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Criss S, Kim M, De La Cruz MM, Thai N, Nguyen QC, Nguyen TT. Experiences of racism in the U.S. - A perspective from Asian & Pacific Islander, Black, Latina, and Middle Eastern women. Heliyon 2024; 10:e28823. [PMID: 38596122 PMCID: PMC11002583 DOI: 10.1016/j.heliyon.2024.e28823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/26/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Racism is a critical social determinant of health because it can have a direct impact on health and well-being, as well as infiltrate systems, policies, and practices. Few studies have explored the similarities and differences of experiences with racism and health between different minoritized groups. The objective of this paper is to examine how racism influences life experiences from the perspectives of Asian & Pacific Islander, Black, Latina, and Middle Eastern women. Methods Eleven online racially/ethnically homogeneous focus groups with a total of 52 participants were conducted in the U.S., with representation from the North, South, and West coast. The online focus groups were recorded, transcribed, and two were translated into English (from Vietnamese and Spanish). The data was coded through NVivo and analyzed through a series of team meetings to establish themes. Results Participants reported experiences of racism and discrimination, including physical and verbal personal attacks. They shared the role of microaggressions in their daily life, along with the ubiquitous anti-Black sentiment discussed in every group. Our participants discussed the complexities of intersectionality in their experience of discrimination, specifically regarding immigration status, language spoken, and gender. Participants also reported the role of direct racism and vicarious racism (e.g., the experiences with racism of friends or family, awareness of racist incidents via the news) in affecting their mental health. Some effects were fear, stress, anxiety, depression, and self-censoring. For participants in the Black and Latina focus groups, mental health stressors often manifested into physical issues. Discussion Understanding the nuances in experiences across racial/ethnic groups is beneficial in identifying potential interventions to prevent and address racism and its negative health impacts.
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Affiliation(s)
- Shaniece Criss
- Department of Health Sciences, Furman University, Greenville, SC, 29613, USA
| | - Melanie Kim
- Department of Anthropology, Brown University, Providence, RI, 02912, USA
| | | | - Nhung Thai
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, 94720, USA
| | - Quynh C. Nguyen
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, 20742, USA
| | - Thu T. Nguyen
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, 20742, USA
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Criss S, Kim M, De La Cruz MM, Thai N, Nguyen QC, Hswen Y, Gee GC, Nguyen TT. Vigilance and Protection: How Asian and Pacific Islander, Black, Latina, and Middle Eastern Women Cope with Racism. J Racial Ethn Health Disparities 2024; 11:773-782. [PMID: 36917397 PMCID: PMC10013280 DOI: 10.1007/s40615-023-01560-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/10/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Research is needed to fully investigate the differential mechanisms racial and ethnic groups use to deal with ongoing intersectional racism in women's lives. The aim of this paper was to understand how Asian American and Pacific Islander, Black, Latina, and Middle Eastern women experience racism-from personal perceptions and interactions to coping mechanisms and methods of protection. METHODS A purposive sample of 52 participants participated in 11 online racially/ethnically homogeneous focus groups conducted throughout the USA. A team consensus approach was utilized with codebook development and thematic analysis. RESULTS The findings relate to personal perceptions and interactions related to race and ethnicity, methods of protection against racism, vigilant behavior based on safety concerns, and unity across people of color. A few unique concerns by group included experiences of racism including physical violence among Asian American Pacific Islander groups, police brutality among Black groups, immigration discrimination in Latina groups, and religious discrimination in Middle Eastern groups. Changes in behavior for safety and protection include altering methods of transportation, teaching their children safety measures, and defending their immigration status. They shared strategies to help racial and ethnic minorities against racism including mental health resources and greater political representation. All racial and ethnic groups discussed the need for unity, solidarity, and allyship across various communities of color but for it to be authentic and long-lasting. CONCLUSION Greater understanding of the types of racism specific groups experience can inform policies and cultural change to reduce those factors.
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Affiliation(s)
- Shaniece Criss
- Department of Health Sciences, Furman University, Greenville, SC, 29613, USA.
| | - Melanie Kim
- Department of Anthropology, Brown University, Providence, RI, 02912, USA
| | - Monica M De La Cruz
- School of Social Welfare, University of California, Berkeley, CA, 94720, USA
| | - Nhung Thai
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, 94720, USA
| | - Quynh C Nguyen
- Department of Epidemiology & Biostatistics, School of Public Health, University of Maryland, College Park, MD, 20742, USA
| | - Yulin Hswen
- Department of Epidemiology and Biostatistics, Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, USA
| | - Gilbert C Gee
- Department of Community Health Sciences, University of California, Los Angeles, CA, 90095, USA
| | - Thu T Nguyen
- Department of Epidemiology & Biostatistics, School of Public Health, University of Maryland, College Park, MD, 20742, USA
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Nguyen TT, Criss S, Kim M, De La Cruz MM, Thai N, Merchant JS, Hswen Y, Allen AM, Gee GC, Nguyen QC. Racism During Pregnancy and Birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern Women. J Racial Ethn Health Disparities 2023; 10:3007-3017. [PMID: 36449130 PMCID: PMC9713108 DOI: 10.1007/s40615-022-01475-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Despite persistent racial disparities in maternal health in the USA, there is limited qualitative research on women's experiences of discrimination during pregnancy and childbirth that focuses on similarities and differences across multiple racial groups. METHODS Eleven focus groups with Asian American and Pacific Islander (AAPI), Black, Latina, and Middle Eastern women (N = 52) in the USA were conducted to discuss the extent to which racism and discrimination impact pregnancy and birthing experiences. RESULTS Participants across groups talked about the role of unequal power dynamics, discrimination, and vulnerability in patient-provider relationships. Black participants noted the influence of prior mistreatment by providers in their healthcare decisions. Latinas expressed fears of differential care because of immigration status. Middle Eastern women stated that the Muslim ban bolstered stereotypes. Vietnamese participants discussed how the effect of racism on mothers' mental health could impact their children, while Black and Latina participants expressed constant racism-related stress for themselves and their children. Participants recalled better treatment with White partners and suggested a gradient of treatment based on skin complexion. Participants across groups expressed the value of racial diversity in healthcare providers and pregnancy/birthing-related support but warned that racial concordance alone may not prevent racism and emphasized the need to go beyond "band-aid solutions." CONCLUSION Women's discussions of pregnancy and birthing revealed common and distinct experiences that varied by race, skin complexion, language, immigration status, and political context. These findings highlight the importance of qualitative research for informing maternal healthcare practices that reduce racial inequities.
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Affiliation(s)
- Thu T Nguyen
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, 20742, USA.
| | - Shaniece Criss
- Department of Health Sciences, Furman University, Greenville, SC, 29613, USA
| | - Melanie Kim
- Department of Anthropology, Brown University, Providence, RI, 02912, USA
| | - Monica M De La Cruz
- School of Social Welfare, University of California, Berkeley, CA, 94720, USA
| | - Nhung Thai
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, 94720, USA
| | - Junaid S Merchant
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, 20742, USA
| | - Yulin Hswen
- Department of Epidemiology and Biostatistics, Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
| | - Amani M Allen
- Division of Epidemiology, University of California, Berkeley, CA, 94704, USA
- Division of Community Health Sciences, University of California, Berkeley, CA, 94704, USA
| | - Gilbert C Gee
- Department of Community Health Sciences, University of California, Los Angeles, CA, 90095, USA
| | - Quynh C Nguyen
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD, 20742, USA
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Bruce JS, De La Cruz MM, Thadani R, Steinberg JR, Brewster R, Chiu S, Dunham R, Ramphos E, Ramirez M, Chamberlain LJ. Kinder Ready Clinics: A Collaborative Model for Creating Equitable and Engaged Early Learning Environments for Low-income Families. J Health Care Poor Underserved 2022; 33:528-541. [DOI: 10.1353/hpu.2022.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Connelly E, Ordaz Y, Perez J, De La Cruz MM, Chamberlain L, Bruguera R, Steinberg JR, Harris S, Foreman J, Bruce J. Clinic-Based School Readiness: A Qualitative Examination of a Text Messaging Intervention. J Health Care Poor Underserved 2021. [DOI: 10.1353/hpu.2021.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Goldhaber-Fiebert SN, Bereknyei Merrell S, Agarwala AV, De La Cruz MM, Cooper JB, Howard SK, Asch SM, Gaba DM. Clinical Uses and Impacts of Emergency Manuals During Perioperative Crises. Anesth Analg 2020; 131:1815-1826. [PMID: 33197160 DOI: 10.1213/ane.0000000000005012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Performing key actions efficiently during crises can determine clinical outcomes, yet even expert clinicians omit key actions. Simulation-based studies of crises show that correct performance of key actions dramatically increases when emergency manuals (EMs) are used. Despite widespread dissemination of EMs, there is a need to understand in clinical contexts, when, how, and how often EMs are used and not used, along with perceived impacts. METHODS We conducted interviews with the anesthesia professionals involved in perioperative crises, identified with criterion-based sampling, occurring between October 2014 and May 2016 at 2 large academic medical centers with a history of EM training and implementation. Our convergent, mixed-methods study of the interview data extracted quantitative counts and qualitative themes of EM use and nonuse during clinical crises. RESULTS Interviews with 53 anesthesia professionals yielded 80 descriptions of applicable clinical crises, with varying durations and event types. Of 69 unique patients whose cases involved crises, the EM was used during 37 (54%; 95% confidence interval [CI], 41-66). Impacts on clinician team members included decreased stress for individual anesthesia professionals (95%), enabled teamwork (73%), and calmed atmosphere (46%). Impacts on delivery of patient care included specific action improvements, including catching errors of omission, for example, turning off anesthetic during cardiac arrest, only after EM use (59%); process improvements, for example, double-checking all actions were completed (41%); and impediments (0%). In 8% of crises, EM use was associated with potential distractions, although none were perceived to harm delivery of patient care. For 32 EM nonuses (46%; 95% CI, 34-59), participants self-identified errors of omission or delays in key actions (56%), all key actions performed (13%), and crisis too brief for EM to be used (31%). CONCLUSIONS This study provides evidence that EMs in operating rooms are being used during many applicable crises and that clinicians perceive EM use to add value. The reported negative effects were minimal and potentially offset by positive effects.
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Affiliation(s)
- Sara N Goldhaber-Fiebert
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Sylvia Bereknyei Merrell
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Aalok V Agarwala
- Department of Anesthesia, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monica M De La Cruz
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jeffrey B Cooper
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steven K Howard
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Steven M Asch
- Division of Primary Care and Population Health, Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Stanford, California
| | - David M Gaba
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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