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Riley T, Enquobahrie DA, Callegari LS, Hajat A. Structural gendered racism and preterm birth inequities in the United States. Soc Sci Med 2024; 348:116793. [PMID: 38547809 DOI: 10.1016/j.socscimed.2024.116793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/29/2024]
Abstract
Structural gendered racism - the "totality of interconnectedness between structural racism and sexism" - is conceptualized as a fundamental cause of the persistent preterm birth inequities experienced by Black and Indigenous people in the United States. Our objective was to develop a state-level latent class measure of structural gendered racism and examine its association with preterm birth among all singleton live births in the US in 2019. Using previously-validated inequity indicators between White men and Black women across 9 domains (education, employment, poverty, homeownership, health insurance, segregation, voting, political representation, incarceration), we conducted a latent profile analysis to identify a latent categorical variable with k number of classes that have similar values on the observed continuous input variables. Racialized group-stratified multilevel modified Poisson regression models with robust variance and random effects for state assessed the association between state-level classes and preterm birth. We found four distinct latent classes that were all characterized by higher levels of disadvantage for Black women and advantages for White men, but the magnitude of that difference varied by latent class. We found preterm birth risk among Black birthing people was higher across all state-level latent classes compared to White birthing people, and there was some variation of preterm birth risk across classes among Black but not White birthing people. These findings further emphasize the importance of understanding and interrogating the whole system and the need for multifaceted policy solutions.
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Affiliation(s)
- Taylor Riley
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Lisa S Callegari
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, WA, USA; Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA; Health Systems Research, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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2
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Martz CD, Benner AD, Goosby BJ, Mitchell C, Gaydosh L. Structural racism in primary schools and changes in epigenetic age acceleration among Black and White youth. Soc Sci Med 2024; 347:116724. [PMID: 38458127 PMCID: PMC11134904 DOI: 10.1016/j.socscimed.2024.116724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/14/2023] [Accepted: 02/23/2024] [Indexed: 03/10/2024]
Abstract
Structural racism generates racial inequities in U.S. primary education, including segregated schools, inequitable funding and resources, racial disparities in discipline and achievement, and hostile racial climates, which are risk factors for adverse youth health and development. Black youth are disproportionately exposed to adverse school contexts that may become biologically embedded via stress-mediated epigenetic pathways. This study examined whether childhood exposure to adverse school contexts is associated with changes in epigenetic aging during adolescent development. DNA methylation-based epigenetic clocks were calculated from saliva samples at ages 9 and 15 among Black (n = 774) and White (n = 287) youth in the Future of Families and Child Wellbeing Study (2009-2015). We performed latent class analyses to identify race-specific primary school contexts using administrative data on segregation, discipline, achievement, resources, economic disadvantage, and racial harassment. We then estimated change in epigenetic age acceleration from childhood to adolescence across school typologies using GrimAge, PhenoAge, and DunedinPACE epigenetic clocks. Three distinct school contexts were identified for Black youth: segregated and highly-disadvantaged (17.0%), segregated and moderately-disadvantaged (52.1%), and integrated and moderately-disadvantaged (30.8%). Two school contexts emerged for White youth: integrated and unequal (46.5%) and predominantly White & advantaged (53.5%). At age 15, Black youth who attended segregated and highly-disadvantaged primary schools experienced increases in their speed of epigenetic aging with GrimAge and DunedinPACE. Slowed epigenetic aging with GrimAge was observed for Black youth who attended integrated and moderately-disadvantaged schools. School contexts were not associated with changes in epigenetic age acceleration for White youth. Our findings suggest that manifestations of structural racism in primary school contexts are associated with early-life epigenetic age acceleration and may forecast future health inequities.
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Affiliation(s)
- Connor D Martz
- Population Research Center, The University of Texas at Austin, United States.
| | - Aprile D Benner
- Population Research Center, The University of Texas at Austin, United States; Department of Human Development and Family Sciences, The University of Texas at Austin, United States
| | - Bridget J Goosby
- Population Research Center, The University of Texas at Austin, United States; Department of Sociology, The University of Texas at Austin, United States
| | - Colter Mitchell
- Institute for Social Research, University of Michigan, United States
| | - Lauren Gaydosh
- Population Research Center, The University of Texas at Austin, United States; Department of Sociology, The University of Texas at Austin, United States
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Brown TH, Homan P. Structural Racism and Health Stratification: Connecting Theory to Measurement. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:141-160. [PMID: 38308499 PMCID: PMC11110275 DOI: 10.1177/00221465231222924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
Less than 1% of studies on racialized health inequities have empirically examined their root cause: structural racism. Moreover, there has been a disconnect between the conceptualization and measurement of structural racism. This study advances the field by (1) distilling central tenets of theories of structural racism to inform measurement approaches, (2) conceptualizing U.S. states as racializing institutional actors shaping health, (3) developing a novel latent measure of structural racism in states, (4) using multilevel models to quantify the association between structural racism and five individual-level health outcomes among respondents from the Health and Retirement Study (N = 9,020) and the Behavioral Risk Factor Surveillance System (N = 308,029), and (5) making our measure of structural racism publicly available to catalyze research. Results show that structural racism is consistently associated with worse health for Black people but not White people. We conclude by highlighting this study's contributions (theoretical, methodological, and substantive) and important avenues for future research on the topic.
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Allen RS, McIntyre AC, Oliver JS, Payne-Foster P, Cox BS, Hay-McCutcheon MJ, Wilson L, Spencer C, Lee HY. Church Leaders Share and Implement Solution-Focused Health Strategies During the COVID-19 Pandemic in Rural Alabama. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01873-2. [PMID: 38048041 DOI: 10.1007/s40615-023-01873-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
Bridging the healthcare access gap and addressing COVID-19 vaccine hesitancy among rural-dwelling Black American adults residing in the Deep South require involvement of faith-based leaders in the community. This study explored perceived barriers and resources to meeting community needs, including vaccination, during the COVID-19 pandemic as reported by 17 Black American church leaders in the rural West Alabama Black Belt geographic region in May 2022. The main themes that emerged included (1) attending to community impact of COVID-19 illness and death; (2) maximizing health literacy and diminishing vaccine hesitancy through engaging in preventive health practices and sharing public health information; (3) addressing challenges created or exacerbated by COVID-19, including reduction in in-person attendance (particularly among adolescents and young adults), limited access to and literacy with technology, and political perceptions influencing engagement in preventive health behaviors; (4) maximizing technological solutions to increase attendance in the church; and (5) engaging in solution-focused and innovative initiatives to meet the identified needs in the congregation and community. Church leaders in West Alabama rural areas facing economic, health, and technological disparities identified "silver linings" as well as challenges created or exacerbated during the pandemic. As the need for COVID-19 vaccination and booster vaccination continues, Black American church leaders play pivotal roles in meeting rural community needs.
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Affiliation(s)
- Rebecca S Allen
- Alabama Research Institute on Aging, The University of Alabama, Box 870348, Tuscaloosa, AL, USA.
- Department of Psychology, College of Arts and Sciences, The University of Alabama, Tuscaloosa, AL, USA.
| | - Alissa C McIntyre
- Alabama Research Institute on Aging, The University of Alabama, Box 870348, Tuscaloosa, AL, USA
- Department of Psychology, College of Arts and Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - JoAnn S Oliver
- Alabama Research Institute on Aging, The University of Alabama, Box 870348, Tuscaloosa, AL, USA.
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA.
| | - Pamela Payne-Foster
- Alabama Research Institute on Aging, The University of Alabama, Box 870348, Tuscaloosa, AL, USA
- Institute for Rural Health Research/Community Medicine and Population Health, College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Brian S Cox
- Alabama Research Institute on Aging, The University of Alabama, Box 870348, Tuscaloosa, AL, USA
| | - Marcia J Hay-McCutcheon
- Alabama Research Institute on Aging, The University of Alabama, Box 870348, Tuscaloosa, AL, USA
- Department of Communicative Disorders, College of Arts and Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | | | | | - Hee Yun Lee
- Alabama Research Institute on Aging, The University of Alabama, Box 870348, Tuscaloosa, AL, USA
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
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Jahn JL, Zubizarreta D, Chen JT, Needham BL, Samari G, McGregor AJ, Douglas MD, Austin SB, Agénor M. Legislating Inequity: Structural Racism In Groups Of State Laws And Associations With Premature Mortality Rates. Health Aff (Millwood) 2023; 42:1325-1333. [PMID: 37782864 DOI: 10.1377/hlthaff.2023.00471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Most evaluations of health equity policy have focused on the effects of individual laws. However, multiple laws' combined effects better reflect the crosscutting nature of structurally racist legal regimes. To measure the combined effects of multiple laws, we used latent class analysis, a method for detecting unobserved "subgroups" in a population, to identify clusters of US states based on thirteen structural racism-related legal domains in 2013. We identified three classes of states: one with predominantly harmful laws ([Formula: see text]), another with predominantly protective laws ([Formula: see text]), and a third with a mix of both ([Formula: see text]). Premature mortality rates overall-defined as deaths before age seventy-five per 100,000 population-were highest in states with predominantly harmful laws, which included eighteen states with past Jim Crow laws. This study offers a new method for measuring structural racism on the basis of how groups of laws are associated with premature mortality rates.
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Affiliation(s)
- Jaquelyn L Jahn
- Jaquelyn L. Jahn , Drexel University, Philadelphia, Pennsylvania
| | | | | | | | - Goleen Samari
- Goleen Samari, Columbia University, New York, New York
| | | | | | - S Bryn Austin
- S. Bryn Austin, Harvard University and Boston Children's Hospital, Boston, Massachusetts
| | - Madina Agénor
- Madina Agénor, Brown University, Providence, Rhode Island
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Luck AN, Elo IT, Preston SH, Paglino E, Hempstead K, Stokes AC. COVID-19 and All-Cause Mortality by Race, Ethnicity, and Age Across Five Periods of the Pandemic in the United States. POPULATION RESEARCH AND POLICY REVIEW 2023; 42:71. [PMID: 37780841 PMCID: PMC10540502 DOI: 10.1007/s11113-023-09817-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/14/2023] [Indexed: 10/03/2023]
Abstract
Racial/ethnic and age disparities in COVID-19 and all-cause mortality during 2020 are well documented, but less is known about their evolution over time. We examine changes in age-specific mortality across five pandemic periods in the United States from March 2020 to December 2022 among four racial/ethnic groups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian) for ages 35+. We fit Gompertz models to all-cause and COVID-19 death rates by 5-year age groups and construct age-specific racial/ethnic mortality ratios across an Initial peak (Mar-Aug 2020), Winter peak (Nov 2020-Feb 2021), Delta peak (Aug-Oct 2021), Omicron peak (Nov 2021-Feb 2022), and Endemic period (Mar-Dec 2022). We then compare to all-cause patterns observed in 2019. The steep age gradients in COVID-19 mortality in the Initial and Winter peak shifted during the Delta peak, with substantial increases in mortality at working ages, before gradually returning to an older age pattern in the subsequent periods. We find a disproportionate COVID-19 mortality burden on racial and ethnic minority populations early in the pandemic, which led to an increase in all-cause mortality disparities and a temporary elimination of the Hispanic mortality advantage at certain age groups. Mortality disparities narrowed over time, with racial/ethnic all-cause inequalities during the Endemic period generally returning to pre-pandemic levels. Black and Hispanic populations, however, faced a younger age gradient in all-cause mortality in the Endemic period relative to 2019, with younger Hispanic and Black adults in a slightly disadvantageous position and older Black adults in a slightly advantageous position, relative to before the pandemic.
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Affiliation(s)
- Anneliese N. Luck
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | - Irma T. Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | - Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | | | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, USA
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Brown TH, Hargrove TW, Homan P, Adkins DE. Racialized Health Inequities: Quantifying Socioeconomic and Stress Pathways Using Moderated Mediation. Demography 2023; 60:675-705. [PMID: 37218993 PMCID: PMC10841571 DOI: 10.1215/00703370-10740718] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Racism drives population health inequities by shaping the unequal distribution of key social determinants of health, such as socioeconomic resources and exposure to stressors. Research on interrelationships among race, socioeconomic resources, stressors, and health has proceeded along two lines that have largely remained separate: one examining differential effects of socioeconomic resources and stressors on health across racialized groups (moderation processes), and the other examining the role of socioeconomic resources and stressors in contributing to racial inequities in health (mediation processes). We conceptually and analytically integrate these areas using race theory and a novel moderated mediation approach to path analysis to formally quantify the extent to which an array of socioeconomic resources and stressors-collectively and individually-mediate racialized health inequities among a sample of older adults from the Health and Retirement Study. Our results yield theoretical contributions by showing how the socioeconomic status-health gradient and stress processes are racialized (24% of associations examined varied by race), substantive contributions by quantifying the extent of moderated mediation of racial inequities (approximately 70%) and the relative importance of various social factors, and methodological contributions by showing how commonly used simple mediation approaches that ignore racialized moderation processes overestimate-by between 5% and 30%-the collective roles of socioeconomic status and stressors in accounting for racial inequities in health.
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Affiliation(s)
- Tyson H. Brown
- Department of Sociology and Population Research Institute, Duke University, Durham, NC, USA
| | - Taylor W. Hargrove
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patricia Homan
- Department of Sociology, Center for Demography and Population Health, and Pepper Institute on Aging and Public Policy, Florida State University, Tallahassee, FL, USA
| | - Daniel E. Adkins
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
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BROWN TYSONH, HOMAN PATRICIA. The Future of Social Determinants of Health: Looking Upstream to Structural Drivers. Milbank Q 2023; 101:36-60. [PMID: 37096627 PMCID: PMC10126983 DOI: 10.1111/1468-0009.12641] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/15/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Policies that redress oppressive social, economic, and political conditions are essential for improving population health and achieving health equity. Efforts to remedy structural oppression and its deleterious effects should account for its multilevel, multifaceted, interconnected, systemic, and intersectional nature. The U.S. Department of Health and Human Services should facilitate the creation and maintenance of a national publicly available, user-friendly data infrastructure on contextual measures of structural oppression. Publicly funded research on social determinants of health should be mandated to (a) analyze health inequities in relation to relevant data on structural conditions and (b) deposit the data in the publicly available data repository.
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