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Moore J, Evans S, Rose CE, Shin M, Carroll Y, Duke CW, Cohen CR, Broussard CS. Increased Stillbirth Rates and Exposure to Environmental Risk Factors for Stillbirth in Counties with Higher Social Vulnerability: United States, 2015-2018. Matern Child Health J 2024:10.1007/s10995-024-04003-4. [PMID: 39377946 DOI: 10.1007/s10995-024-04003-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2024] [Indexed: 10/09/2024]
Abstract
INTRODUCTION Exposure to unfavorable environmental conditions during pregnancy, such as extreme heat and air pollution, has been linked to increased risk of stillbirth, defined as fetal mortality at or after 20 weeks' gestation, however no studies have examined its association with social vulnerability. We examined associations between county-level stillbirth rates, environmental risk factors for stillbirth, and social vulnerability in the United States. METHODS This ecologic study linked county-level data from three nationwide datasets on stillbirths (National Vital Statistics System), environmental conditions (North American Land Data Assimilation System and Environmental Protection Agency), and social vulnerability (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index). Poisson and negative binomial models were fit to the variables and produced rate ratios to estimate associations among stillbirth rates, environmental risk factors, and social vulnerability. RESULTS Social vulnerability was positively associated withn stillbirth rates, annual average number of extreme heat days, and ambient concentration of particulate matter ≤ 2.5 μm in diameter (PM2.5). The average number of days that ozone and PM2.5 each exceeded regulatory standards were not associated with stillbirth rates or social vulnerability. A positive association between average annual PM2.5 concentration and stillbirth rates was detected; no other significant associations between environmental risk factors and stillbirth rates were observed. DISCUSSION We found evidence of associations between social vulnerability and stillbirth rates, and between social vulnerability and environmental risk factors for stillbirth at the county level. Further research could inform understanding of how social vulnerability impacts the relationship between environmental exposures and stillbirth risk.
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Affiliation(s)
- Jazmyn Moore
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, US.
- Division of Infectious Disease Readiness and Innovation, National Center on Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Mail Stop: H24-3, Atlanta, GA, 30329, US.
| | - Shannon Evans
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, US
| | - Charles E Rose
- National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, US
| | - Mikyong Shin
- Division of Environmental Health Science and Practice, National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, US
| | - Yulia Carroll
- Division of Environmental Health Science and Practice, National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, US
| | - Charles W Duke
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, US
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, US
| | - Cheryl S Broussard
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, US
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Battle-Fisher M. Combating COVID-19 health disparities in Black, Indigenous, and People of Colour Communities-A call for critical systems thinking. J Eval Clin Pract 2024; 30:1132-1142. [PMID: 38961762 DOI: 10.1111/jep.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 04/10/2024] [Accepted: 05/13/2024] [Indexed: 07/05/2024]
Abstract
RATIONALE The Black, Indigenous, and People of Colour populations in the United States are disproportionately affected by the emerging health threat SARS-CoV-2, which causes COVID-19. AIMS AND OBJECTIVES This paper aims to demonstrate the usefulness of critical systems thinking by using scenario planning based on epidemiological data and tying epidemiology with soft systems methodology to investigate COVID-19 disparities among disproportionately affected Black, Indigenous, and People of Colour populations. METHODS Using a review of the COVID-19 literature and publicly available US COVID-19 data, critical systems thinking is applied in a scenario planning example and a call to link soft systems methodology with epidemiology. RESULTS According to the four plausible Endgame scenarios, levels of community transmission as well as the current state transmission are based on the driving forces of the scenarios. In addition, soft systems methodology explores the effect on stakeholders and strengthens the picture of disease burden beyond sole reliance on traditional data sources. CONCLUSION This analysis underscores employing critical systems thinking to critically assess diverse methods appropriate for the ongoing complexity of global crises. It is argued that critically engaged subjectivity should be given space alongside data-dependent objectivity. COVID-19 disparities are reliant on the social determinants of health's effects as driving forces on disease transmission in Black, Indigenous, and People of Colour populations. It is moreover argued that critical systems thinking is demonstrated by linking epidemiological evidence with scenario planning and soft systems methodology. This in turn supports a critical systems thinking approach to uncover the state of health disparities among minoritized communities under COVID-19.
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Marshall SM, Tolentino NK, Worthington JK, Matagi CE, Freitas SKM, Birnie KK, Oneha MF. Kū Like Kākou: Utilizing a Community-led Model of Collaboration to Respond to the COVID-19 Pandemic. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2024; 83:187-191. [PMID: 38974804 PMCID: PMC11224955 DOI: 10.62547/rxsl5225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
The outbreak of COVID-19 in 2020 brought significant challenges for Native Hawaiians (NH), Pacific Islanders (PI), and other communities of color worldwide. Rapidly increasing rates of infection and transmission of the virus in Native Hawaiian and Pacific Islander (NHPI) communities and incomplete or unavailable data signaled to Hawai'i's leaders that advocacy and action needed to take place to minimize the impact of COVID-19. The Native Hawaiian and Pacific Islander Response, Recovery, and Resilience team (NHPI 3R Team) emerged from an effort to lead and fill gaps in response to COVID-19. Through the swift, intentional, and collaborative work of the team and its partners, NHPI communities and the entities that serve them were better equipped to navigate the pandemic, improve health outcomes, and contribute to a reduction in the number of infections, a rise in vaccination uptake, and an increase in NH and PI representation on various levels of government agencies. As the world shifts its focus from COVID-19 to broader health topics, the NHPI 3R Team will continue to serve as a hub for the exchange of resources and a model of community-led work that can be used to tackle issues like COVID-19 and beyond.
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Affiliation(s)
- Sarah Momilani Marshall
- Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, HI (SMM)
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Glauberman G, Kabua PM, Camba M, Dela Cruz M, Fontenot HB. Perspectives on Emergency Preparedness Among Indigenous Pacific People in Hawaii: A Qualitative Study. J Community Health Nurs 2024; 41:189-202. [PMID: 38334130 PMCID: PMC11128344 DOI: 10.1080/07370016.2024.2309375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
PURPOSE This study sought an improved understanding of household emergency preparedness (EP) among Native Hawaiian, Pacific Islander, and Filipino (Indigenous Pacific People [IPP]) parents in Hawaii. DESIGN We conducted an exploratory qualitative descriptive study with 60-minute interviews occurring from October 2022 through March 2023. A semi-structured interview guide exploring participant household EP was employed. METHODS Prospective participants were females who identified as IPP, caregivers of a 0-12-year-old child, spoke English, and received health services at a federally qualified health center clinic. Two researchers conducted qualitative content analysis on interview transcripts. Initial coding of transcripts identified broad categories or themes. The process was reviewed continuously to verify data and coding procedures. Three investigators independently verified final themes and subthemes. FINDINGS Participants (N=25) were female, between 30-49 years of age (68%), had received some college education (60%), and were fully employed (68%). Major themes included: 1) Perceptions of family EP and current behaviors, 2) Barriers and challenges to family EP, and 3) Perspectives on strategies to improve family EP. Subthemes included risk perception for emergencies; family EP practices; health protection and pandemic preparedness; lack of knowledge and experience; social, cultural and economic barriers; and clinic-based, technology-driven, and community-based interventions. CONCLUSION Factors impeding access to healthcare services also impede family EP among IPP groups and their ability to mitigate the impact of future public health emergencies. CLINICAL EVIDENCE Targeted, innovative interventions, including ones led by health clinics and those that utilize technology, are needed to overcome common barriers faced and to facilitate the uptake of household EP behaviors among IPP families.
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Affiliation(s)
- Gary Glauberman
- University of Hawaii at Manoa School of Nursing, Honolulu, HI, USA
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Sentell T, Finn J, Tolentino NK, Birnie KK, Phillips MM. Public Health Communication to Build Equity: 10 Best Practice Pandemic Insights and Examples from Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2024; 83:168-172. [PMID: 38855710 PMCID: PMC11161208 DOI: 10.62547/hhzj2325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Affiliation(s)
- Tetine Sentell
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, HI (TS, JF, MMP)
| | - Julia Finn
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, HI (TS, JF, MMP)
| | | | | | - Michael M Phillips
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, HI (TS, JF, MMP)
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Burton DC, Kelly A, Cardo D, Daskalakis D, Huang DT, Penman-Aguilar A, Raghunathan PL, Zhu BP, Bunnell R. Principles of Health Equity Science for Public Health Action. Public Health Rep 2024; 139:277-283. [PMID: 38044623 PMCID: PMC11037219 DOI: 10.1177/00333549231213162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Deron C. Burton
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- US Public Health Service, Washington, DC, USA
| | - Angele Kelly
- Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Denise Cardo
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Demetre Daskalakis
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David T. Huang
- US Public Health Service, Washington, DC, USA
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ana Penman-Aguilar
- Office of Health Equity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Bao-Ping Zhu
- Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca Bunnell
- Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Connolly KK, Lee W, Freitas V, Buenconsejo-Lum LE. Historical Inequities in Medical Education - Commitment to Opportunity, Diversity, and Equity at the University of Hawai'i School of Medicine. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2024; 83:138-143. [PMID: 38716138 PMCID: PMC11070778 DOI: 10.62547/hlhv7741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Medical education in the US has contributed to institutionalized racism through historically exclusionary practices, which has led to health disparities and inequities in health care today. The 1910 Flexner report, which favored schools with greater resources, led to the closure of nearly half of medical schools in the Us, which were mostly small schools located in rural communities that served economically disadvantaged, ethnic minority, and female populations. Closing these schools ultimately limited the availability of physicians willing to serve disadvantaged and minority populations in impoverished and underserved communities. In order to transform medical education to be more equitable, medical schools must be proactive in opportunity, diversity, and equity efforts. This not only includes efforts in admissions and faculty hiring, but also curricula related to social and health disparities, interracial interactions between students and faculty, and service learning activities that engage and work with marginalized communities. The University of Hawai'i John A. Burns School of Medicine has a longstanding commitment to diversity, which is integral to the school's mission. Providing opportunities to underserved populations has been a priority since establishment of the school. As one of the most diverse univeristies in the US, the school of medicine continues to focus on opportunity, diversity, and equity priorities in both its strategic planning and overall mission.
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Affiliation(s)
| | - Winona Lee
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Vanessa Freitas
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
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Santi BM, Verhoef PA. COVID-19 Hospitalization in Hawai'i and Patterns of Insurance Coverage, Race and Ethnicity, and Vaccination. JAMA Netw Open 2024; 7:e243696. [PMID: 38691362 PMCID: PMC11063802 DOI: 10.1001/jamanetworkopen.2024.3696] [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: 06/15/2023] [Accepted: 01/17/2024] [Indexed: 05/03/2024] Open
Abstract
Importance The people of Hawai'i have both high rates of health insurance and high levels of racial and ethnic diversity, but the degree to which insurance status and race and ethnicity contribute to health outcomes in COVID-19 remains unknown. Objective To evaluate the associations of insurance coverage, race and ethnicity (using disaggregated race and ethnicity data), and vaccination with outcomes for COVID-19 hospitalization. Design, Setting, and Participants This retrospective cohort study included hospitalized patients at a tertiary care medical center between March 2020 and March 2022. All patients hospitalized for acute COVID-19, identified based on diagnosis code or positive results on polymerase chain reaction-based assay for SARS-CoV-2, were included in analysis. Data were analyzed from May 2022 to May 2023. Exposure COVID-19 requiring hospitalization. Main Outcome and Measures Electronic medical record data were collected for all patients. Associations among race and ethnicity, insurance coverage, receipt of at least 1 COVID-19 vaccine, intensive care unit (ICU) transfer, in-hospital mortality, and COVID-19 variant wave (pre-Delta vs Delta and Omicron) were assessed using adjusted multivariable logistic regression. Results A total of 1176 patients (median [IQR] age of 58 [41-71] years; 630 [54%] male) were hospitalized with COVID-19, with a median (IQR) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 (25-36) and Sequential Organ Failure Assessment score of 1 (0-2). The sample included 16 American Indian or Alaska Native patients, 439 Asian (not otherwise specified) patients, 15 Black patients, 66 Chinese patients, 246 Filipino patients, 76 Hispanic patients, 107 Japanese patients, 10 Korean patients, 299 Native Hawaiian patients, 523 Pacific Islander (not otherwise specified) patients, 156 Samoan patients, 5 Vietnamese patients, and 311 White patients (patients were able to identify as >1 race or ethnicity). When adjusting for age, BMI, sex, medical comorbidities, and socioeconomic neighborhood status, there were no differences in either ICU transfer (eg, Medicare vs commercial insurance: odds ratio [OR], 0.84; 95% CI, 0.43-1.64) or in-hospital mortality (eg, Medicare vs commercial insurance: OR, 0.85; 95% CI, 0.36-2.03) as a function of insurance type. Disaggregation of race and ethnicity revealed that Filipino patients were more likely to die in the hospital (OR, 1.79; 95% CI, 1.04-3.03; P = .03). When considering variant waves, mortality among Filipino patients was highest during the pre-Delta time period (OR, 2.72; 95% CI, 1.02-7.14; P = .04), when mortality among Japanese patients was lowest (OR, 0.19; 95% CI, 0.03-0.78; P = .04); mortality among Native Hawaiian patients was lowest during the Delta and Omicron period (OR, 0.35; 95% CI, 0.13-0.79; P = .02). Patients with Medicare, compared with those with commercial insurance, were more likely to have received at least 1 COVID-19 vaccine (OR, 1.85; 95% CI, 1.07-3.21; P = .03), but all patients, regardless of insurance type, who received at least 1 COVID-19 vaccine had reduced ICU admission (OR, 0.40; 95% CI, 0.21-0.70; P = .002) and in-hospital mortality (OR, 0.42; 95% CI, 0.21-0.79; P = .01). Conclusions and Relevance In this cohort study of hospitalized patients with COVID-19, those with government-funded insurance coverage (Medicare or Medicaid) had similar outcomes compared with patients with commercial insurance, regardless of race or ethnicity. Disaggregation of race and ethnicity analysis revealed substantial outcome disparities and suggests opportunities for further study of the drivers underlying such disparities. Additionally, these findings illustrate that vaccination remains a critical tool to protect patients from COVID-19 mortality.
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Affiliation(s)
- Brock M. Santi
- Department of Medicine, John A. Burns School of Medicine, University of Hawaiʻi, Honolulu
| | - Philip A. Verhoef
- Department of Medicine, John A. Burns School of Medicine, University of Hawaiʻi, Honolulu
- Hawaiʻi Permanente Medical Group, Honolulu
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Maykin MM, Mercer E, Saiki KM, Kaneshiro B, Miller CB, Tsai PJS. Furosemide to lower antenatal severe hypertension: a randomized placebo-controlled trial. Am J Obstet Gynecol MFM 2024; 6:101348. [PMID: 38485054 DOI: 10.1016/j.ajogmf.2024.101348] [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: 01/29/2024] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy are a leading cause of perinatal morbidity, and timely treatment of severely elevated blood pressure is recommended to prevent serious sequelae. In acute hypertension marked by increased blood volume, it is unknown whether diuretics used as an adjunct to antihypertensive medications lead to more effective blood pressure control. OBJECTIVE This study aimed to evaluate whether the addition of intravenous furosemide to first-line antihypertensive agents reduces systolic blood pressure in acute-onset, severe antenatal hypertension with wide (≥60 mm Hg) pulse pressure. STUDY DESIGN In this double-blinded randomized trial, participants received 40 mg of intravenous furosemide or placebo in addition to a first-line antihypertensive agent. The primary outcome was mean systolic blood pressure during the first hour after intervention. Secondary outcomes included corresponding diastolic blood pressure; systolic blood pressure, diastolic blood pressure, and pulse pressure at 2 hours after intervention; total reduction from qualifying blood pressure; duration of blood pressure control; need for additional antihypertensive doses within 1 hour; and electrolytes and urine output. A sample size of 35 participants per group was planned to detect a 15-mm Hg difference in blood pressure. RESULTS Between January 2021 and March 2022, 65 individuals were randomized: 33 to furosemide and 32 to placebo. Baseline characteristics were similar between the groups. There was no difference in the primary outcome of mean 1-hour systolic blood pressure (147 [14.8] vs 152 [13.8] mm Hg; P=.200). We found a reduction in 2-hour systolic blood pressure (139 [18.5] vs 154 [18.4] mm Hg; P=.007) and a decrease in 2-hour pulse pressure (55 [12.5] vs 67 [15.1]; P=.003) in the furosemide group. Subgroup analysis according to hypertension type showed a significant reduction in 2-hour systolic blood pressure and 2-hour pulse pressure among patients with new-onset hypertension, but not among those with preexisting hypertension. Urine output was greater in the furosemide group, with no difference in electrolytes and creatinine before and after intervention. CONCLUSION Intravenous furosemide in conjunction with a first-line antihypertensive agent did not significantly reduce systolic blood pressure in the first hour after administration. However, both systolic blood pressure and pulse pressure at 2 hours were decreased in the furosemide group. These findings suggest that a 1-time dose of intravenous furosemide is a reasonable adjunct to achieve blood pressure control, particularly in patients in whom increased volume is suspected.
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Affiliation(s)
- Melanie M Maykin
- Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine of the University of Hawaii, Honolulu, HI.
| | - Elizabeth Mercer
- Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine of the University of Hawaii, Honolulu, HI
| | - Kevin M Saiki
- Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine of the University of Hawaii, Honolulu, HI
| | - Bliss Kaneshiro
- Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine of the University of Hawaii, Honolulu, HI
| | - Corrie B Miller
- Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine of the University of Hawaii, Honolulu, HI
| | - Pai-Jong Stacy Tsai
- Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine of the University of Hawaii, Honolulu, HI
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Kader F, Cárdenas L, Lee M, Chebli P, Ðoàn LN, Kamler A, Yi SS, Scherer M. Making Oneself "Fit": Community Perspectives on Disaggregated Race and Ethnicity Data Collection and Reporting in Healthcare Settings. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01946-w. [PMID: 38411798 DOI: 10.1007/s40615-024-01946-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
Patient race/ethnicity data collection in most U.S. health systems abide by federal standards, determined by the federal Office of Management and Budget. Yet, decades of research show that reliance on these categories alone limits understanding of within-group health disparities, systematically erasing key groups from health data. Because granular race/ethnicity data is complex and patients may be hesitant to disclose this personal information, it is important for health leaders to consider community perspectives when making decisions about race/ethnicity data procedures. As such, this study uses community focus groups to understand: (1) how individuals representing different racial/ethnic identities perceive the collection of race/ethnicity in healthcare settings; (2) differences in opinions between disaggregated race/ethnicity data collection instruments and those using federal standards; and (3) recommended practices for collecting race/ethnicity from patients. Participants self-selected into 13 focus groups and one key informant interview based on the race/ethnicity with which they most closely identified. Audio recordings from these groups were transcribed and evaluated using thematic content analysis. Among the 83 total participants in this study, there was a strong preference for more flexible and specific options for self-identifying race/ethnicity in healthcare settings. Participants also felt comfortable disclosing granular race/ethnicity to health providers but expressed discomfort with disclosing this information for other purposes. Recommendations for healthcare leaders include ensuring patients receive detailed communication about race/ethnicity data use and purpose, allowing multiple category selection, keeping the list of disaggregated response options short so as to not overwhelm patients, and providing a free text option to ensure inclusivity.
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Affiliation(s)
- Farah Kader
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Luisa Cárdenas
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY, USA
| | - Matthew Lee
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Perla Chebli
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Lan N Ðoàn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Alexandra Kamler
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY, USA
| | - Stella S Yi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Maya Scherer
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY, USA
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Adzrago D, Sulley S, Williams F. Immigration status-related exclusive e-cigarette use and cannabis use and their dual use disparities associated with mental health disorder symptoms. Drug Alcohol Depend 2024; 255:111083. [PMID: 38215510 PMCID: PMC10866552 DOI: 10.1016/j.drugalcdep.2024.111083] [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: 08/01/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION E-cigarette and cannabis use has been linked to various health risks, including respiratory and cardiovascular conditions. Yet, extant knowledge about the risk factors for exclusive and dual use of e-cigarettes and cannabis is limited, especially among immigrants. We examined exclusive e-cigarette and cannabis use and their dual use associated with mental health disorders among immigrants and U.S.-born. METHODS We analyzed national cross-sectional data collected between May 13, 2021, and January 9, 2022, among adults aged >18 years (n= 4766) living in U.S. Multinomial logistic regression analyses were conducted to model the associations of exclusivity and dual-use (reference group= non-use) with anxiety/depression. RESULTS The dual-use prevalence was higher than exclusive e-cigarette and cannabis use, especially among U.S.-born (dual use= 14.79% vs. cannabis use= 13.53% vs. e-cigarette use= 7.11%) compared to immigrants (dual use= 8.23% vs. cannabis use= 5.03% vs. e-cigarette use= 6.31%). Immigrants had lower risks of exclusive cannabis and dual use compared to U.S.-born. Anxiety/depression was associated with higher risks of exclusive cannabis use and dual use across immigration status, but was associated with exclusive e-cigarette use among only immigrants. While effect sizes of dual-use associated with anxiety/depression were higher among U.S.-born, the effect sizes of exclusive e-cigarette and cannabis use associated with anxiety/depression were higher among immigrants. CONCLUSIONS The findings revealed significant mental health risks for e-cigarette, cannabis, and their dual use among immigrants and U.S.-born, especially among U.S.-born. These findings highlight the need for public health research and interventions to consider immigration status-related disparities in substance use.
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Affiliation(s)
- David Adzrago
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
| | - Saanie Sulley
- National Healthy Start Association, Washington, DC, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Andersen JA, Willis DE, Kaholokula JK, Rowland B, Council S, Riklon S, McElfish PA. Experiences of Discrimination Among Native Hawaiians and Pacific Islanders Living in the USA. J Racial Ethn Health Disparities 2024; 11:184-191. [PMID: 36626048 PMCID: PMC9838348 DOI: 10.1007/s40615-022-01509-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/07/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023]
Abstract
Experiences of racism and discrimination are stressors that adversely affect the well-being of marginalized populations, including Native Hawaiians and Pacific Islanders (NHPI). However, commonly used data aggregation methods obscure information on NHPI communities and their lived experiences. The aim of our study is to understand the types and frequency of discrimination experienced by NHPI adults in the USA. The study utilized online survey data collected from 252 NHPI adults living in the USA between September and October 2021. Younger NHPI adults, those who report constantly thinking about their race/ethnicity, and those who are socially assigned a race/ethnicity that does not match their own report experiencing more types of discrimination. NHPI who constantly think about their race/ethnicity and those who are socially assigned a race/ethnicity that does not match their own report a greater frequency of discrimination. Findings indicate the need to understand the experiences of discrimination in this population.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Joseph Keawe‘aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai’i at Manoa, 651 Ilalo St, Honolulu, HI 96813 USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Sarah Council
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
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Burrage RL, Mills KJ, Coyaso HC, Gronowski CK, Godinet MT. Community Resilience and Cultural Responses in Crisis: Lessons Learned from Pacific Islander Responses to the COVID-19 Pandemic in the USA. J Racial Ethn Health Disparities 2024; 11:560-573. [PMID: 36849862 PMCID: PMC9970122 DOI: 10.1007/s40615-023-01541-5] [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: 10/05/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/01/2023]
Abstract
Pacific Islander communities in the USA experienced some of the most severe effects of the COVID-19 pandemic. This qualitative synthesis examines the literature on Pacific Islander community responses and lessons learned from COVID-19, using a systematic search that identified 28 articles with this focus. Thematic analysis was subsequently used to classify both documented efforts by Pacific Islander communities to respond to the pandemic, as well as lessons learned and best practices from research in this area. Results revealed multiple efforts to address the pandemic, including Pacific Islander grassroots approaches, government responses, inter-sector collaboration, and research. Results further emphasized the importance of culturally and linguistically responsive outreach and messaging; partnership, engagement, and capacity building; and changes in research and policy approaches to promote health equity. Future efforts to address public health crises should make the most of Pacific Islander cultural approaches to disaster response. To achieve this, government and other organizations that work with PI communities need to support the development of the PI leadership, healthcare and research workforces, and work with Pacific Islander communities to build long-term, sustainable, and trustworthy partnerships.
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Affiliation(s)
- Rachel L Burrage
- Department of Social Work, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA.
| | - Kelsey J Mills
- Department of Social Work, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA
| | - Hope C Coyaso
- Department of Social Work, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA
| | - Chrisovolandou K Gronowski
- Department of Social Work, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA
| | - Meripa T Godinet
- Department of Social Work, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA
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14
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Lyren A, Haines E, Fanta M, Gutzeit M, Staubach K, Chundi P, Ward V, Srinivasan L, Mackey M, Vonderhaar M, Sisson P, Sheffield-Bradshaw U, Fryzlewicz B, Coffey M, Cowden JD. Racial and ethnic disparities in common inpatient safety outcomes in a children's hospital cohort. BMJ Qual Saf 2024; 33:86-97. [PMID: 37460119 DOI: 10.1136/bmjqs-2022-015786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 06/11/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Emerging evidence has shown racial and ethnic disparities in rates of harm for hospitalised children. Previous work has also demonstrated how highly heterogeneous approaches to collection of race and ethnicity data pose challenges to population-level analyses. This work aims to both create an approach to aggregating safety data from multiple hospitals by race and ethnicity and apply the approach to the examination of potential disparities in high-frequency harm conditions. METHODS In this cross-sectional, multicentre study, a cohort of hospitals from the Solutions for Patient Safety network with varying race and ethnicity data collection systems submitted validated central line-associated bloodstream infection (CLABSI) and unplanned extubation (UE) data stratified by patient race and ethnicity categories. Data were submitted using a crosswalk created by the study team that reconciled varying approaches to race and ethnicity data collection by participating hospitals. Harm rates for race and ethnicity categories were compared with reference values reflective of the cohort and broader children's hospital population. RESULTS Racial and ethnic disparities were identified in both harm types. Multiracial Hispanic, Combined Hispanic and Native Hawaiian or other Pacific Islander patients had CLABSI rates of 2.6-3.6 SD above reference values. For Black or African American patients, UE rates were 3.2-4.4 SD higher. Rates of both events in White patients were significantly lower than reference values. CONCLUSIONS The combination of harm data across hospitals with varying race and ethnicity collection systems was accomplished through iterative development of a race and ethnicity category framework. We identified racial and ethnic disparities in CLABSI and UE that can be addressed in future improvement work by identifying and modifying care delivery factors that contribute to safety disparities.
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Affiliation(s)
- Anne Lyren
- Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- UH Rainbow Babies & Children's, Cleveland, Ohio, USA
| | - Elizabeth Haines
- Pediatrics and Emergency Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Hassenfeld Children's Hospital at NYU Langone, New York, New York, USA
| | - Meghan Fanta
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Katherine Staubach
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Pavan Chundi
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Valerie Ward
- Boston Children's Hospital, Boston, Massachusetts, USA
- Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lakshmi Srinivasan
- Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Megan Mackey
- Special Education and Interventions, Central Connecticut State University, New Britain, Connecticut, USA
| | - Michelle Vonderhaar
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Patricia Sisson
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ursula Sheffield-Bradshaw
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Maitreya Coffey
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - John D Cowden
- Department of Pediatrics, Children's Mercy Hospital Kansas, Overland Park, Kansas, USA
- University of Missouri-Kansas City School of Medicine, Kansas, Missouri, USA
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15
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Simeone RM, Meghani M, Meeker JR, Zapata LB, Galang RR, Salvesen Von Essen B, Dieke A, Ellington SR. Differences in delivery hospitalization experiences during the COVID-19 pandemic by maternal race and ethnicity, Pregnancy Risk Assessment Monitoring System, 2020. J Perinatol 2024; 44:20-27. [PMID: 37660214 PMCID: PMC11197487 DOI: 10.1038/s41372-023-01763-9] [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: 05/01/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE We investigated maternal COVID-19 related experiences during delivery hospitalizations, and whether experiences differed by maternal race and ethnicity. STUDY DESIGN Data from the Pregnancy Risk Assessment Monitoring System among women with live births between April-December 2020 were used. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) estimated associations between maternal race and ethnicity and COVID-19 related delivery experiences. RESULTS Among 12,879 women, 3.6% reported infant separation and 1.8% reported not being allowed support persons. Compared with non-Hispanic White women, American Indian/Alaska Native (AI/AN) (aPR = 2.7; CI: 1.2-6.2), Hispanic (aPR = 2.2; CI: 1.5-3.1), non-Hispanic Black (aPR = 2.4; CI: 1.7-3.6), and non-Hispanic Asian (aPR = 2.8; CI: 1.6-4.9) women reported more infant separation due to COVID-19. Not being allowed support persons was more common among AI/AN (aPR = 5.2; CI: 1.8-14.8) and non-Hispanic Black (aPR = 2.3; CI: 1.3-4.1) women. CONCLUSIONS COVID-19 related delivery hospitalization experiences were unequally distributed among racial and ethnic minorities.
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Affiliation(s)
- Regina M Simeone
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Mehreen Meghani
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- CDC Foundation, Atlanta, GA, USA
| | - Jessica R Meeker
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- U.S. Public Health Service, Rockville, MD, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauren B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- U.S. Public Health Service, Rockville, MD, USA
| | - Romeo R Galang
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Beatriz Salvesen Von Essen
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- CDC Foundation, Atlanta, GA, USA
| | - Ada Dieke
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sascha R Ellington
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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16
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Zhang X, Kaholokula JK, Kahn-John M, Walters K, Ma G, Thao C, Lepule JT, Stinson N. Elevating Voice and Visibility: Health Research for American Indian and Alaska Native, Asian American, and Native Hawaiian and Pacific Islander Populations in the United States. Am J Public Health 2024; 114:S25-S28. [PMID: 38207264 PMCID: PMC10785185 DOI: 10.2105/ajph.2023.307494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Xinzhi Zhang
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Joseph Keaweʻaimoku Kaholokula
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Michelle Kahn-John
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Karina Walters
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Grace Ma
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Chia Thao
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Jonathon Tana Lepule
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Nathan Stinson
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
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17
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Marks KJ, Nakayama JY, Chiang KV, Grap ME, Anstey EH, Boundy EO, Hamner HC, Li R. Disaggregation of Breastfeeding Initiation Rates by Race and Ethnicity - United States, 2020-2021. Prev Chronic Dis 2023; 20:E114. [PMID: 38096123 PMCID: PMC10723082 DOI: 10.5888/pcd20.230199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Introduction Although breastfeeding is the ideal source of nutrition for most infants, racial and ethnic disparities exist in its initiation. Surveillance rates based on aggregated data can challenge the understanding and monitoring of effective, culturally appropriate interventions among racial and ethnic subgroups. Aggregated data have historically estimated breastfeeding rates among a few large racial and ethnic groups. We examined differences in breastfeeding initiation rates by disaggregation of data to finer subgroups of race and ethnicity. Methods We analyzed births from January 1, 2020, through December 31, 2021, in 48 states and the District of Columbia by using National Vital Statistics System birth certificate data. Data indicate whether an infant received any breast milk during birth hospitalization and include self-reported maternal race and ethnicity. Cross-tabulations of race and ethnicity by breastfeeding initiation were calculated and compared across aggregated and disaggregated categories. Results The overall prevalence of breastfeeding initiation was 84.0%, ranging from 74.5% (mothers identifying as Black) to 94.0% (mothers identifying as Japanese). The aggregated prevalence of breastfeeding initiation among mothers identifying as Hispanic was 86.8%; disaggregated estimates by Hispanic origin ranged from 82.2% (Puerto Rican) to 90.9% (Cuban). Conclusion Substantial variation in the prevalence of breastfeeding initiation across disaggregated racial or ethnic categories exists. Disaggregation of racial and ethnic data unmasked differences that could reflect variations in cultural practices or systemic barriers to breastfeeding. Understanding why these differences exist could guide public health practitioners' efforts to improve and tailor breastfeeding support.
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Affiliation(s)
- Kristin J Marks
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
- Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-5, Atlanta, GA 30341
| | - Jasmine Y Nakayama
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katelyn V Chiang
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia
| | - Mary Ellen Grap
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Erica H Anstey
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ellen O Boundy
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
| | - Heather C Hamner
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruowei Li
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
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18
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Kostareva U, Soo Hoo CA, Zeng SM, Albright CL, Ceria-Ulep CD, Fontenot HB. Understanding Professional Medical Interpreters' Perspectives on Advancing Accurate and Culturally Informed Patient-Provider Communication for Filipinos in Hawai'i: Qualitative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7012. [PMID: 37947568 PMCID: PMC10649552 DOI: 10.3390/ijerph20217012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/27/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
One in every eight persons in Hawai'i, USA, have limited English proficiency (LEP) and are entitled to free language assistance for federally funded services under Title IV of the Civil Rights Act of 1964. They also have the right to culturally and linguistically appropriate services (CLAS) provided by professional medical interpreters (PMIs). This study's goals were to uncover barriers and facilitators of CLAS from the perspective of PMIs. PMIs for Filipino languages (n = 10) participated in an online survey and semi-structured interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using conventional content analysis. Six themes emerged in the qualitative analysis: (1) cultural and social factors that can influence patient-provider communication; (2) barriers to effective patient-provider communication: patient, healthcare provider, and PMI levels; (3) facilitators of effective patient-provider communication: patient, healthcare provider, and PMI levels; (4) COVID-19 and remote interpreting barriers and facilitators; (5) strengths and weaknesses of in-person and stand-by interpreting appointments; and, (6) recommendations: system and provider levels. Proposed interventions could include advertising language services among Filipino communities and educating them about their language rights, providing additional resources for language assistance, employing more PMIs, training staff/providers, and supporting the use of PMIs versus untrained individuals.
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Affiliation(s)
- Uliana Kostareva
- Nancy Atmospera-Walch School of Nursing, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
| | - Carrie A. Soo Hoo
- School of Education, Victoria University of Wellington, Kelburn, Wellington 6012, New Zealand
| | - Suzanne M. Zeng
- Language Services Hawaii, 3747A Waialae Avenue, Honolulu, HI 96816, USA
| | - Cheryl L. Albright
- Nancy Atmospera-Walch School of Nursing, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
| | - Clementina D. Ceria-Ulep
- Nancy Atmospera-Walch School of Nursing, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
| | - Holly B. Fontenot
- Nancy Atmospera-Walch School of Nursing, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
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19
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Kader F, Ðoàn LN, Chin MK, Scherer M, Cárdenas L, Feng L, Leung V, Gundanna A, Lee M, Russo R, Ogedegbe OG, John I, Cho I, Kwon SC, Yi SS. IDEAL: A Community-Academic-Governmental Collaboration Toward Improving Evidence-Based Data Collection on Race and Ethnicity. Prev Chronic Dis 2023; 20:E90. [PMID: 37824700 PMCID: PMC10599325 DOI: 10.5888/pcd20.230029] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Affiliation(s)
- Farah Kader
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Langone Health, 180 Madison Ave, Floor 8, New York, NY 10016
| | - Lan N Ðoàn
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Matthew K Chin
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Maya Scherer
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, New York
| | - Luisa Cárdenas
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, New York
| | - Lloyd Feng
- Coalition for Asian American Children and Families, New York, New York
| | - Vanessa Leung
- Coalition for Asian American Children and Families, New York, New York
| | - Anita Gundanna
- Coalition for Asian American Children and Families, New York, New York
| | - Matthew Lee
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Rienna Russo
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Olugbenga G Ogedegbe
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | | | - Ilseung Cho
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Simona C Kwon
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Stella S Yi
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
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20
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Delafield R, Watkins-Victorino L, Quint JJ, Freitas SM, Kamaka M, Hostetter CJ, Matagi CE, Ku T, Kaholokula JK. No Kākou, Na Kākou - For Us, By Us: Native Hawaiians and Pacific Islanders Informing Race Data Collection Standards for Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:73-76. [PMID: 37901657 PMCID: PMC10612412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
This article describes recommendations for standardized race data collection developed by the Hawai'i Native Hawaiian and Pacific Islander COVID-19 Response, Recovery, and Resilience Team (NHPI 3R Team). These recommendations attempt to address the expressed desires of Native Hawaiians and the diverse Pacific Islander communities in Hawai'i who seek greater visibility in data and research. The Native Hawaiian and Pacific Islander (NHPI) racial category is 1 of the 5 racial categories listed in the 1997 Statistical Policy Directive #15 issued by the Office of Management and Budget (OMB). The OMB directive sets the minimum standard for collection of race data in federal surveys, administrative forms, records, and other data collection. The NHPI 3R Team's recommendation provides a standard for detailed data collection that could improve smaller communities' ability to identify, advocate for, and address their own needs. The article also describes lessons learned through the collaborative and iterative process that was led by members and leaders of NHPI communities impacted by data driven decisions and policies. The NHPI 3R Team focused on expanding and standardizing race data collection as part of their COVID-19 response efforts, but implementation of the recommendations could produce benefits well beyond the pandemic.
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Affiliation(s)
- Rebecca Delafield
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (RD, MK, JKK)
| | | | | | - Sharde Mersberg Freitas
- Native Hawaiian Pacific Islander COVID-19 Response, Recovery, and Resiliency Team - Data and Research Committee, Honolulu, HI (SMF)
| | - Martina Kamaka
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (RD, MK, JKK)
| | | | | | - Tercia Ku
- Papa Ola Lōkahi, Honolulu, HI (JJQ, CEM, TK)
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21
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Quint J, Matagi C, Kaholokula JK. The Hawai'i NHPI Data Disaggregation Imperative: Preventing Data Genocide Through Statewide Race and Ethnicity Standards. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:67-72. [PMID: 37901675 PMCID: PMC10612414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Federal race and ethnicity data standards are commonly applied within the state of Hawai'i. When a multiracial category is used, Native Hawaiians are disproportionately affected since they are more likely than any other group to identify with an additional race or ethnicity group. These data conventions contribute to a phenomenon known as data genocide - the systematic erasure of Indigenous and marginalized peoples from population data. While data aggregation may be unintentional or due to real or perceived barriers, the obstacles to disaggregating data must be overcome to advance health equity. In this call for greater attention to relevant social determinants of health through disaggregation of race and ethnicity data, the history of data standards is reviewed, the implications of aggregation are discussed, and recommended disaggregation strategies are provided.
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Affiliation(s)
| | - Chantelle Matagi
- Center for Pacific Island Studies, University of Hawai‘i at Mānoa, Honolulu, HI (CM)
| | - Joseph Keawe‘aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (JKK)
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22
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Shephard HM, Manning SE, Nestoridi E, Darling AM, Brown CM, Hatch M, Ahnger-Pier K, Pagnano S, Mather D, Yazdy MM. Inequities in COVID-19 Vaccination Coverage Among Pregnant Persons, by Disaggregated Race and Ethnicity - Massachusetts, May 2021-October 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:1052-1056. [PMID: 37768877 PMCID: PMC10545434 DOI: 10.15585/mmwr.mm7239a2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
National estimates suggest that COVID-19 vaccination coverage among pregnant persons is lower among those identifying as Hispanic or Latino (Hispanic) and non-Hispanic Black or African American. When examining COVID-19 vaccination coverage during pregnancy by race and ethnicity, however, data are typically limited to large, aggregate categories that might obscure within-group inequities. To address this, Massachusetts examined COVID-19 vaccination coverage among pregnant persons by combinations of 12 racial and 34 ethnic groupings. Among 102,275 persons with a live birth in Massachusetts during May 1, 2021-October 31, 2022, receipt of ≥1 dose of a COVID-19 vaccine before or during pregnancy was 41.6% overall and was highest among persons who identified as Asian (55.0%) and lowest among those who identified as Hispanic (26.7%). However, within all broad racial and ethnic groupings, disparities in COVID-19 vaccination coverage were identified when the data were disaggregated into more granular categories; for example, COVID-19 vaccination coverage ranged from 10.8%-61.1% among pregnant persons who identified as Hispanic. Disaggregated analyses reveal diverse experiences within broad racial and ethnic groupings. This information can be used to guide outreach to pregnant persons in communities with lower rates of COVID-19 vaccination coverage during pregnancy.
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23
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Cause-specific mortality by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities. Lancet 2023; 402:1065-1082. [PMID: 37544309 PMCID: PMC10528747 DOI: 10.1016/s0140-6736(23)01088-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Large disparities in mortality exist across racial-ethnic groups and by location in the USA, but the extent to which racial-ethnic disparities vary by location, or how these patterns vary by cause of death, is not well understood. We aimed to estimate age-standardised mortality by racial-ethnic group, county, and cause of death and describe the intersection between racial-ethnic and place-based disparities in mortality in the USA, comparing patterns across health conditions. METHODS We applied small-area estimation models to death certificate data from the US National Vital Statistics system and population data from the US National Center for Health Statistics to estimate mortality by age, sex, county, and racial-ethnic group annually from 2000 to 2019 for 19 broad causes of death. Race and ethnicity were categorised as non-Latino and non-Hispanic American Indian or Alaska Native (AIAN), non-Latino and non-Hispanic Asian or Pacific Islander (Asian), non-Latino and non-Hispanic Black (Black), Latino or Hispanic (Latino), and non-Latino and non-Hispanic White (White). We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and generated age-standardised results using direct standardisation to the 2010 US census population. FINDINGS From 2000 to 2019, across 3110 US counties, racial-ethnic disparities in age-standardised mortality were noted for all causes of death considered. Mortality was substantially higher in the AIAN population (all-cause mortality 1028·2 [95% uncertainty interval 922·2-1142·3] per 100 000 population in 2019) and Black population (953·5 [947·5-958·8] per 100 000) than in the White population (802·5 [800·3-804·7] per 100 000), but substantially lower in the Asian population (442·3 [429·3-455·0] per 100 000) and Latino population (595·6 [583·7-606·8] per 100 000), and this pattern was found for most causes of death. However, there were exceptions to this pattern, and the exact order among racial-ethnic groups, magnitude of the disparity in both absolute and relative terms, and change over time in this magnitude varied considerably by cause of death. Similarly, substantial geographical variation in mortality was observed for all causes of death, both overall and within each racial-ethnic group. Racial-ethnic disparities observed at the national level reflect widespread disparities at the county level, although the magnitude of these disparities varied widely among counties. Certain patterns of disparity were nearly universal among counties; for example, in 2019, mortality was higher among the AIAN population than the White population in at least 95% of counties for skin and subcutaneous diseases (455 [97·8%] of 465 counties with unmasked estimates) and HIV/AIDS and sexually transmitted infections (458 [98·5%] counties), and mortality was higher among the Black population than the White population in nearly all counties for skin and subcutaneous diseases (1436 [96·6%] of 1486 counties), diabetes and kidney diseases (1473 [99·1%]), maternal and neonatal disorders (1486 [100·0%] counties), and HIV/AIDS and sexually transmitted infections (1486 [100·0%] counties). INTERPRETATION Disparities in mortality among racial-ethnic groups are ubiquitous, occurring across locations in the USA and for a wide range of health conditions. There is an urgent need to address the shared structural factors driving these widespread disparities. FUNDING National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research, US National Institutes of Health.
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24
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Tagorda-Kama MA, Patil U, Chung-Do JJ, Kehl L, Antonio MCK, Nelson-Hurwitz DC. Shaping undergraduate public health education through critical race theory: a case study. Front Public Health 2023; 11:1192771. [PMID: 37693710 PMCID: PMC10492502 DOI: 10.3389/fpubh.2023.1192771] [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: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
In 2020, the American Public Health Association declared structural racism a public health crisis acknowledging the long-lasting and harmful effects of prejudice, including relatively high rates of morbidity and mortality in many communities of color. Critical Race Theory (CRT) has become an essential lens to view and reconsider education's role in perpetuating racial and ethnic discrimination. Debates over integrating CRT in higher education with the intent to acknowledge and address racial equality and justice are more present than ever, and the discussions held in public health classrooms are no different. We present a case study of CRT integration into the Bachelor of Arts in Public Health (BAPH) program at the University of Hawai'i at Mānoa. In line with Solorzano's framework of CRT in education, initial goals of integrating CRT in instruction and advising included fostering discussions of race and racism, using a social justice framework to highlight opportunities to reduce health inequities, and validating the experiential knowledge of people of color. By engaging in active discussions with community leaders and participating in experiential learning throughout the program, students develop empathy and many underrepresented and marginalized students engage actively in their home communities. Specific examples of CRT integrated in the curriculum and examples of student projects that integrate a CRT lens are provided for educators and researchers.
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Affiliation(s)
- Michelle A. Tagorda-Kama
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, Honolulu, HI, United States
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25
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Pokhrel P, Lipperman-Kreda S, Wills TA, Keaweʻaimoku Kaholokula J, Kawamoto CT, Amin S, Herzog TA. Ethnicity, Coronavirus Disease-Related Stress, and E-cigarette Use and Cigarette Smoking Among Young Adults: A Longitudinal Study. Nicotine Tob Res 2023; 25:1676-1686. [PMID: 37330693 PMCID: PMC10445257 DOI: 10.1093/ntr/ntad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Research has rarely examined ethnic differences in exposure to coronavirus disease (COVID)-related stress in relation to smoking and e-cigarette use. AIMS AND METHODS Using pre- and post-COVID data from a sample of predominantly Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) young adults, this study aimed to test the effects of ethnicity on cigarette smoking and e-cigarette use through exposure to COVID-related stress. Young adults from Hawaii who provided pre-COVID data in or before January 2020 were followed up with in March-May 2021. N = 1907 (mean age = 24.9 [SD = 2.9], 56% women) provided complete data relevant to the current analysis at both waves of data collection. Structural equation modeling was used to test the effects of ethnicity (white, Asian [eg, Japanese, Chinese], Filipino, NHPI, and other) on pre- to post-COVID changes in cigarette and e-cigarette use via effects on COVID-related stress. RESULTS Relative to Asian young adults, members of all other ethnic groups (NHPI, Filipino, white, and other) indicated greater exposure to COVID-related stress. Higher levels of COVID-related stress were associated with increased dual-use status and increased current e-cigarette and cigarette use frequencies. Higher COVID-related stress mediated the effects of NHPI, Filipino, and other ethnicity on increased dual-use status. CONCLUSIONS The current data indicate that young adults of vulnerable ethnic groups who experience higher COVID-related stress are at increased risk for dual use of cigarettes and e-cigarettes. IMPLICATIONS The findings imply that tobacco use prevention and treatment efforts may need to pay increased attention to racial or ethnic groups that have experienced greater adverse impact of the COVID-19 pandemic.
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Affiliation(s)
- Pallav Pokhrel
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Sharon Lipperman-Kreda
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Thomas A Wills
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Joseph Keaweʻaimoku Kaholokula
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, University of Hawaii at Mānoa, Honolulu, HI, USA
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Crissy T Kawamoto
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Samia Amin
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Thaddeus A Herzog
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, University of Hawaii at Mānoa, Honolulu, HI, USA
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26
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Patel SR, Suero-Abreu GA, Ai A, Ramachandran MK, Meza K, Florez N. Inequity in care delivery in cardio-oncology: dissecting disparities in underrepresented populations. Front Oncol 2023; 13:1124447. [PMID: 37361603 PMCID: PMC10289233 DOI: 10.3389/fonc.2023.1124447] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/03/2023] [Indexed: 06/28/2023] Open
Abstract
It is well known that patients with cancer have a significantly higher cardiovascular mortality risk than the general population. Cardio-oncology has emerged to focus on these issues including risk reduction, detection, monitoring, and treatment of cardiovascular disease or complications in patients with cancer. The rapid advances in early detection and drug development in oncology, along with socioeconomic differences, racial inequities, lack of support, and barriers to accessing quality medical care, have created disparities in various marginalized populations. In this review, we will discuss the factors contributing to disparities in cardio-oncologic care in distinct populations, including Hispanic/Latinx, Black, Asian and Pacific Islander, indigenous populations, sex and gender minorities, and immigrants. Some factors that contribute to differences in outcomes in cardio-oncology include the prevalence of cancer screening rates, genetic cardiac/oncologic risk factors, cultural stressors, tobacco exposure rates, and physical inactivity. We will also discuss the barriers to cardio-oncologic care in these communities from the racial and socioeconomic context. Appropriate and timely cardiovascular and cancer care in minority groups is a critical component in addressing these disparities, and there need to be urgent efforts to address this widening gap.
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Affiliation(s)
- Shruti Rajesh Patel
- Department of Medicine, Division of Oncology, Stanford University and Stanford Cancer Institute, Stanford, CA, United States
| | | | - Angela Ai
- Olive View-University of California, Los Angeles Medical Center, Los Angeles, CA, United States
| | - Maya K. Ramachandran
- Department of Medicine, Division of Oncology, Stanford University and Stanford Cancer Institute, Stanford, CA, United States
| | - Kelly Meza
- Dana Farber Cancer Institute, Boston, MA, United States
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27
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Reece S, CarlLee S, Scott AJ, Willis DE, Rowland B, Larsen K, Holman-Allgood I, McElfish PA. Hesitant adopters: COVID-19 vaccine hesitancy among diverse vaccinated adults in the United States. INFECTIOUS MEDICINE 2023; 2:89-95. [PMID: 38013742 PMCID: PMC10038887 DOI: 10.1016/j.imj.2023.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 07/11/2023]
Abstract
Background Despite the United States (US) having an abundant supply of COVID-19 vaccines, vaccination rates lag behind other high-income countries, suggesting that vaccine hesitancy and attitudes play a greater role in public health measures than pure supply and access. With the acknowledgment that vaccination attitudes and status may or may not be correlated, this study examined COVID-19 vaccine hesitancy among vaccinated US adults by asking: 1) What is the prevalence of COVID-19 vaccine hesitancy among the vaccinated? 2) Does COVID-19 vaccine hesitancy vary across sociodemographic characteristics? 3) Does COVID-19 vaccine hesitancy vary by healthcare access and influenza vaccination over the past 5 years? Methods Data were collected through an online survey of 2022 US adults with a final analytic sample of 1383 vaccinated respondents. Results Overall, 48.8% of vaccinated adults reported some level of hesitancy, while a slight majority reported they were "not at all hesitant". Younger respondents, women, and Black and American Indian or Alaska Native participants had greater adjusted odds of being more hesitant towards receiving the COVID-19 vaccine. Respondents who had a primary care physician had greater adjusted odds than those who did not have a primary care physician of being more hesitant towards receiving the COVID-19 vaccine. Conclusions This is the first population-based national sample study examining COVID-19 vaccine hesitancy among vaccinated individuals from subgroups of distinctive backgrounds in order to inform targeted strategies for reducing vaccine hesitancy. Findings can assist in efforts to increase vaccination rates and also decrease vaccine hesitancy at the national level.
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Affiliation(s)
- Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
| | - Kristin Larsen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Ijanae Holman-Allgood
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
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28
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Valier MR, Elam-Evans LD, Mu Y, Santibanez TA, Yankey D, Zhou T, Pingali C, Singleton JA. Racial and Ethnic Differences in COVID-19 Vaccination Coverage Among Children and Adolescents Aged 5-17 Years and Parental Intent to Vaccinate Their Children - National Immunization Survey-Child COVID Module, United States, December 2020-September 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:1-8. [PMID: 36602930 PMCID: PMC9815155 DOI: 10.15585/mmwr.mm7201a1] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Some racial and ethnic groups are at increased risk for COVID-19 and associated hospitalization and death because of systemic and structural inequities contributing to higher prevalences of high-risk conditions and increased exposure (1). Vaccination is the most effective prevention intervention against COVID-19-related morbidity and mortality*; ensuring more equitable vaccine access is a public health priority. Differences in adult COVID-19 vaccination coverage by race and ethnicity have been previously reported (2,3), but similar information for children and adolescents is limited (4,5). CDC analyzed data from the National Immunization Survey-Child COVID Module (NIS-CCM) to describe racial and ethnic differences in vaccination status, parental intent to vaccinate their child, and behavioral and social drivers of vaccination among children and adolescents aged 5-17 years. By August 31, 2022, approximately one third (33.2%) of children aged 5-11 years, more than one half (59.0%) of children and adolescents aged 12-15 years, and more than two thirds (68.6%) of adolescents aged 16-17 years had received ≥1 COVID-19 vaccine dose. Vaccination coverage was highest among non-Hispanic Asian (Asian) children and adolescents, ranging from 63.4% among those aged 5-11 years to 91.8% among those aged 16-17 years. Coverage was next highest among Hispanic or Latino (Hispanic) children and adolescents (34.5%-77.3%). Coverage was similar for non-Hispanic Black or African American (Black), non-Hispanic White (White), and non-Hispanic other race† or multiple race (other/multiple race) children and adolescents aged 12-15 and 16-17 years. Among children aged 5-11 years, coverage among Black children was lower than that among Hispanic, Asian, and other/multiple race children. Enhanced public health efforts are needed to increase COVID-19 vaccination coverage for all children and adolescents. To address disparities in child and adolescent COVID-19 vaccination coverage, vaccination providers and trusted messengers should provide culturally relevant information and vaccine recommendations and build a higher level of trust among those groups with lower coverage.
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29
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Agner J, Meyer M, Kaukau TM, Liu M, Nakamura L, Botero A, Sentell T. Health Literacy, Social Networks, and Health Outcomes among Mental Health Clubhouse Members in Hawai'i. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:837. [PMID: 36613158 PMCID: PMC9820034 DOI: 10.3390/ijerph20010837] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Health literacy is the ability to obtain and utilize health information to make health-related decisions and to navigate health systems. Although health literacy has traditionally been understood as an individual-level construct, current research is revealing the impact that social networks can have on health literacy. To date, no studies have examined associations between health literacy and social networks among people with serious mental illness (PWSMI), who are at high risk of physical illness and premature mortality. To begin to fill this gap, this study explores associations between health literacy, relationships with health discussion partners, and self-reported health outcomes in a racially diverse sample of Clubhouse members in Hawai'i. Clubhouses are community mental health centers that promote recovery from mental illness through destigmatization, meaningful activity, and strong social relationships. Health literacy was assessed using two single-item screeners (SILS). In a sample of 163 members, 56.2% reported adequate ability to understand health-related instructions or pamphlets, and 43.3% reported adequate confidence filling out medical forms independently. This is consistent with other health literacy studies with PWSMI in the United States, and indicates lower health literacy within this group than is reported in national averages. Multivariate logistic regression revealed a larger Clubhouse staff social network and completing high school were significantly associated with requiring less help to read materials. Higher age, male gender, and being Native Hawaiian and/or Pacific Islander were associated with less confidence filling out medical forms, while higher self-efficacy was associated with higher confidence filling out medical forms. This study provides preliminary evidence that relationships fostered within Clubhouses are associated with health literacy among PWSMI, and highlights the need for more research to examine how social networks and health literacy interventions can be leveraged in community mental health settings to improve health outcomes within this vulnerable population.
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Affiliation(s)
- Joy Agner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - Monet Meyer
- Department of Psychology, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
| | | | - Maileen Liu
- Department of Psychology, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
| | - Lisa Nakamura
- Department of Psychology, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
| | - Adriana Botero
- Hawai‘i School of Professional Psychology, Chaminade University of Honolulu, Honolulu, HI 96816, USA
| | - Tetine Sentell
- Office of Public Health Studies, Thompson School of Social Work, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
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30
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Phillips MM, Weldon RH, Maniar A, Patil U, Kostareva U, Agner J, Finn J, Sentell T. Social Networks, Health Information Sharing, and Pandemic Perceptions among Young Adults in Hawai'i during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16833. [PMID: 36554713 PMCID: PMC9779529 DOI: 10.3390/ijerph192416833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
Limited information exists about social network variation and health information sharing during COVID-19, especially for Native Hawaiians (NH), Other Pacific Islanders (OPI), and Filipinos, who experienced COVID-19 inequities. Hawai'i residents aged 18-35 completed an online survey regarding social media sources of COVID-19 information and social network health information measured by how many people participants: (1) talked to and (2) listened to about health. Regression models were fit with age, gender, race/ethnicity, chronic disease status, pandemic perceptions, and health literacy as predictors of information sources (logistic) and social network size (Poisson). Respondents were 68% female; 41% NH, OPI, or Filipino; and 73% conducted a recent COVID-19 digital search for themselves or others. Respondents listened to others or discussed their own health with ~2-3 people. Respondents who talked with more people about their health were more likely to have larger networks for listening to others. In regression models, those who perceived greater risk of acquiring COVID-19 discussed their health with more people; in discussing others' health, women and those with chronic diseases listened to a greater number. Understanding young adults' social networks and information sources is important for health literacy and designing effective health communications, especially to reach populations experiencing health inequities.
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Affiliation(s)
- Michael M. Phillips
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
| | - Rosana Hernandez Weldon
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
| | - Anam Maniar
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
| | - Uday Patil
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
| | - Uliana Kostareva
- Nancy Atmospera-Walch School of Nursing, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
| | - Joy Agner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - Julia Finn
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
| | - Tetine Sentell
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
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Purvis RS, Moore R, Willis DE, Hallgren E, McElfish PA. Factors influencing COVID-19 vaccine decision-making among hesitant adopters in the United States. Hum Vaccin Immunother 2022; 18:2114701. [PMID: 36070518 PMCID: PMC9746519 DOI: 10.1080/21645515.2022.2114701] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Increasing COVID-19 vaccine uptake is crucial to managing the endemic. In this qualitative study, we examine factors influencing the decision-making process of COVID-19 hesitant adopters - those who reported some level of hesitancy and are vaccinated. Using interviews with 49 participants, we documented multiple factors influencing the decision-making process to get the COVID-19 vaccine among a racially and ethnically diverse sample of hesitant adopters in the US. Participants described influences related to sociocultural context and personal and group influences, which affected their decision to get the COVID-19 vaccine despite being hesitant. We find politics, culture, healthcare professionals, employment, vaccine attitudes and beliefs, social networks, and the media influence the decision to get vaccinated. Our findings provide nuanced and in-depth information in their own words. This study expands on prior literature on COVID-19 vaccine hesitancy, especially among hesitant adopters. These findings can inform future interventions and research targeting vaccine-hesitant populations to increase vaccine uptake.
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Affiliation(s)
- Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA,CONTACT Pearl A. McElfish College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR72703, USA
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Willis DE, Montgomery BE, Selig JP, Andersen JA, Shah SK, Li J, Reece S, Alik D, McElfish PA. COVID-19 vaccine hesitancy and racial discrimination among US adults. Prev Med Rep 2022; 31:102074. [PMID: 36466305 PMCID: PMC9703864 DOI: 10.1016/j.pmedr.2022.102074] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Vaccination is a critical preventive measure to reduce COVID-19 health risks. We utilize full information maximum likelihood (FIML) logistic regression to analyze COVID-19 vaccine hesitancy in a national sample of United States (US) adults (N = 2,022). Online survey data was collected between September 7th and October 3rd, 2021. Before weighting, the racial composition of the sample was as follows: Asian American (15.0 %), Black/African American (20.0 %), Hispanic/Latino (20.0 %), American Indian or Alaska Native (12.6 %), Native Hawaiian or Pacific Islander (12.5 %), and White (20.0 %). Informed by the Increasing Vaccination Model (IVM), we assessed the relationship between COVID-19 vaccine hesitancy and experiences of racial discrimination (Krieger's 9-item measure). Odds of COVID-19 vaccine hesitancy were greater for most younger age groups, women (OR = 1.96; 95 % CI[1.54, 2.49]), Black/African American respondents (OR = 1.68; 95 % CI[1.18, 2.39]), those with a high school education or less (OR = 1.46; 95 % CI[1.08, 1.98]), Independent (OR = 1.77; 95 % CI[1.34, 2.35]) or Republican political affiliation (OR = 2.69; 95 % CI[1.92, 3.79]), and prior COVID-19 infection (OR = 1.78; 95 % CI[1.29, 2.45]). Odds of COVID-19 vaccine hesitancy were 1.04 greater for every-one unit increase in lifetime experiences of racial discrimination (95 % CI[1.02, 1.05]). Odds of COVID-19 vaccine hesitancy were lower for Asian American respondents (OR = 0.682; 95 % CI[0.480, 0.969]), and those who had a primary care doctor had reduced odds of COVID-19 vaccine hesitancy (OR = 0.735; 95 % CI[0.542, 0.998). Our primary finding provides support for a link between experiences of racial discrimination and hesitancy towards a COVID-19 vaccine among US adults. We discuss implications for public health officials and future research.
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Affiliation(s)
- Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Brooke E.E. Montgomery
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Sumit K. Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Derek Alik
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA,Corresponding author.
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Seto BK, Nishizaki L, Akaka G, Kimura JA, Seto TB. Differences in COVID-19 Hospitalizations by Self-Reported Race and Ethnicity in a Hospital in Honolulu, Hawaii. Prev Chronic Dis 2022; 19:E72. [PMID: 36395004 PMCID: PMC9673976 DOI: 10.5888/pcd19.220114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2024] Open
Abstract
INTRODUCTION The true extent of racial and ethnic disparities in COVID-19 hospitalizations may be hidden by misclassification of race and ethnicity. This study aimed to quantify this inaccuracy in a hospital's electronic medical record (EMR) against the gold standard of self-identification and then project data onto state-level COVID-19 hospitalizations by self-identified race and ethnicity. METHODS To identify misclassification of race and ethnicity in the EMRs of a hospital in Honolulu, Hawaii, research and quality improvement staff members surveyed all available patients (N = 847) in 5 cohorts in 2007, 2008, 2010, 2013, and 2020 at randomly selected hospital and ambulatory units. The survey asked patients to self-identify up to 12 races and ethnicities. We compared these data with data from EMRs. We then estimated the number of COVID-19 hospitalizations by projecting racial misclassifications onto publicly available data. We determined significant differences via simulation-constructed medians and 95% CIs. RESULTS EMR-based and self-identified race and ethnicity were the same in 86.5% of the sample. Native Hawaiians (79.2%) were significantly less likely than non-Native Hawaiians (89.4%) to be correctly classified on initial analysis; this difference was driven by Native Hawaiians being more likely than non-Native Hawaiians to be multiracial (93.4% vs 30.3%). When restricted to multiracial patients only, we found no significant difference in accuracy (P = .32). The number of COVID-19-related hospitalizations was 8.7% higher among Native Hawaiians and 3.9% higher among Pacific Islanders when we projected self-identified race and ethnicity rather than using EMR data. CONCLUSION Using self-identified rather than hospital EMR data on race and ethnicity may uncover further disparities in COVID-19 hospitalizations.
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Affiliation(s)
- Brendan K Seto
- John A. Burns School of Medicine, University of Hawaii, 651 Ilaalo St, Honolulu, HI 96813.
- The Queen's Medical Center, Honolulu, Hawaii
| | | | | | | | - Todd B Seto
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
- The Queen's Medical Center, Honolulu, Hawaii
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Bhatia R, Sledge I, Baral S. Missing science: A scoping study of COVID-19 epidemiological data in the United States. PLoS One 2022; 17:e0248793. [PMID: 36223335 PMCID: PMC9555641 DOI: 10.1371/journal.pone.0248793] [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: 03/09/2021] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Systematic approaches to epidemiologic data collection are critical for informing pandemic responses, providing information for the targeting and timing of mitigations, for judging the efficacy and efficiency of alternative response strategies, and for conducting real-world impact assessments. Here, we report on a scoping study to assess the completeness of epidemiological data available for COVID-19 pandemic management in the United States, enumerating authoritative US government estimates of parameters of infectious transmission, infection severity, and disease burden and characterizing the extent and scope of US public health affiliated epidemiological investigations published through November 2021. While we found authoritative estimates for most expected transmission and disease severity parameters, some were lacking, and others had significant uncertainties. Moreover, most transmission parameters were not validated domestically or re-assessed over the course of the pandemic. Publicly available disease surveillance measures did grow appreciably in scope and resolution over time; however, their resolution with regards to specific populations and exposure settings remained limited. We identified 283 published epidemiological reports authored by investigators affiliated with U.S. governmental public health entities. Most reported on descriptive studies. Published analytic studies did not appear to fully respond to knowledge gaps or to provide systematic evidence to support, evaluate or tailor community mitigation strategies. The existence of epidemiological data gaps 18 months after the declaration of the COVID-19 pandemic underscores the need for more timely standardization of data collection practices and for anticipatory research priorities and protocols for emerging infectious disease epidemics.
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Affiliation(s)
- Rajiv Bhatia
- Primary Care and Population Health, Stanford University, Stanford, CA, United States of America
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
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Nguyen KH, Lew KP, Trivedi AN. Trends in Collection of Disaggregated Asian American, Native Hawaiian, and Pacific Islander Data: Opportunities in Federal Health Surveys. Am J Public Health 2022; 112:1429-1435. [PMID: 35952328 PMCID: PMC9480465 DOI: 10.2105/ajph.2022.306969] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 11/04/2022]
Abstract
Collection of data for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) persons that is disaggregated by ethnic subgroup may identify disparities that are not apparent in aggregated data. Using content analysis, we identified national population surveys administered by the US Department of Health and Human Services (HHS) and evaluated trends in the collection of disaggregated AANHPI data between 2011 and 2021. In 2011, 4 of 15 surveys (27%) collected disaggregated data for Asian American, 2 of 15 surveys (13%) collected data on Native Hawaiian, and 2 of 15 surveys (13%) collected disaggregated data for Pacific Islander people. By 2019, 14 of 21 HHS-administered surveys (67%) collected disaggregated data for Asian American (6 subgroups), 67% collected data on Native Hawaiian, and 67% collected disaggregated data on Pacific Islander (3 subgroups) people. Collection of disaggregated AANHPI data in HHS-administered surveys increased from 2011 to 2021, but opportunities to expand collection and reporting remain. Strategies include outreach with community organizations, increased language assistance, and oversampling approaches. Increased availability and reporting of these data can inform health policies and mitigate disparities. (Am J Public Health. 2022;112(10):1429-1435. https://doi.org/10.2105/AJPH.2022.306969).
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Affiliation(s)
- Kevin H Nguyen
- Kevin H. Nguyen is with the Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI. Kaitlyn P. Lew is with the Center for Bioethics, Harvard Medical School, and the Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA. Amal N. Trivedi is with the Department of Health Services, Policy, and Practice, Brown University School of Public Health, and Providence VA Medical Center, Providence, RI
| | - Kaitlyn P Lew
- Kevin H. Nguyen is with the Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI. Kaitlyn P. Lew is with the Center for Bioethics, Harvard Medical School, and the Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA. Amal N. Trivedi is with the Department of Health Services, Policy, and Practice, Brown University School of Public Health, and Providence VA Medical Center, Providence, RI
| | - Amal N Trivedi
- Kevin H. Nguyen is with the Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI. Kaitlyn P. Lew is with the Center for Bioethics, Harvard Medical School, and the Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA. Amal N. Trivedi is with the Department of Health Services, Policy, and Practice, Brown University School of Public Health, and Providence VA Medical Center, Providence, RI
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Kaholokula JK, AuYoung M, Chau M, Sambamoorthi U, Carson S, Thao C, Nguyen M, Alo A, Riklon S, Lepule T, Ma GX. Unified in Our Diversity to Address Health Disparities Among Asian Americans, Native Hawaiians, and Pacific Islanders. Health Equity 2022; 6:540-545. [PMID: 36186617 PMCID: PMC9518805 DOI: 10.1089/heq.2022.0034] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic disproportionately impacted Asian Americans, Native Hawaiians, and Pacific Islanders (AA/NHPIs) in the United States. AA/NHPIs have historically been subjected to discrimination, which was exacerbated by the pandemic. To bring attention to their unique concerns, an AA/NHPI Interest Group of the National Institutes of Health Community Engagement Alliance Against COVID-19 Disparities (CEAL) was formed. This article highlights major concerns raised by the Interest Group: The pervasive and arbitrary practice of data aggregation by public health agencies and health-related researchers, the lack of culturally responsive services in the context of cultural safety, and leadership underrepresentation.
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Affiliation(s)
- Joseph Keawe‘aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawai'i, USA
| | - Mona AuYoung
- Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, California, USA
| | - Michelle Chau
- Department of Population Health, Grossman School of Medicine, New York University, New York City, New York, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy and Texas Center for Health Disparities, University of North Texas Health Sciences Center, Fort Worth, Texas, USA
| | - Savanna Carson
- Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, California, USA
| | - Chia Thao
- Department of Public Health, University of California, Merced, California, USA
| | - May Nguyen
- Department of Health Systems and Population Health Sciences, College of Medicine, University of Houston College of Medicine, Houston, Texas, USA
| | - Audrey Alo
- Pacific Islander Health Partnership, Garden Grove, California, USA
| | - Sheldon Riklon
- Department of Family and Preventive Medicine and Center for Pacific Islander Health, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
| | - Tana Lepule
- Pacific Islander Collective of San Diego, San Diego, California, USA
| | - Grace X. Ma
- Department of Urban Health and Population Science, Center for Asian Health and Fox Chase Cancer Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
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Nguyen C, Gilbert L, Diep J, Nguyen BM. Identifying Facilitators and Barriers to Increasing COVID-19 Vaccination and Trial Participation in Vaccinated Vietnamese Americans. Health Equity 2022; 6:485-493. [PMID: 35801146 PMCID: PMC9257542 DOI: 10.1089/heq.2022.0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Preventing morbidity and mortality from COVID-19 requires reaching diverse communities. Purpose: To identify facilitators and barriers to COVID-19 immunization and COVID-19 clinical trial participation in the vaccinated Vietnamese American population in Houston, TX. Methods: Community-based qualitative study using focus groups and key informant interviews. Results: Themes that emerged included culturally appropriate language, generational differences, and a collectivist approach. Conclusion: Promoting science-based information through trusted messengers, improving awareness and access, and illuminating benefits to the community could increase the uptake of COVID-19 vaccines and volunteering for therapeutic trials among Vietnamese Americans.
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Affiliation(s)
| | - Lauren Gilbert
- Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, Texas, USA
| | | | - Bich-May Nguyen
- Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, Texas, USA
- Address correspondence to: Bich-May Nguyen, MD, MPH, Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, 4349 Martin Luther King Boulevard, Health 2 Building 9037, Houston, TX 77004, USA,
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Deutsch-Feldman M, Springer YP, Felix D, Tsang CA, Brostrom R, Haddad M. Tuberculosis Among Native Hawaiian and Other Pacific Islander Persons: United States and U.S.-Affiliated Pacific Islands, 2010-2019. Health Equity 2022; 6:476-484. [PMID: 35801148 PMCID: PMC9257550 DOI: 10.1089/heq.2022.0065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background In recent years, tuberculosis (TB) incidence in the United States has declined overall but remained high among Native Hawaiian and Other Pacific Islander (NH/PI) persons. Few studies have examined the epidemiology of TB among NH/PI persons, particularly in the U.S.-Affiliated Pacific Islands (USAPI). We describe TB incidence and characteristics of NH/PI patients during 2010-2019. Methods We used data from the National Tuberculosis Surveillance System to characterize TB cases reported among NH/PI persons born in the 50 U.S. states (defined to include District of Columbia) and the USAPI. We calculated annual TB incidence among NH/PI patients, stratified by place of birth (U.S. states or USAPI). Using Asian persons born outside the United States-persons historically grouped with NH/PI persons as one racial category-as the reference, we compared demographic, clinical, and socio-behavioral characteristics of NH/PI TB patients. Results During 2010-2019, 4359 TB cases were reported among NH/PI patients born in the U.S. states (n=205) or the USAPI (n=4154). Median annual incidence per 100,000 persons was 6.5 cases (persons born in the U.S. states) and 150.7 cases (persons born in the USAPI). The proportion of TB patients aged <15 years was higher among NH/PI persons (U.S. states: 54%, USAPI: 24%) than among Asian persons born outside the United States (1%). Conclusions TB incidence among NH/PI persons is high, particularly among persons born in the USAPI, emphasizing the need to enhance TB prevention strategies in these communities. Interventions should be tailored toward those who experience the highest risk, including NH/PI children and adolescents.
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Affiliation(s)
- Molly Deutsch-Feldman
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STDs, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yuri P Springer
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STDs, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Derrick Felix
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STDs, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Clarisse A Tsang
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STDs, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard Brostrom
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STDs, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maryam Haddad
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STDs, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Life expectancy by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities. Lancet 2022; 400:25-38. [PMID: 35717994 PMCID: PMC9256789 DOI: 10.1016/s0140-6736(22)00876-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/01/2022] [Accepted: 05/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are large and persistent disparities in life expectancy among racial-ethnic groups in the USA, but the extent to which these patterns vary geographically on a local scale is not well understood. This analysis estimated life expectancy for five racial-ethnic groups, in 3110 US counties over 20 years, to describe spatial-temporal variations in life expectancy and disparities between racial-ethnic groups. METHODS We applied novel small-area estimation models to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual sex-specific and age-specific mortality rates stratified by county and racial-ethnic group (non-Latino and non-Hispanic White [White], non-Latino and non-Hispanic Black [Black], non-Latino and non-Hispanic American Indian or Alaska Native [AIAN], non-Latino and non-Hispanic Asian or Pacific Islander [API], and Latino or Hispanic [Latino]) from 2000 to 2019. We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and then constructed abridged life tables to estimate life expectancy at birth. FINDINGS Between 2000 and 2019, trends in life expectancy differed among racial-ethnic groups and among counties. Nationally, there was an increase in life expectancy for people who were Black (change 3·9 years [95% uncertainty interval 3·8 to 4·0]; life expectancy in 2019 75·3 years [75·2 to 75·4]), API (2·9 years [2·7 to 3·0]; 85·7 years [85·3 to 86·0]), Latino (2·7 years [2·6 to 2·8]; 82·2 years [82·0 to 82·5]), and White (1·7 years [1·6 to 1·7]; 78·9 years [78·9 to 79·0]), but remained the same for the AIAN population (0·0 years [-0·3 to 0·4]; 73·1 years [71·5 to 74·8]). At the national level, the negative difference in life expectancy for the Black population compared with the White population decreased during this period, whereas the negative difference for the AIAN population compared with the White population increased; in both cases, these patterns were widespread among counties. The positive difference in life expectancy for the API and Latino populations compared with the White population increased at the national level from 2000 to 2019; however, this difference declined in a sizeable minority of counties (615 [42·0%] of 1465 counties) for the Latino population and in most counties (401 [60·2%] of 666 counties) for the API population. For all racial-ethnic groups, improvements in life expectancy were more widespread across counties and larger from 2000 to 2010 than from 2010 to 2019. INTERPRETATION Disparities in life expectancy among racial-ethnic groups are widespread and enduring. Local-level data are crucial to address the root causes of poor health and early death among disadvantaged groups in the USA, eliminate health disparities, and increase longevity for all. FUNDING National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Science Research, US National Institutes of Health.
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Tolentino M, Millerd S, Bali NZ, Ranido E, Takiguchi J, Balaz HJ, Atan R, Sentell T. Next Gen Hawai'i: Collaborative COVID-19 Social Media Initiative to Engage Native Hawaiian, Other Pacific Islander, and Filipino Youth. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:201-208. [PMID: 35821668 PMCID: PMC9272528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The Next Gen Hawai'i social media project was initiated in the fall of 2020 to address ongoing public health concerns and the need for accessible and reliable information across Hawai'i's diverse communities by strategically amplifying the voices of Hawai'i's youth in their Native languages. The collaborative effort arose from conversations within the Hawai'i's Native Hawaiian & Pacific Islander COVID-19 Response, Recovery, and Resilience Team, composed of diverse public and private organizations involved in statewide COVID-19 response efforts for Native Hawaiian and Pacific Islander communities. Next Gen Hawai'i's focus was on Native Hawaiian, Pacific Islander, Filipino, and other populations disproportionately suffering from COVID-19. Five social media platforms were developed to spread messaging to youth and young adults about COVID-19. Public Health Ambassadors (from high school to young adults) were recruited and engaged to create culturally and linguistically rooted messaging to promote public health and prevention-based social norms. This strength-based approach recognized youth as important community leaders and ambassadors for change and empowered them to create content for dissemination on platforms with national and global reach. Messaging was designed to build individual, community, and digital health literacy while integrating core cultural values and strengths of Native Hawaiian, Pacific Islander, and Filipino communities. Over 250 messages have been delivered across Next Gen Hawai'i social media channels on topics including vaccine information, mask-wearing, staying together over distances, mental health, and in-languages resources in Chuukese, Chamorro, Marshallese, Samoan, Hawaiian, Ilocano, Tagalog, and other Pacific-basin languages. Reach has included more than 75 000 views from various social media channels, media features, successful webinars, and relevant conference presentations. This Public Health Insights article provides an overview of Next Gen Hawai'i's activities and achievements as well as lessons learned for other youth-focused public health social media campaigns and organizations.
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Affiliation(s)
| | | | | | - Elarie Ranido
- Next Gen Hawai'i Ambassador, Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai'i, Honolulu, HI
| | - Jaelyn Takiguchi
- Next Gen Hawai'i Ambassador, Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai'i, Honolulu, HI
| | | | | | - Tetine Sentell
- Office of Public Health Studies, Thompson School of Social Work & Public Health , University of Hawai'i, Honolulu, HI
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Ohlsen EC, Yankey D, Pezzi C, Kriss JL, Lu PJ, Hung MC, Bernabe MID, Kumar GS, Jentes E, Elam-Evans LD, Jackson H, Black CL, Singleton JA, Ladva CN, Abad N, Lainz AR. Coronavirus Disease 2019 (COVID-19) Vaccination Coverage, Intentions, Attitudes, and Barriers by Race/Ethnicity, Language of Interview, and Nativity-National Immunization Survey Adult COVID Module, 22 April 2021-29 January 2022. Clin Infect Dis 2022; 75:S182-S192. [PMID: 35737951 PMCID: PMC9278203 DOI: 10.1093/cid/ciac508] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The National Immunization Survey Adult COVID Module used a random-digit-dialed phone survey during 22 April 2021-29 January 2022 to quantify coronavirus disease 2019 (COVID-19) vaccination, intent, attitudes, and barriers by detailed race/ethnicity, interview language, and nativity. Foreign-born respondents overall and within racial/ethnic categories had higher vaccination coverage (80.9%), higher intent to be vaccinated (4.2%), and lower hesitancy toward COVID-19 vaccination (6.0%) than US-born respondents (72.6%, 2.9%, and 15.8%, respectively). Vaccination coverage was significantly lower for certain subcategories of national origin or heritage (eg, Jamaican [68.6%], Haitian [60.7%], Somali [49.0%] in weighted estimates). Respondents interviewed in Spanish had lower vaccination coverage than interviewees in English but higher intent to be vaccinated and lower reluctance. Collection and analysis of nativity, detailed race/ethnicity and language information allow identification of disparities among racial/ethnic subgroups. Vaccination programs could use such information to implement culturally and linguistically appropriate focused interventions among communities with lower vaccination coverage.
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Affiliation(s)
| | - David Yankey
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Clelia Pezzi
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jennifer L Kriss
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Peng Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Mei Chuan Hung
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC,Leidos Inc, Atlanta, GA
| | - Maria I Dionicio Bernabe
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC,Applied Epidemiology Fellow, Council of State and Territorial Epidemiologists
| | - Gayathri S Kumar
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Emily Jentes
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Laurie D Elam-Evans
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
| | | | - Carla L Black
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
| | - James A Singleton
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
| | | | - Neetu Abad
- Global Immunization Division, Center for Global Health, CDC
| | - Alfonso Rodriguez Lainz
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
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Juarez R, Phankitnirundorn K, Okihiro M, Maunakea AK. Opposing Role of Trust as a Modifier of COVID-19 Vaccine Uptake in an Indigenous Population. Vaccines (Basel) 2022; 10:968. [PMID: 35746577 PMCID: PMC9229995 DOI: 10.3390/vaccines10060968] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 01/26/2023] Open
Abstract
Native Hawaiians and other Pacific Islanders (NHPIs) were disproportionately impacted by COVID-19 and remain significantly under-vaccinated against SARS-CoV-2. To understand vaccine hesitancy, we surveyed 1124 adults residing in a region with one of the lowest vaccination rates in Hawaii during our COVID-19 testing program. Probit regression analysis revealed that race/ethnicity was not directly associated with the probability of vaccine uptake. Instead, a higher degree of trust in official sources of COVID-19 information increased the probability of vaccination by 20.68%, whereas a higher trust in unofficial sources decreased the probability of vaccination by 12.49% per unit of trust. These results revealed a dual and opposing role of trust on vaccine uptake. Interestingly, NHPIs were the only racial/ethnic group to exhibit a significant positive association between trust in and consumption of unofficial sources of COVID-19 information, which explained the vaccine hesitancy observed in this indigenous population. These results offer novel insight relevant to COVID-19 mitigation efforts in minority populations.
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Affiliation(s)
- Ruben Juarez
- Department of Economics and UHERO, University of Hawaii, Honolulu, HI 96822, USA;
| | - Krit Phankitnirundorn
- Department of Economics and UHERO, University of Hawaii, Honolulu, HI 96822, USA;
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA;
| | - May Okihiro
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA;
| | - Alika K. Maunakea
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA;
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Chen MS, Lee RJ, Madan RA, Ta Park V, Shinagawa SM, Sun T, Gomez SL. Charting a Path Towards Asian American Cancer Health Equity: A Way Forward. J Natl Cancer Inst 2022; 114:792-799. [PMID: 35437573 PMCID: PMC9194616 DOI: 10.1093/jnci/djac055] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/17/2022] [Accepted: 02/24/2022] [Indexed: 12/30/2022] Open
Abstract
On July 29, 2021, the US Food and Drug Administration's Oncology Center of Excellence convened Conversations on Cancer. This Conversation, the first ever by the US Food and Drug Administration, focused on Asian Americans and served as the platform for this Commentary. Panelists elaborated on topics ranging from heterogeneity in Asian American demographics to racism through a path to health equity and supplemented this Commentary with literature citations. Asian Americans are the fastest-growing US race group, yet data aggregation obscures distinctions and cancer disparities within the more than 24 million Asians living in the United States with harmful impacts on communities and patients, as illustrated by breast cancer survivor Susan Shinagawa's patient-to-advocate journey. Bigotry against Asian Americans has been pervasive since the 19th century, but especially during the COVID-19 pandemic. Asian Americans are unique as the first US population to experience cancer as the leading cause of death. Asian Americans are disproportionately affected by cancers because of infectious origins and have the highest rates of lung cancer among never-smoking women. The infinitesimal proportion of the National Institutes of Health's budget compared with experiencing the highest percentage increases of any US racial population more than 3 decades highlights the dearth of focused research among Asian Americans. Recognizing the heterogeneity of Asian Americans and that disaggregated data are critical for accurately characterizing distinct ethnic groups, focusing on the impact of racism and COVID-19 on cancer disparities, and focusing and prioritizing funding resources are necessary steps forward for achieving health equity for Asian Americans.
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Affiliation(s)
- Moon S Chen
- Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA, USA
| | - Richard J Lee
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Ravi A Madan
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Van Ta Park
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Susan M Shinagawa
- Asian and Pacific Islander National Cancer Survivors Network, Spring Valley, CA, USA
| | - Tracy Sun
- Asian and Pacific Islander American Health Forum, Washington, DC, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, UC San Francisco School of Medicine and the Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
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Willis DE, Schootman M, Shah SK, Reece S, Selig JP, Andersen JA, McElfish PA. Parent/guardian intentions to vaccinate children against COVID-19 in the United States. Hum Vaccin Immunother 2022; 18:2071078. [PMID: 35506876 PMCID: PMC9302502 DOI: 10.1080/21645515.2022.2071078] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Vaccination is critical for protecting adults and children from COVID-19 infection, hospitalization, and death. Analyzing subsamples of parent/guardians of children age 0–11 (n = 343) and 12–17 (n = 322) from a larger national survey of US adults (n = 2,022), we aimed to assess intentions to vaccinate children and how intentions might vary across parent/guardian sociodemographic characteristics, healthcare coverage, vaccination status, political affiliation, prior COVID-19 infection, exposure to COVID-19 death(s) of family or friends, perceived norms of vaccination, and COVID-19 vaccine hesitancy. We also report the prevalence of vaccinated children for parents whose oldest child was eligible for vaccination at the time of the survey. More than one third of parents whose oldest child was not yet eligible for vaccination (11 or younger) planned to get them vaccinated right away when a vaccine became available to them. Among parents whose child was eligible to be vaccinated (age 12–17 years), approximately a third reported their child had already been vaccinated and approximately a third planned to do so right away. Intentions to vaccinate children age 0 to 11 were significantly associated with age, gender, race/ethnicity, education, COVID-19 vaccination, political affiliation, social norms, and COVID-19 vaccine hesitancy. Intentions to vaccinate children age 12 to 17 were significantly associated with age, education, healthcare coverage, COVID-19 vaccination, political affiliation, social norms, and COVID-19 vaccine hesitancy. We discuss implications for public health officials and for future research.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Mario Schootman
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sumit K Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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Moore JT, Luna-Pinto C, Cox H, Razi S, St Louis ME, Ricaldi JN, Liburd L. Promoting health equity during the COVID-19 pandemic, United States. Bull World Health Organ 2022; 100:171-173. [PMID: 35125543 PMCID: PMC8795842 DOI: 10.2471/blt.21.286074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jazmyn T Moore
- United States Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341-3717, United States of America
| | - Carolina Luna-Pinto
- United States Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341-3717, United States of America
| | - Heidi Cox
- United States Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341-3717, United States of America
| | - Sima Razi
- United States Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341-3717, United States of America
| | - Michael E St Louis
- United States Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341-3717, United States of America
| | - Jessica N Ricaldi
- United States Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341-3717, United States of America
| | - Leandris Liburd
- United States Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341-3717, United States of America
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Nguyen CJ, Pham C, Jackson AM, Ellison NLK, Sinclair KI. Online Food Security Discussion Before and During the COVID-19 Pandemic in Native Hawaiian and Pacific Islander Community Groups and Organizations: Content Analysis of Facebook Posts. Asian Pac Isl Nurs J 2022; 6:e40436. [PMID: 36212246 PMCID: PMC9528231 DOI: 10.2196/40436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background The Native Hawaiian and Pacific Islander (NHPI) population experiences disproportionately higher rates of food insecurity, which is a risk factor for cardiometabolic diseases such as cardiovascular disease, type 2 diabetes, obesity, and hypertension, when compared to white individuals. Novel and effective approaches that address food insecurity are needed for the NHPI population, particularly in areas of the continental United States, which is a popular migration area for many NHPI families. Social media may serve as an opportune setting to reduce food insecurity and thus the risk factors for cardiometabolic diseases among NHPI people; however, it is unclear if and how food insecurity is discussed in online communities targeting NHPI individuals. Objective The objective of this study was to characterize the quantity, nature, and audience engagement of messages related to food insecurity posted online in community groups and organizations that target NHPI audiences. Methods Publicly accessible Facebook pages and groups focused on serving NHPI community members living in the states of Washington or Oregon served as the data source. Facebook posts between March and June 2019 (before the COVID-19 pandemic) and from March to June 2020 (during the COVID-19 pandemic) that were related to food security were identified using a set of 36 related keywords. Data on the post and any user engagement (ie, comments, shares, or digital reactions) were extracted for all relevant posts. A content analytical approach was used to identify and quantify the nature of the identified posts and any related comments. The codes resulting from the content analysis were described and compared by year, page type, and engagement. Results Of the 1314 nonduplicated posts in the 7 relevant Facebook groups and pages, 88 were related to food security (8 in 2019 and 80 in 2020). The nature of posts was broadly classified into literature-based codes, food assistance (the most common), perspectives of food insecurity, community gratitude and support, and macrolevel contexts. Among the 88 posts, 74% (n=65) had some form of engagement, and posts reflecting community gratitude and support or culture had more engagement than others (mean 19.9, 95% CI 11.2-28.5 vs mean 6.1, 95% CI 1.7-10.4; and mean 26.8, 95% CI 12.7-40.9 vs mean 5.3, 95% CI 3.0-7.7, respectively). Conclusions Food security-related posts in publicly accessible Facebook groups targeting NHPI individuals living in Washington and Oregon largely focused on food assistance, although cultural values of gratitude, maintaining NHPI culture, and supporting children were also reflected. Future work should capitalize on social media as a potential avenue to reach a unique cultural group in the United States experiencing inequitably high rates of food insecurity and risk of cardiometabolic diseases.
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Affiliation(s)
- Cassandra Jean Nguyen
- Institute for Research and Education to Advance Community Health Washington State University Seattle, WA United States
| | - Christian Pham
- Elson S Floyd College of Medicine Washington State University Spokane, WA United States
| | - Alexandra M Jackson
- Institute for Research and Education to Advance Community Health Washington State University Seattle, WA United States
| | | | - Ka Imi Sinclair
- Institute for Research and Education to Advance Community Health Washington State University Seattle, WA United States
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Hill TE, Farrell DJ. COVID-19 Across the Landscape of Long-Term Care in Alameda County: Heterogeneity and Disparities. Gerontol Geriatr Med 2022; 8:23337214211073419. [PMID: 35071695 PMCID: PMC8777322 DOI: 10.1177/23337214211073419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 12/05/2022] Open
Abstract
Throughout the pandemic, public health and long-term care professionals in our urban California county have linked local and state COVID-19 data and performed observational exploratory analyses of the impacts among our diverse long-term care facilities (LTCFs). Case counts from LTCFs through March 2021 included 4309 (65%) in skilled nursing facilities (SNFs), 1667 (25%) in residential care facilities for the elderly (RCFEs), and 273 (4%) in continuing care retirement communities (CCRCs). These cases led to 582 COVID-19 resident deaths and 12 staff deaths based on death certificates. Data on decedents' age, race, education, and country of birth reflected a hierarchy of wealth and socioeconomic status from CCRCs to RCFEs to SNFs. Mortality rates within SNFs were higher for non-Whites than Whites. Staff accounted for 42% of LTCF-associated COVID-19 cases, and over 75% of these staff were unlicensed. For all COVID-19 deaths in our jurisdiction, both LTCF and community, 82% of decedents were age 65 or over. Taking a comprehensive, population-based approach across our heterogenous LTCF landscape, we found socioeconomic disparities within COVID-19 cases and deaths of residents and staff. An improved data infrastructure linking public health and delivery systems would advance our understanding and potentiate life-saving interventions within this vulnerable ecosystem.
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Affiliation(s)
- Terry E. Hill
- Alameda County Public Health
Department, Oakland, CA, USA
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Abstract
Standfirst: AI-based models may amplify pre-existing human bias within datasets; addressing this problem will require fundamental a realignment of the culture of software development.
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Affiliation(s)
- Mildred K Cho
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, CA, USA.
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Welte T. Wi(e)der SARS-CoV-2: Epidemiologie, Booster und Impfstoffkombis. PNEUMO NEWS 2021; 13:30-34. [PMID: 34925629 PMCID: PMC8666187 DOI: 10.1007/s15033-021-2785-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tobias Welte
- Medizinische Hochschule Hannover/MHH, Carl-Neuberg-Str. 1, 30625 Hannover, Deutschland
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