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Dove-Medows E, Knox J, Valentine-Graves M, Sullivan P. I Can't Afford it Right Now, So it Doesn't Matter" Structural Drivers of Viral Suppression Among Men Who Have Sex With Men: A Longitudinal Qualitative Approach. RESEARCH SQUARE 2024:rs.3.rs-4001004. [PMID: 38585772 PMCID: PMC10996790 DOI: 10.21203/rs.3.rs-4001004/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background Racial disparities in outcomes across the HIV care continuum, including in viral suppression, have been observed among sexual minority men (SMM) living with HIV. Structural factors are drivers of these disparities, yet data is lacking at the individual level on how day-to-day experiences of these structural factors contribute to losing viral suppression, and what happens to SMM after loss of viral suppression, including whether they achieve viral suppression again over time. Method We conducted longitudinal semi-structured interviews with a subsample of men living with HIV drawn from a larger cohort study. Three Black and 2 White SMM participated in a series of three interviews after they lost viral suppression, and then again at 6- and 12-months follow-up. The focus of the interviews was on experiences with structural issues (e.g., housing, transportation, employment, insurance) and their impact on HIV care. Results Content analysis showed that multiple structural issues disrupted HIV care, particularly insurance, housing stability, transportation, and employment. Black SMM described experiencing multiple compounding structural barriers, and they struggled to achieve viral suppression again. Conclusions These data show how SMM living with HIV are impacted by structural barriers to HIV care over time. Black SMM experienced multiple, compounding barriers, and these negatively impacted HIV care outcomes over time. Efforts to address long-standing HIV care-related disparities need to address the mechanisms of structural racism.
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Wang R, Carson KA, Sao SS, Coleman JS. Association of Neighborhood Economic Status and Race With Developing Pelvic Inflammatory Disease After Sexually Transmitted Infections. Obstet Gynecol 2023; 142:948-955. [PMID: 37734094 PMCID: PMC10510783 DOI: 10.1097/aog.0000000000005341] [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: 02/01/2023] [Revised: 04/14/2023] [Accepted: 05/05/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To explore the association of neighborhood-level socioeconomic status (SES) and race with developing pelvic inflammatory disease (PID) after sexually transmitted infection (STI) among female adolescents and young adults in Maryland. METHODS We used Maryland statewide hospital claims data (outpatient and inpatient visits) for this retrospective cohort study. Female adolescents and young adults aged 15-24 years who had at least one STI from July 1, 2013, to March 31, 2015, were included. A participant entered the cohort on the date of the first STI diagnosis and was followed up until PID occurrence or 3 years after the first STI. Median household income of the participant's residential ZIP code tabulation area was used as the neighborhood-level SES. Discrete-time hazard models were used to estimate the hazard of PID. RESULTS Of the 2,873 participants, 88.5% were of Black race, and 67.2% were aged 20-24 years. The hazard of PID after an STI among Black women was 1.40 times that of White women (95% CI 1.06-1.85). After adjustment for age, insurance type, and number of STI events, the hazard ratio (HR) did not change. However, adding neighborhood-level SES to the model attenuated the disparity in PID after STI between Black and White women (HR 1.25, 95% CI 0.94-1.67). CONCLUSION Racial disparities in PID diagnosis are mitigated by neighborhood-level SES.
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Affiliation(s)
- Runzhi Wang
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Haro-Ramos AY, Bacong AM, Rodriguez HP. Racial Discrimination, Social Disadvantage, and Racial-Ethnic Disparities in COVID-19 Vaccine Uptake. AJPM FOCUS 2023; 2:100072. [PMID: 36744154 PMCID: PMC9889250 DOI: 10.1016/j.focus.2023.100072] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction Racial-ethnic disparities in COVID-19 vaccination are well documented. The extent to which racism, manifested at the individual and ZIP code levels, explains disparities in early vaccination uptake remains unclear. Methods Data from a statewide poll of California registered voters (N=10,256), conducted between April 29 and May 5, 2021, linked to area-level resource data, were analyzed. Weighted multivariable logistic regression models examined racial disparities in COVID-19 vaccination. Decomposition analyses quantified how much of the observed racial disparities in vaccination were explained by racial discrimination and social disadvantage (i.e., educational attainment, 2019 household income, and ZIP code social vulnerability). Results Latinx (64.6%) and Black (66.7%) adults were less likely to have at least 1 COVID-19 vaccine dose by April or May 2021 than White adults (74.7%). In adjusted analyses, Latinx (AOR=0.69, 95% CI=0.57, 0.84) and Black (AOR=0.51, 95% CI=0.37, 0.70) adults had a lower likelihood of being vaccinated than Whites. Social disadvantage accounted for 77.4% (p<0.05) and 35.8% (p<0.05) of the explainable variation in Latinx-White and Black-White disparities, respectively. Self-reported racial discrimination was not associated with COVID-19 vaccination in adjusted analyses. Conclusions Social disadvantage but not self-reported racial discrimination explained racial-ethnic disparities in COVID-19 vaccination in California. Removing resource-related barriers may help to increase the relatively low COVID-19 vaccination rates among Black and Latinx populations.
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Affiliation(s)
- Alein Y Haro-Ramos
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Adrian M Bacong
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Hector P Rodriguez
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California
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4
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Ibekwe LN, Fernández-Esquer ME, Pruitt SL, Ranjit N, Fernández ME. Associations between perceived racial discrimination, racial residential segregation, and cancer screening adherence among low-income African Americans: a multilevel, cross-sectional analysis. ETHNICITY & HEALTH 2023; 28:313-334. [PMID: 35229698 PMCID: PMC9433466 DOI: 10.1080/13557858.2022.2043246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 02/11/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVES African Americans suffer disproportionately from cancer compared to their White counterparts. Racism may be an important determinant, but the literature on its association with cancer screening is limited. We examine associations between racism and cancer screening among a sample of African Americans. DESIGN Guided by the Public Health Critical Race Praxis and the Behavioral Model of Health Services Use, we conducted a multilevel, cross-sectional study using cancer risk assessment data collected from 405 callers to the 2-1-1 Texas helpline. We merged these data with contextual data from the U.S. Census Bureau. We assessed perceived racial discrimination using the Experiences of Discrimination Scale and racial residential segregation using the Location Quotient for Racial Residential Segregation. We used multilevel regression models to test hypothesized associations between each indicator of racism and four cancer screening adherence outcomes (Pap test, mammography, colorectal cancer screening [CRCS], and any cancer screening). RESULTS Participants were 18-83 years old (mean = 45 years). Most (81%) were non-adherent to at least one recommended screening. Approximately 42% reported experiencing discrimination and 73% lived in a segregated neighborhood. Discrimination was non-significantly related to lower odds of mammography (aOR = 0.68; 95%CI: 0.38-1.22), CRCS (aOR = 0.79; 95%CI: 0.41-1.52), and any cancer screening adherence (aOR = 0.88; 95%CI: 0.59-1.32). Segregation was related to greater odds of mammography (non-significant; aOR = 1.43; 95%CI: 0.76-2.68) and CRCS (significant; aOR = 2.80; 95%CI: 1.21-6.46) but not associated with any cancer screening. Neither indicator of racism was associated with Pap test screening adherence. CONCLUSIONS Racism has a nuanced association with cancer screening among low-income, medically underserved African Americans. Specifically, discrimination appears to be associated with lower odds of screening, while segregation may be associated with higher odds of screening in certain situations. Future research is needed to better explicate relations between indicators of racism and cancer screening among African Americans.
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Affiliation(s)
- Lynn N Ibekwe
- School of Public Health, Center at Houston, Center for Health Promotion and Prevention Research, The University of Texas Health Science, Houston, TX, USA
- Department of Social and Behavioral Sciences, School of Public Health, Boston, MA, USA
- Massachusetts General Hospital, Kraft Center for Community Health, Boston, MA, USA
| | - Maria Eugenia Fernández-Esquer
- School of Public Health, Center at Houston, Center for Health Promotion and Prevention Research, The University of Texas Health Science, Houston, TX, USA
| | - Sandi L Pruitt
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nalini Ranjit
- Michael and Susan Dell Center for Healthy Living, School of Public Health- Austin Regional Campus, The University of Texas Health Science Center at Houston, Austin, TX, USA
| | - Maria E Fernández
- School of Public Health, Center at Houston, Center for Health Promotion and Prevention Research, The University of Texas Health Science, Houston, TX, USA
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Krause KD, Brennan-Ing M, Halkitis PN. Assessing the Factor Structure and Psychometric Properties of the HIV-Related Resilience Screener: The GOLD Studies. AIDS Behav 2022; 27:1703-1715. [PMID: 36369501 DOI: 10.1007/s10461-022-03902-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/15/2022]
Abstract
People who are 50 and older constitute the majority of those living with HIV/AIDS (PLWHA) in the US. Aging PLWHA face myriad biopsychosocial health challenges related to HIV/AIDS and the aging process. Resilience may act as a buffer to the negative impact of these challenges however measuring it among PLWHA has been inconsistent, so the HIV-Related Resilience Screener (HIV-RRS) was developed. Data for the present study are drawn from 250 sociodemographically diverse HIV-positive gay men ages 50-69 in NYC. Tests of reliability and validity were conducted, and an Exploratory Factor Analysis indicated a three-factor model was the most parsimonious solution. Items were examined for their underlying relationships and labeled: adaptive coping, optimism, and effective coping. The total HIV-RRS yielded a Cronbach's α of 0.84. Convergent and face validity were established using psychosocial and physical outcomes. The HIV-RRS is a psychometrically sound instrument to assess resilience among older HIV-positive gay men.
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Hamdan S, Smyth E, Murphy ME, Grussing ED, Wei M, Guardado R, Wurcel A. Racial and Ethnic Disparities in HIV Testing in People Who Use Drugs Admitted to a Tertiary Care Hospital. AIDS Patient Care STDS 2022; 36:425-430. [PMID: 36301195 PMCID: PMC9700355 DOI: 10.1089/apc.2022.0165] [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: 01/29/2023] Open
Abstract
Ending the HIV epidemic requires increased testing, diagnosis, and linkage to care. In the past 10 years, rates of HIV have increased among people with substance use disorder (SUD). HIV testing is recommended during hospitalization. Despite rising rates of infections and recommendations, HIV testing remains suboptimal. This study sought to detect differences in HIV testing by race and ethnicity in people who use drugs (PWUD) admitted to Tufts Medical Center (TuftsMC). This study is a retrospective review of hospitalized PWUD admitted from January 1, 2017 to December 31, 2020. PWUD were identified through toxicology results, medication prescribed for SUD, and nursing intake questions. The primary outcome of interest was whether an HIV test was ordered during hospitalization. The indicator of interest was race and ethnicity. Of 13,486 PWUD admitted to TuftsMC, only 10% had an HIV test ordered. Compared with White patients, Black patients [adjusted odds ratio (AOR): 0.69, 95% confidence interval (CI) (0.59-0.83)] and Hispanic patients [AOR: 0.68, 95% CI (0.55-0.84)] had decreased odds of receiving an HIV test. Our report is the first to show racial and ethnic differences in HIV testing ordering for hospitalized PWUD. Without access to harm reduction tools and expanded systems-based testing strategies, the HIV epidemic will continue and disproportionately impact minoritized communities.
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Affiliation(s)
- Sami Hamdan
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Emma Smyth
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | | | | | - Mingrui Wei
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Rubeen Guardado
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Alysse Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
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Bradford NJ, Amani B, Walker VP, Sharif MZ, Ford CL. Barely Tweeting and Rarely About Racism: Assessing US State Health Department Twitter Use During the COVID-19 Vaccine Rollout. Ethn Dis 2022; 32:257-264. [PMID: 35909637 PMCID: PMC9311300 DOI: 10.18865/ed.32.3.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Introduction The general public was discussing racism and potential inequities in COVID-19 vaccinations among African Americans on Twitter before the first COVID-19 vaccine received emergency use authorization, but it is unclear how US state health departments (SHDs) were using Twitter to address the inequities. This study examines the frequency, content and timing of SHD tweets during the US rollout of the first SARS Co-V2 vaccine. Methods This was a prospective study of tweets posted from the official Twitter accounts of each of the 50 US SHDs and the DC health department from October 19, 2020 to February 28, 2021. We retrieved the content and metadata of 100% of their tweets; calculated frequencies and proportions of tweets containing key terms related to COVID-19 vaccines, equity and racism; stratified the data by region; and charted longitudinal trends. Results Overall, SHDs tweeted infrequently, and rarely tweeted about inequities, mistrust or racism. Though 55.48% of all SHD tweets were about COVID-19, hardly any tweets contained the terms: race/ethnicity (1.20%); equity (1.09); mistrust (.59%); or racism (.06%). Similar patterns existed among vaccination-related tweets, which accounted for 24.38% of all tweets. Only 21.64% of vaccination-related tweets containing any race/ethnicity, equity, mistrust, or racism terms were posted prior to the first Emergency Use Authorization (EUA). Those about African Americans (70.45%) were posted ≥8 weeks after EUA. Conclusions Concerns about racism and inequities in COVID-19 vaccination continue on Twitter, but SHDs rarely tweet about them. This strikes a worrisome chord of disconnection from the science linking health inequities to racism.
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Affiliation(s)
- Natalie J. Bradford
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA,Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, CA,Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Bita Amani
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA,Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, Address correspondence to Bita Amani, PhD, MHS, Charles R. Drew University of Medicine and Science, Los Angeles, CA;
| | - Valencia P. Walker
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA,Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH,Nationwide Children’s Hospital, Columbus, OH
| | - Mienah Z. Sharif
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA,Department of Community Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, CA,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Chandra L. Ford
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, UCLA, Los Angeles, CA,Department of Community Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, CA
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Harrison SE, Muessig K, Poteat T, Koester K, Vecchio A, Paton M, Miller SJ, Pereira N, Harris O, Myers J, Campbell C, Hightow-Weidman L. Addressing Racism's Role in the US HIV Epidemic: Qualitative Findings From Three Ending the HIV Epidemic Prevention Projects. J Acquir Immune Defic Syndr 2022; 90:S46-S55. [PMID: 35703755 PMCID: PMC9204779 DOI: 10.1097/qai.0000000000002965] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Racist socio-political and economic systems in the United States are root causes of HIV disparities among minoritized individuals. However, within HIV implementation science literature, there is scarce empirical research on how to effectively counter racism. This article names racism and White supremacy as key challenges to the success of the Ending the HIV Epidemic (EHE) initiative and delineates opportunities to integrate anti-racism into HIV interventions. METHODS Formative data were synthesized from 3 EHE studies in California, North Carolina, and South Carolina. Each study engaged with community stakeholders to inform pre-exposure prophylaxis interventions. Key informant interviews and focus groups were used to query individuals-including Black individuals-about implementation challenges. Although racism was not an a priori focus of included studies, discourse on race and racism emerged as key study findings from all projects. RESULTS Across diverse stakeholder groups and EHE locales, participants described racism as a threat to the success of the EHE initiative. Institutional and structural racism, intersectional stigma, and maltreatment of minoritized individuals within healthcare systems were cited as challenges to pre-exposure prophylaxis scale-up. Some recommendations for addressing racism were given-yet these primarily focused on the individual level (eg, enhanced training, outreach). CONCLUSIONS EHE implementation scientists should commit to measurable anti-racist actions. To this end, we present a series of recommendations to help investigators evaluate the extent to which they are taking actionable steps to counter racism to improve the adoption, implementation, and real-world impact of EHE interventions for people of color.
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Affiliation(s)
- Sayward E Harrison
- Department of Psychology, University of South Carolina, Barnwell College, Columbia, SC
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Kathryn Muessig
- Institute of Global Health and Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Tonia Poteat
- Center for Health Equity Research, University of North Carolina, School of Medicine, Chapel Hill, NC
| | - Kimberly Koester
- School of Medicine, University of California, San Francisco, CA; and
| | - Alyssa Vecchio
- Institute of Global Health and Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, NC
| | - Mariajosé Paton
- Department of Psychology, University of South Carolina, Barnwell College, Columbia, SC
| | - Sarah J Miller
- Department of Psychology, University of South Carolina, Barnwell College, Columbia, SC
| | - Nastacia Pereira
- Center for Health Equity Research, University of North Carolina, School of Medicine, Chapel Hill, NC
| | - Orlando Harris
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA
| | - Janet Myers
- School of Medicine, University of California, San Francisco, CA; and
| | - Chadwick Campbell
- School of Medicine, University of California, San Francisco, CA; and
| | - Lisa Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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Miller MB, Flores LY, Dorimé-Williams ML, Williams MS, Martinez LD, Freeman LK, Everson AT, Hall NA, Monk JK, McCrae CS, Borsari B. Motives for and Barriers to Research Participation Among Racially and Ethnically Diverse Veterans. Mil Med 2022; 188:usac127. [PMID: 35584195 PMCID: PMC10363000 DOI: 10.1093/milmed/usac127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/09/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Veterans in general-and especially those who identify as Veterans of color-are underrepresented in health-related treatment research. This contributes to health inequity by hindering the development of evidence-based treatment recommendations for people of color. This project utilized culturally centered research procedures to identify health-related research priorities and examine motives for and barriers to research participation in a diverse sample of Veterans. MATERIALS AND METHODS Veterans (N = 330, 32% female; 36% Black, 28% White, 15% Latinx, 12% Asian, 4% Multiracial) reported their experiences with and perspectives on health-related research online from remote locations. Linear regression was used to test associations between discrimination and motives/barriers for research. All procedures were approved by the Institutional Review Board (#2033562). RESULTS Participants identified psychological concerns, particularly PTSD, as research priorities for Veterans in their communities, but also prioritized physical problems (e.g., brain injury) and social concerns (e.g., homelessness, access to care). Perceptions of, motives for, and barriers to research were similar across racial/ethnic groups. The most common motive was contributing to research that seems important, and the most common barrier was not knowing about research opportunities. Every-day experiences with discrimination (e.g., people acting as if they are afraid of you because of your race/ethnicity) were associated with more barriers to research among Black participants. CONCLUSIONS Experiences of racial/ethnic discrimination are associated with different research-related outcomes across racial/ethnic groups. Efforts to engage diverse populations should prioritize access to (not willingness to participate in) health-related research.
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Affiliation(s)
- Mary Beth Miller
- Department of Psychiatry, University of Missouri, Columbia, MO 65212, USA
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Lisa Y Flores
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | | | - Michael S Williams
- Department of Educational Leadership & Policy Analysis, University of Missouri, Columbia, MO 65211, USA
| | - Leticia D Martinez
- Department of Psychiatry, University of Missouri, Columbia, MO 65212, USA
| | - Lindsey K Freeman
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Adam T Everson
- Department of Psychiatry, University of Missouri, Columbia, MO 65212, USA
| | - Nicole A Hall
- Department of Psychiatry, University of Missouri, Columbia, MO 65212, USA
| | - J Kale Monk
- Human Development and Family Science, University of Missouri, Columbia, MO 65211, USA
| | - Christina S McCrae
- Department of Psychiatry, University of Missouri, Columbia, MO 65212, USA
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Brian Borsari
- Mental Health Service, San Francisco VA Health Care System, San Francisco, CA 94121, USA
- Department of Psychiatry and Behavioral Sciences, UCSF, San Francisco, CA 94143, USA
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Ibekwe LN, Fernández-Esquer ME, Pruitt SL, Ranjit N, Fernández ME. Racism and Cancer Screening among Low-Income, African American Women: A Multilevel, Longitudinal Analysis of 2-1-1 Texas Callers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11267. [PMID: 34769784 PMCID: PMC8583140 DOI: 10.3390/ijerph182111267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022]
Abstract
Although racism is increasingly being studied as an important contributor to racial health disparities, its relation to cancer-related outcomes among African Americans remains unclear. The purpose of this study was to help clarify the relation between two indicators of racism-perceived racial discrimination and racial residential segregation-and cancer screening. We conducted a multilevel, longitudinal study among a medically underserved population of African Americans in Texas. We assessed discrimination using the Experiences of Discrimination Scale and segregation using the Location Quotient for Racial Residential Segregation. The outcome examined was "any cancer screening completion" (Pap test, mammography, and/or colorectal cancer screening) at follow-up (3-10 months post-baseline). We tested hypothesized relations using multilevel logistic regression. We also conducted interaction and stratified analyses to explore whether discrimination modified the relation between segregation and screening completion. We found a significant positive relation between discrimination and screening and a non-significant negative relation between segregation and screening. Preliminary evidence suggests that discrimination modifies the relation between segregation and screening. Racism has a nuanced association with cancer screening among African Americans. Perceived racial discrimination and racial residential segregation should be considered jointly, rather than independently, to better understand their influence on cancer screening behavior.
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Affiliation(s)
- Lynn N. Ibekwe
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.E.F.-E.); (M.E.F.)
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Maria Eugenia Fernández-Esquer
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.E.F.-E.); (M.E.F.)
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Nalini Ranjit
- Michael and Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston–Austin Regional Campus, Austin, TX 78701, USA;
| | - Maria E. Fernández
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.E.F.-E.); (M.E.F.)
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11
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Rambachan A, Fang MC, Prasad P, Iverson N. Racial and Ethnic Disparities in Discharge Opioid Prescribing From a Hospital Medicine Service. J Hosp Med 2021; 16:589-595. [PMID: 34613895 PMCID: PMC8494281 DOI: 10.12788/jhm.3667] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Differential opioid prescribing patterns have been reported in non-White patient populations. However, these disparities have not been well described among hospitalized medical inpatients. OBJECTIVE To describe differences in opioid prescribing patterns among inpatients discharged from the general medicine service based on race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS For this retrospective study, we performed a multivariable logistic regression for patient race/ethnicity and whether patients received an opioid prescription at discharge and a negative binomial regression for days of opioids prescribed at discharge. The study included all 10,953 inpatients discharged from the general medicine service from June 2012 to November 2018 at University of California San Francisco Medical Center who received opioids during the last 24 hours of their hospitalization. MAIN OUTCOMES AND MEASURES We examined two primary outcomes: whether a patient received an opioid prescription at discharge, and, for patients prescribed opioids, the number of days dispensed. RESULTS Compared with White patients, Black patients were less likely to receive an opioid prescription at discharge (predicted population rate of 47.6% vs 50.7%; average marginal effect [AME], -3.1%; 95% CI, -5.5% to -0.8%). Asian patients were more likely to receive an opioid prescription on discharge (predicted population rate, 55.6% vs 50.7%; AME, +4.9; 95% CI, 1.5%-8.3%). We also found that Black patients received a shorter duration of opioid days compared with White patients (predicted days of opioids on discharge, 15.7 days vs 17.8 days; AME, -2.1 days; 95% CI, -3.3 to -0.9). CONCLUSION Black patients were less likely to receive opioids and received shorter courses at discharge compared with White patients, adjusting for covariates. Asian patients were the most likely to receive an opioid prescription.
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Affiliation(s)
- Aksharananda Rambachan
- Division of Hospital MedicineUniversity of California, San Francisco, San Francisco, California
- Corresponding Author: Aksharananda Rambachan, MD, MPH;
| | - Margaret C Fang
- Division of Hospital MedicineUniversity of California, San Francisco, San Francisco, California
| | - Priya Prasad
- Division of Hospital MedicineUniversity of California, San Francisco, San Francisco, California
| | - Nicholas Iverson
- Division of Hospital Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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Ling EJ, Frean M, So J, Tietschert M, Song N, Covington C, Bahadurazada H, Khurana S, Garcia L, Singer SJ. Differences in patient perceptions of integrated care among black, hispanic, and white Medicare beneficiaries. Health Serv Res 2021; 56:507-516. [PMID: 33569775 PMCID: PMC8143676 DOI: 10.1111/1475-6773.13637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE This study sought to identify potential disparities among racial/ethnic groups in patient perceptions of integrated care (PPIC) and to explore how methodological differences may influence measured disparities. DATA SOURCE Data from Medicare beneficiaries who completed the 2015 Medicare Current Beneficiary Survey (MCBS) and were enrolled in Part A benefits for an entire year. STUDY DESIGN We used 4-point measures of eight dimensions of PPIC and assessed differences in dimensions among racial/ethnic groups. To estimate differences, we applied a "rank and replace" method using multiple regression models in three steps, balancing differences in health status among racial groups and adjusting for differences in socioeconomic status. We reran all analyses with additional SES controls and using standard multiple variable regression. DATA COLLECTION/EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS We found several significant differences in perceived integrated care between Black versus White (three of eight measures) and Hispanic versus White (one of eight) Medicare beneficiaries. On average, Black beneficiaries perceived more integrated support for self-care than did White beneficiaries (mean difference = 0.14, SE = 0.06, P =.02). Black beneficiaries perceived more integrated specialists' knowledge of past medical history than did White beneficiaries (mean difference = 0.12, SE = 0.06, P =.01). Black and Hispanic beneficiaries also each reported, on average, 0.18 more integrated medication and home health management than did White beneficiaries (P <.01 and P <.01). These findings were robust to sensitivity analyses and model specifications. CONCLUSIONS There exist some aspects of care for which Black and Hispanic beneficiaries may perceive greater integrated care than non-Hispanic White beneficiaries. Further studies should test theories explaining why racial/ethnic groups perceive differences in integrated care.
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Affiliation(s)
- Emilia J. Ling
- Stanford University School of MedicineStanfordCaliforniaUSA
| | - Molly Frean
- The Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jody So
- Stanford University School of MedicineStanfordCaliforniaUSA
| | | | - Nancy Song
- Stanford University School of MedicineStanfordCaliforniaUSA
| | | | | | - Sonia Khurana
- Department of HumanitiesYale UniversityNew HavenConnecticutUSA
| | - Luis Garcia
- Stanford University School of MedicineStanfordCaliforniaUSA
| | - Sara J. Singer
- Stanford University School of MedicineStanfordCaliforniaUSA
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Opara I, Lardier DT, Durkee MI, Garcia-Reid P, Reid RJ. Ethnic Identity as a Moderator Between HIV Knowledge, Viral Hepatitis Knowledge, and Psychological Antecedents Among Racial-Ethnic Minority Youth Living in an Urban Community. J Racial Ethn Health Disparities 2021; 9:1298-1307. [PMID: 34041704 DOI: 10.1007/s40615-021-01069-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/27/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
Racial-ethnic minority youth between the ages of 13 and 24 in the USA are disproportionately impacted by HIV. Low HIV knowledge and psychological antecedents such as low perception of risk and low sexual negotiation skills have all been associated with HIV risk behaviors; however, the role of ethnic identity on these factors is unclear in the literature. Ethnic identity, which is a critical part of identity development among racial-ethnic minority youth, has been found to be a protective factor in risk-taking behaviors. However, limited research is available on the role of ethnic identity in HIV prevention research among youth. For this study, data were collected as part of a larger HIV prevention education program using a sample of 564 students of color (Meanage = 16.30, standard deviation [SD] = 1.26; 67.4% Hispanic, 29.5% Black) from an underserved northeastern US urban community. We examined whether ethnic identity moderated the relationship between psychological antecedents (e.g., perception of risk and sexual negotiation skills), gender, and viral hepatitis knowledge on HIV knowledge. Findings revealed that ethnic identity significantly moderated the relationship between psychological antecedent variables and HIV knowledge by strengthening these associations as ethnic identity increased. Female adolescents were also more likely to have higher levels of HIV knowledge than males. Findings provide support for cultural and gender-specific prevention programs for racial-ethnic minority youth that seek to reduce HIV risk behaviors by increasing ethnic identity, particularly in under-resourced communities.
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Affiliation(s)
- Ijeoma Opara
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT, USA.
| | - David T Lardier
- Department of Individual, Family, and Community Studies, University of New Mexico, Albuquerque, NM, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Myles I Durkee
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Pauline Garcia-Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
| | - Robert J Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
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14
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Bond KT, Chandler R, Chapman-Lambert C, Jemmott LS, Lanier Y, Cao J, Nikpour J, Randolph SD. Applying a Nursing Perspective to Address the Challenges Experienced by Cisgender Women in the HIV Status Neutral Care Continuum: A Review of the Literature. J Assoc Nurses AIDS Care 2021; 32:283-305. [PMID: 33929979 PMCID: PMC10688540 DOI: 10.1097/jnc.0000000000000243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The field of HIV research has grown over the past 40 years, but there remains an urgent need to address challenges that cisgender women living in the United States experience in the HIV neutral status care continuum, particularly among women such as Black women, who continue to be disproportionately burdened by HIV due to multiple levels of systemic oppression. We used a social ecological framework to provide a detailed review of the risk factors that drive the women's HIV epidemic. By presenting examples of effective approaches, best clinical practices, and identifying existing research gaps in three major categories (behavioral, biomedical, and structural), we provide an overview of the current state of research on HIV prevention among women. To illustrate a nursing viewpoint and take into account the diverse life experiences of women, we provide guidance to strengthen current HIV prevention programs. Future research should examine combined approaches for HIV prevention, and policies should be tailored to ensure that women receive effective services that are evidence-based and which they perceive as important to their lives.
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Affiliation(s)
- Keosha T Bond
- Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Rasheeta Chandler, PhD, RN, FNP-BC, FAANP, FAAN, is an Assistant Professor, School of Nursing, Emory University, Atlanta, Georgia, USA. Crystal Chapman-Lambert, PhD, CRNP, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Loretta Sweet Jemmott, PhD, RN, is Vice President, Health and Health Equity, and Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Yzette Lanier, PhD, is an Assistant Professor, School of Nursing, New York University, New York, New York, USA. Jiepin Cao, MS, RN, is a Graduate Student, School of Nursing, Duke University, Durham, North Carolina, USA. Jacqueline Nikpour, BSN, RN, is a Graduate Student, School of Nursing, Duke University, Durham, North Carolina, USA. Schenita D. Randolph, PhD, MPH, RN, CNE, is an Assistant Professor, School of Nursing, and Co-director, Community Engagement Core, Duke Center for Research to Advance Healthcare Equity (REACH Equity), Duke University, Durham, North Carolina, USA
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15
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Jimenez T, Restar A, Helm PJ, Cross RI, Barath D, Arndt J. Fatalism in the context of COVID-19: Perceiving coronavirus as a death sentence predicts reluctance to perform recommended preventive behaviors. SSM Popul Health 2020; 11:100615. [PMID: 32572381 PMCID: PMC7278631 DOI: 10.1016/j.ssmph.2020.100615] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/05/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022] Open
Abstract
To manage the spread of coronavirus, health entities have urged the public to take preventive measures such as social distancing and handwashing. Yet, many appear reluctant to take these measures. Research is needed to understand factors underlying such reluctance, with the aim of developing targeted health interventions. We identify associating coronavirus with death as one such factor. 590 participants completed surveys in mid-March 2020, which included attitudes toward coronavirus, preventive behavioral intentions, and sociodemographic factors. Associating coronavirus with death negatively predicted intentions to perform preventive behaviors. Further, associating coronavirus with death was not evenly distributed throughout the sample and was related with a number of sociodemographic factors including age, race, and availability of sick leave. Following recommended preventive measures to slow the spread of coronavirus appears to relate to the degree to which people associate coronavirus with death. These findings can be used by public health researchers and practitioners to identify those for whom targeted health communication and interventions would be most beneficial, as well as to frame health messaging in ways that combat fatalism.
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Affiliation(s)
- Tyler Jimenez
- Department of Psychological Sciences, University of Missouri-Columbia, 210 McAlester Hall, Columbia, MO, 65211, USA
| | - Arjee Restar
- Departments of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main St, Providence, RI, 02903, USA
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Peter J. Helm
- Department of Psychological Sciences, University of Missouri-Columbia, 210 McAlester Hall, Columbia, MO, 65211, USA
| | - Rebekah Israel Cross
- Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
| | - Deanna Barath
- Department of Health Policy and Management, University of Maryland-College Park, 4200 Valley Dr, College Park, MD, 20742, USA
| | - Jamie Arndt
- Department of Psychological Sciences, University of Missouri-Columbia, 210 McAlester Hall, Columbia, MO, 65211, USA
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16
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Taylor TN, DeHovitz J, Hirshfield S. Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean. Front Public Health 2020; 7:373. [PMID: 31998675 PMCID: PMC6965168 DOI: 10.3389/fpubh.2019.00373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 11/21/2019] [Indexed: 01/08/2023] Open
Abstract
Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.
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Affiliation(s)
- Tonya N. Taylor
- SUNY Downstate Health Sciences University, Brooklyn, NY, United States
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17
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The Portuguese Version of the Schedule of Racist Events. J Racial Ethn Health Disparities 2019; 7:162-168. [PMID: 31741217 DOI: 10.1007/s40615-019-00645-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE There is a lack of research tools in Portuguese to evaluate racial discrimination. The purpose of this study was to psychometrically assess the Portuguese version of the Schedule of Racist Events (SRE) in a sample of individuals enrolled in a research trial with antiretroviral medications in southern Brazil. METHODS Sample of 147 individuals living with HIV and/or AIDS. Research participants completed the Schedule of Racist Events and the WHOQOL-HIV BREF questionnaires. RESULTS The SRE scores of non-white participants were significantly higher than the scores of white-participants. The Crombach's alpha coefficients, for the three subscales of the Portuguese version of the SRE, were high and significant. There were significant correlations between all subscales of the SRE and relevant domains of the WHOQOL-HIV BREF. CONCLUSION The original English version of the SRE was successfully adapted to Portuguese. The Portuguese version of SRE constitutes a valid research instrument for evaluating racial discrimination.
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18
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Mauck DE, Sheehan DM, Fennie KP, Maddox LM, Trepka MJ. Role of Gay Neighborhood Status and Other Neighborhood Factors in Racial/Ethnic Disparities in Retention in Care and Viral Load Suppression Among Men Who Have Sex with Men, Florida, 2015. AIDS Behav 2018; 22:2978-2993. [PMID: 29372456 PMCID: PMC6060015 DOI: 10.1007/s10461-018-2032-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study's objective was to examine the role of gay neighborhood residence and other neighborhood factors in racial/ethnic disparities in retention in HIV care and viral load suppression during 2015. Florida residents diagnosed 2000-2014 with HIV infection and with transmission mode of men who have sex with men (MSM) were included in multi-level logistic regression models. Of 29,156 MSM, 29.4% were not retained and 34.2% were not virally suppressed. Non-Hispanic Blacks (NHB) had a higher likelihood of not being retained (adjusted prevalence ratio [aPR] 1.31, 95% confidence interval [CI] 1.24-1.38, p value < 0.0001) and not being virally suppressed (aPR 1.82, 95% CI 1.67-1.98, p value < 0.0001) compared with non-Hispanic Whites. Among NHBs, rural residence was protective for both outcomes. Although gay neighborhood residence was not associated with either outcome, the role of other neighborhood factors suggests that individual and neighborhood barriers to HIV care and treatment should be addressed among MSM.
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Affiliation(s)
- Daniel E Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Lorene M Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 487, Miami, FL, 33199, USA.
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19
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Fan H, Fife KH, Cox D, Cox AD, Zimet GD. Behavior and health beliefs as predictors of HIV testing among women: a prospective study of observed HIV testing. AIDS Care 2018; 30:1062-1069. [PMID: 29466877 PMCID: PMC6143364 DOI: 10.1080/09540121.2018.1442555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Much of the research examining predictors of HIV testing has used retrospective self-report to assess HIV testing. FINDINGS therefore, may be subject to recall bias and to difficulties determining the direction of associations. In this prospective study, we administered surveys to women in community clinics to identify predictors of subsequent observed HIV testing, overcoming these limitations. Eighty-three percent were tested. In the adjusted multivariable model, being born in the U.S., perceived benefits of testing, worries about being infected with HIV, having had more than 15 lifetime sexual partners, and having had one or more casual sexual partners in the previous three months predicted acceptance of testing. Perceived obstacles to testing predicted non-acceptance. Those who had never been tested for HIV and those tested two to five years previously had greater odds of test acceptance than those who had been tested within the last year. The findings from this study with observed testing as the outcome, confirm some of the results from retrospective, self-report studies. Participants made largely rational decisions about testing, reflecting assessments of their risk and their history of HIV testing. Health beliefs are potentially modifiable through behavioral intervention, and such interventions might result in greater acceptance of testing. ABBREVIATIONS HIV: human immunodeficiency virus; AIDS: acquired immune deficiency syndrome; CDC: Centers for Disease Control and Prevention; ACASI: audio computer-assisted self-interview; TRA: theory of reasoned action; HBM: Health Belief Model; STI: sexually transmitted infection; STD: Sexually Transmitted Disease; AOR: adjusted odds ratio; CI: confidence interval.
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Affiliation(s)
- Hao Fan
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Kenneth H. Fife
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dena Cox
- Department of Marketing, Kelley School of Business, Indiana University, Indianapolis, IN, USA
| | - Anthony D. Cox
- Department of Marketing, Kelley School of Business, Indiana University, Indianapolis, IN, USA
| | - Gregory D. Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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20
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Doll KM, Snyder CR, Ford CL. Endometrial cancer disparities: a race-conscious critique of the literature. Am J Obstet Gynecol 2018; 218:474-482.e2. [PMID: 28964822 DOI: 10.1016/j.ajog.2017.09.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/17/2017] [Accepted: 09/18/2017] [Indexed: 12/31/2022]
Abstract
Racial disparities in endometrial cancer are stark and have increased over the past decade. While the disparities are well documented, intervention work to address the mortality gap is nonexistent. This review critiques how race has been conceptualized to explain the causes of endometrial cancer disparities, assesses gaps in knowledge production, and proposes new research priorities. Using public health critical race praxis, a research approach for examining racial disparities and knowledge production processes, we reviewed the endometrial cancer disparities literature from 1995 through 2016. Using systematic search methods, 133 unique records were identified and 48 studies critiqued. We found that a narrow definition of race as a purely biological construct is common throughout the literature. This appears to result in an underemphasis on the role of modifiable, nonbiological contributors to racial disparities and a lack of follow-up work to address these contributors. Key knowledge gaps identified were the role of health care systems in early diagnosis, a lack of intervention studies to address persistent treatment inequity by race, and the near absence of qualitative work to understand the perspectives of Black women diagnosed with endometrial cancer. We conclude with an iterative demonstration of the public health critical race praxis and suggest new routes of inquiry to broaden the scope of research priorities to understand and improve the outcomes of Black women with endometrial cancer.
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21
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Ben J, Cormack D, Harris R, Paradies Y. Racism and health service utilisation: A systematic review and meta-analysis. PLoS One 2017; 12:e0189900. [PMID: 29253855 PMCID: PMC5734775 DOI: 10.1371/journal.pone.0189900] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/04/2017] [Indexed: 11/18/2022] Open
Abstract
Although racism has been posited as driver of racial/ethnic inequities in healthcare, the relationship between racism and health service use and experience has yet to be systematically reviewed or meta-analysed. This paper presents a systematic review and meta-analysis of quantitative empirical studies that report associations between self-reported racism and various measures of healthcare service utilisation. Data were reviewed and extracted from 83 papers reporting 70 studies. Studies included 250,850 participants and were conducted predominately in the U.S. The meta-analysis included 59 papers reporting 52 studies, which were analysed using random effects models and mean weighted effect sizes. Racism was associated with more negative patient experiences of health services (HSU-E) (OR = 0.351 (95% CI [0.236,0.521], k = 19), including lower levels of healthcare-related trust, satisfaction, and communication. Racism was not associated with health service use (HSU-U) as an outcome group, and was not associated with most individual HSU-U outcomes, including having had examinations, health service visits and admissions to health professionals and services. Racism was associated with health service use outcomes such as delaying/not getting healthcare, and lack of adherence to treatment uptake, although these effects may be influenced by a small sample of studies, and publication bias, respectively. Limitations to the literature reviewed in terms of study designs, sampling methods and measurements are discussed along with suggested future directions in the field.
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Affiliation(s)
- Jehonathan Ben
- Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
| | - Donna Cormack
- Eru Pōmare Māori Health Research Centre, Department of Public Health, University of Otago, Wellington South, New Zealand
| | - Ricci Harris
- Eru Pōmare Māori Health Research Centre, Department of Public Health, University of Otago, Wellington South, New Zealand
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
- * E-mail:
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22
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Crawford ND, Ford C, Rudolph A, Kim B, Lewis CM. Drug use Discrimination Predicts Formation of High-Risk Social Networks: Examining Social Pathways of Discrimination. AIDS Behav 2017; 21:2659-2669. [PMID: 28025736 DOI: 10.1007/s10461-016-1639-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Experiences of discrimination, or social marginalization and ostracism, may lead to the formation of social networks characterized by inequality. For example, those who experience discrimination may be more likely to develop drug use and sexual partnerships with others who are at increased risk for HIV compared to those without experiences of discrimination. This is critical as engaging in risk behaviors with others who are more likely to be HIV positive can increase one's risk of HIV. We used log-binomial regression models to examine the relationship between drug use, racial and incarceration discrimination with changes in the composition of one's risk network among 502 persons who use drugs. We examined both absolute and proportional changes with respect to sex partners, drug use partners, and injecting partners, after accounting for individual risk behaviors. At baseline, participants were predominately male (70%), black or Latino (91%), un-married (85%), and used crack (64%). Among those followed-up (67%), having experienced discrimination due to drug use was significantly related to increases in the absolute number of sex networks and drug networks over time. No types of discrimination were related to changes in the proportion of high-risk network members. Discrimination may increase one's risk of HIV acquisition by leading them to preferentially form risk relationships with higher-risk individuals, thereby perpetuating racial and ethnic inequities in HIV. Future social network studies and behavioral interventions should consider whether social discrimination plays a role in HIV transmission.
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Affiliation(s)
- Natalie D Crawford
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
| | - Chandra Ford
- Department of Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Abby Rudolph
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - BoRin Kim
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Crystal M Lewis
- Division of Social Solutions and Services Research, Nathan Kline Institute for Psychiatric Research, New York State Office of Mental Health, Latham, NY, USA
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HIV and STIs Among MSM in Tajikistan: Laboratory-Confirmed Diagnoses and Self-Reported Testing Behaviors. AIDS Behav 2016; 20:341-349. [PMID: 27307182 DOI: 10.1007/s10461-016-1457-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Little is known about the prevalence and associations of HIV/STI diagnoses and testing behaviors among men who have sex with men (MSM) in Tajikistan. A non-governmental organization conducted a cross-sectional study of MSM (n = 502) assessing laboratory-confirmed HIV/STI diagnoses, HIV/STI testing behavior in the past 6 months, sociodemographics, HIV/STI risk factors, and victimization/discrimination. Overall, 2.6 % were diagnosed with HIV, 2.2 % with syphilis, 17.6 % with chlamydia, and 56.0 % with herpes. Recent testing rates were low for HIV (35.9 %) and STIs (14.1 %). Compared to MSM who completed university, MSM with a high school education or less had lower odds of recent HIV and STI testing; however, victimization and healthcare discrimination were associated with greater odds of recent STI testing. Given the low HIV prevalence, there is a window of opportunity to extinguish the epidemic before it worsens. Non-governmental organizations are indispensable for expanding testing strategies because they can efficiently reach MSM in Tajikistan.
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Ransome Y, Kawachi I, Braunstein S, Nash D. Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing. Health Place 2016; 42:148-158. [PMID: 27770671 PMCID: PMC5584790 DOI: 10.1016/j.healthplace.2016.09.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/29/2016] [Accepted: 09/26/2016] [Indexed: 01/14/2023]
Abstract
In the United States, research is limited on the mechanisms that link socioeconomic and structural factors to HIV diagnosis outcomes. We tested whether neighborhood income inequality, socioeconomic deprivation, and black racial concentration were associated with gender-specific rates of HIV in the advanced stages of AIDS (i.e., late HIV diagnosis). We then examined whether HIV testing prevalence and accessibility mediated any of the associations above. Neighborhoods with highest (relative to lowest) black racial concentration had higher relative risk of late HIV diagnosis among men (RR=1.86; 95%CI=1.15, 3.00) and women (RR=5.37; 95%CI=3.16, 10.43) independent of income inequality and socioeconomic deprivation. HIV testing prevalence and accessibility did not significantly mediate the associations above. Research should focus on mechanisms that link black racial concentration to HIV diagnosis outcomes.
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Affiliation(s)
- Yusuf Ransome
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Denis Nash
- City University of New York (CUNY) Institute for Implementation Science in Population Health, NY, USA
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Blackmon SM, Coyle LD, Davenport S, Owens AC, Sparrow C. Linking Racial-Ethnic Socialization to Culture and Race-Specific Coping Among African American College Students. JOURNAL OF BLACK PSYCHOLOGY 2016. [DOI: 10.1177/0095798415617865] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In addition to the use of coping strategies generally shared by all Americans, research has shown that African Americans tend to make use of culture and race-specific coping styles that distinguish them from other racial/ethnic group populations. These coping styles are important for the negotiation of multiple types of stressors. Little has been written on the antecedents of culture and race-specific coping (i.e., Africultural coping and John Henryism). This exploratory online investigation sought to determine if childhood racial-ethnic socialization (i.e., a cultural practice and protective factor) experiences predicted present self-reported culture and race-specific coping among a group of African American college students ( N = 191). Results indicated that past racial socialization messages encouraging participants to engage in positive cross-racial interactions (i.e., cross-racial relationship messages) were positively predictive of spiritual-centered and collective coping. Racial socialization messages that prescribed how participants should cope with racism were negatively associated with prolonged, active high-effort coping (i.e., John Henryism). Ethnic socialization messages emphasizing participation in African American cultural activities (i.e., African American heritage messages) positively predicted spiritual-centered, collective, and ritual-centered coping. Finally, ethnic socialization messages encouraging participants to have respect for authority figures, retain close relationships with family members, and maintain a collectivistic orientation (i.e., African American cultural values messages) were negatively predictive of John Henryism. Taken together, childhood racial-ethnic socialization experiences are an important resource for coping during college.
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Evangeli M, Pady K, Wroe AL. Which Psychological Factors are Related to HIV Testing? A Quantitative Systematic Review of Global Studies. AIDS Behav 2016; 20:880-918. [PMID: 26566783 PMCID: PMC4799267 DOI: 10.1007/s10461-015-1246-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Deciding to test for HIV is necessary for receiving HIV treatment and care among those who are HIV-positive. This article presents a systematic review of quantitative studies on relationships between psychological (cognitive and affective) variables and HIV testing. Sixty two studies were included (fifty six cross sectional). Most measured lifetime testing. HIV knowledge, risk perception and stigma were the most commonly measured psychological variables. Meta-analysis was carried out on the relationships between HIV knowledge and testing, and HIV risk perception and testing. Both relationships were positive and significant, representing small effects (HIV knowledge, d = 0.22, 95 % CI 0.14-0.31, p < 0.001; HIV risk perception, OR 1.47, 95 % CI 1.26-1.67, p < 0.001). Other variables with a majority of studies showing a relationship with HIV testing included: perceived testing benefits, testing fear, perceived behavioural control/self-efficacy, knowledge of testing sites, prejudiced attitudes towards people living with HIV, and knowing someone with HIV. Research and practice implications are outlined.
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Affiliation(s)
- Michael Evangeli
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK.
| | - Kirsten Pady
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| | - Abigail L Wroe
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
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Scott HM, Irvin R, Wilton L, Van Tieu H, Watson C, Magnus M, Chen I, Gaydos C, Hussen SA, Mannheimer S, Mayer K, Hessol NA, Buchbinder S. Sexual Behavior and Network Characteristics and Their Association with Bacterial Sexually Transmitted Infections among Black Men Who Have Sex with Men in the United States. PLoS One 2015; 10:e0146025. [PMID: 26720332 PMCID: PMC4697821 DOI: 10.1371/journal.pone.0146025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/12/2015] [Indexed: 11/26/2022] Open
Abstract
Background Black men who have sex with men (MSM) have a high prevalence of bacterial sexually transmitted infections (STIs), and individual risk behavior does not fully explain the higher prevalence when compared with other MSM. Using the social-ecological framework, we evaluated individual, social and sexual network, and structural factors and their association with prevalent STIs among Black MSM. Methods The HIV Prevention Trials Network 061 was a multi-site cohort study designed to determine the feasibility and acceptability of a multi-component intervention for Black MSM in six US cities. Baseline assessments included demographics, risk behavior, and social and sexual network questions collected information about the size, nature and connectedness of their sexual network. Logistic regression was used to estimate the odds of having any prevalent sexually transmitted infection (gonorrhea, chlamydia, or syphilis). Results A total of 1,553 Black MSM were enrolled in this study. In multivariate analysis, older age (aOR = 0.57; 95% CI 0.49–0.66, p<0.001) was associated with a lower odds of having a prevalent STI. Compared with reporting one male sexual partner, having 2–3 partners (aOR = 1.74; 95% CI 1.08–2.81, p<0.024) or more than 4 partners (aOR = 2.29; 95% CI 1.43–3.66, p<0.001) was associated with prevalent STIs. Having both Black and non-Black sexual partners (aOR = 0.67; 95% CI 0.45–0.99, p = 0.042) was the only sexual network factor associated with prevalent STIs. Conclusions Age and the number and racial composition of sexual partners were associated with prevalent STIs among Black MSM, while other sexual network factors were not. Further studies are needed to evaluate the effects of the individual, network, and structural factors on prevalent STIs among Black MSM to inform combination interventions to reduce STIs among these men.
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Affiliation(s)
- Hyman M. Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, California, United States of America
- * E-mail:
| | - Risha Irvin
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, New York, United States of America
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Hong Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
- Division of Infectious Diseases, Columbia University Medical Center, New York, New York, United States of America
| | - Chauncey Watson
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, United States of America
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, United States of America
| | - Iris Chen
- Department of Pathology, John Hopkins University, Baltimore, Maryland, United States of America
| | - Charlotte Gaydos
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sophia A. Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Sharon Mannheimer
- Department of Medicine, Harlem Hospital, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Kenneth Mayer
- Fenway Institute, Boston, Massachusetts, United States of America
| | - Nancy A. Hessol
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, United States of America
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, California, United States of America
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Ford CL, Mulatu MS, Godette DC, Gaines TL. Trends in HIV Testing Among U.S. Older Adults Prior to and Since Release of CDC's Routine HIV Testing Recommendations: National Findings from the BRFSS. Public Health Rep 2015; 130:514-25. [PMID: 26327729 PMCID: PMC4529835 DOI: 10.1177/003335491513000514] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study examined temporal trends in HIV testing among U.S. older adults (50-64 years of age) before and after the release of CDC's routine HIV testing recommendations in 2006. METHODS The sample (n=872,797; 51.4% female) comprised 2003-2010 Behavioral Risk Factor Surveillance System respondents in the oldest categories to which the recommendations apply: 50-54 years (34.5%, n=301,519), 55-59 years (34.1%, n=297,865), and 60-64 years (31.3%, n=273,413). We calculated (1) four-year pooled prevalences of past-year HIV testing before and after 2006, when the recommendations were released; and (2) annual prevalences of HIV testing overall and by age category from 2003-2010. Using weighted, multivariable logistic regression analyses, we examined binary (pre- vs. post-recommendations) and annual changes in testing, controlling for covariates. We stratified the data by recent doctor visits, examined racial/ethnic differences, and tested for linear and quadratic temporal trends. RESULTS Overall and within age categories, the pooled prevalence of past-year HIV testing decreased following release of the recommendations (p<0.001). The annual prevalence decreased monotonically from 2003 (5.5%) to 2006 (3.6%) (b=-0.16, p<0.001) and then increased immediately after release of the recommendations, but decreased to 3.7% after 2009 (b=0.01, p<0.001). By race/ethnicity, testing increased over time among non-Hispanic black people only. Annual prevalence also increased among respondents with recent doctor visits. CONCLUSION CDC's HIV testing recommendations were associated with a reversal in the downward trend in past-year HIV testing among older adults; however, the gains were neither universal nor sustained over time.
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Affiliation(s)
- Chandra L. Ford
- University of California at Los Angeles, Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA
| | - Mesfin S. Mulatu
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Dionne C. Godette
- National Institutes of Health, National Institute of Alcohol Abuse and Alcoholism, Division of Epidemiology and Prevention Research, Rockville, MD
| | - Tommi L. Gaines
- University of California at San Diego, Division of Global Public Health, Department of Medicine, San Diego, CA
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Lucas T, Hayman LW, Blessman JE, Asabigi K, Novak JM. Gain versus loss-framed messaging and colorectal cancer screening among African Americans: A preliminary examination of perceived racism and culturally targeted dual messaging. Br J Health Psychol 2015; 21:249-67. [DOI: 10.1111/bjhp.12160] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 07/23/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Todd Lucas
- Department of Family Medicine and Public Health Sciences; Wayne State University; Detroit Michigan USA
- Department of Psychology; Wayne State University; Detroit Michigan USA
| | - Lenwood W. Hayman
- Department of Family Medicine and Public Health Sciences; Wayne State University; Detroit Michigan USA
| | - James E. Blessman
- Department of Family Medicine and Public Health Sciences; Wayne State University; Detroit Michigan USA
- Department of Health and Wellness Promotion; City of Detroit; Michigan USA
| | - Kanzoni Asabigi
- Department of Health and Wellness Promotion; City of Detroit; Michigan USA
| | - Julie M. Novak
- Department of Communication; Wayne State University; Detroit Michigan USA
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Bond KT, Frye V, Taylor R, Williams K, Bonner S, Lucy D, Cupid M, Weiss L, Koblin BA. Knowing is not enough: a qualitative report on HIV testing among heterosexual African-American men. AIDS Care 2014; 27:182-8. [PMID: 25298014 DOI: 10.1080/09540121.2014.963009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite having higher rates of HIV testing than all other racial groups, African-Americans continue to be disproportionately affected by the HIV epidemic in the United States. Knowing one's status is the key step to maintaining behavioral changes that could stop the spread of the virus, yet little is known about the individual- and socio-structural-level barriers associated with HIV testing and communication among heterosexual African-American men. To address this and inform the development of an HIV prevention behavioral intervention for heterosexual African-American men, we conducted computerized, structured interviews with 61 men, focus group interviews with 25 men in 5 different groups, and in-depth qualitative interviews with 30 men living in high HIV prevalence neighborhoods in New York City. Results revealed that HIV testing was frequent among the participants. Even with high rates of testing, the men in the study had low levels of HIV knowledge; perceived little risk of HIV; and misused HIV testing as a prevention method. Factors affecting HIV testing, included stigma, relationship dynamics and communication, and societal influences, suggesting that fear, low perception of risk, and HIV stigma may be the biggest barriers to HIV testing. These results also suggest that interventions directed toward African-American heterosexual men must address the use of "testing as prevention" as well as correct misunderstandings of the window period and the meaning of HIV test results, and interventions should focus on communicating about HIV.
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Affiliation(s)
- Keosha T Bond
- a Department of Health and Behaviors Studies , Teachers College Columbia University , New York , NY , USA
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Scott HM, Pollack L, Rebchook GM, Huebner DM, Peterson J, Kegeles SM. Peer social support is associated with recent HIV testing among young black men who have sex with men. AIDS Behav 2014; 18:913-20. [PMID: 24065436 DOI: 10.1007/s10461-013-0608-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Resiliency factors such as social support have been associated with more frequent HIV testing among MSM. We examined the association between social support and delayed HIV testing in the context of structural discrimination and individual factors among young Black MSM. We combined two independent cross-sectional samples recruited 1 year apart from a venue-based, modified time-location sampling study of young Black MSM aged 18-29 years in the US South. Our subsample (N = 813) was men who self-reported not being HIV positive and who indicated they had one or more male sex partners in the past 2 months. Using a social epidemiology framework we estimated associations of structural (racism and homophobia), social (social support from other Black MSM friends) and individual factors with delayed HIV testing (>6 months ago) using logistic regression. Bivariate analyses demonstrated that individual level variables as well as experiences of racism (OR 1.20, 95% CI 1.02-1.41) and homophobia (OR 1.49, 95 % CI 1.02-2.17) were associated with higher risk of delayed HIV testing. Receiving social support from other Black MSM friends was associated with lower risk of delayed HIV testing (OR 0.80, 95 % CI 0.67-0.95). In multivariable models, social support remained significantly associated with lower risk of delayed HIV testing after inclusion of structural and individual level variables. Social support has a positive and robust association with HIV testing among young Black MSM. Whether community building and development of resiliency factors can overcome structural, social, and individual-level barriers to HIV prevention and care for young Black MSM warrants further study.
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Affiliation(s)
- Hyman M Scott
- Center for AIDS Prevention Studies, University of California, 50 Beale Street Suite 1300, San Francisco, CA, 94105, USA,
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Shacham E, Lian M, Önen NF, Donovan M, Overton ET. Are neighborhood conditions associated with HIV management? HIV Med 2013; 14:624-32. [PMID: 23890194 DOI: 10.1111/hiv.12067] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES HIV infection has become a manageable chronic disease as a result of treatment advances. Secondary prevention efforts have proved inadequate to reduce the estimated incidence of new HIV infections. Epidemiological data suggest that geographical clustering of new HIV infections is a common phenomenon, particularly in urban areas among populations of low socioeconomic status. This study aimed to assess the relationship between neighbourhood conditions and HIV management and engagement in high-risk behaviours. METHODS During routine out-patient HIV clinic visits, 762 individuals from the St Louis metropolitan area completed behavioural assessments in 2008. Biomedical markers were abstracted from their medical records. Multi-level analyses were conducted based on individuals' census tracts. RESULTS The majority of the sample were male and African American. In the adjusted models, individuals residing in neighbourhoods with higher poverty rates were more likely to have lower CD4 cell counts and be current smokers. In neighbourhoods with higher rates of unemployment, individuals were less likely to have a current antiretroviral prescription. In more racially segregated neighbourhoods, individuals reported more depressive symptoms. CONCLUSIONS Despite the advances in HIV disease management, neighbourhood characteristics contribute to disparities in HIV care. Interventions that address neighbourhood conditions as barriers to HIV management may provide improved health outcomes.
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Affiliation(s)
- E Shacham
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
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Latkin CA, German D, Vlahov D, Galea S. Neighborhoods and HIV: a social ecological approach to prevention and care. AMERICAN PSYCHOLOGIST 2013; 68:210-24. [PMID: 23688089 PMCID: PMC3717355 DOI: 10.1037/a0032704] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neighborhood factors have been linked to HIV risk behaviors, HIV counseling and testing, and HIV medical care. However, the social-psychological mechanisms that connect neighborhood factors to HIV-related behaviors have not been fully determined. In this article we review the research on neighborhood factors and HIV-related behaviors, approaches to measuring neighborhoods, and mechanisms that may help to explain how the physical and social environment within neighborhoods may lead to HIV-related behaviors. We then discuss organizational, geographic, and social network approaches to intervening in neighborhoods to reduce HIV transmission and facilitate HIV medical care with the goal of reducing morbidity and mortality and increasing social and psychological well-being.
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Affiliation(s)
- Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Ford CL, Wallace SP, Newman PA, Lee SJ, Cunningham WE. Belief in AIDS-related conspiracy theories and mistrust in the government: relationship with HIV testing among at-risk older adults. THE GERONTOLOGIST 2013; 53:973-84. [PMID: 23362210 DOI: 10.1093/geront/gns192] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE One in 4 persons living with HIV/AIDS is an older adult (age 50 or older); unfortunately, older adults are disproportionately diagnosed in late stages of HIV disease. Psychological barriers, including belief in AIDS-related conspiracy theories (e.g., HIV was created to eliminate certain groups) and mistrust in the government, may influence whether adults undergo HIV testing. We examined relationships between these factors and recent HIV testing among at-risk, older adults. DESIGN AND METHODS This was a cross-sectional study among older adults enrolled in a large venue-based study. None had a previous diagnosis of HIV/AIDS; all were seeking care at venues with high HIV prevalence. We used multiple logistic regression to estimate the associations between self-reported belief in AIDS-related conspiracy theories, mistrust in the government, and HIV testing performed within the past 12 months. RESULTS Among the 226 participants, 30% reported belief in AIDS conspiracy theories, 72% reported government mistrust, and 45% reported not undergoing HIV testing within the past 12 months. Belief in conspiracy theories was positively associated with recent HIV testing (adjusted odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.05-3.60), whereas mistrust in the government was negatively associated with testing (OR = 0.43, 95% CI = 0.26-0.73). IMPLICATIONS Psychological barriers are prevalent among at-risk older adults seeking services at venues with high HIV prevalences and may influence HIV testing. Identifying particular sources of misinformation and mistrust would appear useful for appropriate targeting of HIV testing strategies.
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Affiliation(s)
- Chandra L Ford
- *Address correspondence to Chandra L. Ford, MLIS, Department of Community Health Sciences, Box 951772, UCLA Fielding School of Public Health, 650 Charles E. Young Dr., South, Los Angeles, CA 90095-1772. E-mail:
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Tobler AL, Maldonado-Molina MM, Staras SAS, O'Mara RJ, Livingston MD, Komro KA. Perceived racial/ethnic discrimination, problem behaviors, and mental health among minority urban youth. ETHNICITY & HEALTH 2012; 18:337-49. [PMID: 23043428 PMCID: PMC3914714 DOI: 10.1080/13557858.2012.730609] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES We examined perceived frequency and intensity of racial/ethnic discrimination and associations with high-risk behaviors/conditions among adolescents. DESIGN With surveys from 2490 racial/ethnic minority adolescents primarily with low socioeconomic status, we used regression analysis to examine associations between racial/ethnic discrimination and behavioral health outcomes (alcohol use, marijuana use, physical aggression, delinquency, victimization, depression, suicidal ideation, and sexual behaviors). RESULTS Most adolescents (73%) experienced racial/ethnic discrimination and 42% of experiences were 'somewhat-' or 'very disturbing.' Adolescents reporting frequent and disturbing racial/ethnic discrimination were at increased risk of all measured behaviors, except alcohol and marijuana use. Adolescents who experienced any racial/ethnic discrimination were at increased risk for victimization and depression. Regardless of intensity, adolescents who experienced racial/ethnic discrimination at least occasionally were more likely to report greater physical aggression, delinquency, suicidal ideation, younger age at first oral sex, unprotected sex during last intercourse, and more lifetime sexual partners. CONCLUSION Most adolescents had experienced racial/ethnic discrimination due to their race/ethnicity. Even occasional experiences of racial/ethnic discrimination likely contribute to maladaptive behavioral and mental health outcomes among adolescents. Prevention and coping strategies are important targets for intervention.
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Affiliation(s)
- Amy L Tobler
- College of Medicine, Department of Health Outcomes and Policy, Institute for Child Health Policy, University of Florida, Gainesville, FL, USA.
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Tripathi A, Duffus WA, Kissinger P, Brown TJ, Gibson JJ, Mena LA. Delivering laboratory results by text message and e-mail: a survey of factors associated with conceptual acceptability among STD clinic attendees. Telemed J E Health 2012; 18:500-6. [PMID: 22827295 DOI: 10.1089/tmj.2011.0251] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study examines factors associated with the acceptability of receiving sexually transmitted disease (STD) laboratory results by text message and e-mail among clinic attendees. SUBJECTS AND METHODS An anonymous self-administered survey was conducted with a convenience sample of STD clinic attendees in South Carolina and Mississippi in 2009-2010. In total, 2,719 individuals with a median age of 26 years (interquartile range, 21-32 years) completed the survey. RESULTS More than 70% had Internet access at home, and 80% reported using text messaging daily. Participants preferred receiving laboratory results by text message compared with e-mail (50.2% versus 42.3%; p<0.001). Acceptability of receiving laboratory results by text message was higher with younger age (adjusted odds ratio [aOR] 1.13; 95% confidence interval [CI] 1.10-1.26), daily use of text messaging (aOR 1.30; 95% CI 1.14-1.49), and reporting cell phone and text message as the preferred choice of regular communication with the clinic (aOR 2.31; 95% CI 1.50-3.58) and was significantly lower in female subjects (aOR 0.89; 95% CI 0.81-0.98) and those with college-level education (aOR 0.88; 95% CI 0.77-0.99). CONCLUSIONS A majority of STD clinic attendees have access to cell phones and Internet. The acceptability of receiving STD laboratory results electronically may facilitate test result delivery to patients and expedite treatment of infected individuals.
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Affiliation(s)
- Avnish Tripathi
- Arnold School of Public Health, University of South Carolina , Columbia, South Carolina, USA.
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Ford CL, Airhihenbuwa CO. Critical Race Theory, race equity, and public health: toward antiracism praxis. Am J Public Health 2010; 100 Suppl 1:S30-5. [PMID: 20147679 DOI: 10.2105/ajph.2009.171058] [Citation(s) in RCA: 503] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Racial scholars argue that racism produces rates of morbidity, mortality, and overall well-being that vary depending on socially assigned race. Eliminating racism is therefore central to achieving health equity, but this requires new paradigms that are responsive to structural racism's contemporary influence on health, health inequities, and research. Critical Race Theory is an emerging transdisciplinary, race-equity methodology that originated in legal studies and is grounded in social justice. Critical Race Theory's tools for conducting research and practice are intended to elucidate contemporary racial phenomena, expand the vocabulary with which to discuss complex racial concepts, and challenge racial hierarchies. We introduce Critical Race Theory to the public health community, highlight key Critical Race Theory characteristics (race consciousness, emphases on contemporary societal dynamics and socially marginalized groups, and praxis between research and practice) and describe Critical Race Theory's contribution to a study on racism and HIV testing among African Americans.
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Affiliation(s)
- Chandra L Ford
- Department of Community Health Sciences, UCLA School of Public Health, Los Angeles, CA, USA.
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