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Rowden SN, Lawson M, Ponnapakkam A, Martin PC, Wyatt TR, Percival CS. 'Humility, Concern, Respect': A Qualitative Study Exploring Parent Perspectives on a Pediatrician's Role in Addressing Racism. J Pediatr 2024; 274:114193. [PMID: 39004172 DOI: 10.1016/j.jpeds.2024.114193] [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: 03/14/2024] [Revised: 05/29/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To explore racially minoritized families' perceptions on how, and if, physicians should address children's racial identity and concepts of racism within clinical settings. STUDY DESIGN Parents of racially minoritized children, ages 5 through 18, were interviewed to explore experiences with racial identity formation, discrimination, and the extent to which they wanted pediatricians to address these topics. Children were included at the discretion of their parents. Interviews were transcribed, coded, and analyzed through a critical race theory lens based in constructivist grounded theory. RESULTS Parents encouraged their children to embrace their racial identities but also wanted to shield them from negative experiences of racism to preserve identity safety. Parents felt pediatricians should address racial issues in a manner specific to their child's situation. Thoughtful inclusion of race-related questions, whether in discussion or on questionnaires, is essential to prevent tension in a therapeutic relationship. There was no consensus on the use of preclinical screening. Instead, families highlighted the importance of embracing humility, trust, and respect. CONCLUSIONS Participant families have preferences for approaches to address the effects of racism on their children's health. Pediatricians should understand the importance of identity safety and approach their discussions with cultural humility, which includes self-reflection, empathy, active listening, and flexible negotiation. Above all, pediatricians need to create a safe environment for appropriate discussion of these issues.
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Affiliation(s)
- Samantha N Rowden
- Brooke Army Medical Center, San Antonio, TX; Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Michelle Lawson
- Brooke Army Medical Center, San Antonio, TX; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Adharsh Ponnapakkam
- Brooke Army Medical Center, San Antonio, TX; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Paolo C Martin
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Tasha R Wyatt
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Candace S Percival
- Brooke Army Medical Center, San Antonio, TX; Uniformed Services University of the Health Sciences, Bethesda, MD
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Clark S, Cohen A, Welch SB, Bate A, Anderson AT, Chomilo N, Dougé J, Durkee M, Iruka IU, Jindal M, Jones SC, Li A, Arshad A, Heard-Garris N. Guidance on Conversations About Race and Racism in Pediatric Clinical Settings. Pediatrics 2024; 154:e2023063767. [PMID: 38903051 PMCID: PMC11211695 DOI: 10.1542/peds.2023-063767] [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: 10/26/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVE To develop guidance for pediatric clinicians on how to discuss race and racism in pediatric clinical settings. METHODS We conducted a modified Delphi study from 2021 to 2022 with a panel of pediatric clinicians, psychologists, parents, and adolescents with expertise in racism and child health through scholarship or lived experience. Panelists responded to an initial survey with open-ended questions about how to talk to youth about race and racism. We coded the responses using qualitative methods and presented them back to the panelists. In iterative surveys, panelists reached a consensus on which themes were most important for the conversation. RESULTS A total of 29 of 33 panelists completed the surveys and a consensus was reached about the concepts pediatric clinicians should consider before, during, and after conversations about race and racism and impediments clinicians may face while having these discussions. Panelists agreed that it was within the pediatric clinician's role to have these conversations. An overarching theme was the importance of having background knowledge about the systemic nature of racism. Panelists agreed that being active listeners, learning from patients, and addressing intersectionality were important for pediatric clinicians during conversations. Panelists also agreed that short- and long-term benefits may result from these conversations; however, harm could be done if pediatric clinicians do not have adequate training to conduct the conversations. CONCLUSIONS These principles can help guide conversations about race and racism in the pediatric clinical setting, equipping clinicians with tools to offer care that acknowledges and addresses the racism many of their patients face.
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Affiliation(s)
- Shawnese Clark
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- ARISE Health Lab, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Alyssa Cohen
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- ARISE Health Lab, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
- Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Sarah B. Welch
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Aleha Bate
- Department of Clinical Psychology, Adler University, Chicago, Illinois
| | - Ashaunta T. Anderson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
- Division of General Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Nathan Chomilo
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
- Park Nicollet Health Services, St Louis Park, Minnesota
| | | | - Myles Durkee
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Iheoma U. Iruka
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Monique Jindal
- Department of Medicine, University of Illinois Chicago School of Medicine, Chicago, Illinois
| | - Shawn C.T. Jones
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Angie Li
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, Illinois
| | | | - Nia Heard-Garris
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- ARISE Health Lab, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
- Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
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Barreca JA. Exploring the Relationship between Adverse Childhood Experiences (ACEs) and Mental Health in Low Birthweight Children. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:585-596. [PMID: 38938970 PMCID: PMC11199437 DOI: 10.1007/s40653-023-00577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 06/29/2024]
Abstract
Low birthweight is associated with poor health, developmental, and social outcomes throughout the lifespan. Exposure to adverse childhood experiences (ACEs) is also associated with negative mental and physical health outcomes in adulthood. The aims of this study were to explore the relationship between low birthweight (LBW), exposure to ACES, and subsequent utilization of mental health service. Data analysis was conducted using a subset of data from children ages 6-17 years from the National Survey of Children's Health (NSCH) for 2018-2019 (n = 40,656). Welch ANOVA, Pearson's chi-square, and logistic regression investigated the relationship between LBW, ACEs, and mental health. LBW children in this sample had higher exposure to ACEs when compared to not low birthweight (NBW) children. LBW children also had a higher reported incidence of identified mental health (MH) issues. There was no significant association between birthweight and unmet MH service needs. LBW children with an ACE score or two or more were more likely to have an unidentified MH issue and/or an unmet MH service need. The results demonstrate LBW children experience higher levels of adversity. Children with ACE scores of two or more and those with unidentified MH issues have a higher likelihood of unmet MH needs. Professionals working in the health, education, and social service sectors can use this information to raise awareness of the increased vulnerability and more effectively meet the mental health needs of LBW children.
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Affiliation(s)
- Jessica A. Barreca
- Center for Interprofessional Education and Research, Saint Louis University, 1312 Carr Lane, Suite 110, St. Louis, MO 63104 USA
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Carney-Knisely G, Griffin M, Crawford A, Spates K, Singh P. Police killings of unarmed Black persons and suicides among Black youth in the US: A national time-series analysis. Ann Epidemiol 2024; 94:91-99. [PMID: 38710240 DOI: 10.1016/j.annepidem.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Suicide deaths among Black youth in the US have increased rapidly over the past decade. Direct or vicarious racial trauma experienced through exposure to police brutality may underlie these concerning trends. METHODS We obtained nationally aggregated monthly counts of suicides for non-Hispanic Black and White youth (age ≤ 24 years) and adults (age > 24 years) from the National Mortality Vital Statistics restricted-use data files provided by the Centers for Disease Control and Prevention, from 2013 to 2019. Monthly counts of Black youth suicides constituted our main outcome. We defined our exposure as the monthly counts of police killings of unarmed Black persons over 84 months (2013 to 2019), retrieved from the Mapping Police Violence database. We used ARIMA (AutoRegressive Integrated Moving Average) time-series analyses to examine whether Black youth suicides increased within 0 to 3 months following police killings of unarmed Black persons, controlling for autocorrelation and corresponding series of White youth suicides. RESULTS Suicides among Black youth increase by ∼1 count three months following an increase in police killings of unarmed Black persons (exposure lag 0 coefficient = 0.16, p > 0.05; exposure lag 1 coefficient = -0.70, p > 0.05; exposure lag 2 coefficient = -0.54, p > 0.05; exposure lag 3 coefficient = 0.95, p < 0.05). The observed increase in suicides concentrates among Black male youth (exposure lag 3 coefficient = 0.88, p < 0.05).
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Affiliation(s)
| | | | - Alaxandria Crawford
- Division of Epidemiology, College of Public Health, The Ohio State University, USA
| | - Kamesha Spates
- William S. Dietrich II Endowed Chair in Africana Studies, University of Pittsburgh, USA
| | - Parvati Singh
- Division of Epidemiology, College of Public Health, The Ohio State University, USA.
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Kahhale I, Farrise K, Das A, McPhee J, Galán CA, Park A. Recognizing the Impact of Racism-Based Traumatic Stress on Youth: Implications for Research and Clinical Practice. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00242-9. [PMID: 38734405 DOI: 10.1016/j.jaac.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/06/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Affiliation(s)
| | - Kaela Farrise
- University of California Santa Barbara, Santa Barbara, California
| | | | - Jeanne McPhee
- University of California San Francisco, San Francisco, California
| | - Chardée A Galán
- The Pennsylvania State University, State College, Pennsylvania
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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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Filetti C, Kane-Grade F, Gunnar M. The Development of Stress Reactivity and Regulation in Children and Adolescents. Curr Neuropharmacol 2024; 22:395-419. [PMID: 37559538 PMCID: PMC10845082 DOI: 10.2174/1570159x21666230808120504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 08/11/2023] Open
Abstract
Adversity experienced in early life can have detrimental effects on physical and mental health. One pathway in which these effects occur is through the hypothalamic-pituitary-adrenal (HPA) axis, a key physiological stress-mediating system. In this review, we discuss the theoretical perspectives that guide stress reactivity and regulation research, the anatomy and physiology of the axis, developmental changes in the axis and its regulation, brain systems regulating stress, the role of genetic and epigenetics variation in axis development, sensitive periods in stress system calibration, the social regulation of stress (i.e., social buffering), and emerging research areas in the study of stress physiology and development. Understanding the development of stress reactivity and regulation is crucial for uncovering how early adverse experiences influence mental and physical health.
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Affiliation(s)
- Clarissa Filetti
- Institute of Child Development, University of Minnesota, Minneapolis, USA
| | - Finola Kane-Grade
- Institute of Child Development, University of Minnesota, Minneapolis, USA
| | - Megan Gunnar
- Institute of Child Development, University of Minnesota, Minneapolis, USA
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Childs GD, DeSocio J, Sloand E, Gary F, Burke PJ, Outlaw FH, Snethen JA, Lewandowski LA, Bowen FR. Application of the Toxic Stress Schema: An Exemplar for School Nurses. J Sch Nurs 2023; 39:524-535. [PMID: 36377287 DOI: 10.1177/10598405221135186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
For many children of color, the cumulative impact of pre-existing stressors, disparities, and pandemic-related losses has contributed to a toxic level of stress. Toxic stress can disrupt healthy brain development making children vulnerable to physical and mental health problems. School nurses are the primary health professionals who interact with children daily during the academic year, which positions them to identify risk factors within the social determinants of health that contribute to the development of toxic stress. The Toxic Stress Schema (TSS) provides a framework for assessment and care planning related to social determinants of health and potential sources of stress and/or buffering support for the physical and mental well-being of children. A case study approach is used to demonstrate the application of the TSS to school nursing and provide the basis for conceptualizing a plan of care and identifying resources to support the child's physical and mental health.
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Affiliation(s)
- Gwendolyn D Childs
- Associate Professor and Associate Dean for Undergraduate and Prelicensure Education, University of Alabama at Birmingham, School of Nursing, Birmingham, AL, USA
| | - Janiece DeSocio
- Professor of Nursing, Seattle University College of Nursing, Seattle, WA, USA
| | | | - Faye Gary
- Medical Mutual of Ohio & Kent W. Clapp Chair and Professor of Nursing, Cleveland, OH, USA
| | - Pamela J Burke
- LEAH Program Faculty/Senior Advisor for Nursing, Division of Adolescent & Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Freida H Outlaw
- Executive Academic Consultant, Substance Abuse and Mental Health Services Administration, Minority Fellowship Program, American Nurses Association, Silver Spring, MD, USA
| | - Julie A Snethen
- Professor and PhD Program Director, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Linda A Lewandowski
- Dean, College of Nursing, and Vice-Provost for Health Affairs, University of Toledo College of Nursing, Toledo, OH, USA
| | - Felesia R Bowen
- Professor and Associate Dean for Diversity, Equity, and Inclusion, The University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
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Baiden P, Onyeaka HK, Aneni K, Wood B, LaBrenz CA, Muoghalu C, Peoples JE, Szlyk HS, Gobodzo EC, Baiden JF, Adeku Y, Mets VE, Brown FA, Cavazos-Rehg P. Perceived racial discrimination and polysubstance use among racial/ethnic minority adolescents in the United States. Drug Alcohol Depend 2023; 248:109894. [PMID: 37167795 PMCID: PMC11003345 DOI: 10.1016/j.drugalcdep.2023.109894] [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: 11/28/2022] [Revised: 03/28/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Polysubstance use among adolescents is a significant public health concern, yet most studies on adolescent substance use focus on a singular substance. This study is one of the first to investigate the association between perceived racial discrimination (PRD) in school and polysubstance use among racial/ethnic minority adolescents using a nationally representative sample. METHODS Data was from the 2021 Adolescent Behaviors and Experiences Survey. The sample included 4145 racial/ethnic minority adolescents (52.8% female). Hierarchical binary logistic regression was used to examine the association between PRD in school and polysubstance use among racial/ethnic minority adolescents. RESULTS About 12% of racial/ethnic minority adolescents engaged in polysubstance use and 23.4% reported experiencing PRD in school sometimes/most of the time/always. Controlling for other factors, experiencing PRD in school sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD in school (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use. CONCLUSION Controlling for demographic characteristics and psychosocial stressors, PRD in school was significantly associated with higher odds of polysubstance use among racial/ethnic minority adolescents. The findings of this study could inform clinicians and policymakers of the association between PRD in school and polysubstance use, which could contribute to early identification of polysubstance use among racial/ethnic minority adolescents.
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Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129ArlingtonTX76019USA.
| | - Henry K Onyeaka
- Harvard Medical School, Department of Psychiatry, Boston, MA02115, USA; Massachusetts General Hospital, Department of Psychiatry, Boston, MA02115, USA; McLean Hospital, Department of Psychiatry, Boston, MA02478, USA
| | | | - Bethany Wood
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129ArlingtonTX76019USA
| | - Catherine A LaBrenz
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129ArlingtonTX76019USA
| | - Chioma Muoghalu
- Plains Regional Medical Center, Clovis, New Mexico, NM88101, USA
| | - JaNiene E Peoples
- The Brown School at Washington University in St. Louis, One Brookings Drive, St. Louis, MO63130, USA
| | - Hannah S Szlyk
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Ave, Box 8134, St. Louis, MO63110, USA
| | | | - John F Baiden
- East Airport International School, P.O. Box KAPM 57, KIA, Accra, Ghana
| | - Yvonne Adeku
- Western University, Department of Sociology, Social Science Centre, Room 5306, London, OntarioN6A 5C2, Canada
| | - Vera E Mets
- University of Ghana, Legon, Department of Social Work, P.O. Box LG 419, Legon, Accra, Ghana
| | - Fawn A Brown
- The University of Texas at Arlington, Department of Psychology, 501 Nedderman Dr, Box 19528, Arlington, TX76019, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Ave, Box 8134, St. Louis, MO63110, USA
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Russo LN, Arreola J, Montiel G, Torres G, Leal F, Guerra N, Borelli JL. Examining Interpersonal Traumas Across Low Income Latinx Mother-Youth Dyads: Associations Between Maternal Child Abuse Exposure and Racial Discrimination with Mother and Youth Psychopathology. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01483-9. [PMID: 36534303 DOI: 10.1007/s10578-022-01483-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/03/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
Child abuse has intergenerational consequences for psychopathology, however, there remains a paucity of research regarding how these experiences affect Latinx families, particularly those at risk for additional negative life events, such as racial discrimination. This study aims to contribute to this gap in the literature by examining the impact maternal child abuse exposure has on youth and maternal psychopathology, as well as whether these associations are moderated by racial discrimination, in a sample of 224 Latinx mother-youth dyads. Hierarchical regressions revealed small but significant maternal child abuse exposure x racial discrimination interactions for youth depression and anxiety, but not maternal depression or anxiety, which were solely positively associated with maternal child abuse exposure. Findings highlight the multifarious, and at times convergent, nature of trauma and oppression among Latinx families, as well as the impact across generations. Future work is needed to further elucidate developmental pathways of intergenerational trauma in understudied populations.
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Affiliation(s)
- Lyric N Russo
- University of California, 4201 Social and Behavioral Sciences Gateway, 92697, Irvine, CA, United States.
| | - Jose Arreola
- University of California, 4201 Social and Behavioral Sciences Gateway, 92697, Irvine, CA, United States
| | | | - Gina Torres
- Latino Health Access, Santa Ana, CA, United States
| | | | - Nancy Guerra
- University of California, 4201 Social and Behavioral Sciences Gateway, 92697, Irvine, CA, United States
| | - Jessica L Borelli
- University of California, 4201 Social and Behavioral Sciences Gateway, 92697, Irvine, CA, United States.
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11
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Muacevic A, Adler JR, Kraft D, Mathur A, Ramamurti P, Tabaie S. Racial Disparities in Outcomes Following Open Treatment of Pediatric Femoral Shaft Fractures. Cureus 2022; 14:e33149. [PMID: 36601175 PMCID: PMC9803589 DOI: 10.7759/cureus.33149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction Femoral shaft fractures are a common pediatric injury that can require non-operative or operative management. Several studies have shown that race impacts pain management and a number of emergency department visits in the pediatric femur fracture population. This study aimed to investigate any association between pediatric patient race and number of comorbidities, 30-day postoperative outcomes, and length of stay following open surgical treatment of femoral shaft fractures. Methods Pediatric patients who underwent open treatment of femoral shaft fracture were identified in the National Surgical Quality Improvement Program-Pediatric database from 2012-2019. Patients were categorized into two cohorts: White and underrepresented minority (URM). URM groups included Black or African American, Hispanic, Native American or Alaskan, and Native Hawaiian or Pacific Islander. Demographics, comorbidities, and postoperative complications were compared using bivariate and multivariable regression analyses. Results Of the 5,284 pediatric patients who underwent open treatment of femoral shaft fracture, 3,650 (69.1%) were White, and 1,634 (30.9%) were URM. Compared to White patients, URM patients were more likely to have a higher American Society of Anesthesiologists score (p=0.012), more likely to have pulmonary comorbidities (p=0.005), require preoperative blood transfusion (p=0.006), and have an increased risk of prolonged hospital stay (OR 2.36; p=0.007). Conclusion Pediatric URM patients undergoing open treatment of femoral shaft fractures have an increased risk of extended hospital stay postoperatively compared to White patients. As the racial and ethnic constitution of the pediatric population changes, understanding racial and ethnic health disparities will be crucial to providing equitable care to all patients.
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DeWitt A, Kientz J, Coker TR, Liljenquist K. mHealth Technology Design and Evaluation for Early Childhood Health Promotion: Systematic Literature Review. JMIR Pediatr Parent 2022; 5:e37718. [PMID: 36201391 PMCID: PMC9585442 DOI: 10.2196/37718] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/01/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recent increases in smartphone ownership among underserved populations have inspired researchers in medicine, computing, and health informatics to design and evaluate mobile health (mHealth) interventions, specifically for those supporting child development and growth. Although these interventions demonstrate possible effectiveness at larger scales, few of these interventions are evaluated to address racial disparities and health equity, which are known factors that affect relevance, uptake, and adherence in target populations. OBJECTIVE In this study, we aimed to identify and document the current design and evaluation practices of mHealth technologies that promote early childhood health, with a specific focus on opportunities for those processes to address health disparities and health equity. METHODS We completed a systematic literature review of studies that design and evaluate mHealth interventions for early childhood health promotion. We then analyzed these studies to identify opportunities to address racial disparities in early- and late-stage processes and to understand the potential efficacy of these interventions. RESULTS Across the literature from medical, computing, and health informatics fields, we identified 15 articles that presented a design or evaluation of a parent-facing health intervention. We found that using mobile-based systems to deliver health interventions was generally well accepted by parents of children aged <5 years. We also found that, when measured, parenting knowledge of early childhood health topics and confidence to engage in health-promoting behaviors improved. Design and evaluation methods held internal consistency within disciplines (eg, experimental study designs were the most prevalent in medical literature, while computing researchers used user-centered design methods in computing fields). However, there is little consistency in design or evaluation methods across fields. CONCLUSIONS To support more interventions with a comprehensive design and evaluation process, we recommend attention to design at the intervention (eg, reporting content sources) and system level; interdisciplinary collaboration in early childhood health intervention development can lead to large-scale deployment and success among populations. TRIAL REGISTRATION PROSPERO CRD42022359797; https://tinyurl.com/586nx9a2.
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Affiliation(s)
- Akeiylah DeWitt
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Julie Kientz
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Tumaini R Coker
- Seattle Childrens Research Institute, Seattle, WA, United States
| | - Kendra Liljenquist
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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13
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Sun K, Corneli AL, Dombeck C, Swezey T, Rogers JL, Criscione-Schreiber LG, Sadun RE, Eudy AM, Doss J, Bosworth HB, Clowse MEB. Barriers to Taking Medications for Systemic Lupus Erythematosus: A Qualitative Study of Racial Minority Patients, Lupus Providers, and Clinic Staff. Arthritis Care Res (Hoboken) 2022; 74:1459-1467. [PMID: 33662174 PMCID: PMC8417148 DOI: 10.1002/acr.24591] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/18/2021] [Accepted: 03/02/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Underrepresented racial and ethnic minorities are disproportionately affected by systemic lupus erythematosus (SLE). Racial and ethnic minorities also have more severe SLE manifestations that require use of immunosuppressive medications, and often have lower rates of medication adherence. We aimed to explore barriers of adherence to SLE immunosuppressive medications among minority SLE patients. METHODS We conducted a qualitative descriptive study using in-depth interviews with a purposive sample of racial minority SLE patients taking oral immunosuppressants (methotrexate, azathioprine, or mycophenolate), and lupus clinic providers and staff. Interviews were audiorecorded, transcribed, and analyzed using applied thematic analysis. We grouped themes using the Capability, Opportunity, Motivation, Behavior conceptual model. RESULTS We interviewed 12 SLE patients (4 adherent, 8 nonadherent) and 12 providers and staff. We identified capability barriers to include external factors related to acquiring medications, specifically cost-, pharmacy-, and clinic-related issues; opportunity barriers to include external barriers to taking medications, specifically logistic- and medication-related issues; and motivation factors to include intrinsic barriers, encompassing patients' knowledge, beliefs, attitudes, and physical and mental health. The most frequently described barriers were cost, side effects, busyness/forgetting, and lack of understanding, although barriers differed by patient and adherence level, with logistic and intrinsic barriers described predominantly by nonadherent patients and side effects described predominantly by adherent patients. CONCLUSION Our findings suggest that interventions may be most impactful if they are designed to facilitate logistics of taking medications and increase patients' motivation while allowing for personalization to address the individual differences in adherence barriers.
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Affiliation(s)
- Kai Sun
- Duke University Hospital and Duke University School of Medicine, Durham, North Carolina
| | - Amy L Corneli
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina
| | - Carrie Dombeck
- Duke University School of Medicine, Durham, North Carolina
| | - Teresa Swezey
- Duke University School of Medicine, Durham, North Carolina
| | - Jennifer L Rogers
- Duke University Medical Center and Duke University School of Medicine, Durham, North Carolina
| | | | | | - Amanda M Eudy
- Duke University Medical Center and Duke University School of Medicine, Durham, North Carolina
| | - Jayanth Doss
- Duke University School of Medicine, Durham, North Carolina
| | - Hayden B Bosworth
- Duke University School of Medicine and Durham Veterans Administration Medical Center, Durham, North Carolina
| | - Megan E B Clowse
- Duke University Medical Center and Duke University School of Medicine, Durham, North Carolina
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14
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Jackson J, Mell A. Beyond the Cover-Children's Books as Tools for Positive Social Identity Formation. JAMA Pediatr 2022; 176:637-638. [PMID: 35532920 DOI: 10.1001/jamapediatrics.2022.1060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jasmyne Jackson
- Boston Combined Residency Program, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Boston Combined Residency Program, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Anthony Mell
- Boston Combined Residency Program, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Boston Combined Residency Program, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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15
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Rea KE, Cousino MK. Commentary: Posttraumatic Growth Following Pediatric Solid Organ Transplantation: Making Meaning Out of the Gift of Life. J Pediatr Psychol 2022; 47:978-980. [PMID: 35768960 PMCID: PMC9801703 DOI: 10.1093/jpepsy/jsac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Kelly E Rea
- All correspondence concerning this article should be addressed to Kelly E. Rea, MS, Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602, USA. E-mail:
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16
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Lin B, Appleton AA. Developmental Origins of Pregnancy-Related Morbidity and Mortality in Black U.S. Women. Front Public Health 2022; 10:853018. [PMID: 35769781 PMCID: PMC9234444 DOI: 10.3389/fpubh.2022.853018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
In the US, Black women are at disproportionate risk for pregnancy-related morbidity and mortality (PRMM). Disparities in PRMM have been tied to elevated rates of obstetric cardiometabolic complications for Black women. Research seeking to elucidate the determinants of Black PRMM to date have focused predominantly on risk factors occurring during pregnancy (e.g., health risk behaviors, quantity and quality of prenatal care, provider behaviors, and attitudes). Meanwhile, other research investigating the developmental origins of health and disease (DOHaD) model indicates that the origins of adult cardiometabolic health can be traced back to stress exposures occurring during the intrauterine and early life periods. Despite the relevancy of this work to Black PRMM, the DOHaD model has never been applied to investigate the determinants of Black PRMM. We argue that the DOHaD model represents a compelling theoretical framework from which to conceptualize factors that drive racial disparities PRMM. Research and intervention working from a developmental origins orientation may help address this urgent public health crisis of Black PRMM.
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Affiliation(s)
- Betty Lin
- Department of Psychology, College of Arts and Sciences, University at Albany, State University of New York, Albany, NY, United States
- *Correspondence: Betty Lin
| | - Allison A. Appleton
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, United States
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17
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Walker CJ, Williams CD, Winter M, Everhart R. African American Children's Racial Discrimination Experiences and Mental Health. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:1621-1629. [PMID: 37388712 PMCID: PMC10309156 DOI: 10.1007/s10826-022-02311-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 07/01/2023]
Abstract
The current study examined how African American children's experiences of perceived personal racial discrimination and perceived vicarious racial discrimination were linked with depressive and anxiety symptoms, and whether there were significant sex differences in these relations. The sample included 73 African American children (48% male), ranging from 7 to 12 years of age (M = 8.82, SD = 2.06). Models specified children's personal discrimination and vicarious discrimination as predictors of depressive and anxiety symptoms. Nested model comparisons were also used to examine whether associations varied as a function of children's sex. The current study hypothesized that both forms of discrimination would be associated with greater anxiety and depressive symptoms. Findings indicated that children's personal racial discrimination significantly predicted greater child anxiety symptoms for both boys and girls. No significant sex differences emerged. Neither personal nor vicarious discrimination significantly predicted depressive symptoms. Our findings highlight that racialized experiences occur early in childhood and have important implications for children's mental health.
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Affiliation(s)
- Chloe J Walker
- Department of Psychology, Virginia Commonwealth University; 806 W. Franklin St. Box 842018, Richmond, VA, 23284 USA
| | - Chelsea Derlan Williams
- Department of Psychology, Virginia Commonwealth University; 806 W. Franklin St. Box 842018, Richmond, VA, 23284 USA
| | - Marcia Winter
- Department of Psychology, Virginia Commonwealth University; 806 W. Franklin St. Box 842018, Richmond, VA, 23284 USA
| | - Robin Everhart
- Department of Psychology, Virginia Commonwealth University; 806 W. Franklin St. Box 842018, Richmond, VA, 23284 USA
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18
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Benner AD, Wang Y, Chen S, Boyle AE. Measurement considerations in the link between racial/ethnic discrimination and adolescent well-being: A meta-analysis. DEVELOPMENTAL REVIEW 2022; 64:101025. [PMID: 39006861 PMCID: PMC11244658 DOI: 10.1016/j.dr.2022.101025] [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] [Indexed: 11/18/2022]
Abstract
Racial/ethnic discrimination is a commonplace experience for many adolescents of color, and an increasing number of studies over the past 25 years have sought to document discrimination and its consequences at this stage of the life course. The evidence is clear and convincing that racial/ethnic discrimination is harmful for adolescents' socioemotional and behavioral well-being as well as their academic success. Discrimination measurement, however, poses a critical source of potential variation in the observed effect sizes capturing the associations between racial/ethnic discrimination and adolescents' well-being. This meta-analysis integrated 1,804 effect sizes on 156,030 unique ethnically- and geographically-diverse adolescents (M age = 14.44, SD = 2.27) from 379 studies that used 79 unique instruments to assess racial/ethnic discrimination. The meta-analysis focused on a host of measurement-related moderators, including the number of items, response scale and response dimensions, reliability, retrospective reference period, perpetrators, and initial target populations. Larger effect sizes were observed for instruments with more items and with non-dichotomously rated items. Perpetrator and retrospective reference period also emerged as key moderators, while measure reliability, response dimensions, and initial measurement development characteristics were not significant moderators. Findings provide key insights for the development of more precise, effective instruments to assess perceived racial/ethnic discrimination in adolescence.
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Affiliation(s)
- Aprile D. Benner
- Department of Human Development and Family Sciences, University of Texas at Austin, United States
| | - Yijie Wang
- Department of Human Development and Family Studies, Michigan State University, United States
| | - Shanting Chen
- School of Education and Social Policy, Northwestern University, United States
| | - Alaina E. Boyle
- Collaborative for Academic, Social, and Emotional Learning (CASEL), United States
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Thomas KJA, Gibby AL. Racial Family Configurations and Inequalities in Private School Enrollment Among Adopted Children. JOURNAL OF FAMILY ISSUES 2022; 43:1436-1459. [PMID: 38322181 PMCID: PMC10846902 DOI: 10.1177/0192513x211018251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
This study uses data from the American Community Survey to examine the relationship between race, family configurations, and inequalities in private school enrollment among adoptees. We find that private school enrollment is higher in transracial than in same-race families. This disparity is driven by the outcomes of adoptees in transracial families with zero rather than one same-race parent. Among adoptees themselves, there are diverging patterns of racial stratification in same-race and transracial families. White adoptees in same-race families are more likely to be enrolled in private school than Black, Asian, or Hispanic adoptees in such families. However, among adoptees in transracial families, the highest odds of private school enrollment are found among Asians. Finally, we argue that our findings have important implications for understanding how kinship cues, compensation, and social disadvantage shape parental investment in adopted children.
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Affiliation(s)
- Kevin J. A. Thomas
- Department of African and African Diaspora Studies, University of Texas at Austin, TX, USA
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20
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Jenkins KA, Keddem S, Bekele SB, Augustine KE, Long JA. Perspectives on Racism in Health Care Among Black Veterans With Chronic Kidney Disease. JAMA Netw Open 2022; 5:e2211900. [PMID: 35552724 PMCID: PMC9099421 DOI: 10.1001/jamanetworkopen.2022.11900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/10/2022] [Indexed: 12/20/2022] Open
Abstract
Importance The burden of chronic kidney disease (CKD) and end-stage kidney disease falls disproportionately on Black individuals in the US, with Black veterans experiencing substantial consequences, and only a portion of the disparities in health conditions and health care can be explained by nonbiological factors. Among Black individuals, racism is likely one of those factors, suggesting the need to examine the consequences of racism and the resulting social structures that establish and perpetuate these racial disparities. Objective To investigate the health care experiences of Black veterans with CKD and identify and explore the racial discrimination encountered by this vulnerable population. Design, Setting, and Participants This qualitative study used semistructured interview guides to investigate the health care experiences of 36 Black veterans with CKD who received care at the Corporal Michael Crescenz Veterans Affairs Medical Center in Philadelphia, Pennsylvania, from October 2018 to September 2019. Interview transcripts were analyzed using applied thematic analysis. Results Among 36 Black veterans with CKD who characterized racism in the context of their care at a Veterans Affairs medical center, the mean (SD) age was 66.0 (7.8) years; 35 participants (97.2%) were male, 1 participant (2.8%) was female, and 19 participants (52.8%) were married. The mean (SD) duration of military service was 8.0 (7.0) years. Overall, 15 participants (41.7%) were not dependent on dialysis, and hypertension was the most common comorbidity (9 participants [25.0%]). Veterans described the ways in which racism produced emotional and physical stress, including psychological symptoms (eg, anger and hurt) and physiological symptoms (eg, headaches). Veterans described a strong sense of distrust in the health care system coupled with a need to be hypervigilant during clinical encounters. When encountering racism, veterans described bottling up their feelings, which sometimes led to maladaptive behavior (eg, substance use). Veterans also described individual and collective positive strategies (eg, faith) for coping with the stress of racism. Conclusions and Relevance In this study, Black veterans with CKD experienced racism in the clinical setting that produced physical and emotional stress and a strong sense of distrust in the health care system. These findings highlight an important opportunity for education and training of health care professionals in the implementation of trauma-informed approaches to care as a means of addressing race-based stress and trauma.
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Affiliation(s)
- Kevin A. Jenkins
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Annenberg School of Communications, University of Pennsylvania, Philadelphia
| | - Shimrit Keddem
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Judith A. Long
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
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21
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Malyavko A, Quan T, Howard PG, Recarey M, Manzi JE, Tabaie S. Racial Disparities in Postoperative Outcomes Following Operative Management of Pediatric Developmental Dysplasia of the Hip. J Pediatr Orthop 2022; 42:e403-e408. [PMID: 35200218 DOI: 10.1097/bpo.0000000000002102] [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: 02/07/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip in pediatric patients can be managed conservatively or operatively. Understanding patient risk factors is important to optimize outcomes following surgical treatment of developmental dysplasia of the hip. Racial disparities in procedural outcomes have been studied, however, there is scarce literature on an association between race and complications following pediatric orthopaedic surgery. Our study aimed to determine the association between pediatric patients' race and outcomes following operative management of hip dysplasia by investigating 30-day postoperative complications and length of hospital stay. METHODS The National Surgical Quality Improvement Program-Pediatric database was utilized from the years 2012 to 2019 to identify all pediatric patients undergoing surgical treatment for hip dysplasia. Patients were stratified into 2 groups: patients who were White and patients from underrepresented minority (URM) groups. URM groups included those who were Black or African American, Hispanic, Native American or Alaskan, and Native Hawaiian or Pacific Islander. Differences in patient demographics, comorbidities, and postoperative outcomes were compared between the 2 cohorts using bivariate and multivariate analyses. RESULTS Of the 9159 pediatric patients who underwent surgical treatment for hip dysplasia between 2012 and 2019, 6057 patients (66.1%) were White and 3102 (33.9%) were from URM groups. In the bivariate analysis, compared with White patients, patients from URM groups were more likely to experience deep wound dehiscence, pneumonia, unplanned reintubation, cardiac arrest, and extended length of hospital stay. Following multivariate analysis, patients from URM groups had an increased risk of unplanned reintubation (odds ratio: 3.583; P=0.018). CONCLUSIONS Understanding which patient factors impact surgical outcomes allows health care teams to be more aware of at-risk patient groups. Our study found that pediatric patients from URM groups who underwent surgery for correction of hip dysplasia had greater odds of unplanned reintubation when compared with patients who were White. Further research should investigate the relationship between multiple variables including race, low socioeconomic status, and language barriers on surgical outcomes following pediatric orthopaedic procedures. LEVEL OF EVIDENCE Level III-retrospective cohort analysis.
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Affiliation(s)
- Alisa Malyavko
- Department of Orthopaedic Surgery, George Washington Hospital
| | - Theodore Quan
- Department of Orthopaedic Surgery, George Washington Hospital
| | - Peter G Howard
- Department of Orthopaedic Surgery, George Washington Hospital
| | - Melina Recarey
- Department of Orthopaedic Surgery, George Washington Hospital
| | | | - Sean Tabaie
- Department of Orthopaedic Surgery, Children's National Health System, Washington, DC
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22
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Hamilton JL, Nesi J, Choukas-Bradley S. Reexamining Social Media and Socioemotional Well-Being Among Adolescents Through the Lens of the COVID-19 Pandemic: A Theoretical Review and Directions for Future Research. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2022; 17:662-679. [PMID: 34756118 DOI: 10.31234/osf.io/5stx4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Social media has rapidly transformed the ways in which adolescents socialize and interact with the world, which has contributed to ongoing public debate about whether social media is helping or harming adolescents. The COVID-19 pandemic has magnified both the challenges and opportunities of adolescents' social-media use, which necessitates revisiting the conversation around teens and social media. In this article, we discuss key aspects of adolescent social-media use and socioemotional well-being and outline how these issues may be amplified in the context of the COVID-19 pandemic. We use this as a springboard to outline key future research directions for the field, with the goal of moving away from reductionist approaches and toward a more nuanced perspective to understand the who, what, and when of social-media use and its impact on adolescent well-being. We conclude with a commentary on how psychological science can inform the translation of research to provide evidence-based recommendations for adolescent social-media use.
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Affiliation(s)
| | - Jacqueline Nesi
- Department of Psychiatry and Human Behavior, Brown University
- Bradley Hasbro Research Center, Rhode Island Hospital, Providence, Rhode Island
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23
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Bowen FR, Lewandowski LA, Snethen JA, Childs G, Outlaw FH, Greenberg CS, Burke PJ, Sloand E, Gary F, DeSocio J. A Schema of Toxic Stress Informed by Racism, Transgenerational Stress, and Disadvantage. J Pediatr Health Care 2022; 36:79-89. [PMID: 34627667 DOI: 10.1016/j.pedhc.2021.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Toxic Stress Schema (TSS) is an ecological framework with a social justice lens for identifying and alleviating stress and strengthening social determinants of health for children and families of color impacted by the COVID-19 pandemic and the cumulative effects of racism and generational, systemic inequities. METHOD Relevant literature is reviewed, and examples were provided to illustrate the differential impacts of the "stress superstorm" of 2020 had on children of color based on their family's position on the advantage-disadvantage continuum. RESULTS The utility of the TSS framework as a model for advanced nursing practice is demonstrated, and recommendations are formulated for the pediatric nurse practitioner's role in health policy. DISCUSSION The COVID-19 pandemic elucidated the historical inequities experienced by children and families of color. The TSS framework provides a model for recognizing, organizing, and implementing.
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Chen Y, Wang Z, Zhang Q, Dong W, Xu JHC, Wu SJ, Zhang X, Chen C. Compassion, Discrimination, and Prosocial Behaviors: Young Diasporic Chinese During the COVID-19 Pandemic. Front Psychol 2022; 13:814869. [PMID: 35250745 PMCID: PMC8891152 DOI: 10.3389/fpsyg.2022.814869] [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: 11/14/2021] [Accepted: 01/24/2022] [Indexed: 01/10/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has fueled anti-Asian, especially anti-Chinese sentiments worldwide, which may negatively impact diasporic Chinese youths' adjustment and prosocial development. This study examined the association between compassion, discrimination and prosocial behaviors in diasporic Chinese youths during the COVID-19 pandemic. 360 participants participated and completed the multi-country, cross-sectional, web-based survey between April 22 and May 9, 2020, the escalating stage of the pandemic. This study found compassion as prosocial behaviors' proximal predictor, while discrimination independently predicted participation in volunteering, and could potentially enhance the association between compassion and charitable giving. These findings suggest that prosociality among young people is sensitive to social context, and that racial discrimination should be considered in future prosocial studies involving young members of ethnic and racial minorities.
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Affiliation(s)
- Youli Chen
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zicong Wang
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Zhang
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, United States
| | - Weizhen Dong
- Department of Sociology and Legal Studies, University of Waterloo, Waterloo, ON, Canada
| | - Jia Huei Chen Xu
- School of International Studies, Wenzhou Medical University, Wenzhou, China
| | - Sizhe Ji Wu
- International School of Capital Medical University, Capital Medical University, Beijing, China
| | - Xiangyang Zhang
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
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25
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Hutchins HJ, Barry CM, Wanga V, Bacon S, Njai R, Claussen AH, Ghandour RM, Lebrun-Harris LA, Perkins K, Robinson LR. Perceived Racial/Ethnic Discrimination, Physical and Mental Health Conditions in Childhood, and the Relative Role of Other Adverse Experiences. ADVERSITY AND RESILIENCE SCIENCE 2022; 3:181-194. [PMID: 37181947 PMCID: PMC10174208 DOI: 10.1007/s42844-022-00063-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Adverse childhood experiences (ACEs) are associated with poor health. Childhood experiences of racial/ethnic discrimination and other forms of racism may underlie or exacerbate other ACEs. We explored health-related associations with perceived racial/ethnic discrimination relative to other ACEs, using data from 2016-2019 National Survey of Children's Health, an annual cross-sectional, nationally representative survey. Parent responses for 88,183 children ages 6-17 years with complete data for ACEs (including racial/ethnic discrimination) were analyzed for associations between racial/ethnic discrimination, other ACEs, demographics, and physical and mental health conditions with weighted prevalence estimates and Wald chi-square tests. To assess associations between racial/ethnic discrimination and health conditions relative to other ACEs, we used weighted Poisson regressions, adjusted for exposure to other ACEs, age, and sex. We assessed effect modification by race/ethnicity. Prevalence of other ACEs was highest among children with racial/ethnic discrimination, and both racial/ethnic discrimination and other ACEs were associated with having one or more health conditions. Adjusted associations between racial/ethnic discrimination and health conditions differed by race/ethnicity (interaction P-values < 0.001) and were strongest for mental health conditions among Hispanic/Latino (adjusted prevalence ratio (aPR)=1.62, 95% confidence interval (CI): 1.24-2.10) and non-Hispanic/Latino Asian American (aPR=2.25, 95% CI: 1.37-3.71) children. Results suggest racial/ethnic discrimination and other ACEs are associated with child health conditions, with differences in relative associations by race/ethnicity. Public health efforts to prevent childhood adversity, including racial/ethnic discrimination and other forms of racism could be associated with improvements in child health.
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Affiliation(s)
- Helena J. Hutchins
- Child Development Studies Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy S106-4, Atlanta, GA 30341-3717, USA
- Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs, P.O. Box 117, Oak Ridge, TN 37831-0117, USA
| | | | - Valentine Wanga
- Child Development Studies Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy S106-4, Atlanta, GA 30341-3717, USA
| | - Sarah Bacon
- Office of Strategy and Innovation, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy S106-4, Atlanta, GA 30341-3717, USA
| | - Rashid Njai
- Minority Health and Health Equity Science Team, Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, 4770 Buford Hwy S106-4, Atlanta, GA 30341-3717, USA
| | - Angelika H. Claussen
- Child Development Studies Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy S106-4, Atlanta, GA 30341-3717, USA
| | - Reem M. Ghandour
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD 20857, USA
| | - Lydie A. Lebrun-Harris
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD 20857, USA
| | - Kiana Perkins
- Oglethorpe University, 4484 Peachtree Rd NE, Atlanta, GA 30319, USA
| | - Lara R. Robinson
- Child Development Studies Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy S106-4, Atlanta, GA 30341-3717, USA
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26
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Gonzalez R, Thompson EL, Sanchez M, Morris A, Gonzalez MR, Feldstein Ewing SW, Mason MJ, Arroyo J, Howlett K, Tapert SF, Zucker RA. An update on the assessment of culture and environment in the ABCD Study®: Emerging literature and protocol updates over three measurement waves. Dev Cogn Neurosci 2021; 52:101021. [PMID: 34700197 PMCID: PMC8551602 DOI: 10.1016/j.dcn.2021.101021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/31/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Advances in our understanding of risk and resilience factors in adolescent brain health and development increasingly demand a broad set of assessment tools that consider a youth's peer, family, school, neighborhood, and cultural contexts in addition to neurobiological, genetic, and biomedical information. The Culture and Environment (CE) Workgroup (WG) of the Adolescent Brain Cognitive Development (ABCD) Study curates these important components of the protocol throughout ten years of planned data collection. In this report, the CE WG presents an update on the evolution of the ABCD Study® CE protocol since study inception (Zucker et al., 2018), as well as emerging findings that include CE measures. Background and measurement characteristics of instruments present in the study since baseline have already been described in our 2018 report, and therefore are only briefly described here. New measures introduced since baseline are described in more detail. Descriptive statistics on all measures are presented based on a total sample of 11,000+ youth and their caregivers assessed at baseline and the following two years. Psychometric properties of the measures, including longitudinal aspects of the data, are reported, along with considerations for future measurement waves. The CE WG ABCD® components are an essential part of the overall protocol that permits characterization of the unique cultural and social environment within which each developing brain is transactionally embedded.
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Affiliation(s)
- Raul Gonzalez
- Center for Children and Families and Department of Psychology, Florida International University, USA.
| | - Erin L Thompson
- Center for Children and Families and Department of Psychology, Florida International University, USA
| | - Mariana Sanchez
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, USA
| | - Amanda Morris
- Amanda Sheffield Morris, Laureate Institute for Brain Research and Oklahoma State University, USA
| | | | | | - Michael J Mason
- Center for Behavioral Health Research, University of Tennessee, USA
| | - Judith Arroyo
- National Institute on Alcoholism and Alcohol Abuse, USA
| | | | - Susan F Tapert
- Department of Psychiatry, University of California, San Diego, USA
| | - Robert A Zucker
- Department of Psychiatry and Addiction Center, University of Michigan, USA
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27
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Bradley RH, Bryce CI. The Role of Parents in Reducing Academic, Health, and Behavioral Problems for Native American, African American, and Latinx Adolescents. J Dev Behav Pediatr 2021; 42:726-733. [PMID: 34840316 DOI: 10.1097/dbp.0000000000000957] [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: 09/01/2020] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to determine how parental modeling of thoughtful behavior and the home physical environment may reduce the number of developmental problems exhibited by Native American, African American, and Latinx adolescents. METHOD Demographic and home environmental data were collected from 54 Native American, 131 African American, and 159 Latinx families living in 4 states as part of a home visit. Parents and adolescents were administered surveys that captured adolescent health, social skills, problem behavior, self-efficacy beliefs, vocabulary attainment, and school grades. Scores from the surveys were combined to construct both an adolescent problems index and a household risk index. For each of the 3 racial/ethnic groups examined, the adolescent problems index was regressed on parental modeling and encouragement of mature behavior, the home physical environment, and the household risk index. RESULTS Modeling and encouragement of mature behavior was a significant bivariate predictor of overall problems in all 3 groups of adolescents-albeit the overall regression model was nonsignificant for Native Americans. By contrast, the other 2 predictors were nonsignificant in regression models for all 3 groups. CONCLUSION Native American, African American, and Latinx adolescents often face a multitude of risks, including poverty and discrimination. As a consequence, adolescents from these 3 racial/ethnic groups frequently display problems pertaining to health, competence, and adaptive behavior. The results from this study suggest that adolescents from such demographic groups are less likely to manifest developmental problems if their parents model mature behavior and encourage the adolescent to act in thoughtful ways.
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Affiliation(s)
- Robert H Bradley
- Center for Child and Family Success, T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ
| | - Crystal I Bryce
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ
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28
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A new era: improving use of sociodemographic constructs in the analysis of pediatric cohort study data. Pediatr Res 2021; 90:1132-1138. [PMID: 33603207 PMCID: PMC8371054 DOI: 10.1038/s41390-021-01386-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/30/2020] [Indexed: 01/31/2023]
Abstract
Given the diversity of sex, gender identity, race, ethnicity, and socioeconomic position (SEP) in children across the United States, it is incumbent upon pediatric and epidemiologic researchers to conduct their work in ways that promote inclusivity, understanding and reduction in inequities. Current child health research often utilizes an approach of "convenience" in how data related to these constructs are collected, categorized, and included in models; the field needs to be more systematic and thoughtful in its approach to understand how sociodemographics affect child health. We offer suggestions for improving the discourse around sex, gender identity, race, ethnicity, and SEP in child health research. We explain how analytic models should be driven by a conceptual framework grounding the choices of variables that are included in analyses, without the automatic "adjusting for" all sociodemographic constructs. We propose to leverage newly available data from large multi-cohort consortia as unique opportunities to improve the current standards for analyzing and reporting core sociodemographic constructs. Improving the characterization and interpretation of child health studies with regards to core sociodemographic constructs is critical for optimizing child health and reducing inequities in the health and well-being of all children across the United States. IMPACT: Current child health research often utilizes an approach of "convenience" in how data related to sex, race/ethnicity, and SEP are collected, categorized, and included in models. We offer suggestions for how scholars can improve the discourse around sex, gender identity, race, ethnicity, and SEP in child health research. We explain how analytic models should be driven by a conceptual framework grounding the choices of variables that are included in analyses. We propose to leverage newly available large cohort consortia of child health studies as opportunities to improve the current standards for analyzing and reporting core sociodemographic constructs.
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29
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Ruggeri K, Folke T. Unstandard Deviation: The Untapped Value of Positive Deviance for Reducing Inequalities. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 17:711-731. [PMID: 34813715 DOI: 10.1177/17456916211017865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Behavioral science is increasingly used in public policy to understand and address various manifestations of inequalities. Yet evidence from effective population-level interventions is limited. One framework, known as positive deviance, emphasizes individuals from disadvantaged circumstances who have significantly better outcomes than are typical for their group. Studying their behaviors and outcomes helps to understand what might explain their overall success. These insights could also be used to help others from these circumstances experience positive outcomes. Because positive deviance has been markedly understudied, we present a framework for doing so specifically within behavioral science for public policies aimed at reducing inequalities. Using examples from real-world and experimental insights on choices and outcomes of positive deviants, we encourage further study of their choices and trajectories over time to produce valuable insights. We propose that leveraging those findings would inform public policy by introducing interventions that are more ecologically sound and population-relevant and thus have a better chance at benefiting those who start off under adverse circumstances.
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Affiliation(s)
- Kai Ruggeri
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University
| | - Tomas Folke
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University
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30
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Hamilton JL, Nesi J, Choukas-Bradley S. Reexamining Social Media and Socioemotional Well-Being Among Adolescents Through the Lens of the COVID-19 Pandemic: A Theoretical Review and Directions for Future Research. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 17:662-679. [PMID: 34756118 DOI: 10.1177/17456916211014189] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Social media has rapidly transformed the ways in which adolescents socialize and interact with the world, which has contributed to ongoing public debate about whether social media is helping or harming adolescents. The COVID-19 pandemic has magnified both the challenges and opportunities of adolescents' social-media use, which necessitates revisiting the conversation around teens and social media. In this article, we discuss key aspects of adolescent social-media use and socioemotional well-being and outline how these issues may be amplified in the context of the COVID-19 pandemic. We use this as a springboard to outline key future research directions for the field, with the goal of moving away from reductionist approaches and toward a more nuanced perspective to understand the who, what, and when of social-media use and its impact on adolescent well-being. We conclude with a commentary on how psychological science can inform the translation of research to provide evidence-based recommendations for adolescent social-media use.
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Affiliation(s)
| | - Jacqueline Nesi
- Department of Psychiatry and Human Behavior, Brown University.,Bradley Hasbro Research Center, Rhode Island Hospital, Providence, Rhode Island
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31
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Nagar SD, Conley AB, Sharma S, Rishishwar L, Jordan IK, Mariño-Ramírez L. Comparing Genetic and Socioenvironmental Contributions to Ethnic Differences in C-Reactive Protein. Front Genet 2021; 12:738485. [PMID: 34733313 PMCID: PMC8558394 DOI: 10.3389/fgene.2021.738485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023] Open
Abstract
C-reactive protein (CRP) is a routinely measured blood biomarker for inflammation. Elevated levels of circulating CRP are associated with response to infection, risk for a number of complex common diseases, and psychosocial stress. The objective of this study was to compare the contributions of genetic ancestry, socioenvironmental factors, and inflammation-related health conditions to ethnic differences in C-reactive protein levels. We used multivariable regression to compare CRP blood serum levels between Black and White ethnic groups from the United Kingdom Biobank (UKBB) prospective cohort study. CRP serum levels are significantly associated with ethnicity in an age and sex adjusted model. Study participants who identify as Black have higher average CRP than those who identify as White, CRP increases with age, and females have higher average CRP than males. Ethnicity and sex show a significant interaction effect on CRP. Black females have higher average CRP levels than White females, whereas White males have higher average CRP than Black males. Significant associations between CRP, ethnicity, and genetic ancestry are almost completely attenuated in a fully adjusted model that includes socioenvironmental factors and inflammation-related health conditions. BMI, smoking, and socioeconomic deprivation all have high relative effects on CRP. These results indicate that socioenvironmental factors contribute more to CRP ethnic differences than genetics. Differences in CRP are associated with ethnic disparities for a number of chronic diseases, including type 2 diabetes, essential hypertension, sarcoidosis, and lupus erythematosus. Our results indicate that ethnic differences in CRP are linked to both socioenvironmental factors and numerous ethnic health disparities.
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Affiliation(s)
- Shashwat Deepali Nagar
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States
| | - Andrew B Conley
- IHRC-Georgia Tech Applied Bioinformatics Laboratory, Atlanta, GA, United States.,National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Shivam Sharma
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Lavanya Rishishwar
- IHRC-Georgia Tech Applied Bioinformatics Laboratory, Atlanta, GA, United States.,National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - I King Jordan
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States.,IHRC-Georgia Tech Applied Bioinformatics Laboratory, Atlanta, GA, United States.,PanAmerican Bioinformatics Institute, Cali, Colombia
| | - Leonardo Mariño-Ramírez
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States.,PanAmerican Bioinformatics Institute, Cali, Colombia
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32
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Cuevas AG, Ho T, Rodgers J, DeNufrio D, Alley L, Allen J, Williams DR. Developmental timing of initial racial discrimination exposure is associated with cardiovascular health conditions in adulthood. ETHNICITY & HEALTH 2021; 26:949-962. [PMID: 31064206 PMCID: PMC7026859 DOI: 10.1080/13557858.2019.1613517] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/26/2019] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To examine the association between developmental timing of initial exposure to racial discrimination and cardiovascular health conditions. DESIGN Using data from the 1995 Detroit Area Study, logistic and negative binomial regression models were used to assess the association between timing of initial exposure to racial/ethnic discrimination, classified as early childhood (0-7), childhood (8-12), adolescence (13-19), and adulthood (>19), on physician-diagnosed cardiovascular health conditions during adulthood. Each analysis adjusted for age, gender, race/ethnicity, income, education, marital status, health-related behaviors, and pre-existing health conditions. RESULTS Of the 1,106 participants in the final sample, 520 identified as White and 586 identified as Black. Over half (64%) of the sample experienced at least one major cardiovascular health event at the time of the study, with 39% reporting two or more events. Results from logistic regression models showed that initial exposure to racial discrimination during early childhood was associated with a 2.96 (95%CI:1.15, 7.83) times greater odds of having any cardiovascular-related health condition later in life compared to individuals who reported no discrimination. Results from negative binomial regression models demonstrated that individuals who reported initial exposure to racial discrimination during early childhood and adolescence had a CVD incidence rate that was 1.63 (95%CI:1.11, 2.38) and 1.37 (95%CI:1.10, 1.69) times higher than individuals who reported no discrimination. CONCLUSION Initial exposure to racial discrimination in early childhood and adolescence may increase the risk of cardiovascular conditions later in life. Clinicians and researchers should consider racial discrimination during childhood as a possible risk factor for illness and disease.
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Affiliation(s)
- Adolfo G. Cuevas
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Thao Ho
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Justin Rodgers
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Danielle DeNufrio
- Department of Public Health and Community Medicine, Tufts’ School of Medicine, Boston, MA, USA
| | | | - Jennifer Allen
- Department of Community Health, Tufts University, Medford, MA, USA
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
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33
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Joyce BT, Gao T, Koss K, Zheng Y, Cardenas A, Heiss J, Just A, Zhang K, van Horn L, Allen NB, Greenland P, Cohen S, Gordon-Larsen P, Mitchell C, McLanahan S, Schneper L, Notterman D, Rifas-Shiman SL, Oken E, Hivert MF, Wright R, Baccarelli A, Lloyd-Jones D, Hou L. Impact of paternal education on epigenetic ageing in adolescence and mid-adulthood: a multi-cohort study in the USA and Mexico. Int J Epidemiol 2021; 51:870-884. [PMID: 34534313 DOI: 10.1093/ije/dyab196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Both parental and neighbourhood socio-economic status (SES) are linked to poorer health independently of personal SES measures, but the biological mechanisms are unclear. Our objective was to examine these influences via epigenetic age acceleration (EAA)-the discrepancy between chronological and epigenetic ages. METHODS We examined three USA-based [Coronary Artery Risk Disease in Adults (CARDIA) study, Fragile Families and Child Wellbeing Study (FFCWS) and Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS)] and one Mexico-based (Project Viva) cohort. DNA methylation was measured using Illumina arrays, personal/parental SES by questionnaire and neighbourhood disadvantage from geocoded address. In CARDIA, we examined the most strongly associated personal, parental and neighbourhood SES measures with EAA (Hannum's method) at study years 15 and 20 separately and combined using a generalized estimating equation (GEE) and compared with other EAA measures (Horvath's EAA, PhenoAge and GrimAge calculators, and DunedinPoAm). RESULTS EAA was associated with paternal education in CARDIA [GEEs: βsome college = -1.01 years (-1.91, -0.11) and β<high school = 1.05 (0.09, 2.01) vs college graduates] and FFCWS [GEEs: β<high school = 0.62 (0.00, 1.24)]. We found stronger associations for some paternal education categories among White adults (for GEE, βsome college = -1.39 (-2.41, -0.38)], men (βsome college = -1.76 (-3.16, -0.35)] and women [β<high school = 1.77 (0.42, 3.11)]. CONCLUSIONS These findings suggest that EAA captures epigenetic impacts of paternal education independently of personal SES later in life. Longitudinal studies should explore these associations at different life stages and link them to health outcomes. EAA could be a useful biomarker of SES-associated health and provide important insight into the pathogenesis and prevention of chronic disease.
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Affiliation(s)
- Brian T Joyce
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tao Gao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kalsea Koss
- Department of Human Development and Family Science, University of Georgia, Athens, GA, USA
| | - Yinan Zheng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andres Cardenas
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Jonathan Heiss
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Allan Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Kai Zhang
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Linda van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Norrina Bai Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sheldon Cohen
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Penny Gordon-Larsen
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colter Mitchell
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Sara McLanahan
- Department of Sociology, Princeton University, Princeton, NJ, USA
| | - Lisa Schneper
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - Daniel Notterman
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Department of Endocrinology, Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Andrea Baccarelli
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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St-Pierre S, Tardif-Grenier K, Villatte A. Which Anxiety Symptoms are Associated with Perceived Ethnic Discrimination in Adolescents With an Immigrant Background? CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2021. [DOI: 10.1177/08295735211039944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study assesses the specific anxiety symptoms that are present in the context of perceived ethnic discrimination in 696 (M age = 13.3, σ = .77, 57% girls) seventh and eighth-grade students with immigrant backgrounds from four different Canadian high schools. Multiple hierarchical linear regressions were conducted to determine the association between perceived ethnic discrimination and specific anxiety symptoms. Results demonstrate that perceived ethnic discrimination is significantly associated with more anxiety symptoms, such as panic/somatic, generalized anxiety, social phobia, and school phobia. Findings provide a better understanding of the association between perceived ethnic discrimination and anxiety symptoms reported by adolescents with an immigrant background. These findings could help school-based mental health professionals in the implementation of prevention and intervention measures aimed at reducing specific anxiety symptoms that are often present in the context of perceived ethnic discrimination.
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Affiliation(s)
| | | | - Aude Villatte
- Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
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35
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Priest N, Alam O, Truong M, Sharples R, Nelson J, Dunn K, Francis KL, Paradies Y, Kavanagh A. Promoting proactive bystander responses to racism and racial discrimination in primary schools: a mixed methods evaluation of the 'Speak Out Against Racism' program pilot. BMC Public Health 2021; 21:1434. [PMID: 34289830 PMCID: PMC8293475 DOI: 10.1186/s12889-021-11469-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/14/2021] [Indexed: 11/22/2022] Open
Abstract
Background Racism and racial discrimination are fundamental causes and determinants of health and health inequalities globally, with children and adolescents particularly vulnerable. Racial discrimination is a common stressor in the lives of many children and adolescents, with growing evidence of negative associations between racial discrimination and multiple domains of child and adolescent health. Addressing racism and racial discrimination must be core public health priorities, even more so among children and young people. Schools are key settings in the lives of children and adolescents and become increasingly more important to identity formation. School communities, teachers and peers greatly influence children and adolescents’ beliefs about race and difference. Schools are therefore key sites for the delivery of population-based programs to reduce racism and promote proactive bystander behaviour and healthy resistance to racism among all children and adolescents as well as among the adults. Methods This study examines the feasibility and acceptability of the ‘Speak Out Against Racism (SOAR)’ program, a whole of school, multi-level, multi-strategy program that aimed to promote effective bystander responses to racism and racial discrimination in primary schools. A mixed-methods, quasi-experimental design was used. Students in Years 5 and 6 (10–12 years) across six schools completed surveys pre- and post- intervention (N = 645; 52% female; 6% Indigenous, 10% Middle Eastern, African, Latinx or Pacific Islander, 21% Asian, 52% Anglo/European). Focus groups with students and interviews with staff collected qualitative data about their experiences of the program and their views about the program’s perceived need, implementation, impacts and suggested improvements. Results Quantitative data showed student prosocial skills and teacher inter-racial climate improved in intervention schools compared to comparison schools. Qualitative data highlighted teacher attitudinal and behaviour change regarding racism, and student reduced interpersonal racial discrimination, improved peer prosocial norms, commitment to anti-racism, knowledge of proactive bystander responses and confidence and self-efficacy to intervene to address racism. Conclusions This study provides quantitative evidence of the potential of the SOAR program to improve the prosocial skills of students and their perceptions of the inter-racial school climate provided by their teachers. This program also provided qualitative evidence of the potential to promote teacher and student attitudinal and behavioural change. Further refinement and testing of the program in a large scale implementation trial is recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11469-2.
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Affiliation(s)
- Naomi Priest
- Centre for Social Research and Methods, College of Arts & Social Sciences, Australian National University, RSSS Building, Canberra, 2601, Australia. .,Population Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.
| | - Oishee Alam
- School of Social Sciences & Psychology, Western Sydney University, Penrith South, New South Wales, Australia
| | - Mandy Truong
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.,Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Rachel Sharples
- School of Social Sciences & Psychology, Western Sydney University, Penrith South, New South Wales, Australia
| | - Jacqueline Nelson
- Faculty of Arts and Social Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Kevin Dunn
- School of Social Sciences & Psychology, Western Sydney University, Penrith South, New South Wales, Australia
| | - Kate L Francis
- Population Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Yin Paradies
- School of Humanities and Social Sciences, Faculty of Arts and Education, Deakin University, Burwood, Victoria, Australia
| | - Anne Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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36
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Collins MA, Chung Y, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Cannon TD. Discriminatory experiences predict neuroanatomical changes and anxiety among healthy individuals and those at clinical high risk for psychosis. Neuroimage Clin 2021; 31:102757. [PMID: 34273790 PMCID: PMC8283423 DOI: 10.1016/j.nicl.2021.102757] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/23/2021] [Accepted: 07/03/2021] [Indexed: 01/14/2023]
Abstract
Individuals face discrimination based on characteristics including race/ethnicity, gender, age, and disability. Discriminatory experiences (DE) are associated with poor psychological health in the general population and with worse outcomes among individuals at clinical high risk for psychosis (CHR). Though the brain is sensitive to stress, and brain structural change is a well-documented precursor to psychosis, potential relationships between DE and brain structure among CHR or healthy individuals are not known. This report assessed whether lifetime DE are associated with cortical thinning and clinical outcomes across time, after controlling for discrimination-related demographic factors among CHR individuals who ultimately do (N = 57) and do not convert to psychosis (N = 451), and healthy comparison (N = 208) participants in the North American Prodrome Longitudinal Study 2. Results indicate that DE are associated with thinner cortex across time in several cortical areas. Thickness in several right hemisphere regions partially mediates associations between DE and subsequent anxiety symptoms, but not attenuated positive symptoms of psychosis. This report provides the first evidence to date of an association between DE and brain structure in both CHR and healthy comparison individuals. Results also suggest that thinner cortex across time in areas linked with DE may partially explain associations between DE and cross-diagnostic indicators of psychological distress.
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Affiliation(s)
| | - Yoonho Chung
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Belmont, MA, USA
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior & Department of Psychology, University of California, Los Angeles, USA
| | | | | | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, USA; San Francisco VA Medical Center, San Francisco, CA, USA
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, USA
| | - Larry J Seidman
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA; Department of Psychiatry, Yale University, New Haven, CT, USA
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Sladek MR, Castro SA, Doane LD. Ethnic-Racial discrimination experiences predict Latinx adolescents' physiological stress processes across college transition. Psychoneuroendocrinology 2021; 128:105212. [PMID: 33933893 DOI: 10.1016/j.psyneuen.2021.105212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
Consistent with conceptual frameworks of ethnic-race-based stress responses, and empirical evidence for the detrimental effects of ethnic-racial discrimination, the current study hypothesized that experiencing more frequent ethnic-racial discrimination during adolescence would predict differences in physiological responses to psychosocial stress across the college transition. U.S. Latinx adolescents (N = 84; Mage = 18.56; SD = 0.35; 63.1% female; 85.7% Mexican descent) completed survey measures of ethnic-racial discrimination during their final year of high school and first college semester (~5 months later), as well as a standard psychosocial stressor task during their first college semester. Repeated blood pressure and salivary cortisol measures were recorded to assess cardiovascular and neuroendocrine activity at baseline and stress reactivity and recovery. Data were analyzed using multilevel growth models. Experiencing more frequent ethnic-racial discrimination in high school, specifically from adults, predicted higher baseline physiological stress levels and lower reactivity to psychosocial stress during the first college semester, evidenced by both blood pressure and cortisol measures. Experiencing ethnic-racial discrimination from peers in high school also predicted higher baseline blood pressure in college, but not stress reactivity indices. Results were consistent when controlling for concurrent reports of ethnic-racial discrimination, gender, parents' education level, body mass index, oral contraceptive use, time between longitudinal assessments, depressive symptoms, and general perceived stress. Experiencing frequent ethnic-racial discrimination during adolescence may lead to overburdening stress response systems, indexed by lower cardiovascular and neuroendocrine stress reactivity. Multiple physiological stress systems are sensitive to the consequences of ethnic-racial discrimination among Latinx adolescents transitioning to college.
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Affiliation(s)
- Michael R Sladek
- Harvard Graduate School of Education, Harvard University, United States.
| | - Saul A Castro
- Department of Psychology, Arizona State University, United States.
| | - Leah D Doane
- Department of Psychology, Arizona State University, United States.
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Bernard DL, Calhoun CD, Banks DE, Halliday CA, Hughes-Halbert C, Danielson CK. Making the "C-ACE" for a Culturally-Informed Adverse Childhood Experiences Framework to Understand the Pervasive Mental Health Impact of Racism on Black Youth. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:233-247. [PMID: 33986909 PMCID: PMC8099967 DOI: 10.1007/s40653-020-00319-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The high prevalence and psychological impact of childhood exposure to potentially traumatic events (PTE) is a major public health concern in the United States. Considerable evidence has demonstrated the significant racial disparities that exist with respect to PTE exposure, indicating that Black youth are particularly burdened by these harmful experiences. Racism may serve a unique role in explaining why Black youth are disproportionately exposed to PTEs, and why mental health disparities are more likely to occur following such experiences. Despite clear evidence acknowledging racism as a major life stressor for Black youth, theoretical models of early childhood adversity have largely neglected the multifaceted influence of racism on mental health outcomes. Inspired by bourgeoning literature highlighting the potentially traumatic nature of racism-related experiences for Black youth, we present a culturally-informed Adverse Childhood Experiences (ACEs) model, or "C-ACE", to understand the pervasive and deleterious mental health impact of racism on Black youth. This model extends the ACE framework by noting the significance of racism as an ACE exposure risk factor, a distinct ACE category, and a determinant of post-ACE mental health outcomes among Black youth. The model acknowledges and supports the advancement of ACEs research that takes a culturally informed approach to understanding the intergenerational and multilevel impact of racism on the mental health of Black youth. Future research utilizing the proposed C-ACE model is essential for informing clinical and public health initiatives centered on reducing the mental health impact of racism-related experiences and health disparities in the United States.
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Affiliation(s)
- Donte L. Bernard
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425 USA
| | - Casey D. Calhoun
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425 USA
| | - Devin E. Banks
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425 USA
- Department of Psychological Sciences, University of Missouri of St. Louis, St. Louis, MO 63131 USA
| | - Colleen A. Halliday
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425 USA
| | - Chanita Hughes-Halbert
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425 USA
| | - Carla K. Danielson
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425 USA
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Eliminating disparities improves outcomes. Blood 2021; 137:439-441. [PMID: 33507300 DOI: 10.1182/blood.2020008976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Social Patterning of Racial Discrimination Among a Diverse Sample of School-Aged Children in Australia. J Racial Ethn Health Disparities 2021; 9:830-839. [PMID: 33847925 DOI: 10.1007/s40615-021-01021-8] [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: 07/22/2020] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the prevalence of young childrens' reported experiences of racial discrimination and to assess whether discriminatory experiences vary by gender, religion and country of birth. METHODS Data came from Speak Out Against Racism (SOAR), a cross-sectional study of 4664 public school students in grades 5-9 in two Australian states in 2017. An adaption of the Adolescent Discrimination Distress Index (ADDI), as a measure of discrimination, was used across four Indigenous and ethnic categories (Indigenous, Asian and non-Asian visible minorities, Anglo/European). Effect-measure modification (EMM) examined how experiences of racial discrimination across ethnic groups varied by gender, country of birth and religion. RESULTS A sizeable proportion (40%) of students reported experiencing racial discrimination. Indigenous, Asian and non-Asian visible minority students reported higher rates of experiencing racial discrimination than their Anglo-European peers. Male students reported higher rates of experiencing racial discrimination than female students. Foreign-born students reported experiencing racial discrimination more often than native-born students, and both Christian and religious minorities experienced racial discrimination more often than students identifying with the dominant "No religion" group. CONCLUSIONS The findings highlight the prevalence of racial discrimination among adolescents and how gender, country of birth and religion can increase risk of these experiences.
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Schmitz JCS, Prenoveau JM, Papadakis AA, Johnson AJ, Lating JM, Mendelson T, Dariotis JK. Mindfulness and Posttraumatic Stress Disorder Symptom Severity in Urban African-American High School Students. Psychiatr Q 2021; 92:85-99. [PMID: 32458341 DOI: 10.1007/s11126-020-09774-x] [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] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of the current study was to examine the relations among mindfulness, posttraumatic stress disorder (PTSD) symptom severity, and stressful life events (SLEs) in African-American urban adolescents. Another aim was to examine mindfulness as a moderator of the relation between SLEs and PTSD symptom severity in this population. METHOD Eighty-eight African-American high school students from a low-income urban community completed measures of demographics, PTSD symptom severity, SLEs, and mindfulness. RESULTS Mindfulness was significantly negatively related to PTSD symptom severity, r(86) = -.70, p < .001, 95% CI [-.58, -79], and SLEs were significantly positively related to PTSD symptom severity, r(86) = .29, p = .003, 95% CI [.09, .47]. Mindfulness was an independent predictor of PTSD symptom severity after accounting for SLEs, B = -1.16, t(84) = -9.06, p < .001, 95% CI [-1.41, -0.90], and SLEs were an independent predictor of PTSD symptom severity after accounting for mindfulness, B = 0.49, t(84) = 2.92, p = .004, 95% CI [0.16, 0.82]. Mindfulness did not moderate the relation between SLEs and PTSD symptom severity, B = -.003, t(84) = -0.15, p = .89, 95% CI [-.04, .03]. IMPLICATIONS This study has implications for both mindfulness as a potential protective factor against PTSD symptom severity and SLEs as a potential risk factor for increased PTSD symptom severity in African-American urban adolescents.
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Affiliation(s)
- Jacob C S Schmitz
- Department of Psychiatry, Virginia Commonwealth University, 1308 Sherwood Avenue, Box 980489, Richmond, VA, 23220, USA.
| | - Jason M Prenoveau
- Department of Psychology, Loyola University Maryland, Baltimore, MD, USA
| | - Alison A Papadakis
- Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Adanna J Johnson
- Office of the Provost, Georgetown University, Washington, DC, USA
| | - Jeffery M Lating
- Department of Psychology, Loyola University Maryland, Baltimore, MD, USA
| | - Tamar Mendelson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jacinda K Dariotis
- College of Education, Criminal Justice, and Human Services, Evaluation Services Center, University of Cincinnati, Cincinnati, OH, USA
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Gönültaş S, Mulvey KL. Bystander responses to bias-based bullying and retaliation: Is retaliation perceived as more acceptable than bias-based bullying? BRITISH JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2021; 39:442-461. [PMID: 33629758 DOI: 10.1111/bjdp.12371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/30/2020] [Indexed: 11/30/2022]
Abstract
The current study examined intergroup-related and social-cognitive correlates of bystanders' acceptability judgements and their responses to bias-based bullying of immigrant peers and to possible retaliation for the bullying. Participants included 179 immigrant-origin and non-immigrant-origin youth (Mage = 13.23; SD = 1.55; 79 immigrant-origin youth). Participants' bystander judgements and responses to bullying and retaliation were examined via a hypothetical scenario. Further, participants' intergroup attitudes towards immigrants and their social-cognitive skills were evaluated. ANOVA results showed that immigrant-origin youth judged bullying as less acceptable and retaliation as more acceptable compared to non-immigrant-origin youth, documenting that group membership is related to adolescents' judgements. A similar pattern was observed in active bystander responses. Hierarchical regression analyses revealed that immigration background, intergroup process in the context of immigration, and social-cognitive skills predict bystander responses to bullying and retaliation. This study provides important implications for anti-bullying intervention programmes to overcome the negative consequences of retaliation in the escalation of aggressive behaviours.
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Affiliation(s)
- Seçil Gönültaş
- North Carolina State University, Raleigh, North Carolina, USA
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Sulley S, Bayssie M. Social Determinants of Health: An Evaluation of Risk Factors Associated With Inpatient Presentations in the United States. Cureus 2021; 13:e13287. [PMID: 33728220 PMCID: PMC7955789 DOI: 10.7759/cureus.13287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Social Determinants of Health (SDoH) are socioeconomic indicators that directly or indirectly impact individual and community health outcomes. The distribution of most of these indicators within communities can be traced to public policies. These public policies often lead to diverse inequities with varying impacts on communities across the country. The inequities that arise because of specific public policies can be associated with increased risk factors and poor health outcomes among communities at high risk for these indicators. This study examined inpatient hospitalization and SDoH indicators that put individuals at risk of poor health outcomes. We utilized the National Inpatient Sample (NIS) databases 2012-2014 and 2016-2017 through the Healthcare Cost and Utilization Project (HCUP). The NIS datasets are de-identified to ensure patients' privacy. The HCUP-NIS dataset is a well-established sizable all-payer inpatient dataset for national estimates. It includes primary, secondary inpatient diagnoses as well as demographic information. SDoH indicators were identified using the International Classification of Diseases (ICD), versions 9 and 10 diagnosis codes. The relationship between SDoH indicators such as housing, psychosocial, healthcare access, upbringing, unemployment, social factors, gender, race, income, region, payer, age group, mortality, and severity was evaluated in a regression analysis. A total of 3,002,557 (2012-2014) and 1,254,899 (2016-2017) cases were included in this study. Mental diseases (p < 0.001) were high between 2012-2014 (OR 18.8, 95% CI 18.20-19.42) and 2016-2017 (OR 4.11, 95% CI 3.99-4.23). Native Americans had odds of presentation (p < 0.001) with SDoH indicator between 2012-2014 (OR 1.15, 95% CI 1.12-1.18) and 2016-2017 (OR 1.75, 95% CI 1.70-1.79). The odds of presentation among long income group were high compared to other income categories (p < 0.001) between 2012-2014 (OR 1.15, 95% CI 1.15-1.16) and 2016-2017 (OR 1.26, 95% CI 1.28-1.32). In conclusion, disparities, severity, and mortality risk at presentation were high among minority communities, males, and low-income demographics across all regions of United States
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Affiliation(s)
- Saanie Sulley
- Health Informatics, National Healthy Start Association, Washington DC, USA
| | - Mathios Bayssie
- Emergency Medicine, Southern Tennessee Regional Health System, Nashville, USA
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Brown ED, Holochwost SJ, Laurenceau JP, Garnett ML, Anderson KE. Deconstructing Cumulative Risk: Poverty and Aspects of Instability Relate Uniquely to Young Children's Basal Cortisol. Child Dev 2021; 92:1067-1082. [PMID: 33400295 DOI: 10.1111/cdev.13512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study deconstructs cumulative risk to probe unique relations to basal cortisol for family income and four distinct aspects of poverty-related instability. Participants were 288 children aged 3-5 years who attended Head Start preschool. Parents reported on poverty risks. Children provided samples of salivary cortisol at four times of day on 6 days. Results of hierarchical linear modeling with piecewise latent growth curves representing basal cortisol indicated unique relations for family income, household chaos, neighborhood risk, attachment-disruptive residential changes, and non-attachment changes. The findings support an equifinality implied by cumulative risk models in demonstrating that multiple risks relate to cortisol dysregulation yet also suggest the utility of considering unique effects of different risks for neurophysiological stress response functioning.
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Influence of race/ethnicity and income on the link between adverse childhood experiences and child flourishing. Pediatr Res 2021; 89:1861-1869. [PMID: 33045719 PMCID: PMC8249234 DOI: 10.1038/s41390-020-01188-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/01/2020] [Accepted: 08/18/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The impact of early adversity increases the risk of poor outcomes across the life course. Identifying factors that protect against or contribute to deleterious life outcomes represents an important step in resilience promotion among children exposed to adversity. Informed by resilience science, we hypothesized that family resilience mediates the relationship between adverse childhood experiences (ACEs) and child flourishing, and these pathways vary by race/ethnicity and income. METHODS We conducted a secondary data analysis using the 2016-17 National Survey of Children's Health data reported by parents/guardians for 44,686 children age 6-17 years. A moderated-mediation model estimated direct, indirect, and total effects using a probit link function and stacked group approach with weighted least square parameter estimates. RESULTS The main variables were related in expected directions. Family resilience partially mediated the ACEs-flourishing association. Although White and socioeconomically advantaged families were more likely to maintain family resilience, their children functioned more poorly at high-risk levels relative to Black and Hispanic children and across income groups. CONCLUSION Children suffer from cumulative adversity across race/ethnicity and income. Partial mediation of family resilience indicates that additional protective factors are needed to develop comprehensive strategies, while racial/ethnic differences underscore the importance of prevention and intervention programs that are culturally sensitive. IMPACT The key message of the article reinforces the notion that children suffer from cumulative adversity across race/ethnicity and income, and prevention of ACEs should be the number one charge of public policy, programs, and healthcare. This is the first study to examine family resilience in the National Survey Children's Health (NSCH) data set as mediating ACEs-flourishing by race/ethnicity and family poverty level. Examining an ACEs dose-response effect using population-based data within the context of risk and protective factors can inform a public health response resulting in a greater impact on prevention efforts.
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Lopez M, Ruiz MO, Rovnaghi CR, Tam GKY, Hiscox J, Gotlib IH, Barr DA, Carrion VG, Anand KJS. The social ecology of childhood and early life adversity. Pediatr Res 2021; 89:353-367. [PMID: 33462396 PMCID: PMC7897233 DOI: 10.1038/s41390-020-01264-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/14/2020] [Accepted: 10/12/2020] [Indexed: 01/30/2023]
Abstract
An increasing prevalence of early childhood adversity has reached epidemic proportions, creating a public health crisis. Rather than focusing only on adverse childhood experiences (ACEs) as the main lens for understanding early childhood experiences, detailed assessments of a child's social ecology are required to assess "early life adversity." These should also include the role of positive experiences, social relationships, and resilience-promoting factors. Comprehensive assessments of a child's physical and social ecology not only require parent/caregiver surveys and clinical observations, but also include measurements of the child's physiology using biomarkers. We identify cortisol as a stress biomarker and posit that hair cortisol concentrations represent a summative and chronological record of children's exposure to adverse experiences and other contextual stressors. Future research should use a social-ecological approach to investigate the robust interactions among adverse conditions, protective factors, genetic and epigenetic influences, environmental exposures, and social policy, within the context of a child's developmental stages. These contribute to their physical health, psychiatric conditions, cognitive/executive, social, and psychological functions, lifestyle choices, and socioeconomic outcomes. Such studies must inform preventive measures, therapeutic interventions, advocacy efforts, social policy changes, and public awareness campaigns to address early life adversities and their enduring effects on human potential. IMPACT: Current research does not support the practice of using ACEs as the main lens for understanding early childhood experiences. The social ecology of early childhood provides a contextual framework for evaluating the long-term health consequences of early life adversity. Comprehensive assessments reinforced with physiological measures and/or selected biomarkers, such as hair cortisol concentrations to assess early life stress, may provide critical insights into the relationships between early adversity, stress axis regulation, and subsequent health outcomes.
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Affiliation(s)
- Marcela Lopez
- Pain/Stress Neurobiology Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine
| | - Monica O. Ruiz
- Pain/Stress Neurobiology Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine,Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Cynthia R. Rovnaghi
- Pain/Stress Neurobiology Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine
| | - Grace K-Y. Tam
- Pain/Stress Neurobiology Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine
| | - Jitka Hiscox
- Pain/Stress Neurobiology Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine,Department of Civil Engineering, Stanford School of Engineering, Stanford, CA
| | - Ian H. Gotlib
- Department of Psychology, Stanford University School of Humanities & Sciences, Stanford, CA
| | - Donald A. Barr
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA,Stanford University Graduate School of Education, Stanford, CA
| | - Victor G. Carrion
- Department of Psychiatry (Child and Adolescent Psychiatry), Clinical & Translational Neurosciences Incubator, Stanford University School of Medicine, Stanford, CA
| | - Kanwaljeet J. S. Anand
- Pain/Stress Neurobiology Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine,Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
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Fegan-Bohm K, Minard CG, Anderson BJ, Butler AM, Titus C, Weissberg-Benchell J, Hilliard ME. Diabetes distress and HbA1c in racially/ethnically and socioeconomically diverse youth with type 1 diabetes. Pediatr Diabetes 2020; 21:1362-1369. [PMID: 32893939 DOI: 10.1111/pedi.13108] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/29/2020] [Accepted: 08/22/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Diabetes distress, the emotional burden of caring for the chronic demands of diabetes, has not been well described in children and preadolescents with type 1 diabetes (T1D). This gap is particularly evident among youth of lower socioeconomic status (SES) and/or racial/ethnic minorities. Since these groups are more likely to have disparities in health outcomes and healthcare related to their diabetes, factors that could potentially improve glycemic and other diabetes-related outcomes should be studied closely. OBJECTIVE We hypothesized that (a) diabetes distress levels would be elevated in children with markers of lower SES and those of racial/ethnic minorities, and (b) higher HbA1c would be predicted by higher diabetes distress levels, when controlling for race/ethnicity, SES, and clinical covariates. METHODS One hundred and eighty-seven youth age 9 to 13 with T1D completed age-appropriate Problem Areas in Diabetes (PAID) questionnaires using a web-based portal during routine diabetes care visits. RESULTS PAID scores were significantly elevated in youth who had surrogate markers of lower SES and who were from racial/ethnic minority backgrounds. In multivariate models including race/ethnicity or the SES variables and controlling for clinical covariates, the factor most predictive of higher HbA1c was elevated PAID score. CONCLUSIONS Diabetes distress is elevated in a younger population of children with T1D who are from racial/ethnic minority backgrounds or have markers of lower SES. Interventions that target distress and/or expand the safety net in these populations could potentially improve glycemic outcomes.
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Affiliation(s)
- Kelly Fegan-Bohm
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Charles G Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Ashley M Butler
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Courtney Titus
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Jill Weissberg-Benchell
- Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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Mendelson T, Sheridan SC, Clary LK. Research with youth of color in low-income communities: Strategies for recruiting and retaining participants. Res Social Adm Pharm 2020; 17:1110-1118. [PMID: 32912828 PMCID: PMC7445129 DOI: 10.1016/j.sapharm.2020.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 12/22/2022]
Abstract
Background Youth of color from low-income urban communities are crucial participants in research, as their involvement can shape effective, culturally responsive interventions and policy to promote youth health and well-being. These young people, however, are an often-neglected research population, due in part to perceived challenges associated with their inclusion as well as marginalized communities’ justifiable mistrust of research. Objectives Based on our experience conducting a school-based randomized intervention trial in Baltimore, Maryland, we present strategies for conducting research with low-income, urban youth of color. We discuss strategies in three domains: university-community partnership development, participant recruitment, and participant retention. Methods We reviewed partnership building and recruitment strategies employed by our team across four years of trial implementation and evaluated success of participant retention at our final survey timepoint. Results Partnership building was facilitated by selection of a study design that maximized benefits for all participants, promotion of capacity building at partner institutions, and attention to research staff hiring and training practices. Effective study recruitment strategies included personal contact with parents and close cooperation between school personnel and study staff. Providing incentives and collecting multiple types of participant contact information contributed to increased retention rates. On average, those who participated in the final survey timepoint were less likely to be male and Latinx and exhibited more favorable baseline mental health than those who did not, suggesting differential attrition based on youth characteristics. Conclusions Lessons learned from this school-based trial can be applied more broadly to research with low-income urban youth of color. Researchers should strive to maximize scientific rigor, minimize harm to vulnerable adolescents and their communities, promote positive research experiences for young people, and provide concrete benefits to those who participate.
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Affiliation(s)
- Tamar Mendelson
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, United States.
| | - Steven C Sheridan
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, United States
| | - Laura K Clary
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, United States
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The Detrimental Influence of Racial Discrimination on Child Health in the United States. J Natl Med Assoc 2020; 112:411-422. [PMID: 32532525 DOI: 10.1016/j.jnma.2020.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The current literature describing the largely damaging effect of racial discrimination on child health is weakened by several confounding factors. We aimed to: 1) describe the relation between racial discrimination and child health and 2) evaluate the potential mediating role of mental health relating racial discrimination to child health, using methods that mitigate confounding. METHODS Using the 2011-2012 National Survey of Children's Health (N = 95,677), we performed: 1) propensity score analysis, matching and comparing discrimination-exposed to non-exposed children and 2) structural equation modeling, examining mental health as a mediator of the pathway between discrimination and child health. RESULTS In the first approach, the proportion of children with excellent health was 5.4% (95% Confidence Interval (CI), 3.6,7.2%) lower with exposure to racial discrimination. Among minority children, those with low income had the greatest decrements in general health associated with racial discrimination. Among white children, those with high income had the greatest decrements. In the structural equation model, minority children had higher odds of experiencing racial discrimination (Odds ratios (ORs) ≥ 5.47, [95% CIs, 4.92,10.6]); meanwhile, children who experienced discrimination were more likely to have anxiety and depression (ORs ≥ 3.58, [95% CIs, 2.87,4.58]), which were linked to lower odds of excellent health (ORs ≤ 0.44, [95% CIs, 0.41.52]). CONCLUSION The negative health association of racial discrimination may be mediated by mental health and vary by racial, ethnic, or socioeconomic group. This work may stimulate the formation of targeted interventions to address these disparities.
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Schneider S. Associations between childhood exposure to community violence, child maltreatment and school outcomes. CHILD ABUSE & NEGLECT 2020; 104:104473. [PMID: 32244130 DOI: 10.1016/j.chiabu.2020.104473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/13/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This study examined whether physical abuse and community violence exposure (CVE) at age 5 were independently associated with academic performance at age 9, whether these effects were mediated by externalizing and internalizing behaviors, and whether the effects of CVE on mental health and academic performance were observed after accounting for the effects of physical abuse. METHODS Data were drawn from the Fragile Families and Child Wellbeing Study. Bayesian factor analysis was conducted in Mplus to form latent factors for internalizing behavior, externalizing behavior, and academic performance. Path analysis was then used to examine direct and indirect associations between CVE, internalizing and externalizing behaviors, and academic performance. RESULTS CVE at age 5 was independently negatively associated with academic performance at age 9. Physical abuse at age 5 was not independently associated with academic performance at age 9. The effects of CVE and physical abuse on academic performance were mediated by externalizing behavior, and not internalizing behavior. CVE, externalizing behavior, and internalizing behavior all had a direct negative association with academic performance, after accounting for the effects of physical abuse on externalizing behavior. CONCLUSIONS AND IMPLICATIONS The findings confirmed that community violence has a negative impact on school performance above and beyond the effects of interpersonal violence. These findings reinforce the need for communitywide prevention programs that reduce violence. These findings suggest that more attention needs to be paid to how younger children are impacted by CVE and physical abuse, both through their own experiences or the experiences of their caregivers.
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Affiliation(s)
- Samantha Schneider
- Simmons University School of Social Work, 300 The Fenway, Boston, MA 02115, United States.
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