomas KL, Shepherd JM, Zvolensky MJ. Racism and alcohol-related problems among black adults: The role of negative emotionality to experiencing racism. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024:209448. [PMID: 38955251 DOI: 10.1016/j.josat.2024.209448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 06/10/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Although Black Americans tend to consume less alcohol than non-Hispanic/Latine White Americans, Black Americans who do drink alcohol appear at especially high risk for negative alcohol-related problems. This alcohol-based health disparity indicates a need to identify psycho-sociocultural factors that may play a role in drinking and related problems to inform prevention and treatment efforts. Minority stress-based models posit that stressors such as racism increase negative emotions, which may be associated with using substances such as alcohol to cope with negative emotions. Yet, little research has directly assessed emotional reactions to racism and whether it plays a role in drinking-related behaviors. METHOD Participants were 164 Black American undergraduates at a racially/ethnically diverse university who endorsed current alcohol use 18-48 (M = 21.7, SD = 4.3). Participants completed an online survey regarding their experiences with racism and alcohol-related behaviors. RESULTS Experiencing more frequent racism was related to greater negative emotions experienced in response to racism (i.e., negative emotional reactivity to racism) and alcohol-related problems. More frequent racism was related to more alcohol-related problems via the sequential effects of negative emotional reactivity to racism and coping motivated drinking. CONCLUSIONS These data indicate that the experience of negative emotions that occur after experiencing racism and attempts to cope with those negative emotions by consuming alcohol play important roles in drinking behaviors among Black Americans.
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Affiliation(s)
- Julia D Buckner
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA.
| | - Jas M Sullivan
- Department of Psychology, Political Science and African American Studies, Louisiana State University, Baton Rouge, LA, USA
| | - Katharine L Thomas
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | | | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Psychology, HEALTH Institute, University of Houston, Houston, TX, USA
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11
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Loring B, Curtis E. How racism plays out in contemporary public health practice (commentary). Aust N Z J Public Health 2024; 48:100167. [PMID: 38945054 DOI: 10.1016/j.anzjph.2024.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 04/25/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024] Open
Affiliation(s)
- Belinda Loring
- Public Health Physician and Senior Research Fellow, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
| | - Elana Curtis
- Public Health Physician, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
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12
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Sandberg DJ, Berne S, Hwang CP, Frisén A. Different contexts - different stories: Adolescents' experiences of how ethnicity is addressed in schools and sports and on social media in Sweden. Scand J Psychol 2024. [PMID: 38924590 DOI: 10.1111/sjop.13050] [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: 12/18/2023] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
Ethnicity plays a significant role in adolescents' everyday lives, but there is a limited understanding of adolescents' own experiences with how ethnicity is addressed in different contexts. Three contexts of importance during adolescence are investigated in the present study: schools, social media, and sports. A closer contextual examination has the potential to provide insights into how multiple contexts shape experiences with ethnicity. The aim of the study was to understand more about adolescents' experiences of how ethnicity is addressed in schools, on social media, and in sports. Six focus groups with a total of 21 adolescents (Mage = 14.5, SDage = 0.5, female = 76%) discussed their experiences. Data were transcribed verbatim and analyzed using a close-to-data, inductive thematic analysis. The analysis resulted in three main themes and seven subthemes, indicating that ethnicity was addressed differently in the three studied contexts. For the main theme of how ethnicity was addressed in schools, the subthemes were: Addressing ethnicity is important; Ethnicity is addressed through stereotypes and Everyday racism. The main theme of ethnicity on social media consisted of two subthemes: Sharing ethnic and cultural narratives and Hateful remarks. The main theme of ethnicity in sports also consisted of two subthemes: On equal terms and Clear consequences for racist behaviors. To better understand the multiple contexts, the results are discussed guided by the ecological systems theory. The adolescents highlighted that there are many benefits of addressing ethnicity and that it is important to do so in multiple contexts of adolescent life, just not in the same way. When ethnicity was addressed carelessly, such as through stereotypes or via racism masked as jokes, it had the potential to cause harm. When ethnicity was addressed with reflection, it instead had the potential to build understanding, lead to positive experiences, and provide learning opportunities.
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Affiliation(s)
- David J Sandberg
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Sofia Berne
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - C Philip Hwang
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Ann Frisén
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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Li Verdugo J, Kong Z, Sembukutti Liyanage DS, Keum BT, Moody MD, Oh HY. Associations between vicarious discrimination and mental health among young adult college students: Findings from the 2020-2021 Healthy Minds Study. J Affect Disord 2024; 361:760-767. [PMID: 38925312 DOI: 10.1016/j.jad.2024.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 06/19/2024] [Accepted: 06/22/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Poor mental health among young adults in higher education is a growing concern. In recent years, the visibility of racism has sharply risen. Vicarious discrimination is defined as the secondhand witnessing of racism, and given society's increased accessibility to social media and the Internet, addressing indirect violence is urgently needed to inform anti-racism and mental health efforts. The current study examined associations between vicarious discrimination and mental health across a large sample of young college students in the United States. METHODS We analyzed data from the Healthy Minds Study (HMS; 2020-2021; N=130,566) and used multivariable logistic regression to examine whether past-year vicarious discrimination was associated with various mental health outcomes, adjusting for age, gender, race/ethnicity, and direct discrimination. RESULTS The sample was predominantly white (n=31,438, 63.66%) and female-identifying (n=34,313, 69.49%) with an average age of 21.1 years. Approximately 35.9% of the sample endorsed experiencing vicarious discrimination. Vicarious discrimination was associated with greater depression (OR:1.97; 95% CI: [1.86,2.09], p< 0.001), anxiety (OR:1.82; 95% CI: [1.72,1.92], p<0.001), languishing (OR:1.75; 95% CI: [1.65,1.87], p<0.001), perceived need for treatment (OR:2.24; 95% CI: [2.10,2.40], p<0.001), suicidal ideation (OR:1.86; 95% CI: [1.73,2.01], p<0.001), suicide plan (OR:1.91; 95% CI: [1.71,2.14], p<0.001), suicide attempt (OR:1.89; 95% CI: [1.51,2.36], p<0.001), self-injurious behavior (OR:2.0; 95% CI: [1.88,2.12], p<0.001), and loneliness (OR:1.67; 95% CI: [1.58,1.77], p<0.001). DISCUSSION Consistent with growing literature, vicarious discrimination was associated with poorer mental health among young college students. Additional research should investigate moderators, mediators, and interventions to support those who may be impacted indirectly by discrimination.
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Affiliation(s)
- Juliann Li Verdugo
- University of Washington School of Social Work, United States of America.
| | - Zifang Kong
- Department of Statistics and Data Science, Southern Methodist University, United States of America
| | | | - Brian TaeHyuk Keum
- Department of Counseling, Developmental, and Educational Psychology, Boston College, United States of America
| | - Myles D Moody
- Department of Sociology, The University of Alabama at Birmingham, United States of America
| | - Hans Y Oh
- University of Southern California Dworak Peck School of Social Work, United States of America
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14
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Brandford A, Fernander A, Rayens MK. Harnessing Psychometric Tools to Uproot Racism and Build Equity in Nursing. J Nurs Meas 2024; 32:155-156. [PMID: 38897664 DOI: 10.1891/jnm-2024-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Affiliation(s)
- Arica Brandford
- School of Nursing and Health Professions, Southern New Hampshire University, Manchester NH, USA
| | - Anita Fernander
- Department of Community and Family Medicine, School of Medicine, University of New Mexico Health Sciences, Albuquerque, NM, USA
| | - Mary Kay Rayens
- School of Nursing, University of Kentucky, Lexington, KY, USA
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15
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Mora R, Maze M. The role of cultural competency training to address health disparities in surgical settings. Br Med Bull 2024; 150:42-59. [PMID: 38465857 DOI: 10.1093/bmb/ldae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Disparities in health care delivered to marginalized groups are unjust and result in poor health outcomes that increase the cost of care for everyone. These disparities are largely avoidable and health care providers, have been targeted with education and specialised training to address these disparities. SOURCES OF DATA In this manuscript we have sought out both peer-reviewed material on Pubmed, as well as policy statements on the potential role of cultural competency training (CCT) for providers in the surgical care setting. The goal of undertaking this work was to determine whether there is evidence that these endeavours are effective at reducing disparities. AREAS OF AGREEMENT The unjustness of health care disparities is universally accepted. AREAS OF CONTROVERSY Whether the outcome of CCT justifies the cost has not been effectively answered. GROWING POINTS These include the structure/content of the CCT and whether the training should be delivered to teams in the surgical setting. AREAS TIMELY FOR DEVELOPING RESEARCH Because health outcomes are affected by many different inputs, should the effectiveness of CCT be improvement in health outcomes or should we use a proxy or a surrogate of health outcomes.
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Affiliation(s)
- Roberto Mora
- Department of Anesthesia and Perioperative Care, University of California, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Mervyn Maze
- Department of Anesthesia and Perioperative Care, University of California, 1001 Potrero Avenue, San Francisco, CA 94110, USA
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Williams KKA, Lofters A, Baidoobonso S, Leblanc I, Haggerty J, Adams AM. Embracing Black heterogeneity: the importance of intersectionality in research on anti-Black racism and health care equity in Canada. CMAJ 2024; 196:E767-E769. [PMID: 38857933 PMCID: PMC11173650 DOI: 10.1503/cmaj.230350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Affiliation(s)
- Khandideh K A Williams
- Department of Family Medicine (Williams, Leblanc, Haggerty, Adams), McGill University; St. Mary's Hospital Center (Williams, Haggerty), Montréal, Que.; Department of Family & Community Medicine (Lofters), University of Toronto; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Community Health & Epidemiology (Baidoobonso), Dalhousie University, Halifax, NS; St. Mary's University Family Medicine Group (Leblanc), St. Mary's Hospital Center, Montréal, Que.
| | - Aisha Lofters
- Department of Family Medicine (Williams, Leblanc, Haggerty, Adams), McGill University; St. Mary's Hospital Center (Williams, Haggerty), Montréal, Que.; Department of Family & Community Medicine (Lofters), University of Toronto; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Community Health & Epidemiology (Baidoobonso), Dalhousie University, Halifax, NS; St. Mary's University Family Medicine Group (Leblanc), St. Mary's Hospital Center, Montréal, Que
| | - Shamara Baidoobonso
- Department of Family Medicine (Williams, Leblanc, Haggerty, Adams), McGill University; St. Mary's Hospital Center (Williams, Haggerty), Montréal, Que.; Department of Family & Community Medicine (Lofters), University of Toronto; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Community Health & Epidemiology (Baidoobonso), Dalhousie University, Halifax, NS; St. Mary's University Family Medicine Group (Leblanc), St. Mary's Hospital Center, Montréal, Que
| | - Isabelle Leblanc
- Department of Family Medicine (Williams, Leblanc, Haggerty, Adams), McGill University; St. Mary's Hospital Center (Williams, Haggerty), Montréal, Que.; Department of Family & Community Medicine (Lofters), University of Toronto; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Community Health & Epidemiology (Baidoobonso), Dalhousie University, Halifax, NS; St. Mary's University Family Medicine Group (Leblanc), St. Mary's Hospital Center, Montréal, Que
| | - Jeannie Haggerty
- Department of Family Medicine (Williams, Leblanc, Haggerty, Adams), McGill University; St. Mary's Hospital Center (Williams, Haggerty), Montréal, Que.; Department of Family & Community Medicine (Lofters), University of Toronto; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Community Health & Epidemiology (Baidoobonso), Dalhousie University, Halifax, NS; St. Mary's University Family Medicine Group (Leblanc), St. Mary's Hospital Center, Montréal, Que
| | - Alayne M Adams
- Department of Family Medicine (Williams, Leblanc, Haggerty, Adams), McGill University; St. Mary's Hospital Center (Williams, Haggerty), Montréal, Que.; Department of Family & Community Medicine (Lofters), University of Toronto; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Community Health & Epidemiology (Baidoobonso), Dalhousie University, Halifax, NS; St. Mary's University Family Medicine Group (Leblanc), St. Mary's Hospital Center, Montréal, Que
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Glenn JE, Bridges KM, Boye-Doe K, Taylor L, Peltzer JN, Alexander SL, Binion D, Schuette M, Francis CL, McGee JL. Evaluating the impact of an educational intervention on the history of racism in America for teaching structural competency to medical academicians. BMC MEDICAL EDUCATION 2024; 24:638. [PMID: 38849796 PMCID: PMC11157923 DOI: 10.1186/s12909-024-05626-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 06/03/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND A challenge facing many Academic Health Centers (AHCs) attempting to revise health professions education to include the impact of racism as a social and structural determinant of health (SSDoH) is a lack of broad faculty expertise to reinforce and avoid undermining learning modules addressing this topic. To encourage an institutional culture that is in line with new anti-racism instruction, we developed a six-part educational series on the history of racism in America and its impact on contemporary health inequities for teaching structural competency to health professions academicians. METHODS We developed a six-hour elective continuing education (CE) series for faculty and staff with the following objectives: (1) describe and discuss race as a social construct; (2) describe and discuss the decolonization of the health sciences and health care; (3) describe and discuss the history of systemic racism and structural violence from a socio-ecological perspective; and (4) describe and discuss reconciliation and repair in biomedicine. The series was spread over a six-month period and each monthly lecture was followed one week later by an open discussion debriefing session. Attendees were assessed on their understanding of each objective before and after each series segment. RESULTS We found significant increases in knowledge and understanding of each objective as the series progressed. Attendees reported that the series helped them grapple with their discomfort in a constructive manner. Self-selected attendees were overwhelmingly women (81.8%), indicating a greater willingness to engage with this material than men. CONCLUSIONS The series provides a model for AHCs looking to promote anti-racism and structural competency among their faculty and staff.
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Affiliation(s)
- Jason E Glenn
- Department of History and Philosophy of Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Kristina M Bridges
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kakra Boye-Doe
- Department of Psychiatry, Northwestern University School of Medicine, Chicago, IL, USA
| | - LesLee Taylor
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jill N Peltzer
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
| | - Shawn Leigh Alexander
- Department of African and African American Studies, University of Kansas, Lawrence, KS, USA
| | - Danielle Binion
- Office for Diversity, Equity and Inclusion, University of Kansas Medical Center, Kansas City, KS, USA
| | - Matthew Schuette
- Director of Institutional Research and Academic Analytics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Carrie L Francis
- Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jerrihlyn L McGee
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
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18
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Owens S, Seto E, Hajat A, Fishman P, Koné A, Jones-Smith JC. Assessing the Influence of Redlining on Intergenerational Wealth and Body Mass Index Through a Quasi-experimental Framework. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02044-7. [PMID: 38849692 DOI: 10.1007/s40615-024-02044-7] [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: 01/04/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Higher levels of body mass index (BMI), particularly for those who have obesity defined as class II and III, are correlated with excess risk of all-cause mortality in the USA, and these risks disproportionately affects marginalized communities impacted by systemic racism. Redlining, a form of structural racism, is a practice by which federal agencies and banks disincentivized mortgage investments in predominantly racialized minority neighborhoods, contributing to residential segregation. The extent to which redlining contributes to current-day wealth and health inequities, including obesity, through wealth pathways or limited access to health-promoting resources, remains unclear. Our quasi-experimental study aimed to investigate the generational impacts of redlining on wealth and body mass index (BMI) outcomes. METHODS We leveraged the Panel Study of Income Dynamics (PSID) and Home Owners' Loan Corporation (HOLC) maps to implement a geographical regression discontinuity design, where treatment assignment is randomly based on the boundary location of PSID grandparents in yellowlined vs. redlined areas and used outcome measures of wealth and mean BMI of grandchildren. To estimate our effects, we used a continuity-based approach and applied data-driven procedures to identify the most appropriate bandwidths for a valid estimation and inference. RESULTS In our fully adjusted model, grandchildren with grandparents living in redlined areas had lower average household wealth (β = - $35,419; 95% CIrbc - $37,423, - $7615) and a notably elevated mean BMI (β = 7.47; 95% CIrbc - 4.00, 16.60), when compared to grandchildren whose grandparents resided in yellowlined regions. CONCLUSION Our research supports the idea that redlining, a historical policy rooted in structural racism, is a key factor contributing to disparities in wealth accumulation and, conceivably, body mass index across racial groups.
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Affiliation(s)
- Shanise Owens
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15Th Ave NE, Fourth Floor, Seattle, WA, 98195, USA.
| | - Edmund Seto
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Paul Fishman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15Th Ave NE, Fourth Floor, Seattle, WA, 98195, USA
| | - Ahoua Koné
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Jessica C Jones-Smith
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15Th Ave NE, Fourth Floor, Seattle, WA, 98195, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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Ormiston CK, Villalobos K, Montiel Ishino FA, Williams F. Association Between Discrimination and Depressive Symptoms Among Hispanic or Latino Adults During the COVID-19 Pandemic: Cross-Sectional Study. JMIR Form Res 2024; 8:e48076. [PMID: 38843512 PMCID: PMC11190619 DOI: 10.2196/48076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Discrimination and xenophobia toward Hispanic and Latino communities increased during the COVID-19 pandemic, likely inflicting significant harm on the mental health of Hispanic and Latino individuals. Pandemic-related financial and social instability has disproportionately affected Hispanic and Latino communities, potentially compounding existing disparities and worsening mental health. OBJECTIVE This study aims to examine the association between discrimination and depressive symptoms during the COVID-19 pandemic among a national sample of Hispanic and Latino adults. METHODS Data from a 116-item web-based nationally distributed survey from May 2021 to January 2022 were analyzed. The sample (N=1181) was restricted to Hispanic or Latino (Mexican or Mexican American, Puerto Rican; Cuban or Cuban American, Central or South American, and Dominican or another Hispanic or Latino ethnicity) adults. Depression symptoms were assessed using the 2-item Patient Health Questionnaire. Discrimination was assessed using the 5-item Everyday Discrimination Scale. A multinomial logistic regression with a block entry model was used to assess the relationship between discrimination and the likelihood of depressive symptoms, as well as examine how controls and covariates affected the relationship of interest. RESULTS Mexican or Mexican American adults comprised the largest proportion of the sample (533/1181, 45.13%), followed by Central or South American (204/1181, 17.3%), Puerto Rican (189/1181, 16%), Dominican or another Hispanic or Latino ethnicity (172/1181, 14.6%), and Cuban or Cuban American (83/1181, 7.03%). Approximately 31.26% (367/1181) of the sample had depressive symptoms. Regarding discrimination, 54.56% (634/1181) reported experiencing some form of discrimination. Compared with those who did not experience discrimination, those who experienced discrimination had almost 230% higher odds of depressive symptoms (adjusted odds ratio [AOR] 3.31, 95% CI 2.42-4.54). Also, we observed that sociodemographic factors such as age and gender were significant. Compared with participants aged 56 years and older, participants aged 18-35 years and those aged 36-55 years had increased odds of having depressive symptoms (AOR 3.83, 95% CI 2.13-6.90 and AOR 3.10, 95% CI 1.74-5.51, respectively). Women had higher odds of having depressive symptoms (AOR 1.67, 95% CI 1.23-2.30) than men. Respondents with an annual income of less than US $25,000 (AOR 2.14, 95% CI 1.34-3.41) and US $25,000 to less than US $35,000 (AOR 1.89, 95% CI 1.17-3.06) had higher odds of depressive symptoms than those with an annual income of US $50,000 to less than US $75,000. CONCLUSIONS Our findings provide significant importance especially when considering the compounding, numerous socioeconomic challenges stemming from the pandemic that disproportionately impact the Hispanic and Latino communities. These challenges include rising xenophobia and tensions against immigrants, inadequate access to mental health resources for Hispanic and Latino individuals, and existing hesitations toward seeking mental health services among this population. Ultimately, these findings can serve as a foundation for promoting health equity.
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Affiliation(s)
- Cameron K Ormiston
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, MD, United States
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kevin Villalobos
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, MD, United States
| | | | - Faustine Williams
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, MD, United States
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20
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Macias Burgos MA, Bautista TG, Cruz-Carrillo Y, Cisco M, Sahbaz S, Nehme L, Vo D, Duque M, Schwartz SJ, Montero-Zamora P. Investigating the association between discrimination, internalizing symptoms, and alcohol use among Latino/a immigrants in the United States. Front Psychiatry 2024; 15:1358648. [PMID: 38911705 PMCID: PMC11190828 DOI: 10.3389/fpsyt.2024.1358648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/07/2024] [Indexed: 06/25/2024] Open
Abstract
Internalizing symptoms associated with anxiety and depression have been correlated with harmful alcohol use among Latino/as, but little attention has been paid to assessing the association between perceived discrimination and harmful alcohol use. The present study was designed to investigate the association between perceived discrimination, internalizing symptoms associated with anxiety and depression, and harmful alcohol use among Latino/a immigrants living in the United States (US). Our sample included 426 Latino/a immigrants. Their mean age was 40.05 years (SD = 6.50), 65.50% were women, 80.00% had a partner, 54.20% lived on less than $2,000 a month, and 41.50% reported having attained a college degree. Perceived discrimination was assessed using the Perceived Discrimination Scale, anxious symptoms were assessed using the GAD-7, depressive symptoms were assessed using the CES-D short form, and harmful alcohol use was assessed using AUDIT. We estimated a linear regression model using cross-sectional, self-reported data. The model was statistically significant, R 2 = 0.38, F (8, 425) = 32.09, p < 0.01. Discrimination was significantly associated with AUDIT scores, (β = 0.21, p < 0.01) after accounting for covariates and for symptoms of anxiety and depression. Our results indicate that experiences of discrimination in the US are associated with increased harmful alcohol use even after controlling for other variables. These findings may be useful in designing coping interventions specifically for Latino/a immigrants to reduce the risk of alcohol use disorder. This study also has political and public health implications for acknowledging the detrimental health consequences of experiencing discrimination, providing support to the position that reducing racism and discrimination represent important public health priorities.
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Affiliation(s)
| | - Tara G. Bautista
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | | | - Mia Cisco
- University of Texas at Austin, Department of Kinesiology and Health Education, Austin, TX, United States
| | - Sumeyra Sahbaz
- University of Texas at Austin, Department of Kinesiology and Health Education, Austin, TX, United States
| | - Lea Nehme
- FIU, Department of Epidemiology, Florida International University, Miami, FL, United States
| | - Duyen Vo
- University of Texas at Austin, Department of Kinesiology and Health Education, Austin, TX, United States
| | - Maria Duque
- University of Texas at Austin, Department of Kinesiology and Health Education, Austin, TX, United States
| | - Seth J. Schwartz
- University of Texas at Austin, Department of Kinesiology and Health Education, Austin, TX, United States
| | - Pablo Montero-Zamora
- University of Texas at Austin, Department of Kinesiology and Health Education, Austin, TX, United States
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21
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Keum BT, Wong MJ, Sanders I. Racial Hate at the Intersection of Online and Offline Worlds: The Joint Impact of Online and Offline Racism on the Mental Health of Racially Minoritized Individuals. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:2487-2506. [PMID: 38149586 DOI: 10.1177/08862605231220015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
With the everyday influence of social media and online platforms, racially minoritized individuals face the risk of experiencing racial discrimination in both offline and online contexts. Yet, there is scant research on how online and offline racism could jointly impact the mental health of racially minoritized individuals. Thus, the study examined online racism as a moderator in the link between offline racism and mental health issues. Using data from 651 racially minoritized emerging adults (Mage = 22.15, SD = 3.39), a moderation analysis was conducted using the PROCESS macro with bias-corrected bootstrapping (10,000 resamples). Experiencing more offline racism was significantly associated with greater mental health issues. Online racism was a significant moderator in the link between offline racism and mental health issues. The link between offline racism and mental health issues was not significant at low levels of online racism. However, the link was significant and strengthened at mean to high levels of online racism. The results suggest complex interactions in understanding the compounding impact of online and offline racism on mental health costs among racially minoritized individuals. Implications for future research on understanding the interplay between online and offline racism are discussed.
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22
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Nesterko Y, Jacobsen J, Köhler J, Glaesmer H. [The Connection between Objective and Subjective Attributions of a Migration Background with Perceived Discrimination and Racism]. Psychother Psychosom Med Psychol 2024; 74:214-223. [PMID: 38865997 DOI: 10.1055/a-2305-7890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
BACKGROUND The criteria-oriented assessment of the population with a migration background that is common in Germany is currently being criticized from a social science and methodological perspective, among others. In particular, its usefulness as an indicator of perceived discrimination against the population with a migration background can be critically questioned based on the current state of research METHOD: Based on a population-representative data set (N=1,989) for the city of Berlin, the subjective perception of a migration background based on self-attribution and anticipated external attribution of a migration background was recorded in addition to the objective assessment of a migration background. Furthermore, socio-demographic and migration-specific characteristics as well as perceived discrimination were assessed. Using descriptive and inferential statistical methods, differences between the objective and subjective assessment of a migration background and their relationship with perceived discrimination were analyzed. RESULTS Less than half (38%, 154/400) of the respondents identified as having a migrant background using the criterion-oriented approach reported describing themselves as migrants. 36% (144/405) reported that they believed that others in Germany described them as a person with a migrantion background. Respondents with a migration background are significantly more likely to experience discrimination on grounds of skin color, religion or country of origin compared to respondents without a migration background. Furthermore, it was found that both the self-attribution and the anticipated attribution by others as a migrant are positively associated with experiences of discrimination and racism. DISCUSSION The results suggest that migration-sensitive research should not simply differentiate between people with and without a migration background according to official criteria. Rather, the subjective perceptions of one's own attribution as a migrant seem more suitable as indicators of discrimination and should be taken into account in future research or surveys on experiences of discrimination.
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Affiliation(s)
- Yuriy Nesterko
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig
- Wissenschaftliche Abteilung, Zentrum ÜBERLEBEN, Berlin
- Klinisch-Psychologische Intervention, Freie Universität Berlin
| | - Jannes Jacobsen
- Cluster "Daten - Methoden - Monitoring", Deutsches Zentrum für Integrations- und Migrationsforschung (DeZIM), Berlin
| | - Jonas Köhler
- Cluster "Daten - Methoden - Monitoring", Deutsches Zentrum für Integrations- und Migrationsforschung (DeZIM), Berlin
| | - Heide Glaesmer
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig
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Wamser RA, Richardson J. Criterion A and Non-Criterion A Racial Discrimination Experiences, Posttraumatic Stress Symptoms, and Posttraumatic Cognitions Among Black or African Americans. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:2761-2781. [PMID: 38243747 DOI: 10.1177/08862605231222286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Racial discrimination is an unfortunately common experience for Black Americans with detrimental physical and mental health consequences. Prior research has established an association between discrimination and posttraumatic stress symptoms (PTSS); yet, trauma-related cognitions have not been studied. The majority of the existing empirical work in this area has not examined specific forms of discrimination experiences, despite potential key differences in these adversities. Relatedly, some forms of discrimination constitute "traumatic" events as defined by Criterion A for PTSD in the DSM-5 while others do not, and these distinctions have also been overlooked. Thus, the present study aimed to (a) examine discrimination, including specific types, in relation to PTSS and posttraumatic cognitions and (b) investigate whether Criterion A and non-Criterion A discrimination experiences were tied to PTSS and trauma-related thoughts. Participants were 172 undergraduate students who identified as Black or African American (Mage = 25.11, SD = 8.25, range = 18-56; 84.9% female). Results indicated that while cumulative trauma was unrelated to PTSS, discrimination experiences were linked with higher PTSS and negative posttraumatic cognitions. Specifically, avoidance discrimination experiences were associated with both outcomes. Criterion A discrimination events were not tied to PTSS. These findings support previous research showing a link between racial discrimination and trauma-related outcomes. In addition, the results suggest that avoidance discrimination, while not classified as "traumatic," may have an important contribution to PTSS and posttraumatic cognitions among Black individuals. The study underscores the need to address racial discrimination experiences, including microaggressions, within a traumatic stress context.
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Hicks PM, Lin G, Newman-Casey PA, Niziol LM, Lu MC, Woodward MA, Elam AR, Musch DC, Mehdipanah R, Ehrlich JR, Rein DB. Place-Based Measures of Inequity and Vision Difficulty and Blindness. JAMA Ophthalmol 2024; 142:540-546. [PMID: 38722650 PMCID: PMC11082749 DOI: 10.1001/jamaophthalmol.2024.1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/26/2024] [Indexed: 05/12/2024]
Abstract
Importance Known social risk factors associated with poor visual and systemic health in the US include segregation, income inequality, and persistent poverty. Objective To investigate the association of vision difficulty, including blindness, in neighborhoods with measures of inequity (Theil H index, Gini index, and persistent poverty). Design, Setting, and Participants This cross-sectional study used data from the 2012-2016 American Community Survey and 2010 US census tracts as well as Theil H index, Gini index, and persistent poverty measures from PolicyMap. Data analysis was completed in July 2023. Main Outcomes and Measures The main outcome was the number of census tract residents reporting vision difficulty and blindness (VDB) and the association with the Theil H index, Gini index, or persistent poverty, assessed using logistic regression. Results In total, 73 198 census tracts were analyzed. For every 0.1-unit increase in Theil H index and Gini index, there was an increased odds of VDB after controlling for census tract-level median age, the percentage of the population that identified as female sex, the percentage of the population that identified as a member of a racial or ethnic minority group, state, and population size (Theil H index: odds ratio [OR], 1.14 [95% CI, 1.14-1.14; P < .001]; Gini index: OR, 1.15 [95% CI, 1.15-1.15; P < .001]). Persistent poverty was associated with an increased odds of VDB after controlling for census tract-level median age, the percentage of the population that identified as female sex, the percentage of the population that identified as a member of a racial or ethnic minority group, state, and population size compared with nonpersistent poverty (OR, 1.36; 95% CI, 1.35-1.36; P < .001). Conclusions and Relevance In this cross-sectional study, residential measures of inequity through segregation, income inequality, or persistent poverty were associated with a greater number of residents living with VDB. It is essential to understand and address how neighborhood characteristics can impact rates of VDB.
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Affiliation(s)
- Patrice M. Hicks
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Housing Solutions for Health Equity, University of Michigan, Ann Arbor
| | - George Lin
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
| | - Paula Anne Newman-Casey
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
| | - Leslie M. Niziol
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
| | - Ming-Chen Lu
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
| | - Maria A. Woodward
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
| | - Angela R. Elam
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
| | - David C. Musch
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Roshanak Mehdipanah
- Housing Solutions for Health Equity, University of Michigan, Ann Arbor
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
| | - Joshua R. Ehrlich
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
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Strassle PD, Wilkerson MJ, Stewart AL, Forde AT, Jackson CL, Singh R, Nápoles AM. Impact of COVID-related Discrimination on Psychological Distress and Sleep Disturbances across Race-Ethnicity. J Racial Ethn Health Disparities 2024; 11:1374-1384. [PMID: 37126156 PMCID: PMC10150686 DOI: 10.1007/s40615-023-01614-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/18/2023] [Accepted: 04/22/2023] [Indexed: 05/02/2023]
Abstract
COVID-related discrimination towards historically marginalized racial-ethnic groups in the United States has been well-documented; however, its impact on psychological distress and sleep (overall and within specific racial-ethnic groups) is largely unknown. We used data from our nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Native Hawaiian/Pacific Islander, Latino, White, and multiracial adults, conducted from 12/2020-2/2021. Participants were asked how often they experienced discriminatory behaviors "because they think you might have COVID-19" (modified Everyday Discrimination Scale). Psychological distress was captured as having experienced anxiety-depression symptoms (Patient Health Questionairre-4, PHQ-4), perceived stress (modified Perceived Stress Scale), or loneliness-isolation ("How often have you felt lonely and isolated?"). Sleep disturbances were measured using the Patient-Reported Outcomes Information System Short Form Sleep Disturbance scale (PROMIS-SF 4a). Overall, 22.1% reported COVID-related discriminatory behaviors (sometimes/always: 9.7%; rarely: 12.4%). 48.4% of participants reported anxiety-depression symptoms (moderate/severe: 23.7% mild: 24.8%), 62.4% reported feeling stressed (moderate/severe: 34.3%; mild: 28,1%), 61.0% reported feeling lonely-isolated (fairly often/very often: 21.3%; almost never/sometimes: 39.7%), and 35.4% reported sleep disturbances (moderate/severe:19.8%; mild: 15.6%). Discrimination was only associated with increased psychological distress among racial-ethnic minorities. For example, COVID-related discrimination was strongly associated with anxiety-depression among Black/African American adults (mild: aOR=2.12, 95% CI=1.43-5.17; moderate/severe: aOR=5.19, 95% CI=3.35-8.05), but no association was observed among White or multiracial adults. Mitigating pandemic-related discrimination could help alleviate mental and sleep health disparities occurring among minoritized racial-ethnic groups.
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Affiliation(s)
- Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
| | - Miciah J Wilkerson
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Anita L Stewart
- University of California San Francisco, Institute for Health & Aging, Center for Aging in Diverse Communities, San Francisco, CA, USA
| | - Allana T Forde
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Chandra L Jackson
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Rupsha Singh
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Geier TJ, Timmer-Murillo SC, Brandolino AM, Piña I, Harb F, deRoon-Cassini TA. History of Racial Discrimination by Police Contributes to Worse Physical and Emotional Quality of Life in Black Americans After Traumatic Injury. J Racial Ethn Health Disparities 2024; 11:1774-1782. [PMID: 37249827 PMCID: PMC10228454 DOI: 10.1007/s40615-023-01649-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Black Americans are more likely than their White counterparts to experience traumatic injury and worse functional outcomes. Unfair police treatment has been identified as one specific form of racial discrimination potentially driving these deleterious outcomes. The aim of the investigation was to better understand the relationship between experiences of discrimination by police and trauma-specific quality of life outcomes, including PTSD symptom severity, in Black Americans following traumatic injury. METHOD Traumatically injured Black American adults (N = 53) presenting to a level 1 trauma center completed a measure of police and law enforcement discrimination at baseline, and quality of life and PTSD were assessed 6 months later. RESULTS Stepwise regressions results showed more frequent discrimination by police and law enforcement significantly predicted lower emotional and physical well-being 6 months after injury. Further, more frequent police discrimination resulted in more severe PTSD symptoms by 6 months after injury. CONCLUSIONS Findings underscore that following an injury not specifically related to discrimination by police, patients' historical, negative police experiences contributed to worse physical and emotional recovery in the present. These findings, in unison with prior investigations, reveal the need to consider patients' history of negative police experiences as a social determinant of health in their recovery.
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Affiliation(s)
- Timothy J Geier
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Sydney C Timmer-Murillo
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Amber M Brandolino
- Comprehensive Injury Center, Division of Data Surveillance and Informatics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Isela Piña
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Farah Harb
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Terri A deRoon-Cassini
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Comprehensive Injury Center, Division of Data Surveillance and Informatics, Medical College of Wisconsin, Milwaukee, WI, USA
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Egede LE, Walker RJ, Campbell JA, Linde S. Historic Redlining and Impact of Structural Racism on Diabetes Prevalence in a Nationally Representative Sample of U.S. Adults. Diabetes Care 2024; 47:964-969. [PMID: 38387079 PMCID: PMC11116912 DOI: 10.2337/dc23-2184] [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: 11/14/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE We investigated direct and indirect relationships between historic redlining and prevalence of diabetes in a U.S. national sample. RESEARCH DESIGN AND METHODS Using a previously validated conceptual model, we hypothesized pathways between structural racism and prevalence of diabetes via discrimination, incarceration, poverty, substance use, housing, education, unemployment, and food access. We combined census tract-level data, including diabetes prevalence from the Centers for Disease Control and Prevention PLACES 2019 database, redlining using historic Home Owners' Loan Corporation (HOLC) maps from the Mapping Inequality project, and census data from the Opportunity Insights database. HOLC grade (a score between 1 [best] and 4 [redlined]) for each census tract was based on overlap with historically HOLC-graded areas. The final analytic sample consisted of 11,375 U.S. census tracts. Structural equation modeling was used to investigate direct and indirect relationships adjusting for the 2010 population. RESULTS Redlining was directly associated with higher crude prevalence of diabetes within a census tract (r = 0.01; P = 0.008) after adjusting for the 2010 population (χ2(54) = 69,900.95; P < 0.001; root mean square error of approximation = 0; comparative fit index = 1). Redlining was indirectly associated with diabetes prevalence via incarceration (r = 0.06; P < 0.001), poverty (r = -0.10; P < 0.001), discrimination (r = 0.14; P < 0.001); substance use (measured by binge drinking: r = -0.65, P < 0.001; and smoking: r = 0.35, P < 0.001), housing (r = 0.06; P < 0.001), education (r = -0.17; P < 0.001), unemployment (r = -0.17; P < 0.001), and food access (r = 0.14; P < 0.001) after adjusting for the 2010 population. CONCLUSIONS Redlining has significant direct and indirect relationships with diabetes prevalence. Incarceration, poverty, discrimination, substance use, housing, education, unemployment, and food access may be possible targets for interventions aiming to mitigate the impact of structural racism on diabetes.
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Affiliation(s)
- Leonard E. Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J. Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer A. Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Sebastian Linde
- Department of Health Policy and Management, Texas A&M School of Public Health, College Station, TX
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28
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Chehade M, Murali KP, Dickson VV, McCarthy MM. Intersection of social determinants of health with ventricular assist device therapy: An integrative review. Heart Lung 2024; 66:56-70. [PMID: 38583277 DOI: 10.1016/j.hrtlng.2024.04.002] [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: 02/10/2024] [Revised: 03/15/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Social determinants of health (SDOH) may influence the clinical management of patients with heart failure. Further research is warranted on the relationship between SDOH and Ventricular Assist Device (VAD) therapy for heart failure. OBJECTIVES The purpose of this integrative review was to synthesize the state of knowledge on the intersection of SDOH with VAD therapy. METHODS Guided by Whittemore and Knafl's methodology, this literature search captured three concepts of interest including VAD therapy, SDOH, and their domains of intersection with patient selection, decision-making, treatment outcome, and resource allocation. CINAHL, Embase, PsycINFO, PubMed, and Web of Science were searched in March 2023. Articles were included if they were peer-reviewed publications in English, published between 2006 and 2023, conducted in the United States, and examined VAD therapy in the context of adult patients (age ≥ 18 years). RESULTS 22 quantitative studies meeting the inclusion criteria informed the conceptualization of SDOH using the Healthy People 2030 framework. Four themes captured how the identified SDOH intersected with different processes relating to VAD therapy: patient decision-making, healthcare access and resource allocation, patient selection, and treatment outcomes. Most studies addressed the intersection of SDOH with healthcare access and treatment outcomes. CONCLUSION This review highlights substantial gaps in understanding how SDOH intersect with patient and patient selection for VAD. More research using mixed methods designs is warranted. On an institutional level, addressing bias and discrimination may have mitigated health disparities with treatment outcomes, but further research is needed for implementing system-wide change. Standardized assessment of SDOH is recommended throughout clinical practice from patient selection to outpatient VAD care.
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Affiliation(s)
- Mireille Chehade
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States.
| | - Komal Patel Murali
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States
| | - Victoria Vaughan Dickson
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States
| | - Margaret M McCarthy
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States
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29
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Wu M, Davis JD, Zhao C, Daley T, Oliver KE. Racial inequities and rare CFTR variants: Impact on cystic fibrosis diagnosis and treatment. J Clin Transl Endocrinol 2024; 36:100344. [PMID: 38765466 PMCID: PMC11099334 DOI: 10.1016/j.jcte.2024.100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/21/2024] [Accepted: 04/14/2024] [Indexed: 05/22/2024] Open
Abstract
Cystic fibrosis (CF) has been traditionally viewed as a disease that affects White individuals. However, CF occurs among all races, ethnicities, and geographic ancestries. The disorder results from mutations in the CF transmembrane conductance regulator (CFTR). Varying incidence of CF is reported among Black, Indigenous, and People of Color (BIPOC), who typically exhibit worse clinical outcomes. These populations are more likely to carry rare CFTR variants omitted from newborn screening panels, leading to disparities in care such as delayed diagnosis and treatment. In this study, we present a case-in-point describing an individual of Gambian descent identified with CF. Patient genotype includes a premature termination codon (PTC) (c.2353C>T) and previously undescribed single nucleotide deletion (c.1970delG), arguing against effectiveness of currently available CFTR modulator-based interventions. Strategies for overcoming these two variants will likely include combinations of PTC suppressors, nonsense mediated decay inhibitors, and/or alternative approaches (e.g. gene therapy). Investigations such as the present study establish a foundation from which therapeutic treatments may be developed. Importantly, c.2353C>T and c.1970delG were not detected in the patient by traditional CFTR screening panels, which include an implicit racial and ethnic diagnostic bias as these tests are comprised of mutations largely observed in people of European ancestry. We suggest that next-generation sequencing of CFTR should be utilized to confirm or exclude a CF diagnosis, in order to equitably serve BIPOC individuals. Additional epidemiologic data, basic science investigations, and translational work are imperative for improving understanding of disease prevalence and progression, CFTR variant frequency, genotype-phenotype correlation, pharmacologic responsiveness, and personalized medicine approaches for patients with African ancestry and other historically understudied geographic lineages.
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Affiliation(s)
- Malinda Wu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Pediatric Institute, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Jacob D. Davis
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Conan Zhao
- Interdisciplinary Graduate Program in Quantitative Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Tanicia Daley
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Pediatric Institute, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Kathryn E. Oliver
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Pediatric Institute, Children’s Healthcare of Atlanta, Atlanta, GA, USA
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Tasslimi A, Bell TR, Moore TP, DeBolt C, Ibrahim A, Matheson J. Vaccine Coverage at 36 Months and 7 Years by Parental Birth Country, Washington State. Pediatrics 2024; 153:e2023064626. [PMID: 38774987 DOI: 10.1542/peds.2023-064626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Ensuring equitable vaccination access for immigrant communities is critical for guiding efforts to redress health disparities, but vaccine coverage data are limited. We evaluated childhood vaccination coverage by parental birth country (PBC) through the linkage of Washington State Immunization Information System data and birth records. METHODS We conducted a retrospective cohort evaluation of children born in Washington from January 1, 2006 to November 12, 2019. We assessed up-to-date vaccination coverage status for measles, mumps, and rubella (MMR), diphtheria, tetanus, and pertussis (DTaP), and poliovirus vaccines at ages 36 months and 7 years. Children with ≥1 parent(s) born in selected non-US countries were compared with children with 2 US-born parents, using Poisson regression models to provide prevalence ratios. RESULTS We identified 902 909 eligible children, of which 24% had ≥1 non-US-born parent(s). Vaccination coverage at 36 months by PBC ranged from 41.0% to 93.2% for ≥1 MMR doses and ≥3 poliovirus doses and 32.6% to 86.4% for ≥4 DTaP doses. Compared with children of US-born parents, the proportion of children up to date for all 3 vaccines was 3% to 16% higher among children of Filipino-, Indian-, and Mexican-born parents and 33% to 56% lower among children of Moldovan-, Russian-, and Ukrainian-born parents. Within-PBC coverage patterns were similar for all vaccines with some exceptions. Similar PBC-level differences were observed at 7 years of age. CONCLUSIONS The linkage of public health data improved the characterization of community-level childhood immunization outcomes. The findings provide actionable information to understand community-level vaccination determinants and support interventions to enhance vaccine coverage.
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Affiliation(s)
- Azadeh Tasslimi
- Refugee and Immigrant Health Program, Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, Washington
| | - Teal R Bell
- Office of Immunization, Washington State Department of Health, Tumwater, Washington
| | - Tyler P Moore
- Office of Immunization, Washington State Department of Health, Tumwater, Washington
| | - Charla DeBolt
- Center for Public Health Medical and Veterinary Science, Office of Health and Science, Washington State Department of Health, Shoreline, Washington
| | - Anisa Ibrahim
- Pediatric Clinic, Harborview Medical Center, Seattle, Washington
| | - Jasmine Matheson
- Refugee and Immigrant Health Program, Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, Washington
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Boyd K, Ware M, Mekawi Y. Interactive Effects of Racism and Racial Centrality on ADHD Symptoms. J Atten Disord 2024:10870547241256453. [PMID: 38804503 DOI: 10.1177/10870547241256453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVE Although race-related stress is associated with numerous mental health outcomes, no previous research has examined associations with ADHD symptoms. We examine how such associations differ in Black Americans based on racial identity to allow for more nuanced understandings of racial discrimination's association with ADHD symptoms. METHODS This study asked a sample of Black Americans to answer questionnaires assessing race-related stress, ADHD symptoms, and racial centrality. RESULTS In predicting ADHD symptoms, we found a positive effect of race-related stress and a negative effect of centrality. At low levels of centrality, the association between ADHD symptoms and race-related stress was stronger than at mean and high levels of centrality. Through additional sub-group analyses we found the interaction effect not replicating in one of our conditions. CONCLUSION These results suggest experiences of race-related stress and racial identity are important factors for consideration in the treatment of ADHD symptoms.
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Assari S. Racial Differences in Biopsychosocial Pathways to Tobacco and Marijuana Use Among Youth. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02035-8. [PMID: 38807026 DOI: 10.1007/s40615-024-02035-8] [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: 03/05/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The influence of socioeconomic disparities and multidimensional stressors on youth tobacco and marijuana use is recognized; however, the extent of these effects varies among different racial groups. Understanding the racial differences in the factors influencing substance use is crucial for developing tailored interventions aimed at reducing disparities in tobacco and marijuana use among adolescents. AIMS This study aims to explore the differential effects of socioeconomic disparities and multidimensional stressors on tobacco and marijuana use between Black and White adolescents. METHODS Utilizing longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study, this research includes a cohort of pre-youth, monitored from the age of 9-10 years for a period of up to 36 months. We examined the impact of various socioeconomic status (SES) indicators and multidimensional stressors, including trauma, financial stress, racial discrimination, and family stress, alongside baseline average cortical thickness and the subsequent initiation of tobacco and marijuana use over the 36-month follow-up. RESULTS Overall, 10,777 participants entered our analysis. This included 8263 White and 2514 Black youth. Our findings indicate significant differences in the pathways from SES indicators through stress types to cortical thickness between Black and White youths. Notably, cortical thickness's impact on the future initiation of tobacco and marijuana use was present in both groups. CONCLUSION The study suggests that compared to White adolescents, Black adolescents' substance use and associated cortical thickness are less influenced by stress and SES indicators. This discrepancy may be attributed to the compounded effects of racism, where psychosocial mechanisms might be more diminished for Black youth than White youth. These findings support the theory of Minorities' Diminished Returns rather than the cumulative disadvantage or double jeopardy hypothesis, highlighting the need for interventions that address the unique challenges faced by Black adolescents.
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Affiliation(s)
- Shervin Assari
- Department of Internal Medicine, Charles R Drew University of Medicine and Science, 1731 E. 120th St., Los Angeles, CA, 90059, USA.
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
- Marginalization-Related Diminished Returns, Los Angeles, CA, USA.
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Ikram N, Lewandowski LB, Watt MH, Scott C. Barriers and facilitators to medical care retention for pediatric systemic lupus erythematosus in South Africa: a qualitative study. Pediatr Rheumatol Online J 2024; 22:59. [PMID: 38807125 PMCID: PMC11131184 DOI: 10.1186/s12969-024-00994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a life-threatening, chronic, autoimmune disease requiring long term subspecialty care due to its complex and chronic nature. Childhood-onset SLE (cSLE) is more severe than adult-onset, and the cSLE population in South Africa has been reported to have an even higher risk than patients elsewhere. Therefore, it is critical to promptly diagnose, treat, and manage cSLE. In this paper, we aim to describe and evaluate barriers and enablers of appropriate long-term care of cSLE South Africa from the perspective of caregivers (parents or family members). METHODS Caregivers (n = 22) were recruited through pediatric and adult rheumatology clinics. Individuals were eligible if they cared for youth (≤ 19 years) who were diagnosed with cSLE and satisfied at least four of the eleven ACR SLE classification criteria. Individual in-depth, semi-structured interviews were conducted between January 2014 and December 2014, and explored barriers to and facilitators of ongoing chronic care for cSLE. Data were analyzed using applied thematic analysis. RESULTS Four barriers to chronic care engagement and retention were identified: knowledge gap, financial burdens, social stigma of SLE, and complexity of the South African medical system. Additionally, we found three facilitators: patient and caregiver education, robust support system for the caregiver, and financial support for the caregiver and patient. CONCLUSION These findings highlight multiple, intersecting barriers to routine longitudinal care for cSLE in South Africa and suggest there might be a group of diagnosed children who don't receive follow-up care and are subject to loss to follow-up. cSLE requires ongoing treatment and care; thus, the different barriers may interact and compound over time with each follow-up visit. South African cSLE patients are at high risk for poor outcomes. South African care teams should work to overcome these barriers and place attention on the facilitators to improve care retention for these patients and create a model for other less resourced settings.
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Affiliation(s)
- Naira Ikram
- Harvard Medical School, 02115, Boston, MA, USA
| | - Laura B Lewandowski
- Lupus Genomics and Global Health Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis, Musculoskeletal, and Skin Diseases, NIH, DHHS, 9000 Rockville Pike, Building 10, 12N248 Room 28, Bethesda, MD, 20892-1102, USA.
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Melissa H Watt
- Department of Population Health Sciences, University of Utah, Utah, USA
| | - Christiaan Scott
- Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, Western Cape, South Africa
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Karam SA, Schuch HS, Demarco FF, Horta BL, Borrell LN, Celeste RK, Correa MB. Differential effect of social mobility on tooth loss by race in adulthood: 1982 Pelotas Birth Cohort Study. Community Dent Oral Epidemiol 2024. [PMID: 38778564 DOI: 10.1111/cdoe.12975] [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: 04/12/2023] [Revised: 04/20/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To examine the association between social mobility and tooth loss in adults from the 1982 Pelotas Birth Cohort Study and whether race modifies this association. METHODS The Oral Health Study used data from 541 individuals who were followed up to 31 years of age. Social mobility, composed of the participants' socioeconomic position (SEP) at birth and at age 30, was categorized as never poor, upwardly mobile, downwardly mobile and always poor. The outcome was the prevalence of at least one tooth lost due to dental caries when the participants were examined at 31 years of age. The effect modifier was race (Black/Brown versus white people). Log-binomial regression models were used to estimate crude and sex-adjusted prevalence ratios (PR) and to determine whether the association varied with race. Statistical interactions were tested using an additive scale. RESULTS The prevalence of any tooth loss was 50.8% (n = 274). In social mobility groups, the prevalence of at least one tooth lost in the never-poor group was about 31% points higher for Black/Brown (68.2%) than for white people (37.4%). Antagonistic findings were found for the interaction between race and social mobility (Sinergy Index = 0.48; 95% CI 0.24, 0.99; and relative excess of risk due to the interaction = -1.38; 95% CI -2.34, -0.42), suggesting that the observed joint effect of race and social mobility on tooth loss was lower than the expected sum of these factors. The estimates for Black/Brown people were smaller for those who were always poor during their lives, relative to their white counterparts. CONCLUSIONS The findings suggest a higher prevalence of at least one tooth lost among people in the downward mobile SEP group and Black/Brown people. Greater racial inequity was found among Black/Brown people who had never experienced episodes of poverty, with Black/Brown people having a greater prevalence of at least one tooth lost than their white counterparts.
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Affiliation(s)
- Sarah Arangurem Karam
- Graduate Program in Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
- Professional Master's in Health in the Life Cycle, Catholic University of Pelotas, Pelotas, Brazil
| | | | - Flávio Fernando Demarco
- Graduate Program in Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Luisa N Borrell
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, New York, USA
| | - Roger Keller Celeste
- Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Motley RO, Walker DT, Willock J, Byansi W. Health Impact of Racism-Based Experiences Among Black African Immigrant Adults in the United States: An Integrative Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380241253827. [PMID: 38770911 DOI: 10.1177/15248380241253827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Racism-based experiences among Black African immigrants in the United States are a growing concern due to the prevalence of these events and risk for negative health (mental, behavioral, and physical) outcomes. This integrative review appraised published studies (2012-2023) addressing the relationship between racism-based experiences and adverse health for Black African immigrants. Articles were identified using structured search terms in several databases (APA PsycINFO, CINAHL, PubMed, Web of Science), Google Scholar, and citation mining. A total of fourteen studies met the inclusion criteria. Studies found a significant positive association between racism-based experiences and adverse mental (n = 9), behavioral (n = 3), and physical (n = 2) health outcomes. Racism-based experiences appear to have mental, behavioral, and physical health consequences for Black African immigrant adults. Given the growing population of Black African immigrants in the United States, more work is needed to elucidate the relationship between racism-based experiences and negative health outcomes.
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Affiliation(s)
- Robert O Motley
- Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Danielle T Walker
- Boston College Lynch School of Education and Human Development, Chestnut Hill, MA, USA
| | - Jamelia Willock
- Boston College School of Social Work, Chestnut Hill, MA, USA
| | - William Byansi
- Boston College School of Social Work, Chestnut Hill, MA, USA
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McGee-Avila JK, Suneja G, Engels EA, Rositch AF, Horner MJ, Luo Q, Shiels MS, Islam JY. Cancer Treatment Disparities in People With HIV in the United States, 2001-2019. J Clin Oncol 2024; 42:1810-1820. [PMID: 38513161 PMCID: PMC11095899 DOI: 10.1200/jco.23.02366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE People with HIV (PWH) have worse cancer outcomes, partially because of inequities in cancer treatment. We evaluated cancer treatment disparities among PWH, including an assessment of changes in disparities over time. METHODS We used data from the HIV/AIDS Cancer Match Study, a population-based HIV and cancer registry linkage to examine diffuse large B-cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and cancers of the cervix, lung, anus, prostate, colon, and female breast. Outcomes included receipt of (1) any cancer treatment and (2) standard therapy among patients with local-stage cancer. We assessed associations between HIV and each outcome by estimating adjusted prevalence odds ratios (aORs) with 95% CI and trends over time. We identified predictors of nonreceipt of cancer treatment in PWH. RESULTS From 2001 to 2019, compared with people with cancer without HIV (n = 2,880,955), PWH (n = 16,334) were more likely to not receive cancer treatment for cervical cancer (aOR, 2.03 [95% CI, 1.52 to 2.70]), DLBCL (aOR, 1.53 [95% CI, 1.38 to 1.70]), HL (aOR, 1.39 [95% CI, 1.19 to 1.63]), lung cancer (aOR, 1.79 [95% CI, 1.65 to 1.93]), prostate cancer (aOR, 1.32 [95% CI, 1.21 to 1.44]), colon cancer (aOR, 1.73 [95% CI, 1.43 to 2.08]), and breast cancer (aOR, 1.38 [95% CI, 1.07 to 1.77]). Similar associations were observed in PWH with local-stage cancers although no difference was observed for anal cancers. The association between HIV and nonreceipt of cancer treatment significantly decreased over time for breast, colon, and prostate cancers (all P trend <.0001), but PWH remained less likely to receive treatment in 2014-2019 for DLBCL, cervix, and lung cancers. Among PWH, Black individuals, people who inject drugs, and those 65 years and older were less likely to receive cancer treatment. CONCLUSION Disparities in receipt of cancer treatment persist for PWH in the United States in contemporary time periods. Solutions to address inequitable receipt of cancer treatment among PWH are urgently needed.
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Affiliation(s)
- Jennifer K. McGee-Avila
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, School of Medicine, Salt Lake City, UH
| | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Anne F. Rositch
- Deparment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Marie-Josephe Horner
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Qianlai Luo
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Meredith S. Shiels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Jessica Y. Islam
- Cancer Epidemiology Program, Center for Immunization and Infection in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Williams YA, Fertig AR, Trofholz AC, Kunin-Batson A, Berge JM. Community and household-level incarceration and its association with mental health in a racially/ethnically diverse sample of families. Soc Sci Med 2024; 352:117000. [PMID: 38815283 DOI: 10.1016/j.socscimed.2024.117000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
This study examines the association between community incarceration rates, household incarceration, and the mental health of parents and children. Participant families had children ages 5-9 (n = 1307) from the African American, Latinx, Hmong, Somali/Ethiopian, Native American, and White communities in the Twin Cities, Minnesota. Linear mixed models were used to estimate associations between parent and child mental health, household incarceration exposure, and census tract race, ethnicity and gender-specific incarceration rates matched to the family's home address and race/ethnicity. Findings indicated that living in census tracts with elevated incarceration rates of men from your same racial or ethnic group was significantly associated with psychological distress in parents and externalizing behaviors in boys, regardless of household exposure to incarceration. The association between incarceration rates and externalizing behaviors was only observed among girls with exposure to household incarceration. Policies that deconstruct pervasive racism in penal systems are needed to improve population mental health.
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Affiliation(s)
- Yasin A Williams
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Angela R Fertig
- Humphrey School of Public Affairs, University of Minnesota Minneapolis, MN, USA.
| | - Amanda C Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Alicia Kunin-Batson
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jerica M Berge
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Bernardo FR, Bastos JL, Reichenheim M. [Assessing experiences with discrimination in multiple social groups: invariance analysis of the Explicit Discrimination Scale in university students]. CAD SAUDE PUBLICA 2024; 40:e00127323. [PMID: 38775577 PMCID: PMC11105347 DOI: 10.1590/0102-311xpt127323] [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: 07/10/2023] [Revised: 01/29/2024] [Accepted: 02/19/2024] [Indexed: 05/25/2024] Open
Abstract
This study evaluated the ability of the Explicit Discrimination Scale (EDS) to produce comparable estimates among respondents according to gender, color/race, and socioeconomic status. Analysis was based on data from two studies with students from Brazilian public universities. An abridged version of the EDS with eight items was evaluated by the alignment method. Findings indicated violation of invariance between color/race and gender groups. Reports of discriminatory experiences had better comparability between socioeconomic status strata. This study showed that EDS should be used with caution, especially to compare discrimination estimates between respondents of different colors/races and genders. The observed violation of invariance reinforces the need for additional research examining whether such a scenario persists in larger and more diverse samples from Brazil.
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Affiliation(s)
| | - João L Bastos
- Universidade Federal de Santa Catarina, Florianópolis, Brasil
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Michael Reichenheim
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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Zhou WQ, Gao YT, Wang Y, Liu J, Wang QY, Zhou LS. Understanding Care Needs of Older Adults with Disabilities: A Scoping Review. J Multidiscip Healthc 2024; 17:2331-2350. [PMID: 38770173 PMCID: PMC11104368 DOI: 10.2147/jmdh.s454985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/28/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose To conducted a scoping review of care needs of older adults with disabilities at home and in the community and provide a comprehensive understanding of the essential needs of older adults with disabilities. Methods Eight databases were searched for relevant Chinese and English studies (supplemented by retrospective references of the included studies) from the establishment of the database to February 13, 2023. An thematic synthesis approach was used to qualitatively integrate the retrieved studies and identify need-related themes. Results A total of 6239 studies were retrieved, 2557 were de-weighted and excluded, and 56 were obtained after the double screening. Studies were from 11 countries. Thirty-three studies used a self-prepared survey instrument to investigate needs, and the other research tools commonly used were secondary databases and the Long-Term Care Needs of the Disabled Scale. A total of 78 specific need items were identified and summarized into three need themes based on the ICF framework: physical functioning needs, activity and participation needs, and environment needs. Conclusion The complex physical and mental health conditions faced by older adults with disabilities result in multifaceted, integrated needs that are difficult to identify and meet. Current research on older adults with disabilities is limited to common care. Future research should focus on the specificities of the older disabled population and understand the diverse care needs of people with disabilities in order to better target care services for this group. Policymakers should formulate more operational and strategic measures based on the actual needs of older adults with disabilities to expand the coverage of services and to pinpoint care services.
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Affiliation(s)
- Wan-Qiong Zhou
- School of Nursing, Naval Medical University, Shanghai, People’s Republic of China
| | - Yi-Tian Gao
- School of Nursing, Naval Medical University, Shanghai, People’s Republic of China
| | - Ying Wang
- Department of Nursing, The First Rehabilitation Hospital of Shanghai, Tongji University, Shanghai, People’s Republic of China
| | - Jing Liu
- School of Nursing, Naval Medical University, Shanghai, People’s Republic of China
| | - Qiu-Yi Wang
- School of Nursing, Naval Medical University, Shanghai, People’s Republic of China
| | - Lan-Shu Zhou
- School of Nursing, Naval Medical University, Shanghai, People’s Republic of China
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Cahill M, Illback R, Peiper N. Perceived Racial Discrimination, Psychological Distress, and Suicidal Behavior in Adolescence: Secondary Analysis of Cross-Sectional Data from a Statewide Youth Survey. Healthcare (Basel) 2024; 12:1011. [PMID: 38786419 PMCID: PMC11121279 DOI: 10.3390/healthcare12101011] [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: 03/28/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Developmental, clinical, and epidemiological research have demonstrated the salience of perceived racial discrimination (PRD) as a contributor to negative mental health outcomes in adolescence. This article summarizes secondary analyses of cross-sectional data from a large-scale youth survey within a predominantly rural state, to estimate the prevalence and strength of the association between PRD and serious psychological distress (SPD), suicidal ideation, and prior suicidal attempts. Data from 93,812 students enrolled in 6th, 8th, 10th, or 12th grade within 129 school districts across Kentucky were examined, to determine prevalence rates for subgroups within the cohort. Logistic regression analyses assessed the differences and established comparative strength of the association among these variables for racial/ethnic subgroups. PRD was self-reported at high rates across several demographic subgroups and was most evident among Black (24.5%) and Asian (22.1%) students. Multiracial students experienced the highest rates of both SPD and suicidality (ideation and prior attempt). Both for the entire cohort and for each racial/ethnic subgroup, PRD was significantly associated with an increased likelihood of negative mental health outcomes, although the strength of these associations varied across the subgroups and developmental levels. The implications for early intervention and prevention are discussed.
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Affiliation(s)
| | | | - Nicholas Peiper
- Department of Epidemiology and Population Health, University of Louisville, Louisville, KY 40202, USA;
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Harrington EE, Gamaldo AA, Felt JM, Witzel DD, Sliwinski MJ, Murdock KW, Engeland CG, Graham-Engeland JE. Racial differences in links between perceived discrimination, depressive symptoms, and ambulatory working memory. Aging Ment Health 2024:1-9. [PMID: 38738650 DOI: 10.1080/13607863.2024.2351923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 04/12/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Perceived discrimination is associated with racial cognitive health disparities. Links between discrimination and cognitive performance, like working memory, in everyday settings (i.e. ambulatory performance) require investigation. Depressive symptoms may be a mechanism through which discrimination relates to ambulatory working memory. METHOD Discrimination, retrospective and momentary depressive symptoms/mood, and aggregated and momentary working memory performance among older Black and White adults were examined within the Einstein Aging Study. RESULTS Racially stratified analyses revealed that discrimination did not relate to Black or White adults' ambulatory working memory. Among Black adults, however, more frequent discrimination was associated with greater retrospectively reported depressive symptoms, which related to more working memory errors across two weeks (indirect effect p < 0.05). This path was not significant among White adults. Links between discrimination and momentary working memory were not explained by momentary reports of depressed mood for Black or White adults. CONCLUSION Depressive symptoms may play an important role in the link between discrimination and ambulatory working memory among Black adults across extended measurements, but not at the momentary level. Future research should address ambulatory cognition and momentary reports of discrimination and depression to better understand how to minimize cognitive health disparities associated with discrimination.
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Affiliation(s)
- Erin E Harrington
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Department of Psychology, University of Wyoming, Laramie, WY, USA
| | | | - John M Felt
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Dakota D Witzel
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Martin J Sliwinski
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Kyle W Murdock
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Christopher G Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Ross and Carol, Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Jennifer E Graham-Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
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LeBrón AMW, Rodriguez VE, Sinco BR, Caldwell CH, Kieffer EC. Racialization processes and depressive symptoms among pregnant Mexican-origin immigrant women. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 38713848 DOI: 10.1002/ajcp.12755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/22/2024] [Accepted: 04/24/2024] [Indexed: 05/09/2024]
Abstract
This study examines how racialization processes (conceptualized as multilevel and dynamic processes) shape prenatal mental health by testing the association of discrimination and the John Henryism hypothesis on depressive symptoms for pregnant Mexican-origin immigrant women. We analyzed baseline data (n = 218) from a healthy lifestyle intervention for pregnant Latinas in Detroit, Michigan. Using separate multiple linear regression models, we examined the independent and joint associations of discrimination and John Henryism with depressive symptoms and effect modification by socioeconomic position. Discrimination was positively associated with depressive symptoms (β = 2.84; p < .001) when adjusting for covariates. This association did not vary by socioeconomic position. Women primarily attributed discrimination to language use, racial background, and nativity. We did not find support for the John Henryism hypothesis, meaning that the hypothesized association between John Henryism and depressive symptoms did not vary by socioeconomic position. Examinations of joint associations of discrimination and John Henryism on depressive symptoms indicate a positive association between discrimination and depressive symptoms (β = 2.81; p < .001) and no association of John Henryism and depressive symptoms (β = -0.83; p > .05). Results suggest complex pathways by which racialization processes affect health and highlight the importance of considering experiences of race, class, and gender within racialization processes.
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Affiliation(s)
- Alana M W LeBrón
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
- Department of Chicano/Latino Studies, School of Social Sciences, University of California, Irvine, Irvine, California, USA
| | - Victoria E Rodriguez
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Brandy R Sinco
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Cleopatra H Caldwell
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Edith C Kieffer
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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Faluyi D, Ovseiko PV, Dziedzic K, Scott F. NIHR Race Equality Framework: development of a tool for addressing racial equality in public involvement. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:44. [PMID: 38715152 PMCID: PMC11077722 DOI: 10.1186/s40900-024-00569-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 03/22/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND While there has been a long recognition of the importance of race equality in health and care research, there is a lack of sustained action among research funding and research performing organisations to address racial equality in public involvement. This paper describes how the UK's National Institute for Health and Care Research (NIHR) convened a Race Equality Public Action Group (REPAG), which co-developed with public contributors and stakeholders a Race Equality Framework - a tool for addressing racial equality in public involvement. METHODS The REPAG, through meetings and discussions, defined the focus of the Framework, and developed an initial draft of the Framework. Public contributors identified the need for broader consultation with other public members. Three community consultation events with a total of 59 members of Black African-, Asian- and Caribbean-heritage communities were held to seek their views on health and care research generally and on the draft Framework specifically. The draft Framework was modified and piloted among 16 organisations delivering health and care research. Following feedback from the pilot, the Framework was modified and prepared for publication. RESULTS The Framework is designed as a self-assessment tool comprised of 50 questions pertaining to five domains of organisational activity: 1) individual responsibility, 2) leadership, 3) public partnerships, 4) recruitment, and 5) systems and processes. The questions were co-designed with REPAG public members and provide key concepts and elements of good practice that organisations should consider and address on their path to achieving racial competence. The accompanying materials provide implementation guidance with 20 detailed steps, case studies of actions taken in seven pilot organisations, and links to additional resources. The pilot demonstrated the feasibility of conducting a meaningful self-assessment over a period of three months and the usefulness of the results for developing longer-term action plans. CONCLUSION The Framework represents the first self-assessment tool for addressing racial equality in public involvement. Co-design with REPAG public members enhanced its authenticity and practicality. Organisations in the field of health and care research and any other organisations that use partnerships with the public are encouraged to adopt the Framework.
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Affiliation(s)
- David Faluyi
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Pavel V Ovseiko
- Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Krysia Dziedzic
- Impact Accelerator Unit, School of Medicine, Keele University, Keele, ST5 5BG, UK
| | - Fay Scott
- National Insititute for Health and Care Research (NIHR) Coordinating Centre, Grange House, 15 Church Street, Twickenham, TW1 3NL, UK
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Merz S, Aksakal T, Hibtay A, Yücesoy H, Fieselmann J, Annaç K, Yılmaz-Aslan Y, Brzoska P, Tezcan-Güntekin H. Racism against healthcare users in inpatient care: a scoping review. Int J Equity Health 2024; 23:89. [PMID: 38698455 PMCID: PMC11067303 DOI: 10.1186/s12939-024-02156-w] [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: 01/08/2024] [Accepted: 03/19/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Racism in the healthcare system has become a burgeoning focus in health policy-making and research. Existing research has shown both interpersonal and structural forms of racism limiting access to quality healthcare for racialised healthcare users. Nevertheless, little is known about the specifics of racism in the inpatient sector, specifically hospitals and rehabilitation facilities. The aim of this scoping review is therefore to map the evidence on racial discrimination experienced by people receiving treatment in inpatient settings (hospitals and rehabilitation facilities) or their caregivers in high-income countries, focusing specifically on whether intersectional axes of discrimination have been taken into account when describing these experiences. METHODS Based on the conceptual framework developed by Arksey and O'Malley, this scoping review surveyed existing research on racism and racial discrimination in inpatient care in high-income countries published between 2013 and 2023. The software Rayyan was used to support the screening process while MAXQDA was used for thematic coding. RESULTS Forty-seven articles were included in this review. Specifics of the inpatient sector included different hospitalisation, admission and referral rates within and across hospitals; the threat of racial discrimination from other healthcare users; and the spatial segregation of healthcare users according to ethnic, religious or racialised criteria. While most articles described some interactions between race and other social categories in the sample composition, the framework of intersectionality was rarely considered explicitly during analysis. DISCUSSION While the USA continue to predominate in discussions, other high-income countries including Canada, Australia and the UK also examine racism in their own healthcare systems. Absent from the literature are studies from a wider range of European countries as well as of racialised and disadvantaged groups other than refugees or recent immigrants. Research in this area would also benefit from an engagement with approaches to intersectionality in public health to produce a more nuanced understanding of the interactions of racism with other axes of discrimination. As inpatient care exhibits a range of specific structures, future research and policy-making ought to consider these specifics to develop targeted interventions, including training for non-clinical staff and robust, transparent and accessible complaint procedures.
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Affiliation(s)
- Sibille Merz
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Tuğba Aksakal
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Ariam Hibtay
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Hilâl Yücesoy
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Jana Fieselmann
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Kübra Annaç
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Yüce Yılmaz-Aslan
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Patrick Brzoska
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
| | - Hürrem Tezcan-Güntekin
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
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Park IJK, Wang L, Li R, Yip T, Valentino K, Cruz-Gonzalez M, Giraldo-Santiago N, Lorenzo K, Zhen-Duan J, Alvarez K, Alegría M. A daily diary study of discrimination and distress in Mexican-origin adolescents: Testing mediating mechanisms. Child Dev 2024. [PMID: 38698702 DOI: 10.1111/cdev.14108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The present 21-day daily diary study (conducted 2021-2022) tested anger and racism-related vigilance as potential transdiagnostic mediators linking exposure to racial and ethnic discrimination (RED) to distress (negative affect and stress, respectively). The data analytic sample included N = 317 Mexican-origin adolescents (Mage = 13.5 years; 50.8% male, 46.7% female; 2.5% non-binary) from the Midwestern United States. Results from longitudinal mediation models revealed significant mediation effects through anger and racism-related vigilance, respectively, in the association between daily RED and daily distress, both within and across adolescents. Implications for theory, research, and practice are discussed so that future work can leverage these novel findings toward promoting the well-being of Mexican-origin adolescents, especially those who live in contexts of ethnoracial adversity.
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Affiliation(s)
- Irene J K Park
- Department of Psychiatry, Indiana University School of Medicine-South Bend, South Bend, Indiana, USA
| | - Lijuan Wang
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Ruoxuan Li
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Tiffany Yip
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Kristin Valentino
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia Giraldo-Santiago
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kyle Lorenzo
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kiara Alvarez
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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46
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Fuller-Rowell TE, Zeringue MM, Saini EK, Yip T, El-Sheikh M. Do Sleep Problems Exacerbate the Mental Health Consequences of Discrimination Among Adults? Psychosom Med 2024; 86:324-333. [PMID: 38588054 DOI: 10.1097/psy.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
OBJECTIVE An emerging literature suggests that sleep may play an important role in moderating the association between discrimination and mental health problems among adolescents. However, few if any studies have considered this topic among adults. Addressing this knowledge gap, the current study examined multiple sleep parameters as moderating variables in the association between discrimination and mental health problems among adults. METHODS Participants were 874 adults residing in small towns and semirural contexts within the Southeastern region of the United States ( Mage = 41 years, SD = 7; 57% female; 31% Black, 69% White; 52% income-to-needs < 2). Sleep duration and night-to-night variability in duration were assessed using wrist actigraphy. Established self-report measures were used to assess global sleep problems, experiences of discrimination, and mental health problems (anxiety, depression, and externalizing symptoms). RESULTS Experiences of discrimination were associated with more depression, anxiety, and externalizing problems. Two out of three sleep parameters were found to moderate the effects of discrimination on mental health. The association between discrimination and externalizing problems (but not anxiety or depression) was attenuated among those with less night-to-night variability in sleep duration. The associations between discrimination and anxiety and externalizing problems (but not depression) were attenuated among those with fewer global sleep problems. Less variability in sleep duration and fewer global sleep problems were also directly associated with lower levels of depression, anxiety, and externalizing problems. CONCLUSIONS Greater consistency in sleep duration from night-to-night, and fewer overall sleep problems appear to mitigate risk of mental health problems among adults, particularly in contexts where discrimination is prevalent.
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Affiliation(s)
- Thomas E Fuller-Rowell
- From the Department of Human Development and Family Science (Fuller-Rowell, El-Sheikh), Auburn University, Auburn, Alabama; Department of Psychology (Zeringue), Middle Tennessee State University, Murfreesboro, Tennessee; Department of Human Development and Family Studies (Saini), Pennsylvania State University, University Park, Pennsylvania; and Department of Psychology (Yip), Fordham University, Bronx, New York
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47
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Lewis J, Turner A, James T, Brown I, Wilson LT. We outside: Modeling equity-centered, antiracist, community-driven partnerships in resident education. AEM EDUCATION AND TRAINING 2024; 8:S36-S42. [PMID: 38774826 PMCID: PMC11102943 DOI: 10.1002/aet2.10984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 05/24/2024]
Abstract
Background Community engagement is increasingly recognized as a necessity in addressing intractable racial and ethnic health disparities in the United States. However, institutions have not adequately trained resident physicians in developing symbiotic community partnerships that preserve community autonomy and identity without exploitation. Our goals were to highlight the experiences of expert academic emergency physicians in creating innovative, community-driven, and anti-racist solutions to achieving measurable equity in health outcomes and to introduce a novel framework entitled the Social Change Method to take a community-embedded intervention from concept to creation. Methods The methodology was based on the development of a didactic session at the 2023 SAEM Annual Meeting. The three novel initiatives discussed were Emergency Medicine Remix (EMR); Trust, Research, Access, and Prevention (TRAP) Medicine; and The Health Equity Accelerator (HEA). A team of multi-institutional experts convened to develop the session objectives through priority setting. Results Our expert panel discussed successes and challenges encountered while using evidence-informed strategies to conduct their community-based programming. Participant questions were centered on fostering sustainability, emphasizing the importance of carefully crafted interventions in the face of uncertain legislative challenges and strategies to empower others. Conclusions Emergency medicine residency education should incorporate training on methods to leverage community partnerships to improve individual and community health outcomes. The Social Change Method can be used as a conceptual framework to generate easily re-creatable and scalable partnerships that establish trust and forge relationships that honor identity and autonomy without exploiting community members.
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Affiliation(s)
- John Lewis
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Anisha Turner
- Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Thea James
- Department of Emergency MedicineBoston Medical Center Health SystemBostonMassachusettsUSA
| | - Italo Brown
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
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Kwon D, Knorr DA, Wiley KS, Young SL, Fox MM. Association of pica with cortisol and inflammation among Latina pregnant women. Am J Hum Biol 2024; 36:e24025. [PMID: 38050975 PMCID: PMC11062838 DOI: 10.1002/ajhb.24025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023] Open
Abstract
Pica, the urge to consume items generally not considered food, such as dirt, raw starch, and ice, are particularly common among pregnant women. However, the biology of pica in pregnancy is not well understood. Therefore, this study aimed to assess how pica relates to endocrine stress and immune biomarkers in a cohort of pregnant Latina women in Southern California. Thirty-four women completed a structured pica questionnaire. Maternal urinary cortisol and plasma cytokine levels were measured between 21 and 31 weeks' gestation. Associations between pica during pregnancy and biomarkers were assessed using linear regression models adjusting for gestational age. Twelve (35.3%) of the pregnant women reported pica (geophagy and amylophagy) during pregnancy. In multivariate models, those who engaged in pica had higher levels of cortisol (β: 0.37, 95% CI: 0.01, 0.073) and lower levels of IL-1β (β: -0.06, 95% CI: -0.11, -0.02), IL-8 (β: -0.30, 95% CI: -0.56, -0.05), IL-21 (β: -0.35, 95% CI: -0.63, -0.08), and type-1 inflammation composite (β: -0.29, 95% CI: -0.44, -0.14) than women who did not engage in pica. These results suggest that biological stress and immune response differ for women with pica compared to those without. This study suggests novel physiological covariates of pica during pregnancy. Further research is needed to better understand the mechanisms and temporality underlying the observed associations between pica and endocrine and immune biomarkers.
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Affiliation(s)
- Dayoon Kwon
- Department of Epidemiology, University of California, Los Angles, California, USA
| | - Delaney A Knorr
- Department of Anthropology, University of California, Los Angles, California, USA
| | - Kyle S Wiley
- Department of Anthropology, University of California, Los Angles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angles, California, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Molly M Fox
- Department of Anthropology, University of California, Los Angles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angles, California, USA
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Ng WYK. Editorial: Equity, diversity and inclusion in child and adolescent mental health - a perspective from the American Academy of Child and Adolescent Psychiatry (AACAP). Child Adolesc Ment Health 2024; 29:192-193. [PMID: 38634296 DOI: 10.1111/camh.12697] [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] [Accepted: 02/28/2024] [Indexed: 04/19/2024]
Abstract
Advancing diversity, equity and inclusion (DEI) are key priorities for the American Academy of Child and Adolescent Psychiatry (AACAP). AACAP was founded in 1953. The mission of the AACAP includes promoting the healthy development of all children, adolescents, and families through advocacy, education, and research. AACAP's Presidential Initiative of CAPture Belonging's goal was to prioritize diversity, equity, inclusion and belonging to create transformational and sustainable changes in the organization and child and adolescent psychiatry. The presidential initiative's strategy had three pillars: advancing diversity, equity, inclusion, and belonging (DEIB) in all program and services, creating a pipeline for diverse child and adolescent psychiatrists, and monitoring DEIB activities and progress. A presidential task force was created and charged with implementing a 2-year action plan and strategy. A 5-point action plan prioritized: awareness, advocacy, workforce and professional development, national partnerships, and sustainability. Focusing on DEIB for any organization enriches the work, community and success that can be achieved. AACAP is proud to have committed to this DEIB path and has already experienced success through continuous membership growth, membership engagement, and record attendance at annual meetings and volunteer involvement. These accomplishments can only enhance AACAP's ability to serve the mission of promoting the healthy development of all children, adolescents, and families through advocacy, education, and research.
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Affiliation(s)
- Warren Yiu Kee Ng
- Columbia University Medical Center, New York, NY, USA
- New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY, USA
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50
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Gloger EM, Segerstrom SC. Repetitive thought, cognition, and systemic inflammation in the midlife in the United States study. Psychol Health 2024; 39:651-669. [PMID: 35758133 PMCID: PMC10026601 DOI: 10.1080/08870446.2022.2092104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 04/28/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Poor cognition increases risk for negative health outcomes, and this may be explained by associations with systemic inflammation. Previously, amount of repetitive thought (Total RT) interacted with IQ to predict interleukin-6 (IL-6) in older adults. This study continued the investigation of repetitive thought (RT) as an element involved in the effect of cognition on inflammation. DESIGN Participants (N = 164) came from the Midlife in the United States Refresher project (Mage = 45.33, SD = 11.51, ranges = 25-74; 48.2% female; 85% Caucasian). Cognition was assessed via telephone, inflammatory biomarkers (IL-6, C-reactive protein (CRP), and tumour-necrosis factor-alpha (TNF- α)) analysed after blood draw, and RT derived from daily diary data. RESULTS Cognition significantly interacted with RT valence (p = .009) to explain CRP after covariate adjustment. Better cognition and more negative RT valence was associated with lower CRP (β = -0.190 [-.387, .008]). Worse cognition and more negative RT valence was associated with higher CRP (β = 0.133 [-.031, .297]). No significant effects were found for IL-6 or TNF-α. CONCLUSION RT may interact with cognition to affect different inflammatory biomarkers. Those with worse cognition may benefit more from skills related to regulating thought than those with better cognition.
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Affiliation(s)
- Elana M Gloger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
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